West Java, Indonesia—Neng Supartini, 24 years old and 38 weeks pregnant, climbed on a motorcycle for a downhill ride along a steep, narrow path to reach Ciparay Health Center, where she would give birth to her child. The trip took over an hour, with occasional stops to walk the motorcycle across terrain too rough to ride on.
She would not have even tried to make the trip a few years ago.
Back then, Ciparay Health Center logged practically zero births each day. The midwives on staff were scared of handling routine pregnancies, and although the health center was intended to be a place where mothers could safely give birth under the care of skilled doctors and midwives, the staff routinely rejected more patients than they accepted.
“The health center was becoming a place to meet, sit, chat and sleep,” Ciparay Health Center Coordinator Lilis Nurhanah admitted.
Turning away patients meant that pregnant women like Supartini and babies who faced life-threatening emergencies during pregnancy, delivery and the days after didn’t receive care when needed.
Then, in 2012, everything changed.
Ciparay Health Center began to receive support from the U.S. Agency for International Development’s (USAID’s) Expanding Maternal and Neonatal Survival (EMAS) program. In partnership with the government of Indonesia, the program aims to improve the quality of emergency maternal and newborn care in health facilities across the country.
One of the oldest health centers providing basic emergency obstetric and neonatal care in the region, Ciparay needed a strategy for improvement. So EMAS worked with Dr. Rikmasari, head of Ciparay Health Center, to identify and evaluate the areas in which the health center was underperforming. EMAS then prioritized a list of needed improvements: better handling of emergencies involving mothers and their newborns, increased staff capacity and skills, and more resources—from medical equipment to properly administered medicines.
“This became my turning point,” said Dr. Rikmasari, who today is credited as the motivator behind her team’s commitment to change and improve.
Over the course of the next year, EMAS trainers conducted refresher training for Ciparay staff in core skills such as newborn resuscitation and treatment of pre-eclampsia/eclampsia. Midwives and doctors alike participated in a myriad of emergency drills aimed at strengthening their capacity to manage common complications encountered during pregnancy, delivery and the early days after birth.
Just a year into their partnership with EMAS, Ciparay’s staff were substantially more confident and motivated. Taking initiative themselves, they moved unused beds from other care units into the maternity ward to accommodate more patients and worked with their district health office to obtain essential drugs and equipment to better prepare their facilities to handle both routine and complicated births.
And Ciparay Health Center began to transform.
“We used to be afraid of handling even normal patients, so to give MgSO4 was even worse,” recalled Nurhanah, referring to magnesium sulfate, the recommended treatment for a woman who is experiencing eclampsia-related convulsions. “Through EMAS’s mentoring, emergency simulations and assistance, our confidence grew.”
Indeed, her staff can now handle nearly 100 percent of pre-eclampsia cases.
As word of the high-quality care and motivated staff at Ciparay spread through the region, expectant mothers like Supartini chose to give birth there—and the number of deliveries began to increase.
In 2012, Ciparay recorded just 44 deliveries throughout the year. By 2013, that number had grown to 281. Now, in just the first five months of the year, Ciparay staff have managed 259 births, and they estimate that today, they are handling up to 60 births per month.
“When a mother successfully delivers her baby here, she will tell her neighbor about this,” Nurhanah said. “We now have patients every day.”
EMAS’s Maternal and Newborn Health Coordinator for West Java, Dr. Firda Dewi Yani, is encouraged by the great progress she’s seen at Ciparay: “I hope Ciparay can be a role model for nearby facilities, to help them apply the right standards and achieve better services.”
Ciparay’s staff describe their experiences with EMAS using the metaphor of sleeping, dreaming and waking up. As they look back at the changes in Ciparay, they see their success as an encouragement to other facilities across Indonesia. In Nurhanah’s words, “Wake up and go get the dream to come true!”
Before and After EMAS Interventions at Ciparay Health Center
|Pregnancy Visits||74 in 2012||346 in 2013|
|Deliveries||44 in 2012||281 in 2013|
|Pre-eclampsia Cases Treated||1 in 2012||12 in 2013|
|Key Maternal and Newborn Health Staff||15 midwives||
|Routines||Weekly schedule, no maternal and newborn health staff on Sundays||
|Skills Strengthening||Specialist visits every 3 months for knowledge sharing||