THE USAID JALIN PROJECT Year 1 Annual Report

This publication was produced by the USAID Jalin Project under Contract No. AID-497-C-17-00001at the request of the United States Agency for International Development. This document is made possible by the support of the American people through the United States Agency for International Development. Its contents are the sole responsibility of the author or authors and do not necessarily reflect the views of USAID or the U.S. Government.

Program Title: The USAID Jalin Project

Sponsoring USAID Office: USAID/Indonesia

Contract Number: AID-497-C-17-00001

Contractor: DAI Global, LLC

Date of Publication: January 14, 2019

Author: DAI, Global LLC

USAID Jalin Project Year 1 Annual Report

LIST OF ACRONYMS

AIPI Akademi Ilmu Pengetahuan Indonesia (Indonesian Academy of Sciences) BAPPEDA Badan Perencanaan Pembangunan Daerah (Regional Development Planning Agency) BAPPENAS Badan Perencanaan Pembangunan Nasional (Ministry of National Development Planning) BPJS Badan Penyelenggara Jaminan Sosial (Social Insurance Administration Organization) CoP Community of Practice DAK Dana Alokasi Khusus (Special Allocation Fund) DE Developmental Evaluation DHO District Health Office EMAS Expanding Maternal and Newborn Survival EMNC Every Mother and Newborn Counts ESAS Evidence Summit Assessment and Scoping FMP Forum Media Peduli (Media Cares Forum) GERMAS Gerakan Masyarakat Hidup Sehat (Community Healthy Living Movement) GOI Government of Indonesia GP General Practitioner HKN Hari Kesehatan Nasional (National Health Day) HP Plus USAID Health Policy Plus IBI Ikatan Bidan Indonesia (Indonesian Midwives Association) J2SR Journey to Self-Reliance JKN Jaminan Kesehatan Nasional (National Health Insurance) KEMENDESA Kementerian Desa, Pembangunan Daerah Tertinggal, dan Transmigrasi (Ministry of Village, Development of Disadvantaged Regions, and Transmigration) KEMKOMINFO Kementerian Komunikasi dan Informatika (Ministry of Communication and Informatics) KIA Kesehatan Ibu dan Anak (Maternal and Child Health) KM Knowledge Management MAB Multistakeholder Advisory Body MCH Maternal and Child Health MERLA Monitoring, Evaluation, Research, Learning, and Adaptation MNH Maternal and Newborn Health MOH Ministry of Health MOHA Ministry of Home Affairs MPDA Maternal and Perinatal Death Audit MPDN Maternal and Perinatal Death Notification MPDR Maternal and Perinatal Death Review MPDSR Maternal and Perinatal Death Surveillance and Response MSS Minimum Service Standards NIHRD National Institute of Health Research and Development NSPC Norms, Standards, Procedures, and Criteria PHO Provincial Health Office POGI Perkumpulan Obstetri dan Ginekologi Indonesia (Indonesian Obstetrics and Gynecology Association) PPJK Pusat Pembiayaan dan Jaminan Kesehatan (Center for Health Financing and Insurance) PUSKA-UI Pusat Penelitian Keluarga Sejahtera – Universitas Indonesia (Center for the Study of Family Welfare – University of Indonesia) PWI Persatuan Wartawan Indonesia (Indonesian Journalists Association) QI Quality Improvement

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SDG Sustainable Development Goals SLRT Sistem Layanan dan Rujukan Terpadu untuk Perlindungan Sosial dan Penanggulangan Kemiskinan (Integrated Service and Referral System for Social Protection and Poverty Reduction) SOP Standard Operating Procedure SPM Standar Pelayanan Minimum (Minimum Service Standards) SUPD Direktorat Jenderal Bina Pembangunan Daerah (Directorate General of Regional Development) UGM Gajah Mada University UNFPA United Nations Population Fund UNICEF United Nations International Children’s Emergency Fund USAID United States Agency for International Development VASA Verbal and Social Autopsy VCA Value Chain Assessment WHO World Health Organization

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TABLE OF CONTENTS

Executive Summary ...... 6

Introduction ...... 7 Activity Description ...... 7

Theory of Change ...... 9

Intermediate Outcomes ...... 9

Overall Progress ...... 10

Year 1 Progress ...... 14 Summary ...... 14 Component 1: Partnership Process Managed to Generate, Implement, Evaluate, and Scale Successful Local Solutions and Utilize Critical Evidence to Result in Sustainable MNH Impact 14

Component 2: Technical Assistance Deployed Effectively to Support Impact at Scale ...... 22 Component 3: Catalytic Financing Efficiently Disbursed to Support the Incubation and Implementation of Local Solutions ...... 25

Project Management ...... 26

Social Impact and the Developmental Evaluation ...... 27

Lessons Learned ...... 28

Appendix 1: Results Framework ...... 29

Appendix 2: Problem Statements...... 30

Appendix 3: Indicator Table ...... 31

Appendix 4: Value Chain Assessment – Executive Summary ...... 38 Appendix 5: Rapid Synthesis of Recent Maternal and Neonatal Mortality Evidence in Indonesia - Summary ...... 45

Appendix 6: Evidence Synthesis Framework ...... 48

Appendix 7: MNH Perception Survey Results ...... 50

Appendix 8: EMNC Schedule – Wave 1 ...... 51

Appendix 9: Media Coverage ...... 52

Appendix 10: Activity Location ...... 64

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EXECUTIVE SUMMARY

In September 2017, the United States Agency for International Development (USAID)/Indonesia initiated the USAID Jalin Project (hereafter referred to as “Jalin” or “the Project”), a five-year activity contributing to the reduction of preventable maternal and newborn deaths, particularly among the poorest and most vulnerable. Jalin—meaning “intertwined” in Bahasa Indonesia—weaves together Government of Indonesia (GOI), private sector, civil society, and other stakeholders to use evidence to co-define, co-create, and co-finance sustainable and scalable local solutions to improve maternal and newborn health (MNH).

This report contains a summary of activities implemented and results achieved during Work Plan Year 1—January to December 2018. It is organized in three parts: an activity overview, a summary of progress toward objectives, and lessons learned. This report details Jalin’s progress toward achievement of expected results and presents successes and challenges.

In Year 1, Jalin established physical office presence in Jakarta and in six provinces, hired and trained 70 staff members, and launched activities in 8 provinces (see Appendix 10 for details). Jalin also made significant strides towards collaborative implementation: for example, the project published or held events around 275 evidence-dissemination activities, engaged 196 entities in partnership activities, developed 65 tailored problem statements, and held 39 co-creation design sessions.

Jalin is designed with a clear sequencing and layering of activities, such that year 1 focused primarily on Component 1: Partnership Process Managed to Generate, Implement, Evaluate, and Scale Successful Local Solutions and Utilize Critical Evidence to Result in Sustainable MNH Impact. As year 1 concludes, activities under Component 2: Technical Assistance Deployed Effectively to Support Impact at Scale have also begun implementation.

Preparation to Evidence Generate Synthesis Evidence

Year 1: Opportunistic Implementation Evidence Learning from Dissemination Local Solutions / Partnerships

Partnership / Solution Simultaneous Definition Problem with Co- Definition and Investment Partner Engagement

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INTRODUCTION Activity Description

The USAID Jalin Project, initiated in September 2017 through a contract with DAI, is a five-year effort to contribute to the reduction of preventable maternal and newborn deaths, particularly among Indonesia’s poorest and most vulnerable. Jalin, a word that means “intertwined” in Bahasa Indonesia, brings a fresh approach to addressing Indonesia’s persistent maternal and newborn health (MNH) challenges, emphasizing broad stakeholder engagement, non-traditional partnerships, and local investment and ownership. Jalin’s co-creation process convenes diverse public and private sector actors to analyze and apply evidence and data to define problems and generate solutions. Jalin promotes creative, out-of-the-box thinking to reveal new ideas. The Project supports relevant, impactful, and sustainable interventions through evidence-based problem definition and solution development informed by continuous learning and adaptation.

Socio-political Context

Strong economic growth is leading Indonesia towards middle income status, consolidating the country’s position on USAID’s Journey to Self-Reliance (J2SR) Roadmap (2019)1. However, government investment in the health system remains limited. Government spending levels on health increased from 3.1% of gross domestic product in 2015 to 5% in 2018, but remain inadequate to fully meet priority needs. While spending is unlikely to increase significantly in the near term, there is an emerging Indonesian MNH movement that is supported by national and subnational government and non- government actors, and growing resource commitments from diverse public and private sector actors. Indeed, there is more opportunity for private sector investment and wider recognition that public sector investment must be more efficient, particularly as it relates to Jaminan Kesehatan Nasional (JKN), the national health insurance system, and the Badan Penyelenggara Jaminan Sosial (BPJS), Social Insurance Administration Organization.

Health sector improvements remain a top political priority, second only to national education. Indeed, health is an important part of Indonesia’s national development priorities as set forth in the Nawacita, or nine pillars. The Ministry of Health’s (MOH’s) Healthy Indonesia program, incorporated within the National Medium-term Development Plan (2015-2019), was designed to improve health status through financial protection and equitable service provision, as well as promote prevention-focused initiatives such as the People’s Healthy Lifestyle Movement (GERMAS) and implementation of health Minimum Service Standards (MSS). Since 2012, the MOH has led a national action plan to reduce maternal and newborn mortality, and in 2018 it was incorporated into Indonesia’s sustainable development goals (SDG). A national-level MNH regulatory framework exists, and MNH considerations are included during national planning and budget appropriations processes, although rollout to subnational levels remains a work in process.

With general elections scheduled for April 2019 Jalin may have to adapt to changing political contexts, including new leadership at national and subnational ministries, and new policy priorities.

Jalin works in six provinces, each with differing sociopolitical contexts and considerations, as presented below.

1 https://selfreliance.usaid.gov/country/indonesia

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Coordination with Government

It is critical that Jalin and USAID coordinate effectively with the MOH, Jalin’s primary Government of Indonesia (GOI) counterpart, as well as with BAPPENAS (Badan Perencanaan Pembangunan Nasional or the National Development Planning Agency), the Ministry of Home Affairs (MOHA), and other GOI

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agencies. Given Indonesia’s decentralized system, it is also important to build strong relationships with subnational GOI agencies, particularly provincial and district health offices (PHO/DHOs), and governors, mayors (walikotas), and subdistrict regents (bupatis).

Effective coordination requires the right kind of engagement at the right time with the with the right person in the relevant unit within each GOI agency. For example, per MOH policy, Jalin coordinates primarily with the Directorate General of Public Health. Within this Directorate, Jalin coordinates with the Director General of Public Health on MNH technical matters, and with other offices, including the Directorate of Primary Health Services and Directorate of Referral Health Services. For coordination focused on private sector partnerships, Jalin coordinates with the Directorate of Health Promotion, as well as with the Center of Health Financing and Health Insurance under the Secretary General.

During Year 1, Jalin worked closely with USAID to establish partnerships with the abovementioned MOH units that will support implementation in Year 2 and beyond. To do so, Jalin contracted a respected senior Indonesian consultant, and former Director General of Public Health (later hired to serve as Jalin’s full-time Senior Government Advisor) to manage the Project’s GOI coordination approach to ensure:

• Effective information sharing among USAID-funded programs at national and subnational levels to build coherence across the USAID portfolio, communicate a consistent shared vision and core messages to shared stakeholders, and contribute to achievement of USAID’s Country Development Cooperation Strategy objectives; • Promotion of synergies and coherence between USAID and other donor programs; and • Capture of information and results to inform national and subnational policy agendas. Theory of Change

Activities are grounded in the Jalin theory of change (TOC) which states:

If MNH evidence is available and compellingly communicated, and if influential multistakeholder actors are engaged and properly incentivized across the health system using market forces, then constructive and inclusive partnerships, solutions, and advocacy can flourish…and these efforts can spur an MNH Movement that contributes to reducing maternal and newborn mortality in Indonesia, specifically for the poorest and most vulnerable.

Key assumptions underpinning the TOC remain true and include:

• There is a need and a market for robust and compelling evidence that informs decision making and galvanizes interest in and a sense of urgency around MNH; • The whole of market has an interest in and a collective willingness to support MNH solutions; • The diversity of actors, perspectives, and interests represented by the whole of market will leverage resources, ideas, networks, and partnerships that will break through barriers to progress and incentivize action beyond what USAID alone can support; and • Increased attention to MNH by existing and new actors will draw more attention to important issues, shift public perception of the severity of the crisis, and therefore change policy and behavior. Intermediate Outcomes

In September 2018, Jalin, worked with Developmental Evaluation (DE) to discuss and articulate what success means for each Intermediate Outcome.

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Intermediate Outcome 1: Critical Information and Evidence Made Available

• Synthesis and generation of evidence translated into different communication materials targeting various audiences, incorporating accountability and actionable recommendations. • Existing knowledge management and communication platforms demonstrate engagement with MNH evidence to support the culture of evidence utilization in the public and private sectors. • Evidence from Jalin solutions and partnerships used by multistakeholder actors for further planning, and decision-making to improve MNH outcomes within their own programming

Intermediate Outcome 2: Local Evidence-Driven Solutions and Partnerships Tested

• Co-created local solutions based on evidence and involving broad stakeholders improve MNH outcomes. • Established partnerships support the implementation of local solutions (with detailed, measurable plans). • Local solutions demonstrate plausible MNH results.

Intermediate Outcome 3: Increased Investment from Public and Private Sector in MNH

• Public investment supports and improves evidence-based policies and/or programs that are responsive to priority MNH needs. • Increased new and existing actors invest to improve MNH outcomes.

Results Framework

The current Jalin Results Framework is presented in Appendix 1. Following USAID’s approval of the Jalin Year 1 Work Plan, in April 2018, the Results Framework was updated to include two additional ‘Behaviors and Processes’ that would evolve across the health system over three to five years to lead to nine total behaviors and processes. During Year 2 work planning, the entire Jalin team reviewed the Results Framework to ensure a shared understanding of the project’s priorities and objectives. Activities and outputs contribute to the desired top-level outcome: Contribute to national goals to reduce maternal and newborn mortality and provide catalytic support to improve essential maternal and newborn services reaching the poorest and most vulnerable. Specifically, results will include:

• Evidence on MNH in Indonesia collected, synthesized, and made available in a variety of formats, and communicated to a variety of audiences, raising awareness and yielding more clearly defined problems with actionable areas for solution development; • A broader knowledge base and more effective policy and program implementation within the MOH; • Increased mobilization of domestic public and private resources for MNH; and • Locally sustainable, evidence-informed solutions and partnerships developed and scaled.

With facilitation support from the DE in Quarter 3, Jalin and USAID further refined our Results Framework to incorporate intermediate outcomes, which will be used to measure whether or not Jalin has been successful at the end of Year 3. Overall Progress

During Jalin’s first year, in addition to completing operational set up in Jakarta and six regions, significant investment was made in developing key relationships. The Project took an opportunistic approach, in which stakeholder engagement and solution development took place concurrently, thus positioning Jalin as relationship broker and facilitator, rather than traditional project implementer. Jalin also established a Multistakeholder Advisory Body (MAB) that has provided and will continue to provide important guidance and input.

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Opportunistic implementation during Year 1 produced lessons learned, enabled Jalin to test and refine systems and processes, and built a foundation for Year 2 implementation. Understanding that institutional partnerships are driven by interpersonal relationships, Jalin focused much effort identifying and meeting with key individuals at national and subnational levels. Through this approach, the Project established partnerships with the MOH, including PHOs and DHOs, and other key stakeholders. Through these partnerships, Jalin developed problem statements, and finalized and communicated prioritization criteria that will inform ongoing design of local MNH solutions. These relationships also informed management and operations-focused adjustments, including updating the Project’s staffing structure and clarifying national and regional roles to ensure more responsive implementation.

Successes Media Matters On November 6, 2018, Jalin brought together Critical to success is building relationships and structuring print, digital, and social media professionals to mechanisms that allow productive partnerships to flourish. discuss how to more creatively and compellingly shared MNH evidence—for Year 1 success is demonstrated by the plans for Year 2 that instance, moving beyond dry pie charts or bar were co-determined and will be supported by Indonesian charts to show time-series data that stakeholders. For example, District Chiefs in North Sumatra demonstrated the true frequency of maternal and South Sulawesi will work with Jalin to draft decrees to and newborn mortality. Jalin focused on the ensure village funds are allocated to community-level MNH fact that relatively high maternal and newborn activities. mortality in Indonesia is not consistent with the country’s economic indicators and that Partnerships. Partnerships at the national level facilitate mortality is preventable if the whole of market (including media) take action. effective programming at the subnational level. MOH’s endorsement of the Project opens doors with PHOs, and Participants noted that it was not until the meeting that they became aware of the therefore DHOs, with whom Jalin will work most closely to severity of MNH in Indonesia, and after the design and implement local solutions. Successful relationship meeting some participants began posting MNH building at both levels was demonstrated in December when issues on their respective media channels. Jalin Regional Managers together with their PHO In one case of a social media actor, his tweets counterparts presented the Year 2 Work Plan to the MOH about MNH were viewed by more than 2,000 in Jakarta. people in one day. This individual is now committed increasing awareness of MNH and Additionally, the Ministry of Villages, Development of has asked that Jalin share evidence with him Disadvantaged Regions, and Transmigration (KEMENDESA) that he can broadcast. This individual also have committed to assisting Jalin. KEMENDESA will identify launched the Forum Media Peduli – Kesehatan Ibu dan Anak (Media Cares Forum – MNH) village-level interventions that could be supported by the that includes media and banking professionals, Village Fund. members of Persatuan Wartawan Indonesia (Association of Indonesian Journalists, and Jalin also established the MAB that informs Project provincial government officials. programming approaches, and brings a wider network of traditional and non-traditional actors to advocate for MNH in Indonesia. The MAB comprises 5 Task Forces that focus on quality of care and referrals, local governance, social protection, communication and evidence utilization, and private sector engagement. Jalin also began working with provincial level advisory bodies in North Sumatra and East Java that will support the Project moving forward.

Communication. Maintaining and promoting wider interest about MNH issues, writ large, is germane to advocacy and awareness strategies that generate increased demand for adequate resources and quality services to address MNH challenges. Jalin began working with journalists, and other media outlets and professionals through targeted meetings and a series of seven roundtables—in Jakarta and all six target provinces—to gather insights on how to effectively engage media and disseminate MNH information. These and other events attracted significant local media coverage. In the Jakarta Post, in August and September, Jalin published an op-ed and a series of articles about the danger of malnutrition for pregnant women. Jalin also conducted a survey to better understand public awareness and perceptions about MNH, which will inform advocacy activities in Year 2.

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Technical Assistance. Early in Year 1, Jalin provided expertise to synthesize evidence from previous USAID-funded studies and use it to build initial partnerships and inform problem definition activities. Jalin also worked with MOH to prioritize technical assistance packages that Jalin could support, contracted consultants to support Maternal and Perinatal Death Surveillance and Response (MPDSR) and MSS, and help PHOs and DHOs monitor and evaluate MSS. The project also conducted a “deep dive” review of issues related to quality of care, referrals, the JKN, and potential MNH data management frameworks.

Management. Jalin completed operational set-up and all major start-up tasks in Jakarta and the 6 geographic target areas. Almost fully staffed, 70 Jalin members are in place and working in 7 functioning offices. Core policies and procedures are in place to help staff implement activities and manage partnerships that address the Jalin TOC, Results Framework, and Work Plan activities. The project also laid the foundation for effective implementation and management through staff training and development. This included conducting Monitoring, Evaluation, Research, Learning, and Adaptation training for Jalin regional office staff; and conducting procurement training for relevant Jalin staff.

Challenges

At times during Year 1 Jalin sacrificed efficiency in the pursuit of collaboration. Shifting from opportunistic partnerships to problem-driven implementation was and will continue to present a challenge for Jalin staff and counterparts. Stakeholders are often confused when they learn that Jalin does not come with predetermined interventions but rather works collaboratively with stakeholders to identify problems and design solutions. While this approach offers promise for sustainable impact, it will take time for stakeholders, staff, and even USAID to fully embrace. Jalin must clearly define and communicate its problem-driven co-creation approach to bring more actors into the design and investment in local MNH solutions.

Partnerships. Appealing to the private sector as a development partner is difficult. Results frameworks and development jargon must be replaced by business cases and bottom-line propositions. Partnership mechanisms have to be carefully drafted to ensure quick action, appropriate transparency, and responsible sharing of potentially sensitive data. To more successfully engage with private sector interests, Jalin revised some staffing positions and scopes of work to focus on developing a business approach to working with businesses. These adjustments together with Year 2 Work Plan activities will help the Project better encourage whole of market partnerships.

Communication. Clinical facts, while extremely important for designing MNH solutions, are not always effective for media outreach and awareness campaigning, and do not tell the whole story regarding MNH. Media stakeholders themselves struggled to understand clinical data and how it might resonate with target audiences. This issue illustrates a clear point of departure vis-à-vis the MOH and the public, writ large. Jalin must work with MOH and media partners to ensure that clinical and other evidence (e.g., access and equity) informs compelling narratives that support effective advocacy that speaks to whole of market actors, notably citizens and communities.

Technical Assistance. Early in Year 1, Jalin was poised to provide responsive assistance to GOI counterparts but due to factors outside the Project’s direct control requests for and provision of assistance was not as frequent and substantial as planned. As noted above under the Coordination with Government, coordinating communication, activities, and technical assistance across divisions within the MOH and across GOI agencies is complicated. There are still internal MOH discussions about how they want to manage relations with Jalin and USAID.

Aside from these challenges, there were other GOI-related issues that hampered more effective provision of assistance, including:

• Delays in promulgation of the Ministerial Decree providing guidance on how to implement health MSS at the subnational level stalled efforts to work directly with provincial authorities;

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• Limitations of the MOH’s server capacity delayed operationality of the updated Maternal and Perinatal Death Notification (MPDN) application and therefore delayed Jalin-supported assistance to migrate data and train MOH staff. • Most district-level governments did not initiate the updated Maternal and Perinatal Death Audit (MPDA) process and therefore were not ready to receive assistance. • To mitigate future delays, Jalin will more regularly meet with GOI counterparts to design tailored assistance that meets their unique needs.

Management. The primary management challenge during the reporting period was attracting and retaining Key Personnel who met contractual requirements and USAID expectations. To address key personnel turnover, Jalin has worked closely with USAID to identify replacement staff, realign scopes of work to ensure complementarity and ownership, and add new positions to better manage internal and external communication and coordination. Jalin also reviewed and revised its Local Employee Compensation Plan to better reflect and compensate staff according to market demand. This will ensure employees are comfortable with their contracts and focused on their work. These adaptations facilitate efficient operations and creative thinking that contributes to partnerships and local solution development.

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YEAR 1 PROGRESS

Due to the structure of the Project and the sequenced implementation of Jalin’s interventions across components, Jalin’s technical implementation in Year 1 focused primarily on Component 1. Initial activities under Component 2 have just begun and no activities under Component 3 were implemented. Summary

On May 22-23, 2018, Jalin held a high-profile kick-off event to introduce the Project’s goal and objectives, and its co-creation approach. 169 participants were in attendance representing national and subnational government agencies, private sector firms, non-governmental organizations (NGOs), institutions of higher education, and media outlets.

Jalin focused much effort on and was successful in establishing key relationships with MOH, and other GOI and non-GOI national and subnational counterparts. Initial meetings with these counterparts resulted in deeper partnerships and commitments to support MNH, including participation in events to co-define priority MNH challenges and co-design local solutions. Component 1: Partnership Process Managed to Generate, Implement, Evaluate, and Scale Successful Local Solutions and Utilize Critical Evidence to Result in Sustainable MNH Impact

Component 1 activities comprised the bulk of Jalin’s activities in Year 1 and centered around [1] evidence synthesis and dissemination, and [2] whole of market engagement that combined will support design and implementation of sustainable and scalable local solutions.

Key Achievements and Lessons Learned

• Worked with the University of Indonesia’s Pusat Penelitian Keluarga Sejahtera (Center for the Study of Family Welfare) (PUSKA-UI) to complete the preparation phase of the Every Mother and Newborn Counts (EMNC) Survey. This included [1] updating verbal and social autopsy (VASA) protocols, [2] securing PUSKA-UI commitment to use Android tablets for data collection (an important change from the primarily paper-based methods used to date), [3] training MOH and PUSKA-UI stakeholders, and [4] working with the MOH and PHOs to select and prioritize districts for Wave I data collection in East Java and Banten. • Worked closely with the World Health Organization (WHO), United Nations International Children’s Emergency Fund (UNICEF), and the MOH to plan the MPDSR roll-out across Indonesia, including development and integration of an innovative perinatal component to be introduced and supported by Jalin during Year 2. • In collaboration with USAID/Washington, conducted an Evidence Summit Assessment and Scoping (ESAS) activity to understand how USAID’s Evidence Summit was used and to identify ways to improve knowledge management (KM) for MNH across Indonesia. This was followed by a rapid KM assessment. • Coordinated with the MOH and Gajah Mada University (UGM) to support a national forum, titled “MCH, Family Planning and Nutrition for Research and Development: Effective interventions in the

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regions in Maternal and Child Health, Family Planning, and Community Nutrition: What is the role of Evidence Based Policy?” held in Yogyakarta during Q4 of Year 1. As an outcome of the event, UGM has committed to establishing a national-level community of practice (CoP) for stunting, MNH, and family planning. Jalin will support the MNH CoP and cross-learning across CoPs. • Produced and disseminated communication aimed at raising MNH awareness, including an opinion article in the Jakarta Post and activating a LinkedIn page to engage senior-level Indonesia professionals around MNH-related content. Worked with PHOs in all Jalin provinces to develop tailored fact sheets reflecting local data. • Conducted a Value Chain Assessment (VCA) in Jakarta and all Jalin provinces to better understand challenges and opportunities related to referrals, transportation, blood supply, and the JKN. The study includes recommendations and areas for further problem definition that Jalin will explore in Year 2. (See Appendix 4 for details) • Synthesized and shared current and emerging MNH evidence during workshops and meetings with key partners, in Jakarta and Jalin’s six provinces. This included engaging 222 stakeholders in problem definition exercises, with 196 resulted in multiple partnership discussions and a number of potential MNH Public-Private Partnership Development solutions that are proceeding to agreement and will begin in Banten implementation during Year 2. With support from Jalin, the local government • Established key relationships with private sector and in Banten jointly developed a Memorandum of Understanding (MOU) with Alfamart and state-owned enterprises with potential to invest in local Forum Peduli Keseheatan Ibu dan Anak (FOPKIA; solutions. Several verbal commitments have been MNH Forum). The MOU lays out a process to secured, and teams are finalizing working arrangements formalize coordination among the government, with the Pan Brothers, Gap, Nike, Bank Sumut, and FOPKIA, and Alfamart to increase awareness Alfamart. about and improve services for MNH.

Subcomponent 1.1. MNH Evidence Available and Compellingly Communicated

Evidence and learning are crucial to inform resource allocation and prioritization for Jalin and its counterparts. Activities under this sub-component therefore curate and disseminate evidence and knowledge to inform problem definition and development of local solutions, increase MNH awareness, and optimize supply- and demand-side actors’ uptake, buy-in, and advocacy. During Year 1, Jalin:

• Supported PUSKA-UI to complete the preparation phase of the EMNC survey;

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• Developed a KM strategy that includes building national and subnational KM capacity; and • Synthesized and disseminated existing MNH evidence.

Every Mother and Newborn Counts Survey

Jalin worked closely with PUSKA UI to prepare for implementation of the EMNC Survey. By the end of the reporting period Jalin awarded to PUSKA UI two Fixed Amount Awards (USD 74,030 and USD 1,409,203) and two In-kind Grants (USD 5,793 and USD 28,200) to conduct the Survey in Banten and East Java. EMNC data collection will contribute to the MPDSR process by providing additional information on the social and cultural determinants of maternal and newborn mortality. This work is important to the MOH as it continues to establish a national MPDSR system with PHOs, DHOs, the Perkumpulan Obstetri dan Ginekologi Indonesia (POGI, the Indonesian Obstetrics and Gynecology Association), and international partners such as WHO, the United Nations Population Fund (UNFPA), and UNICEF.

Jalin supported national and provincial level discussions to MPDSR better understand the MOHs approach and requirements for establishing MPDSR. By the end of the year clear roles and Maternal & Perinatal Death Notification (MPDN): supporting the integration the app into MOH responsibilities were established amongst the partners to system; supporting the development of manual promote MPDSR nationally. guideline for MPDN; supporting the pilot (testing the system) in selected districts of MNH Knowledge Management Capacity Jalin-supported provinces and supporting the development of a report on MPDN In April and May 2018, in support of the ESAS, Jalin worked implementation in 6 Jalin-supported provinces. with USAID/Indonesia and USAID/Washington (John Maternal & Perinatal Death Review (MPDR): Borrazzo, Deputy Director of the Office of Maternal and providing technical assistance in the Child Health and Laurel Hatt, Program Director at Results implementation of MPDR and supporting the for Development) to conduct a series of interviews and development of a report on MPDR Focus Groups Discussions to: implementation in 6 Jalin-supported provinces. MPDSR: providing technical assistance on • Understand lessons learned from the USAID-supported dissemination on the MPDSR report to MNH Evidence Summit; broader audiences and providing technical • Recommend a framework to improve the use and assistance on the development of a fact sheet on the report. dissemination of evidence related to MNH in policy and program decision-making; • Identify opportunities for USAID to support the collection, synthesis, analysis, and dissemination of MNH evidence.

On May 4, results of the ESAS were presented to the Akademi Ilmu Pengetahuan Indonesia (Indonesian Academy of Sciences) (AIPI) and USAID highlighting two primary findings: [1] a need to design a Jalin KM strategy to more effectively collect, synthesize, analyze, and disseminate MNH evidence and [2] a need to engage and increase the capacity of a broader network of national and subnational KM partners to collect, synthesize, analyze, and disseminate MNH evidence.

Based on ESAS findings, Jalin revised its KM Strategy, and USAID and Jalin agreed to [1] assess opportunities to collaborate with more KM partners at the national and provincial levels and [2] revise Jalin’s Monitoring, Evaluation, Research, Learning and Adaptation (MERLA) Plan to include the following objectives:

• Updating KM culture and capacity for MNH in Indonesia. Continuously update policy, standards, and guidelines, based on existing and new evidence that emerges, from periodic systematic reviews, expert consultations, or other proven approaches. Filter, review, and synthesize evidence; produce recommendations on specific policy topics through convening of experts. • Identifying and filling the knowledge/evidence gaps. Employ mechanisms that engage policymakers, implementers, and researchers.

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• Responding to time-critical evidence needs. Provide ongoing analytic support, technical assistance, and action recommendations at the national level and local level, especially as it applies to: a) quality oversight; b) development of composite metrics that can assist national level actors assess performance; and c) facilitating improved planning and budgeting at the decentralized levels. • Making MNH information accessible to key audiences. Design messaging and advocacy that resonates with political actors, civil society, faith-based organizations, the media, private sector actors, and other non-governmental stakeholders, and generates demand for improved services.

From July to September 2018, Jalin conducted a rapid Brokering a PHO and media partnership assessment of MNH KM in Indonesia. The assessment in South Sulawesi included stakeholder interviews and consultations, and a Jalin helped facilitate collaboration between the desk-top literature review. Based on assessment findings PHO and the East Tribune newspaper to Jalin revised and and tailored its KM Strategy that was promote news related to MNH. Thanks to submitted to USAID in November 2018. Jalin’s work, the frequency of news reported on Recommendations incorporated into the strategy MNH and PHO programming has increased, and include: East Tribune has even reported on AKI and AKB in Sulawesi. Thanks to the reporting, the • Translating knowledge into policy and action; Governor emphasized the importance of reducing AKI and AKB to all government • Improving MNH knowledge availability and access; officials in attendance at HKN 2018. These • Enhancing KM communities of practice and support points are now included in the contents of the an overall knowledge-sharing culture; and MOH speech readout. • Defining Strategic Areas of Focus for KM Activities. These included: knowledge generation and knowledge capture, knowledge synthesis, knowledge sharing, and utilization of knowledge to lead to outputs and outcomes.

Evidence Synthesis

To better understand how to make MNH knowledge more accessible to a broader audience, Jalin reviewed and synthesized existing MNH evidence against a modified “Pathway to Survival” Framework

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based on Henry D. Kalter’s2 Social Autopsy for Maternal and Child Deaths. The Framework incorporates and builds upon the “three delays” model, which is commonly used for analyzing maternal mortality. While being a widely accepted global tool, its use for problem definition and local solution development is limited in that it provides only high-level rather than specific data and therefore does not reflect gestational stages or post-partum care, or the specific MNH contexts and challenges in Indonesia.

Jalin refined the tool enable collection of data on how the MNH enabling environment contributes to maternal and neonatal survival in Indonesia. While this refined tool will provide more comprehensive data, triangulating and analyzing data from other sources will still be important. Jalin also synthesized recent evidence available from other USAID-supported activities on maternal and neonatal mortality in Indonesia. This Rapid Evidence Synthesis will inform the project’s overall evidence dissemination, problem definition, prioritization, and co-creation efforts. It also served as the basis for specific activities for the Jalin Launch Event held in May 2018. The synthesis, a summary of which is included as Appendix 5, includes:

• A framework to review evidence and identify priorities; • Available recent evidence against the proposed framework • A list of evidence gaps to help stakeholders prioritize further evidence generation and improve the focus, efficacy, and actionability of local solutions • Potential problems that might arise during the problem co-definition exercise for the Jalin launch.

During Q4 of Year 1, Jalin engaged TA to conduct deep dives into the three priority areas and develop/adapt an MNH framework to broadly organize MNH evidence. The deep dive review revealed a number of more specific areas within the three focus areas that merit further attention, including:

• Improving quality of care at the primary health care and community levels to reduce inequity and develop a more responsive, people-centered health system;

2 Kalter et al.: Social autopsy for maternal and child deaths: a comprehensive literature review to examine the concept and the development of the method. Population Health Metrics 2011 9:45. Note that this Framework informed design of the EMNC design protocol.

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• Reducing barriers to referrals from homes to the health system and improving the efficiency of the current referral system; and • Addressing ongoing barriers to acceptance of JKN among high-need population; • Facilitating improved involvement of the private sector and community midwives in JKN; and • Supporting local district managers to address implementation challenges for JKN to increase access to MNH services.

Early in Year 2, Jalin will detail these findings and articulate them so that Regional Managers and provincial counterparts can co-define root causes for potential local solution development. Initial review of the findings suggests that follow-up discussion may focus on addressing inequity, promoting midwifery, facilitating community empowerment, involving the private sector more effectively, embedding a culture of quality and accountability, and promoting multisectoral action.

Subcomponent 1.2. Constructive and Inclusive Partnerships, Solutions, and Advocacy Developed

Year 1 evidence synthesis, problem definition, and stakeholder engagement led to potential partnerships and the development of solutions that are ready or near-ready for design and implementation. By the end of the reporting period, in Jakarta and Jalin’s 6 provinces, the Project worked with PHOs, DHOs, BAPPEDA, and other stakeholders to begin co-creation of local solutions based on defined priority MNH problems.

• MAB Jalin presided over quarterly plenary meetings with the MAB but quickly found that these meetings needed to be complemented by more tailored thematic meetings to elicit information relevant to Jalin programming. During these meetings MAB members provided guidance on stakeholder engagement strategy, MNH advocacy, and MOH Solving Public-Private Coordination communication. As an example, the MAB advised Jalin Challenges to focus on private sector workplace programming, a The Boyolali District Health Office explained to strategy that has demonstrated significant traction with Jalin that they had tried to provide health the MOH, PHOs, and businesses. services to the employees of PT. Pan Brothers Tbk, a company operating in the district, but had • Provincial Steering Committees. In all Jalin provinces, not been able to successfully engage Pan the Project is establishing or strengthening existing Brothers. Rather To support the DHO, Jalin MNH advisory bodies. The constitution and role of leveraged its relationship with APINDO, the these “committees” will vary by region and play an Indonesian Employers’ Association, to reach out important coordination and advocacy role. These to Pan Brothers, and share opportunities to include: improve health services, particularly for female employees. o South Sulawesi: The Provincial Steering Committee plans to play an advocacy role, promoting MNH Thanks to Jalin’s efforts, several parties, including POGI Surakarta, IDAI Surakarta, IBI policy improvements and building sustained support Boyolali and PMI Boyolali besides of course the for MNH. Participants include representatives from Boyolali District Health Office, have expressed academia, media, business and industry, interest in collaborating with Pan Brothers to development partners and CSOs, the GOI, health improve health services. Currently, an MOU to sector and community religious leaders. formalize cooperation among the parties is o Central Java and North Sumatra: Provincial Steering planned, with efforts to improve maternal and newborn health and safety for Pan Brothers Committees plan to help coordinate public-private employees the main focus. partnership development, including fostering provincial leadership in hospitals with an MNH focus as well as partnerships with entities outside of the health sector. o East Java: Jalin is partnering with PENAKIB, an East-Java based movement with the goal of reducing maternal and newborn mortality, to expand awareness of Jalin’s approach. o West Java: Jalin will help revitalize an existing steering committee (the Coordination Team for Saving Mothers and Newborns), which has existed since 2014.

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Other Whole of Market Actors. Jalin met with a range MNH radio campaign in East Java of whole of market actors that may be promising partners in Year 2. For example, Jalin met with Ministry of Social Affairs In Malang, East Java Jalin worked with state- owned Radio Kanjuruhan to produce and experts who manage the integrated digital platform broadcast public service announcements (PSA) overseeing the Sistem Layanan dan Rujukan Terpadu untuk about MNH issues. Because of this work with Perlindungan Sosial dan Penanggulangan Kemiskinan (SLRT; Jalin, Radio Kanjuruhan committed its own time Integrated Service and Referral System for Social Protection and resources to continue running these PSAs. and Poverty Reduction) andlearned that they connect Radio Kanjuruhan has always aired without communities to government agencies responsible for charge important announcements for its listenership, the level of its new commitment to providing essential health services. The SLRT uses mobile MNH is significant. The station has tracked applications that citizens can use to register complaints impact and has reported that there is an uptick regarding health and other services (e.g., lack of support in interest and listener participation in MNH through government-mandated programs to support issues. For example, one call-in listener reported pregnant women and newborns) that can be monitored for that after hearing the PSAs she spoke with her responsiveness. Jalin also met with Samsul Widodo, the pregnant neighbor and encouraged her to follow the MOH-suggested ANC plan—at least four Director General of Marginalized Region Development of visits to the doctor (1 visit in each of the first KEMENDESA, who is looking for ways to earmark Village two trimesters and 2 in the last trimester). Funds to address barriers to access to healthcare for pregnant and new mothers.

As noted above, in Year 1, Jalin dedicated much time and resources, including the rapid evidence synthesis, to define problem statements that have informed and will continue to inform co-creation processes at national and subnational levels. Problem co-definition activities identified bottlenecks and potential solutions (please refer to Figure 2. Evidence Utilization in Problem Definition in Six Jalin Provinces).

Jalin also conducted a Value Chain Assessment of four core health services issues (see Appendix 4 for more details). • Referral systems, as directly linked to improving referral systems and processes effectiveness; • Blood supply, as suggested by USAID and directly linked to improving quality of care in facilities; • Relevant transportation services, as directly linked to improving referral systems and processes effectiveness and improving quality of care; and • JKN payment system (including consideration of out-of-pocket costs), to improve JKN MNH linkages and impacts.

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Evidence Utilization in Problem Definition in Six Jalin Provinces

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Jalin then grouped the problem statements into categories that align with three important focus areas.

Focus Area Problem Statement(s)

Quality of Weak management and technical capacity, including weak accountability mechanisms, within MNH Care professional associations, is a critical barrier to improving quality of care in MNH. (source: meetings with MOH, MAB, VCA)

Quality Improvement (QI) is a relatively new concept in Indonesia and not yet embedded in the provision of public and private MNH services. (Source: KARS website, depkes.go.id)

The Provincial Mentoring Scheme (an example of QI) established under EMAS, needs support/revitalizing to ensure mentoring is operational, effective and a sustainable model (source: meeting with Director General Public Health MOH)

MNH accountability mechanisms are largely absent. (source: consultations with PHOs)

Referrals In maternal and/or perinatal emergency, standard operating procedure (SOP) is immediate referral to hospital. However, different interpretations of what constitutes an emergency and when direct hospital referral is permitted result in potential delays in referrals which may contribute to maternal and perinatal mortality (source: VCA, stakeholder conversations with IBI, JKN referral policy)

A third of maternal deaths are caused by referral system problems, i.e., delay reaching health facility, inappropriate treatment and pre-referral management at the primary health facility, or prolonged transport time. (source: EMAS Maternal Death Review, Banten II study, VCS)

JKN The JKN is not yet fully leveraging private providers to deliver services and as a resource for improving Utilization quality. Better linkages between private general practitioners (GPs) and private midwives offer an opportunity to improve access to JKN. NB: Given feedback from MOH Senior Leadership and news coverage of the JKN, changes to the JKN are anticipated following elections. Jalin will carefully monitor the situation for development and provide more targeted TA around JKN access beginning in Q2 onwards.

Cross- Lack of clarity in regional autonomy law regarding Norms, Standards, Procedures and Criteria (NSPC) Cutting impacts national and sub national level MNH services management and resources allocation. (source: PHOs, Adinkes)

Limited capacity of PHOs and DHOs to facilitate linkages across critical local resources, including budgeting, to improve MNH. (source: local stakeholder consultations)

Subcomponent 1.3. Implement, Evaluate and Identify Opportunities to Scale Implementation of Local Solutions

In year 1, Jalin focused on building the relationships that build the foundations for partnership in Jakarta and target provinces that will design, co-invest in, implement, monitor progress of, document, share outcomes and lessons-learned, and identify opportunities to take successful initiatives to scale. With active LOIs and MOUs—North Sumatra, Banten, Central Java, and South Sulawesi—concomitant implementation agreements will be finalized and govern activities in year 2. Component 2: Technical Assistance Deployed Effectively to Support Impact at Scale

Activities under component 2 focus Jalin efforts to establish a repository of technical and management expertise to be deployed in a timely manner, as directed by Component 1, to [1] provide technical advice to policy and program decision makers, [2] contribute to the design, implementation, and scaling of promising local solutions, [3] provide business development services to appropriate counterparts,

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and [4] assist GOI counterparts, as requested, including Engaging Private Sector Partners in organiza tional development and capacity building. Workplace Health Promotion in West Java Key Achievements and Lessons Learned In Garut, Jalin brought together important private sector interests to discuss reproductive • Worked with PHOs and other provincial stakeholders health promotion and maternal and child health (Kesehatan Ibu dan Anak, or KIA) in the work to identify and prioritize TA to support Year 2 local place. This gathering was one part of Jalin’s solution development and implementation. support of “Women’s Health Month,” and a • Worked with MOH and MOHA to identify and celebration of Indonesia’s National Health Day prioritize TA including for organizational development (Hari Kesehatan Nasional, or HKN). During and capacity building, provincial roll-out of GOI- HKN, Jalin worked with Nike and its local mandated Minimum Service Standards (MSS) for health partner Pt. Changshin Reksa Jaya to facilitate a talk show on MNH. These two companies policies and programs, and strengthening MPDSR. currently employ 8,000 female employees and plan on recruiting upwards of 20,000 more. They have already established a factory health Subcomponent 2.1. Provision of Specialized TA clinic replete with doctors, nurses, midwives, for Local Solutions and nutritionists who provide a range of MNH awareness programming. As a result of its work In consultation with PHOs, DHOs and other stakeholders, with Jalin, Pt. Changshin Reksa Jaya has begun Jalin identified a number of TA needs to support local advocating for improved MNH with other solution design and implementation during Year 1. Jalin companies in the region. grouped these needs into categories that align with the Component 1 problem statements.

Technical Assistance – Local Solutions

Problem Statement Description of Planned TA

Weak management and technical capacity, including Feasibility study of Ikatan Bidan Indonesia’s (IBI; Indonesian insufficient accountability mechanisms, within MNH Midwives Association) preparedness and capacity to assume more professional associations substantial role in accreditation and oversight of midwives, and develop process for continuous quality assurance and performance assessment (including assessment of the Bidan Delima3 program)

Relatively new Quality Improvement (QI) concept in Comparative review of national QI strategy and WHO guidelines, Indonesia that is not yet embedded in the provision and review of existing QI tools and processes, and effective health and monitoring of public and private MNH services worker performance incentives to identify constraints and opportunities for improvement

Map relationship between JKN payment system (capitation and diagnosis-based groups, known as INA CBGs) and quality

The Provincial Mentoring Scheme established under Map and assess current status of the Provincial Mentoring EMAS must be improved to ensure mentoring is Scheme, including lessons learned and necessary incentives for an operational, effective, and sustainable effective mentoring scheme

Absence of MNH accountability mechanisms Assess existing social accountability mechanisms, relevant global models, and develop approach to integrate social accountability into regional co-creation processes

While standard operating procedures (SOP) are Review official definition of and protocols related to maternal and available and used at hospitals during emergencies, perinatal emergency, and how protocols are executed different interpretations of what constitutes an emergency and when direct hospital referral is permitted result in delays that may contribute to

3 Bidan Delima is a midwife accreditation program aimed at improving the quality midwifery services in Indonesia. The program was launched in 2003 by the Indonesian Midwives' Association

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Problem Statement Description of Planned TA maternal and perinatal mortality

A third of maternal deaths are due to poor referral Review existing referral constraints, referral strengthening systems and processes (i.e., delay in reaching health processes, and best and promising practices facility, inappropriate treatment and pre-referral management at primary health facilities, or prolonged Review online referral processes and impact on reducing referral transport time) delays

Private provider buy-in to the JKN (including general Help general practitioners register as providers, with linkages to practitioners and private midwives) who can private midwives, who can receive capitation incentives in contribute to delivery of quality services must increase underserved areas to improve access to JKN

Lack of clarity in regional autonomy law regarding Map existing MNH legal framework and explore regional Norms, Standards, Procedures and Criteria (NSPC) variations impacts national and subnational level MNH services management and resources allocation

PHOs and DHOs do not have the capacity and Map local MNH resources and champions that could support resources to leverage local resources to improve PHOs and DHOs MNH (e.g., local development budgets)

Subcomponent 2.2. Provision of Responsive TA to MOH and Other Government of Indonesia Actors Minimum Service Standards

Jalin brought together the MOH, BAPPENAS, and MOHA to discuss health MSS implementation priorities, including integrating health MSS into subnational planning & budgeting activities, establishing an information system for national-level MSS reporting, and improving cross-ministry implementation of MSS. MOHA proposed that Jalin provide TA to monitor, assess, and report on compliance with MSS focusing at the community level and local governments’ responsibility to provide adequate political and financial support (i.e. infrastructure, equipment, human resources)personnel, and funding) to ensure MSS are delivered. The MOH requested that Jalin provide TA to help develop the Health MSS costing system and applications, and provide technical guidance, instructions, and test runs for its implementation, and support subnational government implementation, monitoring, and reporting. Responding to an MOH request, Jalin proposed a TA plan to expedite the roll-out of mandated MSS policies and programs. MOH’s Health Financing and Insurance Department (PPJK) requested specific assistance to develop an MSS costing application and implementation guide that could be used at national and subnational levels and will align with the newly released Technical Guidance issued by the MOHA through Permendagri (Ministerial Decree) 100/2018. Working with PPJK, Jalin developed programming and milestones to guide Project-supported TA in promoting subnational MSS implementation, including:

• Finalize the MSS costing application using a standardized Microsoft excel form for district-level reporting. The form will enable tracking of targets and achievements, and therefore performance. • Develop a model data input form (that enables data analysis using pivot tables) for MSS costing. • Present the costing application with MOH units (planning bureau and National Institute of Health Research and Development), BAPPENAS, Bappeda, MOHA, and the health division from the Directorate General of Regional Development (SUPD). • Support MOH testing of the application at national and subnational levels.4

4 Jalin tested the tool in West Java (Bandung City, West Bandung, Cimahi City) and Central Java (Solo, Demak and Kudus).

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• Draft local regulations regarding the use of the costing East Java Provincial Health Office 'opens application at subnational levels as mandated by the the door' for Jalin Ministerial Decree. The East Java PHO was initially hesitant to work with Jalin. They did not understand Jalin’s goal, National Jamboree on Health Services objectives, activities, and approaches, and were inundated with meetings to discuss the EMNC In November, in Jogjakarta, Jalin worked with Asosiasi Dinas Survey, VCA, and MPDSR. The PHO was Kesehatan (Health Service Association) (ADINKES) to notably concerned about the source and conduct the National Jamboree on Health Services by reliability of data related to the EMNC Survey. supporting the participation of provincial and district Additionally, delays in implementation of the governments from Jalin’s intervention area. The objective of Survey further weakened trust and therefore the event was to: the prospects of contructive partnership with the PHO. • Learn how to improve the final draft MSS Costing Jalin worked very hard to reset the relationship application; by following adhering to PHO protocols and clearly communicating Jalin plans and activities in • Increase understanding and knowledge of PHO and the province. By the end of 2018, Jalin nominal DHO staff from Jalin’s six provinces regarding trust was revived and the PHO and DHOs subnational implementation of MSS; and began jointly owning Jalin activities, including • Elicit commitment from local government officials to jointly presenting Jalin’s Year 2 Work Plan to implement MSS in 2019. the MOH in Jakarta in December.

During the event, and directly following presentations of MSS best practices and “how-to” sessions, many districts within Jalin target provinces expressed commitment to institutionalize MSS in 2019. This commitment begat PHO commitment in North Sumatra, Banten, and West Java to establish support teams to oversee district-level MSS implementation, monitoring, and evaluation.

In November, after the Jamboree, Jalin met with the USAID-funded HP+ to discuss the projects’ joint interest in working on MSS with the MOH. The two projects determined that to avoid duplicative assistance and leverage specific project expertise, the best way forward was for Jalin to focus on subnational implementation of MSS while HP+ researches the gaps between resources available and resources needed to effectively implement MSS at the subnational level. HP+ will use data from Jalin target provinces to inform advocacy on the need to use Dana Alokasi Khusus (DAK), or special allocation fund, to fill funding gaps and ensure effective implementation of subnational MSS. During the meeting, the projects agreed on the following follow-up actions:

• Develop a joint MSS 2019 work plan (finalized in October 2018); and • Monthly coordination meetings to ensure coordination of national and subnational activities.

Note that the final version of the MSS application is expected to be ready by June 2019.

Jalin and HP+ Complementary Outputs

USAID Jalin HP Plus

• Application system and guidance on Health MSS costing • Gap analysis of MSS needs at the district level • Mainstreaming costing in district-level development • Map of the fiscal gap to be addressed through the DAK in planning the health sector at the district level

Component 3: Catalytic Financing Efficiently Disbursed to Support the Incubation and Implementation of Local Solutions

During Year 1, Jalin did not implement activities under this Component. However, stakeholder engagement resulted in potential resource commitments that Jalin will pursue during Year 2. USAID Jalin Project Year 1 Annual Report P 25/64 [01/15/2019]

Project Management

Remote management of staff, assets, and activities is a challenge inherent to the design of Jalin, what with an initial staffing profile of upwards of 95 persons, and the necessity of maintaining on-the-ground presence (and offices) in the initial 6 geographic target provinces. For these reasons, project management priorities comprised equally technical start-up activities—developing the TOC, Results Framework, MERLA Plan, Work Plan, and whole of market engagement—and operational details— recruitment, personnel policies, procurement and financial systems and policies, numerous office fit- outs, and regular staff training to ensure understanding of their work and compliance with Jalin policies and procedures.

Personnel

In Year 1, Jalin focused primarily on identifying and onboarding qualified staff for the Jakarta and regional offices. Not unsurprisingly, recruiting and retaining high quality professionals (particularly for senior technical positions) presented a challenge. Regarding regional staff, those with feet on the ground, Jalin put a premium on individuals who had a broad network in the public and private sectors, understand MNH, and could manage staff and activities. Finding individuals who exhibited this combination of skills and experience took time. Jalin worked closely with USAID to mitigate the effects of recruitment delays and staff turnover. The project realigned scopes of work and added new positions to respond to new priorities, and recruited staff who have the skills to effectively manage internal and external coordination and communication.

Jalin is now almost fully staffed, with 70 staff contracted and working in 7 functioning offices. During Year 1, staff were brought together frequently to participate in training and design programming approaches and activities.

• MAB Core Meeting, Jakarta, 26 March 2018 • USAID Jalin Kick-off Event, Jakarta, 22 to 23 May 2018 • Open Data Kit Training, Depok, 4 to 7 June 2018 • MAB Quarterly Meeting, Jakarta, 26 June 2018 • Procurement Training, Jakarta, 13 to 16 August 2018 • Coordination Meeting: Opportunities to Support MPDSR Activities, Jakarta, 14 September 2018 • MERLA and TAMIS Training, Jakarta, 25 to 27 September 2018 • Year 2 Work Planning Retreat, Jakarta, 15 to 19 October 2018 • Year 2 Workplan Workshop with DE, Jakarta, 25 to 26 October 2018 • Year 2 Workplan Presentation with MOH, Jakarta, 6 December 2019,

Operations

Jalin focused on Project operations focused on establishing program offices, training staff, and mobilizing in Jalin’s focus regions. The table below highlights the dates for completed office fit-out and operations start-up for all of Jalin permanent offices.

Office Dates Jakarta, DKI Jakarta April 16, 2018 Medan, North Sumatra October 1. 2018 Serang, Banten October 1, 2018 Bandung, West Java September 1, 2018 Semarang, Central Java September 24, 2018

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Office Dates Surabaya, East Java October 1, 2018 Makassar, South Sulawesi September 26, 2018

Social Impact and the Developmental Evaluation

The Developmental Evaluation (DE) is intended to contribute to Jalin’s overall learning agenda and support a culture of adaptive management that supports achievement of Jalin objectives. Despite not yet having an acculturation workshop, DE and Jalin continue to communicate common objectives internally and with external stakeholders, particularly with various MOH units. The two projects continue to develop and refine shared expectations regarding roles, responsibilities, and communication protocols.

Jalin has and will continue to invite DE to participate, as appropriate, in meetings and events, and discuss DE evaluation questions to support Jalin’s work. During Year 1, DE [1] facilitated four workshops between Jalin and USAID, and one workshop between Jalin and HP Plus, [2] assisted with development of Jalin’s Results Framework, and [3] presented findings and recommendations from research on its first evaluation question focused on the MAB.

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LESSONS LEARNED

The first year of any project yields significant lessons learned. For Jalin, the most salient Year 1 learning revolved around [1] opportunistic implementation, [2] stakeholder engagement, and [3] refining priorities. These lessons are not independent of each other and together highlight the importance of relationships—particularly with key counterparts, such as USAID, MOH, PHOs, and DHOs. These relationships form the foundation for effective co-creation and local solution implementation, and design and provision of technical assistance.

Opportunistic Implementation

Jalin applied an opportunistic approach to implementation, pursuing stakeholder engagement and problem definition simultaneously. Opportunistic implementation facilitated introduction of Jalin’s new MNH approach to a range of traditional and non-traditional actors in Jakarta and the regions that resulted in opportunities to co-define priority MNH challenges. Through these activities potential partners gained a level of comfort with the co-creation model and nominally committed to work together to co-design and support local MNH solutions. It is through this work that Jalin established itself as a partner in strengthening the Indonesian MNH movement.

Stakeholder Engagement

Reflection on Jalin’s Year 1 partner engagement activities reinforced the lesson that is there is no one- size-fits-all approach to working with stakeholders. A multitude of actors—health service beneficiaries, health workers, public and private sector providers, service providers, impact investors, media, and others—must contribute to solutions to measurably impact MNH. At the same time, it is unrealistic to expect every actor to engage at the same times or in the same ways. The diversity of individual and institutional understanding, priorities, and incentives will not always align. It is therefore critical that Jalin bring together actors that can be aligned and therefore constructively co-design and significantly co- invest in evidence-driven solutions.

Jalin has adapted its management approach based on the abovementioned learning. In Year 2, Jalin will adopt a solutions-oriented approach to compel the right stakeholders to commit to the right MNH investments. Tailored partner engagement strategies will attract potential partners to co-creation events designed around specific, clearly defined MNH challenges and opportunities. This approach will likely result in fewer participants with common interests contributing to solution design processes.

Note that while targeting partners with specific shared-value propositions, Jalin will also look for out-of- the-box opportunities that present compelling strategic rationale for partnerships and solutions.

Fine-Tuning Priorities

Early in Year 1, Jalin learned that it was important to clearly define criteria for prioritizing MNH challenges. With defined challenges, especially when contextualized for specific stakeholder interests or in line with geographic and cultural nuances, co-creation activities are more productive and partnerships more likely to emerge. Jalin worked closely with USAID to continually fine-tune criteria to address the Project’s three core principles—plausible MNH impact, scalability, and sustainability through investment. Moving forward Jalin will use EMNC, MPDSR, and other activities that generate and validate evidence (including learning from local solutions) to further refine technical approaches and priorities that will help the Project manage expectations among diverse stakeholders.

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APPENDIX 1: RESULTS FRAMEWORK

t Maternal and Newborn Mortality reduced (5-10 years) c

a MNH Movement Takes Hold p

s JALIN GOAL: Contribute to national goals to reduce maternal & newborn mortality and provide catalytic support to improve essential maternal and newborn services

m I

u reaching the poorest and most vulnerable

s e e 1. Evidence on maternal-newborn health in Indonesia has been collected, synthesized, and made available in a 3. Domestic resources (both public and private) have been mobilized and leveraged towards maternal-

R variety of formats and communicated to a variety of audiences, which provided defined problems newborn health.

e o

n with actionable areas for solution development and raising awareness. 4. Local Solutions and Partnerships, which have a realistic chance of improving maternal-newborn health and

c p

t 2. Ministry of Health has developed a broader knowledge base and more effective policy and/program being scaled, and moving forward. o

u implementation because of technical assistance.

t s

a Critical Information & Evidence Made Available & Used Partnerships Implementing Evidence-Driven Solutions e

i A. New and existing MNH evidence is synthesized and compellingly Improved Public & Private Sector Investment* in MNH

d m

e communicated through knowledge management and communication C. Co-created solutions developed based on evidence involving broad o

c stakeholders to improve MNH outcomes.

m platforms to the public and private sector for action. F. Improved public and private investment* in evidence-based policies, t

r B. Multiple actors, both individually and as groups, use MNH evidence D. Partnerships support the implementation of solutions with detailed programs, or products/services responsive to priority MNH needs.

u e

t to strengthen policies/programs and products/services to improve measurable plans. G. New actors invest* to improve MNH outcomes. O n MNH outcomes. I E. Solutions tested for plausible MNH results and potential for scale.

Component 3: Catalytic financing efficiently disbursed to support the incubation and implementation of local solutions

Component 1: Partnership process managed to generate, Component 2: TA deployed effectively to implement, evaluate, and scale successful local solutions and support impact at scale

utilize critical evidence to result in sustainable MNH impact

e l

e Sub-component 1.2: Constructive Sub-component 1.3 Implement, Feedback

b a t Loop

l Evaluate, and Scale Local

i and inclusive partnership,

i Sub-component 2.1 Provision of specialized TA

a v

d Solutions v i solutions, and advocacy developed for local solutions

e Feedback

c Loop

c i

c • Engage influential multi-stakeholder • Implement and Test local

e actors solutions

m v

e • Define problem statements for co- • Monitor Local Solutions

o creation efforts • Learn and Adapt for Scale and

r Impact N • Deploy co-creation approaches to

y Sub-component 2.2 Provision of responsive TA

e develop evidence-driven solutions to the MOH and other GOI actors

l .

l Prioritize partnership, solutions,

n 1

I p

t advocacy for impact

C o

Feedback Loop

c -

b • Conduct EMNC activity across selected districts • Synthesize MNH evidence from Indonesia u

S • Mobilize MNH KM Strategy with appropriate local partners • Value chain assessment

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APPENDIX 2: PROBLEM STATEMENTS

Focus Area Problem Statement Description of Planned TA

Quality Weak management and technical capacity, Feasibility study of Ikatan Bidan Indonesia (IBI - Indonesian of Care including weak accountability mechanisms, Midwives Association) preparedness and capacity to assume within MNH professional associations, is a more substantial role in accreditation and oversight of critical barrier to improving quality of care in Indonesia’s midwives, and develop process for continuous MNH. quality assurance and performance assessment (including assessment of Bidan Delima.

Quality Improvement (QI) is a relatively new Comparative review of national QI strategy and WHO concept in Indonesia and not yet embedded in guidelines. Review Indonesia’s existing QI tools and the provision of public and private MNH processes and effective health worker performance services. incentives and identify constraints for implementing QI.

Map relationship between JKN payment system (capitation and diagnosis-based groups, known as INA CBGs), and quality.

The Provincial Mentoring Scheme (an example Map and assess current status of the Provincial Mentoring of QI) established under EMAS, needs Scheme in Jalin provinces, including lessons learned and support/revitalizing to ensure mentoring is necessary incentives for an effective mentoring scheme. operational, effective and a sustainable model

MNH accountability mechanisms are largely Assess existing social accountability mechanisms, relevant absent. global models, and develop approach to integrate social accountability into regional co-creation processes.

Referrals In maternal and/or perinatal emergency, SOP is Review official definition of maternal and perinatal immediate referral to hospital. However, emergency and current procedures. Rapid assessment in different interpretations of what constitutes an Jalin provinces of how protocols are interpreted and applied. emergency and when direct hospital referral is permitted result in potential delays in referrals which may contribute to maternal and perinatal mortality

A third of maternal deaths are caused by Report from review of existing referral constraints, referral referral system problems, i.e., delay reaching strengthening processes and best and promising practices. health facility, inappropriate treatment and pre- referral management at the primary health Report from review of online referral processes and impact facility, or prolonged transport time. on reducing referral delays.

JKN The JKN is not yet fully leveraging private TA around helping GPs register as providers receiving providers to deliver services and as a resource capitation in underserved areas with linkages to private for improving quality. (JKN). Better linkages midwives. between general practitioners (GPs) and private midwives could be an opportunity to improve access to JKN.

Cross- Lack of clarity in regional autonomy law Map existing MNH legal framework and explore regional Cutting regarding Norms, Standards, Procedures and variations. Criteria (NSPC) impacts national and sub national level MNH services management and resources allocation

Limited capacity of PHOs and DHOs to Actor mapping of local entities with potential to support facilitate linkages across critical local resources, PHOs and DHOs on MNH. including budgeting, to improve MNH.

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APPENDIX 3: INDICATOR TABLE

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Data ariance

USAID# Target Base Total % Jalin # Jalin Indicator Type Disaggregated Data Source Q1 Q2 Q3 Q4

Goal: Contribute to national goals to reduce maternal and newborn mortality and provide catalytic support to improve essential maternal and newborn services reaching the poorest and most vulnerable

High Level National Data Maternal Mortality Ratio Impact Age (HL)- Sources 1

HL- Maternal Mortality as reported in EMNC Studies Impact Age and District EMNC Studies 1.1

HL- National Data Neonatal Mortality Rate Impact Sex 2 Sources

HL- Neonatal Mortality as reported in the EMNC Impact Sex and District EMNC Studies 2.1 Studies

MNH Movement Takes Hold

Behaviors and Processes Evolve Across Health Systems

Number of innovations supported through USG Sector; Technical Program HL-3 STIR-11 assistance with demonstrated uptake by the public Outcome Focus Area; 0 0 0 0 0 0 0 0 Documents and/or private sector Province

Component 1: Partnership process managed to generate, implement, evaluate, and scale successful local solutions and utilize critical evidence to result in sustainable MNH impact

Component 1.1: MNH Evidence Available and Compellingly Communicated

Number of peer-reviewed scientific publications Journal 1.1. STIR-12 resulting from USG support to research and Outcome 0 0 0 0 0 0 0 0 Publication implementation programs

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Data ariance

USAID# Target Base Total % Jalin # Jalin Indicator Type Disaggregated Data Source Q1 Q2 Q3 Q4

Activity 1.1.1 Conduct EMNC activity across selected districts

1.1.1. Program EMNC Activity conducted Milestone Province, District 2.5 0 0 0 0 0 0 -100% a Documents.

1.1.1. Province, District, Program EMNC results reported and communicated Milestone Y 0 N N N N N n/a b media type Documents.

Activity 1.1.2 Build Knowledge Management capacity for MNH (knowledge management partners)

1.1.2. Assessment Assessment of AIPI Evidence Summit Milestone Y 0 N N N N N n/a a Report

1.1.2. MNH KM Strategy in Place (updated every 24 Milestone KM Strategy Y 0 N N N Y Y n/a b months)

Activity 1.1.3 Synthesize MNH evidence from Indonesia (USAID MNH portfolio, Jalin partnerships & solutions, GOI, etc.)

MNH evidence disseminated (Op Eds, peer-review Publication or 1.1.3. articles submitted for publication, policy briefs Event Type; Program Output 8 0 0 2 47 226 275 3338% a published, evidence dissemination events held) Technical Focus Documents (Note 1.1 is a subset of 1.1.3.a) Area; Province

Synthesize latest MNH Evidence from Evidence Summit, GOI evidence, Jalin lessons (see 1.1.3. component 1.2); other USAID MNH partners. Technical Focus Program Milestone Y 0 N Y Y Y Y n/a b Goes into annual report and slide deck of Evidence Areas Document Driven Communications Materials updated semi- annually.

MNH evidence slide deck available (updated semi- 1.1.3. Technical Focus Program annually based on synthesis) for use in co-creation, Milestone Y 0 N N N Y Y n/a c Areas Documents design, and TA

Component 1.2: Constructive and inclusive partnerships, solutions, and advocacy developed

District; Technical 1.2 Partnerships implementing solutions or advocacy Output Program 0 0 0 0 0 0 0 0 Focus Area

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Data ariance

USAID# Target Base Total % Jalin # Jalin Indicator Type Disaggregated Data Source Q1 Q2 Q3 Q4 Solution Documents

Activity 1.2.1 Engage influential multistakeholder actors for MNH through Partnership (includes MAB, targeted outreach, and identification of provincial participants for co-creation workshops).

District, Sector represented (e.g. civil society, private 1.2.1. New multistakeholder actors engaged and or public sector, Program Output 225 0 0 0 55 141 196 -13% a participating in partnerships process etc.); Individuals (by Documents sex) vs Organizations/ Entities

Partnership Engagement Type (e.g. MAB, targeted outreach, provincial outreach), Sector Events and targeted outreach held to share 1.2.1. represented (e.g. evidence (Activity 1.1.3) and engage Output 10 0 0 2 27 38 67 570% b civil society, private multistakeholder actors or public sector, etc.), Individuals (by sex) vs Organizations/Entiti es

Activity 1.2.2 Define problem statements for co-creation efforts

1.2.2. Province; Technical Program Problem statements defined Milestone 12 0 0 0 20 45 65 442% a Focus Area Documents

Activity 1.2.3 Deploy co-creation approaches to develop evidence-driven solutions and advocacy (inclusive of targeted partnerships as well as workshop model)

1.2.3. Program Co-creation events held Output Province 8 0 0 0 2 12 14 75% a Documents

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Data ariance

USAID# Target Base Total % Jalin # Jalin Indicator Type Disaggregated Data Source Q1 Q2 Q3 Q4

1.2.3. Co-creation design sessions via targeted Technical Focus Program Output 5 0 0 0 3 36 39 680% b partnerships and outreach Area Documents

1.2.3. Solutions or advocacy initiatives identified as a Technical Focus Program Output 5 0 0 0 0 21 21 320% c result of co-creation events or targeted outreach Area; Province Documents

Activity 1.2.4 Prioritize partnerships, solutions, advocacy for impact

Province; Technical STIR-10 Focus Area(s); 1.2.4. Number of innovations (solutions) supported Program (a and Output New/Ongoing; 6 0 0 0 0 8 8 33% a through USG assistance Documents b) Type of USG Support

Province; Technical Focus Area(s); Type of Organization Receiving Support; 1.2.4. Type of Implementatio Partnerships receiving local funding beyond Jalin Outcome 0 0 0 0 0 0 0 0 b Organization n Plans Providing Support (GOI, private Sector); Proportion of non-Jalin Support

Number of civil society organizations (CSOs) 1.2.4. DR.4.2- Province; Technical Program receiving USG assistance engaged in advocacy Output 4 0 0 0 0 6 6 50% c 2 Focus Area(s); Documents interventions

Activity 1.2.5 Build local capacity to use a facilitative/co-creation approach

MAB Meeting 1.2.5. Date of Event, Sex MAB meetings held quarterly Milestone Agenda and 4 0 1 1 0 2 4 0% a of Participants; Sector Minutes

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Data ariance

USAID# Target Base Total % Jalin # Jalin Indicator Type Disaggregated Data Source Q1 Q2 Q3 Q4 Represented

Activity 1.2.6 Monitor and learn from local partnerships, solutions, and advocacy

Geographic Zone Partnerships implementing local solutions with (e.g. Province or 1.2.6. Implementatio Mini-MELAs** and Technical Assistance plans in Output District), and 6 0 0 0 0 0 0 -100% a n Plans place. Technical Focus Area(s)

Geographic Zone (e.g. Province or 1.2.6. Number of local solutions/innovations documented Program Output District), and 0 0 0 0 0 0 0 0% b with a pathway for scale and sustainability. Documents Technical Focus Area(s)

Activity 1.2.7 Package local solutions for adaptation/replication, investment, and scale (begins Year 2)

Geographic Zone Number of local solutions/innovations packaged (e.g. Province or 1.2.7. Program with how-to guides, or mentoring plans to ease Output District), and 0 0 0 0 0 0 0 0% a Documents adaptation/replication and scale. Technical Focus Area(s)

Component 2: TA deployed effectively to support impact at scale

Activity 2.1 Provision of specialized TA for local solutions; and Activity 2.2 Provision of responsive TA to the GOI

Geographic Zone (e.g. Province or District), Technical Number of technical assistance requests (from: 2.1.a; Focus Area; Program partnership plans, grants, GOI support requests, Output 8 0 0 0 0 2 2 -75% 2.2.a Multistakeholder Documents etc.) fulfilled by Jalin Type (Private Sector, GOI, CSO, etc.)

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Data ariance

USAID# Target Base Total % Jalin # Jalin Indicator Type Disaggregated Data Source Q1 Q2 Q3 Q4

UHC Category USAID (essential health 2.1.b; Health Number of Universal Health Coverage (UHC) Program Output services; quality; 3 0 0 0 0 0 0 -100% 2.2.b; Leaders areas supported by USG investment Documents financial hip -1 protection);

Activity 2.3 Monitor TA with feedback survey

Geographic Zone (e.g. Province or District), Technical Feedback 2.3.a Percentage of TA with positive feedback Output Focus Area; Multi- 85% 0 0 0 0 0 0 -100% Survey stakeholder Type (Private Sector, GOI, CSO, etc.)

Component 3: Catalytic financing efficiently disbursed to support the incubation and implementation of local solutions

Geographic Zone (e.g. Province or District), Technical Grant

3.1 Total value of USG GUC provided Output Focus Area; Multi- Agreements TBD 0 0 0 0 0 n/a stakeholder Type and Reports (Private Sector, GOI, CSO, etc.)

Activity 3.1 Jalin provides catalytic financing to local solutions in a timely manner

Geographic Zone (e.g. Province or District), Technical Grant

3.1.a Number of grants for catalytic financing provided Output Focus Area; Multi- Agreements TBD 0 0 0 0 0 n/a stakeholder Type and Reports (Private Sector, GOI, CSO, etc.)

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Data ariance

USAID# Target Base Total % Jalin # Jalin Indicator Type Disaggregated Data Source Q1 Q2 Q3 Q4

Activity 3.2 Jalin funding is provided in a timely manner

Geographic Zone (e.g. Province or District), Technical Percentage of local solutions requiring GUC Grant Financial 3.2.a Output Focus Area; Multi- 100% 0 NA NA 0 0 0 -100% funding where funds disbursed in a timely manner Monitoring stakeholder Type (Private Sector, GOI, CSO, etc.)

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APPENDIX 4: VALUE CHAIN ASSESSMENT – EXECUTIVE SUMMARY

Introduction

Nationally, maternal and neonatal mortality in Indonesia has been relatively stagnant in the past decade.5 To respond to this challenge, the Government of Indonesia, in partnership with USAID, designed the Jalin Project (hereafter referred to as “Jalin” or the “Project”). Jalin, USAID/Indonesia’s Flagship Maternal and Newborn Health Activity, is a is a five-year initiative to support a maternal and newborn health (MNH) movement in Indonesia that will result in better health outcomes nationally by:

• Bringing together actors, including those traditionally outside the health system, to use local evidence and global best practices to co-create, test and adapt local solutions; • Addressing evidence gaps by identifying where and why maternal and newborn deaths are happening and using that information to co-define and create local solutions; and • Engaging the public and private sectors to co-finance scalable local solutions across Indonesia to support partnerships and ensure that the poor and vulnerable have access to essential services.

Jalin used a value chain methodology to assess specific health services and identify opportunities to improve health service delivery to reduce maternal and neonatal mortality in Indonesia. Value Chains map functions and actors and their relationships and transactions within a system. Typically, the value in a value chain approach is financial. For this value chain assessment, the value being assessed also includes improved health outcomes. Findings are structured to illustrate functions, relationships/transactions, and service providers along each chain. The “value” used to prioritize recommendations for optimization within each chain from this assessment is primarily increased public health outcomes and secondarily improved opportunities for private sector engagement.

Context

An analysis of recent evidence indicates challenges in the quality of continuum of care by health professionals. Jalin identified several potential problems for Co-Creation action:

1. Improving referral effectiveness to prevent maternal deaths: Maternal death review in EMAS affiliated hospitals recorded that referral-related factors were contributed to 39% of maternal death cases – with 87% of those related to inadequate treatment prior to referring, and 46% due to prolonged transportation to hospitals. Saving maternal and newborn lives will depend heavily on quality of care (QOC) at delivery and immediate post-delivery care, in addition to effective management of referred maternal emergencies. 2. Improving Quality of Care to prevent maternal and newborn deaths in facilities: Sixty-five percent of maternal deaths in the Banten II study occurred in facilities, indicating deficiencies in QOC. Improving QOC within and across facilities is a first priority. Given the EMAS and Banten evidence, particular attention should be given to ANC and post-partum hemorrhage. 3. Improving JKN maternal and newborn health linkages and impacts (leveraging the private sector to address quality): 4. Low coverage of JKN-PBI and high rates of out-of-pocket expenditure indicate a problem in JKN implementation, particularly as it relates to improving access to health services for the poor and vulnerable.

Jalin selected the value chains in consultation with USAID using two criteria:

5 Akademi Ilmu Pengetahuan Indonesia. Evidence Summit untuk Mengurangi Kematian Ibu dan Bayi Baru Lahir. Jakarta: AIPI, 2018.

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• Potential linkage to priority problem areas with the potential to impact mortality rates; and • Potential for opportunities to engage private sector actors beyond the health sector (health and non-health) as part of market-driven solution development.

Jalin selected the following four value chains for initial analysis:

• Referral systems as directly linked to Improving Referral Effectiveness; • Blood supply as suggested by USAID and directly linked to Improving QOC in facilities; literature review strongly relates that hemorrhagic is a major cause of maternal death (MADE-IN/MADE-FOR Component of Banten II Study); • Relevant transportation services as directly linked to Improving Referral Effectiveness and Strengthening the Continuum of Quality of Care; and, • JKN payment system (including consideration of out-of-pocket costs) to Improve JKN maternal and newborn health linkages and impacts.

Methodology

The Value Chain Study (VCS) used a mixed-methods approach to data collection. Beginning with a review of other value chain frameworks, the team developed a list of key questions to answer through focus group discussions and key informant interviews. The VCS team consists of Jalin staff and consultants with expertise in economic growth, health financing, health costing, maternal and newborn health, and the overall health system in Indonesia. The team conducted focus group discussions and key informant interviews in Jakarta as well as each of Jalin’s six target provinces: Banten, West Java, Central Java, East Java, North Sumatra and South Sulawesi. Jalin consulted over 300 people from a range of stakeholders including government, civil society and private sector actors relevant to the four value chains. The team triangulated information by reviewing the broader literature and regulations, interviewing key informants, and holding a consultation workshop in Jakarta with national stakeholders.

Findings - Referrals

The referral value chain comprises three functions: 1) Informing women about high risk and normal pregnancies; 2) detecting high risk pregnancies, and 3: providing emergency obstetric and newborn care. Across these functions there are a number of actors including, midwives, primary health facilities, private clinics and public and private hospitals.

Information. Although there is increasing awareness—through GOI resources such as the KIA handbook or simply increased internet access—among women to better plan and manage their pregnancies, delays in determining when women should be referred to emergency care facilities persist. Midwives need to actively inform their patients on the potential risks and how to manage these risks, through better screening. Women also need to be better informed, so that they can seek appropriate advice from their midwife or doctor. Husbands and families also need to understand potential risks to ensure appropriate action is taken in an emergency.

Risk Identification. While midwives play an important role in assisting women during pregnancy, childbirth, and postpartum, they may lack the knowledge and skills to detect maternal-neonatal complications. There are interventions focused on improving the skills and knowledge of midwives, like Bidan Delima, but the achievements and sustainability of these interventions is mixed. Furthermore, reimbursement schedules that require midwives to prefinance Ante Natal Care visits and treatment costs limit their ability to manage risks effectively; compensation through BPJS or Jampersel, which only pays midwives after the the delivery of an infant, discourages referrals to high-risk obstetricians. Finally, once a high-risk pregnancy is identified, strategies to minimize these risks require further development and implementation. For example, women will need to seek advice from their GP or Obstetrician to manage risks like high blood pressure, diabetes or anemia throughout their pregnancy.

Emergency Obstetric and Newborn Care. The quality of CEMONC and BEMONC services in Jalin Provinces varies. Not all facilities meet the minimum standards with respect to staff and resources:

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Only 8% of Puskesmas were deemed ready to provide basic obstetric care, while no private clinics met all of the criteria for service readiness in basic obstetric care.

Online referral managements systems—such as SijariEMAS67, a computerized referral exchange system—have the potential to dramatically improve referrals management. However, the cost of establishing and maintaining the service prevent optimal use of the service in all health facilities.

Recommendations

Strengthen Midwives’ access to resources. Qualified midwives have access to the GOI’s subsidized microfinance program (KUR), which enables an individual to borrow up to IDR 25 million at 7 % pa interest. Alternatively, midwives could form partnerships with accredited private clinics, who could finance the midwives practice, and in return, the clinic benefits through having more woman and their family registering with the clinic, which will enable the clinic to increase capitation income.

Integrate videos into the digitized “Mother and Child Handbook (KIA).” Consideration should be given to integrating short informative videos involving “social media influencers” with the KIA. Socially responsible companies could produce these videos, as part of their marketing strategy, to increase sales and improve market share.

Expand and sustain ICT interventions by establishing an mMCH Health network to bring together ICT companies, health sector partners and investors. A network similar to the GSMA mHealth network, but clearly owned and developed by the Indonesian health and ICT sector could be established. Initial members could include organizations currently investing in the mHealth sector. The Network could also develop a platform to promote and demonstrate different interventions.

Develop online referral systems. SijariEMAS should be reviewed and strategies to develop and sustain the system identified. This could include integrating the service with a major telecommunications company’s existing service or with PSC 119.

Findings – Transportation

The transportation value chain comprises four functions: 1) promoting awareness of the need to plan transportation needs during pregnancy, labor, and post-partum;2) facilitating, through telecommunication systems, planning around when transportation is required; 3) transporting patients (whether in ambulances or other modes of transport), and 4) transfer of patients from transport to health facilities. Across these functions there are several actors, including ambulance providers, public transport companies, communication networks, primary health facilities, private clinics and public and private hospitals.

Awareness. Women are aware of the need to plan their transportation needs but are not fully informed of the transportation options available. Pregnant women seldom use ambulances to be transported to emergency care facilities, preferring to use the most readily form of transport available. Midwives and women need information on safe transportation options and how to contact transportation coordination centers, like PSC119.

Coordination. Over the last 5 years, a few telecommunication systems have evolved to facilitate coordination of transportation services. These telecommunication systems maybe nationally based or city based, which results in inefficiencies and confusion by potential users.

Transport. The government (through national, regional and district budgets) villages (through the Village Fund, Dana Desa) and not for profit organizations (through public donations) are purchasing ambulances without fully understanding the ongoing operating and maintenance costs of a transportation service. Fully equipped emergency ambulances are expensive, and if not in regular

6 http://sijarimas.co.id/index.php 7 http://sijariemas.net/ USAID Jalin Project Year 1 Annual Report P 40/64 [01/15/2019]

service, may not be financially viable to operate. Transport ambulances are not as expensive, as they do not have a complete set of equipment but still need to be operated and maintained.

Public transportation operators and online transportation platforms are interested in understanding how to adapt their vehicles to provide safer and more reliable transport for pregnant women in a time of an emergency. However, emergency services offered by these organizations would need to be carefully assessed to ensure they meet minimum health and safety standards.

Recommendations

Define the cost of operating and maintaining an emergency and general ambulance service. Information is required on the costs to operate and maintain an ambulance, to ensure any organization considering investing in ambulances fully understands the investment costs, the cost per trip, and the minimum number of trips required each month to operate and sustain the service. Once reliable financial information is available, financing models, like leasing, and other private sector investments maybe possible.

Define the minimum requirements to safely transport women in an emergency. Women who need emergency care seldom take ambulances; they take the most appropriate transportation available at the time. If villages or NGOs are considering investing in ambulances, it may be more feasible to purchase the equipment on standby, so that any available and suitable public or private transport can be quickly modified to safely transport pregnant women. In an emergency, a midwife or family member could access this equipment, or have it on standby during the birth.

Evaluate the potential of transportation platforms, like Grab and Gojek. Grab and/or Gojek could identify drivers within their network who are interested in and capable of providing transportation for pregnant women and, if appropriate, for emergency transportation. Drivers could receive appropriate first aid training. Customers, who mainly utilize motorcycle transport for their day- to-day needs, could use their accrued points to access more suitable four-wheeled vehicles for safe transport to their closest health facility for regular checkups and for returning home after leaving the hospital. Transportation applications could integrate the locations of BPJS registered facilities to enable people to plan their journey.

Findings – Blood Supply

The blood supply value chain comprises four core functions: 1) planning and inventory management of blood; 2) blood donations; 3) blood processing; and 4) blood transport logistics. Across these functions there are a number of actors including PMI, District Health Offices, logistics companies, and medical suppliers.

Planning. Indonesia requires about 5 million bags of blood a year but only produces about 4 million bags. Obstetric emergencies utilize about 17% of the total blood produced. Large cities like Jakarta, Bandung, Surabaya, Semarang, Medan and Makassar produce a surplus of blood, but many smaller districts have a deficit. Inventory and planning of blood supplies is poorly managed by district governments, and oversight of blood stocks, nationally, is not effectively coordinated. Districts that produce more blood than needed seldom share with those districts that have deficits, but often have to pay to dispose of the blood. Better inventory management by Blood Centers and Blood Banks, along with a national blood inventory management system, could help prevent shortages, as blood banks with excess blood could transfer bags of blood to areas with shortages.

Blood Donations. Blood is a public good and cannot be sold commercially, as it is sourced through voluntary public donations. The PMI collects about 98% of the blood sourced through donations. About 60% of blood is donated through repeat donors. NGOs, like Blood for Life and Red Blood, inform and mobilize the community about blood donations; they can further facilitate the increase in pool of potential donors in districts where there are deficits in blood stocks.

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Processing. Blood is processed and screened for infectious diseases at either PMI or Government blood centers. Blood is processed into two types of products: Blood components (whole blood, red blood cells) which are manufactured from single donations for direct transfusions; and Plasma derived medical products (albumin, immunoglobulins and blood coagulation factors). There are opportunities to process more blood into plasma products, as Indonesia discards 70,000 liters of plasma each year, which costs about USD 100,000, while at the same time, imports USD $25 million worth of plasma products each year. There are many blood centers in Indonesia (421, of which 303 lack appropriate human and financial resources. The WHO has suggested Indonesia should consolidate blood centers, and better manage inventory and logistics to overcome the resourcing and supply issues.

Storing Blood. Blood is stored in blood banks, which are located either in blood centers or hospitals. Not all hospitals have blood banks, as cost of managing blood in the blood bank is more than the IDR 360,000 the hospital can claim through BPJS. Hospitals find it hard to recruit qualified technicians to operate and manage the blood bank. Improvements in managing the cold chain, through improved transportation and storage systems, could facilitate better inventory management.

Recommendations

Improve blood supply inventory management systems to prevent shortages of blood by developing a National Blood Inventory Management System (NBIMS). There are limited opportunities for the Private sector to participate in developing the NBIMS, as the management and supply of blood must be controlled by the government. GOI leadership and ownership over developing the NBIMS is therefore necessary, although a private contractor could develop the NBIMS.

Develop blood supply logistics systems with improved blood cold chain management. To meet shortfalls by improving blood transportation, Indonesia will also need to strengthen the blood cold chain. Opportunities include designing and providing the government with more reliable storage systems to transport blood, and for transportation companies to transport blood. The government could source these services through competitive tendering.

Process blood into plasma-derived medical products. The private sector could produce plasma products for the Indonesian market and export, and pay the Government or PMI USD50/per liter for plasma, rather than using limited financial resources to destroy the unused plasma.

Findings – JKN

The access to JKN value chain comprises five functions: 1) promote community awareness on the benefits of JKN; 2) undertake BPJS registration; 3) pay premiums; 4) communicate the benefits of BPJS, and; and 5) ensure quality of care provided by BPJS health facilities. Across these functions there are a few actors including, BPJS, midwives, primary health facilities, private clinics and public and private hospitals.

Registering with BPJS. Since its inception in 2014, JKN has resulted in a significant increase in hospital and outpatient services throughout Indonesia. More women are giving birth in a health facility and there has been a decline in the number of women engaging traditional birth attendants. Over 190 million Indonesians are registered with BPJS. However, there are about 50 million Indonesians, primarily employed in the informal sector, who are not registered. They must voluntarily register and pay premiums. Targeted awareness programs are therefore required to inform those people, who have not yet registered, about the benefits of BPJS. BPJS needs to also address the challenges of voluntary registration and payment of premiums.

Quality of care. The private sector is the main provider of health services in Indonesia. Currently, about 60% of all BPJS registered health facilities are either operated by NGOs or for-profit private companies. There is significant scope to further increase the number of private health providers.

BPJS does not directly support midwives, as they need to be part of a primary health facility network in order to receive compensation for non-capitation services, like prenatal care and normal delivery.

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Partnerships between private clinics and midwives are an option, whereby the midwife receives regular income through the clinic, in return for providing maternal and child health services for the population registered with the clinic. This could help clinics provide a holistic quality health care service, not just MNC, which could result in more families registering with the clinic.

Government-owned and -operated Hospitals and Puskesmas could improve the quality of services if they become a Badan lLayanan Umum Daerah (BLUD, or Regional Public Service Agency)8. By becoming a BLUD, the business unit can manage its revenue flows and improve the quality of health care. However, the requirements for a public facility achieving BLUD status, is time-consuming and can take several years to achieve.

BPJS services for registration, payment of premiums, managing referrals and for hospitals to claim CBG are managed through a BPJS online platform. However, there is significant variation in the quality of 3G services throughout the six Jalin Provinces. Many health clinics and Puskesmas have trouble accessing the online system, due to poor telecommunication networks. To address this problem a partnership with the Ministry of Communications and Information through their Universal Service Obligation (USO) program could significantly improve telecommunication coverage.

Recommendations

Strengthen private clinics to deliver BPJS services in areas not adequately serviced by a Puskesmas. There are opportunities for a private company to scale up a network of single GP clinics throughout the country, benefitting from economies of scale by providing the ancillary services required of a BPJS-registered clinic. These clinics would need to provide quality care to scale up patient loads adequate to cover their costs. To benefit pregnant women, the clinic will need to recruit midwives, who could be compensated through capitation and non-capitation income, as the clinic can invoice BPJS, for non-capitation fees like ANC services and assisting normal deliveries.

Assist Government Health facilities to become BLUDs. There is a potential opportunity for Business Development Providers to assist public facilities to gain BLUD status, however this would need to be funded through existing APBD funding.

Establish partnerships between the private sector and NGOs/ CSOs. Private sector companies that are operating in the health sector could establish clinics, and partner with CSOs’ community health outreach programs to increase the number of people registered with the clinics. Members of the CSOs’ networks could also partner with the private sector clinic. Organizations like NU and Muhammadiyah collectively have over 100 million members. Clinics managed by CSOs could develop referral networks, if they meet BPJS’s referral zonation criteria. CSOs could also establish class C and D hospitals that can be linked to class B and A hospitals, which are primarily managed and operated by the private sector.

Support private health facilities with the registration and credentialing process. Currently there are insufficient auditors to meet demand for accreditation of private hospitals and health facilities. There are opportunities for the private sector to provide accreditation services to private and public health facilities. Auditors would need to be trained and registered with HCA.

Improve telecommunication coverage to improve the delivery of services and access to information. Jalin could partner with local governments and the USO program to identify which areas in the six Jalin provinces should be prioritized to improve telecommunication coverage.

8 Peraturan Menteri Dalam Negeri Nomor 61 Tahun 2007 Tentang Pedoman Teknis Pengelolaan Keuangan Badan Layanan Umum Daerah

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Conclusion

Opportunities exist for the private sector to invest either directly or indirectly in the four value chains assessed. Direct support could be through existing stakeholders in the health industry, such as CSOs and NGOs, while indirect support could be through supporting organizations, like the telecommunications and ICT sectors.

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APPENDIX 5: RAPID SYNTHESIS OF RECENT MATERNAL AND NEONATAL MORTALITY EVIDENCE IN INDONESIA - SUMMARY

Background

Nationally, maternal and neonatal mortality in Indonesia has been relatively stagnant in the past decade.9 USAID has supported various studies in its working areas to further understand this phenomenon. Evidence obtained from these studies is expected to provide the basis for problem co-definition and co- creation during Jalin’s kick-off held in May 2018.

Jalin conducted a review of the recent evidence available on maternal and neonatal mortality, generated from activities supported by USAID. Studies included in this review are: (1) Banten II Study; (2) EMAS Maternal Death Review; (3) EMAS Neonatal Death Review; (4) EMAS review results; (5) Evidence Summit; and (6) Maternal and Neonatal Portfolio Review. Applying a rapid review approach, the results from this activity will guide the initial problem identification for co-definition and prioritization process. Priority problem will be decided in discussion with the Ministry of Health, USAID, and Jalin’s MAB member.

The Evidence

The World Bank reported that non-institutional birth delivery rate in 2015 was 33% - the rate was higher for rural (35%) than urban areas (10%). In relation to this, within 2015 – 2017, 25% of maternal death cases in Banten II study areas (during 2015 – 2017), took place at home – compared to 65% in health facility, and 10% during transport. Majority of the maternal death cases took place during post- partum (64%)10. Similar with this finding, 88% of 90 maternal death cases reviewed in EMAS affiliated hospital also happened during post-partum (42% within the first 24 hours). Meanwhile, 68% of the neonatal mortality took place during 0 – 7 days post-delivery.11

There was discrepancy in relation to cause of maternal death at the community level and data obtained from hospital. At the community level, the main cause of death was hemorrhage (38%), followed by Pre- eclampsia/Eclampsia – PE/E (19%). Whereas PE/E was identified as the majority cause of maternal death in hospital – both in Banten II study and EMAS maternal death review – followed by hemorrhage. The proportion of maternal death causes by PE/E found in Banten II study and EMAS maternal death review was 29% and 42%, respectively.

The evidence indicates challenges in quality of continuum of care provided by health professionals. Banten II study found that among mothers who died at home, 50% were assisted by health professionals, and 43% were giving birth at health facilities. Meanwhile, 86% of newborn death cases reviewed in EMAS affiliated hospital were assisted by skilled birth attendant during birth delivery – 46% assisted by obstetrician. Further, the evidence also indicate that the ANC quality is not yet adequate. Both EMAS and The World Bank reported low levels of provided ability to provide comprehensive ANC visit – for example fetal heart monitoring was conducted only to 59% of women having ANC in EMAS hospital (compared to 39% in non-EMAS hospital). Such problem may hinder health professional’s ability in detecting high risk pregnancy. The inadequate capacity of health professionals indicates the

9 Akademi Ilmu Pengetahuan Indonesia. Evidence Summit untuk Mengurangi Kematian Ibu dan Bayi Baru Lahir. Jakarta: AIPI, 2018. 10 Banten II Summary Tables: Table I 11 Latief K, Koblinsky M, Rianty T, et al. Piloting a community based method for neonatal mortality and stillbirth measurement. DRAFT 2018. USAID Jalin Project Year 1 Annual Report P 45/64 [01/15/2019]

need of capacity building. The AIPI Evidence Summit indicates gaps in training and quality of providers across professional cadres.12 Supporting this, the World Bank reported that the proportion of health professionals in single-private maternal clinic who ever received ANC training and obstetric care training in the past two years was 27% and 41%, respectively.13

At the primary care level, only 31% and 8% of Puskesmas were indicated ready to provide adequate ANC and basic obstetric care, respectively. Lower rate was found among private health service provider, where only 5% of single-practitioner health provider were indicated ready to provide adequate ANC, while none met all the criteria for providing adequate basic obstetric care.

Banten II data illustrates clear challenges around the number of referrals patients receive. Of the 25% that die at home/relatives’ home, 70% had previously been referred, accounting for 17.5 % of total deaths.14 Further, review of 90 maternal death in EMAS affiliated hospitals recorded that referral-related factors were contributed to 39% of maternal death cases – with 87% of those was related to inadequate treatment prior to referring, and 46% was due to prolonged transportation to hospitals.15 Confirming this, EMAS reported that only 55% of women with pre-eclampsia/eclampsia received MgSO4 at the health facility prior to referral to the hospital.16

In relation to financial protection during JKN implementation, HP+ survey found that the utilization of MNH service increased in private hospitals empaneled with BPJS/ JKN. These include increased in number of patients accessing gynecology clinic, and average admission in maternity wards.17 Despite this finding, the AIPI Evidence Summary suggests that to date, the JKN has not demonstrated impact on maternal and newborn health service quality.18 Further, out of pocket costs also remains a challenge. Only 55% of women who recently giving birth (in the past 2 years) in Banten II study areas were covered by any health insurance for their birth delivery (29% covered by JKN-PBI). EMAS data also indicate as a part of emergency preparedness, families were asked to purchase or get supplies in 58% of non-EMAS sites and 34% of EMAS sites.19

Potential Problems for Co-Creation Action

Generated from the recent evidence, Jalin identified several potential problems for Co-Creation action as below:

1. Improving referral effectiveness to prevent maternal deaths. Maternal death review in EMAS affiliated hospitals recorded that referral-related factors were contributed to 39% of maternal death cases – with 87% of those was related to inadequate treatment prior to referring, and 46% was due to prolonged transportation to hospitals. Saving maternal and newborn lives will depend heavily on quality of care at delivery and immediate post-delivery care, in addition to effective management of referred maternal emergencies. 2. Improving Quality of Care to prevent maternal and newborn deaths in facilities. Sixty-five percent of maternal deaths in Banten II study occur in facilities, indicating important deficiencies in quality of care. Improving QOC within and across facilities is a first priority. Given EMAS and Banten evidence – particular attention should be given to ANC and post-partum hemorrhage. 3. Improving JKN maternal and newborn health linkages and impacts (incorporating leveraging the private sector to address quality). Low coverage of JKN-PBI and high rate of OOP indicate a

12 AIPI Evidence Summit Executive Summary Topic Area 1 13 World Bank Report: Revealing the Missing Link, Table 4.11 14 Banten Determinants, Table 2 15 EMAS Maternal Death Review, Figure1 16 EMAS Draft Report Figure 14 17 HP+L Private Health Sector in the JKN Era, Slide Presentation 7 May 2018, slide 12 18 AIPI Evidence Summit, Topic Area 2 19 EMAS Data Analysis Preliminary Report Figure 33 USAID Jalin Project Year 1 Annual Report P 46/64 [01/15/2019]

problem in JKN implementation, particularly for improving health outcomes (through access) for the poor and vulnerable

USAID Jalin Project Year 1 Annual Report P 47/64 [01/15/2019]

APPENDIX 6: EVIDENCE SYNTHESIS FRAMEWORK

Jalin undertook an evidence synthesis to address the Indonesia’s need for a comprehensive understanding of MNH issues. While many sources of evidence are available, synthesizing them created concise, actionable, and user-friendly information that now informs Jalin’s activities and programs.

Throughout Year 1, Jalin has conducted activities related to evidence synthesis three times. The below table summarizes evidence synthesis conducted by Jalin. In addition to the activities in the table, Jalin also developed a subnational MNH profile that provides an initial understanding of the current MNH situation at the subnational level. Jalin used the profile as an advocacy tool, which, when coupled with provincial factsheets, provided information that helped stakeholder in the initial problem definition process. Because the profile proved so valuable as an engagement and advocacy tool, the project will update it regularly in future years.

USAID Jalin Project Year 1 Annual Report P 48/64 [01/15/2019]

Table X: Evidence Synthesis Framework

Period of Evidence No Synthesis Purpose and literature reviewed Outputs Utilization

1 Initial Evidence To enhance initial understanding related to the 6 thematic • Slide decks on the 5 thematic areas – no specific slide decks developed Resource materials for Synthesis areas (Quality of Care, Referral Care, Financial Protection, for poor and vulnerable population presentations Dec 2017 – March Governance, Poor and vulnerable population, Financial • (Indonesia Jalin - 08. Technical\1. Technical\Slide decks) 2018 protection, Evidence utilization) through literature review of global and national MNH resources

2 Rapid Evidence To identify the key priority areas leading to the reduction • Rapid evidence synthesis full report, emphasizing Quality of Care, Problem definition Synthesis of recent on maternal and newborn mortality through review of: Referral care, and JKN utilization for MNH as the three priority areas Advocacy materials for USAID-funded studies engagement with • Banten II Study Results (Manuscripts and the Summary • (Indonesia Jalin - 08. Technical\1. Technical\Evidence Synthesis Review\ April – May 2018 potential partners at Tables) Updated Rapid Evidence Synthesis after JHPIEGO inputs.docx) national and • Evidence Summit to reduce maternal and neonatal • 2-page summary of evidence synthesis in Bahasa Indonesia subnational level mortality in Indonesia • (Indonesia Jalin - 08. Technical\1. Technical\Factsheets\National\ • EMAS review results USAID Jalin - Sintesis Bukti Terkini tentang Kematian Ibu dan Bayi • Maternal and Neonatal Heath portfolio review Baru Lahir di Indonesia.pdf) • The World Bank Report – Revealing the Missing Link: • 5 Facts on Maternal and Newborn Death in Indonesia (Indonesia Jalin - Private Sector Supply-Side Readiness for Primary 08. Technical\1. Technical\Factsheets\National\ 2018-05-22 Fact Sheet Maternal Health Services in Indonesia for Jalin Kick Off Co-creation - Eng v1.1 YC PG.pdf) • EMAS Maternal and Neonatal Death Review • Provincial factsheets developed based on adaptation of the national factsheet (Indonesia Jalin - 08. Technical\1. Technical\Factsheets\June- 18\Factsheet)

3 Deep Dive review of To obtain deeper understanding on the three priority areas • Deep dive review report Year 2 Work Plan the three key priority and guide Jalin’s actions in Year 2 related to the three areas areas through review of global and national resources • 2-pager brief on priority sub-topics within the key areas (ongoing) Oct – Dec 2018

4 MNH Frameworks To review the current MNH frameworks available and TBD TBD review identify the one suitable the most for Jalin’s program (ongoing

USAID Jalin Project Year 1 Annual Report P 49/64 [01/15/2019]

APPENDIX 7: MNH PERCEPTION SURVEY RESULTS

Nielsen conducted a survey looking into maternal health and mortality awareness in Indonesia between 16 November and 4 December 2018. The areas they covered include Jabodetabek, North Sumatra (P.Siantar, Medan, Mandailing), Banten (Cilegon, Serang), West Java (Bandung, Sukabumi, Cirebon, Garut), Central Java (Semarang, Boyolali, Magelang, Solo), East Java (Surabaya, Jember, Malang, Madiun), and South Sulawesi (Makassar, Gowa), where they spoke to male and female respondents aged 18-35 years old of all socioeconomic statuses.

Altogether, around 49% of women across all those provinces take their own decisions when it comes to pregnancy health. A significant number of women, 43%, entrust that to their husbands, while a marginal number involves their family, their husband’s family, as well as relatives and friends in the decision-making process.

The research also found that there is a lack of concern regarding maternal and newborn mortality rates in Indonesia. Those are not considered as a significant health problem in the country. However, the issue of maternal and newborn mortality rates elicits feelings of sympathy and sadness among respondents. Interestingly enough, in the provinces of Banten and South Sulawesi, respondents also associated the issue with feelings of “scared” and “trauma” – when discussing maternal and newborn mortality.

Respondents suspect that lack of awareness and lack of information are among the factors that drives up the maternal mortality rate. In Banten and North Sumatra, however, respondents also considered other factors, such as the far and often unreachable distances of healthcare facilities, inadequate medical facilities, ineffective referral system, and medical workers that are not up to par.

In general, respondents do not show an active interest regarding the issue of maternal and newborn mortality, except in West Java and Central Java. Where respondents in the other regions show a high but passive interest, respondents in those two provinces say that they actively seek information on pregnancy health, as well as for the delivery process and for newborn health.

Respondents in general agree that the government plays an important role in slowing down maternal and newborn mortality. Besides that, they also pointed to communities, academics, the media, and private sector to also contribute in improving maternal and newborn health.

USAID Jalin Project Year 1 Annual Report P 50/64 [01/15/2019]

APPENDIX 8: EMNC SCHEDULE – WAVE 1

2018 2019 Dec Jan Feb Mar Apr May June July Aug 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Banten East Java Milestones 1 2 3 4 5 6 7 8 Deliverables 1 Workplan 2 Preparation for data collection report-- Banten 3 Interviewer training report - Banten 4 Preparation for data collection report - East Java 5 Report of East Java training and Progress report of data collection in Banten 6 Report of Data collection in Banten 7 Draft Report Banten & Report of Data Collection in East Java 8 Draft Report East Java & Final Grand Report

Legend

Preparation phase Training Phase Data Collection phase Data Cleaning & Analysis Idul Fitri Holiday

USAID Jalin Project Year 1 Annual Report P 51/64 [01/15/2019]

APPENDIX 9: MEDIA COVERAGE

Date of No Product Title Source Province Publication Link to File

1 Published Pemprov SUMUT dukung program tekan angka kematian ibu Bisnis.com North 2-Nov-18 http://surabaya.bisnis.com/read/20181102/533/856072/p Interview dan bayi USAID Jalin Sumatra emprov-sumut-dukung-program-tekan-angka-kematian-

ibu-dan-bayi-usaid-jalin

2 Published Wagub SUMUT harapkan program usaid jalin usaid jalin Sumutprov North 2-Nov-18 http://humas.sumutprov.go.id/wagub-sumut-harapkan-

Interview fokus di SATU Daerah Sumatra program-usaid-jalin-fokus-di-satu-daerah/

3 Published Program USAID Jalin untuk keselamatan Media Apa Kabar North 2-Nov-18 http://www.mediaapakabar.com/2018/11/program-

Interview Sumatra usaid-jalin-untuk-keselamatan.html

4 Published Wagub SUMUT harapkan program usaid jalin usaid jalin Asarpua.com North 2-Nov-18 https://asarpua.com/wagubsu-harapkan-program-usaid-

Interview fokus di SATU Daerah Sumatra jalin-fokus-di-satu-daerah/

5 Published Wagub SUMUT harapkan program usaid jalin usaid jalin Pewarta North 3-Nov-18 https://pewarta.co/news/sumut/wagub-sumut-harapkan-

Interview fokus di SATU Daerah Sumatra program-usaid-jalin-fokus-di-satu-daerah

6 Published Angka Kematian Ibu dan Bayi di Provinsi Banten Tinggi Jawa Pos Tv Banten 9-Nov-18 P:\Indonesia Jalin - 08. Technical\5 Interview Regional\Banten\Media

7 Published Kematian Ibu masih tinggi Radar Banten Banten 9-Nov-18 P:\Indonesia Jalin - 08. Technical\5 Interview Regional\Banten\Media

8 Published Kematian Ibu dan Anak tinggi Kabar Banten Banten 9-Nov-18 P:\Indonesia Jalin - 08. Technical\5 Interview Regional\Banten\Media

9 Published USAID Jalin: Jumlah Kematian Ibu Di Banten Tinggi Rmol Banten Banten 8-Nov-18 http://www.rmolbanten.com/read/2018/11/08/4230/US

Interview AID-Jalin:-Jumlah-Kematian-Ibu-Di-Banten-Tinggi-

10 Published Kematian Ibu dan Anak di Banten Tinggi, Per Pekan 5 Ibu Mediabanten Banten 8-Nov-18 https://mediabanten.com/kematian-ibu-dan-anak-di-

Interview dan 27 Bayi Meninggal banten-tinggi-per-pekan-5-ibu-dan-27-bayi-meninggal/

11 Published Di Banten, dalam Seminggu Sedikitnya Terjadi Lima Tangis Bantentribun Banten 8-Nov-18 http://bantentribun.id/8911-2/ Interview Keluarga Akibat Kematian Ibu

12 Published Kematian Ibu dan Anak di Provinsi Banten Tinggi Kabar Banten Banten 9-Nov-18 https://www.kabar-banten.com/kematian-ibu-dan-anak-

USAID Jalin Project Year 1 Annual Report P 52/64 [01/15/2019]

Date of No Product Title Source Province Publication Link to File Interview di-provinsi-banten-tinggi/

13 Published 27 bayi mati setiap pekan Banten Raya Banten 9-Nov-18 P:\Indonesia Jalin - 08. Technical\5 Interview Regional\Banten\Media

14 Published Manajer USAID Jalin Jabar Sebut,di Jabar Setiap Hari 9 Bayi Tribun News West Java 26-Nov-18 http://jabar.tribunnews.com/2018/11/26/manajer-usaid- Interview Baru Lahir Meninggal Dunia jalin-jabar-sebutdi-jabar-setiap-hari-9-bayi-baru-lahir-

meninggal-dunia

15 Hard Copy kematian neonatus terbesar di Jabar Pikiran Rakyat West Java 26-Nov-18 Published Interview

16 Published Tekan Angka Kematian Ibu dan Bayi, Dinkes Jateng Gandeng Radio Idola Central Java 26-Jul-18 https://www.radioidola.com/2018/tekan-angka- Interview USAID-Jalin kematian-ibu-dan-bayi-dinkes-jateng-gandeng-usaid-jalin/

17 Published Tekan AKI dan AKB, Bupati Boyolali Luncurkan Program PPID Boyolali Central Java 26-Jul-18 http://ppid.boyolali.go.id/new/2018/06/26/tekan-aki-dan-

Interview SATITI akb-bupati-boyolali-luncurkan-program-satiti/

18 Published Dinkes Jateng dan USAID Jalin Tekan Angka Kematian Ibu Suara Merdeka Central Java 27-Jul-18 https://www.suaramerdeka.com/news/baca/108542/dink Interview dan Bayi Baru Lahir es-jateng-dan-usaid-jalin-tekan-angka-kematian-ibu-dan- bayi

19 Published Dinkes Jateng dan USAID-Jalin Tekan Angka Kematian Ibu Suara Merdeka Central Java 27-Jul-18 https://www.suaramerdeka.com/news/baca/108542/dink Interview dan Bayi es-jateng-dan-usaid-jalin-tekan-angka-kematian-ibu-dan-

bayi

20 Published Angka Kematian Ibu Hamil di Boyolali Meningkat KRJ Jogja Central Java 5-Aug-18 http://krjogja.com/web/news/read/4868/Angka_Kematia

Interview n_Ibu_Hamil_di_Boyolali_Meningkat

21 Published USAID Jalin Deteksi Kematian Ibu Hamil Suara Merdeka Central Java 7-Aug-18 https://www.suaramerdeka.com/smcetak/baca/112713/u Interview said-jalin-deteksi-kematian-ibu-hamil

22 Published USAID Jalin Deteksi Kematian Ibu Hamil Suara Merdeka Central Java 8-Aug-18 https://www.suaramerdeka.com/smcetak/baca/112713/u

Interview said-jalin-deteksi-kematian-ibu-hamil

23 Published Angka Kematian Ibu Melahirkan Tinggi, Semarang Peringkat Metro Jateng Central Java 12-Aug-18 https://metrojateng.com/angka-kematian-ibu-

Interview Kelima melahirkan-tinggi-semarang-peringkat-kelima/

USAID Jalin Project Year 1 Annual Report P 53/64 [01/15/2019]

Date of No Product Title Source Province Publication Link to File

24 Published Jalin, Dukungan USAID Untuk Jateng Gayeng Nginceng Radar Malang Central Java 8-Oct-18 https://radarmalang.id/jalin-dukungan-usaid-untuk-

Interview Wong Meteng jateng-gayeng-nginceng-wong-meteng/

25 Published USAID Jalin Berikan Saran 3 Gerakan Nyata Jateng Gayeng Tribun News Central Java 8-Oct-18 http://jateng.tribunnews.com/2018/10/09/usaid-jalin- Interview Nginceng Wong Meteng berikan-saran-3-gerakan-nyata-jateng-gayeng-nginceng-

wong-meteng

26 Published Jalin, Dukungan USAID Untuk Jateng Gayeng Nginceng Jawa Pos Central Java 8-Oct-18 https://www.jawapos.com/jpg-today/08/10/2018/jalin- Interview Wong Meteng dukungan-usaid-untuk-jateng-gayeng-nginceng-wong-

meteng

27 Published Program "Nginceng Wong Meteng" Pemprov Jateng Dilirik Gatra Central Java 8-Oct-18 https://www.gatra.com/rubrik/nasional/pemerintahan- Interview USAID daerah/352881-Program-Nginceng-Wong-Meteng-

Pemprov-Jateng-Dilirik-Usaid

28 Published USAID Dukung Program Unggulan Jateng Ini Masganjar.id Central Java 8-Oct-18 http://masganjar.id/usaid-dukung-program-unggulan- Interview jateng-ini/

29 Published Ganjar: USAID dukung Jateng Gayeng Nginceng Wong Antara News Central Java 8-Oct-18 https://jateng.antaranews.com/berita/202231/ganjar-

Interview Meteng usaid-dukung-jateng-gayeng-nginceng-wong-meteng

30 Published Pemprov Jateng Klaim Program Ini Tekan Kematian Ibu… Solopos Central Java 8-Oct-18 http://semarang.solopos.com/read/20181009/515/94441

Interview 6/pemprov-jateng-klaim-program-ini-tekan-kematian-ibu

31 Published Program 5NG Bawa Jawa Tengah Turunkan AKI Republika Central Java 8-Oct-18 https://www.republika.co.id/berita/nasional/daerah/18/1 Interview 0/08/pga1xg399-program-5ng-bawa-jawa-tengah-

turunkan-aki

32 Published USAID Bantu Program 5NG Melalui Jalin Asatu.id Central Java 9-Oct-18 http://asatu.id/2018/10/09/usaid-bantu-program-5ng-

Interview melalui-jalin/

33 Published Dukung Program 5NG, USAID Jadi 'Mak Comblang' Asatu.id Central Java 9-Oct-18 http://asatu.id/2018/10/09/dukung-program-5ng-usaid-

Interview siap-jadi-mak-comblang/

34 Published Kebijakan 5NG Jateng Peroleh Support USAID Melalui Semarangpedia Central Java 9-Oct-18 https://semarangpedia.com/kebijakan-5nh-jateng-

Interview Program Jalin peroleh-support-usaid-melalui-program-jalin/

35 Published Pemprov dan Jalin Kerja Sama Tekan Angka Kematian Ibu di Radio Idola Central Java 9-Oct-18 https://www.radioidola.com/2018/pemprov-dan-jalin-

Interview Jateng kerja-sama-tekan-angka-kematian-ibu-di-jateng/

USAID Jalin Project Year 1 Annual Report P 54/64 [01/15/2019]

Date of No Product Title Source Province Publication Link to File

36 Published Sukses Pangkas AKI, Pemprov Diajak Kerja Bareng USAID Jateng Today Central Java 9-Oct-18 https://jatengtoday.com/sukses-pangkas-aki-pemprov-

Interview diajak-kerja-bareng-usaid-15149

37 Published USAID Melalui Program Jalin Support Kebijakan 5NH Jateng Kampusnesia Central Java 9-Oct-18 https://kampusnesia.com/2018/10/09/usaid-melalui-

Interview program-jalin-support-kebijakan-5nh-jateng/

38 Published Ganjar Dinilai Sukses dengan Program 'Nginceng Wong Akurat.co Central Java 9-Oct-18 https://akurat.co/news/id-345484-read-ganjar-dinilai- Interview Meteng', USAID Siap Suport Program Jalin sukses-dengan-program-nginceng-wong-meteng-usaid-

siap-suport-program-jalin

39 Published USAID Dukung Jateng Turunkan Kematian Ibu Validnews.id Central Java 9-Oct-18 https://www.validnews.id/USAID-Dukung-Jateng-

Interview Turunkan-Kematian-Ibu-bxi

40 Published Tekan Kematian Ibu dan Bayi, USAID Danai "Nginceng Kompas Central Java 9-Oct-18 https://regional.kompas.com/read/2018/10/09/05071921 Interview Wong Meteng" /tekan-kematian-ibu-dan-bayi-usaid-danai-nginceng-

wong-meteng

41 Published Di Boyolali Angka Kematian Ibu Melahirkan Masih Tinggi Suara.com Central Java 13-Nov-18 https://www.suara.com/bisnis/2018/11/13/084206/di-

Interview boyolali-angka-kematian-ibu-melahirkan-masih-tinggi

42 Published Angka Kematian Ibu dan Bayi di Boyolali Masih Tinggi Republika Central Java 13-Nov-18 https://www.republika.co.id/berita/nasional/daerah/18/1 Interview 1/13/pi3wfj335-angka-kematian-ibu-dan-bayi-di-boyolali-

masih-tinggi

43 Published Kadinkes Jateng Sebut Kemitraan Bisa menjadi Solusi Tribun Jateng Central Java 24-July-18 http://jateng.tribunnews.com/2018/07/25/kadinkes- Interview penurunan jateng-sebutkemitraan-bisa-menjadi-solusi-penurunan- angka-kematian-ibu-dan-bayi

44 Published Angka kematian ibu melahirkan di Boyolali mencapai 40 Antara News Central Java 13-Nov-18 https://jateng.antaranews.com/berita/204598/angka-

Interview kasus kematian-ibu-melahirkan-di-boyolali-mencapai-40-kasus

45 Published Angka Kematian Ibu dan Bayi di Boyolali Tinggi Validnews.id Central Java 13-Nov-18 https://www.validnews.id/Angka-Kematian-Ibu-Dan-

Interview Bayi-Di-Boyolali-Tinggi--wfv

46 Published USAID Ungkap Banyaknya Kisah Tragis di Balik Kematian Solopos Central Java 22-Nov-18 http://semarang.solopos.com/read/20181122/515/95444 Interview Ibu Melahirkan 2/usaid-ungkap-banyaknya-kisah-tragis-di-balik-

kematian-ibu-melahirkan

47 Published Kematian Ibu dan Bayi di Jawa Tengah Termasuk Tinggi di Tribun News Central Java 22-Nov-18 http://jateng.tribunnews.com/2018/11/22/kematian-ibu- Interview Indonesia, Kabupaten Brebes Paling Banyak dan-bayi-di-jawa-tengah-termasuk-tinggi-di-indonesia-

USAID Jalin Project Year 1 Annual Report P 55/64 [01/15/2019]

Date of No Product Title Source Province Publication Link to File

kabupaten-brebes-paling-banyak

48 Published Begini upaya PC Fatayat NU tekan AKI dan AKB di Kab Times Indonesia East Java 3-Nov-18 https://www.timesindonesia.co.id/read/188474/2018110 Interview Jember 3/202918/begini-upaya-pc-fatayat-nu-tekan-aki-dan-akb-

di-kab-jember/

49 Published Begini upaya PC Fatayat NU tekan AKI dan AKB di Kab Times Indoensa East Java 3-Nov-18 https://www.timesindonesia.co.id/read/189939/2018111 Interview Jember 6/102047/usaid-identifikasi-penyebab-tingginya-angka-

kematian-bayi-di-jatim/

50 Published Fatayat NU Jember upayakan penurunan AKI/AKB bersama pcnujember East Java 4-Nov-18 http://pcnujember.or.id/2018/11/04/fatayat-nu-jember- Interview Program Jalin-USAID bersama-program-jalin-usaid-upayakan-penurunan-aki-

akb/

51 Siaran n/a Radio Kanjuruhan East Java 7-Nov-18 ..\..\LIPUTAN BERITA\RADIO\Radio Kanjuruhan_7 radio Nov 2018_24616914-ef75-4bce-81d3-

3551be5f7102.mp4

52 Siaran n/a Radio Kanjuruhan East Java 7-Nov-18 ..\..\LIPUTAN BERITA\RADIO\Radio Kanjuruhan_2018-

radio 11-07 at 07.34.29.mpeg

53 Published RSUD Kanjuruhan Malang dan Jalin-USAID bahas AKI/AKB rsudkanjuruhan East Java 8-Nov-18 http://rsud-kanjuruhan.malangkab.go.id/berita-515.html Interview

54 Published Antisipasi Kematian Ibu - Bayi, USAID Asesmen Kabupaten Radar Malang East Java 8-Nov-18 https://radarmalang.id/antisipasi-kematian-ibu-bayi-

Interview Malang usaid-asesmen-kabupaten-malang/

55 Published Optimalkan Program Jalin, IBI-USAID lakukan Assesment Times Indonesia East Java 9-Nov-18 https://www.timesindonesia.co.id/read/189184/2018110 Interview 9/195225/ikatan-bidan-indonesia-ingatkan-tingginya-

kematian-ibu-melahirkan-dan-bayi/

56 Siaran n/a Radio Kanjuruhan East Java 10-Nov-18 ..\..\LIPUTAN BERITA\RADIO\Radio Kanjuruhan_10 radio Nov 2018_196932d7-9b13-4a34-843f-

42c30943bd71.mp4

57 Siaran n/a Radio Kanjuruhan East Java 11-Nov-18 ..\..\LIPUTAN BERITA\RADIO\Radio Kanjuruhan_

radio 2018-11-28 at22.21.34.mp4

58 Published USAID ajak awak media di Surabaya bahas kasus Kematian Tribun News East Java 15-Nov-18 http://jatim.tribunnews.com/2018/11/15/usaid-ajak- Interview Ibu dan Bayi Baru Lahir awak-media-di-surabaya-bahas-kasus-kematian-ibu-dan-

USAID Jalin Project Year 1 Annual Report P 56/64 [01/15/2019]

Date of No Product Title Source Province Publication Link to File

bayi-baru-lahir

59 Published Kasus Kematian Ibu dan Anak di Jatim Nomor 2 se- ngopibareng East Java 15-Nov-18 https://www.ngopibareng.id/timeline/usaid-jalin-ajak- Interview Indonesia media-berperan-dalam-isu-kematian-ibu-dan-anak-

1996400

60 Published Kematian Bayi dan Ibu Tinggi di Jatim, Pahami 5 Fakta ini IDN Times East Java 15-Nov-18 https://jatim.idntimes.com/health/fitness/vanny- Interview rahman/kematian-bayi-dan-ibu-tinggi-di-jatim-pahami-5-

fakta-ini

61 Published Miris! 3 Ibu dan 18 Bayi meninggal setiap 2 hari di Jatim IDN Times East Java 15-Nov-18 https://jatim.idntimes.com/news/jatim/vanny- Interview rahman/miris-3-ibu-dan-18-bayi-meninggal-setiap-2-hari-

di-jatim

62 Published USAID Soroti tingginya Angka Kematian Bayi Baru Lahir di Times Indonesia East Java 15-Nov-18 https://www.timesindonesia.co.id/read/189924/2018111 Interview Indonesia 5/174946/usaid-soroti-tingginya-angka-kematian-bayi-

baru-lahir-di-indonesia/

63 Published Melalui Jalin, USAID berkomitmen tekan Angka Kematian Times Indonesia East Java 16-Nov-18 https://www.timesindonesia.co.id/read/189941/2018111 Interview Bayi di Indonesia 6/105033/melalui-jalin-usaid-berkomitmen-tekan-angka-

kematian-bayi-di-indonesia/

64 Published USAID Identifikasi penyebab tingginya Angka Kematian Bayi Times Indonesia East Java 16-Nov-18 https://www.timesindonesia.co.id/read/189939/2018111 Interview di Jatim 6/102047/usaid-identifikasi-penyebab-tingginya-angka-

kematian-bayi-di-jatim/

65 Published USAID : Ironis, Angka Kematian Ibu dan Bayi di Jatim masih Times Indonesia East Java 16-Nov-18 https://www.timesindonesia.co.id/read/189938/2018111 Interview tinggi 6/095037/usaid-ironis-angka-kematian-ibu-dan-bayi-di-

jatim-masih-tinggi/

66 Published Jawa Timur dalam Lingkaran Kematian Ibu dan Bayi IDN Times East Java 14-Dec-18 https://jatim.idntimes.com/news/jatim/vanny- Interview rahman/jawa-timur-dalam-lingkaran-kematian-ibu-dan-

bayi

67 Published USAID Jalin Gelar Workshop Penyebab Kematian Ibu dan Times Indonesia East Java 20-Dec-18 https://www.timesindonesia.co.id/read/193574/2018122 Interview Bayi 0/172453/usaid-jalin-gelar-workshop-penyebab- kematian-ibu-dan-bayi/

68 Published Angka Kematian Ibu dan Bayi Baru Lahir di Jatim Masih Times Indonesia East Java 20-Dec-18 https://www.timesindonesia.co.id/read/193601/2018122 Interview Tinggi 0/210542/angka-kematian-ibu-dan-bayi-baru-

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Date of No Product Title Source Province Publication Link to File

melahirkan-di-jatim-masih-tinggi/

69 Published Ini Tiga Daerah di Jatim Tertinggi Angka Kematian Ibu dan Times Indonesia East Java 20-Dec-18 https://www.timesindonesia.co.id/read/193620/2018122 Interview Bayi Baru Lahir 0/225543/ini-tiga-daerah-di-jatim-tertinggi-angka-

kematian-ibu-dan-bayi-baru-melahirkan/

70 Published USAID Jalin Times Banyuwangi East Java 20-Dec-18 https://www.timesbanyuwangi.com/berita/55198/angka-

Interview Angka Kematian Ibu dan Bayi Baru Lahir di Jatim Masih kematian-ibu-dan-bayi-baru-lahir-di-jatim-masih-tinggi Tinggi

71 Published Jumlah Kematian Ibu Hamil Capai 431 Kasus jatimnet East Java 21-Dec-18 https://jatimnet.com/jumlah-kematian-ibu-hamil-capai-

Interview 431-kasus

72 Published USAID JALIN fokus dampingi enam kabupaten Antara News South 15-Nov-18 https://makassar.antaranews.com/berita/105703/usaid- Interview Sulawesi jalin-fokus-dampingi-enam-kabupaten

73 Published Memprihatinkan, Ini Fakta-fakta Kematian Ibu dan Anak di Terkini.id South 15-Nov-18 https://makassar.terkini.id/memprihatinkan-ini-fakta- Interview Sulawesi Selatan Sulawesi fakta-kematian-ibu-dan-anak-di-sulawesi-selatan/

74 Published Tekan Angka Kematian Bayi & Ibu, Dinas Kesehatan Provinsi Kabarta.com South 15-Nov-18 https://kabarta.com/2018/11/15/tekan-angka-kematian- Interview Teken MoU Dengan PKK Luwu Utara Sulawesi bayi-ibu-dinas-kesehatan-provinsi-teken-mou-dengan- pkk-luwu-utara/

75 Published Sulsel Provinsi Dengan Angka kematian Ibu Terbanyak Berita Kota South 15-Nov-18 http://beritakotamakassar.fajar.co.id/berita/2018/11/15/s Interview Makassar Online Sulawesi ulsel-provinsi-angka-kematian-ibu-terbanyak/

76 Published PKK dihimbau bantu tekan angka kematian ibu PalopoKota.go.id South 5-Nov-18 http://palopokota.go.id/post/pkk-dihimbau-bantu-tekan- Interview Sulawesi angka-kematian-ibu

77 Published Tekan Angka Kematian Ibu Melahirkan Ibu Hamil diminta InfoPublik South 5-Nov-18 http://www.infopublik.id/kategori/nusantara/308714/tek Interview rutin periksa kesehatan Sulawesi an-angka-kematian-ibu-melahirkan-ibu-hamil-diminta- rutin-periksa-kesehatan

78 Published USAID Gandeng FKM Unhas Turunkan Angka Kematian Ibu Tribun Timur South 26-Jul-18 http://makassar.tribunnews.com/2018/07/26/usaid- Interview Sulawesi gandeng-fkm-unhas-turunkan-angka-kematian-ibu

79 Published Tiap Pekan, Dua Ibu dan 16 Bayi Neonatal Meninggal di Tribun Timur South 2-Aug-18 http://makassar.tribunnews.com/2018/08/02/tiap-pekan- Interview Sulsel Sulawesi dua-ibu-dan-16-bayi-neonatal-meninggal-di-sulsel

80 Published Kasus Kematian Ibu Masih Tinggi, Dinkes Sulsel Minta Gowa Tribun Timur South 2-Aug-18 http://makassar.tribunnews.com/2018/08/02/kasus- kematian-ibu-masih-tinggi-dinkes-sulsel-minta-gowa-

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Date of No Product Title Source Province Publication Link to File Interview Belajar ke Bantaeng Sulawesi belajar-ke-bantaeng

81 Published Sulsel Belum Ramah Ibu dan Anak, Setiap Hari 16 Bayi Tribun Timur South 2-Aug-18 http://makassar.tribunnews.com/2018/08/02/sulsel- Interview Meninggal Dunia Sulawesi belum-ramah-ibu-dan-anak-setiap-hari-16-bayi- meninggal-dunia?page=3

82 Published Pemprov Sulsel Dukung Program Jalin USAID Turunkan Berita Kota South 2-Aug-18 read:http://beritakotamakassar.fajar.co.id/berita/2018/08 Interview Angka Kematian Ibu dan Bayi Makassar Online Sulawesi /02/pemprov-sulsel-dukung-program-jalin-usaid- turunkan-angka-kematian-ibu-dan-bayi/

83 Published Ternyata Tiap 8 Hari, 2 Ibu dan 16 Bayi Neonatal Meninggal Tribun Timur South 3-Aug-18 scanned copy in Jalin TAMIS Interview di Sulsel Sulawesi

84 Published Nurdin Abdullah Siap Kembangkan Empat Sektor Melalui Sulsel Ekspres South 24-Aug-18 http://sulselekspres.com/2018/08/24/nurdin-abdullah- Interview Investor Sulawesi siap-kembangkan-empat-sektor-melalui-investor/

85 Published USAID Jalin Project Siap Bantu NA Kurangi Angka Kematian Inipasti South 24-Aug-18 https://inipasti.com/usaid-jalin-project-siap-bantu-na- Interview Ibu dan Anak Sulawesi kurangi-angka-kematian-ibu-dan-anak/

86 Published Liestiaty Nurdin Paparkan Peran PKK Dalam Penanggulangan Sulselprov South 9-Oct-18 https://sulselprov.go.id/post/liestiaty-nurdin-paparkan- Interview Masalah Kesehatan Sulawesi pengalaman-penanggulangan-masalah-kesehatan-di- bantaeng

87 Published Desember, Ambulans Laut Pemprov Sulsel Tiba di Makassar Tribun Timur South 29-Nov-18 http://makassar.tribunnews.com/2018/11/29/desember- Interview Sulawesi ambulans-laut-pemprov-sulsel-tiba-di-makassar

88 Published Peran Ibu PKK dalam Penanggulangan Kesehatan Menurut Sulselsatu South 9-Oct-18 https://www.sulselsatu.com/2018/10/09/makassar/peran Interview Liestiaty Sulawesi -ibu-pkk-dalam-penanggulangan-kesehatan-menurut- liestiaty.html

89 Published Pemprov Gandeng USAID Tekan Angka Kematian Ibu dan Rakyatku South 9-Oct-18 http://news.rakyatku.com/read/122714/2018/10/09/pem Interview Anak di Sulsel Sulawesi prov-gandeng-usaid-tekan-angka-kematian-ibu-dan- anak-di-sulsel

90 Published Ini 6 Kabupaten dengan Angka Kematian Ibu Tertinggi di Rakyatku South 9-Oct-18 http://news.rakyatku.com/read/122713/2018/10/09/ini- Interview Sulsel Sulawesi 6-kabupaten-dengan-angka-kematian-ibu-tertinggi-di- sulsel

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91 Published Cegah Kematian Ibu Hamil, Istri Gubernur Sulsel Berbagi Tribun Timur South 9-Oct-18 http://makassar.tribunnews.com/2018/10/09/cegah- Interview Pengalaman di Forum USAID Sulawesi kematian-ibu-hamil-istri-gubernur-sulsel-berbagi- pengalaman-di-forum-usaid

92 Published Jadi Kabupaten dengan Jumlah Kematian Ibu Terendah, Rakyatku South 9-Oct-18 http://news.rakyatku.com/read/122670/2018/10/09/jadi- Interview Bantaeng Berbagi Tips di Makassar Sulawesi kabupaten-dengan-jumlah-kematian-ibu-terendah- bantaeng-berbagi-tips-di-makassar

93 Published Tekan Angka Kematian Ibu Melahirkan, Pemprov Tambah 10 Tribun Timur South 9-Oct-18 http://makassar.tribunnews.com/2018/10/12/tekan- Interview Ambulans Sulawesi angka-kematian-ibu-dan-bayi-di-sulsel-nurdin-abdullah- bakal-sediakan-kapal-ambulans

94 Published USAID Jalin Bahas Angka Kematian Ibu dan Bayi di Sulsel, Tribun Timur South 9-Oct-18 http://makassar.tribunnews.com/2018/10/09/usaid-jalin- Interview Kadis Kesehatan Ungkap Daerah ini Sulawesi bahas-angka-kematian-ibu-dan-bayi-di-sulsel-kadis- kesehatan-ungkap-daerah-ini

95 Published Jadi Pembicara di Forum KI dan BBL, Liestiaty Paparkan Republiknews South 9-Oct-18 https://republiknews.co.id/jadi-pembicara-di-forum-ki- Interview Pengalaman Penanggulangan Masalah Kesehatan Sulawesi dan-bbl-liestiaty-paparkan-pengalaman-penanggulangan- masalah-kesehatan/

96 Published Bantaeng Jadi Percontohan Program Kesehatan Ibu dan Bayi Kabar Makassar South 9-Oct-18 https://www.kabarmakassar.com/posts/view/3427/peme Interview Sulawesi rintah-sulsel-amerika-terkait-kematian-ibu-dan- anak.html

97 Published USAID jalin Kemitraan Dengan Pemerintah Indonesia Berita Sumut South 27-Nov-18 http://beritasumut.com/peristiwa/USAID-Jalin-- Interview Kurangi Angka Kematian Ibu Dan Bayi Baru Lahir Sulawesi Kemitraan-Amerika-Indonesia-untuk-Selamatkan- Kematian-Ibu-dan-Bayi-Baru-Lahir

98 Published Enam Kabupaten Tertinggi Angka Kematian Ibu dan Bayi Kabar Makassar South 9-Oct-18 https://www.kabarmakassar.com/posts/view/3170/bupat Interview Sulawesi i-resmikan-kantor-desa-dan-3-paud-di-bijawang.html

99 Published Pemprov Sulsel Tambah 10 Unit Ambulans Guna Tekan Terkini.id South 9-Oct-18 https://makassar.terkini.id/tekan-angka-kematian-ibu- Interview Angka Kematian Ibu Melahirkan Sulawesi melahirkan-pemprov-tambah-10-ambulans/

100 Published USAID Jalin, Dinkes Sulsel, dan Tribun Timur Kerjasama Tribun Timur South 10-Oct-18 http://makassar.tribunnews.com/2018/10/10/usaid-jalin- Interview Bidang Data Kesehatan Ibu dan Bayi Sulawesi dinkes-sulsel-dan-tribun-timur-kerjasama-bidang-data- kesehatan-ibu-dan-bayi

101 Published 11 Kabupaten di Sulsel Penyumbang Angka Kematian Ibu Sindonews South 10-Oct-18 https://makassar.sindonews.com/read/15052/1/11- kabupaten-di-sulsel-penyumbang-angka-kematian-ibu-

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Date of No Product Title Source Province Publication Link to File Interview dan Bayi Sulawesi dan-bayi-1539105004

102 Published Ketua TP PKK SulSel Optimis Bisa Menekan Tingkat KLA South 10-Oct-18 http://www.kla.id/ketua-tp-pkk-sulsel-optimis-bisa- Interview Kematian Ibu dan Bayi Lahir di SulSel Sulawesi menekan-tingkat-kematian-ibu-dan-bayi-lahir-di-sulsel/

103 Published Kabupaten Gowa Penyumbang Kematian Ibu Terbesar di Media Indonesia South 10-Oct-18 http://mediaindonesia.com/read/detail/189830- Interview Sulsel Sulawesi kabupaten-gowa-penyumbang-kematian-ibu-terbesar-di- sulsel

104 Published Pangkep Penyumbang Angka Kematian Ibu dan Bayi Koran Pangkep South 10-Oct-18 https://www.koranpangkep.co.id/2018/10/pangkep- Interview Terbanyak Ke 4 di Sulsel Sulawesi penyumbang-angka-kematian-ibu.html

105 Published Fakta-fakta Kematian Ibu dan Neonatal di Sulsel Rakyatku South 28-Oct-18 http://news.rakyatku.com/read/125333/2018/10/28/fakta Interview Sulawesi -fakta-kematian-ibu-dan-neonatal-di-sulsel

106 Published Dalam Sehari Ada 3 Bayi Meninggal di Sulsel Tribun Timur South 30-Oct-18 http://makassar.tribunnews.com/2018/10/30/dalam- Interview Sulawesi sehari-ada-3-bayi-meninggal-di-sulsel

107 Published PKK Sulsel Bertekad Tekan Angka Kematian Ibu dan Anak Rakyat Sulsel South 30-Oct-18 http://rakyatsulsel.com/pkk-sulsel-bertekad-tekan- Interview Sulawesi angka-kematian-ibu-dan-anak.html

108 Published PKK Luwu Utara Siap Entaskan Kasus Kematian Ibu dan Bayi ElJohnnews South 1-Nov-18 https://eljohnnews.com/pkk-luwu-utara-siap-entaskan- Interview Sulawesi kasus-kematian-ibu-dan-bayi/

109 Published Komitmen Tuntaskan Kematian Ibu dan Bayi di Sulsel, Tribun Timur South 11-Nov-18 http://makassar.tribunnews.com/2018/11/11/komitmen- Interview Dinkes Libatkan Istri Bupati Sulawesi tuntaskan-kematian-ibu-dan-bayi-di-sulsel-dinkes- libatkan-istri-bupati

110 Published Kematian Bayi di RSUD Sulthan Dg Radja Bulukumba Tribun Timur South 12-Nov-18 http://makassar.tribunnews.com/2018/11/12/kematian- Interview Didominasi BLBR Sulawesi bayi-di-rsud-sulthan-dg-radja-bulukumba-didominasi- blbr?page=all

111 Published Angka Kematian Bayi Meningkat, Dinkes Bulukumba Bakal Tribun Timur South 12-Nov-18 http://makassar.tribunnews.com/2018/11/12/angka- Interview Lakukan Evaluasi Program Sulawesi kematian-bayi-meningkat-dinkes-bulukumba-bakal- lakukan-evaluasi-program

112 Published Angka Kematian Ibu Melahirkan Tinggi, Ini Kata Kadis Tribun Timur South 12-Nov-18 http://makassar.tribunnews.com/2018/11/12/angka- Interview Kesehatan Gowa Sulawesi kematian-ibu-melahirkan-tinggi-ini-kata-kadis-kesehatan- gowa

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113 Published Kata Iksan Iskandar soal Tingginya Angka Kematian Ibu dan Tribun Timur South 12-Nov-18 http://makassar.tribunnews.com/2018/11/12/kata-iksan- Interview Bayi di Jeneponto Sulawesi iskandar-soal-tingginya-angka-kematian-ibu-dan-bayi-di- jeneponto

114 Published Dinkes Jeneponto Klaim Angka Kematian Ibu Melahirkan Tribun Timur South 12-Nov-18 http://makassar.tribunnews.com/2018/11/12/dinkes- Interview Turun Sulawesi jeneponto-klaim-angka-kematian-ibu-melahirkan-turun

115 Published Ini 3 Daerah di Sulsel Paling Banyak Kasus Bayi Meninggal Tribun Timur South 12-Nov-18 http://makassar.tribunnews.com/2018/11/12/ini-3- Interview Sulawesi daerah-di-sulsel-paling-banyak-kasus-bayi-meninggal

116 Published Tim Penggerak PKK Sulsel dan Dinkes MoU Soal Pelayanan Tribun Timur South 13-Nov-18 http://makassar.tribunnews.com/2018/11/13/tim- Interview Kesehatan Sulawesi penggerak-pkk-sulsel-dan-dinkes-mou-soal-pelayanan- kesehatan

117 Published Januari-September 2018, 870 Bayi Baru Lahir Meninggal di Celebes Media South 13-Nov-18 https://celebesmedia.id/celebes/artikel/1031131118/janu Interview Sulsel Sulawesi ari-september-2018-870-bayi-baru-lahir-meninggal-di- sulsel

118 Published HKN Ke-54, Gubernur Sulsel Nurdin Abdullah Meminta RRI.co.id South 13-Nov-18 http://rri.co.id/makassar/post/berita/597908/daerah/hkn Interview Pemda Menekan Angka Kematian Ibu Hami dan Anak Sulawesi _ke54_gubernur_sulsel_nurdin_abdullah_meminta_pe mda_menekan_angka_kematian_ibu_hami_dan_anak.ht ml

119 Published Tingkat Kematian Ibu dan Bayi di Sulsel Tinggi, Ini Celebes Media South 13-Nov-18 https://celebesmedia.id/celebes/artikel/1032131118/ting Interview Penyebabnya Sulawesi kat-kematian-ibu-dan-bayi-di-sulsel-tinggi-ini- penyebabnya

120 Published Sulsel Urutan Ke 5 Daerah Tertinggi Angka Kematian Ibu RRI.co.id South 13-Nov-18 http://rri.co.id/post/berita/597913/kesehatan/sulsel_urut Interview Melahirkan dan Anak Sulawesi an_ke_5_daerah_tertinggi_angka_kematian_ibu_melahi rkan_dan_anak.html

121 Published USAID Jalin Libatkan Media Tekan Angka Kematian Ibu dan Tribun Timur South 14-Nov-18 http://makassar.tribunnews.com/2018/11/14/usaid-jalin- Interview Anak di Sulsel Sulawesi libatkan-media-tekan-angka-kematian-ibu-dan-anak-di- sulsel

122 Published Diskusi USAID Jalin, Dr Willy Kumurur Bahas Keselamatan Tribun Timur South 14-Nov-18 http://makassar.tribunnews.com/2018/11/14/diskusi- Interview Ibu Melahirkan Sulawesi usaid-jalin-dr-willy-kumurur-bahas-keselamatan-ibu- melahirkan

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Date of No Product Title Source Province Publication Link to File

123 Photo GALERI FOTO: USAID Sebut AKI dan AKB Masih Tinggi di Sulselsatu South 14-Nov-18 https://www.sulselsatu.com/2018/11/14/foto/galeri-foto- gallery Indonesia Sulawesi usaid-sebut-aki-dan-akb-masih-tinggi-di-indonesia.html

124 Published USAID Jalin Ungkap Data Angka Kematian Ibu dan Anak di Gosulsel.cm South 14-Nov-18 https://gosulsel.com/2018/11/14/usaid-jalin-ungkap-data- Interview Sulsel Sulawesi angka-kematian-ibu-dan-anak-di-sulsel/

125 Published Dekan Kesehatan se-Unhas Siap Bantu Pemerintah Tangani Fajar Pendidikan South 14-Nov-18 http://www.fajarpendidikan.co.id/dekan-kesehatan-se- Interview Kematian Ibu dan Anak Sulawesi unhas-siap-bantu-pemerintah-tangani-kematian-ibu-dan- anak-2/

126 Published Kemenkes: 2018, Angka Kematian Ibu dan Bayi Meningkat! TimurIndonesia.com South 14-Nov-18 https://timurindonesia.com/2018/11/14/kemenkes-2018- Interview Sulawesi angka-kematian-ibu-dan-bayi-meningkat/

127 Published Dinkes Sulsel Gandeng Semua Dekan Fakultas Kesehatan di MediaSulsel.com South 14-Nov-18 https://www.mediasulsel.com/dinkes-sulsel-gandeng- Interview Unhas Tangani Kematian Ibu dan Anak Sulawesi semua-dekan-fakultas-kesehatan-di-unhas-tangani- kematian-ibu-dan-anak/

128 Published Improve mothers, newborns’ health The Jakarta Post DKI Jakarta 15-Aug-18 scanned copy in the folder Interview

129 Published Malnutrisi ibu Bisa Bahayakan Kehamilan, Ketahui Faktanya Dream.co.id DKI Jakarta 13-Sep-18 https://parenting.dream.co.id/diy/malnutrisi-ibu-bisa- Interview (Online) bahayakan-kehamilan-ketahui-faktanya-1809125.html

130 Published Menyepelekan Konsumsi Obat-Obatan dari Kandungan Tabloid Bintang DKI Jakarta 13-Sep-18 https://aura.tabloidbintang.com/kesehatan/read/111416/ Interview Beresiko kematian? menyepelekan-konsumsi-obat-obatan-dari-dokter- kandungan-berisiko-kematian

131 Published Bahaya Mengabaikan Obat pemberian dokter saat hamil Tempo Online DKI Jakarta 13-Sep-18 https://cantik.tempo.co/read/1126336/bahaya- Interview mengabaikan-obat-pemberian-dokter-saat- hamil/full&view=ok

132 Published Cegah Malnutrisi pada Ibu Hamil dengan Lila, apa itu? Tempo Online DKI Jakarta 25-Sep-18 https://cantik.tempo.co/read/1129939/cegah-malnutrisi- Interview pada-ibu-hamil-dengan-periksa-lila-apa-itu

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APPENDIX 10: ACTIVITY LOCATION

# of Province Building Type Alamat Head of Office Staff Geospatial Data DKI Jakarta Office Building WTC 5, 16th Floor Chief of Party 35 S 6.214112°, E 106.819731° Jl. Jenderal Sudirman Kav. 29 Jakarta Selatan DKI Jakarta 12920 North Sumatra Residence Puri Sriwijaya Harry Masyrafah 7 S 3.575211°, E 98.663495° Jl. Panglima Nyak Makam No. 88A Medan South Sumatera 20222 Banten Residence Perum Bukit Ciracas Permai Blok C7 No. 14, Kel. Harrys Rambey 7 S 6.131723°, E 106.145180° Serang, Kec. Serang Banten 42116 West Java Residence Jl. Terusan Karang Tineung No. 60 Bandung Sambas Suparman 7 S 6.883531°, E 107.586273° Jawa Barat Central Java Residence Jl. Pandean Lamper I No.9 Hartanto Hardjono 7 S 6.996719°, E 110.435694° Peterongan, Kec. Semarang Selatan Kota Semarang Jawa Tengah 50242 East Java Office Building AMG Tower, 8th Floor - Unit B03 Purwida Liliek 7 S 7.343615°, E 112.72792° Jl. Dukuh Menanggal No. 1A Surabaya East Java South Sulawesi Office Building Tribun Timur Building, 3rd Floor Willy Kumurur 7 S 5.176140°, E 119.409199° Jl. Cendrawasih No. 430 Makassar South Sulawesi

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