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PROGRAM BIDAN DELIMAImproving Quality Care of Private Sector Midwives

Damaryanti Suryaningsih, MPHAbt Associates – USAID/ HSP

34th Annual Global Health ConferenceWashington, DC, USA,

May 31, 2007

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What is the Bidan Delima program?

Program to improve quality of service delivery and family planning in private sectorCertifies high quality midwives as “Bidan Delima”Promotes brand recognition among the general publicImplemented by Indonesian Midwives Association

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Source: Bull World Health Organ v.79 n.3 Geneva, IDHS 2002/3 World Health Report 2005

The Millennium Development Goals (MDGs): Progress Report in the context of health

Indonesia: 307Thailand: 129Malaysia: 39Singapore: 6

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Hemorrhage

28%

Infection

11%Eclampsia

24%

Unsafe abortion5%

Obstructed labor 5%

Obstetric Embolism 3%

5%

PuerperiumComplication

8%

Others

11%

Obstetric Trauma

Causes of Maternal Mortality

Every 2 hours Every 2 hours 1 Maternal Death1 Maternal Death

Source Household survey 2001

5Sources: MNH 2002, HHS 1995, NHS 2000

• Excessive bleeding: 46% (67% after delivery)• Induced abortion: 14 %• Anemia: 51% (when pregnant)

45% (after delivery)• Protein malnutrition: 4.8% • Chronic under nutrition: 21.2%

Causes of Maternal Mortality in Indonesia

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Why private sector?

HomePrivatePublic

Place of Delivery

31%

9%

59%

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Delivery Assistant

TBADoctorMidwifeOther

50% by midwife

53,468 midwives in Indonesia

26,662 private midwives

50%

12%

32%

5%

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Growing role for private sector

8%

15%

31%

19%

9%

9%8%

12%

1%

6%

11%

16%

21%

26%

31%

36%

1991 1994 1997 2002/03

% of deliveries in private and public sector Source: IIDHS series

Private sector

Public Sector

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Work relationshipUSAID provides technical assistance to the Indonesian Midwives

Association (IBI):

• Support start up activities in 11 provinces (2003 – 2009)• Working with IBI to develop:

- Management of Bidan Delima guidelines- Quality assurance instruments- Facilitator training package- Promotion Materials- Bidan Delima kits- Management Information System

• Develop capacity of IBI management in workshop facilitation and facilitator training

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Bidan Delima ProcessRegistration/

Pre-qualificationsSelf Learning

tools

Validation(external)Recognition

Quality Assurance

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Family Planning

Infection Prevention

Informed choice poster (3 Set)

sticker

Brochure

10 Messages for mother and midwife

MNH

Signage

Apron and pin

Bidan Delima Kit

Decision Making tool FP

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•Pre qualification •Self Assessment

Facilitator tools:•Validation tools•Facilitator guideline •Monitoring tools

Guidelines and instruments

Management Guidelines:•Management guidelines for central, provinces and districts level•Financial guideline

Facilitator training package:- Reference book- Trainers guideline- Participant book

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Where are we now……

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3942,190

6061,108

7125,5352,5031,0121,5434,8246,364

Private Midwives

TotalBantenAcehYogyakartaSouth SumateraBaliWest JavaNorth SumateraJakartaSouth SulawesiCentral JavaEast Java

Province

6,2961,0005,2562,807202011.202010.

17233139469.684915931068.403603432267.

1,2981421.1565686.19686123305.20230172344.5011383635123.

1,2472021,0454212.1,5402181,3228241.

FacilitatorBDCandidate of BD

Total BDAmount

No

Coverage (data as of May ’07)

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Challenges• Improve fee collection rates• Maintain Quality Assurance

systems• Ensure that the benefit

package for BD member is valued by bidans

• Improve “Business management” in IBI and private clinics

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• Bidan Delima website: www.bidan-delima.org• My e-mail address: dsuryaningsih@jsi.or.id