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“Better management will result in better services,” explained Dr. Bernadette Rizky Natalia (Dette), Head of Halilulik Health Clinic (puskesmas) in Belu, a district in Nusa Tenggara Timur Province (NTT), Eastern Indonesia.
“Improved capacity and services from the supply side and access to maternal and neonatal health (MNH) services for women and babies will save more lives here,” she said.

Dr. Dette is Head of one of the puskesmas supported by the Performance Management and Leadership program (PML) through the Australia Indonesia Partnership for Maternal and Neonatal Health (AIPMNH). Through this activity, the Partnership builds the capacity of managers and leaders in puskesmas, hospitals and the local government health office to support the achievement of MNH key indicators throughout NTT – one of Indonesia’s poorest provinces with one of the highest rates of maternal and neonatal deaths.

By developing training modules and materials specifically geared toward individuals holding management positions at these organisations in select districts, AIPMNH aims to create future leaders working in MNH in NTT, who can in turn bring about institutional change.
PML is a step-wise program using classroom training, comparative studies, web-based distance learning, workshops and mentoring. The Indonesian Public Health Association (IAKMI) provides technical input on the PML program and has worked closely with the regional technical implementation unit responsible for training health workers, UPTD Latnakes NTT. What differentiates PML from previous programs is consistent follow up after the management training. The Partnership works in six puskesmas in four districts for a total of 24 puskesmas, and with the related DHO that manages them.

Puskesmas training focuses on skills such as leadership and management (planning and budgeting, conducting mini-workshops, performance assessment) as well as service, professionalism and analytical capacity. Training for DHO managers focuses on planning and implementing supervision, providing technical guidance, and better understanding of health policy and regulations, amongst other leadership skills.

“As a doctor, I know how to treat my patients,” Dr. Dette explained. “However, when I was appointed Head of Puskesmas Halilulik back in 2011, I realised it was not an easy task to lead a puskesmas – I had never had any training on management and leadership in the university or my professional life.”

“But starting in August 2012 when the PML Program began at Puskesmas Halilulik, I learned that my staff needed direction and ongoing assistance so that we can all provide better service,” she said. “I can say that PML has helped me as the Head of the Puskesmas to better manage my staff and the clinic.”
Mr. Viktor Fahik from the DHO in Belu, who is assigned to work with AIPMNH’s PML program, confirmed Dr. Dette’s statements.

“You can really see the difference in the performance of Puskesmas Halilulik, where PML is being implemented,” he said.
“In terms of management, services in the Puskesmas have significantly improved,” he said. “I think it’s because they now have a clear vision and mission, and very clear Standard Operating Procedures (SOPs).” “PML has also helped the Puskesmas staff to work in a more transparent environment,” he said.

Indeed, Dr. Dette explained that PML’s guidance in establishing the vision from the start has been extremely helpful.
“Now we prioritise determining the vision and mission of the Puskesmas,” Dr. Dette said. “I can’t believe we didn’t have this before - having a clear idea of our goals has enabled us to determine the next steps to improve our service.”

“The SOPs for all divisions especially helped us to work in a more organised and focused manner,” she said.
“Since PML, we also have clear written job descriptions for staff and for each service unit,” Dr. Dette explained. “This has resulted in better management in drug supply – keeping a daily stock register, for example – and better monitoring and evaluation. Before PML, we had none of this.”

The improvements at the puskesmas level are designed to complement AIPMNH’s PML support to managers at the DHO. The PML program encourages the DHO to play a more active role in supervising puskesmas activities to strengthen the link between those managing MNH at both organisations.
According to Victor, the PML program has improved their capacity in supervision, especially in monitoring and evaluation (M&E).

“We at the DHO are much better and well-organised in terms of monitoring and evaluation,” he said. “Before PML, we didn’t really have a regular schedule for M&E.”
“Now we have a clear schedule and purpose for monitoring and evaluation, and more importantly we have the skills to do proper M&E,” he said. “We also have a schedule to provide technical guidance and mentoring which we didn’t have before; we make time to attend the puskesmas’ monthly meeting, something we didn’t prioritise before.”

It appears the local government in Belu has also been impressed with the results of PML. It has agreed to replicate the program in eight other puskesmas in the district.
With better collaboration between the management of DHOs and puskesmas, resources can used more effectively to combat NTT’s high maternal and neonatal mortality rates.

“Before PML, the DHO and puskesmas would often ‘fight’ over the budget,” Dr. Victor explained.
“But now instead of arguing about money, we put our heads together to find alternative solutions,” he said.

Dr. Dette (third from left), Head of Puskesmas Halilulik, Belu District, NTT. AIPMNH started the PML program in this puskesmas in August 2012. Dr. Dette credits the management training and support she received through PML for helping her to run a more efficient clinic that better serves its patients


Mr. Victor Fahik, who oversees implementation of PML for the Belu District DHO at puskesmas, including Puskesmas Halilulik. Victor says that AIPMNH’s PML program has helped the DHO to “improve its capacity in supervision, monitoring and evaluation and providing technical guidance to puskesmas.”

AIPMNH is managed by Coffey on behalf of the Australian Government

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