Evaluation of a comprehensive home-based midwifery programme in South Kalimantan, Indonesia

We report the findings of an evaluation of a programme in three districts i n South Kalimantan, Indonesia, which consisted of the training, deployment and supervision of a large number of professional midwives in villages, an information, education and communication (IEC) strategy to increase use of village midwives for birth, and a district-based maternal and perinatal aud it (MPA). Before the programme, the midwives had limited ability to manage obstetric complications, and 90% of births took place at home. Only 37% wer e attended by a skilled attendant. By 1998-99, 510 midwives were posted in the districts and skilled attendance at delivery had increased to 59%. Thro ugh in-service training, continuous supervision and participation in the au dit system midwives also gained confidence and skills in the management of obstetric complications. Despite this, the proportion admitted to hospital for a Caesarean section declined from 1.7 to 1.4% and the proportion admitt ed to hospital with a complication requiring a life-saving intervention dec lined from 1.1% to 0.7%. The strategy of a midwife in every village has dra matically increased skilled birth attendance, but does not yet provide spec ialized obstetric care for all women needing it. The high cost of emergency obstetric interventions may well be the most important obstacle to the use of hospital care.