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PROGRAM BIDAN DELIMAImproving Quality Care of Private Sector Midwives
Damaryanti Suryaningsih, MPHAbt Associates – USAID/ HSP
34th Annual Global Health ConferenceWashington, 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 sectorCertifies high quality midwives as “Bidan Delima”Promotes brand recognition among the general publicImplemented by Indonesian Midwives Association
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Source: Bull World Health Organ v.79 n.3 Geneva, IDHS 2002/3 World Health Report 2005
The Millennium Development Goals (MDGs): Progress Report in the context of health
Indonesia: 307Thailand: 129Malaysia: 39Singapore: 6
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Hemorrhage
28%
Infection
11%Eclampsia
24%
Unsafe abortion5%
Obstructed labor 5%
Obstetric Embolism 3%
5%
PuerperiumComplication
8%
Others
11%
Obstetric Trauma
Causes of Maternal Mortality
Every 2 hours Every 2 hours 1 Maternal Death1 Maternal Death
Source Household survey 2001
5Sources: MNH 2002, HHS 1995, NHS 2000
• Excessive bleeding: 46% (67% after delivery)• Induced abortion: 14 %• Anemia: 51% (when pregnant)
45% (after delivery)• Protein malnutrition: 4.8% • Chronic under nutrition: 21.2%
Causes of Maternal Mortality in Indonesia
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Why private sector?
HomePrivatePublic
Place of Delivery
31%
9%
59%
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Delivery Assistant
TBADoctorMidwifeOther
50% by midwife
53,468 midwives in Indonesia
26,662 private midwives
50%
12%
32%
5%
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Growing role for private sector
8%
15%
31%
19%
9%
9%8%
12%
1%
6%
11%
16%
21%
26%
31%
36%
1991 1994 1997 2002/03
% of deliveries in private and public sector Source: IIDHS series
Private sector
Public Sector
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Work relationshipUSAID 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 ProcessRegistration/
Pre-qualificationsSelf Learning
tools
Validation(external)Recognition
Quality Assurance
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Family Planning
Infection Prevention
Informed choice poster (3 Set)
sticker
Brochure
10 Messages for mother and midwife
MNH
Signage
Apron and pin
Bidan Delima Kit
Decision Making tool FP
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•Pre qualification •Self Assessment
Facilitator tools:•Validation tools•Facilitator guideline •Monitoring tools
Guidelines and instruments
Management Guidelines:•Management guidelines for central, provinces and districts level•Financial guideline
Facilitator training package:- Reference book- Trainers guideline- Participant book
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Where are we now……
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3942,190
6061,108
7125,5352,5031,0121,5434,8246,364
Private Midwives
TotalBantenAcehYogyakartaSouth SumateraBaliWest JavaNorth SumateraJakartaSouth SulawesiCentral JavaEast Java
Province
6,2961,0005,2562,807202011.202010.
17233139469.684915931068.403603432267.
1,2981421.1565686.19686123305.20230172344.5011383635123.
1,2472021,0454212.1,5402181,3228241.
FacilitatorBDCandidate of BD
Total BDAmount
No
Coverage (data as of May ’07)
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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
