FACILITATOR AND BARRIER TOWARD MATERNAL AND CHILD HEALTH HANDBOOK IMPLEMENTATION IN 5 PROVINCES IN INDONESIA

Tiara Amelia, Kamaluddin Latief, Erna Mulati, Keiko Osaki, Poppy E.Deviany

As part of improving quality of Maternal and Child Health (MCH) in Indonesia, the government started using MCH handbook which adopted from Japan since 1998 until recently. It has been 13 years since then Ministry of Health is trying to improve the implementation of the book. However, policy remains change from centralization to decentralization that facing different challenges. Therefore, we conducted qualitative research to seek barrier and facilitator factors in implementation of MCH Handbook in decentralization era and its possibility of self reliance in 5 provinces; West Sumatra, South Sulawesi, South Kalimantan, Banten and East Java. Our research involved local government, health personnel, community, pregnant women, and women with children under 5 years old. Studies found that decentralization contributes to instability of MCH handbook implementation. Decentralization is very much depending on the local leaders commitment especially local parliament, Developing and Planning Board and District Health Office, in allocating adequate budget for MCH Handbook. There is unclear cost sharing mechanism between central, province and district level in procurement of MCH handbook. Solid commitment of district will define the successful of MCH Handbook implementation which included distribution and dissemination. Findings revealed that there are still less socialization, monitoring, evaluation, support from cross program integration within maternal and child health section; and cross sector in community level due to limited budget. Nevertheless, other sources such professional organization, private midwives and Corporate Social Responsibilities of private sectors as facilitator factors cooperate very well in improving the utilization of the book. The successful implementation of MCH Handbook depend on readiness of province and district level that should be prepared very well by central level so that they have solid commitment to fulfill all needs such as policies, logistics and roles from across program and across sector and the community. Keywords: Maternal Health, Child Health, Health Policy, Decentralization, Maternal and Child Health Handbook