Maternal and Child Health Handbook use for maternal and child care: a cluster randomized controlled study in rural Java, Indonesia.

BACKGROUND: Effectiveness of the Maternal and Child Health Handbook (MCHHB), a home-based booklet for pregnancy, delivery and postnatal/child health, was evaluated on care acquisition and home care in rural Java, a low service-coverage area. METHODS: We conducted a health centre-based randomized trial, with a 2-year follow-up. Intervention included (i) MCHHB provision at antenatal care visits; (ii) records and guides by health personnel on and with the MCHHB; and (iii) sensitization of care by volunteers using the MCHHB. RESULTS: The follow-up rate was 70.2% (183, intervention area; 271, control area). Respondents in the intervention area received consecutive MCH services including two doses of tetanus toxoid injections and antenatal care four times or more during pregnancy, professional assistance during child delivery and vitamin A supplements administration to their children, after adjustment for confounding variables and cluster effects (OR = 2.03, 95% CI: 1.19-3.47). In the intervention area, home care (continued breastfeeding; introducing complementary feeding; proper feeding order; varied foods feeding; self-feeding training; and care for cough), perceived support by husbands, and lower underweight rates and stunting rates among children were observed. CONCLUSION: MCHHB use promoted continuous care acquisition and care at home from pregnancy to early child-rearing stages in rural Java.

District team problem solving as an approach to district health programme planning: a review, and survey of its status in selected districts in Indonesia.

District team problem solving (DTPS) was developed by WHO in the 1980s to explicitly engage local stakeholders in decentralized planning and, in later iterations, budgeting of health services. It became WHO's global flagship approach to district-level health priority-setting and planning. DTPS entails multisectoral stakeholders (the team) using local data to prioritize and fund services, and should enhance capacity in management of decentralized healthcare. From the late 1990s, DTPS evolved through several phases in Indonesia. Multiple donors supported its use for planning maternal and child health (MCH) services, with substantive national government input, despite no formal assessment of its sustained uptake or benefits. In the context of new interest to promote DTPS for MCH in Indonesia, we assessed its status there in 2013-14, focussing on its implementation status and on associated MCH data collection (PWS-KIA). We used mixed methods to capture local challenges to and opportunities for DTPS in seven sub-national locations in 6 of Indonesia's 31 provinces. DTPS remained active only in the two locations whose local government ever allocated funds to the process; in the others, it stopped once the initial non-government funding ceased. An official decree establishing DTPS and team membership was only issued in four locations, and it was not evident that the intended multisectoral representation was achieved in any site. Trained DTPS facilitators remained available in only four locations. In all districts, interviewees described PWS-KIA as potentially serving a revived DTPS, but insufficiently robust to underwrite local advocacy for investment in MCH. Although efforts to introduce DTPS as a uniform approach to district MCH planning in Indonesia have not been sustained, strong commitment to evidence-based planning remains. Decentralized health planning processes require quality data, local government buy-in and associated funding, and should link explicitly to broader administrative planning processes and budget cycles.

Applying the Innov8 approach for reviewing national health programmes to leave no one behind: lessons learnt from Indonesia.

The World Health Organization's Innov8 Approach for Reviewing National Health Programmes to Leave No One Behind is an eight-step process that supports the operationalization of the Sustainable Development Goals' commitment to 'leave no one behind'. In 2014-2015, Innov8 was adapted and applied in Indonesia to review how the national neonatal and maternal health action plans could become more equity-oriented, rights-based and gender-responsive, and better address critical social determinants of health. The process was led by the Indonesian Ministry of Health, with the support of WHO. It involved a wide range of actors and aligned with/fed into the drafting of the maternal newborn health action plan and the implementation planning of the newborn action plan. Key activities included a sensitization meeting, diagnostic checklist, review workshop and in-country work by the review teams. This 'methods forum' article describes this adaptation and application process, the outcomes and lessons learnt. In conjunction with other sources, Innov8 findings and recommendations informed national and sub-national maternal and neonatal action plans and programming to strengthen a 'leave no one behind' approach. As follow-up during 2015-2017, components of the Innov8 methodology were integrated into district-level planning processes for maternal and newborn health, and Innov8 helped generate demand for health inequality monitoring and its use in planning. In Indonesia, Innov8 enhanced national capacity for equity-oriented, rights-based and gender-responsive approaches and addressing critical social determinants of health. Adaptation for the national planning context (e.g. decentralized structure) and linking with health inequality monitoring capacity building were important lessons learnt. The pilot of Innov8 in Indonesia suggests that this approach can help operationalize the SDGs' commitment to leave no one behind, in particular in relation to influencing programming and monitoring and evaluation.