Since 2014 Wahana Visi Indonesia (WVI) has a implemented Global Partnership for Social Accountability (GPSA) project supported by the World Bank through Citizen Voice and Action (CVA) program. The program focuses on government accountability to improve basic maternal and child health services (MCH). Baumata Village in Kupang District, East Nusa Tenggara Province (NTT), is one of 60 villages in NTT where the GPSA project is implemented.
When traveling to Baumata Pond (tourist attraction), on the side of the main road, you will see Taebenu Sub-district community health center (pusekesmas), Baumata Puskesmas. Across the street there is a 24-hour maternity clinic that has simple equipment, unlike a large mother and child care hospital. However, the clinic has health workers on standby 24 hours. They also treat the patient kindly and attentively. These are the results of the CVA program.
"At the beginning, the health workers – including the midwives and nurses whom I placed in the supporting puskesmas in each village - felt uncomfortable because their performance was assessed. They also complained that WVI provoked the people to assess all what they do," Head of Baumata Semri Kanadjara Health Center said.
WVI looked like giving people a chance to interfere the performance of poor service providers. The result was that the activity facilitated by WVI, was not attended by the service providers, such as midwives and nurses. "We are not allowed by the Head of the Community Health Center to participate in the activity. According to him, there are still other activities that are more important than just finding the weakness of midwives and nurses in the village," Pattiwelapia, one of the midwives, said.
Development Facilitator of CVA program in Taebenu Sub-district, Morstens Hanas, emphasized that the situation did not make him desperate. "That was the condition when the program began to run in Kupang District, especially in Taebenu Sub-district. Full of resistance, but we don't give up," Hanas explained.
He admitted, he and his friends of the village facilitators believed that the work they were doing was something right. "I told them (service providers), that this is not a rally (a mass meeting people), we do it by sitting together and having a dialogue. We discuss our weaknesses," Hanas continued.
After running for three years, the CVA program started showing a positive result. Little by little, the action plan begins to be fulfilled, both at the village level of integrated health post (posyandu), as well as at the district level for supporting puskesmas. Some of the changes of services are the improvement of the opening time of health facilities, the presence of nurses and midwives, the equipment and medicines, also the number of less health personnel. Moreover, the buildings and facilities for health facilities are renewed.
"There are many changes that we experienced at Baumata Puskesmas. We proposed the construction of a new health center and the government has responded. Now, the health center is being built on the new location which is according to the standard. It is near Taebenu Sub-district Office," Kanadjara said. He added, now Baumata Puskesmas has already had an ambulance, obtained from the 2018 Special Allocation Fund (DAK). “We are very happy, because of the ambulance; we can go to the hard-to-reach areas such as Bokong Village and some other locations.”
Meanwhile, the Midwife Coordinator of Baumata Puskesmas, Beatrix Bunga added, there are also other changes to the clear schedule distribution for midwives who have double-work to support puskesmas in the village and in the maternity clinic in Baumata, so that there is no more empty schedules. Related to the system of availability of equipment and consumables at the puskesmas, it has been addressed. "Thank to CVA program, we are prepared to do accreditation, "Beatrix said.
On another occasion, Head of East Baumata Village, Daniel Baitanu, revealed that the atmosphere of service has changed greatly. “There was no doctor at the puskesmas back then although it is near the city. If the patients arrived after midday, they were asked to go home," Daniel said. He is grateful now for the positive changes.
In general, the CVA program in Taebenu Sub-district includes seven villages and these areas are the service area of Baumata Puskesmas. In each village there have been significant changes as a result of the long process of the CVA program. At the beginning, the program was difficult to run, but finally it gives good results regarding to the basic maternal and child health services in these villages.
One of the village facilitators involved in the CVA program, Marcel Lalus, delivered his testimony that initially this process was quite difficult to pass. Communities and health workers were not familiar with the process of CVA program. However, after two to three years, everything is getting better. The community is not afraid to provide input and criticism to health workers at the health facilities. On the other hand, the health workers as health service providers are increasingly open to input and criticism from the public to build better services.
Written by: Lusty Budiman, GPSA Project, Wahana Visi Indonesia