The Republic of Indonesia, home to over 240 million people, is the world's fourth most populous nation. Ethnically, culturally, and economically diverse, the Indonesian people are broadly dispersed across an archipelago of more than 13,000 islands. Rapid urbanization has given rise to one megacity (Jakarta) and to 10 other major metropolitan areas. And yet about half of Indonesians make their homes in rural areas of the country. Indonesia, a signatory to the United Nations Millennium Declaration, has committed to achieving the Millennium Development Goals (MDGs). However, recent estimates suggest that Indonesia will not achieve by the target date of 2015 MDG 4 - reduction by two-thirds of the 1990 under - 5 infant mortality rate (number of children under age 5 who die per 1,000 live births) - and MDG 5 - reduction by three-quarters of the 1990 maternal mortality ratio (number of maternal deaths within 28 days of childbirth in a given year per 100,000 live births). Although much has been achieved, complex and indeed difficult challenges will have to be overcome before maternal and infant mortality are brought into the MDG-prescribed range.

Reducing Maternal and Neonatal Mortality in Indonesia is a joint study by the U.S. National Academy of Sciences and the Indonesian Academy of Sciences that evaluates the quality and consistency of the existing data on maternal and neonatal mortality; devises a strategy to achieve the Millennium Development Goals related to maternal mortality, fetal mortality (stillbirths), and neonatal mortality; and identifies the highest priority interventions and proposes steps toward development of an effective implementation plan. According to the UN Human Development Index (HDI), in 2012 Indonesia ranked 121st out of 185 countries in human development. However, over the last 20 years the rate of improvement in Indonesia\'s HDI ranking has exceeded the world average. This progress may be attributable in part to the fact that Indonesia has put considerable effort into meeting the MDGs. This report is intended to be a contribution toward achieving the Millennium Development Goals.

Contents

• THE NATIONAL ACADEMIES
• THE INDONESIAN ACADEMY OF SCIENCES (AIPI)
• JOINT COMMITTEE ON REDUCING MATERNAL AND NEONATAL MORTALITY
• Preface
• Acknowledgments
• Acronyms and Abbreviations
• Summary
  • Recommendations
• 1. Introduction
  • The MDGs and Indonesia
  • Indonesian Health Care System
  • The Role of the Science Academies
  • Statement of Task
  • Methodology
  • Recommendations
  • References
• 2. The Data Conundrum
  • Data Sources for Estimating Mortality in Indonesia Health Information System and Civil Registration and Vital Statistics System
  • Facility-Based and Community-Based Data Sources
  • Facility-Based Data for MNCH-Related Measures
  • Community-Based Data: Household Surveys
  • Estimates of MNCH-Related Rates
  • Background Characteristics of Maternal Deaths in Indonesia Underlying Causes of Maternal Deaths
  • Background Characteristics of Maternal Deaths
  • References
• 3. Maternal, Fetal, and Neonatal Mortality
  • Causes of Maternal, Fetal, and Neonatal Mortality in Low-Income Countries
  • History of Outcome Improvements in High-Income Countries
  • Saving Lives
  • Birth Attendant Capacity
  • Data
  • Summary
  • References
• 4. The Indonesian Health Care System
  • Overview of Indonesia's Health Care System for Maternal and Child Health
  • Continuum of Care: From Primary Care (Health Centers) to Hospitals
  • Community Involvement
  • Public versus Private
  • Health Personnel
  • Regional Variation in Health Services
  • References
• 5. The Quality of Care
  • Human Resources Availability
  • Training
  • Accreditation and Licensing of Hospitals and Health Care Providers
  • Guidelines
  • Assessing the Factors Affecting Quality of Care Offered by Birth Attendants
  • Effects of Location on Quality of Care
  • Technical Recommendations: Improving Quality of Care
  • References
• 6. Governance Issues
  • Decentralization
  • Local Governments and Civil Servants
  • Unequal Access to Health Services
  • Local Politics
  • Central-Regional Relations
  • Conclusion
  • References
• 7. Strengthening the Financing of Maternal and Neonatal Health
  • Data Sources and Methods
  • Total Health Expenditure
  • Ministry of Health Financing of MNH Services
  • Financing of MNH Health Insurance Programs
  • References
• 8. Recommendations
• Appendix Fertility Decline in Indonesia and Its Relationship to Maternal Mortality
• Glossary

This study was supported by Contract No. 10000242 between the National Academy of Sciences and the United States Agency for International Development.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the sponsors who provided support for the project.