The condition of Mother and Child Health service in Akomi village, in Indonesia, was inadequate before the existence of the Citizen Voice and Action (CVA) program. Now, that has changed.
“Citizen Voice and Action for Government Accountability and Improved Services: Maternal, Newborn, Infant and Child Health Services” was a project implemented by Wahana Visi with the support of the Global Partnership for Social Accountability (GPSA). This is just one of the stories collected from the GPSA’s first project in Indonesia. A project that aimed at improving maternal, newborn, child health, and nutrition (MNCHN) services.
From 2013 to 2018, village leaders have improved health service delivery in posyandu (health service center) and polindes (village birth clinic).
Melania Sanlain, the midwife of the village, says that, “in the past, pregnant women and mothers of toddlers would not come to posyandu, so cadres had to visit their houses but that has changed”.
Before the existence of the CVA program, the community was not aware about the importance of the posyandu. The chief of Akomi village, Arnoldus Bana, explains, “in the past, I wouldn’t even attend the posyandu. I realized that, as leaders, we must do a lot of public education to make people aware of their health, how parents need to take their children to posyandu and how pregnant women need to check their pregnancy in the village birth clinic”.
Prior to the program, pregnant women in the village preferred to give birth at home to health facilities where village midwives can handle the labors. According to midwife Melania, the community did not think it was dangerous “because their ancestors and parents were used to do it at home”. The program helped mothers of under-five children change their behavior. Pregnant women and mother are now aware that antenatal care should be provided at the public health post at village level. More women are giving birth at health centers rather than at home, as well as more children are being immunized while more infants and pregnant women receive checkups.
Florida Selan, cadre of Akomi Posyandu, states, “a lot has changed. Every month, mothers come with their under-five children to do their checkup, pregnant women examine their health in polindes and give birth at the health center.” The facilitator of the village, Maximus Seo, also acknowledge, “many pregnant women now give birth at proper health facilities. Through community education, there are communication activities with citizens to exchange thoughts regarding basic health and they are becoming more aware about it.”
The CVA program has also helped service providers and citizens improve the standards of and access to services. A project evaluation, completed late in 2018, shows that over 50 percent of the health centers are achieving their standards. Community members rated health services through scorecards and social audits and 45 percent said the services were “good to very good”, almost the double of the rating in the beginning of the program implementation. Selan says, “previously, I did not know much about the service standards. But then I joined the training on Citizen Education, Standard Monitoring, Rating Cards and face-to-face meetings at the district and that’s where I learned about service standards in posyandu and polindes.”
The chief of Akomi village shared that he felt ashamed after being alerted to the conditions of the health service center: “During a face-to-face meeting at the district level, I found out that the posyandu activity was evaluated 3 in a rating scale of 10 because the posyandu activity was held at Lopo (traditional house), with no conditions. I felt embarrassed. The Lopo’s roof would leak every time it rained. I realized that something should be done. The construction of posyandu at Akomi village became a priority. We held a special meeting with the chief of the village, where I shared the Akomi village posyandu’s rates. Today, we have two new posyandu buildings integrated with Early Childhood Care and Development”. Around 2000 action plans were developed in multi-stakeholder meetings involving villagers, village governments and health services. Of these, 64 percent have been implemented.
The project was implemented in 60 villages in three districts of Nusa Tengara Timor province in Indonesia: Kupang, Sikka, and TTU. Overall, political leaders and community leaders became more motivated to improve the quality of their health services and its promotion.
Today, the Government of Indonesia plans to institutionalize these collaborative social accountability practices.
On March 12th, the GPSA organized a webinar with some of the specialists involved in the project evaluation’s design and approach. The recording is available on the GPSA Knowledge Platform.