Decreasing the high maternal and neonatal mortality rates in Eastern Indonesia requires more than improving the skills of health care workers or local health facilities. Working steadily throughout villages in 14 districts in Nusa Tenggara Timur province (NTT) are 28 Community Engagement (CE) mentors supported by the Australia Indonesia Partnership for Maternal and Neonatal Health program (AIPMNH), who live and work in these communities to bring the local government, community members and health care workers together to ensure more mothers and babies survive.
Contracting individual mentors directly, rather than through local NGOs or institutions, allows the program to take a more personalised, cost effective approach to ensure Value for Money. All mentors receive specialised training on how to support specific AIPMNH CE programs at the village level and on working through inter-sectoral government agencies at the District level. They are well known in their communities and can give targeted advice and assistance to stakeholders in the community.
“I have been working in village development for a very long time, and I know how people in the village struggle for a better life and what the government can and cannot do,” explained Mr. Frans Pito, a mentor supporting the Alert Village, or Desa Siaga, program in Ngada, Flores. “I want to help the community, and I saw a chance to do that through AIPMNH.”
Frans, 58, is a mentor for Desa Siaga, a government program supported by AIPMNH that encourages the community to build networks responsible for getting pregnant women to health care facilities in time for a safe delivery. With more than 30 years experience working in local government, Frans understands that although government support is key to keep Desa Siaga functioning long term, it is crucial that community members recognise that maternal and neonatal health (MNH) is an issue that they have the power to address.
Like other CE mentors, Frans travels regularly to villages to hold meetings with villagers to “facilitate them and keep their spirits up.” He also meets with the Head of the Village, puskesmas staff, and government agencies involved with MNH, advising them on planning and budgeting.
It’s this kind of sustained, daily work at the ground level and the results that Desa Siaga has produced that has led to the local government allocating more funds to support MNH.
Frans explains that the District Government has already allocated around Rp. 2–5 million/month per village to fund waiting houses, or rumah tunggu, where pregnant women can stay next to the puskesmas for a few days before they’re ready to give birth. In 2012, the local government proposed that 15 MNH activities should be funded by their budget. Part of this increase went to Desa Siaga, and in 2013, the budget for it increased to Rp. 1.3 billion. In 2014, the budget increased to Rp. 8 billion to focus specifically on continuing the work in villages supported by AIPMNH.
“I think this is a very good start,” Frans said. “Budget sustainability is very much dependent on support from the local government.”
The Head of the Village in Manubahara, Mr. Markus Lina, attests to this.
“We’ve had Desa Siaga here since 2010,” he explained. “But it was dormant until the AIPMMH mentor came and helped us reactivate it in 2011.”
With support from Frans, Markus created the One Thousand Rupiah Movement, Geger, where each household contributes Rp. 1000 every day to village development. According to Markus, 18% of this budget is used to support health, specifically MNH. As a result, every pregnant woman now receives Rp. 250,000 to assist with transportation and accommodation to make sure she has the means to deliver her baby at the puskesmas.
“I truly believe that when people are engaged in planning and finding solutions for their own issues, the chance of success is better,” Markus said.
Mr. Thomas Dolaradho, 65, also works as a mentor in Ngada District, supporting AIPMNH’s Puskesmas Reformasi program, which supports puskesmas to implement a more professional and customer-service oriented approach.
Having led the Ngada District Parliament himself for five years after serving as a member for more than 20 years, Thomas says he tries his best to “apply his political and technical skills” to his current role as a mentor.
“I still have many connections in this district because of my past position,” he said. ”This helps me build good relations with the church, puskesmas, officials in sub-districts and villages, women’s groups, local NGOs, and community representatives, who are all key to making changes.”
Thomas explains that the first step was helping the puskesmas to lead a complaint survey, through which the community voiced their concerns about the puskesmas, such as poor service or uncleanliness. This standard practice of the AIPMNH CE program helps puskesmas staff understand how the community views it and why it does or does not use its services.
Through this survey, informal gatherings, workshops and meetings with different parties, Thomas believes he and other mentors have “successfully convinced the community that MNH is not only the government’s responsibility but everyone’s in the village too.”
Thomas’ work has paid off. In addition to allocating more funding to MNH, the local government actually decided to replicate the mentor model in its 2015 budget so that the mentor’s support to the community will remain after AIPMNH finishes this year.
“I am very happy that replication is happening in the district, not only of Puskesmas Reformasi but also mentor replication,” he said. “The decision is not because of me – it’s the people’s voice.”
But not all CE mentors have years of political or village development experience. Fresh perspectives are also needed to reinvigorate programs that support MNH in the village.
Marselina Sedo, 25, works as a mentor in Kota Kupang, for Kelurahan Siaga (similar to Desa Siaga but at the city level) and Revitalisasi Posyandu, which aims to revitalise local health services provided through small, mobile health clinics in the villages.
Marselina has helped villages identify their issues and write proposals to find funds from private companies through their Corporate Social Responsibility (CSR) programs.
“I wanted to help the community understand the possibility of other sources of funds, and I guide them to write a good and convincing proposal,” she said. “When people do this together, it creates a sense of belonging.”
“When AIPMNH is finished, I want the village program to remain active and independent,” she said.
Marselina’s support helped the village of Manutapen obtain Rp. 15 million from a CSR proposal, which they used to build a posyandu – which led to their award for “Best Independent Posyandu“ in 2013.
Beyond this, the Kupang Municipal Government has replicated the Kelurahan Siaga program in 10 villages in addition to those already being supported through AIPMNH using their own budget with support from Marselina to help them write their strategic plan.
Marselina says she is very happy that the number of neonatal deaths has decreased in Kupang City, the capital of NTT. She believes this is the result of many parties’ efforts and contributions, including Kelurahan Siaga and Revitalisasi Posyandu.
“When I see that Desa Siaga can save the life of a mother or baby, that is what I find most rewarding,” Frans said. “After all, that’s the point, isn’t it? To make all pregnancies and deliveries safer.”
|Frans Pito is one of AIPMNH’s Desa Siaga, or Alert Village program, mentors. As a former civil servant for more than 30 years, many of which were spent on village development, Frans believes that engaging government stakeholders is key to bringing about policy changes that can reduce maternal and neonatal mortality. However, support and participation from the community is what will bring about lasting change||Marselina Sedo works as a mentor in Kota Kupang for Kelurahan Siaga (similar to Desa Siaga but at the city level) and Revitalisasi Posyandu, which aims to revitalise local health services provided through small, mobile health clinics in the villages. She is “very happy” that the number of neonatal deaths has decreased in Kota Kupang and believes it is the result of many parties’ efforts and contributions, including the Kelurahan Siaga and Revitalisasi Posyandu||Thomas Dolaradho works in Ngada District, Flores as a mentor for Reformasi Puskesmas, which supports health clinics to implement a more professional and customer-service oriented approach. He believes that AIPMNH mentors have helped to convince communities that maternal and neonatal health is their responsibility as well as the government’s|