International Cooperation for Maternal, Newborn and Child Health Using the Maternal and Child Health Handbook in the Republic of Indonesia

For over 70 years, Japan has employed the Maternal and Child Health Handbook to track the health of mothers and their children throughout pregnancy, childbirth, and early childhood, as well as to guide mothers and families to monitor the child's health at home. Japan now has one of the lowest maternal and child mortality rates in the world. The Japan International Cooperation Agency (JICA) has supported the introduction of the handbook in the Republic of Indonesia (hereinafter, "Indonesia"), and has provided technical cooperation on the development, pilot, and promotion of a handbook that is suitable for the country for many years. In this section, Osaki Keiko, a health senior advisor, gives an outline of the initiative.

Indonesia once faced high rates of infant and maternal mortality. The Maternal and Child Health Handbook is a tool long employed in Japan. The introduction of the handbook in Indonesia can be traced back to a request from an Indonesian doctor who visited Japan as part of a JICA training course. JICA's support started with Maternal and Child Health Improvement Projects in the 1990s. After planning, development, and training phases, the handbook began to be distributed and were gradually expanded throughout Indonesia. Osaki recalls the situation at the time as follows.

"At that time, in Indonesia, it was still common for midwives to assist with childbirth at home, and when medical care was necessary, families needed to bring women, mothers and children to the hospital on their own. Also, despite there were community-based child health checkups under the Posyandu system, once the mandatory vaccinations were completed, mothers tended to stop attending, resulting in limited opportunities to monitor the growth of infants and young child thereafter," she explains. "The introduction of the Maternal and Child Health Handbook has played a significant role in ensuring records of pregnancy progress, childbirth, and childcare, providing a means to communicate within families and between families and healthcare professionals, then regularly monitor the health of both mother and child."

The introduction of the Maternal and Child Health Handbook in Indonesia involved tailoring it to the country's unique context rather than simply translating the Japanese model. This adaptation included incorporating text as well as numerous illustrations to provide health and childcare information for pregnant women, mothers and their families, ensuring the provision of valuable health-related insights. In regions where the handbook was actively utilized, there have been observed improvements in the environment surrounding mothers and children, with continuous care provided throughout the pregnancy, childbirth, and period after childbirth. There has also been an increase in support from husbands for childbirth and home-based care. The handbook's design, featuring a photo of a local mother holding her infant on the cover, further enhances its appeal to Indonesian mothers.

"Differing from Japan's Maternal and Child Health Handbooks, the use of photos of mothers and children on the cover sparked considerable enthusiasm in the newly introduced regions. There was a strong desire to feature local parent-child photos on the cover, emphasizing the importance of increasing their sense of ownership," explains Osaki. "While the standard version of the handbook now features a single cover, there was a time when we incorporated different parent-child photos for each of the 33 provinces in Indonesia."

Now, with the introduction of the National Health Insurance system in 2014, the system is being put in place that anyone can receive the medical care they need. The circumstances surrounding childbirth has improved considerably. In addition, international training has begun in order to share the insights gained from the Indonesian projects with countries in Asia and Africa that are considering adopting Maternal and Child Health Handbooks like Indonesia. JICA is also continuing to cooperate.

"Continued cooperation in various forms since the project began in the 1990s has provided Japan with a valuable learning experience in the field of international cooperation and development," observes Osaki. "In fact, when the Maternal and Child Health Handbook was introduced, the Indonesian Ministry of Health had a strong desire to reduce infant mortality and was taking proactive steps to achieve this goal. While exploring approaches, the universal value of Japan's Maternal and Child Health Handbook, applicable globally, was recognized. I suppose that it was an opportunity for Japan to discover valuable tool that can contribute to the world."

<Reference> Key JICA international cooperation projects utilizing the Maternal and Child Health Handbook in Indonesia

Reference websites:
https://www.jica.go.jp/oda/project/0600435/index.html
https://www.jica.go.jp/oda/project/1600614/index.html