Governmental Institution
Lasinrang Public Hospital, Pinrang Regency

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Maternal and infant’s mortality rate in Indonesia is high compared to that of another developing countries. In 2012, the rate was estimated at 32 deaths per 1.000 success deliveries, way higher than the 24 deaths per 1.000 success deliveries targeted for 2014. For 2015, we set to reduce the number to 23 deaths per 1.000 success delivery. Lasinrang Public Hospital in Pinrang Regency South Sulawesi is the only tertiarry medication center in the regency and serves 12 districts. The total population in the regency is 360.019 individuals. Its geographic conditions limits the access to get medical attention located in the regency capital. Perinatal mortality rate in Pinrang Regency was registered at 60 deaths per 522 deliveries, a staggering 11.5%. Key factors causing the severity of the problems are: a. Poor commitment of civil servant in providing services. The civil servants are unaware of the need to the right attitude in delivering service, to the point that hospitalities were nearly absent. b. Overdue medical emergency. Most maternal cases that were transferred to Perinatology Unit in Pinrang Public Hospital have high severity and were overdue. Procedural barriers and incoordination between Community Health Centers, Maternity Centers and individual midwives contribute significantly to the problem. c. The lack of information centers to communicate public’s need and to socialize our services. d. The Standard Operating Procedure that we had was not tied nor consolidated with the need of the service users. e. The limitation of infrastructures. f. The lack of competence human resources.

B. Strategic Approach

 2. What was the solution?
As its respond to the high mortality rate, Pinrang Public Hospital’s management initiated the development of the perinatology unit. We coordinated with vertical government units in Regency, Provincial and National levels as well as NGOs and community members. The steps taken to put the initiative forward are: a. Consolidating ideas and perception regarding the matter at hand. All staffs and various supporting government units are involved in this process though series of meetings and discussion. The consolidation processes encourage the employees to be committed in providing better services. Such commitment is conceptualized in a series of motivating statements by all hospital’s staffs. b. Reorganization of referral system: we provide an Internet-based referral system that connects the hospital with community health centers, sub-centers and municipal midwives. This referral system facilitates immediate respond for any medical emergencies. I has successfully increase the timeliness of our respond towards emergency maternities. c. Providing call center: this step opens broader access for the society communicate with our staffs. It eliminates the need for complicated bureaucratic procedure thus increasing the quality of our responds. d. Constructing new Standard Operating Procedures: the SOP dictates the formation of several teams (red, green, yellow) to respond different level of medical emergency. It also regulates the execution of kangaroo care for infants. e. The improvement of hospital’s infrastructures: this step is part of our business and strategic planning and allocated in our annual budget. It comprises the construction of new perinatology ward, new medical equipment and other infrastructure to fulfill the service standard. This strategy accelerates the improvement of our service to the public as adequate rooms and facilities means more flexibility in delivering services. f. Improving the competence and skills of the human resources: Perinatology Unit of Lasinrang Public Hospital has a cooperation program with USAID in providing trainings and workshops for all administration and medical staffs.

 3. How did the initiative solve the problem and improve people’s lives?
Perinatology Unit of Lasinrang Public Hospital provides medical care for neonatals (0-28 days) with high medical risks. It is innovative in at least four different aspects: a. Online referral system as a product of our cooperation with USAID: this system is superior to conventional system because it integrates the services given by other medical center across Pinrang Regency. It helps the identification of maternity patients with high risk thus allowing better preparation when the patients and their infants are referred to Lasinrang Hospital. b. The improvement public’s accessibility: our call center provides various information such as medical advice and infant status information, thus helping the society in obtaining immediate and proper health care. c. Free transportation for patients from poor family. d. The existence of public complaints and reporting center through complaint box, text message of phone calls.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Our Perinatology Unit is an effort to optimize the care for neonatals. The forms of its development are 1) online referral system; 2) service information access; 3) special service methods; and 4) ease of service administration. It is aimed at increasing public’s access to perinatology services, especially for infants with high risks. The referral system prioritizes the management of information regarding maternity patients who will be potentially referred to our unit, i.e. patients with high medical risks. It opens intensive communication between care givers across Pinrang so that immediate actions can be taken with proper preparations. With this system, information such as patient social information, list of diagnosis and action already taken by care givers can be obtained in due time. Online referral system provides clear instructions for medical staffs and midwives on the proper steps to be taken. To ease the public’s access towards the information that we have, our unit provides a call center special for mobile phones. This information access is a channel for the society to get direct reference, service information, medical consultation, and the status of infants being cared in Perinatology Unit. Another type of care that we provide is kangaroo care for infants with low body weight. It benefits the infant because during the procedure its body temperature is maintained by a direct contact with its mother. This type of infant care helps increase its body weight, and accelerate its recovery and creates bonds with its mother. The procedure is only taken if the parents are willing and in healthy condition. Our unit forms special teams to respond to different types of medical emergencies. Red team attends infants with breathing problems and takes actions such as oxygen therapy or if needed positive pressure ventilation. Yellow team is responsible for the preparation of emergency trolley, prepares fluid infusion and other medications as instructed by the physician, monitors blood circulation and assists in CPRs. Green team controls oxygen supply, emergency trolley and suction, assists in patient’s fixation, contacts the physician, documents every medical actions taken, administers medicine intakes and delivers samples to laboratory.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The stakeholders are as follows: a. Pinrang Regent who authorized budget allocation for the formation of the unit. The Regent is committed to provide high quality service for its people and regulates that poor patients will receive free medication in Lasinrang Public Hospital. b. The Director Lasinrang Public Hospital, Management Board and all staffs who continuously develop new methods of service betterment. c. The Health Affairs Agency of Pinrang Regency as the coordinating body in the public’s health care service provided by both state and private sectors. d. NGOs especially Madani Society Forum that monitor and evaluate our performance in delivering public service. e. USAID that assists the management in training and assessment programs for the development of our human resources f. Ministry of Health Affairs
 6. How was the strategy implemented and what resources were mobilized?
a. Budget allocation for the improvement of infrastructures in Lasinrang Public Hospital are as follow:  IDR2.338.571.428 in 2012 were allocated for the construction of perinatology ward, equipment procurement and human resources development.  IDR2.309.312.000 in 2013 were allocated for the procurements of incubator, CPAP, syringe pump, infusion pump, trainings and the development of referral system.  For 2014, our budget appropriation is IDR1.857.283.000. b. In providing the network utilized in online referral system, Lasinrang Public Hospital is assisted USAID. Those resources are mobilized through: a. Service need analysis based on service standards, equipment and infrastructure standards, and unit’s initiative proposals in the development of Perinatology Unit. b. Seminars, workshops, meeting, focus discussion groups that are conducted to evaluate the execution of the initiative and produced the latest information on service mechanism, system and procedures.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Since 2012, infants mortality rate has been reduced significantly. From 11.5% to 5.1% (46 out of 935) in 2013 and 4.15% (42 out of 1.013) in 2014. The details are: a. Immediate actions can be taken thanks to online referral system and information obtained from (and given by) our call center. b. The improvements of staff’s commitment and motivation thanks to simpler mechanism of patient’s referral system. c. Reducing the cases where patients are transferred in an already critical conditions or if it’s critical, preparations can be made to accommodate immediate actions. d. Ease of communications between hospital’s staffs, medical personnel outside the hospital i.e. community health centers and midwives, and between the hospital and the public. It has directly improve the speed of our responds toward various emergency situations and thus reducing infants mortality rate. e. Eliminating financial barriers for maternity patients who come from poor family because our hospital provides free medications for them.

 8. What were the most successful outputs and why was the initiative effective?
a. Routine inspection and observation by management board. b. Coordination meetings with external parties to communicate the challenges faced in the implementation of the system. c. Three monthly competence evaluation to ensure the performance of our medical staffs (midwives and nurses). d. Training and technical assistance to improve the skills and competence of medical staffs. e. Evaluation board to assist our staffs in maintaining the perinatology ward and measure the performance. f. Public participation in evaluating the quality of the service through:  Public satisfaction index surveying.  Opening public reports and complaint center i.e. direct reports and phone or text messages.

 9. What were the main obstacles encountered and how were they overcome?
The obstacles encountered are as follows: a. The need to procure high-tech equipment due to the uniqueness of medical cases and need in perinatology. b. Social taboo on separating infants and their mother after birth The solutions taken are: a. Improving the allocation of Regency and National budget for the hospitals as well as optimizing the increasing independency of Lasinrang Hospital in managing its own fund. b. Personal approaches in providing information for the family before, during and after hospitalization.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
a. From infants mortality rate perspective, the publics are benefited through:  reducing neonatal mortality rate  broadening the scope of service on neonatal with risks  increasing coordination between medical centers b. The impacts on public’s access towards health care services:  The increase in the number and quality of infrastructures also increases public’s confidence in our unit: o 2010 - 376 patients o 2011 - 458 patients o 2012 - 522 patients o 2013 - 935 patients o 2014 (January to August) - 1.013 patients  Ease of access for Pinrang people to care for their neonatal in their own region. In some instances, our unit even handles patients from outside Pinrang Regency. Patients referred to the Perinatology Unit of Lasinrang Hospital are increasing each year: o 33 referrals out of 458 patients in 2011 (6%) o 36 referrals out of 522 patients in 2012 (7%) o 153 referrals out of 935 patients in 2013 (16%)  Public satisfaction index is increasing: o 69.52 (Good) in First Semester of 2013 o 72.56 (Good) in Second Semester of 2013 o 74.68 (Good) in First Semester 2013 c. Public participation as the result of public complaints and reports center:  25, 50 and 6 reports through text message/phone, complaints box and report counter respectively in 2013 (a total of 81 reports)  22, 7 and 1 reports through text message/phone, complaints box and report counter respectively in 2014 (a total of 30 reports)

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Every hospital is expected to develop its own perinatology unit to increase their services, especially in maternity cases. Such development is possible if commitments and supports from the related parties are there. Lasinrang Hospital does have extensive supports from Pinrang Regency Government. It has become study case for various hospitals in South Sulawesi namely Fatimah Maternity Center Makassar, Aisyiah St. Khadijah Hospital Pinrang and several other hospitals. In 2014, we receive the honor of being included in Top 33 Public Service Innovation by The Ministry of Government Apparatus Empowerment and Bureaucracy Reform, and a top 5 spot in a public service award by The Fajar Institute of Pro Autonomy. With the accolades we hope Lasinrang Public Hospital’s Perinatology unit can inspire other units in the regency

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
The formation of on Perinatology Unit in Lasinrang Public Hospital has reduced neonatal mortality rate and provide the following lessons: a. Leaders commitment and attention is key to supporting efforts in solving various problems in society especially regarding the high rate of neonatal mortality b. The importance of the involvement and supports form all parties i.e. shared perception, work focus, responsibility and the sustainability of the program. c. The importance of the availability of adequate infrastructure and human resources. d. Ease of communication can contribute significantly to the quality of service, especially when methods to realize it are continuously developed and improved. e. The importance of monitoring and evaluation f. The need to realize service accountability: the step toward this have been taken through the “Statement of Service” and all parties in Perinatology Unit of Lasinrang Hospital will be committed to it.

Contact Information

Institution Name:   Lasinrang Public Hospital, Pinrang Regency
Institution Type:   Government Agency  
Contact Person:   Siti Hasnah Syam
Title:   Head of Lasinrang Public Hospital  
Telephone/ Fax:   +62421921298/ +62421924776
Institution's / Project's Website:  
Address:   jl.macan no 22 of pinrang district
Postal Code:   91211
City:   Pinrang
State/Province:   South Sulawesi

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