Skip to content
DraconiticResearch
Search Sources API
197,788 studies31 sourcesUpdated 5 min ago
Peer-reviewedCC BYKEMAS: Jurnal Kesehatan Masyarakat

District-Level Quality Improvement Collaborative to Reduce Maternal and Neonatal Complications in Indonesia

  • Muhammad Ardian Cahya Laksana1
  • Dyah Listyaningtyas2
  • Ratna Dwi Wulandari3
  • Asti Alya Rahmahdia4
  • Dinda Zhafira5
5 affiliations
  1. 1Obstetrics and Gynecology Social, Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
  2. 2Resident in training Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  3. 3Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
  4. 4Department of Epidemiology, Biostatistics, Population Studies and Health Promotion Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
  5. 5Universitas Airlangga Hospital, Surabaya, Indonesia
Read full textPDFDOICite

Abstract

Maternal and neonatal mortality remain critical public health challenges in Indonesia, particularly within decentralized health systems where early detection, referral coordination, and continuity of care are often fragmented. This study aimed to evaluate the implementation and outcomes of a district-level Quality Improvement (QI) Collaborative designed to strengthen maternal and neonatal services and reduce major obstetric and neonatal complications in Jember Regency, Indonesia. A quasi-experimental implementation study was conducted using aggregated routine data from primary healthcare centers and referral hospitals. The QI Collaborative was implemented in two phases from December 2023 to April 2025, focusing on standardized risk screening, early clinical recognition, strengthened referral pathways, and district-level supervision. Trends in postpartum hemorrhage, preeclampsia/eclampsia, and neonatal asphyxia were analyzed using run charts and median-based trend analysis. The findings demonstrated improved adherence to standardized screening and referral protocols, indicating strengthened district clinical governance. Reductions below baseline medians were observed for postpartum hemorrhage and neonatal asphyxia. An initial increase in preeclampsia/eclampsia cases reflected improved detection, followed by declining trends as supervision and service integration improved. This study provides empirical evidence that district-level QI Collaboratives can enhance service performance and clinical governance, offering a scalable model to strengthen decentralized maternal and neonatal health systems in low- and middle-income settings.

Related

  1. E-MPATHY: Development, validation, reliability, and acceptability of a decision-support tool for district-level maternal death review in Indonesia
    Ratnasari Dwi Cahyanti, Widyawati Widyawati, Mohammad Hakimi
    BMC Pregnancy and ChildbirthPeer-reviewedCC BY 4.0Full textObstetrics, gynaecology & paediatricsPMC
  2. When Data Reform Meets Bureaucratic Hierarchy: A Political Economy Analysis of Institutionalizing a District Health Data Bank in West Sumbawa District, Indonesia
    M. Asrullah, A. W. Ati, D. K. Fortunandha +6
    medRxivPreprintCC BYFull textEpidemiology & public healthmedRxiv
  3. Incidence and prevention of postprocedural bacteraemia and complications following water vapour therapy of the prostate: a retrospective review and quality improvement initiative at a tertiary care centre
    Elias Tannous, Waleed Hassan, Jeffrey Chapman +6
    Infection prevention in practicePeer-reviewedCC BY-NC-NDFull textGeneral medicineEurope PMC
  4. Complications among Postpartum Mothers in Indonesia
    Elisa Ulfiana, Tandiyo Rahayu, Yuni Wijayanti +1
    KEMAS: Jurnal Kesehatan MasyarakatPeer-reviewedCC BYFull textObstetrics, gynaecology & paediatricsDOAJ
  5. Epidemiology of malaria and district-level factors associated with malaria elimination in Sumatra region, Indonesia: a retrospective analysis of surveillance data
    Karina D Lestari, Henry Surendra, Bimandra A Djaafara +12
    BMC MedicinePeer-reviewedCC BY 4.0Full text1 citedEpidemiology & public healthPMC

Cite

BibTeXRIS
BibTeX
@article{laksana2026districtlevel,
  title = {{District-Level Quality Improvement Collaborative to Reduce Maternal and Neonatal Complications in Indonesia}},
  author = {Muhammad Ardian Cahya Laksana and Dyah Listyaningtyas and Ratna Dwi Wulandari and Asti Alya Rahmahdia and Dinda Zhafira},
  journal = {KEMAS: Jurnal Kesehatan Masyarakat},
  year = {2026},
  month = sep,
  doi = {10.15294/kemas.v22i1.41425},
  url = {https://doi.org/10.15294/kemas.v22i1.41425},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - District-Level Quality Improvement Collaborative to Reduce Maternal and Neonatal Complications in Indonesia
AU  - Muhammad Ardian Cahya Laksana
AU  - Dyah Listyaningtyas
AU  - Ratna Dwi Wulandari
AU  - Asti Alya Rahmahdia
AU  - Dinda Zhafira
PY  - 2026
DA  - 2026/09/01
JO  - KEMAS: Jurnal Kesehatan Masyarakat
DO  - 10.15294/kemas.v22i1.41425
UR  - https://doi.org/10.15294/kemas.v22i1.41425
AB  - Maternal and neonatal mortality remain critical public health challenges in Indonesia, particularly within decentralized health systems where early detection, referral coordination, and continuity of care are often fragmented. This study aimed to evaluate the implementation and outcomes of a district-level Quality Improvement (QI) Collaborative designed to strengthen maternal and neonatal services and reduce major obstetric and neonatal complications in Jember Regency, Indonesia. A quasi-experimental implementation study was conducted using aggregated routine data from primary healthcare centers and referral hospitals. The QI Collaborative was implemented in two phases from December 2023 to April 2025, focusing on standardized risk screening, early clinical recognition, strengthened referral pathways, and district-level supervision. Trends in postpartum hemorrhage, preeclampsia/eclampsia, and neonatal asphyxia were analyzed using run charts and median-based trend analysis. The findings demonstrated improved adherence to standardized screening and referral protocols, indicating strengthened district clinical governance. Reductions below baseline medians were observed for postpartum hemorrhage and neonatal asphyxia. An initial increase in preeclampsia/eclampsia cases reflected improved detection, followed by declining trends as supervision and service integration improved. This study provides empirical evidence that district-level QI Collaboratives can enhance service performance and clinical governance, offering a scalable model to strengthen decentralized maternal and neonatal health systems in low- and middle-income settings.
SN  - 1858-1196
SN  - 2355-3596
ER  -