Collaborative Innovation in Maternal Mortality Rate (MMR) and

Neonatal Mortality Rate (NMR) Handling Program in Sidoarjo

Nurul Jamila Hariani and Falih Suaedi

Faculty of Social and Political Science, Universitas Airlangga, Surabaya, Indonesia

Keywords: Collaborative Innovation, Maternal Mortality Rate, Neonatal Mortality Rate, Public Service.

Abstract: Maternal Mortality Rate (MMR) and Neonatal Mortality Rate (NMR) are the indicators to determine the

degree of health of the country. Indonesia's progress in reducing MMR and NMR rated decreased by Unicef

over the past five years. The government of Indonesia made various efforts. One of which was made by the

Sidoarjo government created through technological innovation and collaboration program. This study aims to

describe the collaborative innovation process and the strategies in efforts to decrease MMR and NMR in

Sidoarjo. The study employed the qualitative method. This research finds that the government of Sidoarjo has

used the collaborative innovation as well in making the innovative programme to solve the maternal and

neonatal problems. The existence of empowerment, participation and learning process are mutually beneficial

and transformative to all stakeholders. The driving shaft and obstacles can be overcome and managed through

creative social activities. All of the collaborative strategies have used in this program. The cooperation and

the public-private partnership shows the cultivation, replication and partnership strategies. The user of an

integrated application applies the networking strategy. The open-sources strategy is conducted by gathering

of academician in sharing knowledge and improving the innovation.

1 INTRODUCTION

Health is a fundamental human right which is

essential for every human being. As the United

Nations agreement on 10 November 1948 in the

Declaration of Human Rights article 25 paragraph 1

states that "everyone is entitled to an adequate level

of life for the health and well-being of themselves and

his or her family. The degree of public health affects

the level of welfare that is closely related to the level

of poverty (Hardiansyah, 2011). Improving maternal

health and reducing child mortality are essential to the

public health status of the country.

In every country, the neonatal mortality rate

(NMR) and maternal mortality (MMR) are one of the

benchmarks of the implementation of state health

development (Infodatin, 2014). In 2015, 5.9 million

children died under five years old (WHO, 2016).

More than half of neonatal mortality caused by

preventable causes. As for maternal death, WHO

(2016) says that about 830 women die every day

because of avoidable cases associated with pregnancy

and childbirth. More than 90% of maternal deaths

occur in the developing countries.

Table 1: Mother and Infant Mortality Trends in Developed

and Developing Countries 2005-2015

2005 2010 2015

Developed

Countries

186.667

(1,81%)

162.140

(1,78%)

132.768

(1,62%)

Developing

Countries

10.091.965

(98,19%)

8.936.219

(98,22%)

8.014.434

(98,37%)

Jumlah 10.278.632 9.098.359 8.147.202

Source: United-Nation-IGME, 2015

Most of Indonesia’s child deaths now take place

during the neonatal period, the first month of life

(Unicef Indonesia, 2012). Neonatal mortality is now

the main hurdle in reducing further child deaths. In

recent years, however, the reduction of maternal and

neonatal mortality appears to have stalled (Unicef

Indonesia, 2012). Therefore, serious efforts are

needed by the Indonesian government to reduce

MMR and NMR.

One of the regions that attempted to decrease

MMR and NMR is Sidoarjo Regency. In East Java

Province, Sidoarjo regency had been becoming the

fourth large contributor to maternal and neonatal

deaths over the last five years. The efforts of Sidoarjo

680

Hariani, N. and Suaedi, F.

Collaborative Innovation in Maternal Mortality Rate (MMR) and Neonatal Mortality Rate (NMR) Handling Program in Sidoarjo.

DOI: 10.5220/0007549506800684

In Proceedings of the 2nd International Conference Postgraduate School (ICPS 2018), pages 680-684

ISBN: 978-989-758-348-3

regency gets an appreciation from awarding

institution to public service innovation. In 2014 the

Jawa Pos Institute of Pro Autonomy (JPIP) awarded

the Anugerah Autonomy Awards for Sidoarjo

Regency for the innovation of reducing the maternal

and neonatal mortality rate. The novelty of maternal

and neonatal mortality program in Sidoarjo District

was unique and comprehensive because the program

involved multi-sector actors. Participants not only

come from government but also private, NGO,

academicians and expert practitioners and society.

Previous research by Arganoff was limited to

government areas. Arganoff did not go further on the

involvement of private and third sectors or

communities. Therefore, the focus of this research is

on the process of collaborative innovation and

identifying the strategies of the government of

Sidoarjo.

2 LITERATURE REVIEW

2.1 Innovation in Public Sector

According to Lloyd-Reason, Wall & Muller, 2002),

innovation is an elusive concept. Innovation is very

tough to describe in the form of the sentence because

it is complicated. Innovation is the ideas of a new

thought that works (Mulgan and Albury, 2003). In the

public sector, innovation is one of the new “magic

concepts” (Hood and Hupe, 2011). However, the

public sector innovation research is thin, so the level

of conceptualisation is low (Hartley, 2005). Public

innovation is known as the result of compound

thinking to address a problem in the public sphere.

Innovation is considered a complicated process by

Eggers & Singh (2009). Then the innovation is

defined into four stages. The four steps include the

generation of the ideas, the selection of the ideas, the

implementation of new ideas and the dissemination of

new practices.

2.2 Collaborative Innovation

Collaborative innovation is a collaborative approach

to innovation and problem-solving in the public

sector that relies on harnessing the resources and the

creativity of external networks and communities, to

amplify or enhance the innovation speed as well as

the range and quality of innovation outcomes

(Nambisan, 2008:11). Collaborative Innovation, in

this case, is a non-linear process because the

collaborative innovation process involves multi-

stakeholders in making a public innovation. So, the

collaborative innovation will initially focus on the

participation of empowered actors with different

identities, roles and resources (March & Olsen,

1995). Therefore, collaborative innovation needs the

empowerment of the human resources or actors.

Sørensen and Torfing (2011) said that the

collaborative innovation drives the activity of the

participants, including the governments, the

bureaucrats, the academicians, the private

organisations and the society. This term in public

sector is increasingly used as a strategy for balancing

citizens’ rising expectations for public services with

limited public resources (Agger & Lund, 2017).

Collaborative innovation can be defined as a process

of creative problem solving through which relevant

and affected actors work across formal institutional

boundaries to develop and implement innovative

solutions to urgent problems (Sørensen and Torfing,

2018).

2.2.1 Collaborative Innovation Processes

Collaborative innovation is the crucial resource for

the public sector innovation. Collaborative

innovation arenas distribute authority horizontally,

valorize creativity, experimentation and change,

define good governanve in light of outcome and

problem-solving capacity and are inter-organizational

in perspective (Agger & Sørensen, 2018).

The focus of the collaborative innovation process

includes:

(1) The empowered participation is the empowering

of the involvement of public and private actors

in processes of creative problem solving tends

to create a joint ownership o new and bold ideas

and spreads the costs of failure (Torfing,

2016:3). The process requires the significant

changes in power relations between the actors of

collaborative innovation. So, the challenge of

public leaders here is to stimulate processes of

future emergence through proactive actions,

rather than reacting to the past performance of

an organisation and its employees (Sørensen &

Torfing 2018).

(2) Mutual and transformative learning is the

process that can mutually enrich each actor and

lead to new understandings for the actors (Pettit,

2012). The exchanges among actors with

different experiences, perspectives, opinions,

ideas, and resources tend to challenge

conventional wisdom and inspire the creation of

something new (Sørensen & Torfing 2017). So,

individuals and groups can develop capacities to

address the conditions to reach the objectives.

Collaborative Innovation in Maternal Mortality Rate (MMR) and Neonatal Mortality Rate (NMR) Handling Program in Sidoarjo

681

Figure 1: Analytical Model of Collaborative Innovation Study (Source:

Sørensen

& Torfin, 2011

(3) Joint ownership refers to a situation in which the

properties of the actors in the collaborative

process are own by the public. Joint design,

testing and assessment of prototypes is a

promising way of selecting and adapting the most

promising solutions (Eggers & Singh, 2009). The

development of joint ownership over new and

bold solutions enhances the prospect of successful

implementation (Eggers & Singh, 2009).

2.2.2 Collaborative Innovation Strategies

Collaborative innovation is a crucial resource for the

public sector innovation. Shalabh Singh (2009),

mentioned there are five collaborative strategies,

including:

a) The cultivation strategy aims to facilitate

collaboration between different kinds of public

employees so that they can exchange and

develop new ideas and test them in their

everyday working life;

b) The replication strategy aims to foster

collaborative relationships with other public

agencies to identify, translate, adapt, and

implement their best and most successful

innovations;

c) The partnership strategy aims to develop and

test new and creative ideas through

collaboration between public and private

partners, which have a different rule and

resource bases;

d) The network strategy aims to facilitate the

exchange of ideas, mutual learning, and joint

action through horizontal interaction between

relevant and affected actors who have different

kinds of resources and expertise;

e) The open-source strategy aims to produce

innovation by using the Internet to invite

unknown cocreators from around the world to

help to solve a specific problem.

3 METHOD

The approach of this research is a qualitative

approach. The object of the study is a program of

handling of maternal and neonatal deaths in Sidoarjo

Regency. This study described the process dan the

strategies of innovation program through the

perspective of collaborative innovation theory. The

informants was taken by the purposive technique.

Informants consist of various actors involved in the

collaborative innovation process in Sidoarjo Regency

including governments, private, non-government

organisations, society or citizens, and the other

stakeholders.

ICPS 2018 - 2nd International Conference Postgraduate School

682

Data collection did by the various activities such

as 1). Define the settings of the locations; 2). Gaining

the access and building the relationships; 3).

Purposeful Sampling (Informant Determination); 4).

Collecting the data; 5). Recording the information; 6).

Solving the field problems, and 7). Store the data

(Creswell, 2015). Data analysis technique is done by

data compiling, reduction and categorisation

(disassembling), data compilation (reassembling),

Interpretation of data (interpreting) and concluding

(Yin, 2011).

4 RESULT AND DISCUSSION

4.1 Collaborative Innovation Process in

Sidoarjo

(1) The empowered participation. Collaborative

innovation in the public sector regard to the

integration of a variety of actors (Bommert,

2010). So, empowered the participation is the

important preliminary process of collaborative

innovation. The maternal and neonatal handling

program empowered the engagement through the

socialisation. The government gained the

involvement of the actors by approaching with the

stakeholders.

The training program has done for all actors.

Based on the evidence in the field, it is done to

make each actor holding the same ability. Ability,

in this case, is an awareness of maternal and

neonatal death cases. Later they have been aware

of the importance of maternal and neonatal death

cases. Furthermore, they will contribute to the

reduction of maternal and neonatal mortality

cases. So, not only from the government but all

actors from various sectors with different

backgrounds mixed and participated in the

process of collaborative innovation.

(2) Mutual and transformative learning. This process

was carried out through training and learning for

the handling of maternal and neonatal mortality

cases. Hence, they collaborate each other because

they believe that it may bring a different set of

resources, views, and ideas to the table, and

instead of eliminating these differences in the

pursuit of an all including consensus, they must

learn to exploit each other to spur innovation

(Sørensen & Torfing, 2018). Learning between

the actors has been done primarily regarding

sharing culture, science and social life. The

approach conducted through PKK and recitation

groups. The process has been done to make all the

actors connected with the community directly

because the community culture is more trust the

words of religious leaders. So the religious leader

is the main actors to increase the community

awarness of the high risk of maternal and neonatal

death cases. Then at the second level, there were

healthcare agents/cadres in the community who

are specially trained to monitor and give first aid

when there are signs of an emergency for maternal

or neonatal death. In this case, academics and

practitioners of experts prepared software

emergency handling that can be used by all parties

easily. The next level started to spread to the

medical, which also assisted with the software to

know what to do. The informed dialogue among

actors with different kinds of knowledge an

experience helped to develop a deeper

understanding of a problem (Eggers & Singh,

2009). Regarding government management, there

were non-profit institutions which handle it.

While the private sector provides technology and

places that can be used together in the handling of

maternal and neonatal mortality rate.

(3) Joint ownership. Joint ownership demonstrated

through sharing of the resources such as

technology, equipment, human resources and the

network of the maternal and neonatal system. All

the actors can directly access (real time) the

system by their own gadgets. Information and

Communication Technologies (ICT) here

facilitated the coordination and knowlegde

sharing at low cost across boundaries and thus

supports collaborative innovation (Bommert,

2010). The barrier that existed in various sectors

has now faded. Ultimately the problems of MMR

and NMR become a burden and responsibility

together. The actors work together and joint

ownership to make the MMR and NMR handling

program.

4.2 Collaborative Innovation Strategies

in Sidoarjo

a) The cultivation strategy. The strategy had done by

various actors. The ideas were not limited to the

scientists but also from the society who

understand their own needs, such as cultural ideas.

b) The replication strategy. The strategy had done

through visits and lessons from various regions.

Also, this strategy used in Sidoarjo itself by

replicating the innovation to another area.

c) The partnership strategy. This strategy evidenced

through the establishment of partnerships between

donor agencies (USAID), local governments,

Collaborative Innovation in Maternal Mortality Rate (MMR) and Neonatal Mortality Rate (NMR) Handling Program in Sidoarjo

683

private organisations (Private Hospital), Non-

Profit Organizations (Research Triangle Institute

and Save The Children), Community Groups

(PKK and Muhammadiyah) and Community

(Health and Family Cadres).

d) The network strategy. This strategy did by the

building of the relationship between the actors.

The construction of the network did the network

strategy through social media such as WhatsApp

groups, direct meeting (monthly and yearly) and

also through the network of the maternal and

neonatal handling system.

e) The open-source strategy. This strategy did by

making the application based on the early warning

system. The cadres could detect signs of the

vulnerability of maternal and neonatal death

through specific procedures.

5 CONCLUSIONS

The collaborative innovation process in Sidoarjo

Regency had well implemented. The government had

used the collaborative innovation as well in making

the innovative programme to solve the maternal and

neonatal problems. The existence of empowerment,

participation and learning process are mutually

beneficial and transformative to all stakeholders. The

driving shaft and obstacles could be overcome and

managed through creative social activities. All of the

collaborative strategies have used in this program.

The cooperation of public agencies showed the

cultivation. The replication strategy had done through

visits and lessons from various regions. The public-

private partnership conducted the partnership

strategy. The user of an integrated application did the

networking strategy. The open-sources strategy was

done by gathering of academician in sharing

knowledge and improving the innovation.

REFERENCES

Agger, A., & Lund, Dorthe H., 2017. Collaborative

Innovation in the Public Sector – New Perspectives on

the Role of Citizens? Scandinavian Journal of Public

Administration. 21 (3). 17-37.

Agger, A., & Sørensen, E., 2018. Managing collaborative

innovation in public bureaucracies. Planning Theory.

17 (1). 53-73.

Bommert, Ben, 2010. Collaborative Innovation in The

Public Sector. International Public Management

Review. 11 (1). 15-33.

Creswell, J. W., 2015. Penelitian Kualitatif & Desain Riset,

Pustaka Pelajar. Yogyakarta. Edisi 3.

Eggers, B., & Singh, S., 2009. The public innovator's

playbook, Harvard Kennedy School of Government.

Washington, DC.

Hardiansyah, 2011. Kualitas Pelayanan Publik, Gava

Media. Yogyakarta.

Hartley, J., 2005. Innovation in governance and public

services: Past and present. Public Money &

Management, 25(1). 27-34.

Kementerian Kesehatan RI, 2014. Infodatin 2014,

Kementerian Kesehatan RI. Jakarta.

Llyod-Reason, L., Wall S., & Muller K., 2002. Innovation

and education policy in SMEs: A Czech perspective.

Education & Training, 44.378-387.

March, J.G., & Olsen, J.P., 1995. Democratic governance,

Free Press. New York.

Nambisan S., 2008. Transforming government through

collaborative innovation, Harvard Kennedy School of

Government. Washington, DC.

Pettit, J., 2012. Empowerment and Participation: bridging

the gap between understanding and practice, UN

Department of Economic and Social Affairs. New York

Sørensen, E., & Torfing, J., 2011. Enhancing Collaborative

Innovation in The Public Sector. Administration &

Society, 43 (8). 842-868.

Sørensen, E., & Torfing, J., 2017. Metagoverning

Collaborative Innovation in Governance Networks.

American Review of Public Administration, 47 (7). 826-

839.

Sørensen, E., & Torfing, J., 2018. Co-initiation of

Collaborative Innovation in Urban Spaces. Urban

Affairs Review. 54 (2). 388-418.

Torfing J., 2016. Collaborative Innovation in The Public

Sector, Georgetown University Press. Washington DC

Unicef Indonesia, 2012. Ringkasan Kajian Kesehatan Ibu

dan Anak, https://www.unicef.org/indonesia/id/A5_-

_B_Ringkasan_Kajian_Kesehatan_REV.pdf, retrieved

June 6

, 2018

United Nations-IGME, 2015. Word Mortality Report,

http://www.childmortality.org/index.php?r=site/compa

re, retrieved March 13

, 2018

World Health Organization, 2016. World health statistics

2016: monitoring health for the SDGs, sustainable

development goals, WHO Press. Switzerland.

Yin, R. K., 2016. Qualitative Research from Start to Finish,

Guilford Press. New York

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