Country Program Action Plan Output:
Strengthened national capacity in establishing policies for improving universal access to reproductive health.
Universal access to reproductive health is a key target of both the International Conference for Population and Development (ICPD) Programme of Action and the Millennium Development Goals (MDGs), and is central to development and poverty reduction.
Ultimately, this goal is about providing access to a full package of services, including comprehensive sexuality education, access to contraception, maternity care (ante- and post-natal care and skilled birth attendance), and emergency obstetric care. The prevention and treatment of sexually transmitted infections, including HIV, and programmes that address violence against women and promote gender equality are also part of this package.
UNFPA’s global strategy includes achieving universal access to sexual and reproductive health (SRH) and realizing reproductive rights as a goal. The focus is on increasing availability and use of quality SRH services and equitable access to these services. UNFPA remains the only international agency that promotes universal access to reproductive health as a package.
Maternal health, which is a component of reproductive health, is one of the top ten priorities of the Government of Indonesia. Indonesia has developed several policies to strengthen maternal services and improve access and availability.
However, Indonesia’s MDG and ICPD progress reports indicate that the country is far from reaching the targets for reduction in maternal mortality as well as universal access to reproductive health. Based on the latest Indonesian Demographic Health Survey (IDHS) in 2012, the maternal mortality ratio (MMR) stands at 359 deaths per 100,000 live births. It now appears unlikely that Indonesia will met the MDG target of 102 per 100,000 live births by 2015. Women in Indonesia today face a lifetime risk of maternal death of 1 in 210, compared with 1 in 870 in Vietnam and 1 in 1,400 in Thailand. The MMR also varies from province to province, with studies showing higher risks in poorer regions of Indonesia.
UNFPA is working with the Government of Indonesia on the Action Plan 2013-2015 for Accelerated Reduction of Maternal and Neonatal Mortality. The key strategies identified include improving the quality and coverage of maternal health services, strengthening skills of midwives, and ensuring quality of and improved access to basic and comprehensive emergency obstetric care (EmOC). UNFPA is assisting to develop a manual for an EmOC referral system in Jayapura district, and to identify area of quality of care that needs improvement, e.g: training of staffs, improvement of facilities, and availability of essensial maternal and neonatal medications. This activities result will be further used for upstream policy advocacy.
As part of the committment in improving quality of care, UNFPA also supports the initiative in formulating of supportive regulatory framework for midwifery in Indonesia with development of position paper on midwifery workforce in Indonesia. This initiative is addresing the key role of midwives in delivering maternal and neoanatal care services and in response to the need to ensure the availability of effective legislation and regulation to improve quality of care.
H4+ Partnership on Maternal Health
UNFPA has joined the H4+ Partnership with UNICEF, WHO, the World Bank and UNAIDS in supporting the Ministry of Health to reduce maternal and neonatal mortality and morbidity, and to prevent mother-to-child transmission of HIV. As one of its contributions to improved maternal health, UNFPA is helping the Government of Indonesia to review the national maternity health insurance scheme (JAMPERSAL) to examine gaps in service and to identify ways of promoting and sustaining the programme following the introduction of a universal public health insurance scheme in 2014.
Cervical Cancer Screening
Screening and early treatment of cervical cancer falls within the lifecycle of reproductive health needs. UNFPA is assisting the Ministry of Health to improve the existing national protocol on the management and treatment of cervical cancer with the implementation strategy. UNFPA will support a trial of the protocol for screening and early treatment of cervical cancer in one district near Jakarta. The inputs and recommendations from the trial will be used for finalization of the national protocol.
Monitoring Universal Access to Reproductive Health
UNFPA is working with the Government of Indonesia to build a system for monitoring universal access to reproductive health and to build the capacity of programme managers to implement the monitoring system and analyze the information and data it gathers. These initiatives will also lead to future planning and policy changes to improve universal access to reproductive health, such as providing technical information for all parties, particularly government stakeholders, to use in advocacy efforts for improving this area.