Evaluation of Childbirth Insurance Implementation for Reducing
MMR and IMR in Dawarblandong Districts Mojokerto Regency
Widhi Dwi Pawestri
Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia
Keyword: Maternity insurance, MMR and IMR.
Abstract: The government's efforts in reducing Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR)
need to be worked hard. The decline of MMR and IMR is one of the goals of national development in
Indonesia. But MMR and IMR in Indonesia are still high, according to Indonesia Demographic and
Health Survey (IDHS) in 2012 amounted to 359 per 100.000 live births. The majority of maternal and
infant mortality occur in middle-income peoples due to economic inhibition and access. Thus, the
government issued a Childbirth Insurance Program aimed at the poor to reduce MMR and IMR. This
research uses descriptive type research method, with purposive sampling technique. Selected two
respondents who are considered to provide results in accordance with this research are two Village
Midwives. Data analysis use qualitative and explanative approach. The results of the research that the
implementation of Childbirth Insurance in Dawarblandong Districts is in accordance with the Technical
Guidelines of Childbirth Insurance in 2011. Data collection of Childbirth Insurance participants is
evenly distributed because data collection is done in detail. The shortcomings in the implementation of
Childbirth Insurance are less contribution from Head of Public Health Center, Village Head, and Head
of Districts. MMR and IMR coverage declining in 2016 can prove that the implementation of Childbirth
Insurance succeeded in reducing MMR and IMR.
1 INTRODUCTION
Maternal Mortality Rate (MMR) and Infant
Mortality Rate (IMR) became one of the important
indicators in determining the health status of the
community. Indonesia is the country with the
highest Maternal Mortality Rate (MMR) in
Southeast Asia. Indonesia Demographic and Health
Survey (IDHS, 2012) reported that every 100,000
live births in Indonesia there are 359 mothers who
died during childbirth. In the Millennium
Development Goals (MDGs), maternal mortality is
also one of the predetermined targets, that is
improving maternal health where the target to be
achieved by 2015 is reducing to ¾ the risk of
maternal mortality. Maternal death is an event that
can be caused by various things. The biggest cause
of maternal death to date is bleeding (Indonesian
Ministry of Health, 2014). Other causes such as
history of disease, abortion, pregnant in old age and
infection.
Indirectly, the low awareness of the community
about the educational background, the health of
pregnant women, the socio-economic of the family,
and the community environment allegedly
contributed to the increase of maternal mortality.
In addition, maternal mortality can also be
attributed to 3 risk factors of delay (Three Late) and
4 risk factors too. In addition, maternal mortality can
also be attributed to 3 risk factors for delays and 4
risk factors too. The risk factors for delay are family
delay in making contact decisions with health
personnel, delay in obtaining health service, and late
referring. Whereas four too are too young / old age
mother to decide to get pregnant, too often give
birth, and too close distance between pregnancy /
labor one with next (Mojokerto District Health
Office, 2013). From several known factors, there is
an important effort to decrease Mother Mortality
Rate (MMR) is to increase public access to healthy
delivery by providing easy financing for all pregnant
women who do not have health insurance because
MMR and IMR are the majority of the poor.
Pawestri, W.
Evaluation of Childbirth Insurance Implementation for Reducing MMR and IMR in Dawarblandong Districts Mojokerto Regency.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 171-174
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
171

The Ministry of Health of the Republic of
Indonesia launched a policy stipulated in the
Childbirth Insurance Program in 2011. Childbirth
Insurance is dedicated to assisting mothers with
financial difficulties in accessing health services.
Childbirth Insurance Program itself becomes priority
program of Ministry of Health with budget year
2011 equal to 1,223 Trillion rupiahs. This program
is designed to assist in the achievement of National
Health Development Goals and Millennium
Development Goals (MDGs) by 2015.
2 METHODS
This research is a descriptive research with
qualitative approach. This research was conducted
exactly in Districts of Dawarblandong Mojokerto
Regency. Determination of respondents in the study
was purposive sampling. Selected respondents are
those who play a role in the implementation of the
Childbirth Delivery Program at Dawarblandong
Public Health Center, ie two midwives, one midwife
as the coordinator of the Maternity Care Program
and other midwives as representatives who know the
implementation of the Maternity Insurance Program
in the field. The data were collected through in-
depth interviews using interview guides and
secondary data obtained from Dawarblandong
Primary Health Care’s data. The data obtained are
listed descriptively. Data analysis is done
qualitatively and explanatively.
3 RESULT
3.1 Childbirth Insurance in
Dawarblandong Districts
Childbirth Insurance in Dawarblandong Districts
held since 2015. This program is required by the
government not the desire of Dawarblandong Public
Health Center to implement Childbirth Insurance.
Since the implementation of Childbirth Insurance,
Dawarblandong Public Health Center already
understand about Childbirth Insurance, that is
Program from government which is addressed to
pregnant women especially for poor people used for
Antenatal Care (ANC), maternity services, post-
natal service and access to family planning services.
For those who have other Health Insurance, cannot
recorded as a participant Childbirth Insurance.
Requirements to become a participant Childbirth
Insurance by showing ID Card, Family Identity, and
Poor Certificate.
3.2 Implementation of Childbirth
Insurance in Dawarblandong
Districts
Preparation of the implementation of Childbirth
Insurance is held a meeting with the Health Services
of Mojokerto regency before socialized to the
community. The meeting was represented by the
program holder Mother and Child Health (MCH)
Dawarblandong Districts. At the meeting discussed
Childbirth Insurance targets, Childbirth Insurance
claim, and the amount to be received by the
maternity helper. After conducting an official
meeting with the Health Service, then socialized to
all health workers in Dawarblandong Districts
including village midwives in all work areas. The
task of the village midwife as the Childbirth
Insurance implementing team is to socialize
Childbirth Insurance to the community who is
entitled to obtain Childbirth Insurance through
Maternal & Child Health Centre or meetings held in
the Village. Data collection to the people who are
entitled to use Childbirth Insurance when Maternal
& Child Health Centre activities take place or the
community comes to the Village Maternity Post to
meet the village midwife. Data entered to the Cohort
Book.
The registered community of Childbirth
Insurance may use it for ANC, childbirth and family
planning by the village midwife. Afterwards the
Village Midwife can make a claim by reporting to
the Public Health Center by making a complete
delivery report and proof of patient identity such as
ID card and Family Identity. By Public Health
Center reported to the Health Services by submitting
reports from the Village Midwife. Childbirth
Insurance is only able to bear for normal maternity,
not for surgery (C-section). Obstacles that occur in
the implementation of Childbirth Insurance Program
in Dawarblandong Districts when data collecting
there are some people do not have ID card or Family
Identity.
3.3 Equity of Childbirth Insurance in
Dawarblandong Districts
According to Minister Health Regulation in 2011
about the Technical Guidance of Childbirth
Insurance that the Program implemented by the
government in order to reduce the MMR and IMR.
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
172

The participation of Childbirth Insurance in
Dawarblandong Districts has been equitable,
especially for all poor people belonging to pregnant
women, maternal mothers, postpartum and babies,
except for people who have other insurance.
Implementation of Childbirth Insurance in
Dawarblandong Districts for health worker have
purpose and desire to strive for Dawarblandong Sub-
district can be maternity with low cost for poor
society safely and comfortably. Based on the
Constitution of the Republic of Indonesia in 1945
article 27 paragraph (2) it says "every citizen shall
have decent work and livelihood". Data collection is
done in detail so that all communities can be
registered as Childbirth Insurance participants. This
is done in every village in Dawarblandong Districts.
In Indonesia, various national development efforts
have been made, one of them is health development.
Thus equity in development needs to be revisited.
3.4 Evaluation of Childbirth Insurance
Every year at the Dawarblandong Public Health
Center, an evaluation of the Childbirth Insurance
Program is conducted for a year. The evaluation
meeting was attended by Childbirth Insurance
Program supporters such as Sub district Head, Urban
Village Head, Head of Public Health Center and all
Village Midwives. The purpose of the evaluation is
to know the success of the Childbirth Insurance
Program every year. Success has seen from the
accuracy of the target. This means that with the
Childbirth Insurance, the achievement of the MCH
program has been successful.
3.5 MMR and IMR coverage
MMR and IMR coverage in Dawarblandong
Districts in 2016 decreased, that’s compared to the
previous year. Utilization of Childbirth Insurance of
Dawarblandong was done by participation really
proven. The desire of the implementing team is the
Village Midwife is also one of the supporters of
Childbirth Insurance Program to improve health
status by providing the best service for pregnant
women.
4 DISCUSSION
To evaluate the implementation of Childbirth
Insurance using the indicator of the success of
Childbirth Insurance this contained in the Health
Minister Regulation 2011 about Guideline for the
Technical Childbirth Insurance.
Health workers in Dawarblandong Districts have
knowledge and understanding about Childbirth
Insurance. It is in accordance with the Technical
Guideline for Childbirth Insurance, that the
Childbirth Insurance is an effort to ensure and
protect the process of pregnancy, childbirth,
postnatal and family planning. Childbirth Insurance
in Dawarblandong Districts provide services as
written in technical guidance covering Antenatal
Care (ANC), childbirth help, postnatal care and
family planning services, and newborn health
services, including referral preparation service at the
time of complications (pregnancy, childbirth,
bleeding or childbed and infant newborn and family
planning).
Childbirth Insurance Financing is an integral part
of Public Health Assurance financing, so its
management in Management Team/Health Office at
Regency/City Level is not done separately for the
first level service/basic service and for the
advanced/referral service. The management of
financing Public Health Assurance in the first level
service/basic service is done by the Health Office.
Claim Childbirth Insurance at Dawarblandong
District conducted by midwives to Public Health
Center. Based on technical guidelines of Childbirth
Insurance, the management claimed by reporting the
completeness of claims covering ID card, photocopy
of service sheet in Mother and Child Health (MCH)
book, pantograph, cohort book, and family planning
note by birth attendant. Public Health Center
reported to Health Office.
Socialization on Childbirth Insurance is done to
all pregnant women especially poor people.
Childbirth Insurance socialization by Public Health
Center aims to provide information about Childbirth
Insurance and benefits of Childbirth Insurance. That
way there is no doubt for the community in
following the Childbirth Insurance Program. Only
the poor people are targeted by the Childbirth
Insurance Program. From the informants are ensured
that all the rightful people at Dawarblandong
Districts become participants of Childbirth Insurance
have entered Childbirth Insurance data.
One of the indicators to improve maternal health
is the achievement of MMR and IMR decline which
in the delivery process is assisted by trained health
personnel. Childbirth workers in Dawarblandong
Districts each Village has one midwife. According
to Ministry of Health of the Republic of Indonesia in
2006 about Village Standby, in Indonesia for the
whole region there is at least one village midwife to
Evaluation of Childbirth Insurance Implementation for Reducing MMR and IMR in Dawarblandong Districts Mojokerto Regency
173

help deliver the childbirth. The role of midwives is
to provide services to the health of mother and child.
Mother and Child Health (MCH) services include
Antenatal Care (ANC), childbirth, postpartum
services, and postnatal care (Ministry of Health of
the Republic of Indonesia, 2013). The services
provided by the village midwife to the Childbirth
Insurance participants already covered the MCH
program.
Claims process conducted by the Village
Midwife in Dawarblandong District according to the
technical guidance of labor. Such as telling the
health Ministry of RI in the information of Birth
Insurance that this labor claim does not have to be in
the package (overall) but can be done separate
claims, such as ANC alone, labor alone or PNC
only.
There are no funding constraints and amounts
received by the Village Midwife as a result of the
provision of services using Mortality Insurance.
Coverage of MMR and IMR has declined since
Asuransi Dawar in Dawarblandong district. IMR in
2016 of 0.04 per 100 live births, the rate is decreased
when compared to infant mortality in the previous
year. Thus, the decrease in MMR and IMR occurs in
2016.
5 CONCLUSION
Childbirth Insurance Program implemented in
Dawarblandong Districts Mojokerto Regency has
been implemented in accordance with the Technical
guideline of Childbirth Insurance at regulation of
health ministry in 2011 in terms of understanding of
Childbirth Insurance, Childbirth Insurance goals and
Childbirth Insurance utilization.
Implementation of Childbirth Insurance in
Dawarblandong Districts is supported by hard work
done by Childbirth Insurance executing team
especially to officer of delivery helper that is
midwife who have desire to succeed the program in
work area of each midwife. However, there are a
few shortcomings in the implementation, namely the
lack of other stakeholder roles such as Head of
Public Head Center, Head of Districts, and Village
Head in the implementation of Childbirth Insurance
Program.
The implementation of the Childbirth Insurance
program in the field is also in accordance with the
Technical Guidelines of Childbirth Insurance.
Childbirth process is handled by birth attendant that
is midwife. Birth attendant are well aware of the
claim process and the evaluation of the Childbirth
Insurance program that is implemented yearly, but
there needs to be an integrated monitoring program
to improve performance. Childbirth Insurance in
Dawarblandong Districts for membership is evenly
distributed.
The successful implementation and equity of
Childbirth Insurance in Dawarblandong Districts to
decrease Maternal Mortality Rate and Infant
Mortality has been successful with proven that the
coverage of MMR and IMR in 2016 decreased from
the previous year.
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