Throughout the developing world, postpartum hemorrhage (PPH), or severe bleeding after birth, 
is among the leading causes of maternal deaths. Another threat to a woman’s survival 
is a pregnancy-related hypertensive condition known as pre-eclampsia. When left untreated, pre-eclampsia can develop into the more severe condition of eclampsia, which can result in the death of both mother and baby.

In Indonesia, Jhpiego worked with hospitals across the country, ensuring that pregnant women received appropriate care for each of these life-threatening conditions. The Expanding Maternal and Newborn Survival (EMAS) program also targeted women at risk for premature birth and promoted the use of a drug that helps mature the lungs of the unborn.

Through this innovative health systems strengthening program:

  • 100 percent of the women giving birth in participating hospitals received a uterotonic, a drug that contracts the uterus to prevent or stop excessive bleeding during labor;
  • 97 percent of women with pre-eclampsia/eclampsia (PE/E) were given the proper drug to address the condition; and
  • 91 percent of mothers who gave birth early had received prenatal corticosteroids to help develop the unborn baby’s lungs.

Decreasing preventable deaths among mothers and newborns requires communities and health systems to address the reasons women don’t access or receive care in a timely way. When they go into labor, many women delay leaving home 
to travel to a health facility. Once they make the decision to leave, lack of transportation or poor roads can pose additional delays. Upon arrival at a health facility, a pregnant woman may not be seen quickly enough by providers, leading to a further delay in receiving appropriate services. The EMAS program set out to improve the delay women face at the health facility by establishing a referral system and network to get them to the right facility quickly and receive the right care promptly.

At least 100 health facilities designated referral mentors, employed an innovative, computerized referral exchange system and developed job aids for small, non-participating facilities to plan for timely care.

This referral exchange system, known as SijariEMAS, was able to reduce delays through improved communication between local health centers and hospitals, resulting in patients getting to the right facility to receive lifesaving services. The network was such a success that 29 of the 30 districts participating in the EMAS program have committed to carrying on this important work. Impressed by the outcomes, 15 additional districts also plan to adopt the referral system.