Reducing Maternal and Infant Mortality through High Risk Pregnancy Seekers

In Banyuwangi of Indonesia, one of the districts in East Java, 16 pregnant women died in 2015, as well as 28 babies. The largest contributing factor was a lack of data concerning the existence and whereabouts of women with high-risk pregnancies. So, in 2016, Sempu Public Healthcare Center launched an innovative solution using female vegetable sellers on motorbikes as high risk pregnancy seekers. As a result, the number of women and babies dying during and/or shortly after childbirth fell to zero.

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The Initiative has two main objectives. First, to prevent maternal and infant mortality rate from rising in Sempu Sub-district, Banyuwangi, Indonesia. This is a critical situation because between 2012-2013m, Banyuwangi, a city with a population of 1.6 million, was threatened by high maternal and infant mortality rates. There were 48 cases of maternal death and 404 cases of infant death. This rate is higher than any other region in Indonesia. The highest number of deaths was in Sempu Sub-district, a population of 86,027: there were 16 cases of maternal death and 28 cases of children’s death.

Secondly, to educate women in rural areas about high-risk pregnancy. This is important because a third of Sempu Sub-district is jungle and mountains. There is an average of 1,000 pregnant women in a year. Their location can only be reached on foot so it is difficult for them to get access to healthcare services. As a result, they must rely on traditional birth attendants.

To achieve these objectives, in 2016 the Sempu Community Healthcare Center initiated an innovation by recruiting mobile female vegetable sellers to seek women with high-risk pregnancy. They were chosen because they sell their vegetables in rural communities and villages every day.

Using these local vegetable sellers as high risk-pregnancy seekers fulfilled at least three strategic criteria. Firstly, mobile vegetable sellers visit virtually every village between them every day, from just after dawn prayers until around 10 a.m. The total number of sellers was estimated to be in the hundreds so, by using these vegetable vendors, villages in the district could be reached and accessed more easily. This ultimately meant that public health facilities did not need to recruit additional staff to specifically to carry out this task.

Secondly, in keeping with local tradition, the primary customers of mobile vegetable sellers are housewives. They interact with each other every day, providing a well-established level of closeness and trust. As is the custom, information beyond the immediate task of buying and selling vegetables is often shared, including information about who is pregnant as well as their social, physical and mental condition. By providing the vegetable sellers with a little training on the key characteristics of high-risk pregnancies, they became reliable and accurate high risk-pregnancy seekers.

Thirdly, vegetable sellers in Banyuwangi possess fairly good knowledge and skill in using information technology (IT). Based on initial observations by members of the Banyuwangi Health Office’s Zero Maternal/Infant Mortality Team, almost all the vegetable vendors owned a mobile phone, while the majority were also familiar with smartphones. Their knowledge and experience of using mobile phones made the vendors all the more suitable to be high risk-pregnancy seekers.

A WhatsApp Group was employed to enable the high risk-pregnancy seekers to report any cases of high-risk pregnancies that they found, while an incentive scheme is also offered for those who successfully identify women with high-risk pregnancies.

The results of the programme have been quite significant. Before this intiative was launched, there was no programme to identify women with high-risk pregnancies in Banyuwangi. Now, a team of high risk-pregnancy hunters is in place that operates in three villages located within Puskesmas Sempu’s catchment area.

Between the launch of the programme in November 2016 and November 2019, high risk-pregnancy seekers successfully identified 117 women with high-risk pregnancies. Of this total, 98 women gave birth safely, while the remaining 19 women have yet to go into labour.

The information system at Sempu Healthcare Center is far more complete than before this programme was introduced. Now, the system has a map detailing the whereabouts of women with high-risk pregnancies, as well as complete data and referral reports on all pregnant women across the health centre’s working areas. Previously, data on women with high-risk pregnancies was only noted in midwife journals. In order to provide more detailed information, volunteer health workers conducted widespread first-stage checks to detect new pregnancies early on.

It should be noted that this innovation, which is barely three years into its implementation, does not yet possess strong legislation such as a regional regulation or district head decree. Nevertheless, the intense coverage that the programme has received and the number of visits from people in other areas in Indonesia proves that it is hugely beneficial for local communities, which is acknowledged by many parties. This is a tremendous encouragement to the healthcare center and the Banyuwangi Health Office to continue implementing the programme. A number of other regions have been studying and learning from this innovation, including Central Java, South Sulawesi, East Nusa Tenggara, and several other districts/cities in East Java.

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Year: 2016
Level of government: Local government


  • Implementation - making the innovation happen
  • Evaluation - understanding whether the innovative initiative has delivered what was needed
  • Diffusing Lessons - using what was learnt to inform other projects and understanding how the innovation can be applied in other ways

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