"Mrs Sayuti has a stomachache" was the message that Apriatin Eka Marta received from a Posyandu cadre over her phone. Apriatin is a midwife in the Jatisari Village in the Wringin District of the Bondowoso Regency in East Java. Although she was on maternity leave, without missing a single beat, Apriatin accessed the Mother and Infant Information System (SIBUBA) through her mobile device to check the patient's status. She learned that Sayuti was in her third trimester with a high-risk pregnancy as she had high blood pressure.
"At that moment, I asked the cadre and village officials to take Mrs Sayuti to the local public health clinic (puskesmas) in Wringin immediately," said Apriatin, who served as a midwife in Jatisari for ten years. Jatisari Village head, Muhammad Yasin, and the health-service cadres took Sayuti to the puskesmas, where she was examined and then referred to the Dr H. Koesnadi General Hospital (RSU) in Bondowoso.
SIBUBA is a data collection and monitoring system for expectant mothers and childbirth, which entail health-related information of expectant mothers, childbirth history, vaccination history, and congenital diseases. This Android-based system helps village midwives and health officials map the risks in pregnancy complications. This system also helps in assisting expectant mothers through the delivery planning programs and preventing complications (P4K).
This innovation started with the Total Synergy Program for Preventing Delivery at Traditional Midwives and Saving Mothers (STOP BERDUKA) initiated by the Bondowoso District Health Office to reduce the high maternal and neonatal mortality rate. The head of the public health division of the district health office in Bondowoso, Titik Erna Erawati, confirmed that the maternal mortality rate (MMR) in the Bondowoso District was relatively high.
"The MMR in Bondowoso is on average higher than the MMR in East Java," she explained. “For example, in 2018, the MMR in Bondowoso reached 187 per 100,000 births. Meanwhile, the MMR in East Java was 91 per 100,000 births," said Titik.
The Bondowoso District government has previously implemented various breakthroughs to reduce the maternal and neonatal mortality rate. "However, these efforts have not been entirely successful in reducing the maternal mortality because we lacked accurate data to support us in actively monitoring the expectant mothers’ conditions, especially those with high-risk pregnancies," said Titik.
Titik explained that prior to SIBUBA, if district-level health officials wanted to review the maternal and neonatal mortality cases, they had to wait for the chronology reports from the puskesmas. The reports then would be evaluated everyone to three months in a puskesmas mini workshop.
Midwives had to recapitulate the data manually first. Thus, the information itself is somewhat out of date. Apriatin shared how she would have to spend days on end analysing cases, with an error margin of 20 to 30 per cent. "With SIBUBA, the data become more valid and are available on the dot, as they are recorded in real-time and are already recap. So, it is much easier to analyse," said Apriatin.
The Bondowoso District Government collaborated with KOMPAK, a partnership program between the Indonesian and Australian governments, to develop this application in 2018.
KOMPAK assisted the Bondowoso District Government in conducting a series of coordination and focus group discussions on determining the needed data types and target users for the application. They came up with the specifications for the programmers and conducted piloting in 13 villages in six sub-districts in the Bondowoso Regency. One of which was the Jatisari Health Center (Ponkesdes), where Apriatin provides daily health services within the jurisdiction of the Wringin Puskesmas.
Upon receiving the training, Apriatin wasted no time recording the information on new expectant mothers in her jurisdiction based on their ID cards. SIBUBA are connected to the Village Administration and Information System (SAID) and the Regional Health Information System (SIKDA). Thus, the application has made synchronising the civil registry data with maternal-related data much more seamless.
“All we have to do is key in theNational Identity Number (NIK), and we have the complete data of the person at our hand. We can see the expectant mother’s age and the interval between pregnancies. What’s more, because it is based on the NIK, there is much less room for data error," said Apriatin.
"Furthermore, SIBUBA has a birth planning feature to help expectant mothers prepare details of their childbirth process. Details such as where the birth will take place, the details of prospective blood donors, the type of transports they use to the facility, and how they would fund their childbirth process," Apriatin explained.
"With this application, we can have a comprehensive birth plan starting from the moment a woman learns about her pregnancy," she said. At the other end of the scale, village midwives can also include all the services that the expectant mothers have received throughout their pregnancies and the postpartum periods.
This effort has received a favourable response from beneficiaries such as Sayuti. "For that means that Bondowoso has advanced. Now we have an application for expectant mothers that can be accessed using mobile phones," the mother of two responded when she heard about the application whose data could be accessed by the heads of the villages, sub-districts, and district
However, the use of the application itself is not always without a hitch. Working in rural areas, with intermittent mobile network coverage, Apriatin time and again found it difficult to open the application and enter the data, especially during rainy seasons and power outages. "Ponkesdes (village health clinic) Jatisari is not located by a cable line network, so we cannot install wifi," she said. She must wait until there is a stable mobile signal or go to the village hall or health centre to use their wifi.
Even so, Apriatin still feels that the benefits of the application outweigh the drawbacks of using it. "Because it is Android based, we no longer need to carry the cohort everywhere we go," said Apriatin, referring to the stack of maternal health forms that midwives used to fill out manually.
The application makes it convenient for Apriatin to access data for expectant mothers anytime and anywhere. This feature is invaluable for her as she also facilitates posyandu (village health centre) activities at three posts every second week of the month, conducts home visits, and provides parentingservices at the Raudhotul Athfal (RA) PAUD for pre-schoolers.
Further, village and sub-district heads, health centres, and district governments can also access the application. The governments then use the data as the basis for planning and budgeting in the Bondowoso District. The SIBUBA data on expectant mothers and their risks are submitted to the village heads and discussed in the development planning forum. "The forum then determines how best to identify expectant mothers and prepare necessary referrals for expectant mothers with high- and extremely high-risk pregnancies, such as transportation and potential blood donors," said Titik.
Moreover, the data are mined to invigorate the Maternity Planning and Complications Prevention (P4K) program. The revitalised program will ensure proper community assistance for expectant mothers, especially those with high- and extremely high-risk pregnancies. "From now on, there will be no such thing as late referrals or late emergency assistance," said Titik.
In 2019, the Bondowoso District Government allocated a budget for Maternal and Child Healthcare (KIA) of IDR270 million, an increase of 15 per cent from the 2018 budget. “Now that we have accurate data on the maternal healthcare conditions in the Bondowoso District, the regional government can have a solid foundation for its budget allocation based on the actual needs,” said Titik.
As a result, the maternal mortality rate in Bondowoso has decreased from 19 in 2018 to 14 in 2019. Unfortunately, the number crept up again in 2020 to 19. The COVID-19 pandemic has lessened the frequencies of health checks among expectant mothers. But now, the 214 village midwives in Bondowoso Regency have been using SIBUBA in the hope that the maternal mortality rate will decline yet again in the coming years.
The SIBUBA application continues to be enriched with various, such as data for children under two years old. "The plan is for us to develop SIBUBA further so that other Regional Apparatus Organizations (OPD), such as the Population Control and Family Planning Service (DPPKB), the Population and Civil Registration Office (Dispendukcapil), the Social Service (Dinsos) and RSU, can benefit from the data as well," said Titik.
DPKB, for example, may use the data as the basis to provide contraceptives for postpartum mothers, while RSU may use them as part of the initial preparation for referrals of expectant mothers with high-risk pregnancies. Concurrently, Dispendukcapil can map out the need for birth certificates. Dinsos can also ensure that expectant mothers who cannot afford and do not have health insurance are recorded in the Social Welfare Integrated Data (DTKS) and are eligible for government social assistance.
In mid-January 2020, Sayuti gave birth to her second child at the RSU Dr H. Koesnadi Bondowoso. "Alhamdulillah, the birth of my child went smoothly," said Sayuti. Thanks to SIBUBA, village midwives like Apriatin can always oversee the childbirth process of expectant mothers with high-risk pregnancies in Bondowoso, such as Sayuti.