Recognizing that private-sector midwives provide most family planning services in Indonesia, Jhpiego adapted its signature quality improvement approach to raise the standard of care delivered by these essential frontline health care workers. The program, known as Bidan Delima, has been in operation for the past 10 years and is an example of a sustainable initiative to improve maternal health care services delivered by midwives. (Bidan Delima is an Indonesian expression that refers to a midwife with a high-quality private practice.)
The SustainingTechnical Achievements in Reproductive Health (STARH) project, funded by the U.S. Agency for International Development and led by Jhpiego and the Johns Hopkins University Center for Communication Programs (JHUCCP), designed Bidan Delima in 2002 to specifically target the private sector. Bidan Delima was one of Jhpiego’s early applications of its Standards-Based Management and Recognition (SBM-R®) approach to improve the performance and quality of health care services offered by the midwives.
Through self-assessments and self-funded improvements guided by SBM-R, private-sector midwives strive to achieve defined standards for quality midwifery services. Once they are validated by the Indonesian Midwives Association (known as “IBI”) as achieving the standards for quality care, midwives are designated as “Bidan Delima.” In recognition of this achievement, they receive sign boards that indicate their Bidan Delima status and encourage clients to seek services at their high-quality clinics. Today, a Bidan Delima sees five to 10 clients each day for family planning and antenatal care and assists with about 15 births each month.
Although the six-year STARH project initiated and developed the Bidan Delima program, IBI continues to manage it. Since its launch, more than 10,000 midwives have been qualified as Bidan Delima across 15 of Indonesia’s 30 provinces. Their clinics continue to offer the highest-quality private midwifery services. Through a combination of member fees, IBI volunteer services, corporate sponsors and small amounts of USAID funding, the program has sustained itself and expanded over the years. Jhpiego has nurtured a commitment from Johnson & Johnson to support training opportunities and awards for Bidan Delima—a commitment that has continued for more than 10 years.
As the head of IBI, Harni Koesno, explains, “Bidan Delima represents IBI’s efforts to standardize practices of private midwives aimed at improving quality of midwifery care. Bidan Delima’s motto is ‘quality service.’ Service quality is not only influenced by the quality of the midwives, but also by the availability of good health facilities. All these factors affect the well-being of mothers and newborns and impact the maternal mortality rate and infant mortality rate in Indonesia.”