SIAGA Campaigns - Indonesia

The MNH programme takes place primarily in the provinces of West Java and Banten, which have a combined population of 42 million. Warga SIAGA, Suami SIAGA, Bidan SIAGA, and Desa SIAGA use radio, television, print materials, special events, and training programmes to reach Indonesian families and communities with the concept of being alert ("siaga") for emergencies during childbirth. For each of the audiences, MNH has identified behaviours that make a person "siaga".

Implemented between 1998 and 2002, the Suami SIAGA (Alert Husband) campaign (with funding from UNFPA) focused on promoting the husband's involvement in the pregnancy, preparation for the delivery, and any potential emergency. Formative research was conducted to help design national public relations events, television and radio spots, one-day counseling training for midwives, the 3-part television drama "Kembang untuk Nur" (which was edited for display using a mobile van), local mobilisation events, mini grants to the community, and tie-ins to existing activities (e.g., a radio drama called "Lilin-lilin di Depan" - "The Guiding Light").

The Warga and Bidan SIAGA are follow-ups of the Suami SIAGA campaign and address other audiences that play a crucial role in facilitating a safe pregnancy, delivery, and postpartum period.

Specifically, the kick-off launch event for the Warga SIAGA (Alert Citizen) campaign was held in November 2001. The launch included the airing of the Warga SIAGA TV spots, popular songs, and readings from the Quran by Iis Dahlia, a popular singer and spokeswoman for the SIAGA campaign since its inception. This campaign encourages the individual citizen to be alert and prepared for a delivery by doing their part in arranging for transport, funds, and/or a blood donor, as well as to recognise danger signs. For example, one of the TV spots models positive Warga SIAGA behaviours by showing how alert citizens are attentive towards a pregnant woman in a market setting, and mobilise when they see that she is going into labour.

The Bidan SIAGA (Alert Midwife) campaign, launched in February 2002, promoted the bidan, or midwife, as a skilled, friendly provider. The campaign again featured Iis Dahlia as its spokesperson, sponsored television and radio messages, and promoted a karaoke concert organised by local radio stations and local NGOs. One tool was a calendar featuring an attractive, young, smiling woman and the slogan "Ayo ke bidan siaga" ("Come on, let's go to the alert midwife"). The idea here was that skilled providers are key to reducing maternal mortality - organisers assessed that traditional birth attendants (TBAs) are more likely to merely assist with a delivery and they are frequently not equipped to deal with problems. Furthermore, because the bidans are connected to facilities, they are also more likely to refer in case of a serious complication). Formative research results found that community members acknowledged the difference in skill levels; most report confidence in the bidans' abilities. The campaign sought to position the bidans as the preferred provider, in concert with government policies to develop partnerships with midwives and to increase skilled attendance.

Desa SIAGA, implemented with technical assistance from PATH, focuses on how to get the entire community involved in safe motherhood. A total of 566 village facilitators have played a central role in organising birth preparedness and complication readiness actions within their communities. These community actions have been supported by strong political commitment of diverse stakeholders through the White Ribbon Alliance movement, and community awareness has been raised through a communication campaign. Within the 55 MNH supported villages, 226 hamlets have established all 4 components of the Desa SIAGA system: pregnancy notification to a midwife, emergency fund schemes, transportation, and blood donation mechanisms. Desa SIAGA is a model for making pregnancy a common responsibility for family and community rather than sole responsibility of a woman.

Women, Children, Health.

According to organisers, about 2 women die each hour in Indonesia as a result of pregnancy and childbirth. To address this issue, the MNH Program in Indonesia was started in 1998 and has, since its inception, focused on the concept of shared responsibility for healthy mothers. The MNH/Indonesia country strategy includes interventions within 4 principal components: performance and quality improvement; behaviour change interventions; monitoring, evaluation, and operations research; and advocacy and policy. Click here to access further resources and information on MMH Indonesia on the JHPIEGO website. Click here to read about the MNH Program being carried out in Nepal.

Indonesia is a predominately Muslim society; organisers state that Muslim organisations have played a key role in increasing acceptance of the SIAGA campaigns. "We believe it does indeed 'take a village' to make sure mothers survive to raise their children," claims Donna Vivio, JHPIEGO's Deputy Director of the MNH Program. "The MNH Program has been remarkably successful in engaging everyone in the village, from the husbands to faith-based groups."

A behaviour change intervention evaluation report (April 2004) found that almost 3/4 of the respondents who were exposed to the overall SIAGA campaign answered in the affirmative with regard to use of information contained in the campaign. Organisers state that this figure indicates that respondents found the information relevant and were able to apply it to their lives. Other data from this report include:

• 40.7% of the women who were exposed to the campaign were aware of 'bleeding' as an indicative danger sign during pregnancy, as opposed to 16.4% who were unexposed.
• Exposed respondents were significantly more knowledgeable about Birth Preparedness and Complication Readiness (BP/CR) schemes and were more likely to have used the BP/CR schemes. For most of the schemes, wives and husbands who were exposed to the campaign were more likely to report using arrangements for safe childbirth.
• Nearly 67% of the exposed women reported using a skilled provider for childbirth in comparison to 44.2% of women who were not exposed to the campaign.
• 83% of respondents who reported their village was a Desa SIAGA indicated that they had taken some actions to ensure the same. 46% of the respondents reported discussing Desa SIAGA schemes within their social networks. In addition, respondents (husbands and wives) exposed to Desa SIAGA were significantly:
  1. More likely to display higher levels of knowledge of most danger signs in comparison to their unexposed counterparts.
  2. More likely to have delivered at a health facility or with a midwife.
  3. Less likely to report having delivered with a TBA in comparison to those not exposed to the Desa SIAGA campaign.

Partners
JHU/CCP, JHPIEGO, PATH, Centre for Development and Population Activities (CEDPA), and the National Family Planning Coordinating Board are implementing USAID's MNH Program in support of the Indonesian Ministry of Health (MoH).