How East Java used vegetable sellers to cut childbirth deaths

By Nurfilzah Rohaidi

Indonesia’s Banyuwangi district developed a unique programme to reduce infant and maternal mortality.

Image: OXLAEY.comCC BY 2.0

The numbers are sobering. In 2015, 567 women and 5,000 babies in the province of East Java, Indonesia, died during or shortly after childbirth.

It is a difficult reality to face today. In the case of Banyuwangi district, there is a lack of data on at-risk pregnancies, and no reliable means to get them. The midwives are overworked and stretched thin. And there is insufficient education amongst the locals on what to look out for once they are pregnant.

The local government in the district worked with TRANSFORMASI, a programme for public sector reform, to develop an initiative to find and help women who were at risk of complications during delivery. TRANSFORMASI is a joint effort between GIZ, a German development agency, and the Ministry of Administrative and Bureaucratic Reform and the Ministry of Finance in Indonesia.

Remarkably, the initiative led to zero mum and baby deaths for most of 2017.

The challenges

Banyuwangi district lacked data on women with high-risk pregnancies and where they lived. There were not enough midwives to serve the entire district, and it was difficult for them to travel to the more isolated villages. This small pool of midwives also have to do double duty - they run administrative tasks, oversee finances, coordinate programmes, and manage auxiliary health clinics.

And women in the district’s villages lacked awareness on the dangers of high-risk pregnancies. They did not know whether their pregnancies would be considered high-risk, and would only seek the services of a midwife a few days before their due date. This meant that the midwives could only help during childbirth, instead of enabling mothers-to-be to prepare for a safe delivery.

The solution

In October 2016, a district community health centre launched the High-Risk Pregnancy Hunters programme, an effort to identify and locate women with high-risk pregnancies and determine their risk of complications during childbirth.

They recruited vegetable hawkers as “high-risk pregnancy hunters” as they were naturally privy to information about who was pregnant in the village. These sellers were already well-known and accepted by local communities; they had their own means of transportation; owned mobile phones; would visit every village everyday; and interact with housewives on a daily basis.

The programme trained them on how to spot a high-risk pregnancy. Factors include: being pregnant under the age of 20 or over 35; being too close to delivery; already having a lot of children; having previously suffered a miscarriage; and so on. They were given vests to wear, with “High-Risk Pregnancy Hunters” printed on the back, and their motorbikes and vegetable baskets were painted with information on high-risk pregnancies.

The health centre also developed a mobile app for these sellers to input real-time information and photos of women with suspected high-risk pregnancies. These data fed into a map, which helped the head of the health centre and midwife coordinator to deploy resources to the women in these areas.

One challenge they encountered was that there was limited 3G or data access in a few of the villages. In this case, they would simply SMS the data to a midwife at the health centre, who add it into the clinic’s system for them.

The impact

There has been a decrease in mother and infant mortality since the programme started. Between November 2016 and September 2017, the hunters successfully identified 37 women with high-risk pregnancies. Between January and August 2017, the number women or babies dying during or just after childbirth went down to zero.

The health centre also has much more complete information on the whereabouts of women with high-risk pregnancies, and data on other pregnant women. Volunteer health workers now conduct widespread first-stage checks to identify newly pregnant women in the villages. These volunteers also immediately follow up on the hunters’ findings, serving as additional resources to help midwives check up on pregnant women.

View the entire report here.