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Yosepha (Sepha) Sita understands the importance of education. As a School Supervisor in Wolowaru Sub-district on Flores Island in Eastern Indonesia for the last 25 years, she knows that women need accurate information to make smart decisions about their health. But knowledge is nothing without the right services and facilities.  “A poor woman might receive information about how giving birth at a health facility (puskesmas) is safer for her and her baby, but she may not have the money to pay for transportation or accommodation once she’s there” Sepha said.

Sepha Sita, Head of the Wolowaru Puskesmas Community Board (BPK) and former Manager of the rumah tunggu, believes providing a place where women with little income can stay before and after they give birth is crucial to lowering the high maternal and neonatal mortality rates in this area.

“But with a ‘waiting house’ next to the health clinic, we can make sure that a woman with a high risk pregnancy quickly gets the care she needs,” she explained.  With support from the Australia Indonesia Partnership for Maternal and Neonatal Health Program’s (AIPMNH) Puskesmas Reformasi Program, Sepha, who is now Head of the Puskesmas Community Board (BKP) in Wolowaru, has played a major role in ensuring that women have access to this kind of waiting house, or rumah tunggu.

Often a very basic room or hut built next to a puskesmas, the rumah tunggu provides women and close family members with a free place to stay in the days before and after the woman gives birth. Especially for women with high-risk pregnancies in isolated villages where funds and transportation are scarce, being next door to a puskesmas at the moment of delivery can be a matter of life and death for them and their baby. 

“Imagine how complicated it is for a heavily pregnant woman who has just started having contractions to ride on the back of a motorbike or walk for hours just to reach the puskesmas,” Sepha explained. “Most of the women we see are poor farmers with very little education – the rumah tunggu provides a place for them to stay for free, where they can bring food and cook their own meals,” she said. 

Since the rumah tunggu began operating in Wolowaru, the number of women giving birth at the puskesmas has increased almost 65%. In 2012, 274 women gave birth at the puskesmas compared to 178 in 2011. Almost 50% of the women used the rumah tunggu.

Maria Erni Dhiu, 22, her husband and their two children. Maria gave birth to her first child at home but delivered her second at Puskesmas Wolowaru when she learned that she and her husband could stay at the rumah tunggu free of charge.

Maria Erni Dhiu, a 22 year-old farmer, lives with her husband in a village about six kilometres away from Puskesmas Wolowaru. It takes 45 minutes to get to the village by car, and even during the dry season, the road is littered with rocks and trees left behind by landslides. During the wet season, only motorbikes will attempt to travel on this road.
Erni, who gave birth to her first child at home during a rainstorm, used the rumah tunggu for the birth of her second child two weeks ago. The experience was far less stressful.

“The rumah tunggu was very clean and warm,” she said. “I was calm because my family was with me; the midwives and nurses were checking on me every few hours, so I felt safe.” 

Magdalena Vin, who has given birth to five children at home, used the rumah tunggu for the birth of her sixth child just a week ago. Magdalena, 32 and also a farmer, said she had not planned to give birth at the puskesmas, but the Head of her village convinced her to use the rumah tunggu, since her pregnancy was considered high-risk and because she lost her second child during childbirth. 

“I was surprised. My husband and I didn’t have to pay for the health service or the rumah tunggu,” Magdalena said.

Magdelena Vin, 32, gave birth to her sixth child at Puskesmas Wolowaru in April 2013. She delivered her previous five children at home. Having lost her second child shortly after she was born, Magdelena said she was happily surprised that she and her husband were able to stay there at the rumah tunggu for free, where they were “very comfortable” and attended to regularly by trained midwives and nurses from the Puskesmas.

“We were very comfortable there,” she explained. ”Also, the staff talked to my husband and me about birth control, and we have decided to use the IUD for family planning.”

As in the other 98 puskesmas supported by AIPMNH in 14 districts of East Nusa Tenggara Province (NTT), the Wolowaru rumah tunggu was partly funded through Puskesmas Reformasi. Through this program, AIPMNH has also provided staff of the Wolowaru Puskesmas with training on non-clinical service delivery (including standard operating procedures, ethics, transparency and team-building) and support for the formation of the BKP, which manages the rumah tunggu.

Pukesmas Reformasi works hand-in-hand with AIPMNH’s Desa Siaga, or Alert Village, Program, which supports communities to build finance, family planning, transportation and blood donor networks that ensure women give birth safely at health facilities versus at home with an unskilled birth attendant – one of the main factors contributing to high mortality rates of mothers and newborns in NTT.
Both of these community-centred programs complement AIPMNH’s work in Clinical Services, which aims to improve the skills of Puskesmas staff to handle emergency obstetric and neonatal complications (PONED). 

Since 2011, ten desa siaga have been established in the Wolowaru Puskesmas coverage area, a result of AIPMNH’s work with local governments to advocate for better planning and more funding for maternal and neonatal health. In fact, the sub-district now requires that a portion of its annual budget is put towards construction and maintenance of the rumah tunggu. The BKP works closely with the Head of Desa Siaga and the Desa Siaga Management Board to inform and encourage women to use the rumah tunggu. 

Wolowaru’s waiting house has been so successful in increasing births in the puskesmas that other villages have visited it in the hopes of replicating it in their own communities.

The rumah tunggu at Puskesmas Wolowaru (left). In just one year, the number of women giving birth at the puskesmas has increased 65%. AIPMNH is funding the construction of a new, larger rumah tunggu (right) to be ready in July 2013.

Marsel Roga, Head of the BKP for Puskesmas Welamosa in a nearby sub-district, visited Wolowaru and then established a rumah tunggu at Welamosa. According to Marsel, it has been occupied since “day one.”
“Sepha inspired us,” he said. “Besides excellently managing the rumah tunggu, she is very forward thinking and shares her knowledge.”
“Also, she has handed over management of the rumah tunggu to a younger member of the BKP,” he explained. “This is an important step to improve the competency of other members of the Board.”

“I am grateful for the knowledge I learned in the Puskesmas Reformasi and Puskesmas Management workshops conducted by AIPMNH in 2011,” Sepha said. “I worked in education for many years, but I see that it’s time for me to start paying more attention to health.
“I just do what I can to help people in this community,” she explained. “And if I can do a little to empower them, I will be very proud.”

 

AIPMNH is managed by Coffey on behalf of the Australian Government

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