Desita examines a mother-to-be during a prenatal check-up.Photo credit: Save the Children/Irma Hidayana.

Desita is a midwife from Seuneubok Lhong, Aceh Province, Indonesia.

“Before I came to the village, many mothers here were still giving birth at home using traditional birth attendants. This was very dangerous because of the increased risk of infections. Also, these traditional birth attendants are not trained to handle complications that can kill a mother or her baby during childbirth. When I decided to become a midwife, one of my greatest motivations was knowing that I could help prevent these unnecessary deaths of mothers and babies.

Recently, I helped a woman named Syafrina when she gave birth to her first child. She was complaining of increased pain. I suggested we should go to the village health center but she didn’t want to go because there were a lot of people around the health center working on the building and she felt embarrassed. Later that day when most people had left, I managed to persuade Syafrina to have her birth at the health center instead of at home.

It was a long and difficult birth. The baby had the umbilical cord wrapped around her. It took two hours, but eventually I delivered the baby. When she came out, the baby was a blueish colour and she didn’t cry. I cleared her airways and tried to stimulate her by gently rubbing her body, but still she didn’t cry. So then I resuscitated her using a tube, and finally she cried! We all felt so happy and relieved! Soon after the birth, I showed Syafrina the correct position for breastfeeding her baby. The baby had some problems latching, but I encouraged Syafrina to keep trying, and after about an hour she was breastfeeding successfully.

Since the birth, I have visited Syafrina and the baby at home many times. I always do these postpartum visits to check on the health of the mother and baby, to make sure they are breastfeeding, and to help with any questions or problems”. You can read more about Desita’s journey as a midwife here .

Neonatal mortality rate  (per 1,000 live births) (2011) 15
Under-five mortality rate (per 1,000 live births) (2011) 32
Maternal mortality ratio (per 100,000 live births) (2010) 220
Number of doctors, nurses and midwives per 10,000 people (2010) 15.9
Births attended by skilled personnel (2010) 79.8%
Total expenditure on health as a percentage of gross domestic product (2011) 2.7%
General government expenditure on health as a percentage of total expenditure on health (2011) 34.1%

In Indonesia, various insurance systems offer coverage to approximately 65% of the population. The country has made progress in reducing maternal mortality, and is on track to meet MDG 4. The rise of non-communicable diseases is the next great health challenge to be addressed.

The broad picture across the domains of availability, accessibility, acceptability and quality shows many strengths: the availability of skilled health professionals is currently below thresholds but could realistically be scaled-up to meet these by 2035 – this need is recognised in current policy mechanisms, with a focus in the HRH plan on improving quality and distribution of education institutions to address HRH production, and including costed strategies. Acceptability indicators are favourable, with female physicians comprising over half the workforce, and the ratio of nurses to physicians above the OECD average. However, challenges remain in guaranteeing equitable access. In terms of quality, accreditation procedures are currently being improved, and regulatory mechanisms also need strengthening, particularly for nurses and midwives.

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