STARH (Sustaining Technical Achievements in Reproductive Health/Family Planning)

• Overview
• Advocating Quality Improvement & Informed Choice

Overview

A partnership between Johns Hopkins University Bloomberg School of Public Health Center for Commu ication Programs (CCP) and JHPIEGO, the STARH program focuses on improving quality and choice of FP/RH services in Indonesia. STARH's partners include BKKBN (the National Family Planning Coordinating Board), the Ministry of Health, the Ministry for Women's Empowerment and local NGOs including IBI, the Indonesian Midwife Association. Indonesia has been undergoing dramatic changes in the past few years - economic, political, and social. In response to these changes, the Government of Indonesia has decentralized control of many of its functions to the district level - a radical shift from its previous programs, which were centrally-driven.

Advocating Quality Improvement & Informed Choice

BKKBN has promoted family planning in Indonesia for over 30 years, and the national program has enjoyed considerable success and international acclaim. With a CPR rate of 57% for any modern method (DHS 2002-2003), it has graduated into the ranks of a “mature” program. BKKBN’s New Era vision of “Quality Families in the Year 2015” reflects the transition of the national family planning movement to a client-oriented approach from its past centrally-driven approach. The new approach seeks to empower Indonesians to make informed choices about their own reproductive health including their right to access quality services.

The STARH program's areas of work include

• Increasing Client demand for quality
• Adolescent reproductive health
• NGO sustainability
• External quality assessment
• Quality Recognition of Private Sector Midwives (Bidan Delima)
• Contraceptive security
• Advocacy for family planning and reproductive health
• Standards and Guidelines for FP/RH clinical services
• Clinical training capacity-building
• Site-Based quality improvement

Increasing client demand for quality

STARH has motivated clients to seek out high-quality FP/RH services through the Smart Brochure, Appreciative Community Participation tools (ACP), and the Sahabat campaign. The “Smart” Brochure encourages FP/RH clients to engage providers in a dialogue and to get answers to their questions about their health. The ACP tools encourage communities to articulate what they want from health services and empower them to express those desires. The Sahabat campaign encouraged clients to seek quality services, and to see their provider as a “loyal friend” (Sahabat) in the clinic – someone they could trust to give them helpful, informative service to meet their needs.

Adolescent reproductive health

STARH and KuIS (Healthy Indonesia Coalition) held Indonesia 's first conference of adolescent-serving NGOs in May 2004 to look at best practices for ARH services and to provide a forum for professional collaboration. Youth at the conference released the Kuta Declaration demanding that the government provide information, services, and protection for youth, both those youth who are in school and those who are not in school, and that youth be involved in policy making that affects them.

NGO sustainability

STARH has worked with YKB, Yayasan Kusuma Buana, to strengthen the sustainability of RH/FP services provided through the NGO sector. YKB is assisting 9 NGOs across Indonesia to make their FP/RH services self-sufficient, and not dependent on donor support, while still serving their lower-income target populations. This capacity building for financial sustainability has involved review and revision of management systems, financial structures, payment mechanisms, marketing, procurement, etc. STARH and YKB have expanded this work to clinics in the service systems of Muslimat and Muhammadiyah, the two largest Muslim NGOs in Indonesia .

External quality assessment

STARH introduced QIQ, the Quick Investigation of Quality, in 137 clinics in 9 provinces across Indonesia . QIQ is a tool for monitoring the quality of services provided in family planning clinics. In Indonesia it consists of a facility audit and observations of client provider interaction. The baseline QIQ results showed that in the clinics surveyed the quality of services, particularly with regard to infection prevention, were below standard. A second round of QIQ conducted after 12 months in a sub sample of facilities showed improvements, after the introduction of quality improvement initiatives.

Quality Recognition of Private Sector Midwives (Bidan Delima)

STARH is collaborating with IBI, the Indonesian Midwives Association, to form and launch the Bidan Delima network of high-quality midwives. Members of Bidan Delima have passed rigorous evaluations of their professional midwifery practices, including clinical and counseling practices for safe delivery, family planning, pre- and post-natal care.

Contraceptive security

STARH convened an international meeting in Penang , Malaysia in October 2003 to examine options for promoting contraceptive security through media advocacy. Subsequently STARH worked with BKKBN to produce the Contraceptive Security Tool Kit, a planning tool to help districts and provinces ensure that contraceptive security remains a priority, particularly during decentralization.

Advocacy for family planning and reproductive health

STARH and KUIS convene a monthly Journalists Forum of print and broadcast journalists at the national level in Indonesia . STARH brings technical experts to speak and answer questions on a variety of timely reproductive health topics, which results in skillful, accurate, and nuanced coverage of reproductive health issues. Topics have included: Birth Spacing, SARS, Male Participation in RH/FP, Sex Education for Young Adults, Reproductive Health in Trafficking, and Pricing of Generic Medicine. STARH is also working to develop cross-sectoral advocacy teams at the district level to keep RH/FP issues “center stage” during this new era of decentralization and competing budgetary priorities.

Standards and Guidelines for FP/RH clinical services

STARH has worked closely with international and Indonesian medical professional organizations to update and disseminate standards of care for family planning and reproductive health. STARH worked closely with members of POGI (Association of Indonesian OB/GYN), and Dr. Barisaffudin of Yayasan Bina Pustak (a local publishing house) to develop the Family Planning Practical Guidelines. This document represents a consensus set of clinical standards and guidelines for FP providers and has been formally adopted by the Government of Indonesia and distributed to service providers across the country. Similarly, the Infection Prevention (IP) Manual and IP VCD have been translated into Bahasa Indonesia and are being disseminated throughout the country. STARH translated and adapted the World Health Organization's Decision Making Tool for client/provider counseling on family planning methods and is distributing it through IBI, Muslimat, Muhammadiyah, and AusAID. STARH also supported BKKBN to develop policy guidelines on the delivery of Voluntary Surgical Contraception and is disseminating this document through the Ministry of Health, BKKBN, and PKMI at the district and service delivery points.

Clinical training capacity building

STARH developed a Contraceptive Technology Update (CTU) on family planning for use at in-service training centers across the country. STARH also developed a curriculum for updating clinic staff in infection prevention practices that can be used at training centers and service delivery points. STARH has worked with the National Clinical Training Network, professional organizations, and the Ministry of Health to strengthen and ensure the sustainability of clinical training centers at the district level. Finally, STARH has worked extensively with BKKBN and PKMI to increase capacity to provide up-to-date training in Voluntary Surgical Sterilization, through development and dissemination of a VSC Learning Resource Package.

Site-based quality improvement

STARH has worked with the Ministry of Health, building on previous work in quality improvement, to provide facilities with a tool to conduct internal quality assessments of family planning services. This tool assures attention to quality even when the external supervision system is unreliable. The self-assessment process, used in conjunction with the community ACP tools provides a holistic approach to quality improvement at the community/facility level. Specific quality assessment tools have also been developed for use at service delivery points that provide VSC services. STARH has also worked with the Ministry of Health to develop a facilitative supervision manual to improve the performance of the external supervision system.

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