Analysis of Basic Emergency Obstetric and Neonatal Care Services Data
Executive Summary
Most maternal and newborn deaths can be prevented if pregnancy and childbirth complications are managed promptly and appropriately. To ensure readiness at the primary care level, the World Health Organization (WHO) defines seven signal functions—the minimum clinical actions that basic health facilities must be able to perform to manage obstetric and neonatal emergencies. In Indonesia, these seven signal functions form the core of PONED services (Basic Emergency Obstetric and Neonatal Care) at primary health centers (Puskesmas).
Signal functions reflect the actual capacity of health facilities to deliver emergency care, rather than merely the availability of infrastructure or personnel. The seven functions include the administration of parenteral antibiotics, uterotonics, and anticonvulsants for pre-eclampsia and eclampsia; removal of retained products of conception; assisted vaginal delivery; basic neonatal resuscitation; and manual removal of the placenta. Fulfillment of all these functions indicates that a facility is prepared to manage the most common and life-threatening childbirth complications.
National analysis reveals substantial gaps in service readiness. Of more than 5,800 Puskesmas providing delivery services, only a very small proportion are able to perform all seven signal functions. The most limited capacities are found in assisted vaginal delivery, removal of retained products of conception, and the administration of parenteral antibiotics. These gaps contribute directly to delays in care and increased risks of maternal and newborn mortality.
Strengthening PONED services requires a focus on the availability of essential medicines and equipment, continuous improvement of health worker competencies, and routine monitoring of signal function performance as a key indicator of maternal and child health services. This study was conducted by Reconstra with funding support from UNFPA as technical assistance to the Ministry of Health of the Republic of Indonesia to strengthen maternal and neonatal health services nationwide.