| 4. In which ways is the initiative creative and innovative?
|
|
The transit house was freely lent from the resident. The empowerment of the vegetable seller as the hunters was the successful strategy to overcome the limitation of the number of midwives. Within hours, as a result of using smartphone application, the hunter’s finding can directly be managed and executed by the laskar and midwife in charge. Another uniqueness, of this initiative is the obligation of the hunters to educate the community about the high risk pregnancy. The container of the vegetables, besides fully contained with the merchandises is also written with the information of high risk pregnancy. Might be, this type of innovation, is the one and only in Indonesia
Together with the midwives, the Laskar’s duty is to accompany the high risk expectant mother who previously founded by the hunters until the mothers had a birth. Since the SAKINA initiative started to be activated, the traditional midwives duty was reduced to only accompany the pregnant mother to go to the Puskesmas. The empowerment of the hunters, the Laskar and the traditional midwives actually was a simple collaboration, however, the collaboration have effectively solved the critical problem of maternal and child mortality of Sempu.
|
|
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
|
|
The spearheads of this initiative are the itinerant vegetables sellers. The empowerment of the vegetable sellers as the hunters of high risk expectant mothers was very strategic. It can be ascertained that in every villages in Banyuwangi, there are many itinerant vegetable sellers who starts their activity at 03.00 in the early morning and finishes at 10.00 AM. Equiped with the knowledge of the characteristic of a high risk pregnant, it had been proven that the hunters can easily detect the fragile pregnant. This fact, clearly shown that the itinerant vegetables seller are able to be not only the reliable and accurate hunters.
The other key actors are the Laskar who are recruited from the women local figures who have strong influence in the society. The traditional midwives also play an important role. Like in the competition, to get the reward they had competed each other to escourt as many as possible of the expectant mothers to the Puskesmas. The more number of the expectant mothers, the more they will get the reward.
Behind the successful collaboration among the three actors, there are very important roles by the Team of PUSKESMAS Sempu not only as the coordinator. Therefore, in the last three years, there was no maternal dan child mortality at all. The early age marriage of under 20 year old girls could also be suppressed. Previously from all of the marriage, 20 % were the early age marriage, in the last three years the percentage could be reduced to 9,2 %. This decreased of the early age marriage had an important contribution in reducing the number of high risks pregnant mothers. This initiative has specifically covered 10.020 poorest who are isolated in the middle of the forest with the income far under the average income of Indonesian citizens.
|
| 6. How was the strategy implemented and what resources were mobilized?
|
|
The initiative was legalized by issuing the Camat of Sempu decree with number 445/143/KEP/429.519/2014 3 January 2014. SAKINA is directly lead by the head of PKK of Sempu. The concrete programs that had been executed were :
• A MOU also signed with the head of the office of Religion Affair of Sempu to ensure that all candidates of the brides must attend the consultation in healthy reproduction, contraception and nutrition. Including pregnant examination and the healthy childbirths.
• The recruitment of the hunters by the midwives. The requirements for the hunters are : woman, energetic, communicative and able to operate a smartphone. From 39 applicants there were 10 applicants who have been selected to be the hunters. The hunters are equipped with smartphone, waistcoat with the logo “Pemburu Bumil Risti” (The hunters of high risk pregnant mother) and booth shoes. The training of the hunters is conducted regularly with the subject of the indication of the high risk pregnancy. The report by using the smartphone also was given in the training.
• The training for 23 members of the Laskar covered the indication of the high risk of pregnancy, the signs of childbirths, dangerous alert of childbirth, dangerous indication of newborn baby, reference system, recording and reporting. The duty of the Laskar is together with the midwives, accompany pregnant mother until giving a birth. The other duty are to adher the sticker in the house of the high risk Expectant Mothers and to socialize the transit house.
• Built an android application. Every information from the hunters will appear in the monitor screen in Puskesmas. In the screen, there is an areal service map of Puskesmas includes the villages. Every information that had been sent by the hunters will be converted to be a red dot in the screen. If the red dot clicked, in the screen will automatically appear the name, the age, the address, the name of the husband of the pregnant mother, the picture of her house and also her symptom of high risk pregnant. This type of presentation method via visualization is relatively new in Indonesia.
• Administrated a specific Village Regulation. The regulation mentioned that the every hunter and Laskar get IDR.100.000,-(US$ 7,48) plus IDR 60.000,- (US$ 4,49) from Banyuwangi health department as transportation cost.
• Monitoring and evaluating of the initiative became the responsibility of the areal midwives assisted by the PKK which consists of the wives of officials village. The public took part in giving the information about the high risk expectant mother who did not observed by the team.
The human resources who actively involved in the initiative are the Head of Puskesmas, doctors, midwives, traditional midwives, the driver of ambulance, the laskar, the hunters, head of Public Health Office of Banyuwangi, head of sub district of Sempu, head of Marriage Administrative Office of Sempu, Religious Preach, Cultural figures, PKK and Head of Villages.
Financial:
Banyuwangi health department 2014-2016 IDR 71.280.000 (US$5.335) As the transport fo the hunters and the laskar.
The village budget allocation 2015 – 2016 IDR 79.200.000,- ( US $ 5.928) as the incentive for the hunters and the laskar.
The initiative got the grant of US$ 7500 from Deutsche Fuer Internasionale Zusammenargeit (GIZ) . The grant, was given as a reward to the uniqueness of the idea of the hunters in the event of URUN IDE Jawa Timur 2016 which managed by GIZ in collaboration with Pulsa Lab Jakarta. The grant was used to buy the smartphones, built the application, buy the weistcoats, revitalization of the vegetables box and procurement of the huntters’booth shoes.
|
|
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
|
|
The Head of the public health office of Banyuwangi as the initiator and the person in charge of public health in Banyuwangi. He has to provide the budget to fund the program and the transportation for the hunters and the laskar. More over, he has to have commitment to increase the budget for the initiative every year.
The head of Sub-district of Sempu as the head of the region had issued the decree as the legal basis of the initiative.
The Head of PKK of Sempu as the Head of initiative. Her duty beside responsible in successing of the initiative, also to stimulate the members of PKK in the village level to actively involve in supporting the initiative. She had also involved in designing and initiating of the initiative.
The Head of PUSKESMAS besides as the initiator and the Team Secretary, he also as the motor of the initiative. He must also directly command the hunters, the Laskar include the traditional midwives. He kept the unity of the three important pillars include the ambulance’s driver. Since the existency of them is the spearhead of the initiative.
the head of Marriage Registrar Office of Sempu is the fasilitator of consoling for the candidate of brides in Puskesmas.
The head of the villages, issued the regulation of the village to allocate the village budget to monthly give incentive to the laskar and the hunter.
Religious and cultural figures actively involved in dissemination of the initiative. Their involvement of the key figures, especially the religiuos leaders, have made the public easily directed to use the health service rightly . Even, there were the resident who voluntarily lend his house to be the transit house.
|
|
| 8. What were the most successful outputs and why was the initiative effective?
|
|
Firstly, the availability of the two transit houses. The location is in the main road therefore can be reach by the ambulance easily. The mortality of the mother often occurred because of the late of birth aid delivery by the midwive. That is the result of the mountain road which can hardly be reached. By providing the transit houses, as the temporary house for the expectant mothers, the aid delivery can be conducted faster therefore the mortality can be avoided.
Secondly, the establishment of simple but effective collaboration among the hunters, the laskar and the traditional midwives. the finding by the hunters, as a result of application system, within hours, can be followed up by the laskar and midwives until the expectant mother give a birth. With the system, the head of Puskesmas will be able to monitor the high risk expectant mother via monitor screen easily. The traditional midwives, who previously always helped labor, after the activation of the initiative, changed their function to be only escourt the expectant mother to go to Puskesmas.
The third, sticker of emergency contact, as a mean of fast aid. The stickers were adhered at the house of the expectant mother. Therefore, if she need an emergency aid, the neighbor can contact the midwives or ambulance’s driver that standby 24 hours via the number in the stickers.
The fourth, the issued of village regulation which ruled the incentive to the hunters and the laskar. Added by the budget that prepared by the public health office of Banyuwangi for funding the program.
The fifth, the involvement of the key figures in the society. The key figures, especially religious and cultural figure include the traditional midwives as the role models. Because of the key figures, the public can be easily directed to used the healthy services. The position of the figure in Indonesia is noble and what they say will become the reference.
The five output clearly become the key factor of the initiative in reaching the third target of SDGS point 1 and 2 that are to suppress the maternal of mortality by 70/100.000 save birth and the child mortality by 25/1000 life birth. Even in the last three years, the out put could save 1.514 mothers and their babies. And the peak was, until Desember 2016 the mortality became zerro.
|
|
| 9. What were the main obstacles encountered and how were they overcome?
|
|
The prime obstacle were the living mythos among the people that the death in giving a birth was the insurance to enter the paradise and the strong reluctance of the public to change. The believe that if they inform the paramedic about their pregnancy their fetus would easily be attacked by the black magic. However, an intensive and embraching approach by the team supported by the key actors as the agent of change had reduced the cultural and the tradition obstacles.
The areal service of Puskesmas of Sempu mainly located in the remote area with road which was very difficult to accessed by an ordinary vehicle. The geographic obstacle was solved by renting truck to provide jemput bola (proactive) services in the area. Because only the truck that is able to stab the hard field of mountain area. To pay attention on the problem and to avoid the late birth aid delivery, the team provided the transit house located in the edge of the forest and the main road therefore could easily be reached by the ambulance.
In the beginning, this initiative was only known by the member of Puskesmas and few people. This problem was overcame by printing the sticker to be adhered in the house of the expectant mothers. If the public need an emergency help, the can contact the telephone number which is contained in the sticker. In addition, the team had also printed the leaflet contains all of initiative’s activities to be distributed to the public.
The last was psychology obstacle, the hesitation to be success. The head of PUSKESMAS of Sempu had continuously ascertained the people that building of the strong collaboration from all of elements will become the key success of this initiative.
|