Maternal and neonatal mortality is still a problem for many developing countries, including Indonesia. The Government of Indonesia has a commitment to achieve Millenium Development Goals (MDGs), particularly in decreasing maternal and neonatal mortality in Indonesia.
Defficiencies in the provision of health services, including for maternal and neonatal, are often said to be due to the lack of monitoring of the public demand for services. That is the reason for Expanding Maternal and Neonatal Survival (EMAS) Program through the implementation of Citizen Report Card (CRC) on Emergency Services for Maternal and Neonatal Health.
This study provides an analysis about the implementation of Citizen Report Card in efforts to improve emergency services for maternal and neonatal health in Bandung Regency, West Java and Pinrang Regency, South Sulawesi. By looking at the results of the CRC and the objectives to be achieved by the program, this study wants to find out whether or not there is a divergence between the objectives and the results, and attempts to analyze the reasons why parts of CRC’s activities work and others do not.
The research made use of qualitative method. The data were collected through in-depth interviews with relevant actors involved in CRC Program in the two regencies. Interviews were conducted with governance specialists of EMAS Program, government officers in the two District Health Offices (DHO), managers of hospitals, doctors, midwives, nurse, dukun (shaman) and members of civil society organizations. There were 50 peoples interviewed in the research.
In the research, it is observed that the CRC on emergency services for maternal and neonatal health in Bandung Regency and Pinrang Regency are based on collaborative mechanism. EMAS program encourages civil society, local government (DHO) and health providers (hospital and health centers) in the regencies to participate in the CRC. Other EMAS Program interventions in the regencies, for instance the program to build working groups and to strengthen civil society in the beginning of that program, became a way to expedite the implementation of the CRC in the field.
We also observed that the role of EMAS Program is very strong in the early stage of CRC preparation. The program gave capacity building to the civic forums so that they could implement the different steps of activities of CRC. Then civic forums in both regencies implemented stages of CRC by accepting inputs from health providers. The Civic Forum’s work produced an assessment of the respondents’ perception and satisfaction related to emergency services used by the respondent or his or her family. As CRC developed its activities, it tried in both regencies to mobilize civil society and make it more active in monitoring the quality of service at local hospitals and health centers, as well as at DHO, by conducting meetings regularly. In contrast, the CRC does not seem to have devoted a great effort in developing its advocacy directed at local legislatives.
For increasing participation to a higher level, namely a shared decision-making mechanisms or empowerment mechanisms, there is a need for leadership, and awareness by the actors that efforts to improve quality of service in regencies need to happen to be able to implement CRC independently.
This study has shown that the improvement of service delivery cannot only be obtained through advocacy and the mobilization of civil society participation. More stringent mechanisms would be needed which would confer some authority to the CRCs in monitoring directly the health services’ activities on the basis of the assessment organized by them. In other words, the participation of civil society is only a first step, if serious improvement of health delivery is to be obtained.
(This essay is the executive summary of the graduate thesis by Sri Haryanti, a graduate of School of Government and Public Policy – Indonesia and currently a civil servant at the Ministry of Trade.)
Haryanti, S. (2014). Citizen Report Card for Maternal and Neonatal Health Services. Jakarta: Unpublished.