DEVELOPMENTAL EVALUATION FOR USAID JALIN PROJECT

DE EQ 6 FINAL REPORT i

DEVELOPMENTAL EVALUATION FOR USAID JALIN PROJECT

EVALUATION QUESTION 6 “How did Jalin co-define, co-create, co-implement, and learn from approaches to improve maternal and newborn survival at the regional and national levels? What knowledge and outputs did Jalin generate through this process, and how can USAID and Jalin apply this to decision making and adaptive management going forward?”

DE EQ 6 FINAL REPORT ii

TABLE OF CONTENTS TABLES & FIGURES ............................................................................................................... ii ACRONYMS & ABBREVIATIONS ....................................................................................... iii I. EXECUTIVE SUMMARY................................................................................................. 1 II. EVIDENCE USE ............................................................................................................... 4

Jalin Indicator Data .............................................................................................................................................................. 7 Lessons Learned ................................................................................................................................................................... 7

III. STAKEHOLDER ENGAGEMENT .............................................................................. 7 Jalin Indicator Data ............................................................................................................................................................ 12 Events & Meetings .............................................................................................................................................................. 12 Provincial Health Office Engagement ............................................................................................................................ 13 Lessons Learned ................................................................................................................................................................. 13

IV. PROBLEM DEFINITION ........................................................................................... 14 Problem Definition by Region......................................................................................................................................... 14 Lessons Learned ................................................................................................................................................................. 20

V. REGIONAL APPROACHES ......................................................................................... 20 Banten ................................................................................................................................................................................... 21 Central Java ......................................................................................................................................................................... 22 East Java ................................................................................................................................................................................ 24 North Sumatera ................................................................................................................................................................. 25 South Sulawesi .................................................................................................................................................................... 26 West Java ............................................................................................................................................................................. 28 Lessons Learned ................................................................................................................................................................. 29

VI. Local Solutions ........................................................................................................... 30 Clinical Competency & Compliance ............................................................................................................................. 31 ANC Coverage ................................................................................................................................................................... 35 Finance .................................................................................................................................................................................. 40 Awareness Raising ............................................................................................................................................................. 43 Blood Supply ........................................................................................................................................................................ 46 Transportation .................................................................................................................................................................... 47 Individual & Community Tracking ................................................................................................................................. 50 Referral Systems ................................................................................................................................................................. 52 Evidence Gathering ............................................................................................................................................................ 54 Family Planning .................................................................................................................................................................... 55 Maternity Waiting Homes ............................................................................................................................................... 55 Other .................................................................................................................................................................................... 56 Lessons Learned ................................................................................................................................................................. 58

ANNEX 1: LOCAL SOLUTION TABLE ............................................................................. 60 Cover Photo: a pregnant woman receives antenatal care at Gerai KIA in Tangerang District, Banten, in April 2019 (DE).

TABLES & FIGURES Table 1: Status of Local Solutions by Topic .......................................................................................................... 3 Table 2: Evidence Use by Region ............................................................................................................................ 4 Table 3: Regional Partners & Stakeholders .......................................................................................................... 7 Table 4: Jalin Events & Meetings by Region ........................................................................................................ 13 Table 5: PHO Direction to Regional Teams ...................................................................................................... 13 Table 6: Banten Provincial Problem Definition Results ................................................................................... 14 Table 7: Central Java District Problem Definition Results ............................................................................. 15 Table 8: East Java Provincial Problem Definition Results ................................................................................ 16 Table 9: North Sumatera Provincial Problem Definition Results .................................................................. 17 Table 10: South Sulawesi District Problem Definition Results ...................................................................... 18 Table 11: West Java District Problem Definition Results ............................................................................... 19 Table 12: Differences in Regional Approaches .................................................................................................. 20

Figure 1: Graphic of Jalin’s Cocreation in Numbers .......................................................................................... 2 Figure 2: Timeline of Banten Regional Approach .............................................................................................. 21

DE EQ 6 FINAL REPORT iii

Figure 3: Map of Banten Activities ........................................................................................................................ 22 Figure 4: Timeline of Central Java Regional Approach .................................................................................... 23 Figure 5: Map of Central Java Activities .............................................................................................................. 23 Figure 6: Timeline of East Java Regional Approach ........................................................................................... 24 Figure 7: Map of East Java Activities ..................................................................................................................... 25 Figure 8: Timeline of North Sumatera Regional Approach ............................................................................ 25 Figure 9: Map of North Sumatera Activities ...................................................................................................... 26 Figure 10: Timeline of South Sulawesi Regional Approach ............................................................................. 27 Figure 11: Map of South Sulawesi Activities ....................................................................................................... 28 Figure 12: Timeline of West Java Regional Approach ...................................................................................... 29 Figure 13: Map of West Java Activities ................................................................................................................ 29

ACRONYMS & ABBREVIATIONS A2F Access to Finance Program ADINKES Asosiasi Dinas Kesehatan (Association of Health Offices) AIPI Akademi Ilmu Pengetahuan Indonesia (Indonesian Academy of Sciences) AIS Software Perangkat Lunak Anak Ibu Selamat (Safe Mother and Child Software) AJI Aliansi Jurnalis Independen (Association of Independent Journalists) Alfamart Sumber Alfaria Trijaya AMP Audit Maternal Perinatal (Maternal Perinatal Audit) AMP-SR Maternal and Perinatal Audit, Surveillance, and Response ANC Antenatal care APBD Anggaran Pendapatan dan Belanja Daerah (Local Revenue and Expenditure Budget) APINDO Asosiasi Pengusaha Indonesia (Indonesian Employers Association) APS Annual Program Statement AMMDES Alat Mekanis Multiguna Pedesaan (Village Multifunction Mechanical Equipment) ARSSI Asosiasi Rumah Sakit Swasta Indonesia (Indonesia Private Hospitals Association) ASKLIN Asosiasi Klinik Indonesia (Clinics Association of Indonesia) ASPERINDO Asosiasi Perusahaan Jasa Pengiriman Ekspres, Pos dan Logistik Indonesia (Association of

Indonesia Express, Post, and Logistics Services) BAPPEDA Badan Perencana Pembangunan Daerah (local development planning agency) BKKBN Badan Kependudukan dan Keluarga Berencana Nasional (National Population and Family

Planning Board) BKPSDM Badan Kepegawaian dan Pengembangan Sumber Daya Manusia (Human Resources

Development Agency) BNPB Badan Nasional Penanggulangan Bencana (National Disaster Management Agency) BPCR Birth Preparation and Complication Readiness BPJHC Badan Pekerja Joint Health Council (council of health workers in North Sumatera) BPJS Badan Penyelenggara Jaminan Sosial (Indonesian Social Insurance Administration

Organization) BUMN Badan Usaha Milik Negara (State Owned Enterprise) CATIN Sehat Calon Pengantin Sehat (Healthy Premarital Certification) C-Section Caesarean Section CHPM-UGM Center of Health Policy and Management at the University of Gadjah Mada COP Chief of Party CRVS Civil Registration and Vital Statistic CSO Civil Society Organization CSR Corporate Social Responsibility CTG Cardiotocography DCOP Deputy Chief of Party DE Developmental Evaluation DG Director General DHO District Health Office DISDUKCAPIL Dinas Kependudukan dan Catatan Sipil (Population and Civil Registration Office) DISKOMINFO Dinas Komunikasi dan Informasi (Communication and Information Office) DJSN Dewan Jaminan Sosial Nasional (National Social Security Council) DP3A Dinas Pemberdayaan Perempuan dan Perlindungan Anak (Women Empowerment and Child

Protection office) DP3AK Dinas Pemberdayaan Perempuan, Perlindungan Anak, dan Kependudukan (Women

Empowerment, Child Protection, and Population office)

DE EQ 6 FINAL REPORT iv

DP3AKKB Dinas Pemberdayaan Perempuan, Perlindungan Anak, Kependudukan, dan Keluarga Berencana (District Women Empowerment, Child Protection, Population, and Family Planning Office)

DPMD Dinas Pemberdayaan Masyarakat dan Desa (District Village and Community Empowerment Office)

DPPKB Dinas Pengendalian Penduduk dan Keluarga Berencana (Population Control and Family Planning Office)

DPPKBPPPA Dinas Pengendalian Penduduk, Keluarga Berencana, Pemberdayaan Perempuan dan Perlindungan Anak (Population Control, Family Planning, Women Empowerment and Child Protection Office)

DPRD Local Parliament (Dewan Perwakilan Rakyat Daerah) DQR Data Quality Review EMAS Expanding Maternal and Newborn Survival project EMNC Every Mother and Newborn Counts EQ Evaluation Question ESAS Evidence Summit Assessment and Scoping FGD Focus Group Discussion FKM Fakultas Kesehatan Masyarakat (Public Health Faculty) FMM KIA Forum Masyarakat Madani Peduli Kesehatan Ibu dan Anak (Civil Society Forum for Maternal

and Newborn Health) FOPKIA Forum Peduli Kesehatan Ibu dan Anak (Maternal and Newborn Healthcare Forum) GASURKES KIA Petugas Surveillans Kesehatan Ibu dan Anak (Maternal and Child Health Surveyor) GERAI KIA Gerai Kesehatan Ibu dan Anak (Maternal and Child Health Corner) GOI Government of Indonesia GP2SP Gerakan Pekerja/Buruh Perempuan Sehat Produktif (Healthy and Productive Women

Workers Movement) HOGSI Himpunan Obstetri dan Ginelokogi Sosial Indonesia (Indonesia Social Obstetric Gynecology

Society) HPU Health Policy Unit HQ Headquarter HR Human Resources HRD Human Resources Department IBI Ikatan Bidan Indonesia (Indonesian Midwives Association) ICT Information and Communication Technology IDAI Ikatan Dokter Anak Indonesia (Indonesian Paediatricians Society) IDFoS Institute Development Society Indonesia IDHS Indonesia Demographic and Health Survey IDI Ikatan Dokter Indonesia (Indonesian Doctors Association) ILO International Labour Organization IMAN Integrated Mentoring and Accreditation National IMATAP Direktorat Jenderal Industri Logam, Mesin, Alat Transportasi, dan Elektronika (Directorate

General of Metal, Machinery, Transportation Equipment, and Electronics Industry) IMR Infant Mortality Ratio INA CBG Indonesia Case Based Groups INAP Indonesia Newborn Action Plan INDO HCF Indonesia Health Care Forum IPC Inter-Professional Collaboration IPE Inter-Professional Education IPTT Indicator Performance Tracking Table IR Intermediate Result IT Information Technology Jampersal Jaminan Persalinan (Insurance for Delivery) JICA Japan International Cooperation Agency JKN Jaminan Kesehatan Nasional (Indonesian national health insurance system) KB Keluarga Berencana (Family Planning) KESGA Kesehatan Keluarga (Family Health Directorate) KIA Kesehatan Ibu dan Anak (maternal and child health) KM Knowledge Management KNPI Komite Nasional Pemuda Indonesia (National Youth Committee of Indonesia) KOMIDA Koperasi Mitra Dhuafa (cooperatives for poor people) LKBN Lembaga Kantor Berita Nasional (State Owned National News Agency) M&E Monitoring and Evaluation MAB Multi-stakeholder Advisory Body

DE EQ 6 FINAL REPORT v

MCH Maternal Child Health MDN Maternal Death Notification MELA Monitoring, Evaluation, Learning and Adaptation MERLA Monitoring, Evaluation, Research, Learning and Adaptation MFI Microfinance Institution MgSO4 Magnesium Sulfate MKIA Motivator Kader Ibu dan Anak (Mother and Child Cadre Motivator) MMR Maternal Mortality Ratio MN Maternal and Newborn MNH Maternal and Newborn Health MOH Ministry of Health MOU Memorandum of Understanding MPDN Maternal and Perinatal Death Notification MPDSR Maternal Perinatal Death Surveillance and Response MUI Majelis Ulama Indonesia (Indonesia Ulema Council) MUYAN Mobil Unit Kendaraan Keluarga Berencana (Family Planning Mobile Unit) NGO Non-governmental organization NHIRD Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan, Republik Indonesia NIU National Intervention Unit NMR Neonatal Mortality Rate NU Nahdlatul Ulama (Islamic group) OBGYN Obstretrician-Gynecologist P2JK Pusat Pembiayaan dan Jaminan Kesehatan (Health Financing and Insurance Center) PASTI Pekerja Aktif Sehat Bugar & Produktif PBI Penerima Bantuan Iuran (Insurance Premium Subsidy Recipients) PBM Praktik Bidan Mandiri (Single Practitioner Midwives) PDN Perinatal Death Notification PEI Perhimpunan Entomologi Indonesia (Indonesian Entomology Association) PENAKIB Forum Penurunan Kematian Ibu dan Bayi (Forum for the Maternal and Newborn Mortality) PERMENKES Peraturan Menteri Kesehatan (Regulation of the Minister of Health) PERSAGI Persatuan Ahli Gizi Indonesia (Indonesian Nutritionist Association) PERSI Perhimpunan Rumah Sakit Seluruh Indonesia (Hospital Association of Indonesia) PERUSDA Perusahaan Daerah (District Owned Company) PGI Persekutuan Gereja Indonesia (Council of Churches in Indonesia) PHO Provincial Health Office PHRI Perhimpunan Hotel dan Restoran Indonesia (Hotel and Restaurant Association of Indonesia) PI Performance Indicator PID Program Inovasi Desa (Village Innovative Program) PIRS Performance Indicator Reference Sheet PKBI Indonesia Family Planning Association PKK Pemberdayaan Kesejahteraan Keluarga (Family Welfare Movement) PKS Perjanjian Kerjasama (Cooperation Agreement) PLKB Penyuluh Lapangan Keluarga Berencana (Family Planning Extension Field) PMI Palang Merah Indonesia (Indonesian Red Cross) PNC Post-natal Care PNM Permodalan Nasional Madani POGI Perkumpulan Obstetri dan Ginekologi Indonesia (Indonesian Obstetrics and Gynecology

Association) POLTEKKES Politeknik Kesehatan (Medical College) PoP Period of Performance Posyandu Pos Pelayanan Terpadu (Integrated Health Service Post) PPP Public Private Partnership PPNI Persatuan Perawat Nasional Indonesia (Indonesian National Nurses Association) PSA Public Service Announcement PSE Private Sector Engagement PT Perseroan Terbatas (limited company) PT KMWD PT. Kreasi Mandiri Wintor Distributor PT KMWI PT. Kreasi Mandiri Wintor Indonesia PT PNM PT. Permodalan Nasional Madani PT SAMA PT. Sandang Asia Maju Abadi PT STI PT. Sijarimas Teknologi Inovasi

DE EQ 6 FINAL REPORT vi

PUSKA-UI Pusat Penelitian Keluarga Sejahtera Fakultas Kesehatan Masyarakat Universitas Indonesia (Center for the Study of Family Welfare)

Puskesmas Pusat Kesehatan Masyarakat (Primary Health Care Centre) PUWNTEN Paguyuban Warga Banten (Bantenese People Community) PWI Association of Journalists Indonesia PWS-KIA Pemantauan Wilayah Setempat Kesehatan Ibu dan Anak (Local Maternal and Newborn Health

Monitoring) RCA Root Cause Analysis RF Results Framework RFP Requests for Proposals Riskesdas Riset Kesehatan Dasar (Primary Health Care Survey) RM Regional Manager RSUD Rumah Sakit Umum Daerah (Regional General Hospital) SATITI Program Sahabat Ibu Sehati Boyolali SDG Sustainable Development Goals SDKI Indonesian Demographic Health Survey Sekda Sekretaris Daerah (Secretary of Provincial or District Government) SiCantik Sidoarjo Cegah Angka Kematian Ibu dan Anak (Sidoarjo Prevents Maternal and Children

Mortality Rate) SiMANIES Sidoarjo Maternal Neonatal Emergency SMS GATEWAY SISRUTE Sistem Rujukan Terpadu (Integrated Referral System) SKK MIGAS Satuan Kerja Khusus Pelaksana Kegiatan Usaha Hulu Minyak dan Gas Bumi (Special Working

Unit of Oil and Gas) SMS Short Message Service SOP Standard Operating Procedure SOW Scope of Work SPM Standar Pelayanan Minimum (Minimum Service Standard) SRS Sample Registration System STIKES Sekolah Tinggi Ilmu Kesehatan (Medical College) STTA Short-Term Technical Assistance TAMIS Technical and Administrative Management Information System TBA Traditional Birth Attendant TBD To Be Determined ToC Theory of Change TOPDeAMOR Tukang Ojek Puskesmas dengan Electronik Ambulans (Puskesmas Ojek Driver with

Motorcycle Ambulance) TOR Terms of Reference TP PKK Tim Penggerak Program Keluarga Berencana (Family Planning Program Organizing Team) TWG Technical Working Group UI University of Indonesia UIN Universitas Islam Negeri (State Islamic University) UN United Nations UNFPA United Nations Population Fund UNICEF United Nations International Children’s Emergency Fund UNPAD Universitas Padjadjaran (Padjadjaran University) UNS Universitas Sebelas Maret Solo (Sebelas Maret University of Solo) UNTIRTA Universitas Sultan Ageng Tirtayasa (Sultan Ageng Tirtayasa University) USAID United States Agency for International Development USU Universitas Sumatera Utara (North Sumatera University) UTD Unit Transfusi Darah (Blood Transfusion Unit) VASA Verbal and Social Autopsy VCA Value Chains Analysis WB World Bank WEALTH Women’s Health and Wellbeing project WHO World Health Organization

DE EQ 6 FINAL REPORT 1

I. EXECUTIVE SUMMARY

The Developmental Evaluation for USAID Jalin (DE) assessed Jalin’s cocreation process for its sixth evaluation question (EQ 6): “How did Jalin co-define, co-create, co-implement, and learn from approaches to improve maternal and newborn survival at the regional and national levels? What knowledge and outputs did Jalin generated through this process, and how can USAID and Jalin apply this to decision making and adaptive management going forward?”

The objective of EQ 6 is to provide USAID with information for internal reporting and to assess Jalin’s performance. EQ 6 assists Jalin’s headquarters (HQ) in Jakarta to understand regional programming and helps Jalin’s six regional teams learn from each other. Furthermore, it documents the project’s regional work in 2018 and 2019, which was not comprehensively reported to HQ and USAID.

This report describes Jalin’s evidence use, stakeholder engagement, problem definition, regional approaches, and local solutions1 quantitatively (graphic on page 2) and through narrative.

Evidence Use The DE found that Jalin utilized 96 sources of critical information and evidence in cocreation. The most commonly used were provincial health profiles, Provincial Health Office (PHO) and District Health Office (DHO) data, and the Jalin produced factsheets and slide decks. The DE garnered the following lessons learned from this evidence:

• Jalin did not consistently socialize information from the Maternal and Newborn Health (MNH) Evidence Summit, Rapid Evidence Synthesis, Banten II study, EMAS program, and IDHS at the regional level. Two teams used EMAS and Banten II, but the others did not. This contributed to local solutions being designed with unclear causal pathways to increasing MN survival.

• Regional teams could not use evidence from the Every Mother and Newborn Counts (EMNC) Survey for cocreation, because results arrived after they designed activities.

Stakeholder Engagement Jalin’s regional teams engaged 311 stakeholders in cocreation at the national, provincial, and district level through 536 meetings and events. Furthermore, Jalin’s regional teams received 18 directives from PHOs. This engagement led to the following lessons learned:

• Teams succeeded in engaging a variety of stakeholders including local governments, private sector actors, CSOs, media, and academia in line with a whole of market approach.

• Regional teams incorporated almost all PHO guidance in their activities.

Problem Definition Jalin identified 61 MNH problems in its six regions: 32 at the provincial level and 29 at the district level. The Banten, East Java, North Sumatera, and West Java teams defined these first provincially and then in target districts. Whereas teams in Central Java and South Sulawesi started by identifying problems at the district level. The primary lesson from Jalin’s problem definition is:

• Stakeholders led Jalin’s problem definition, which formed the basis for its local solutions. Jalin did not significantly inform stakeholder discussions with its own systematic analysis of MNH in Indonesia, such as by socializing the Evidence Synthesis or EMAS data.

Regional Approaches

Regional teams took different approaches to cocreation. The South Sulawesi and East Java teams allowed stakeholders to design activities with less Jalin involvement, while the Banten and North Sumatera teams develop their interventions more internally with less stakeholder direction. The West Java regional team engaged stakeholders and developed solutions concurrently, and the Central Java team started similarly and then switched to a more problem-driven approach. These different approaches led to the following lessons learned:

1 This report uses the terms local solution, activity, intervention, and initiative interchangeably.


• Regional teams and their HQ Partnership and Technical liaisons did not fully report activities to Jalin’s leadership. In turn, Jalin did not accurately report regional activities to USAID.

• Regional teams lacked guidance from Jalin HQ on cocreation, coordination, and implementation. Other common causes for delays included changes in HQ leadership and approach, strategic pause and resets, and confusion about drafting and approving Memorandum of Understanding (MOUs) and Short-Term Technical Assistance (STTA).

• Regional teams received varying levels of assistance from the HQ Communications, Partnerships, Monitoring, Evaluation, Learning and Adaptation (MELA), and Technical teams.

Figure 1: Graphic of Jalin’s Cocreation in Numbers


Local Solutions Jalin generated 71 local solutions in its six regions. The project is currently implementing 17 of these, designing another 17, and has discarded or postponed 37 ideas for solutions (table below). Table 1: Status of Local Solutions by Topic

Topic Discarded/ Postponed

Implementing In Design

Total

Clinical Competency & Compliance

6 4 1 11

ANC Coverage 3 6 1 10 Finance 5 1 3 9 Awareness Raising 6 1

7

Blood Supply 5 1

6 Transportation

2 4 6

Individual & Community Tracking 3

2 5 Referral Systems 1 1 3 5 Evidence Gathering 1

1 2

Family Planning 1

1 2 Maternity Waiting Homes 2

2

Other 4 1 1 6 Total 37 17 17 71

Please see the Local Solutions Section for a description of each activity and Annex 1 for a table of interventions. The DE found the following themes in among local solutions:

• Ten activities intend to increase Antenatal Care (ANC) coverage, of which Jalin is implementing six. These include Gerai Kesehatan Ibu dan Anak (Gerai KIA), MNH in the Workplace (Pekerja Aktif Sehat Bugar dan Produktif/PASTI and Gerakan Pekerja/Buruh Perempuan Sehat Produktif/GP2SP), and Program Perencanaan Persalinan dan Pencegahan Komplikasi (P4K) Inovasi.

• Four of Jalin’s six regional teams developed media campaigns to raise awareness of MNH.

• Four of six regional teams prepared initiatives to increase blood supply. • The North Sumatera, South Sulawesi, and West Java teams developed interventions to assist

village heads to use village funding for MNH programs.

• The North Sumatera, South Sulawesi, and West Java regional teams designed Information and Communication Technology (ICT) solutions to track pregnant women’s health in communities.

• The Banten, Central Java, and North Sumatera regions have activities to support private midwives through increased access to finance, medicine, and equipment.

• The Banten, South Sulawesi, and West Java teams started interventions to improve transportation in remote areas through feeder ambulances and floating ambulances.

• The Central Java and West Java regional teams both designed solutions to screen for pre-eclampsia and eclampsia.

The DE generated the following lessons learned from these activities:

• Jalin did not accurately apply prioritization criteria when deciding which local solutions to implement. In April 2019, HQ directed teams to prioritize interventions that were closest to implementation rather than those with a plausible impact on reducing MN mortality.2

• Most of Jalin’s work to date has been activities conducted by its regional teams. Regional teams brokered the relationships and partnerships which implement most of Jalin’s ongoing activities.

• Regional teams developed similar local solutions yet did not coordinate with each other to replicate activities.

• Previously discarded or postponed ideas warrant further consideration by Jalin.

2 Jalin’s 2018 Rapid Evidence Synthesis recommends improving referral systems, clinical quality of care, and health financing as priority intervention areas. However, these are a minority of Jalin’s 71 local solutions to date.


II. EVIDENCE USE Jalin utilized 96 sources of critical information and evidence in cocreation, according to the DE’s findings (table below). The most commonly used evidence was provincial health profiles, PHO and DHO data, and Jalin’s factsheets and slide decks. Jalin’s regional teams used these to inform problem definition, stakeholder engagement, and solution development and prioritization. The DE defined a source of evidence as a document, report, or data collection activity like a focus group discussion (FGD) or field assessment which provided information that Jalin used in its cocreation process. For example, the DE counted district health profiles and PHO monthly reports which Jalin used in a problem definition workshop. The DE did not count the problem definition workshop. Jalin did not consistently use data from the MNH Evidence Summit and Rapid Evidence Synthesis to inform problem definition, stakeholder engagement, and solution development and prioritization. The DE found that only the West Java regional team used the Evidence Synthesis, and Jalin’s slide decks and factsheets omitted much of this information. Furthermore, Jalin could not use the EMNC Survey. Regional teams indicated EMNC produced results too late to inform activities and lacked buy-in from key stakeholders, like PHOs. Table 2: Evidence Use by Region

Region Evidence Usage National • Slide Deck on USAID Jalin

• Factsheet on USAID Jalin "Partnership to Save Mother and Newborn in Indonesia"

• Factsheet on "5 Facts on Maternal and Newborn Mortality in Indonesia"

• Jalin’s Value Chains Analysis (VCA)

• Stakeholder engagement • Problem definition

Banten • District MNH profile • District health profile • DHO routine data • Banten II Study • Indonesia Demographic Health Survey (SDKI) 2017 • Indonesia Health Profile • Slide deck on Banten MNH Profile • Factsheet on "5 Facts on Maternal and Newborn Mortality in

Banten" • Survey results on the Alfamart stores location for Gerai KIA

• Stakeholder engagement • Problem definition • Solution development

Central Java

• Indonesian Obstetrics and Gynecology Association (Perkumpulan Obstetri dan Ginekologi Indonesia/POGI) 2018 Maternal and Perinatal Audit

• PHO monthly reports • Provincial Health Profile • Root Cause Analysis (RCA) on maternal mortality • Slide deck on Central Java MNH Profile • Factsheet on "5 Facts on Maternal and Newborn Mortality in

Central Java" • Slide deck of Central Java PHO • Slide deck from POGI Surakarta on Eradication of Pre-

Eclampsia • DHO Semarang City factsheet on “Maternal and Child Health

Surveyor (Petugas Surveillans Kesehatan Ibu dan Anak/GASURKES KIA)"

• Slide deck from POGI Surakarta on Regional General Hospital (Rumah Sakit Umum Daerah/RSUD) Pandan Arang as Comprehensive Obstetric and Neonatal Emergency Service (Pelayanan Obstetri Neonatal Emergensi Komprehensif/PONEK) Hospital

• Stakeholder engagement • Problem definition • Solution development • Solution prioritization


• Factsheet on "Do you know about the danger signs in pregnancy?"

• Presentation from DHO Semarang City on “Condition on Maternal Mortality Ratio (MMR) and Infant Mortality Ratio (IMR) in Semarang City 2018”

• Slide deck from POGI Semarang on “Analysis on POGI Strategy in the development of Team Performance in Acceleration of MMR Decreasing”

• Slide deck from PHO on “Saving mothers and newborn babies Program in Central Java”

• Slide deck from Indonesia Employers’ Association (Asosiasi Pengusaha Indonesia/APINDO) on the role of APINDO in Maternal and Child Health

• Current Status of Maternal and Child Health Programs in Grobogan District 2019

• Potential Solutions for Increasing the Safety of Mothers and Newborns Through the Village Innovation Program (Program Inovasi Desa/PID)

• Optimizing the Role of Village Facilitators through Village Development Planning and Village Innovation Program

• FGDs in Boyolali • Field assessments on the MNH situation at the PT. Pan

Brothers factory East Java • MDN database, part of the Maternal and Perinatal Audit

Surveillance and Response (AMP-SR) and Maternal Perinatal Death Notification (MPDN) system

• DHO routine data • PHO audit • Slide deck on East Java MNH Profile • Factsheet on "5 Facts on Maternal and Newborn Mortality in

East Java" • Slide Deck on EMNC socialization • Ministry of Health (MOH) Presentation on Maternal and

Newborn Death • Slide deck on “Maternal Neonatal Situation and Initial Design

of Local Solution in Sidoarjo” • Slide deck on “Maternal Neonatal Situation and Initial Design

of Local Solution in Malang” • Slide deck on “Maternal Neonatal Situation and Initial Design

of Local Solution in Jember” • Slide deck on the Role of Forum for the Reduction of

Maternal and Newborn Mortality (Forum Penurunan Kematian Ibu dan Bayi/PENAKIB) East Java

• Existing standard operating procedure (SOP) for ANC and PNC

• Local Solution Implementation Plan Documents • Local Solution Implementation Plan and Flyer of SiCantik

• Problem definition • Solution development

North Sumatera

• PHO routine data • DHO routine data • Banten II Study • Slide deck on North Sumatera MNH Profile • Maternal and Perinatal Audit from USAID Expanding Maternal

and Newborn Survival (EMAS) project in North Sumatra • Slide Deck by Public Health Faculty (Fakultas Kesehatan

Masyarakat/FKM) of North Sumatera University (Universitas Sumatera Utara/USU) on National Health Insurance (Jaminan Kesehatan Nasional/JKN) Implementation Research

• Slide Deck by Public Health Faculty of North Sumatera on Social Determinant factors related to MNH

• Factsheet on "5 Facts on Maternal and Newborn Mortality in North Sumatera"

• Langkat DHO presentation • MOH Presentation on Maternal Death Notification (MDN)

Socialization



• Maternal and Newborn Mortality in Labuhanbatu • FGDs in Langkat District • Field assessment on the implementation of P4K in Langkat

South Sulawesi

• MNH profiles for each district. • Slide deck on South Sulawesi MNH Profile • Maternal and Neonatal Mortality South Sulawesi 2016-2017 • Factsheet on "5 Facts on Maternal and Newborn Mortality in

South Sulawesi" • Program Achievement versus Minimum Services Standards

(SPM) in South Sulawesi • Slide deck by the Head of South Sulawesi PHO • Slide deck on Bantaeng District Good Practices in Reducing

MMR/Neonatal Mortality Rate (NMR) • Slide deck by Admedika Total Health Solution • MNH Situation & Maternal-Perinatal Audit in Sinjai • Slide deck from Indonesia Doctors Association (Ikatan Dokter

Indonesia/IDI) of South Sulawesi • Slide deck from Bone DHO • Documents on Ambulance Management • MNH Program in South Sulawesi

• Stakeholder engagement • Problem definition • Solution development

West Java

• Indonesia Basic Health Research (Riset Kesehatan Dasar/Riskesdas), MOH Research and Development Agency, 2018.

• Kavlee, J.A., et al., “Association between Anemia during Pregnancy and Blood Loss.” Journal of Health Population and Nutrition. Vol. 26 No. (2), 2018.

• Local MNH Monitoring (Pemantauan Wilayah Setempat Kesehatan Ibu dan Anak/PWS KIA), 2017.

• Fetomaternal Medical Association of POGI, National Guidance on Preterm Delivery Management, POGI, 2016.

• World Health Organization (WHO) report • United Nations Population Fund (UNFPA) report • Factsheet on "5 Facts on Maternal and Newborn Mortality in

West Java" • New Evidence Synthesis on MNH in Indonesia • Factsheet on "Do you know about the danger signs in

pregnancy?" • VCA results on the blood demand and uneven supply • MNH Situation and Problems Tree Result in Sukabumi • Socialization Materials of Maternal Death Notification • Reproductive Health and MNH Information • Documents on the Midwives and Traditional Birth Attendants

(TBAs) Partnership • Analysis on the MNH situation in Garut District • Documents on the Partnership between Primary Health Care

Centre (Pusat Kesehatan Masyarakat/Puskesmas) Cihurip and Ojek Drivers

• Documents on the partnership between Midwives and Traditional Birth Attendants (TBAs) in Cihurip Sub-district

• Documents on MNH services • Information on Saving Mother and Child Tools • Problem Statements Map of Bogor Raya and Depok City • FGDs in Bogor Raya and Depok City • Field assessment in PT. Chang Shin factory • Field assessment on the geographical challenges in Garut



Jalin Indicator Data Please note Jalin reports evidence use differently than the DE. It’s Year 1 and Year 2 Monitoring, Evaluation, Learning, and Adaptation (MELA) plans include performance indicators3 for the number of MNH evidence products disseminated. This data indicates Jalin has disseminated 371 MNH evidence products: 275 in Year 1, and 96 in Year 2 thus far.4 The performance indicator reference sheet (PIRS) for this indicator acknowledges that it double counts evidence products. Jalin’s Q1 2019 (Year 2) Report, Jalin states “A total of 35 percent of the products produced were presentations by partners and disseminated during USAID Jalin-sponsored events. Another 21 percent of products are factsheets that showcase regional MNH contexts.” This corroborates the DE’s findings about the prominent role of slide decks and one-pagers in Jalin’s evidence utilization. Lessons Learned

• Jalin did not consistently socialize evidence from the MNH Evidence Summit and Synthesis, Banten II study, EMAS program, and the Indonesia Demographic and Health Survey (IDHS). Two regional teams used EMAS and Banten II, but the others did not. Teams commonly utilized regional and local government data, such as PHO and DHO data and local audits, and Jalin’s one-pager and slide deck. These do not identify critical pathways to reducing MN mortality in the same way as the Evidence Synthesis. This led to solutions being designed without a plausible likelihood of increasing MN survival.

• Regional teams could not utilize evidence from the EMNC Survey for cocreation. The East Java regional team did not use EMNC results because they arrived after activities were designed. The Banten regional team also did not report using EMNC.

III. STAKEHOLDER ENGAGEMENT Jalin’s regional teams engaged 316 total stakeholders in cocreation at the national, provincial, and district level (table below). Of these, 212 partnered with Jalin to implement an ongoing local solution, and 104 other stakeholders participated at some stage in discarded or postponed activities or those being designed. The DE defines a partner as a stakeholder involved in some way (e.g. problem definition, solution development, etc.) in a local solution that Jalin is implementing. The DE defines other stakeholders as actors who participated in some way in initiatives that Jalin discarded, postponed, or is designing. The table below does not double count. The Partners column plus the Other Stakeholders column equal the total number of stakeholders that Jalin has engaged. Table 3: Regional Partners & Stakeholders

Region Partners Implementing Solutions Other Stakeholders Involved in Cocreation

Banten Provincial Level: • PHO • Indonesian National Nurses Association

(Persatuan Perawat Nasional Indonesia/PPNI)

District Level: • DHO Tangerang • DHO Lebak

National Level: • Directorate General of Metal,

Machinery, Transportation Equipment, and Electronics Industry (Direktorat Jenderal Industri Logam, Mesin, Alat Transportasi, dan Elektronika/IMATAP)

3 Year 1 MELA Plan Indicator 1.1.3.a: “MNH evidence disseminated (Op Eds, peer-review articles submitted for publication, policy briefs published, evidence dissemination events held).” Year 2 MELA Plan Indicator A.3: “# of MNH evidence products disseminated.” 4 Jalin’s Year 1 Annual Report, Q1 Calendar Year (CY) 2019 Report, and Q2 CY 2019 Report.


• Local Development Planning Agency (Badan Perencanaan Pembangunan Daerah/Bappeda) Tangerang

• District Village and Community Office (Dinas Pemberdayaan Masyarakat dan Desa/DPMD) Lebak

• PT. Sumber Alfaria • PT. Kreasi Mandiri Wintor Indonesia

(KMWI) • PT. Kreasi Mandiri Wintor Distributor

(KMWD) • PT. Samudera Marine Indonesia • Maternal and Newborn Healthcare

Forum (Forum Peduli Kesehatan Ibu dan Anak/FOPKIA)

• Puskesmas

• Center for the Study of Family Welfare (Pusat Penelitian Keluarga Sejahtera Fakultas Kesehatan Masyarakat Universitas Indonesia/PUSKA FKM UI)

• Opportunity International Australia

• Koperasi Mitra Dhuafa (KOMIDA)

• Opportunity International Australia

• Healing Fields Provincial Level:

• Provincial Social Office • Provincial Agriculture Office • Provincial Industry Office • Provincial Religion Office • Health Social Security Agency

(Badan Penyelenggara Jaminan Sosial/BPJS)

• Manpower BPJS • District Women Empowerment,

Child Protection, Population, and Family Planning Office (Dinas Pemberdayaan Perempuan, Perlindungan Anak, Kependudukan, dan Keluarga Berencana/DP3AKKB)

• Indonesian Pediatricians Association (Ikatan Dokter Anak Indonesia/IDAI) Banten

• Indonesian Midwives Association (Ikatan Bidan Indonesia/IBI)

• National Population and Family Planning Board (Badan Nasional Keluarga Berencana Nasional/BKKN) Banten

• Indonesian Ulema Council (Majelis Ulama Indonesia/MUI) Provinsi Banten

• Bantenese People Community (Paguyuban Warga Banten/PUWNTEN)

• Indonesian Nutritionists Association (Persatuan Ahli Gizi Indonesia/Persagi) Banten

• State Islamic University (Universitas Islam Negeri/UIN) Banten

• Sultan Ageng Tirtayasa University (Universitas Sultan Ageng Tirtayasa/Untirta) Banten

• Medical College (Politeknik Kesehatan/Poltekkes) of Banten

• Indonesian Red Cross (Palang Merah Indonesia/PMI) of Banten

• Sehati • Lazismu Foundation • Halodoc


• Awal Bros. Hospital District Level:

• DHO Pandeglang • DHO Serang • DHO Lebak

Central Java Provincial Level: • PHO • APINDO • Center of Health Research of

Diponegoro University • Medical Faculty of Sebelas Maret

University District Level:

• DHO Boyolali • DHO Brebes • BPJS • Population Control and Family Planning

Office of Semarang City (Dinas Pengendalian Penduduk dan Keluarga Berencana/DPPKB)

• DPMD of Brebes • DPPKB of Boyolali • District Religious Office of Boyolali • PMI Boyolali • PMI Semarang • IBI Boyolali • IBI Semarang • POGI Semarang • POGI Surakarta • IDI Boyolali • PT Pan Brothers Tbk • PT. Sandang Asia Maju Abad • PT. Charoen Phokpan Tbk • Puskesmas Mojosongo • Puskesmas Karanganyar • Tugurejo Regional Hospital • Dera As-Syifa Hospitals, • Puskesmas in Karanggede • Puskesmas Gladagsari • Puskesmas Ngemplak • Civil Society Forum for Maternal and

Newborn Health (Forum Masyarakat Madani Peduli Kesehatan Ibu dan Anak/FMM KIA)

Provincial Level: • Central Java Bank • PT. Sijarimas Teknologi Inovasi

(PT STI) • Hospitals Association of

Indonesia (Perhimpunan Rumah Sakit Seluruh Indonesia/PERSI)

• Association of Indonesia Express, Post and Logistics Services (Asosiasi Perusahaan Jasa Pengiriman Ekspres, Pos, dan Logistik/ASPERINDO)

• Association of Hotel and Restaurant (Perhimpunan Hotel dan Restoran Indonesia/PHRI)

• Public Relations Association of Indonesia (Perhimpunan Hubungan Masyarakat Indonesia/PERHUMAS)

• Semarang runners • Muhammadiyah

District Level: • DHO Semarang City • DHO Grobogan • Grobogan District Village and

Community Empowerment Office • PMI Brebes • Hospital in Boyolali • Puskesmas in Boyolali • RSUD Dr. R. Soedjati Purwadi

East Java Provincial Level • PHO

District level: • DHO Sidoarjo • DHO Jember • DHO Malang • Bappeda Sidoarjo • Bappeda Jember • District Social Office Sidoarjo • District Social Office Sidoarjo Malang • District Communication and Information

Office Sidoarjo (Dinas Komunikasi dan Informasi/DISKOMINFO)

• District Population and Civil Registration


Office Sidoarjo (DISDUKCAPIL) • DPMD Jember • DPMD Malang • District Social Office Jember • DPPKB Malang • IBI Sidoarjo • IBI Jember • IBI Malang • POGI Sidoarjo • RSUD Sidoarjo • Siti Khodijah Hospital of Sidoarjo • Soebandi Hospital • Siloam Hospital • Klinik Jember Hospital • Srikandi Hospital • Balung Regional Hospital • Kalisat Regional Hospital • RSUD Lawang • RSUD Kanjuruhan • Wava Husada Hospital • Fatayat Nahdlatul Ulama (NU) Sidoarjo • Fatayat Jember • Fatayat NU Malang • Aisyiyah Sidoarjo • PENAKIB • Muhammadiyah University • Mitra Tani • Lingga Indonesia Foundation • District Owned Company (Perusahaan

Daerah/Perusda) Jasa Yasa • Perusda Tirta Kanjuruhan • Times Indonesia

North Sumatera Provincial level: • PHO • Bank of North Sumatera • IBI of North Sumatera • Clinics Association of Indonesia (Asosiasi

Kinik Indonesia/ASKLIN) • Media Forum for MNH • Nahdlatul Ulama • Muhammadiyah • Council of Churches in Indonesia

(Persekutuan Gereja Indonesia/PGI) • Family Welfare Program (Program

Kesejahteraan Keluarga/PKK) • National Youth Committee of Indonesia

(Komite Nasional Pemuda Indonesia/KNPI)

District level: • DHO Langkat • District Village Community

Empowerment Office • District Social Office • Hinai Head of Sub-District • Tanjung Pura Head of Sub-District • Village Governments from 30 pilot

villages, • Village Midwives from 30 pilot village

Provincial level • BPJS • Provincial DISKOMINFO • Trade and Industry Office of

North Sumatera Province • Integrated Licensing Agency at

provincial and district level • APINDO of North Sumatera

Province • GRAB • Gojek • Financial Institution • Android application developer • Companies communication

providers


• Puskesmas Tanjung Beringin • Puskesmas Pantai Cermin • Puskesmas Pematang cengal • MNH Motivator Cadres of Tanjung

Beringin Sub-Districts • FOPKIA of Langkat District • North Sumatera University (Faculty of

Medicine, Public Health Faculty, and Nursing Faculty, and Faculty of Psychology)

South Sulawesi

Provincial Level: • PHO • Transportation Office of South Sulawesi

Provincial Government • National Disaster Management Agency

(Badan Nasional Penanggulangan Bencana/BNPB)

• Basic Social Services Expert of South Sulawesi Province

• Human Resources Department (HRD) Agency of the Ministry of Transportation

• Provincial Communication and Information Office

• Special Working Unit of Oil and Gas (Satuan Kerja Khusus Pelaksana Kegiatan Usaha Hulu Minyak dan Gas Bumi/SKK Migas)

• Kalla Foundation • Faculty of Shipping of Hasanuddin

University, • Bank of South Sulawesi • Bank of West Sulawesi • Corporate Social Responsibility (CSR)

Forum District Level:

• DHO Pangkep • DHO Bone • DHO Bulukumba • DHO Sinjai • Bappeda Pangkep • Bapeda Bone • Bappeda Bulukumba • Bappeda Sinjai • District Transportation Office Pangkep • DISKOMINFO Pangkep • PMI Bulukumba • PKK Pangkep • PKK Bone • PKK Bulukumba • PKK Sinjai • Jakarta Post • IDI • IDAI • POGI • IBI • PPNI • RSUD Bone • RSUD Pangkep

Provincial Level: • Women Empowerment Section

of Provincial Government • Provincial PKK

District Level: • DHO Jeneponto • DHO Gowa • Bappeda Jeneponto • Bappeda Gowa • RSUD Jeneponto • RSUD Gowa • PKK Jeneponto • PKK Gowa • Tribun Timur • Kompas • State owned enterprise news

agency (Lembaga Kantor Berita Nasional/LKBN) Antara

• Berita Kota • Bosowa Foundation • PT Mayora


• RSUD Bulukumba • RSUD Sinjai

West Java

Provincial Level: • PHO • APINDO West Java • BKKBN

District level: • DHO Garut • BPJS Garut • Population Control, Family Planning,

Women Empowerment and Child Protection Office (Dinas Pengendalian Penduduk, Keluarga Berencana, Pemberdayaan Perempuan dan Perlindungan Anak/DPPKBPPPA)

• Garut Religion Office • PT Chang Shin Reksajaya • PT Bio Farma • Labour unions of PT. Changsin Reksajaya • ASKLIN • Clinic in PT. Changsin • Puskesmas Leles • POGI Garut

Provincial Level: • West Java think thank • Bappeda Province • Provincial Secretary • POGI • IDAI • Indonesia Private Hospitals

Association (Asosiasi Rumah Sakit Swasta Indonesia/ARSSI)

District level: • DHO Sukabumi • DHO Karawang • DHO Bogor • DHO Bogor City • DHO Depok City • Bappeda Sukabumi • District Religion Office Sukabumi • BKKBN Sukabumi • Family Planning Extension Field

(Penyuluh Lapangan Keluarga Berencana/PLKB)

• Village Community Empowerment Office

• POGI Karawang • POGI Bogor • POGI Bogor City, • POGI Depok City • IBI Sukabumi • PT Sinergantara • Dompet Dhuafa • PT Kreasi Mandiri Wintor

Indonesia • PT STI • Puskesmas in Karawang • Private hospital in Karawang • Puskesmas Cihurip • RSUD Bogor • RSUD Bogor City • RSUD Depok City • RSUD Karawang • FMM KIA

Jalin Indicator Data Please note Jalin reports numbers of stakeholders engaged differently than the DE. It’s Year 1 and Year 2 MELA plans include performance indicators5 for stakeholders involved in co-creating solutions to improve MNH outcomes. This data indicates Jalin has engaged 1,399 total stakeholders: 196 in Year 1, and 1,203 in Year 2 thus far. 6 However, these Jalin indicators define a stakeholder as a person, rather than the institution to which they belong. Events & Meetings Jalin engaged these stakeholders in cocreation by organizing or participating in 536 formal regional meetings and events (table below). This may not count informal discussions.

5 Year 1 MELA Plan Indicator 1.2.1.a: “New Multistakeholder actors engaged and participating in partnerships process.” Year 2 MELA Plan Indicator C.3: “# of stakeholders involved in co-creating solutions to improve MNH outcomes.” 6 Jalin’s Year 1 Annual Report, Q1 CY 2019 Report, and Q2 CY 2019 Report.


Table 4: Jalin Events & Meetings by Region

District Year 1 Year 2 (Jan. - Jul. 2019)

Total

Banten 56 49 105 Central Java 44 47 91 East Java 50 53 103 North Sumatera 65 39 104 South Sulawesi 26 53 79 West Java 30 24 54 Total 271 264 536

Provincial Health Office Engagement Jalin’s regional teams receive approximately 18 directives from PHOs, which they engaged soon after starting up (table below). PHOs run provincial hospitals, organize the health services, and coordinate health issues within regions and across districts. Table 5: PHO Direction to Regional Teams

Region PHO Guidance Banten • Work in Serang, Lebak, Pandeglang, and Tangerang districts.

• Assist the PHO’s Jamilah program. Central Java

• Work in districts with the highest number of maternal deaths, such as Grobogan, Brebes, Boyolali, Semarang City, Sragen and Banyumas.

• Focus on the leading causes of maternal deaths, notably eclampsia and pre-eclampsia. • Utilize maternal death audit results, including facility level data.

East Java • Follow local government administrative procedures, such as attain a MOH letter of endorsement to present to the Provincial Government Cooperation Bureau.

• Use valid data and transparent methods to identify systemic issues and opportunities for intervention.

• Select districts based on the number of MN deaths, commitment of district governments, and the presence of government and donor funded MNH programs that need assistance.

North Sumatera

• Coordinate programming with the Provincial Secretariat. • Collaborate with PT Telkom, which worked with the PHO on Short Message Service (SMS)

Bunda. • Coordinate with the Joint Health Council, which consists of former members of the MOH

and PHO who are based in North Sumatera. • Invite the media to activities.

South Sulawesi

• Support all government programs in South Sulawesi. • Immediately develop SOPs for floating ambulances.

West Java • Avoid duplicating EMAS activities. The PHO is replicating EMAS with their own budget, including the referral system (Sijari Emas), clinical components, and community engagement through FMM KIA.

• Synchronizing and synergizing Jalin with the replication of EMAS program funded by Local Revenue and Expenditure Budget (Anggaran Pendapatan dan Belanja Daerah/APBD)

• Work in districts with the highest number of maternal and neonatal deaths, such as Garut, Karawang, Indramayu, Bogor, Sukabumi, and Bandung.

• Partner with the five largest companies in West Java: PT. Chang Shin Reksajaya Garut, PT Hini Daiki Tasikmalaya, PT Epson Bekasi, PT Goldstar Indonesia Sukabumi, and PT Ceres.

Lessons Learned

• Regional teams engaged a variety of stakeholders including local governments and agencies, private sector actors, CSOs, media, and academia. Please see the sections below for information about the outcomes of this engagement.

• Regional teams followed PHO guidance. Jalin incorporated almost all PHO direction.


IV. PROBLEM DEFINITION Jalin’s regional teams defined 61 key MNH issues by collaborating with stakeholders: 32 at the provincial level and 29 at the district level. Each team consulted with partners and other actors to identify issues and opportunities for interventions. This process usually involved an initial problem definition stage and then a refinement stage, which further contextualized issues at the local level. However, each team’s approach and the level of detail defined differed. Problem Definition by Region Banten The Banten regional team defined MNH problems at the provincial level. The team conducted two multi-stakeholder workshops in July 2018 and August 2018 with the same attendees. Participants established a list of key issues (table below) in the July workshop. The regional team presented these results and a problem tree analysis at the follow-up August workshop, and attendees identified programs working on these issues, additional potential solutions, and plans for improvements. Table 6: Banten Provincial Problem Definition Results

Participants Problems Defined in July 2018

Solution Developed in August 2018

MUI Banten FOPKIA Banten PUWNTEN University of Indonesia, PUSKA FKM UI PHO Bappeda Banten Provincial Religious Office Department of Industry and Commerce Prov. Banten Provincial Social Office Provincial Agricultural Office BKKBN Banten UIN Banten Untirta Banten Poltekkes Banten IDAI Banten PMI Banten PERSAGI Banten Health BPJS Banten Manpower BPJS Banten DP3AKKB Prov. Banten

• Suboptimal early detection of pregnancy risks

• Poor management of perinatal asphyxia cases

• Low availability of blood stock • Poor health services • Lack of quality for ANC • Mismanagement of emergency

births • Low health worker and facility

compliance against with service standards (accreditation, integrated referral system)

• Minimum health services not fulfilled

• JKN program participation below 100%

• Low family living standards • Lack of government support

for emergencies • Poor management of

provincial health programs • Lack of data for budgeting and

planning • Poor controls for planning

and budgeting • Lack of awareness and

concern for MNH issues • Public lacks access to

information • Lack of community awareness

of MNH

• Improve ANC services o At health facilities, strengthen human

capacity through training, mentoring, equipment, medicine, and routine ANC for pregnant women

o Empower cadres in the community to support health workers

• Optimizing early detection of pregnancy risks o Strengthen capacity of health workers o Increase awareness of reproductive

health among teenagers o Increase community awareness o Use culturally appropriate approaches

• Improve management of perinatal asphyxia cases with emergency procedures

• Increase awareness to health information for pregnant women and their families o Education and discussion groups o Leverage social media to reach a wider

audience o Connect cadres and health workers

with families to provide assistance • Improve existing programs, including

ambulance transportation • Increase government support for

emergency case management o Add health facilities o Facilitate access to health facilities o Increase minimum service standards at

all facilities o Improve and increase the

competencies of health facilities o Equip ambulances for referrals o Ensure pregnant women have

insurance • Online system to access patient data • Cross check and update data • Government support for CSR


Central Java The Central Java regional team conducted workshops in three districts to define key MNH issues and brainstorm solutions (table below). Table 7: Central Java District Problem Definition Results

District Participants Problems Defined Boyolali October 2018

Boyolali DHO POGI Boyolali IDAI Boyolali IDI Boyolali IBI Boyolali PMI Kabupaten Boyolali Kantor Kementrian Agama Kabupaten Boyolali Dinas Koperasi dan Tenaga Kerja Kabupaten Boyolai BPJS Kesehatan Boyolali BPJS Tenaga Kerja Boyolali Bappeda Kabupaten Boyolali Dinas Pendidikan Kabupaten Boyolali Bagian Kerjasama Sekretariat Daerah Kabupaten Boyolali Bagian Hukum Sekretariat Daerah Kabupaten Boyolai Pandan Arang Hospital Waras Wiris Hospital Umi Barokah Hospital Islam Sambi Hospital Puskesmas Mojosongo Puskesmas Ngemplak Puskesmas Ampel Puskesmas Sambi Puskesmas Teras Puskesmas Karanggeda Resource person: POGI Surakarta Fakultas Kedokteran Universitas Sebelas Maret (UNS) Solo Medical College (Sekolah Tinggi Ilmu Kesehatan/STIKES) Estu Utomo Boyolali

• Inadequate adherence to standards.

• Limited knowledge and capacity of health workers in detecting and providing pre-referral treatment (i.e. Magnesium Sulfate/MgSO4 administration) at health facilities.

• Inadequate MNH services in factory clinics and low awareness MNH issues among female workers, which contributes to poor quality of ANC for mothers and increases the chance that risks are not followed up on.

Semarang December 2018

Semarang Municipality Health Office IBI Semarang Puskesmas Mijen Panti Wilasa Hospital Semarang Municipality DPPKB PERHUMAS St. Elizabeth Hospital Muslimat NU Puskesmas Halmahera Columbia Asia Hospital Islam Sultan Agung Hospital Roemani Hospital KRMT Wongsonegoro Hospital Health Market Semarang Semarang Municipality Labor Office Faculty of Public Health Diponegoro University IDI Semarang Puskesmas Ngesrep BPJS Kesehatan IDAI Semarang Semarang Municipality Bappeda PMI Semarang Semarang Runners Medicine Faculty Sultan Agung University Puskesmas Bangetayu PSS/Peaceful Birth APINDO Semarang Dr. Kariadi Hospital Puskesmas Gunungpati Central Java PHO

• Inadequate MNH services in factory clinics and low awareness MNH issues among female workers, which contributes to poor quality of ANC for mothers and increases the chance that risks are not followed up on.


Puskesmas Karanganyar KRMT Wongsonegoro Regional Hospital Tugurejo Provincial Hospital Dian Nuswantoro University PPNI Semarang Puskesmas Mangkang Semarang Municipality Office of Women's Empowerment and Child Protection (Dinas Pemberdayaan Perempuan dan Perlindungan Anak/DP3A)

Brebes January 2019

Brebes DHO Bappeda of Brebes District DPMD Brebes FMM KIA Brebes PT. Charoend Phokpand Derra Asyifa Hospital Puskesmas Banjarharjo Banjarharjo Sub-district Government Villages Government in Sub-district Banjarharjo PMI Kabupaten Brebes

• Low involvement of non-health actors in collaborative action to reduce MN deaths.

• Lack of clinical and public accountability in referral hospitals.

East Java The regional team organized a workshop in September 2018 that defined 14 key MNH issues across East Java. The next day the team met with the PHO to refine these 14 issues into five prioritized problems (table below). Table 8: East Java Provincial Problem Definition Results

September 2018 Workshop PHO Follow-Up Participants 14 MNH Issues Five Refined Problems

East Java PHO Bappeda of East Java Province East Java DISKOMINFO East Java Social Office East Java Agriculture and Maritime Office East Java Women Empowerment, Child Protection, and Population (Dinas Pemberdayaan Perempuan, Perlindungan Anak, dan Kependudukan/DP3AK) BPJS Kesehatan of East Java Dr. Soetama General Public Hospital Jemursari Islamic Hospital PKU Muhammadiyah Hospital Siti Khodijah Sidoarjo Hospital Unilever (private sector) PT. Sinergantara (private sector) Icon+ (private sector) Bank of East Java (private sector) IBI of East Java POGI IDAI Pattiro Gresik (CSO) Pattiro Malang (CSO)

• Inadequate coverage of ANC • Delayed treatment from health

workers • Poor skills and competency in

handling maternal and neonatal emergency case

• The lack of infrastructure in health facility to support maternal and neonatal emergency treatment

• Increasing number of malnourished pregnant women

• Unwanted pregnancies • Early marriage and pregnancy

before marriage • Low awareness on reproductive

health • Low coverage of family planning

programs • Delayed treatment because of

late decision making by family • Lack of health monitoring for

pregnant women and newborn • Delayed referral for high-risk

pregnancy • Ineffective referral system

network • High number of poor families

not covered by health insurance

• Low quality ANC to detect high-risk pregnancies

• Insufficient capacity to manage emergencies during delivery

• Lack of awareness and education about reproductive health

• Inadequate referral system. The tiered referral system is still being designed and structured.

• Poor mothers cannot pay for MNH services via BPJS participation mechanism. The use of Insurance for Delivery (Jaminan Persalinan/Jampersal) is constrained by regional regulations.

North Sumatera The regional team defined problems in North Sumatera first with a smaller group of stakeholders (a “think tank”) in July 2018 and then refined them with a broader group of stakeholders in August 2018.


Table 9: North Sumatera Provincial Problem Definition Results

Initial Problem Areas in July 2018 Refined Problem Definition in August 2018 Think Tank Problem Areas Participants Specific Problems

Health Professional Organizations Communication Forum (Badan Pekerja Joint Health Council/BPJHC) IDAI Public Health Faculty of North Sumatera University FMM KIA North Sumatera PHO POGI Indonesia Social Obstetric Gynecology Society (Himpunan Obstetri dan Ginekologi Sosial/HOGSI) Muhammadiyah of North Sumatera

Poor quality of care by single practice midwives: • Midwives lack access

to finance to meet the standard quality of care (health care facilities and medicine).

• Midwives lack of access to advance education or sustainable training.

• Lack of institutional supervision of single practice midwives.

• Limited number of certified training institutions for single practice midwives.

• Midwives lack of awareness on the importance of certification.

• Poor quality of midwifery educational institutions.

• People do not understand their rights on qualified health care.

• Inadequate implementation of regulations for single practice midwives.

• The lack of DHO and Puskesmas capacity in supervising and accompanying single practice midwives.

Referral system: • Low capacity of

primary health facility workers to identify the clinical signs to refer.

• Low capacity of primary health facility workers in handling pre-referral patients (i.e. stabilizing patients).

• Inadequate handling of emergency cases.

• Poor distribution and availability of specialist health workers, OB-GYNs, and pediatricians.

• Lack of standardized transportation.

North Sumatera PHO Bappeda of North Sumatera Village and Community Empowerment Office DPMD of North Sumatera BKKBN of North Sumatera DP3A of North Sumatera DPPKB of North Sumatera Social Office of North Sumatera Research and Development Bureau of North Sumatera Government Regional Research Council (Dewan Riset Daerah) Religions Office of North Sumatera DISKOMINFO of North Sumatera Langkat DHO Deli Serdang DHO Mandailing Natal DHO Bappeda of Langkat District Bappeda of Deli Serdang District Bappeda of Mandailing Natal District BPJS Kesehatan Regional Division I North Sumatera-Aceh BPJHC POGI HOGSI PERSI IDI IDAI PPNI ASKLIN IBI RSUP H. Adam Malik RSUD dr. Pirngadi Medan RSU Haji PMI of North Sumatera FMM KIA of North Sumatera Jaringan Kesehatan Masyarakat Foundation Pusaka Indonesia Foundation Public Health Faculty of

Poor quality of care of single practice midwives: • Lack of institutional

supervision of single practice midwives.

• Limited number of certified training institutions for single practice midwives.

• Midwives lack access to finance to meet the standard quality of care (health care facilities and medicine).

Referral system: • Inadequate handling

emergency cases at primary health facility.

• The suboptimal implementation of P4K or Desa Siaga.


• Suboptimal information system that support the communication between referral health facilities.

• Poor implementation of P4K or Desa Siaga.

North Sumatera University TP PKK of North Sumatera Ombudsman Commission of North Sumatera

South Sulawesi The Jalin regional team used an October 2018 workshop with stakeholders to conduct problem definition in six districts in South Sulawesi. The table below defines the key MNH issues in each district and the stakeholders which helped identify them. Table 10: South Sulawesi District Problem Definition Results

District Stakeholders Participating MNH Problems Defined Bone South Sulawesi PHO

Bone DHO Bappeda of Bone District Bone RSUD Provincial and Bone District PKK CSR Forum Media Kalla Foundation University

• Culturally pregnant women move to their parents or in-law’s residence near their due date.

• There are few village midwives, and they have difficult accessing villages.

• No budget available for village midwives.

Pangkep South Sulawesi PHO Pangkep DHO Bappeda of Pangkep District Pangkep RSUD Provincial and Pangkep District PKK CSR Forum Media University

• Limited number of health worker have difficulty monitoring pregnant women and identifying high-risk pregnancies.

• Transportation issues on islands and in the mountainous areas.

• No cross-sectoral cooperation on MNH.

Bulukumba South Sulawesi PHO Bulukumba DHO Bappeda of Bulukumba District Bulukumba RSUD Provincial and Bulukumba District PKK CSR Forum Media University Provincial and Bulukumba District PMI

• Late decision-making action. • Inadequate referral mechanism. • Long response time during

emergencies.

Jeneponto Head of Family Welfare Program Organizing Team (Ketua TP PKK) Bappeda Head of DHO Director of RSUD Head of Health Care Division of Jeneponto DHO Head of Public Health Division of Jeneponto DHO Head of Diseases Anticipation Division of Jeneponto DHO Women Empowerment Section of South Sulawesi Provincial Government Bosowa Foundation Head of District Government Units in Jeneponto Working Group IV of South Sulawesi PKK Kompas Newspaper

• Not all midwives implement standard ANC.

• Lack of understanding in communities about how to detect high-risk pregnancies

• Poor monitoring and reporting system for pregnant women

Sinjai Head of Family Welfare Program Organizing Team (Ketua TP PKK) Head of Bappeda Head of DHO Director of RSUD Head of Health Care Division of Sinjai DHO Head of Public Health Division of Sinjai DHO

• High maternal and child mortality rate due to pre/eclampsia, bleeding, asphyxia, low birth weight, and serotines.

• Low awareness of ANC and factors for high-risk pregnancies among pregnant women.


Head of Mother and Child Health and Nutrition Division of South Sulawesi PHO. Bank of South and West Sulawesi Chairperson of CSR Forum Working Group IV of PKK Jakarta Post

• Bad attitude and lack of coordination by OBGYN.

Gowa Head of Family Welfare Program Organizing Team (Ketua TP PKK) Head of Bappeda Head of DHO Director of RSUD Head of Health Care Division of Gowa DHO Head of Public Health Division of Gowa DHO Head of Public Health Division of South Sulawesi PHO Bank of South and West Sulawesi PT. Mayora (Private Sector) Working Group IV of PKK News Office (LKBN Antara) Berita Kota (Media)

• Poor collaboration between sectors for MNH.

• Supervision of pregnant women in the last three months is lacking.

• Late referral and late arrival at hospitals.

West Java The West Java regional team defined district level MNH problems over a year period meeting with PHO, Bappeda, and Sekda in June and July 2018, DHOs in August 2018, and additional stakeholders in March 2019 (table below). The team also conducted field assessments in Garut and Sukabumi districts October 2018 and March 2019 and workshops in Bogor District in June and August 2019 to further refine and specify these issues. Table 11: West Java District Problem Definition Results

Stakeholders Involved in Definition Districts Problems Defined West Java PHO Bappeda of West Java Provincial Government Secretary POGI IBI BKKBN of West Java APINDO PT Bio Farma

Provincial • Poor coordination between cross-sectoral government units on reducing MN mortality.

• Uneven blood supply distribution.

Garut DHO Sukabumi DHO Bappeda of Sukabumi Sukabumi Religion Office Sukabumi BKKBN Garut BKKBN Dompet Dhuafa PT. Chang Shin Management PT. Chang Shin Labour Unions Puskesmas Cihurip BPJS Kesehatan Garut DPPKBPPPA of Garut District POGI HOGSI IBI Jhpiego Garut Religion Office PT. Biofarma ASKLIN DPMD of Garut District FMM KIA Padjadjaran University

Garut and Sukabumi

• Inattention of industrial sector on MNH. • TBAs are still active and preferred by many

mothers due to geographical and cultural challenges in remote areas.

• Inaccessible geography creates delays in referrals and limits access to ANC.

Bogor DHO Bogor City Health Office Depok City Health Office ARSSI

Bogor Raya and Depok City

• Inefficient, multiple referrals for high-risk pregnant women and newborns occur in and between Bogor District and City, and Depok City.


POGI IDAI Bappeda of Bogor District Bappeda of Bogor City Bappeda of Depok City Provincial Government Secretary Regional hospitals PT. STI PT. Sinergantara Karawang DHO POGI Kawarang Puskesmas Private Hospital Regional Public Hospital

Karawang • Low Quality of ANC in Karawang District based on AMP results in 2017.

Lessons Learned

• Jalin co-defined regional MNH issues extensively with stakeholders, which formed the basis for its local solutions. This ensured that Jalin’s regional activities were responsive to stakeholder requests and conformed with stakeholder’s perceptions of how to improve MNH outcomes. However, as noted in Section II. Evidence Usage, Jalin did not prominently inform stakeholders discussions with its own systematic or extensive analysis of the health system, such as from the MNH Evidence Summit and Synthesis. This contributed to many local solutions being designed without a credible logic model for increasing MN survival.

V. REGIONAL APPROACHES Jalin’s six regions took different approaches to cocreation. The most common differences are the extent that a region allowed stakeholders to design its local solutions and whether a region followed Jalin’s opportunistic or problem-driven approach (table below). Table 12: Differences in Regional Approaches

Opportunistic Approach

In Between Problem-Driven Approach

Stakeholders Design Solutions with Less Jalin Involvement

South Sulawesi East Java

In Between West Java Central Java

Jalin Designs Solutions More Internally

Banten North Sumatera

Regional teams that designed solutions internally, with relatively less stakeholder involvement, began implementation slightly earlier. For example, the Banten team was the first to sign a MOU and commence implementation with the Gerai KIA activity in April 2019. Teams where stakeholders designed the solutions, with less Jalin involvement, generated more ideas for interventions. For example, the South Sulawesi team produced 21 ideas and the West Java team 15 ideas. Differences mattered less between an opportunistic approach, which engages stakeholders and develops solutions concurrently, or a problem-driven approach, which develops problem statements before engaging stakeholders. Both the East Java and North Sumatera teams followed a problem-driven approach, generating six and eight local solutions respectively. Central Java is an outlier allowing stakeholders to design some solutions and choosing to develop others more internally. It also pivoted from an opportunistic to problem-driven approach when directed by Jalin HQ. It produced 14 ideas and commenced implementing MNH in the Workplace (PASTI) in May 2019 soon after Banten began Gerai KIA.


Banten The Banten regional team began work in May 2018 by engaging the PHO, which recommended that they work in Tangerang, Lebak, Serang, and Pandeglang districts. The regional manager (RM) met with these DHOs, Bappeda, Sekda, and other local government entities in June and July (timeline below), discussing MN mortality and morbidity in their area and assessing their commitment to participate in Jalin. The team elected to work in Tangerang and Lebak based on their commitment and previous contribution to EMAS. In July 2018, Jalin HQ conducted a dissemination workshop for the Banten II study, which the regional team used to introduce local stakeholders to the program. However, the team primarily used PHO monthly mortality data and the provincial health profile in discussions and problem definition. Stakeholders preferred PHO data, because Banten II surveyed Serang, and other districts do not believe its findings apply to them. Between July and October, the RM and his staff commenced developing potential MNH interventions internally. Multi-stakeholder workshops, a value chain analysis (VCA) workshop, and initial meetings with future partners occurred during this period. However, the regional team recalled designing most solutions itself with minimal input from Jalin HQ, and in some cases, it felt HQ unnecessarily delayed implementing solutions. Figure 2: Timeline of Banten Regional Approach

Once they generated ideas, the regional team contacted likely partners for implementation using personal connections. For example, the team brainstormed Gerai KIA in June and introduced the idea to Alfamart in July via an HQ staff member with personal contacts at Alfamart. It continued meeting with Alfamart and other local government partners through September before securing their consent to proceed. Three ideas for interventions were discarded in October when stakeholders disengaged or when Jalin deprioritized the VCA’s focus on blood supply. Generating ideas internally and engaging partners personally limited the number of solutions that the team brainstormed but enabled it to progress rapidly relative to other Jalin regions. Banten was the first region to implement a solution, Gerai KIA in March 2019 (map below). Compared to Central Java, the Banten team conducted few broad stakeholder engagement events, chose not to utilize the VCA and were unaffected by HQ switching from an opportunistic to problem-driven approach.


Figure 3: Map of Banten Activities

Central Java The Central Java regional team began work in July 2018 by engaging health sector stakeholders and expecting to take a clinic approach to reducing MN mortality (timeline below). The RM began with this approach because he lacked formal guidance or detailed guidelines on cocreation from Jalin’s HQ and it corresponded with his skill set and experience as former Provincial Health Director for Central Java. During this period, HQ instructed regional teams to take an opportunistic approach. In August, Jalin HQ directed the RM to more broadly engage stakeholders from multiple sectors and use Jalin’s VCA to define problems to MN survival in Central Java. Meanwhile, the regional team continued to coordinate with the PHO and consider their recommendations for interventions. Multi-stakeholder engagement, the VCA, and PHO recommendations helped the regional team generate several ideas for interventions. In September and October, Jalin transitioned from an opportunistic to a problem-driven approach, where regional teams develop problem statements before engaging stakeholders. During this transition period, POGI in Boyolali published the 2018 Maternal Perinatal Audit. The regional team used the audit as its keystone evidence to engage new stakeholders, develop new solutions, and discard several previous ideas for interventions. In November and December, the regional team engaged stakeholders in problem definition and solution co-creation in Boyolali District, resulting in two interventions: MNH in the Workplace and Pre-Eclampsia and Eclampsia Eradication. In January and February 2019, the regional team conducted a similar process in Brebes District, resulting in its MNH Human Resources (HR) and Mentoring initiative. Between March and June, HQ instructed the regional team to first prioritize implementing only MNH in the Workplace and then to also prioritize Pre-Eclampsia and Eclampsia Eradication (map below).


Figure 4: Timeline of Central Java Regional Approach

Figure 5: Map of Central Java Activities


East Java The East Java RM joined Jalin in May 2018 and recruited the regional team by August. During this time, she met stakeholders like the PHO, Bappeda, DHOs, ExxonMobil Bojonegoro, and PT Sijariemas. to introduce the project. As in North Sumatera, the RM followed a problem-driven approach (timeline below) despite HQ instruction at the time to take an opportunistic approach. Like South Sulawesi, the RM sought to enable local stakeholders to develop their own interventions with minimal guidance from Jalin. In contrast, the regional teams in North Sumatera and Banten developed their interventions internally and then approached stakeholders to gauge their willingness to participate. In September, the East Java regional team held a workshop that defined 14 MNH problems across the province. The next day the team met the PHO to refine these into five prioritized problems. Then, in October, the team coordinated with the PHO to selected three focus districts: Sidoarjo, Malang, and Jember. They selected these using PHO and district data and the MDN database and considering the commitment from district governments and whether complimentary donor programs worked there. Figure 6: Timeline of East Java Regional Approach

In November, the team conducted assessments in the focus districts that included key informant interviews and focus group districts (FGD) with DHO, IBI, Bappeda, hospitals, CSOs, and other stakeholders. These assessments led to a better understanding of the local context and facilitated a root cause analysis. Cocreation began with workshops in December that led to the designs for most solutions. In 2019, the regional team followed up with specific partners in January to disseminate the outcomes of the December workshop and postponed two interventions for higher priority initiatives. In February, the team began preparing MOUs with partners in Jember and Malang Districts (map below). It began work on the Optimizing SiCantik local solution in March, and in April, it confirmed the roles and responsibilities of partners for other priority initiatives. The East Java regional team applied a significant amount of time and effort into building a relationship with the PHO. Unlike PHOs elsewhere, the PHO in East Java refused to work with Jalin at first because it lacked a MOH endorsement letter. In addition, EMNC survey of maternal and newborn deaths in Jember District upset the PHO, which felt the survey meant that USAID did not trust their data. Because Jalin approached the PHO with EMNC at the start, they were slow to participate in other activities. Furthermore, the regional team has been unable to integrate EMNC in their local solutions because they developed them before the EMNC concluded and because some activities are not in Jember.


Figure 7: Map of East Java Activities

North Sumatera The North Sumatera RM joined Jalin in May 2018 and onboarded the team by September 2018. Lacking direction from Jalin HQ, the regional manager commenced by approaching the PHO, Sekda, and Bappeda in June to introduce the program, discuss problems with MNH in the province, and identify focus districts (timeline below). The HQ Technical team assisted the RM to assemble evidence on MN mortality, including Jalin one-pagers, PHO (monthly health profile), and DHO (routine data). In addition, the Partnerships team distributed a list of large private sector companies in the province and recommended contacting them. However, the RM declined, intending to first develop potential solutions and then contact potential partners. In July, the regional team assembled a “think tank” of 12 stakeholders, including the PHO, DHO Langkat and Deli Serdang, Puskesmas Langkat and Deli Serdang, POGI, HOGSI, and others to discuss available evidence and define problems. Through root cause analysis and problem trees, stakeholders agreed to work on referral systems and support private midwives. Figure 8: Timeline of North Sumatera Regional Approach

In August, the team refined problems identified by the “think tank” by conducting a prioritization workshop with a broad selection of multi-stakeholders, including private sector companies such as


Grab, Gojek, PT. Telkom, Ombudsman Agency, Pharmaceutical Companies Association, Provincial Transportation, etc. This workshop identified suboptimal implementation of birth preparedness and complication readiness, poor quality of service provided by private midwives, and lack of public MNH awareness as specific as priority issues for Jalin. It also began generating designs for the team’s three priority local solutions: P4K Inovasi, Access to Finance, and MNH Campaign (map below). Between September 2018 and Jun 2019, the regional team engaged with the necessary stakeholders to implement its local solutions, refined these solutions based on their stakeholders’ commitment levels, and constructed these partnerships. It conducted a workshop for the VCA in September and FGDs to gauge financing needs for midwives in Deli Serdang in October and to understand MNH issues in Langkat in October and November. The RM engaged only those stakeholders likely to contribute to the three priority solutions. This approach is like the focused approach of Banten as opposed to the broad multi-stakeholder engagement of Central Java. In 2019, the regional team prepared to implement P4K Inovasi, which began in July, coordinated with Banks and IBI to further develop Access to Finance, and held workshops to start the MNH Awareness Campaign. Furthermore, the regional team brainstormed five alternative interventions to pursue after completing its first three. These included evidence generation in Nias, an IT system, district MNH fund, a JKN saving product, and online transportation for pregnant women. Figure 9: Map of North Sumatera Activities

South Sulawesi The South Sulawesi RM commenced activities between April and July 2018 meeting with the PHO, Bappeda, Sekda, PKK, and members of the Faculty of Medical and Public Health of Universitas Hasanuddin and Universitas Islam Negeri Alauddinn and the media (timeline below). These meetings introduced Jalin and its approach and understand priorities from stakeholders.


In August, the regional team conducted a multi-stakeholder event with 54 participants, including the PHO and Bappeda, to again introduce Jalin, present Jalin’s one-page fact sheets of evidence, and gather evidence from the audience. The August workshop began to broadly define South Sulawesi’s recalcitrant MNH issues and solutions to address them. In September, the team disseminated the event’s outcomes and collected feedback in one-on-one meetings., including with private sector actors such as Tribun News, Yayasan Kalla, Bosowa, PT. Semen Tonasa, PT STI, PT Telkom, Yayasan Bhakti, and Bank Sulselbar, Also in August, it held a VCA workshop but did not use the outcomes. In October, the regional team conducted a broad, multi-stakeholder cocreation event with province-level participants and those from six districts: Bone, Pangkep, Bulukumba, Jeneponto, Sinjai, and Gowa. The event broadly defined South Sulawesi’s MNH problems as early child marriage, low ANC awareness, transportation issues, inadequate IT referral system, poor collaboration between health sector actors, and the discontinuation of SijariEMAS. Participants defined specific problems by district and then brainstormed potential solutions to address them. The team asked stakeholders to consider scalability and plausible impact when prioritizing solutions. Figure 10: Timeline of South Sulawesi Regional Approach

In November, Jalin HQ issued guidance to reduce the number of districts from six to three based on their proximity to Makassar and their commitment to Jalin. The team also reached out the professional organizations and communities (POGI, IDAI, IDAI, ARSSI, PMI, PPNI, Muhammadiyah, Ikatan Mesjid, etc) to introduce Jalin, strengthen relationship, and to identify the potential for collaboration. During the workplan presentation in December, HQ had the region further reduce this to two focus districts. However, the regional team does not recall being affected by other changes in HQ direction, such as the shift from an opportunistic to problem driven approach. In December, Jalin strengthened the procedures and working relationship between doctors, hospital managers, and members of POGI, IDI, and IDAI in Sinjai district (map below). The October event found that poor coordination between OBGYNs and other doctors in providing care for patients had contributed to maternal and neonatal deaths at the hospital. The regional team’s role involved facilitating a meeting between members of POGI, IDI, and IDAI to discuss doctor’s relationships and attitudes, revoking licenses, accrediting clinics, and establishing a public safety center to support referrals at the subdistrict level. However, this activity was not reported to HQ or USAID. In April 2019, the RM resigned, and a new RM joined in May 2019. In May 2019, the HQ Partnerships Team worked with the regional team to conduct a workshop with private sector actors, the DHO and local government from Bone, Bulukumba, and Pangkep. This spurred interest from the provincial CSR Form to work with Jalin.


Figure 11: Map of South Sulawesi Activities

West Java The West Java RM joined Jalin in April 2018, and in June, he commenced introductory meetings with stakeholders, including the PHO, Bappeda, and Sekda (timeline below). The PHO informed Jalin that they were replicating USAID EMAS with their own budget and asked Jalin to focus on private sector engagement in the districts with the highest maternal and newborn mortality, especially the five largest companies in West Java. Bappeda recommended working with the CSR Forum and provided Jalin with a list of 175 companies to contact. In July, the PHO, Bappeda, and Sekda specified for the regional team to focus on private sector engagement in the Garut, Sukabumi, and Karawang districts. These initial meetings defined three challenges for MNH in West Java: providing MNH services to remote populations where traditional birth attendants (TBA) are prominent in Sukabumi, reaching large numbers of female workers who are of reproductive age in Garut, and improving cross-border referrals. In October, the West Java team conducted assessments in Garut and Sukabumi to learn more about their local contexts. The RM explained that the delay between the initial problem definition in June and assessment in October arose because of the need to recruit a team and open an office. In addition, the team facilitated the VCA workshop in September. This generated a potential activity to improve blood supply. However, Jalin postponed this activity in January 2019 when HQ informed them that MOH was no longer interested in blood supply assistance.


Figure 12: Timeline of West Java Regional Approach

In March and April 2019, the team held FGDs and workshops in Garut and Sukabumi to further refine activities there. It also began drafting MOUs for MNH in the Workplace and Improving MNH access and TBA partnerships. For Cross Border Referrals, the regional team define problems with stakeholders in June and solution cocreation in August, which is continuing now. To date, only MNH in the Workplace anticipated beginning activities in Quarter 3 2019. Like Banten, the West Java regional team followed Jalin’s opportunistic approach engaging stakeholders and undertaking problem definition and solution development simultaneously. The RM said that the switch from an opportunistic to problem-driven approach did not hinder the team. However, he reported that the pause and reset in January 2019 and instructions to prioritize one local solution in April did. Figure 13: Map of West Java Activities

Lessons Learned The DE gained the following lessons learned by considering Jalin’s regional approaches:

• Regional teams and their HQ Partnerships and Technical team liaisons did not fully report activities to Jalin’s leadership. In turn, Jalin did not comprehensively


report regional activities to USAID. Regional teams and HQ Communications, Partnerships, MELA, and Technical teams did not share knowledge of activities to Jalin’s senior leadership team. This produced inaccurate reports to USAID. A dearth of information in English exacerbated this issue. Jalin improved regional reporting by creating a Regional Implementation Director position and starting detailed weekly reports in February 2018.

• Regional teams lacked guidance from Jalin HQ on cocreation, coordination, and implementation. All regional teams reported not receiving guidance from HQ on how to conduct cocreation and coordinate assistance from the HQ Communications, Partnerships, MELA, and Technical teams. Several regional teams recalled not knowing whether Jalin could fund trainings, hire STTA, and utilize catalytic financing. This lack of guidance slowed implementation as each regional team tried their own approach, developed their own relationships with HQ teams, and learned over time what activities HQ would allow.

• Other common causes for delays included changes in HQ leadership and

approach, strategic pause and resets, and confusion about MOUs and STTA. Each affected the regional teams differently, but all teams were delayed by these to some extent. The arrival of new and acting COPs corresponded with changes in approach or resets that distracted regional teams and slowed their activities. Delays in HQ approval for STTA and confusion over how to draft MOUs and the approval process also hindered local solutions.

• Regional teams received varying levels of assistance from the HQ

Communications, Partnerships, MELA, and Technical teams. For example, members of the Technical Team traveled frequently to North Sumatera and South Sulawesi and less frequently to other regions. Notably, members of the Partnerships Team guided partnerships in Banten and West Java. Because specific personnel assisted certain regions, activities there often reflected their skill sets. For instance, their Technical Team liaison to South Sulawesi is a JKN expert, which led to most local solutions containing a JKN component.

VI. Local Solutions Jalin generated 71 local solutions in six regions. It is implementing 17 of these and designing another 17. Jalin has discarded or postponed 37 ideas for solutions (table in Executive Summary). The East Java regional team preferred to use the term “postponed” to suggest they will resume designing and implementing such ideas in the future, while the other five regional teams used the term “discarded.” The section below and Annex 1 describe 64 solutions rather than 71, because they combine similar solutions in different districts within a region. For example, the Central Java regional team implements MNH in the Workplace (PASTI) in Boyolali and Semarang and discarded it in Brebes. The DE’s topline finding and the table below count this as three solutions to delineate their different outcomes. However, the section below and Annex 1 have one entry for MNH in the Workplace (PASTI). The following section describes the local solutions according to their topic (table below). However, many interventions address multiple issues. For example, P4K Inovasi in North Sumatera has ANC coverage, awareness raising, finance, media, and individual and community tracking components. The DE describes it as ANC coverage, because the North Sumatera team has focused most of its effort on this component. The DE found the following themes in among Jalin’s interventions:

• Ten activities intend to increase ANC coverage. Jalin has focused its efforts on implementing these activities, such as Gerai KIA, MNH in the Workplace (PASTI and GP2SP), and P4K Inovasi, despite their unclear impact on MN mortality.


• Four of Jalin’s six regional teams developed media campaigns to raise awareness of MNH. Most regions discontinued these when Jalin HQ centralized communications work in 2019.

• Similarly, four of six regional teams prepared initiatives to increase blood supply. Most regions discarded these when Jalin HQ indicated MOH did not favor these in January 2019.

• The North Sumatera, South Sulawesi, and West Java teams developed interventions to assist village heads to use village funding for MNH programs.

• Furthermore, the North Sumatera, South Sulawesi, and West Java regional teams designed ICT solutions to track the health of pregnant women in communities.

• The Banten, Central Java, and North Sumatera regions have activities to support private midwives through increased access to finance, medicine, and equipment.

• The Banten, South Sulawesi, and West Java teams began interventions to improve transportation in remote areas through feeder ambulances and floating ambulances.

• The Central Java and West Java regional teams both designed solutions to screen for pre-eclampsia and eclampsia.

Local Solutions by Topics Banten Central

Java East Java

North Sumatera

South Sulawesi

West Java

Total

Clinical Competency & Compliance

2 3

4 2 11

ANC Coverage 2 3

1 3 1 10 Finance 1 2

3 2 1 9

Awareness Raising

1 1 1 4

7 Blood Supply 1 3

1 1 6

Transportation 1

1 1 3 6 Individual & Community Tracking

1 1 3 5

Referral Systems

2 2

1 5 Evidence Gathering

1

1 2

Family Planning

1 1 2 Maternity Waiting Homes

1

1

2

Other 2

3 1 6 Total 7 14 6 8 21 15 71

Further below is a section on lessons learned from these local solutions. Clinical Competency & Compliance Title: MNH in the Community / Mentoring Status: Implementation Region & Focus Area: Brebes, Central Java Description: The objective of this activity is unclear. The regional team reported intending to assist the provincial hospital to mentor two hospitals in Central Brebes (RS Dera As Syifa) and South Brebes (RS Bumiayu). However, this activity also involves community engagement. Initiator: Jalin Central Java Regional Team in October 2018 Partners & Stakeholders: Brebes DHO, Brebes District Village and Community Empowerment Office, FMM KIA, Dera As-Syifa Hospitals: a hospital located in Banjarharjo (serves as referral from Puskesmas), POGI Semarang, and PT. Charoen Phokpan Tbk (supports improvements on MNH in the sub-district). Background: Stakeholders developed a local solution for MNH in the Community / Mentoring at an engagement meeting in Brebes in October 2018. The idea and its genesis are unclear to the DE, but the regional team says it identified existing cooperation between PT. Charoen Phokpan and FMM KIA Brebes.


Charoen Phokpan distributes eggs via FMM KIA to improve community nutrition. The same meeting uncovered a lack of clinical and public accountability in referral hospitals. MNH in the Community / Mentoring will improve quality of care, the referral system, and strengthening the implementation of P4K. The regional team received a request from the DHO to support facilities that did not meet PONEK standards. Jalin expects to assist the provincial hospital to mentor two hospitals in Central Brebes (RS Dera As Syifa) and South Brebes (RS Bumiayu). With Jalin’s new technical direction after its modification in August 2019, the regional team has likely decided to focus on mentoring rather than the community outreach aspect of this solution. Title: Quality Improvements for Integrated ANC and PNC in Jember and Malang districts Status: Implementation Region & Focus Area: Jember and Malang, East Java Description: This idea aims to improve health worker compliance with ANC and PNC SOPs. Initiator: Jalin East Java Regional Team in Malang in May 2019 and in Jember in December 2018 Partners & Stakeholders: Malang: DHO, Bappeda, DP3AKB of Malang District, Jalin East Java Regional Team, in May-2019 Jember: IBI, Fatayat, and Jalin East Java Regional Team in Dec-2018 Background: This intervention focuses on improving health worker compliance with SOPs for integrated ANC and PNC. It involves a partnership between DHO, RSUD Soebandi, IBI and CSOs to reduce maternal and newborn mortality by improving ANC and PNC provisions. Together they intend to develop indicators for ANC, strengthen clinical accountability through audits, and develop a public education campaign for communities in MNH. While ANC and PNC SOPs in have been developed in Jember District, they have not been completed nor have they been standardized/integrated into one single SOP. IBI, Fatayat, and the East Java regional team proposed this local solution during the December workshop. The team required additional time to plan this intervention because the government is restructuring the DHO. For several months, Jalin lacked a counterpart. Another barrier is that the DHO has a different organization structure than other DHOs. For example, the Maternal Section in Jember is under the Health Service Division. In other regions, it is under the Family Health Division. Title: Pre-Eclampsia / Eclampsia Eradication Status: Implementation Region & Focus Area: Boyolali, Central Java Description: The solution aims to decrease incidences of pre-eclampsia in pregnancy through early detection, as well as introduce comprehensive and effective treatments of pre-eclampsia/eclampsia to reduce overall maternal mortality. Initiator: POGI Surakarta in October 2018 Partners & Stakeholders: Boyolali DHO, PT. Pan Brothers Tbk (factory for solution), BPJS (referrals for emergency cases), PMI Boyolali, Puskesmas Mojosongo: IBI Boyolali, POGI Surakarta, Medical Faculty of Sebelas Maret University (technical support from doctors and students), DPPKB of Boyolali (socialization of MNH knowledge and awareness), District Religious Office of Boyolali, IDI Boyolali, and Puskesmas in Karanggede, Gladagsari and Ngemplak (location for this solution). Background: The regional team developed the Pre/Eclampsia Eradication solution in October 2018 following POGI’s 2018 Maternal Perinatal Audit in Boyolali. The solution responds to evidence that pre-eclampsia caused eight of 15 deaths in Boyolali. The solution aims to:

• Improve pre-pregnancy service provision to increase reproductive-age couples’ knowledge of reproductive health and high-risk factors for pregnancy.


• Strengthen early detection and treatment of pre/eclampsia among pregnant women. Jalin will train health workers to detect pre/eclampsia and perform ultrasonography, MgSO4 administration, low dose aspirin, anti-hypertension care, and post-natal care for mothers with a history of high blood pressure.

• Improve pregnant mother classes for those with risk factors related to pre/eclampsia. The pregnant mother class component intends to increase mothers and families’ knowledge of home treatment, such as dietary plans and physical activities, and how to recognize danger signs and seek care.

• Increase the quality of post-natal care (PNC) for mothers with a history of high blood pressure. Jalin will improve midwives’ skills to deliver quality PNC.

The Boyolali DHO envisions starting the pre/eclampsia eradication local solution as a campaign but is concerned about funding and sustainability. POGI Surakarta remains interested in the idea, and Jalin is finalizing a MOU and mini-MELA for the intervention. Title: Zoom Preeklamsi Status: In design since July 2019 Region & Focus Area: West Java Description: This intervention is similar to activities implemented by the Central Java regional team and involves promoting initial screening, risk identification, and referral treatment for preeclampsia and eclampsia. Initiator: POGI of West Java in July 2019 Partners & Stakeholders: POGI of West Java, PHO of West Java, DHO, Puskesmas, and IBI. Background: POGI initiated the idea in February 2019 during a meeting with the PHO and regional team about MNH in the Workplace in Garut. The team followed up with POGI in July 2019 about the equipment, such as obstetric ultrasonography, and the skills necessary for health workers to use them. According to POGI, this solution has been implemented in Karawang District and is associated with a reduction in maternal deaths. Title: Improving Health Worker Compliance with ANC and PNC SOPs Status: Postponed in January 2019 Region & Focus Area: Sidoarjo, East Java Description: This idea would have improved health worker compliance with ANC and PNC SOPs. Initiator: Sidoarjo DHO and Jalin East Java Regional Team in December 2018 Partners & Stakeholders: Sidoarjo DHO, IBI, POGI, Sidoarjo RSUD, Siti Khodijah Hospital and Anwar Medika Hospital, District Communication and Information Office, District Population and Civil

Solution development workshop in Central Java.


Registration Office, Muhammadiyah University, Fatayat NU and Aisyiyah, Bappeda, and District Social Office. Background: Stakeholders in Sidoarjo brainstormed this idea to improve health worker compliance with ANC and PNC SOPs during the December cocreation workshop. The regional team’s assessment identified low quality ANC and high-risk pregnancy screening as key MNH problems. Health workers demonstrated low capacity to analyze and follow up with women facing high-risk pregnancies. However, the regional team and Sidoarjo stakeholders agreed to postpone this intervention to prioritize Optimizing SiCantik in 2019. Title: Monitoring, Detection, and Readiness for high-risk pregnancies Status: Discarded in November 2018 Region & Focus Area: Gowa, South Sulawesi Description: This idea was for midwives or health workers to improve their monitoring and checkups for high-risk pregnancies. It also had a component to set minimum standards at hospitals and formulate a SOP to improve the health worker standards. Initiator: Gowa DHO in October 2018 Partners & Stakeholders: Ketua TP PKK, Bappeda, DHO, RSUD, PHO, Bank of South and West Sulawesi, PT. Mayora, PKK, LKBN Antara (media), and Berita Kota (media). Background: The regional team discarded this solution because of HQ guidance to reduce the number of focus districts and a lack of commitment from Gowa local government. Title: "Ibu-Ibu Syantik" MNH Education Forum Status: Discarded in November 2018 during work planning Region & Focus Area: Jeneponto, South Sulawesi Description: Bosowa Foundation initiated this idea to improve early detection of high-risk pregnancies in Jeneponto at the October workshop. Initiator: Bosowa Foundation, Bosowa DHO, and RSUD in October 2018 Partners & Stakeholders: Family Welfare Program (Ketua TP PKK), Bappeda, DHO RSUD, Women Empowerment Section of Provincial Government, other district government, PKK, Bosowa Foundation, and Kompas Newspaper. Background: The Regional Hospital and head of DHO supported the idea. It is a replication of Bowosa Foundation’s Ibu-Ibu Syantik program in Makassar. Bosowa has implemented MNH programs in Jeneponto before where PT. Bosowa does business. The regional team discarded it because of HQ guidance to reduce the number of focus districts. Title: Puskesmas Internal Audit based on the MOH Regulation No. 44/2016 Status: Discarded in November 2018 during work planning Region & Focus Area: Jeneponto, South Sulawesi Description: This idea intended to look at facility standardization and integrated ANC for pregnant women. Initiator: Jeneponto DHO and RSUD in October 2018 Partners & Stakeholders: Family Welfare Program (Ketua TP PKK), Bappeda, DHO RSUD, Women Empowerment Section of Provincial Government, other district government, PKK, Bosowa Foundation, and Kompas Newspaper. Background:


The Jeneponto DHO and Director of Jeneponto RSUD presented this potential solution at the October workshop. The regional team discarded it because of HQ guidance to reduce the number of focus districts and abandon work in Jeneponto because it was too far from Makassar. Title: Capacity improvement for Health Workers Status: Discarded in November 2018 during work planning Region & Focus Area: Jeneponto, South Sulawesi Description: see title. Initiator: Jeneponto DHO and RSUD in October 2018 Partners & Stakeholders: Family Welfare Program (Ketua TP PKK), Bappeda, DHO RSUD, Women Empowerment Section of Provincial Government, other district government, PKK, Bosowa Foundation, and Kompas Newspaper. Background: The Jeneponto DHO and Director of Jeneponto Regional Public Hospital initiated this idea during the October workshop. An inadequate system of recording and reporting by health workers at the health facility had complicated caring for pregnant women. The team discarded this local solution because of HQ guidance to reduce the number of focus districts and abandon work in Jeneponto. Title: Replicating and Strengthening Pregnant Women Screening Status: Discarded in January 2019 Region & Focus Area: Karawang, West Java Description: This solution intends to improve Puskesmas quality of care by involving OBGYNs in screening for high-risk pregnancy cases. Initiator: Karawang DHO in September 2018 Partners & Stakeholders: Karawang DHO, POGI Karawang, Puskesmas, Private Hospital, Regional Public Hospital Background: This is an existing intervention in the Karawang District where OBGYNs from private hospitals conduct screenings at Puskesmas. According to the Karawang DHO, this activity decreased the number of maternal deaths from two in 2016 to none in 2018. The regional government funds the activity through APBD, and the DHO and PHO raised the idea of Jalin strengthening and replicating this in September 2018. However, Jalin discarded it because Karawang is not a prioritized district. ANC Coverage Title: MNH Outlet (Gerai KIA) Status: Implementation Region & Focus Area: Tangerang, Banten Description: Gerai KIA intends to increase awareness of ANC. Midwives and MNH motivators (MKIA) hold Gerai KIA at Alfamart convenience stores, where they provide free counselling to women of reproductive age and information on how to use the government’s MNH Book (Buku KIA) to track pregnancy, schedule ANC, and understand symptoms of high-risk pregnancies. Initiator: Jalin Banten Regional Team and Jalin HQ in August 2018 Partners & Stakeholders: PT. Sumber Alfaria (provides Alfamart store locations for Gerai KIA), PHO, Tangerang local government, and FOPKIA, cadres. Background: After opting to work in Tangerang in coordination with the PHO and DHO, the regional team held eight meetings in June and July 2018 with the DHO, Bappeda, local parliament (Dewan Perwakilan


Rakyat Daerah/DPRD), Vice-Governor, PKK, women movement under the local government, and religious leaders. These discussions raised the following issues:

• An estimated 30% of pregnant women attend integrated health service post (Pos Pelayanan Terpadu/Posyandu), indicating many receive little information about ANC and pregnancy. This number was cited by the PHO.

• Many women and men work in factories and have limited time to take classes or visit Puskesmas, and few pregnant women complete their Buku KIA in Banten.

• Tangerang has the highest maternal and newborn deaths in Banten, and Banten is in the top five provinces for mortality nationally.

In response, the regional team developed the design for Gerai KIA. HQ questioned the sustainability of Gerai KIA and withheld its approval to proceed until October. In the meantime, the team reached out to Alfamart. It chose Alfamart because it has 1,400 outlets in Tangerang and because an HQ staff has a personal connection with the company. The RM included the Tangerang Bupati, DHO, and FOPKIA in these meetings. Alfamart initially wanted to participate under its CSR programs. In addition, the regional team had to coordinate with its national corporate offices because its Tangerang office did not have the authority to discuss the solution. In October, Alfamart agreed to participate, and HQ endorsed Gerai KIA. In November, the regional team identified the respective Puskesmas and participating Alfamart store locations, and discussions began on the MOU in December, which all parties signed in February 2019 before Gerai KIA launched in March. Title: PASTI (MNH in the Workplace) Status: Implementation in Boyolali and Semarang, and discarded in Brebes in October 2019 Region & Focus Area: Boyolali, Brebes, and Semarang, Central Java Description: MNH in the Workplace intends to improve the quality of maternal health services for female workers, especially those who are pregnant. Services include mother’s classes, early detection for noninfectious diseases, nutrition consultation, and support for breastfeeding mothers. Initiator: Jalin Central Java Regional Team in October 2018 in Boyolali, November 2018 in Brebes, and December 2018 in Semarang Partners & Stakeholders: Boyolali: Boyolali DHO, PT. Pan Brothers Tbk (factory for solution), BPJS (referrals for emergency cases), PMI Boyolali, Puskesmas Mojosongo: IBI Boyolali, and Medical Faculty of Sebelas Maret University (technical support from doctors and students). Brebes: Brebes DHO, APINDO Semarang: Semarang City DHO, PMI Semarang, PT. Sandang Asia Maju Abadi (factory for solution), Puskesmas Karanganyar, IBI Semarang, Tugurejo Regional Hospital (provide mentoring to improve factor clinic), and Semarang City Population Control and Family Planning Office.

A pregnant woman meets with a midwife at Gerai KIA (DE).


Background: Following the presentation of POGI’s 2018 Maternal Perinatal Audit in Boyolali in October, the Central Java team developed MNH in the Workplace in coordination with HQ. The region and HQ believed two maternal deaths at factories in 2017 resulted from limited access to ANC and poor care at factory clinics. In Boyolali, the similarities between MNH in the Workplace and the GOI’s GP2SP initially confused the DHO. GP2SP is currently in Solo but not Boyolali. GP2SP involves a competition between factories for female workers’ well-being, where the government provides an award to the winner. Jalin preferred to develop MNH in the Workplace separately, feeling it provides more comprehensive ANC. The regional team partnered with Pan Brothers, Boyolali’s largest employer with around 1,200 pregnant workers per year. In December, Jalin opted not to include the Provincial Manpower Office and labor union as partners, because neither identified a meaningful role. Female workers expressed concern that participating in MNH in the Workplace activities will keep them from meeting production targets and earning additional income. In November, the regional team considered introducing MNH in the Workplace to Brebes. They met with the DHO but could not identify large factories for partners and discarded the idea. In December, the team presented MNH in the Workplace at an APINDO meeting, where participants recommended expanding from Boyolali to Semarang. PT. Sandang Asia Maju Abadi (PT SAMA) attended the meeting and expressed interest in partnering. PT SAMA has 2,000 female workers, and an assessment showed their clinic is below standards, with only one general practitioner, nurse, and midwife. The Semarang DHO proved an enthusiastic partner, using the solution as an opportunity for its Gasurkes to reach pregnant factory workers. Title: P4K Inovasi Status: Implementation Region & Focus Area: Langkat, North Sumatera Description: 4K Inovasi seeks to strengthen P4K, a MOH program launched in 2007 to improve MNH by increasing community involvement in ANC. In P4K, midwives arrange maternity savings, blood donations, transportation, husband involvement, breastfeeding, and postpartum and home visits, and MNH motivators (cadres) facilitate village meetings, apply marking stickers, and collect data on pregnancies. In 2018, Jalin identified problems with P4K and designed P4K Inovasi to strengthen financial support, community outreach, monitoring, mentoring, and awareness raising. Initiator: Jalin North Sumatera “Think Tank” in July 2018 Partners & Stakeholders: Langkat DHO, DPMD of Langkat (village fund management and allocation), District Social Office (managing the Family Hope Program), FMM KIA of Langkat District (monitoring the services from MNH cadres), Hinai and Tanjung Pura Head of Sub-District, Puskesmas Tanjung Beringin, Puskesmas Pantai Cermin and Puskesmas Pematang cengal, Village Governments (Head of Villages and Village Assembly Body) from 30 pilot villages, Village Midwives from 30 pilot villages (health care provider to mother and newborn in the village level), MNH Motivator Cadres of

An assessment of PT. SAMA’s factory clinic (Jalin).


Tanjung Beringin Sub-Districts, and Faculty of Medicine, Public Health Faculty, Nursing Faculty, and Faculty of Psychology of North Sumatera University Background: Jalin commenced developing P4K Inovasi in July 2018. HOGSI, BPJHC, PHO and DHO initiated the idea. FMM, Public Health Faculty of North Sumatera University, and IDAI later bought into it. HQ was initially unsure about supporting P4K Inovasi. Ibu Fatni, the Former Director of MNH in MOH and Former Head of North Sumatera PHO when it launched P4K, promoted P4K Inovasi. Ms. Fatni is now a STTA with Jalin. The HQ Technical Team and Regional Implementation Director supported the intervention, although some HQ personnel considered it a government program and recommended designing something new. The regional team selected Tanjung Pura and Hinai subdistricts for P4K Inovasi in discussion with the DHO. The DHO found these subdistricts had high MMR and NMR and were close to Medan. The team approached subdistrict heads to ensure P4K Inovasi could be sustained using village funding. It coordinated regularly with the Langkat District Village and Community Empowerment Office, and Social Office. The DHO proposed an ICT data synchronization with the Social Office for data on Hope Family Program (PKH). Through Jalin’s facilitation both agreed to share data and develop a system. In November, the team held FGDs with midwives and cadres to ascertain their training and resource needs. An FGD with village heads and the village community assembly council provided ideas for accessing village funding based on the area, number of cadres in the village, and an estimated amount of budget needed. In February 2019, Jalin conducted a planning workshop for P4K Inovasi with 113 participants to reconfirm stakeholder commitment and generate information to formulate the mini-MELA. In March 2019, with assistance from Jalin, the DHO formulated its strategic plan for the next five years, which promoted MNH and P4K Inovasi. Title: Bola Asseddingeng Status: Implementation Region & Focus Area: Bone, South Sulawesi Description: Bola Assedingeng constitutes clases for pregnant women to promote ANC visits and MNH information. Initiator: Bone DHO, Bappeda, and Puskesmas in October 2018 Partners & Stakeholders: PHO, Bone DHO, Bappeda, Bone RSUD, Provincial and Bone District PKK (through its Dasawisma cadres), CSR Forum, Media, Kalla Foundation (historical and cultural ties to Bone), and University. Background: The Bone DHO implements Bola Assedingeng based on the “Three Delay” framework: (1) deciding to seek appropriate medical help for an obstetric emergency; (2) reaching an appropriate obstetric facility; and (3) receiving care when a facility is reached. The program intends to:

1. Improve “Mothers’ Class,” a national MOH program, to scale in other areas.

A problem definition workshop conducted by the North Sumatera regional team (Jalin).


2. Build knowledge of pregnant women and families through village midwives at the local level using village fund with close coordination between village heads, PKK, cadres, midwives, and health facilities.

3. Strengthen the relationship between the DHO and private sector to commit to scale up Bole Asseddingeng elsewhere.

In an October 2018 workshop, the DHO created a proposal for Kalla Foundation for medical training for midwives. Kalla Foundation committed to support training throughout 2019. A MOU for Bola Assedingeng was signed by only DHO and Kalla Foundation, and the local solution also involves a media component. Title: GP2SP (MNH in the Workplace) Status: Implementation Region & Focus Area: Garut, West Java Description: MNH in the Workplace in Garut District comprises six components: 1) Pregnant mother class; 2) Post-partum family planning program; 3) Healthy Premarital Certification (Calon Pengantin Sehat/CATIN Sehat); 4) Anemia and chronic malnutrition detection; 5) Providing a cold box for breast milk; and 6) Mentoring for the factory clinic. This intervention intends to build these MNH components into the pre-existing GP2SP in which PT. Chang Shin and other factories participate. Initiator: Jalin West Java Regional Team, IBI, PT. Chang Shin, Garut DHO, and ASKLIN between January and March 2019 Partners & Stakeholders: PT. Chang Shin Reksajaya (factory owner), Labour unions of PT. Changsin Reksajaya (3 labor unions), IBI of West Java, Clinic in PT. Chang Shin (one clinic with 3 doctors and 3 midwives, DHO Garut (Puskesmas Leles), PHO, BPJS Garut, Manpower and Transmigration Office, APINDO of West Java, BKKBN, DPPKBPPPA, Jhpiego, POGI, Garut Religion Office, PT. Bio Farma, and ASKLIN. Background: The regional team developed the idea for a pregnant mother’s class in discussions with IBI and the PHO in January 2019. In March, the team conducted an FGD with PT Chang Shin and labor unions that found the follow problems at the factory: maternal deaths had occurred among factory workers, many women left the workforce after pregnancy or marriage, and women lacked access to ANC. The factory clinic’s staff is limited: three midwives, two general practitioners, and one nurse. The assessment found that the existing pregnant mother’s class at the factory cannot reach all pregnant workers. Four hundred women are pregnant each month at the factory, and the class occurs once a month for a maximum of 19 participants. In March, the regional team expanded its class idea to include the other five components listed above. The team met with IBI and POGI to initiate the family planning post-delivery for female workers in April. The Garut DHO initiated pre-marriage certificate (CATIN Sehat) to improve the population’s MNH and nutrition status. This activity will cover female factory workers and the wider population. The regional team assessed the factory clinic in May to advocate to PT Chang Shin to improve the clinic. Title: One Nurse, One Village Status: In design since December 2018 Region & Focus Area: Lebak, Banten Description: This initiative aims to staff one nurse in each village in Lebak District and Bojong Manik Sub District. Initiator: Jalin Banten Regional Team in December 2018 Partners & Stakeholders: PHO, DHO, and PPNI of Banten Province Background:


During an October 2018 visit to Lembak, the UI Dean of the Faculty of Nursing and PPNI in Banten, who is also Head of HR for the PHO, discussed this idea. PPNI developed a TOR, in coordination with a Jalin STTA, on the role and function of nurses in villages. Since a presentation to the PHO in November 2018, this has been under design with little progress. Title: Pro-active home visits to pregnant women reluctant to receive ANC at a health facility Status: Discarded December 2018 Region & Focus Area: Bulukumba, South Sulawesi Description: See title Initiator: Bulukumba DHO and PKK in October 2018 Partners & Stakeholders: South Sulawesi PHO, Bulukumba DHO, Bappeda, RSUD, Provincial and Bulukumba District PKK, CSR Forum, Media, University, Provincial and Bulukumba District PMI. Background: This potential local solution originated in a October 2018 workshop. However, the regional team discarded it to focus on the Blood Donation Emergency Response solution in Bulukumba. Title: Advocating for Village Regulations for MNH Status: Discarded (Pending) since April 2019 Region & Focus Area: Bone, South Sulawesi Description: See title. Initiator: Bone DHO, Bappeda, and Puskesmas in October 2018 Partners & Stakeholders: South Sulawesi PHO, Bone DHO, Bappeda, Bone RSUD, Provincial and Bone District PKK (through its Dasawisma cadres), CSR Forum, Media, Kalla Foundation (historical and cultural ties to Bone), and University. Background: At an October 2018 workshop, stakeholders from Sinjai District, including the DHO, identified the need to advocate for village regulations for MNH. These regulations would ensure at least four ANC visits during pregnancy, obligate pregnant women to deliver in a health facility, support arranging birth certificates from Puskesmas, and require checkups for blood type and that maternal and newborn deaths be report from the village to the Puskesmas. The Sinjai DHO said he would complete this local solution without Jalin’s assistance but requested help engaging IDI, IDAI, POGI, hospitals, and doctors in the area (see Other Section below).

Finance Title: Access to Finance for Private Midwives and Clinics Status: Implementation Region & Focus Area: Deli Serdang, North Sumatera Description: This intervention intends to increase access to finance for private PBM (Single Practitioner Midwives) to enable them to adhere to standardize medical equipment and medicine for providing servicing and access training. This will improve the quality of pregnancy, childbirth, and postpartum health services provided to mothers by private midwives to reduce the risk of mothers and/or newborns deaths. A financing options is also being developed for clinics. Initiator: Jalin North Sumatera Regional Team in August 2018 Partners & Stakeholders: Bank of North Sumatera (manages saving and loan for 24,000 women in North Sumatera), IBI of North Sumatera, ASKLIN (provides support for clinics in preparing high quality of care). Background:


Discussions with multi-stakeholders in August 2018 generated the idea. The regional team and stakeholders reviewed evidence that showed most pregnant women delivered in private midwife clinics, and a high number of maternal deaths happened in these facilities. An assessment by the team found poor facilities at midwives’ clinics and low skill levels among private midwives. There are 1,500 private midwives in Deli Serdang. IBI regularly conducts training for midwives but many midwives cannot join because they lack the necessary funds. The regional team approached Bank North Sumatera in October and November 2018 to describe the financial situation of midwives and demonstrate the potential market. The Bank already has products for female savers and small and medium enterprises. However, it lacks experience in health financing and credit analysts with this background. The team verbally committed to help the Bank increase its capacity for health-related financing. The team also met with ASKLIN of North Sumatera in October to explore building a network with clinics that cooperates more closely with BPJS. It followed up with Provincial IBI and Bank North Sumatera in March 2019. Recently, Jalin conducted discussions with PT. PNM as a potential partner and hired a STTA candidate to develop, design and advocate a new finance scheme for private midwives. MOUs between partners are pending. Title: Saving Product for JKN Status: In design since November 2018 Region & Focus Area: Deli Serdang, North Sumatera Description: The Saving Product for JKN intends to help low income groups pay JKN premiums in installments. Initiator: Jalin North Sumatera Regional Team in November 2018 Partners & Stakeholders: Financial institutions, BPJS Background: The regional team thought up this idea when they studied the conditions of workers in Deli Serdang in November 2018. Potential support existed from private sector companies’ CSR programs to support JKN through paying premiums for BPJS premium assistance recipient (Penerima Bantuan Iuran/PBI). For example, a private hospital in Deli Serdang covers more than 100 recipients of BPJS premium assistance. Title: District MNH Fund Status: In design since January 2019 Region & Focus Area: Deli Serdang, North Sumatera Description: This potential solution would create a forum to manage funding for MNH, such as subsidizing the JKN or BPJS premium, and would be established based on a Bupati Decree. Initiator: Jalin North Sumatera Regional Team in January 2019 Partners & Stakeholders: DHO, Trade and Industry Office (Dinas Perindustrian) of North Sumatera Province, Integrated Licensing Agency at provincial and district level (Badan Pelayanan Ijin terpadu Provinsi dan kabupaten), and APINDO of North Sumatera Province. Background: The idea arose in January 2019 and was discussed with Jalin HQ before being deprioritized. Title: Utilizing Village Funds Status: In design since February 2019 Region & Focus Area: Garut, West Java Description: This activity aims to enable village funding to incentivize TBAs to refer pregnant women for ANC and delivery to Puskesmas or village midwives.


Initiator: West Java Provincial and District DPMD in Feb-2019 Partners & Stakeholders: DPMD (government unit responsible for village funds), FMM KIA, DHO and Puskesmas. Background: In February 2019, the regional team considered advocating for the DPMD in Garut to enable village funding to incentivize TBAs to refer pregnant women for ANC and delivery to Puskesmas or village midwives. A Bupati Decree in Garut already exists to use village funding to support MNH, and another is under consideration to support the process of Supermen (a written statement to deliver in health facility) designed to decrease the use of TBAs. The team conducted a workshop on this topic in April 2019. Title: Financing for Bidan Delima Status: Discarded in Boyolali in September 2018 and in Semarang in October 2018 Region & Focus Area: Boyolali and Semarang, Central Java Description: The regional team brainstormed a solution to provide financing for Bidan Delima through soft loans to midwives in Boyolali and Semarang. Initiator: Jalin Central Java Regional Team in July 2018 Partners & Stakeholders: Boyolali: Boyolali DHO, IBI Boyolali (midwives will receive soft loan), and Central Java Bank (loan provider). Semarang: Semarang City DHO, IBI Semarang (midwives will receive soft loan), and Central Java Bank (loan provider). Background: In discussions with provincial IBI in July 2018, the regional team brainstormed a solution to provide financing for Bidan Delima through soft loans to midwives in Boyolali and Semarang. Jalin and IBI felt that a lack of financial resources prevented midwives from improving their skills. The team met with the Provincial Governor’s staff who recommended that they approach government-owned Central Java Bank as a potential partner. The team invited Central Java Bank to the VCA workshop and shared the idea to finance Bidan Delima but received a tepid response. In Boyolali, in September, the district IBI chairperson rejected the solution out of concern that midwives would not repay loans. In October, the team discarded the idea for Semarang too because of a lack of response from Central Java Bank. Title: Health Insurance for Pregnant Women Status: Discarded in December 2018 Region & Focus Area: Bulukumba, South Sulawesi Description: This attempts to convince a local hospital in Bulukumba accept letters from village heads for patients who could not pay due to economic status. Initiator: Bulukumba DHO and PKK in October 2018 Partners & Stakeholders: PHO, Bulukumba DHO, Bappeda, RSUD, Provincial and Bulukumba District PKK, CSR Forum, Media, University, Provincial and Bulukumba District PMI. Background: Stakeholders from Bulukumba intended for this to address that its hospital did not accept letters from village heads for patients who could not pay due to economic status. The hospital required pregnant women to have BPJS to get free health coverage or otherwise pay out of pocket. The regional team discarded it in December 2018, because they believed it would require extension collaboration with BPJS. Title: Village fund allocation for MNH


Status: Discarded (Pending) since April 2019 Region & Focus Area: Bone, South Sulawesi Description: This local solution intends to provide financial incentives for midwives and support their transportation to conduct ANC visits and monitoring pregnant women in remote areas. Initiator: Bone DHO, Bappeda, and Puskesmas in October 2018 Partners & Stakeholders: PHO, Bone DHO, Bappeda, Bone RSUD, Provincial and Bone District PKK (through its Dasawisma cadres), CSR Forum, Media, Kalla Foundation (historical and cultural ties to Bone), and University. Background: The regional team brainstormed this idea with Bappeda in Bone, where villages would implement one approach to funding allocation across the district. Many village heads do not know what kind of MNH activities can be implemented with village funds. The previous RM attempted to discard this activity in 2018 for unknown reasons; however, the current RM returned to the idea in April 2019. She consulted with the RM in Banten about adopting his approach to village funding in Lebak District for South Sulawesi. The regional team proposed a STTA for this activity to HQ in July 2019. Title: Integrated Microfinance Institution for MNH Status: Discarded June 2019 Region & Focus Area: Lebak, Banten Description: The Banten regional team’s idea for microfinance aimed to finance lodging and transportation for pregnant women who need to stay at health facilities. Initiator: Jalin HQ and Jalin Banten Regional team Partners & Stakeholders: Local Government of Lebak District, Opportunity International Australia (potential source of financing), Healing Fields (micro health insurance India), and KOMIDA (local MFI). Background: The team discussed this idea with MAB Co-Chair Meynar Sihombing, Opportunity International Australia, Healing Fields from India, and Indonesia Microfinance Institution (MFI) KOMIDA. These stakeholders believed that mothers required financial support beyond what JKN provides when referred to hospitals away from their homes. The Banten regional team and Jalin HQ discarded this after USAID did not approve a related SOW, according to the regional team.

Awareness Raising Title: MNH Campaign Status: Implementation Region & Focus Area: 15 districts in North Sumatera Description: The MNH Campaign aims to raise awareness on MNH issues, such as rights, services, JKN, and self-assessments. Initiator: Jalin North Sumatera Regional Team in November 2018 Partners & Stakeholders: North Sumatera Provincial Health Office, Provincial Communication and Information Office, Media Forum for MNH (forum established by Jalin and consisting of 12 media, influencer, and Public Relations Office of North Sumatera Government), religious Organization, such as Nahdlatul Ulama, Muhammadiyah, and PGI, KNPI, and PKK. Background: The MNH Campaign aims to raise awareness on MNH issues, such as rights, services, JKN, and self-assessments. Problem definition at meetings and workshops in July and August 2018 identified low awareness among the public of MNH issues as a contributor to high maternal and neonatal mortality in North Sumatera. According to the RM, low awareness of MNH issues means that people still believe


in pregnancy myths, taboo food, and cultural rituals. In November 2018, after meeting with members of the media, the regional team decided to improve this via a media campaign involving 15 districts with a high rate of maternal and neonatal deaths. In December, Jalin held a meeting with 12 media companies from North Sumatera, the Public Relations Office of the Provincial Government, and the chairperson of PWI (Indonesian Journalists Association). Using Mentimeter software recommended by the DE, the team found that 73% of meeting participants had low awareness of MNH issues. Later in the month, Jalin and these stakeholders established the Media Forum on MNH as a network of media and journalists to promote these issues. Jalin hired the Chairperson of the Forum as a STTA to design the campaign strategy and material. Recently, the regional team conducted five workshops to establish networks at the field for the MNH Campaign, improve understanding on local issues and context for the MNH Campaign Roadmap, and disseminate existing materials on MNH. These workshops included the PHO, DHO, Communication and Information Office, Religious Office, CSO, and youth organizations and resulted in multiparty agreement on critical MNH facts to promote. Furthermore, PNM’s Mekar (Family Economic Empowerment) activity has committed to supporting the MNH Campaign. Title: Improving public awareness of MNH via the Media Status: Postponed in January 2019 Region & Focus Area: Jember, East Java Description: This local solution engages Times Indonesia to educate the public on MNH and the importance of ANC, and to train midwives on writing media content. Initiator: IBI, Fatayat NU, and Jalin East Java Regional Team in December 2018 Partners & Stakeholders: Jember DHO, IBI, PENAKIB, Soebandi Hospital, Siloam Hospital, Bappeda, Fatayat NU, District Village and Community Empowerment Office, Mitra Tani, District Social Office, Klinik Jember Hospital and Srikandi Hospital, and Balung Regional Hospital and Kalisat Regional Hospital. Background: IBI, Fatayat, and the regional team proposed this idea for Jember during the December 2018 workshop. Stakeholders believe a root cause for maternal deaths is low public awareness on MNH. This problem is heightened by the lack of overall health education for the public, especially on reproductive health and nutrition. However, the team decided to postpone this solution until 2020 to focus on Quality Improvements for Integrated ANC and PNC in Jember. This local solution engages an online media company Times Indonesia to partner with Malang DHO. Times Indonesia will educate the public on MNH and the importance of ANC. Times Indonesia also provided a training for midwives on writing media content. It expects that through this training midwives will be able to promote MNH through blogs, websites, and social media. Radio Kanjuruhan will broadcast MNH information for free. Previously, the DHO had to pay. Title: Dasa Wisma Reactivation and Improvement Status: Discarded in October 2018 at workshop Region & Focus Area: Sinjai, South Sulawesi Description: This intervention intended to reactive Dasa Wisma where a group of mothers from 10 households participate in activities in coordination with PKK, such as building latrines, wells, and developing health funds for PMT, medical treatment, building waste and sewage facilities. Stakeholders aimed to add pregnant woman monitoring and MNH education components to Dasa Wisma. Initiator: Sinjai DHO in October 2018 Partners & Stakeholders: Ketua TP PKK, Bappeda, DHO, RSUD, DHO, PHO, Bank of South and West Sulawesi, CSR Forum, PKK, and Jakarta Post. Background:


The Sinjai DHO believed he had the ability to complete this local solution without Jalin’s assistance but requested help Engaging IDI, IDAI, POGI, hospitals, and doctors in the area (see below). Title: Establish MNH Forum & Optimize social media for MNH Status: Discarded in November 2018 Region & Focus Area: Gowa, South Sulawesi Description: This solution intended to establish an MNH Forum in Gowa District to optimize MNH exposure on social media, mainly WhatsApp groups, and to arrange for students to accompany PKK and health workers. Initiator: Gowa DHO in October 2018 Partners & Stakeholders: Ketua TP PKK), Bappeda, DHO, RSUD, PHO, Bank of South and West Sulawesi, PT. Mayora, PKK, LKBN Antara (media), and Berita Kota (media). Background: Gowa Districts has the highest number of maternal deaths in South Sulawesi. An MNH Forum and Optimizing Social Media is a solution identified at the October workshop. However, the regional team later discarded this solution because of HQ guidance to reduce the number of focus districts and a lack of commitment from Gowa local government. However, the PHO expressed continued interest in Jalin engaging Gowa in a meeting with USAID in August 2019. Title: Encourage local public figures to socialize MNH Status: Discarded in December 2018 Region & Focus Area: Bulukumba, South Sulawesi Description: See title. Initiator: Bulukumba DHO and PKK in October 2018 Partners & Stakeholders: PHO, Bulukumba DHO, Bappeda, RSUD, Provincial and Bulukumba District PKK, CSR Forum, Media, University, Provincial and Bulukumba District PMI. Background: The regional team discarded it to focus on the Blood Donation Emergency Response solution in Bulukumba. Title: Communication, Information, and Education on MNH Status: Discarded January 2019 Region & Focus Area: Central Java Description: This would have involved awareness raising by reaching out to the millennial generation and providing training for bloggers to write about MNH. Initiator: Jalin Central Java Regional Team in September 2018 Partners & Stakeholders: PHO, PERHUMAS, Semarang Runners (has public event that can support a MNH campaign), Muhammadiyah (networks and members to disseminate information), and Center of Heath Research of Diponegoro University. Background: In September 2018, the regional team approached PERHUMAS in Semarang City for advice on development MNH communication materials. PERHUMAS recommended that Jalin conduct awareness raising by reaching out to millennials and providing training for bloggers to write about MNH. HQ assumed control of most regional MNH media campaigns in January 2019. Title: MNH Campaign Status: Discarded in February 2019


Region & Focus Area: South Sulawesi Description: This activity involved a newspaper publishing information on MNH provided by the PHO. Initiator: Jalin South Sulawesi Regional Team in October 2018 Partners & Stakeholders: South Sulawesi PHO and Tribun Timur. Background: In October 2018, the PHO and Tribun Timur agreed to increase public awareness of MNH where the newspaper will publish information on MNH, and the PHO will supply the data and information. They agreed to a Letter of Intent to formalize this collaboration. Tribun Timur committed to providing space in its newspaper for PHO’s MNH related information at a 70% discount from the normal price of IDR 1 million per column. The scheme did not work because the acting PHO director lacked the authority to pay for newspaper articles.

Blood Supply Title: Blood Donation Emergency Response Status: Implementation Region & Focus Area: Bulukumba, South Sulawesi Description: This activity includes resolving bureaucratic disputes between a hospital and PMI to enhance blood supplies for emergencies. Initiator: Bulukumba DHO and PKK in October 2018 Partners & Stakeholders: PHO, Bulukumba DHO, Bappeda, RSUD, Provincial and Bulukumba District PKK, CSR Forum, Media, University, Provincial and Bulukumba District Red Cross (PMI). Background: This intervention arose because the structure of the Blood Transfusion Unit (Unit Transfusi Darah/UTD) caused delays in treatment. Darah/UTD in Bulukumba is under the responsibility of PMI, but its office building and staff are from Bulukumba RSUD. The hospital aims to have PMI’s facility transferred over to it. However, the regional team learned such a transfer would require complicated bureaucratic and organization steps with PMI HQ in Jakarta. The team instead facilitated meetings where the head of PMI agreed to close the blood donation unit in Bulukumba, and the hospital agreed to build a new office for the hospital blood transfusion unit. Forum CSR also supported this process. Title: Awal Bros Hospital Status: Discarded in October 2018 Region & Focus Area: Banten Description: This would have involved blood supply assistance to Awal Bros. Hospital. Initiator: Jalin HQ Partnership Team in July 2018 Partners & Stakeholders: Awal Bros. Hospital (potential blood bank raised by VCA). Background: The regional team followed up with RS Awal Bros after the VCA workshop in Banten. The HQ Partnerships team facilitated the meeting, which discussed potential collaboration on blood stock. HQ later directed the team to stop the blood supply assistance designed in the VCA. Title: Hospital Blood Bank Status: Discarded in October 2018 Region & Focus Area: Boyolali, Semarang, and Brebes, Central Java Description: see title.


Initiator: Jalin Central Java Regional Team in September 2018 Partners & Stakeholders: Boyolali: Boyolali DHO, PMI Boyolali (role in blood supply, blood type data collection, blood donor, and blood bank establishment), PERSI (advocate on importance of blood banks), and ASPERINDO (deliver blood to hospitals). Semarang: Semarang City DHO, PMI Semarang (role in blood supply, blood type data collection, blood donor, and blood bank establishment), PERSI (advocate on importance of blood banks), and ASPERINDO (deliver blood to hospitals). Brebes: Brebes DHO, PMI Brebes (role in blood supply, blood type data collection, blood donor, and blood bank establishment), PERSI (advocate on importance of blood banks), and ASPERINDO (deliver blood to hospitals). Background: The VCA workshop in September generated an idea to develop hospital blood banks in Brebes, Boyolali, and Semarang in partnership with ASPERINDO. ASPERINDO expressed interest in partnering with Jalin but preferred not to work with the Government of Indonesia (GOI) because it had been in arrears. Furthermore, the Boyolali DHO lacked the human resources and equipment to manage a hospital blood bank. In October, the regional team opted to discard the idea after finding that the area’s hospitals are within PMI’s coverage area. Title: Optimizing Private Sector Support for Improving Blood Supply Status: Discarded in January 2019 Region & Focus Area: West Java Description: The regional team discussed private sector support for blood supply by developing cold storage bags for blood delivery at the provincial level. Initiator: Jalin HQ in September 2018 Partners & Stakeholders: PT. Bio Farma (pharmaceutical company with cold bag technology). Background: Participants brainstormed this idea at the VCA workshop in Bandung in September 2018. PT. Bio Farma proposed a partnership to utilize its cold bag technology to deliver blood. HQ discarded this idea indicating that blood supply was not a priority for MNH and that MOH did not support blood supply work.

Transportation Title: Jamilah (Feeder Ambulances) Status: Implementation Region & Focus Area: Lebak, Banten Description: Jamilah is an existing Government of Indonesia program to improve access to health facilities for patients in remote areas and strengthen the cadre program. A key Jamilah activity is the procurement of feeder ambulances. Standard ambulances are not able to reach areas of Lebak. To address these transportation challenges, Jalin worked with PT. Kreasi Mandiri Wintor Indonesia (KMWI) to develop a feeder ambulance prototype that can operate in rural areas to transfer patients from remote locations to a main road where a standard ambulance can transport them to a health facility. Initiator: Jalin Banten Regional Team in September 2018 Partners & Stakeholders: Banten PHO, PPNI, DHO and Puskesmas (implementing the Jamilah program), DPMD, PT KMWI (produces the Village Multi-Function Transporting Vehicle or feeder ambulances), PT KMWD (licensed ambulance distributor), and PT. Samudera Marine Indonesia (which provided one unit of ambulances).


Background: Building off earlier meetings with the DHO, the regional team visited the Puskemas Bojongmanik in September 2018 with the Dean of the Faculty of Nursing from the University of Indonesia (UI). The visit uncovered that in 2017 there were 81 cases of high-risk pregnancy in the area. In October, the team conducted follow up visits with the DHO and DPMD, determining that the alternative of using motorbikes as ambulances for pregnant created potential risks. In November, the regional team discussed with Bupati and Bappeda Lebak, and the Vice Governor of Banten for the idea of a “feeder ambulance” to the point where a regular ambulance can transport the patient. In December, the team met Yayasan Astra which had developed a vehicle to transport agricultural products such as palm oil in off-road situations. In January 2019, it took the Yayasan Astra model to PT KMWI. PT KMWI presented Lebak with two feeder ambulances in 2019 under a grant from the Ministry of Industry with a proposal to pilot them in isolated areas. Bupati Lebak plans to replicate the feeder ambulances with Puskesmas in other areas. PT KMWI believes that the ambulance will have a market in other provinces. Moreover, the regional team advocated with the local government including District Village Development and Empowerment Lebak, Head of Sub District Bojong Manik and village heads for utilizing budget allocations from village funding to procure feeder ambulances. To date six villages have allocated this to the budget for fiscal year 2020. Title: Floating Ambulance Status: Implementation Region & Focus Area: Pangkep, South Sulawesi Description: The Floating Ambulance local solution has included at least four tasks: assistance with the procurement of floating ambulances for islands and coastal areas; development of an SOP for floating ambulance (medical and operational); multi-sectoral cooperation to support the utilization of floating ambulance to improve health services and referrals; and advocating for Governor Decree on the utilization of floating ambulances. Initiator: South Sulawesi PHO, Pangkep DHO, Jalin South Sulawesi Regional Team, Forum CSR of South Sulawesi, and IDI in August 2018 to March 2019 Partners & Stakeholders: South Sulawesi PHO, Pangkep DHO, Bappeda of Pangkep District, RSUD, Provincial and Pangkep District PKK, CSR Forum, Media, University, IDI, IDAI, POGI, IBI, PPNI, BNPB, District Transportation Office, District Communication and Information Office, Basic Social Services Expert of South Sulawesi Province and Pangkep District, SKK Migas: Oil and gas State owned enterprises (BUMN), Provincial Transportation Office, Faculty of Shipping of Hasanuddin University, HRD Agency of the Ministry of Transportation, and Provincial Communication and Information Office. Background: In an August 2018 meeting, the Pangkep DHO indicated to the regional team that they needed floating ambulances to reach the island areas, and the regional team began to plan to procure the ambulances. Then, at an October 2018 workshop, the Head of South Sulawesi’s PHO said the Governor will provide floating ambulances as assistance to some districts, including Pangkep, but did not specify

Sea trials for the floating ambulance (Jalin).


which other districts. In coordination with the DHO, the team began developing a SOP to operate and provide medical assistance on the floating ambulance. In May 2019, HQ staff visited the regional team and questioned the utility of only providing a SOP. In response, the team agreed to bring together multi-sectoral stakeholders to improve the utilization of floating ambulances, including advocating for a Governor’s decree on standards for boat financing, ownership, licensing, and overall operations. This will allow floating ambulances to be scaled outside of Pangkep. Poor coordination between Jalin HQ and the regional team delayed this local solution. Procurement occurred in Jakarta with delivery in January 2019. Yet, HQ did not approve a regional STTA to develop the SOP until March 2019. The regional team reported that the STTA underperformed, and a draft SOP is still being finalized over six months later. Title: Online Transportation for Pregnant Women Status: In design since September 2018 Region & Focus Area: Districts/Cities in North Sumatera with available online transportation Description: This aims to provide online transportation companies, such as Grab or Gojek, with special bonuses for drivers who take pregnant women for ANC. The solution would also offer discounts for pregnant women who use online transportation for ANC. Initiator: Jalin North Sumatera Regional Team in September 2018 Partners & Stakeholders: Grab and Gojek (on-demand multi-service platform, including transportation, and digital payment technology groups) Background: The regional team generated this idea in September 2018 through the VCA workshop and remains in the design stage. Title: TOPDeAMOR Status: In design since October 2018 Region & Focus Area: Garut, West Java Description: This solution utilizes motorcycles (ojek) near Puskesmas to serve as ambulances transporting pregnant women for ANC, delivery, medicine, and midwife visits. Initiator: Garut DHO and Puskesmas Cihurip Garut in October 2018 Partners & Stakeholders: Puskesmas Cihurip Garut (which currently implements TOPDeAMOR) Background: In October 2018, DHO Garut presented TOPDeAMOR as an innovative idea for the West Java team’s consideration. Puskesmas Cihurip in Garut has signed an agreement with nearby ojek drivers that they will be available 24 hours a day to help transport pregnant women to deliver at the Puskesmas. The transportation cost for ojek drivers is covered by Jampersal (delivery insurance), and ojeks serve as feeder ambulances, transporting pregnant women to Puskesmas' ambulance pick-up points.

The West Java regional team conducts a FGD with the head of Puskesmas, village midwives, and midwife coordinator (Jalin).


The regional team intends to strengthen this program and combined it with Puskesmas quality of care improvements. DHO Garut says that the number of pregnant women delivering at Puskesmas Cihurip has increased from 70 in 2016 to 270 in 2018, and suggested scaling this to five other subdistricts with similar geographic conditions. In turn, Jalin committed to replicate TOPDeAMOR in four of these. Title: Utilizing Feeder Ambulances Status: In design since June 2019 Region & Focus Area: Sukabumi and Garut, West Java Description: This involves using feeder ambulances (AMMDeS multi-function vehicles) to transport pregnant women to health facilities, based on the idea from Jalin’s Banten regional team. Initiator: Jalin HQ Partnership Team in June 2019 Partners & Stakeholders: PT Kreasi Mandiri Wintor Indonesia (feeder ambulance manufacturer), Secretary of Tim Jawa Barat Juara, West Java Governor's think tank, and West Java PHO. Background: The regional team initiated the concept of feeder ambulances (AMMDeS multi-function vehicles) to transport pregnant women to health facilities in June 2019 based on the success of Jalin’s Banten regional team. HQ suggested to the West Java team to apply this intervention in Garut and Sukabumi districts where remote communities lack access to health services and facilities. PWS KIA 2017 showed that the number of deliveries at non-health facilities remains high there. The West Java team conducted a meeting with the Jawa Barat Juara team (West Java Governor's think tank) and Bappeda to discuss this solution. In Sukabumi District, the team discussed this idea during a meeting with the Vice of District Head, and in Garut District, the team socialized this with the DHO. In Garut, the DHO expects AMMDes to replace or support TOPDeAMOR, as feeder ambulances are safer and more comfortable for pregnant women to reach the Puskesmas' ambulance pick-up point.

Individual & Community Tracking Title: Bumil Trace Status: In design since January 2019 Region & Focus Area: Pilot in Deli Serdang (potentially as part of P4K), North Sumatera Description: Bumil Trace is an idea for an Android-based tracking application to provide information on pregnant women’s health profiles and ANC. Initiator: Jalin North Sumatera Regional Team in January 2019 Partners & Stakeholders: North Sumatera Provincial Health Office and District Health Offices, Android application developer companies and communication providers, and Provincial Communication and Information Office. Background: The regional team brainstormed a map-based application to identify the location of pregnant women under the supervision of village midwives and monitor their ANC progress online. Title: Safe Mother and Child Software Status: Discarded (included in West Java’s cross-border referral solution) Region & Focus Area: West Java Description: The software supports MNH monitoring MNH and tracking high-risk pregnancies. Initiator: PT. Sinergantara between March and May 2018 Partners & Stakeholders: PT. Sinergantara Background:


This local solution aims to utilize software AIS (Anak Ibu Selamat) developed by PT Sinergantara, Institute Development of Society (IDFoS) Indonesia, and Bojonegoro DHO, and funded by the Ford Foundation. The software supports MNH monitoring MNH and tracking high-risk pregnancies. For example, the program uses a map with a yellow symbol for each pregnant mother who did not go to Puskesmas for an ANC visit. Data collection is conducted by assigned contributors in each village. Based on its experience in implementing the application in Bojonegoro, Sinergantara approaching Jalin West Java team to explore whether the application can be utilized in one of Jalin West Java districts. However, the application is more on data collection and monitoring. Meanwhile, Jalin West Java team needs IT support for the improvement of quality of care and referral system. PT. Sinergantara has been in communication with the HQ Partnership Team since March 2018, and the regional team has invited PT. Sinergantara to participate in most provincial level events, including facilitating a meeting between them and Bappeda in May 2019. The team is currently promoting PT. Sinergantara’s involvement in cross-border referrals in Depok. Title: Tidung Suci Status: Discarded in October 2018 Region & Focus Area: Sukabumi, West Java Description: This local solution tracks women’s health using an ICT system during their premarital period (high school age), premarital preparations, and after marriage. Initiator: Sukabumi DHO in September 2018 Partners & Stakeholders: Sukabumi DHO, Bappeda, District Religion Office, BKKBN Background: The DHO presented this idea in September 2018, but the team deemed it a low priority because the idea remains abstract. Title: Android Application for Pregnant Women Tracking and Monitoring Status: Discarded (Pending) since December 2018 Region & Focus Area: Bone, South Sulawesi Description: This idea was to create an android-based application to track and monitor women during pregnancy. Initiator: Bone DHO, Bappeda, and Puskesmas between Apr and June 2018 Partners & Stakeholders: PHO, Bone DHO, Bappeda, Bone RSUD, Provincial and Bone District PKK (through its Dasawisma cadres), CSR Forum, Media, Kalla Foundation (historical and cultural ties to Bone), and University. Background: This idea originated with stakeholders during an October 2018 workshop. The team received information from HQ that MOH is working with Japan International Cooperation Agency (JICA) to digitalize the MNH Book (Buku KIA) nationally, and a monitoring function will be included in this application. The idea stems from MNH issues in Bone, where pregnant women traditionally move back to their parents’ home during pregnancy. This can cause village midwives to lose contact with them. Pregnant women will also seek ANC visits at a new facility without reporting to the previous one, and many discontinue their ANC altogether. Before the October workshop, Bone DHO met with PT. Telkom to discuss this idea in a meeting facilitated by the regional team. PT. Telkom presented its program for an android application for tracking pregnant women in West Nusa Tenggara Province at the October workshop. PHO expressed interest in the idea and had a follow-up meeting. PT. Telkom still asks Jalin for updates on this idea, but the DHO is not ready to finance the maintenance of this system once it is developed.


Title: Saving the Next Generation and Baby Memo Software Status: Discarded in April 2019 Region & Focus Area: Garut, West Java Description: The West Java regional team postponed this solution to monitor the health status of pregnant women and nutrition status of children. Initiator: Dompet Dhuafa in August 2018 Partners & Stakeholders: Dhompet Dhuafa (a philanthropic foundation) Background: The software belongs to the Dompet Dhuafa philanthropic foundation, which discussed partnering with Jalin in August 2018. Cadres and midwives at the community level in Garut District input monitoring data into the system, and an OBGYN at Dompet Dhuafa HQ in Jakarta can provide an assessment and advice on nutrition and medicines. Lower income members of Dompet Dhuafa (below Rp. 1 million per month) receive free healthcare in Dompet Dhuafa Hospital. However, the team deprioritized this intervention in favor of others in Garut.

Referral Systems Title: Optimizing SiCantik Status: Implementation in Sidoarjo and under design in Malang since June 2019 Region & Focus Area: Sidoarjo and Malang, East Java Description: The SiCantik digital application is a health information system developed in Sidoarjo to record maternal health history online and improve the communications of information in the referral system. It serves as a monitoring mechanism where doctors and midwives can monitor the data of pregnant women who are regarded as “high-risk”. Initiator: Sidoarjo DHO in December 2018, and the Malang DHO in June 2019 Partners & Stakeholders: Sidoarjo: Sidoarjo DHO, IBI (involves its members), POGI (involves its members), Sidoarjo RSUD (main referral hospital in the district), Siti Khodijah Hospital and Anwar Medika Hospital (private hospitals), DISKOMINFO, DISDUKCAPIL (shares population data for application), Muhammadiyah University (deploying students in accompanying the health worker), Fatayat NU and Aisyiyah (religious CSOs with many female members), Bappeda, and District Social Office. Malang: Malang DHO. Background: Optimizing SiCantik involves increasing the utilization of a digital application monitoring mechanism where doctors and midwives can monitor data on pregnant women who are regarded as “high-risk.” The Sidoarjo DHO initiated this idea at the regional team’s December workshop when in discussions with IBI, POGI, RSUD, Siti Khodijah Hospital, Anwar Medika Hospital, District Communication and Information Office, District Population and Civil Registration Office, Muhammadiyah University, Fatayat NU and Aisyiyah, Bappeda, and the District Social Office. The local solution employs two strategies: 1) increased utilization of the application by health workers (supply-side); and 2) collaboration on maternal health promotion efforts related to service rights and the referral system (demand-side). Sidoarjo developed the information system SiCantik (Sidoarjo Cegah Kematian Ibu dan Anak/Sidoarjo Preventing Maternal and Child Mortality). SiCantik is used by health workers providing ANC to record health data for pregnant women, and it has been socialized at most of the district’s health facilities. Yet, DHO monthly reports show not all health workers use the application and not all pregnant women are registered. Research in 2018 found that health workers have been slow to change from paper-based data collection to digital, and the application lacks a SOP and accompanying regulations. However, the regional team has had difficulty coordinating potential partners because it lacks a MOU. Muhammadiyah University of Sidoarjo is ready to deploy students to accompany health workers to


promote using SiCantik, but the University needs a MOU first. Furthermore, OBGYNs have not expressed enthusiasm for SiCantik, because they are unsure how it can benefit them. Kanjuruhan Radio, the local government radio, asked the regional team to participate, and the DHO has shown strong ownership of the solution, according to the RM. CV Natusi, the developer of SiCantik, has been invited to the PENAKIB MNH forum to provide rapid support in case of system errors. The Malang DHO has been inspired by a management information system (similar to SiCantik) during a visit to Brebes District in Central Java. The DHO also knows about SiCantik in Sidoarjo, and the regional team has met with it to discuss how such applications can strengthen the referral system. Title: To Be Determined (TBD) in Grobogan Status: In Design since March 2019 Region & Focus Area: Grobogan, Central Java Description: This solution is likely to improve referrals. Initiator: Jalin Central Java Regional Team in March 2019 Partners & Stakeholders: Grobogan DHO, Grobogan DPMD, POGI Semarang, and RSUD Dr. R. Soedjati Purwadi Background: The regional team began discussions with the Grobogan DHO, DPMD, POGI Semarang, and a regional hospital in March. Anecdotal evidence shows that Grobogan has the highest maternal mortality in Central Java. Title: Cross-Border Referrals Status: In Design since June 2019 Region & Focus Area: Bogor District, Bogor City, Depok City, West Java Description: This initiative aims to strengthen the cross-border referral system. Initiator: ARSSI, Bogor DHO, Bogor City Health Office, and Depok City Health Office, (has its own referral system), POGI, IDAI, Bappeda, Provincial Government, Provincial Secretary (Sekretaris Daerah Provinsi), RSUD from the three regions, in Workshop on August 2019. Partners & Stakeholders: ARSSI, Bogor DHO, Bogor City Health Office, and Depok City Health Office, (has its own referral system), POGI, IDAI, Bappeda, Provincial Government, Provincial Secretary (Sekda Provinsi), RSUD from the three regions, PT. STI and PT. Sinergantara (private sectors with capacity in developing IT system for MNH improvement). Background: Following a problem definition workshop in June 2019 and a cocreation event in August, the regional team envisions that the cross-border referral activity in Bogor District and Bogor and Depok cities will include:

1. PONEK hospital standards mapping, analyzing 24-hour availability of OBGYNs, the existence of a hospital blood bank, and surgery room. Hospitals in the area do not meet PONEK standards much of the time, despite stating that they do. For this activity, the regional team will conduct a meeting with hospital representatives and administer a questionnaire developed by EMAS to gauge their actual PONEK capacity. The team will analyze their results against DHO data.

2. MOU on cross-border information sharing, referral systems, budgeting, and maternal and perinatal audits. The MOU will help actors manage their communication system, cross border AMP and mentoring, and blood supply availability. Bogor District asked that the MOU extend to Sukabumi, Cianjur, Lebak, and South Tangerang districts. The regional team indicated that they wish to focus on Bogor District and Bogor and Depok cities.


3. Strengthening the implementation of the information and communication system for referral (Sistem Rujukan Terpadu/SISRUTE, the national application for referral systems). Stakeholders are still discussing whether they should create a new system or integrating the existing systems in the three focus areas. However, they agree SISRUTE should include a dashboard, assign general practitioners for answering the call center, assign operators for the implementation of SOPs for communication between hospitals and call centers, and include a plan for referrals for high-risk pregnancies that could be integrated with Zoom Preeklamsi.

4. Cross-border regulations. The regional team found that every district and city has a different referral system and that SISRUTE is poorly implemented. The intended regulation will establish rules governing the first three components of the cross-border referral solution.

Title: SijariEMAS Status: Discarded in September 2018 Region & Focus Area: Boyolali, Central Java Description: This would expand the SijariEMAS IT referral system to Boyolali. Initiator: Jalin Central Java Regional Team in September 2018 Partners & Stakeholders: Boyolali DHO, Hospitals and Puskesmas in Boyolali, and Sijariemas TI (IT support for referral system). Background: From his experience with EMAS and PT STI, the Central Java RM demonstrated the system to the Provincial Governor, who supported it, and to the Boyolali DHO, who rejected the idea in September. The DHO said it already used the Sahabat Ibu Sehati (SATITI) system and claimed that users found WhatsApp more intuitive than SijariEMAS despite the different intention and capabilities of the system.

Evidence Gathering Title: Sociological Research in Nias Status: In design since May 2019 Region & Focus Area: 5 Districts on Nias Island, North Sumatera Description: see title. Initiator: Jalin North Sumatera Regional Team in May 2019 Partners & Stakeholders: North Sumatera PHO, DHO, and North Sumatera University. Background: The team brainstormed this idea to do sociological research on Nias Island. They believe there are distinct societal and ethnic characteristics specific to the people of Nias that contribute to high maternal and neonatal mortality, particularly in the South Tapanuli and Tanah Karo districts. They generated this potential solution in discussion with Puskesmas in these areas. Title: Supporting Evidence-Based MNH Policymaking Status: Discarded in October 2018 Region & Focus Area: Sukabumi, West Java Description: Bumi Walagri proposed using students to conduct research on the health conditions of female factory workers. Initiator: Padjadjaran University-Bumi Walagri in September 2018 Partners & Stakeholders: UNPAD-Bumi Walagri (an integrated & evidence-based education program). Background:


UNPAD-Bumi Walagri, an education program run by Padjadjaran University in Bandung, proposed areas for potential collaboration with Jalin. UNPAD-Bumi Walagri masters students work in Tasikmalaya, Karawang, and Sukabumi districts conducting research on MNH, epidemiology, and medicine with local partners. The regional team was invited to Bumi Walagri's meeting with the PHO and Bappeda, where they discussed engaging in MNH research using a health status assessment tool previously developed by USAID. Bumi Walagri proposed using students to conduct research on the health conditions of female factory workers. However, Jalin discarded this potential partnership because Bumi Walagri does not work in Garut where MNH in the Workplace. Additionally, HQ said no funding exists for evidence generation outside of EMNC and MPDSR.

Family Planning Title: Family Planning Contraception Services Mobile Unit (MUYAN) Status: In design since February 2019 Region & Focus Area: Garut, West Java Description: MUYAN is a program by BKKBN to use a vehicle (usually minibus) to provide family planning services in remote areas. Initiator: West Java BKKBN in February 2019 Partners & Stakeholders: BKKBN of West Java (runs MUYAN), PT Chang Shin (women workers need these services), Puskesmas Leles, PLKB (provides contraception tools), and DPPKBPPA of Garut District. Background: The regional team brainstormed an idea to support MUYAN in February 2019 in a discussion about contraception methods, tools, and challenges at factories, but the Family Planning Office of Garut District proved reluctant to support the supply of contraception as part of MNH in Workplace. BKKBN currently uses two cars to provide services for family planning in West Java, and this solution remains under design. Title: Improve Quality and Quantity of Family Planning Program (Keluarga Berencana, KB) Status: Discarded in December 2018 Region & Focus Area: Bulukumba, South Sulawesi Description: see title. Initiator: Bulukumba DHO and PKK in October 2018 Partners & Stakeholders: PHO, Bulukumba DHO, Bappeda, RSUD, Provincial and Bulukumba District PKK, CSR Forum, Media, University, Provincial and Bulukumba District PMI. Background: PKK and Bulukumba DHO brainstormed this idea at the October workshop, which it based on the Three Delays framework. The regional team discarded it in December 2018, because it believed the BKKBN should implement the solution.

Maternity Waiting Homes Title: Maternity Wairing Homes for Pregnant Mothers Status: Discarded in October 2018 Region & Focus Area: Semarang, Central Java Description: The regional team internally generated a halfway house (Rumah Tunggu/Singgah) idea with PHRI as a potential partner in September. PHRI would work with member hotels to provide rooms for pregnant mothers and families in Semarang while they waited for space at a hospital. Initiator: Jalin Central Java Regional Team in September 2019


Partners & Stakeholders: Semarang City DHO, Governor of Central Java (advocate on needs of pregnant women waiting for rooms in hospital), and Hotels and Restaurants Association (PHRI, to provide rooms for pregnant mothers and family). Background: PHRI rejected the idea in October. Again, in April 2019, the Provincial Governor asked PHRI to contribute to reducing maternal mortality. Jalin attempted to meet with them, but PHRI did not respond. Title: Improving Maternity Waiting Homes & Ambulances for Villages Status: Discarded in November 2018 Region & Focus Area: Gowa, South Sulawesi Description: This local solution intended to arrange maternity waiting homes for pregnant women transported by floating ambulances in Gowa. Initiator: Gowa DHO and RSUD in October 2018 Partners & Stakeholders: Ketua TP PKK, Bappeda, DHO, RSUD, PHO, Bank of South and West Sulawesi, PT. Mayora, PKK, LKBN Antara (media), and Berita Kota (media). Background: The regional team discarded it because of HQ guidance to reduce the number of focus districts and a lack of commitment from Gowa local government.

Other Title: Engaging IDI, IDAI, POGI, Hospitals, and Doctors Status: Implemented by Jalin in December 2018 Region & Focus Area: Sinjai, South Sulawesi Description: This activity resolved poor coordination and built relationships to increase accountability among professional associations, hospitals, and doctors. Initiator: Sinjai DHO in Oct-2018 Partners & Stakeholders: Ketua TP PKK, Bappeda, DHO, RSUD, DHO, PHO, Bank of South and West Sulawesi, CSR Forum, PKK, and Jakarta Post. Background: The October workshop found that poor coordination between OBGYNs and other doctors in providing care for patients had contributed to maternal and neonatal deaths at the hospital in Sinjai District. In December, Jalin strengthened the procedures and working relationship between doctors, hospital managers, and members of POGI, IDI, and IDAI in Sinjai district. The regional team’s role involved facilitating a meeting between members of POGI, IDI, and IDAI to discuss doctor’s relationships and attitudes, revoking licenses, accrediting clinics, and establishing a public safety center to support referrals at the subdistrict level. However, this activity was not reported to HQ or USAID. Title: MOU with CSR Forum to Improve MNH

A problem definition workshop in East Java (Jalin).


Status: In design since May 2019 Region & Focus Area: South Sulawesi Description: see title. Initiator: CSR Forum of South Sulawesi in May 2019 Partners & Stakeholders: South Sulawesi PHO and CSR Forum Background: This intervention originated in a May 2019 workshop assisted by the HQ Partnerships Team with the CSR Forum and PHO. The CSR Forum expressed interest in supporting many of the regional team’s local solutions. The intervention aims to overcome the challenged that many DHOs do not know how to cooperate with the CSR Forum and many Forum member are not familiar with MNH issues. Most CSR work in South Sulawesi is in education (e.g. providing scholarship) and emergency response (e.g. flooding). Title: Halodoc-IBI Partnership Status: Discarded in January 2019 Region & Focus Area: Banten Description: The Halodoc-IBI Partnership intended to improve access to medicines and supplies for private midwives in Banten via Halodoc’s mobile application. Initiator: Jalin HQ Partnership Team in August 2018 Partners & Stakeholders: Halodoc (provides mobile application to deliver medical supplies) and IBI Tangerang (private midwives serve as users). Background: In August 2018, the HQ partnerships team used personal connections to engage Halodoc and facilitated discussions between Halodoc, national IBI, and MOH. The Partnerships Director resigned in October 2018, and Jalin delegated responsibility for Halodoc-IBI from HQ to the regional team because the Banten IBI chapter expressed interest in it. The regional team met Halodoc and IBI and drafted a Survey Monkey to understand midwives’ needs at Banten IBI’s quarterly meeting in December. However, the HQ Technical team recommended revisions to the survey. The regional team requested support from the HQ MELA team on the revisions but did not receive a response. In January, the regional team postponed the solution, citing a lack of HQ support for the survey and a desire to focus on Gerai KIA. In addition, MOH and national IBI expressed concern about partnering with Halodoc because of regulatory uncertainty on doctors, midwives, and patients communicating through online applications. Furthermore, the regional team felt the lack of wireless and cell connectivity in Lebak would hinder the solution. Title: Potential Solutions with Sehati and Lazismu Status: Discarded in October 2018 Region & Focus Area: Banten Description: N/A. Initiator: Jalin HQ Partnership Team in July and August 2018 Partners & Stakeholders: Sehati and Lazismu Foundation Background: In July and August, the regional team held meetings with the following stakeholders about potential interventions before discarding them. The HQ Partnership team invited the regional team to join two meetings with Sehati, an organization that focuses on coaching and mentoring for midwives and developing an application for cardiotocography (CTG). Sehati did not follow up with the regional team after their meetings, and Jalin discontinued the idea. The team used a personal connection to hold


several meetings with Lazismu, a charity body under Muhammadiyah with a large number of members and resources, that did not result in a potential solution. Title: PKK for Pregnant Women and 1,000 Days of Life Status: Discarded in December 2018 Region & Focus Area: Bulukumba, South Sulawesi Description: PKK and Bulukumba DHO aimed to revitalize its programs for pregnant women around the first 1,000 days of life – the time between conception and one’s second birthday. Initiator: Bulukumba DHO and PKK in October 2018 Partners & Stakeholders: PHO, Bulukumba DHO, Bappeda, RSUD, Provincial and Bulukumba District PKK, CSR Forum, Media, University, Provincial and Bulukumba District PMI. Background: This intended to address malnutrition, mortality, and significant morbidities such as poor health and loss of neurodevelopmental potential. In December 2018, the regional team discarded this idea to focus on the Blood Donation Emergency Response solution in Bulukumba Title: Advocating for a Regulation on TBAs Status: Discarded in July 2019 Region & Focus Area: Sukabumi, West Java Description: This activity aims for a regulation in Sukabumi that transitions TBA from midwives' partners to pregnant women’s companions, which will limit TBA’s role in delivery process. Initiator: Head of Jampang Kulon Regional Hospital in Sukabumi in June 2019. Partners & Stakeholders: IBI, DHO, Subdistrict Government, POGI of West Java, HOGSI of West Java Background: The Head of the Jampang Kulon Regional Hospital presented this idea in June 2019. A regulation already prohibits TBA involvement in delivery, and the regional team intends to further assess this activity in the future. Lessons Learned

• Jalin did not accurately apply its prioritization criteria when deciding which local solutions to implement. Jalin’s prioritization criteria is plausible impact on reducing MN mortality, scalability of intervention, and share of resource allocation. In addition, Jalin’s Evidence Synthesis identified three areas for impact on reducing mortality: improving referral effectiveness, improving quality of care, and improving JKN.7 Instead, in April 2019, HQ directed regional teams to prioritize local solutions that were closest to implementation rather than referral systems, clinical quality of care, and health financing. This led many ANC coverage activities, which have less plausible impact on reducing MN mortality.

• Much of Jalin’s work to date has been regional activities conducted by its regional teams, rather than HQ. Regional teams brokered the relationships and partnerships which implement most of Jalin’s ongoing activities. Without the knowledge and efforts of regional teams, the DE considers it unlikely that these activities would have occurred.

• Regional teams developed similar local solutions yet did not coordinate to plan or replicate activities. For example, Jalin is implementing MNH in the Workplace in

7 Jalin Year 1 Annual Report: Appendix 5: Rapid Synthesis of Recent Maternal and Neonatal Mortality Evidence in Indonesia – Summary. January 2019. Pg. 45.


neighboring provinces, yet these programs use different approaches and content: PASTI in Central Java and GP2SP in West Java. This lack of coordination may result in duplication of efforts or hinder scaling interventions in the future.

• Previously discarded or postponed ideas warrant further consideration by Jalin. Its new results framework from August 2019 now supports previously deprioritized ideas. For example, regional teams have discarded the Financing to Support Bidan Delima solution in Central Java and the IBI-Halodoc Partnership initiative in Banten, yet both aim to improve quality of care by private midwives, Intermedia Result 3 from the results framework.


ANNEX 1: LOCAL SOLUTION TABLE

Region Solution Name Coverage Area

Date Developed

Partners (Role in Parenthesis) Status If Discarded or Postponed, Why?

Banten Gerai KIA - addresses inadequate MNH knowledge among mothers and families leading to incomplete ANC and PNC visits. Unequal quality of midwives and volunteers lead to unstandardized counseling.

Tangerang Jul-2018 PT. Sumber Alfaria (provides Alfamart store locations for Gerai KIA), PHO, Tangerang local government, and FOPKIA, cadres to provide free counselling to women of reproductive age and information on how to use the government’s Buku KIA to track pregnancy, schedule ANC, and understand symptoms of high-risk pregnancies).

Implementation -

Banten Sehati - Jul-2018 Sehati Discarded Oct-2019

Sehati stopped returning calls.

Banten Awal Bros - Jul-2018 Awal Bros. Hospital (potential blood bank raised by VCA).

Discarded Oct-2019

HQ directed to stop blood supply work.

Banten Lasizmu - Aug-2018 Lasizmu Foundation Discarded Oct-2019

Could not identify a potential activity for collaboration.

Banten IBI-Halodoc Partnership - improve access to medicines and supplies for private midwives in Banten via a mobile application.

Tangerang Aug-2018 Halodoc (provides mobile application to deliver medical supplies) and IBI Tangerang (private midwives serve as users).

Discarded Jan-2019 Lack of staff to conduct an online survey of private midwives to assess needs. FGD showed private midwives do not treat patients with BPJS. MOH against partnering with Halodoc.


Banten Jamilah Feeder Ambulance - strengthen the Jamilah Program to improve access to health facilities for patients in remote areas and strengthen the cadre program.

Lebak Oct-2018 PHO, PPNI, DHO and Puskesmas (implementing the Jamilah program), DPMD, PT KMWI (produces the Village Multi-Function Transporting Vehicle or feeder ambulances), PT KMWD (licensed ambulance distributor), and PT. Samudera Marine Indonesia (which provided one unit of ambulances).

Implementation -

Banten One Nurse, One Village - to improve the quality of neonatal care.

Lebak Dec-2018 PHO, DHO, and PPNI In Design -

Banten Integrated Microfinance Institution for MNH

Lebak Mar-2019 Local Government of Lebak District, Opportunity International Australia (potential source of financing), Healing Fields (micro health insurance India), and KOMIDA (local MFI).

Discarded Jun-2019 USAID did not approve a SOW to further develop this solution.

Central Java Financing for Bidan Delima Boyolali & Semarang

Jul-2018 Partners in Boyolali: Boyolali DHO, IBI Boyolali (midwives will receive soft loan), and Central Java Bank (loan provider). Partners in Semarang: Semarang City DHO, IBI Semarang (midwives will receive soft loan), and Central Java Bank (loan provider).

Boyolali: Discarded Sep-2018 Semarang: Discarded Oct-2018

Boyolali: IBI concerned members will not repay loans. Semarang: Difficulty approaching Central Java Bank.

Central Java SijariEMAS Innovation Technology Boyolali Aug-2018 Boyolali DHO, Hospitals and Puskesmas in Boyolali, and Sijariemas TI (IT support for referral system).

Discarded Sep-2018 DHO already has "SATITI" as an information system.

Central Java Hospital Blood Bank Boyolali, Semarang, & Brebes

Sep-2018 Partners in Boyolali: Boyolali DHO, PMI Boyolali (role in blood supply, blood type data collection, blood donor, and blood bank establishment), PERSI (advocate on importance of blood banks), and ASPERINDO (deliver blood to hospitals). Partners in Semarang: Semarang City Health Office, PMI Semarang (role in blood supply, blood type data collection, blood donor, and blood bank establishment), PERSI (advocate on importance of blood banks), and ASPERINDO (deliver blood to hospitals).

Boyolali, Semarang, & Brebes: Discarded Oct-2018

Boyolali, Semarang, & Brebes: High cost of establishing hospital blood banks, and all hospitals in range of PMI.


Partners in Brebes: Brebes DHO, PMI Brebes (role in blood supply, blood type data collection, blood donor, and blood bank establishment), PERSI (advocate on importance of blood banks), and ASPERINDO (deliver blood to hospitals).

Central Java Maternity waiting house for pregnant women and family

Semarang Sep-2018 Semarang City Health Office, Governor of Central Java (advocate on needs of pregnant women waiting for rooms in hospital), and PHRI (to provide rooms for pregnant mothers and family).

Discarded Oct-2018

No support from PHRI, PHO, and DHO.

Central Java Communication, Information, and Education on MNH

Central Java Sep-2018 PHO, PERHUMAS, Semarang Runners (has public event that can support a MNH campaign), Muhammadiyah (networks and members to disseminate information), and Center of Heath Research of Diponegoro University.

Discarded Jan-2019 Jalin HQ assumed control of regional MNH media campaigns to form a national media campaign.

Central Java MNH in Workplace (PASTI) - Improve access and quality of services for female factory workers

Boyolali, Brebes, & Semarang

Boyolali: Oct-2018 Brebes: Nov-2018 Semarang: Dec-2018

Partners in Boyolali: Boyolali DHO, PT. Pan Brothers Tbk (factory for solution), BPJS (referrals for emergency cases), PMI Boyolali, Puskesmas Mojosongo: IBI Boyolali, and Medical Faculty of Sebelas Maret University (technical support from doctors and students). Partners in Brebes: Brebes DHO, APINDO Partners in Semarang: Semarang City DHO, PMI Semarang, PT. SAMA (factory for solution), Puskesmas Karanganyar, IBI Semarang, Tugurejo Regional Hospital (provide mentoring to improve factor clinic), and Semarang City Population Control and Family Planning Office.

Boyolali: Implementation Brebes: Discarded Oct-2018 Semarang; Implementation

Boyolali: - Brebes: Few large factories exist in Brebes. Semarang: -


Central Java MNH in Community / Mentoring - Strengthen clinical and public accountability in referral hospitals

Brebes Oct-2018 Brebes DHO, Brebes DPMD, FMM KIA, Dera As-Syifa Hospitals: a hospital located in Banjarharjo (serves as referral from Puskesmas), POGI Semarang, and PT. Charoen Phokpan Tbk (supports improvements on MNH in the sub-district).

Implementation -

Central Java Pre/eclampsia Eradication – Improve early detection of high-risk pregnancies and readiness of health facilities

Boyolali Oct-2018 Boyolali DHO, PT. Pan Brothers Tbk (factory for solution), BPJS (referrals for emergency cases), PMI Boyolali, Puskesmas Mojosongo: IBI Boyolali, POGI Surakarta, Medical Faculty of Sebelas Maret University (technical support from doctors and students), DPPKB Boyolali (socialization of MNH knowledge and awareness), District Religion Office of Boyolali, IDI Boyolali, and Puskesmas in Karanggede, Glagasari and Ngemplak (location for this solution).

Implementation -

Central Java TBD – Referrals Grobogan Mar-2019 Grobogan DHO, Grobogan DPMD, POGI Semarang, and Dr. R. Soedjati Purwadi Regional Hospital.

In Design -

East Java Optimizing SiCantik – digital application monitoring mechanism where doctors and midwives can monitor the data of pregnant women who are regarded as “high-risk”. Scaling SiCantik (or a similar application) in Malang District

Sidoarjo Malang

Dec-2018 Jun-2019

Sidoarjo: Sidoarjo DHO, IBI (involves its members), POGI (involves its members), Sidoarjo RSUD (main referral hospital in the district), Siti Khodijah Hospital and Anwar Medika Hospital (private hospitals), DISKOMINFO, DISDUKCAPIL (shares population data for application), Muhammadiyah University (deploying students in accompanying the health worker), Fatayat NU and Aisyiyah (religious CSOs with many female members), Bappeda, and District Social Office. Malang: Jalin has not formally discussed this idea with the Malang DHO yet.

Sidoarjo: Implementation Malang: In design

-


East Java Improving Health Worker Compliance with ANC and PNC SOPs

Sidoarjo Dec-2018 Sidoarjo DHO, IBI, POGI, Sidoarjo RSUD, Siti Khodijah Hospital and Anwar Medika Hospital, District Communication and Information Office, District Population and Civil Registration Office, Muhammadiyah University, Fatayat NU and Aisyiyah, Bappeda, and District Social Office.

Postponed Jan-2019 The regional team and stakeholders agreed to prioritize Optimizing SiCantik in 2019.

East Java Quality Improvements for Integrated ANC and PNC - develop indicators for ANC, strengthen clinical accountability through audits, and develop a public education campaign for communities in MNH.

Jember & Malang

Jember: Dec-2018 Malang: May-2019

Jember: Jember DHO, IBI, PENAKIB (MNH forum in Jember, consists of health and non-health stakeholders), Soebandi Hospital (referral hospital), Siloam Hospital (private hospital), Bappeda, Fatayat NU, District Village and Community Empowerment Office, Mitra Tani (agricultural private company), District Social Office, Klinik Jember Hospital and Srikandi Hospital (private hospitals), and Balung Regional Hospital and Kalisat Regional Hospital (government hospitals). Malang: Malang DHO, IBI (involves its members), DPPKB (disseminate SOPs via Family Planning Cadres), DPMD, District Social Office (supporting via its Family Hope Program), Fatayat NU (religious CSO with female members), Lingga Indonesia Foundation, Times Indonesia (Media), Perusda Jasa Yasa and Perusda Tirta Kanjuruhan (government owned enterprises), Lawang RSUD, Kanjuruhan RSUD, and Wava Husada Hospital (a private hospital).

Implementation -

East Java Improving public awareness of MNH via the Media

Jember Dec-2018 Jember DHO, IBI, PENAKIB, Soebandi Hospital, Siloam Hospital, Bappeda, Fatayat NU, DPMD, Mitra Tani, District Social Office, Klinik Jember Hospital and Srikandi Hospital, and Balung Regional Hospital and Kalisat Regional Hospital.

Postponed Jan-2019 The regional team decided to prioritize one local solution in Jember.


North Sumatera

P4K Inovasi - seeks to strengthen P4K, a Ministry of Health program launched in 2007 to improve MNH by increasing community involvement in ANC.

Langkat Aug-2018 Langkat DHO, DPMD (village fund management and allocation), District Social Office (managing the Family Hope Program), FMM KIA (monitoring the services from MNH cadres), Hinai and Tanjung Pura Head of Sub-District, Puskesmas Tanjung Beringin, Puskesmas Pantai Cermin and Puskesmas Pematang cengal, Village Governments (Head of Villages and Village Assembly Body) from 30 pilot villages, Village Midwives from 30 pilot villages (health care provider to mother and newborn in the village level), MNH Motivator Cadres of Tanjung Beringin Sub-Districts, and Faculty of Medicine, Public Health Faculty, Nursing Faculty, and Faculty of Psychology of North Sumatera University

Implementation

North Sumatera

Access to Finance for Private Midwives and Clinic (A2F) - to finance them to adhere to standardize medical equipment, and medicine for providing service; and training.

Deli Serdang Aug-2018 Bank of North Sumatera (manages saving and loan for 24,000 women in North Sumatera), IBI of North Sumatera, ASKLIN of North Sumatera (provides support for clinics in preparing high quality of care).

Implementation

North Sumatera

MNH Campaign – to address lack of awareness on MNH issues (self-rights, services, JKN, self-assessments, etc.)

15 districts in North Sumatera

Aug-2018 North Sumatera PHO, Provincial DISKOMINFO, Media Forum for MNH (forum established by Jalin and consisting of 12 media, influencer, and Public Relations Office of North Sumatera Government), religious Organization, such as NU, Muhammadiyah, and PGI, KNPI, and PKK.

Implementation

North Sumatera

Online Transportation for Pregnant Women - provide discount for pregnant women who use services for ANC.

Districts/Cities with available online transportation

Sep-2018 GRAB and Gojek In design

North Sumatera

Saving Product for JKN - saving product to help low income groups pay premium by installments.

Deli Serdang Nov-2018 Financial institutions, BPJS In design


North Sumatera

Bumil Trace – Android-based application to provide information on the pregnant women’s health profile and ANC

Pilot in Deli Serdang (potentially as part of P4K)

Jan-2019 North Sumatera PHO and DHO, Android application developer companies and communication providers, and DISKOMINFO.

In design

North Sumatera

District MNH Fund - to create a forum to manage funding for MNH, such as for subsidizing the JKN or BPJS premium, and to be established based on a Bupati Decree.

Deli Serdang Jan-2019 DHO, Trade and Industry Office of North Sumatera Province, Integrated Licensing Agency at provincial and district level (Badan Pelayanan Ijin terpadu Provinsi dan Kabupaten), and APINDO of North Sumatera Province.

In design

North Sumatera

Sociological Research in Nias – identify relevant socio-cultural, economic, and behavioral factors related to the high maternal and newborn mortality rate among persons in Nias.

5 Districts on Nias Island

May-2019 North Sumatera PHO, DHO, and North Sumatera University.

In design

South Sulawesi Android Application for Pregnant Women Tracking and Monitoring

Bone Apr - Jun 2018

PHO, Bone DHO, Bappeda, Bone RSUD, Provincial and Bone District PKK (through its Dasawisma cadres), CSR Forum, Media, Kalla Foundation (historical and cultural ties to Bone), and University.

Discarded (Pending) Dec-2018

HQ directed to focus on one solution per district: Bola Asseddinggen in Bone. Also, MOH and JICA are digitalizing the MNH Book (Pink Book), and HQ asked the team to wait for this.


South Sulawesi Floating Ambulance – multiple phases: 1) Procurement of floating ambulances for islands and coastal areas 2) SOP for floating ambulance (medical and operational) 3) Multi-sectoral cooperation to support the utilization of floating ambulance to improve health services and referrals 4) Advocating for Governor Decree on the Utilization of Floating Ambulance

Pangkep for Phases 1) – 3) Provincial for Phase 4)

1) Aug-2018 2) Oct-2018 3) May – Jun-2019 4) May-2019

1) PHO, Pangkep DHO, Bappeda, RSUD, Provincial and Pangkep District PKK, CSR Forum, Media, and University. 2) Actors from Phase 1), plus IDI, IDAI, POGI, IBI, PPNI, BNPB, and District Transportation Office 3) Actors from Phase 1) and 2), plus District Communication and Information Office, Basic Social Services Expert of South Sulawesi Province and Pangkep District, SKK Migas: Oil and gas State owned enterprises (BUMN) 4) Actors from Phase 1) – 3), plus Provincial Transportation Office, Faculty of Shipping of Hasanuddin University, HRD Agency of the Ministry of Transportation, Provincial Communication and Information Office.

Implementation -

South Sulawesi MNH Campaign – Tribun Timur publishes MNH-related news

Provincial Oct-2018 PHO and Tribun Timur. Discarded Feb-2018 PHO did not have authority to pay for articles in Tribune Timor because PHO director was acting. However, HQ also told the region to discard it because it “is not a real solution.”

South Sulawesi Bola Asseddingeng – capacity building for midwives on counseling skills to strengthen mother classes and improving access to transportation for referral

Bone Oct-2018 PHO, Bone DHO, Bappeda, Bone RSUD, Provincial and Bone District PKK (through its Dasawisma cadres), CSR Forum, Media, Kalla Foundation (historical and cultural ties to Bone), and University.

Implementation -

South Sulawesi Village fund allocation for MNH Bone Oct-2018 PHO, Bone DHO, Bappeda, Bone RSUD, Provincial and Bone District PKK (through its Dasawisma cadres), CSR Forum, Media, Kalla Foundation (historical and cultural ties to Bone), and University.

Discarded (Pending) Apr-2019

Supported by Sunardi as Governance Specialist and lingered after his resignation.

South Sulawesi Blood Donation Emergency Response

Bulukumba Oct-2018 PHO, Bulukumba DHO, Bappeda, RSUD, Provincial and Bulukumba District PKK, CSR Forum, Media, University, Provincial and Bulukumba PMI.

Implementation -


South Sulawesi PKK for Pregnant Women and 1,000 Days of Life

Bulukumba Oct-2018 PHO, Bulukumba DHO, Bappeda, RSUD, Provincial and Bulukumba District PKK, CSR Forum, Media, University, Provincial and Bulukumba District PMI.

Discarded Dec-2018

District PKK will conduct this.

South Sulawesi Encourage local public figures to socialize MNH


Discarded Dec-2018

This was included in the Blood Donation Emergency Response solution in Bulukumba.

South Sulawesi Pro-active home visits to pregnant women reluctant to receive ANC at a health facility


Discarded Dec-2018

This was included in the Blood Donation Emergency Response solution in Bulukumba.

South Sulawesi Improve Quality and Quantity of Family Planning Program (Keluarga Berencana, KB)


Discarded Dec-2018

Team believe this requires further consultation with National Population and Family Planning Agency (Badan Kependudukan dan Keluarga Berencana Nasional/BKKBN).

South Sulawesi Health Insurance for Pregnant Women into the Highest Referring Health Facility


Discarded Dec-2018

Team believe this requires further consultation with BKKBN.

South Sulawesi Puskesmas Internal Audit based on the MOH Regulation No. 44/2016

Jeneponto Oct-2018 Family Welfare Program (Ketua TP PKK), Bappeda, DHO RSUD, Women Empowerment Section of Provincial Government, other district government, PKK, Bosowa Foundation, and Kompas Newspaper.

Discarded Nov-2018 during work planning

HQ directed to focus on one solution in each of three districts: Bulukumba, Pangkep, and Bone. Not Jeneponto.

South Sulawesi "Ibu-Ibu Syantik" MNH Education Forum - private sector helps to improve early detection of high-risk pregnancies





South Sulawesi Capacity improvement (on job training) for health workers




South Sulawesi Advocating for Village Regulations for MNH

Sinjai Oct-2018 Ketua TP PKK, Bappeda, DHO, RSUD, DHO, PHO, Bank of South and West Sulawesi, CSR Forum, PKK, and Jakarta Post.

Discarded Oct-2018 at workshop

DHO took responsibility to implement this with existing resources.

South Sulawesi Dasa Wisma Reactivation and Improvement


Discarded Oct-2018 at workshop

DHO took responsibility to implement this with existing resources.

South Sulawesi Engaging IDI, IDAI, POGI, hospitals, and doctors to enhance coordination – improve relationships and willingness of doctors to accept others’ patients, revoking practice licenses, conducting clinic accreditation, and establishing a Public Safety Center (PSC) to support the referral system.


Implemented by Jalin in December 2018

South Sulawesi Establish MNH Forum & Optimize social media for MNH

Gowa Oct-2018 Ketua TP PKK, Bappeda, DHO, RSUD, PHO, Bank of South and West Sulawesi, PT. Mayora, PKK, LKBN Antara (media), and Berita Kota (media).

Discarded Nov-2018

District government lacked commitment.

South Sulawesi Monitoring, Detection, and Readiness for high-risk pregnancies


Discarded Nov-2018


South Sulawesi Improving Maternity Waiting Homes & Ambulances for Villages


Discarded Nov-2018


South Sulawesi MOU with CSR Forum to Improve MNH

Province May-2019 PHO and CSR Forum In design -

West Java Safe Mother and Child Software Provincial Mar – May 2018

PT Sinergantara Now cross border referrals

-


West Java Saving Next Generation and Baby Memo Software – monitors the health status of pregnant women and nutrition status of children.

Garut Aug-2018 Dhompet Dhuafa (a philanthropic foundation)

Discarded Apr-2019 The team prioritized other solutions.

West Java Tidung Suci - Puskesmas will accompany and monitor women’s health during premarital period and after marriage.

Sukabumi Sept-2018 Dinkes Sukabumi, Dinkes, Bappeda, Kemenag, BKKBN

Discarded Oct-2018

Ideas is still an abstract concept.

West Java Supporting Evidence-Based MNH Policy Making - MNH research using a health status assessment tools developed by USAID.

Sukabumi Sept-2018 UNPAD-Bumi Walagri (an integrated & evidence-based education program).

Discarded Oct-2018

HQ said regions should not generate evidence.

West Java Replicating and Strengthening Pregnant Women Screening Program - collaborate with OBGYNs from private hospitals to conduct screening at Puskesmas

Karawang Sept-2018 Karawang DHO, POGI Karawang, Puskesmas, Private Hospital, Regional Public Hospital

Discarded Jan-2019 Jalin decided not to prioritize Karawang.

West Java Optimizing Private Sector Support for Improving Blood Supply in West Java

Provincial Sept-2018 PT. Bio Farma (pharmaceutical company with cold bag technology).

Discarded Jan-2019 HQ directed regions to stop blood supply work.

West Java TOPDeAMOR – utilizes ojek drivers near Puskesmas to serve as motorcycle ambulances transporting pregnant women for ANC, delivery, medicine, and midwife visits.

Garut Oct-2018 Puskesmas Cihurip Kab. Garut (currently implements TOPDeAMOR)

In Design

West Java MNH in the Workplace (GP2SP) – 1) Pregnant mother class 2) Post-partum family planning program 3) Healthy Premarital Certification (Calon Pengantin Sehat/CATIN) for Women Workers at PT. Changsin. 4) Anemia and chronic malnutrition detection 5) Providing cold box for breast milk supply 6) Provide Mentoring for PT. Chang Shin Factory Clinic

Garut 1) Jan-2019 2) - 6) Mar-2019

PT. Chang Shin Reksajaya (factory owner), Labour unions of PT. Changsin Reksajaya (3 labor unions), IBI of West Java, Clinic in PT. Changsin (one clinic with 3 doctors and 3 midwives, DHO Garut (Puskesmas Leles), PHO, BPJS Garut, Manpower and Transmigration Office, APINDO of West Java, BKKBN, DPPKBPPPA, Jhpiego, POGI, Garut Religion Office, PT. Bio Farma, and ASKLIN.

Implementation -


West Java Family Planning Contraception Services Mobile Unit - MUYAN is a program of BKKBN to use minibus to provide family planning services for populations in remote areas.

Garut Feb-2019 BKKBN of West Java (runs MUYAN), PT Changshin (women workers need these services), Puskesmas Leles, PLKB (provides contraception tools), and DPPKBPPA of Garut District.

In Design

West Java Utilizing Village Fund - solve geographical Challenges and traditional birth attendants

Garut Feb-2019 DPMD (government unit responsible for village funds), FMM KIA, DHO and Puskesmas

In Design

West Java Advocating for a regulation that converts TBA from midwives' partners into pregnant women’s companions – limit TBA’s role in delivery process

Sukabumi Jun-2019 IBI, DHO, Subdistrict Government, POGI of West Java, HOGSI of West Java

Discarded Jul-2019 Similar regulation already exists.

West Java Utilizing Feeder Ambulances - utilizing AMMDeS multi-function vehicles to transport pregnant women to health facilities

Sukabumi & Garut

Jun-2019 PT KMWI (feeder ambulance manufacturer), Secretary of Tim Jawa Barat Juara (dr. Siska): West Java Governor's think tank, and West Java PHO.

In Design -

West Java Zoom Preeklamsi - initial screening, risk identification, and referral treatment for preeclampsia and eclampsia (similar to activities in Central Java).

Provincial Jul-2019 POGI of West Java, PHO of West Java, DHO, Puskesmas, and IBI.

In Design -

West Java Cross-Border Referrals – 1) PONEK hospital standards mapping, analyzing 24-hour availability of OBGYNs, the existence of a hospital blood bank, and surgery room 2) MOU on cross-border information sharing, referral systems, budgeting, and maternal and perinatal audits 3) Strengthening the implementation of information and communication system for referral (SISRUTE) 4) Cross-border regulations

Bogor District, Bogor City, Depok City

Aug-2019 ARSSI, Bogor DHO, Bogor City Health Office, and Depok City Health Office, (has its own referral system), POGI, IDAI, Bappeda, Provincial Government, Provincial Secretary (Sekda Provinsi), RSUD) from the three regions, PT STI and PT Sinergantara (private sectors with capacity in developing IT system for MNH improvement).

In Design -