Community participation in improved maternal health care service utilization in Bali, Indonesia

BACKGROUND: Maternal and child health (MCH) care service utilization continues to be low throughout the developing world, especially in rural areas. This project used a community organizing approach to promoting MCH services in an isolated community in East Bali, Indonesia, that lacks access to water, roads or schools. Most villages are located a three hours walk (each way) from the local government health clinic. Poor pregnancy outcomes and high rates of maternal morbidity and infant mortality are common. METHODS: A partnership was formed between The East Bali Poverty Project (a local NGO), the community and the government health clinic staff. This presentation outlines the major successful strategies of this program, including: community participation in establishing priorities and choosing health volunteers, commitment from village leaders to promote the program, commitment from the government health clinic to provide the staff and to improve service quality, and the restructuring of MCH services to take services directly to the villages on a monthly basis. RESULTS: This informal partnership led to the creation of 27 new monthly clinics. In 2005, more than 6000 visits of pregnant women and children under five were conducted, providing immunizations, family planning, prenatal care and other services previously only available at the local government health clinic. RECOMMENDATIONS/CONCLUSIONS: Local communities must be involved in the identification of needs and solutions of health problems. The key strength of this approach is participatory research and community organizing. This program demonstrates the importance of adapting health services to fit the needs of the community.