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Joria Parmin, Head of 2H2, and her staff monitor SMS messages 24 hours a day to make sure women have time to make it to health clinics and hospitals to give birth.

When a mother died while giving birth in her garden in 2009, the people of Flores Timor were deeply disturbed. Not that the death of a mother or newborn is foreign to this community - it is one of 21 districts in Nusa Tenggara Timor, Indonesia, a province with one of the highest rates of maternal and neonatal mortality in Southeast Asia. But the Province’s policy that all women should give birth in a health facility with a skilled birth attendant to reduce those high rates had been in place since 2001, and the number of maternal and neonatal deaths weren’t decreasing fast enough.

After this tragedy, the local government established the innovative 2H2 program that eventually won them an Indonesian MDG Award in 2011.  “What’s unique about this program is that it came out of real problems happening in this area,” said Joria Parmin, the Head of 2H2. “And the entire community is behind it.”

The “H” in the program’s name stands for hari, the Indonesian word for “day”. Under 2H2, women are monitored closely for two days before their delivery date and two days after through a mobile phone network that extends from far-flung villages to the district’s capital, Larantuka.

Through text messages that are automatically recorded in a central database, midwives in the villages inform midwives at community health clinics called puskesmas about who is pregnant and when they are due. Midwives at the puskesmas then inform the district hospital of those women who need to be referred. The result is a collection of data on all the pregnant women scheduled to give birth – and more women giving birth in the hands of skilled health workers at equipped facilities.

Considering that rural communities may lack running water and electricity, the fact that this data is gathered and transmitted via SMS demonstrates the power of this simple and cheap technology.

2H2 is an initiative of the local government, but the Australia Indonesia Partnership for Maternal and Neonatal Health Program (AIPMNH) has worked with and through 2H2 to help it grow into the successful initiative it is now.

“AIPMNH has really helped us advocate and push for this program to get it going,” Joria said.

Helena Eda Baluk and her baby in Riangkotek village, Flores Timor. Helena was referred to the district hospital by the village midwife through the 2H2 system

“It would not be as successful without AIPMNH’s support.”  

This support extends to the health workers involved at various points along the 2H2 network, from the village to the health clinic to the hospital.  Ibu Bidan is the midwife in Riangkotek, a village nestled in the hills outside of Larantuka. She helped get 26 year old Helena Eda Baluk to the hospital to give birth to her first child, who was in the breech position.

If Ibu Bidan and Helena are the points in the village along the network, then Nurhayati Burhan, Acting Head of the Perinatal Division at the District Hospital, is at the receiving end.

The Flores Timor District Hospital is part of AIPMNH’s Sister Hospital Program, - a partnership where a team of health workers from nationally renowned hospitals are contracted to provide on-the-job training to staff in district hospitals throughout NTT so that staff are capable of providing 24-hour emergency maternal and child health services.

Both Ibu Bidan and Nurhayati have been trained through support from AIPMNH in Normal Delivery Care and Family Planning. Nurhayati has also attended training in Basic Emergency Care, where she learned about managing C-sections and basic emergencies.

“The training was really about the transfer of knowledge” Nurhayati said.
“I have directly applied the skills I learned in resuscitation and C-sections since I attended,” she explained while in the small Perinatal Unit, where underweight babies weighing as little as 1.5 kilograms are cared for in incubators and equipment supplied by AIPMNH.

Fortunately, Helena’s baby Katherina was born without complications and is happy and healthy with her parents and in-laws in Riangkotek. By working closely with programs like 2H2, AIPMNH is helping to move mothers like her through a referral system so that tragedies like the one that started 2H2 no longer occur.

AIPMNH is managed by Coffey on behalf of the Australian Government

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