Currently, the achievement of Millennium Development Goals (MDGs) 4 and 5, namely the reduction in the under-five mortality rate (AKABA) and maternal mortality rate (MMR) in Indonesia is still far from the 2015 target of 102 AKI per 100.000 live births and 34 AKABA per 1.000 births. Although there was a decrease in AKABA from 97 (1991) to 44 (2007) and AKI decreased from 390 (1991) to 228 (2007), this achievement is still far from the target that must be achieved. In addition, this achievement is still below other countries in Asia such as: Vietnam, Nepal, Sri Lanka, and Malaysia. MMR in Vietnam achieved better achievement than Indonesia, even though Vietnam's gross domestic product (GDP) was only US$ 141 billion and far below Indonesia's US$ 878 billion (2012). Sri Lanka with a GDP of only US$ 59,4 billion and Nepal US$ 19,4 billion, the achievements of AKI and AKABA are far above Indonesia.
Various strategies have been launched to reduce MMR and AKABA, including: increasing the quality and quantity of health workers, increasing infrastructure and capacity of health facilities such as PONEK Hospitals (Comprehensive Emergency Neonatal Obstetrics Services) and PONED Health Centers (Basic Emergency Neonatal Obstetrics Services) and increasing the number of Polindes. (Village Maternity Boarding School), community empowerment through standby ambulances and maternity savings (tabulin), as well as exemption from delivery costs through Jampersal (Jaminan Persalinan). However, the decline in MMR and AKABA was still far from what was expected.
The two years leading up to 2015 are a golden opportunity to catch up with the AKI 102 and AKABA 34 targets. Various obstacles have arisen, starting from the non-fulfillment of the health budget allocation of 5% of the total APBN excluding employee salaries, the lack of facilities and health workers, low access to health facilities. PONED and PONEK, the low utilization of Jampersal, the non-functioning of the Polindes and the very fast change of officials and so on. This problem indicates that the Government of Indonesia needs to pay attention and carefully examine the current maternal and child health policies to be improved and developed in the future. In addition, the government needs to organize health policies better.
To achieve this MDGs target, apart from evaluating the steps that have been taken by Indonesia to date, we also need to look at the efforts made by other developing countries in Asia that have succeeded in achieving sharp reductions in MMR and AKABA. Nepal and Sri Lanka are examples of countries that have experienced a very significant decline in MMR and AKABA in the last 10 years. Learning about things that are efficient and highly leveraged for Indonesia to identify existing opportunities to achieve the MDGs targets in the next 2 years. Then, by knowing the AKI and AKBA policies in the two countries, we will be able to learn about the challenges and obstacles faced in achieving the target for reducing AKI and AKABA.
