Special delivery: reaching pregnant women with health care in Papua

Neli Kogoya, 23, sits on the floor of a communal house that she shares with two other families. She cradles a two-week old baby wrapped in a blanket on her lap, while a nurse checks her blood pressure. It is election season and convoys of trucks pass by outside, broadcasting campaign messages through megaphones.

The house is in Sapalek village in Jayawijaya, a remote mountainous region of Papua. Neli works here as a caterer, while her husband is away studying. She has two children – a girl Yosiana, who is nearly two years old, and baby boy Eliup, who was born just two weeks ago.

“When I had Yosiana, I didn’t know what to do or what to expect,” Neli says. “I didn’t know about breastfeeding or vaccinations, and there was no health centre nearby. When Yosiana was three months old she got a fever. I had to pay for a taxi to Wamena to take her to the hospital.”

The second time around, things were much easier for Neli. A new health centre has been established in Napua sub-district, serving nine villages. UNICEF has supported the centre to do village mapping and outreach to the local community, including identifying and supporting pregnant women.

“Someone from the health centre has visited me every month since I got pregnant,” Neli continues. “I was past my due date, so they took me to the hospital to have an induced birth. They’ve helped me with vaccinations and breastfeeding, and they give Eliup regular check-ups to make sure he’s healthy.”

This kind of support saves lives. Without it, young children like Eliup are at risk of birth complications, malnutrition, and vaccine-preventable diseases such as measles and diphtheria. In the worst cases, without proper health care they could die.

Maps and cadres

Theresia demonstrates the village maps at Ilekma Health Centre
© UNICEF Indonesia/2014/Andy Brown


At Ilekma Health Centre, the walls are covered with maps of the nine villages. Coloured pins mark the locations of pregnant women, and a calendar shows their due dates. Red pins indicate high risk patients, such as malnourished children.

With support from UNICEF, staff from the centre have mapped the health care needs of the nine villages and made a tailored plan for each one. This is called microplanning. “It allows us to decide how to best spend our budget in each village,” Director Theresia Resubun says.

Jayawijaya is a mountainous area with few proper roads, and reaching the most remote villages is a challenge. Often, the only way to get there is on foot. To help health centres reach these villages, UNICEF is training volunteers from local communities to provide basic health services.

So far, 39 volunteers, or ‘health cadres’ have been trained to deal with common child health issues in their village, such as coughs, fever and diarrhoea. They have also learned how to recognise more serious cases, and refer these to the nearest health centre.

One of these remote villages is Minimo. Here, health cadre Keliopas Mulait, 32, performs a check up on two-year-old Kristin in the family’s traditional, thatched honai house. On an earlier visit, he found that she had a respiratory tract infection. He gave her some medicine and came back three days later to follow up.

“I’m so grateful that our cadre was able to help Kristin recover from her sickness,” the girl’s grandmother says. “The health centre is very far away, so it’s a huge help to the village to have someone nearby who can assist, even in the middle of the night.”

In Jayawijaya, the outreach scheme is run by World Vision and the District Health Office, with financial support, monitoring and evaluation from UNICEF.

“We have done many activities with UNICEF but the most remarkable is the training of the health cadres,” Afrieda from the District Health Office says. “Previously we lacked the resources to reach people in remote areas. This project has really helped us serve our own communities.”

Scaling up

A  nurse checks Neli’s blood pressure as part of her regular check-up
© UNICEF Indonesia/2014/Andy Brown


UNICEF has piloted the mapping and cadres approach in four provinces of Indonesia, including Papua. It has been so successful that the Indonesian government has now decided to scale up the project and roll it out nationally.

Having regular help from a medical professional has been a big relief for Neli. “I’m so happy that the health centre is here,” she says. “I’m most thankful to them for taking me to the hospital and making sure my baby is alright. If it wasn’t for the midwife, I wouldn’t have known what to do.”

Thanks to UNICEF, many more pregnant mothers and newborn children in Indonesia will soon get the health care they need, not just a few lucky ones like Neli. Please donate to help us change the lives of all newborn children in Indonesia.

The author
Andy Brown is Communication Specialist for UNICEF East Asia and Pacific. Additional reporting by Jasmine Masih.

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