What We Are Doing

Indonesia's Plan to Save Newborn Lives 16 May 2014

Dr. Pancho Kaslam, Senior Newborn Advisor, Save the Children Indonesia

In Indonesia, the number of newborns that die annually on their first day of life from preventable causes stands at 48,000.  Despite making great progress in the last decade by cutting child mortality by 40%, Indonesia’s newborn mortality figures are stagnant and are slowing the effort to reach the global target of reducing child mortality rates by two thirds by 2015 as set out in the Millenium Development Goals.

To overcome these newborn deaths, the government of Indonesia has developed its version of the Every Newborn Action Plan - a joint action platform to help galvanize national commitments to reducing newborn mortality, and hold governments accountable for progress.  Indonesia still struggles with a neonatal mortality rate of 19 out of 1,000 live births.  Many of these deaths are caused by infections, complications during labour and birth such as asphyxia, prematurity and low birth weight, and pneumonia and diarrhoea.   However most of these deaths can be prevented through relatively low-cost solutions, including improving nutrition and giving antenatal corticosteroid for preterm labour during antenatal care, safe and clean delivery, immediate and exclusive breastfeeding practices, infection prevention practice and antibiotics for infections, and “kangaroo mother care” or —keeping newborn babies warm through continuous skin-to-skin contact with the mother. Ensuring that skilled birth attendants are present to provide immediate care to mothers, and that health workers are accessible to mothers and newborn babies before, during and after child birth, is critical to delivering these life-saving services.

Access to and distribution of health services is a major issue in Indonesia. In a country of over 240 million, there are only 25,000 registered OBGYN’s--9,000 of those registered are in Jakarta alone.  Children in the poorest 20% are more than twice as likely to die as children born into the wealthiest 20%.These inequalities will need to be addressed if we are make real progress in reducing preventable newborn deaths. 

COLLABORATION OF ‘PONED-PONEK’ IN REFERRAL SYSTEM

Central to Indonesia’s Newborn Action Plan has been the need to strengthen the health system for emergency response and operationalized referral, such as  Basic Emergency Obstetric Neonatal Care-BEONC or PONED and Comprehensive Emergency Obstetric Neonatal Care-CEONC or PONEK.

From the community perspective that lack of trained staff performance, poor sanitation and hygiene practice and a shortage of basic equipment meant women and their families did not feel confident going to a health centre or Puskesmas PONED even though it was usually the closest facility to them. Instead they would risk the longer journey to a hospital PONEK which was further away and usually overloaded and unable to take them in.  So the mother would then make the long journey back to her village and instead of returning to the Puskesmas PONED, she would make the dangerous decision of giving birth at home, without the help of a skilled health worker.  If a woman were to develop any complications with her pregnancy, that journey to the hospital PONEK would become  life threatening for both her unborn child. 

In response to this problem, the government recognised the need to invest heavily to improve the quality of care mothers received at the PONED and PONEK which in turn would play a critical role in reducing the mortality rates of mothers and newborns in Indonesia. 

Health workers were given emergency obstetric training and facilities began receiving better equipment.  The most recent data shows that this investment is working, as more women are now beginning to go to their local Puskesmas PONED to give birth instead of making the long trip to the hospital PONEK. Therefore to avoid preventable maternal and neonatal death, the delivery should be conducted by skill birth attendant at health facility which provide emergency for stabilization and pre-referral services.

INDONESIA’S NEWBORN ACTION PLAN:

Indonesia has not only developed its newborn action plan, it has already begun the process or rolling out and implementing the plan across the country by getting ownership and commitment from local districts.  Between April and June 2014, Indonesia’s Newborn Action Plan, or Rencana Aksi Nasional tentang Neonatus-RAN as it’s called here, is being rolled out in six of its most populous provinces which contribute the highest rates of newborn mortality:  North Sumatra, South Sulawesi, Banten, Central, East & West Java.  Under USAID-EMAS funded program, Save the Children with its consortium members led by Jhpiego has been facilitating a collaboration between the Ministry of Health Indonesia, the Indonesian Paediatrician Association, and Indonesian Ob-gyn Society with representatives at the provincial and district level to roll out and implementation of INAP which aims to reduce maternal and newborn mortality rates by 25% by 2035. 

With a decentralised government, much of the implementation work around INAP is done at the district level, so a three day workshop was developed in each province to bring together civil society leaders, professional organizations, health workers, representatives from the provincial and district legislature.  Participants received an updated situation of the newborn health in their own province, an overview of the national newborn action plan, and were then asked to adapt the national plan into a localized blueprint that could be implemented at the district level.  Feedback from the first four provinces where the national plan has been unveiled will been incorporated into the final draft of the Indonesia Newborn Action Plan, which will be presented to the World Health Assembly next week by the Minister of Health.

 

The government of Indonesia has made a concerted effort to address the need to improve the health of its mothers and provide better care to newborns in their first day of life.    If successful, the Indonesia Newborn Action Plan will result in a strengthened health system supported by fully trained and skilled health workers with an adequately serviced health facility which can save the lives of millions of newborns and their mothers.