PROGRAM BIDAN DELIMA

Improving Quality Care of Private Sector Midwives

Damaryanti Suryaningsih, MPH Abt Associates USAID/ HSP 34th Annual Global Health Conference Washington, DC, USA, May 31, 2007
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What is the Bidan Delima program?

Program to improve quality of service delivery and family planning in private sector Certifies high quality midwives as Bidan Delima Promotes brand recognition among the general public Implemented by Indonesian Midwives Association
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The Millennium Development Goals (MDGs): Progress Report in the context of health
Indonesia: 307 Thailand: 129 Malaysia: 39 Singapore: 6

Source: Bull World Health Organ v.79 n.3 Geneva, IDHS 2002/3 World Health Report 2005

Causes of Maternal Mortality

Puerperium Complication 8% Obstetric Trauma Obstetric Embolism Obstructed labor Unsafe abortion 24%
Source Household survey 2001 4

Others 11% Hemorrhage 28%

Every 2 hours 1 Maternal Death

5% 3% 5% 5% Eclampsia

Infection 11%

Causes of Maternal Mortality in Indonesia

Excessive bleeding: Induced abortion: Anemia: 46% (67% after delivery) 14 % 51% (when pregnant) 45% (after delivery) Protein malnutrition: 4.8% Chronic under nutrition: 21.2%
Sources: MNH 2002, HHS 1995, NHS 2000 5

Why private sector?

Place of Delivery

9% 31% 59%
Home Private Public

Delivery Assistant
50% by midwife
12% 32% 50% 5%
TBA Doctor Midwife Other

53,468 midwives in Indonesia 26,662 private midwives

Growing role for private sector

Private sector
36% 31% 26% 21% 16%

31%

Public Sector
19% 15%

11% 6% 1%

12% 8% 8% 9%

9%

1991

1994

1997

2002/03

% of deliveries in private and public sector

Source: IIDHS series

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Work relationship
USAID provides technical assistance to the Indonesian Midwives Association (IBI): Support start up activities in 11 provinces (2003 2009) Working with IBI to develop: - Management of Bidan Delima guidelines - Quality assurance instruments - Facilitator training package - Promotion Materials - Bidan Delima kits - Management Information System Develop capacity of IBI management in workshop facilitation and facilitator training
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Bidan Delima Process

Registration/ Pre-qualifications Self Learning tools

Recognition

Validation (external)

Quality Assurance
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Bidan Delima Kit

Family Planning Infection Prevention MNH Informed choice poster (3 Set)

sticker

Apron and pin

Decision Making tool FP

Brochure

10 Messages for mother and midwife

Signage

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Guidelines and instruments

Management Guidelines: Management guidelines for central, provinces and districts level Financial guideline

Pre qualification Self Assessment Facilitator training package: - Reference book - Trainers guideline - Participant book

Facilitator tools: Validation tools Facilitator guideline Monitoring tools

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Where are we now

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Coverage
Amount No 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Province East Java Central Java South Sulawesi Jakarta North Sumatera West Java Bali South Sumatera Yogyakarta Aceh Banten Total Private Midwives 6,364 4,824 1,543 1,012 2,503 5,535 712 1,108 606 2,190 394 Candidate of BD 824 421 512 34 30 568 226 106 46 20 20 2,807 5,256 BD 1,322 1,045 363 172 123 1.156 343 593 139

(data as of May 07)

Total BD 1,540 1,247 501 202 196 1,298 403 684 172 20 20 1,000 6,296 14

Facilitator 218 202 138 30 86 142 60 91 33

Challenges
Improve fee collection rates Maintain Quality Assurance systems Ensure that the benefit package for BD member is valued by bidans Improve Business management in IBI and private clinics
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 Bidan Delima website: www.bidan-delima.org My e-mail address: dsuryaningsih@jsi.or.id

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