Child and Maternal Mortality
in Islamic Countries
101
Physical accessibility was one of the biggest barriers noted by the Key Informants in Indonesia,
especially in the remote islands of the country. Indonesia is a country of over 17,000 islands, and
especially in Eastern Indonesia, accessibility is a major challenge. There are fewer doctors
available in the remote islands, and it is difficult to convince health professionals to move to or
work in these areas. The government has a special program that sends teams of health
professionals to these remote areas to live and work for a period of time to try and increase
access to healthcare.
Financial affordability was a moderate barrier. But it was mostly the cost of traveling to and
from seeking healthcare services and the need for the father or other family members to miss
work to accompany the pregnant woman to service seeking centers that was the biggest
contributor to the financial affordability aspect. The actual services sought were usually covered
by insurance in the public sector, but it was the related costs of getting to the health service
center that impacted the finances the most.
Quality of care was also a commonly mentioned challenge. For example, there are a large
number of midwives, but the quality of the services they provide and the skills they possess need
to be improved upon.
Regarding the adequate number of health staff, it was clear that while the absolute number of
healthcare professionals is no longer an issue, the distribution of the personnel is a major
challenge, especially in the more remote islands of Indonesia. Human resource development and
management were also mentioned by the experts to be a challenge. There seems to be a general
plan in terms of what is the need and how the need is met in terms of production of healthcare
professionals, but more emphasis is needed on how to help the professionals with career
development and maintaining both motivation and skills. More planning is needed to ensure the
longevity of health professionals as well as better systems for staffing.
Another challenge that was mentioned by the Key Informants was the cultural barriers that
exist, especially in the Eastern provinces of Indonesia. Indonesia has many tribes so the culture
has an impact on the acceptability of health care services. Some tribes have more traditional
care preferences and may think that a traditional birth assistant is better than a midwife for
delivery. It is the sentiment among the Key Informants that with new generations, this is
changing, but it is still a barrier that exists in the more remote islands.
According to the Key Informants, the health information system is developing but is still a
challenge because it is not centralized. Due to the decentralization of the government with
regards to healthcare, the higher levels of government do not have access to real-time data
coming from the local level. For example, at the central level, they cannot monitor the stocks of
contraception drugs or supplies at the service delivery point. Another issue related to health
information systems is that there is a lot of data with different indicators being used, but
standardization on what data is needed for monitoring is important to have a common platform
with reliable data.
Regarding leadership and governance, decentralization has caused issues of concern in general.
Because Indonesia is in an era of decentralization, local governments have more power to decide
where they want to invest and what they want to do for healthcare. For example, even if there is
a national policy or strategy, it is not automatically adopted by the local governments. Rather, it
depends on the commitment of the mayor/district leader if funds will be allocated and if
activities will be rolled out. The central government does have a minimum package for
healthcare delivery that is supposed to be maintained, but the Key Informants feel like too many
critical elements of MNCH and delivery care are not being prioritized.