A Midwife’s Mission: Saving Lives in West Lombok
Transforming Maternal and Child Care with Simple, Powerful Quality Improvements in Hospitals
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At Patut Patuh Patju Hospital in West Nusa Tenggara (NTB) province, a profound transformation is underway. Health workers are not just treating patients, they are reshaping the future of health care for mothers and children. At the forefront of this change is Ibu Desak, a midwife who has dedicated nearly 30 years to this profession.
Desak’s commitment is driven by the heart-wrenching number of infant deaths she has witnessed. “It used to seem like babies dying was just fate,” she reflects. “But now, we are so cautious, even with the smallest issue.”
It used to seem like babies dying was just fate. But now, we are so cautious, even with the smallest issue.
The stakes are high. In 2023 alone, NTB reported 76 maternal deaths (85.4%) and 631 neonatal deaths (94.2%) in hospitals, most of which could have been prevented. As a major hospital that serves a large population and receives referrals of mothers and infants from various districts throughout NTB, it became imperative for Patut Patuh Patju Hospital to change course.
The hospital turned to an approach known as Point of Care Quality Improvement (POCQI), introduced by UNICEF in 2019 (https://www.unicef.org/indonesia/health/stories/small-fixes-big-changes), which is used to improve the quality of healthcare services.
Healthcare teams identified specific issues affecting maternal and neonatal care, examined the root causes of these problems and developed practical solutions. They continuously assess the impact of the changes.
Ibu Desak, a key member of the Patut Patuh Patju Hospital’s Quality Committee, leads the meticulous daily effort to monitor and evaluate the services. What started in the maternal and neonatal units has expanded to at least seven departments in the hospital, all committed to one goal: saving lives.
The results have been life changing. “We used to see so many infections after caesarean sections,” Desak recalls. “Mothers often had to do unnecessary repair surgeries, adding to their physical and financial burden.
Desak and her team identified the main causes for these challenges and focused on simple, effective quality improvements to solve them. “We have reduced post-caesarean section infections from 3.3 per cent in 2021 to 0.3 per cent in 2023, and almost eliminated the need for repair surgery,” she says.
The journey has not been without its challenges. She and her team faced resistance from colleagues when they first introduced the new measures. “At first, many refused, because they saw it as extra work,” she says. “But our perseverance and continuous efforts led many hospital staff to gradually come on board and to believe that this approach actually helps.”
The leadership of the hospital director, Dr. Suryadi, has been crucial. Under his guidance, quality improvement has become a core part of the hospital’s culture, with several dedicated support teams now in place. Quality improvement has even become one of the measures to determine performance incentives for staff.
“POCQI has allowed us to provide the best care possible for patients, especially in reducing the number of maternal and child deaths,” says Dr. Suryadi. “We are proud that many hospitals come to us to learn about how to implement quality improvement, such as from Papua and Maluku. My message to other hospitals, especially outside Lombok, is that we must continue improving.”
POCQI has allowed us to provide the best care possible for patients, especially in reducing the number of maternal and child deaths
Patients like 27-year-old Nurhayani have noticed the differences too. “In the past, when I brought my mother here, she did not receive quality care and the administrative process was slow. Now, everything has changed drastically.”
The success of the quality improvement initiative has earned the hospital several awards from the Ministry of Health. Ibu Desak and her team have been recognized nationally and were invited to support the development of new national guidelines for quality improvement in health care facilities across Indonesia.
"This initiative has helped to improve the quality of services, which also helps with getting better accreditation,” says Arif, Head of the West Lombok District Health Office. “Now, two hospitals in West Lombok have received the highest accreditation status and we hope all health facilities in NTB will follow.".
The impact of this work goes beyond the hospital. UNICEF has been supporting the Ministry of Health in rolling out quality improvement implementation, piloting the approach at 52 hospitals across Indonesia. Based on the success of the pilot, the Ministry is now preparing to expand it to all health facilities in the country.
For Ibu Desak, this work is more than a job – it’s a mission. And her efforts are part of a much wider effort to improve the survival and the health of mothers and children in Indonesia. “Children are the hope for our future,” says Abe, Head of the Health Services Department of West Lombok. "Our lives will not be forever, but Indonesia will keep moving forward, and that progress will depend on the health of our children."
Our lives will not be forever, but Indonesia will keep moving forward, and that progress will depend on the health of our children.
