Reducing Maternal and Neonatal Mortality in Indonesia Saving Lives, Saving the Future (2013) / Chapter Skim
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Chapter 8 Recommendations
Chapter 8 Recommendations
Pages 91-100
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From page 91... ...
As defined by the World Health Organization, a CEmONC facility must be staffed by trained doctors, nurses, and midwives and must be able to perform cesarean sections, provide blood transfusions, undertake vacuum delivery of the baby, administer magnesium sulfate and antibiotics, and render the other services necessary to remedy those conditions that most commonly cause maternal or neonatal mortality in Indonesia. The joint committee recognizes that in Indonesia, as in other countries, most births occur without problems.
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From page 92... ...
In the meantime, community health centers and midwives must continue to serve their patients. The transition will occur as BEmONC and CEmONC facilities, supported by effective health insurance plans, begin to provide adequate services and gain the confidence of patients and their families.
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From page 93... ...
The BEmONC clinics now found in all districts could be brought up to accreditation level and linked with CEmONC facilities when blood transfusions and cesarean sections are required. Table 4-5 in Chapter 4 reveals that in parts of Indonesia private hospital services have become much more significant over the last decade and may be able to play an important role in increasing access to good-quality maternity care.
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From page 94... ...
Only strong leadership from the central government can effect the changes required to reduce mortality at childbirth. Creation of a systems approach to obstetric and neonatal care would be greatly facilitated if there were greater coordination among organizations charged with training and licensing care providers, operating health care facilities, setting standards for quality of care, approving birth plans, and collecting data for monitoring performance.
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From page 95... ...
The system for training skilled birth attendants should be revised to include the training of physicians and nurses who specialize in emergency obstetric, neonatal, and anesthesia services. Training of midwives should emphasize recognition of obstetric emergencies and the design and implementation of birth plans that include prenatal care and evaluation and early referral for complications, as well as, most important, a clear plan for the birth to take place in a BEmONC or CEmONC facility.
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From page 96... ...
Midwives will likely have a larger impact on maternal and neonatal survival by focusing on implementation of a certified safe birth plan for each woman and providing other routine services such as family planning, immunizations, and integrated management for childhood illnesses such as diarrhea and pneumonia rather than by managing or treating obstetric emergencies, which generally require a higher skill level. However, training might include some critical childbirth interventions such as administration of misoprostol, treatment of neonatal sepsis or asphyxia, or kangaroo mother care, 1 especially in the more remote regions where other services might be unavailable.
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From page 97... ...
Furthermore, many districts do not spend their entire allocated health budgets because of inefficiencies in the budget delivery process. New programs that provide health insurance coverage for childbirth-related services are possibly increasing overall funding.
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From page 98... ...
Different approaches to measuring mortality rates yield different results and different assessments of the progress made. Estimates employing both the sibling technique and models based on the maternal mortality ratio and childhood mortality rates offer no conclusive assessment of trends and MDG achievements.
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From page 99... ...
As part of a multi-tiered system, the posyandu serves as the first line of care, followed by basic professional care at health centers and clinics, and then higher referrals to district and advanced hospitals. Consistent with recommendation 4 on the role and training of midwives, the current village-based midwives would also focus on community-based activities in support of safe childbirth, including provision of antenatal care and more active development of a birth plan ensuring delivery in a certified facility.
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From page 100... ...
However, with little recorded change in fertility rates since 2000 and a consistent gap in unmet need for contraception as measured by subsequent IDHS reports in 2007 and 2012, there is room for further decrements in fertility that would likely have a positive impact on maternal health. These decrements need to be encouraged by means of a reinvigorated family planning program that should constitute an integral part of safe childbirth services offered to Indonesian women.
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