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s the deadline for reaching the Millennium Development Goals (MDGs) approaches, Indonesia is facing problems in meeting its target for halving the maternal mortality rate by 2015.

Although the health minister claims that the rate of childbirths assisted by skilled birth attendants has increased to 87.4 percent in 2011, up from 61.4 percent in 2007, Indonesia’s maternal mortality rate of 228 per 100,000 births remains one of the highest in Southeast Asia.

In accordance with the MDGs, the country’s maternal mortality rate will have to decrease to 102 per 100,000 by 2015.

A lack of medical professionals in remote areas has been blamed for the difficulties in reducing the maternal mortality rate. Although the government introduced its non-permanent assignment program (PTT) in 1992, in which young professional health workers are sent to remote places all over Indonesia, a shortage of professional health workers remains in some provinces. Last year alone, the Health Ministry recruited 10,819 healthcare workers, comprising 2,425 doctors, 504 dentists and 7,881 midwives, under the PTT program.

In 2008, I joined the PTT program and was sent to Saketa, a remote island in South Halmahera, North Maluku, where the maternal mortality rate was quite high. Saketa regency covers 17 districts and two remote islands with a population of around 9,000. Although the PTT program had been in place for some time, when I visited one of the islands inside my work area, I saw midwives refuse to work there due to low wages, a lack of facilities and unfriendly environment.

One solution to the problems is recruiting and training local young people to become midwives. This will help the government ensure that midwives stay and serve their own communities, which will in turn reduce the shortage of midwives in remote places. In return the government will have to provide them with incentives under the PTT program.

The government might also initiate a midwife family program. Under the program, the government could provide incentives to midwives to carry out preventive and promotional programs to reduce the maternal mortality rate in an area. If the maternal mortality does not decline, the government could lower the incentives. Apart from incentives, continuous training for the midwives on the prevention of maternal mortality is imperative.

To trim the maternal mortality rate, the Health Ministry has implemented a program for the poor called Jampersal. Under this program, the government pays healthcare professionals to attend and aid the delivery process. Medical fees are all that usually keep people from seeing healthcare workers.

The program aim is to increase the number of deliveries attended by skilled healthcare officials, thus reducing the maternal mortality rate. However, that program is not actually the answer. People who oppose the program say that Jampersal will instead increase birth rates due to the free-of-charge delivery process.

The real answer is expanding prenatal care. Good prenatal care program will enable healthcare workers to identify if a pregnancy is in the danger zone and thus requires special referral treatment to a hospital for delivery.

Too heavy a reliance on healthcare professionals for deliveries may reduce awareness of the people’s real need for a higher level of treatment and better healthcare facilities. Prenatal care programs are an example of preventative programs. We need to change the healthcare paradigm from a curative way of thinking to preventive one.

The successful story of the polio eradication program may teach the government a lesson on how to curb maternal mortality rates. Margaret Chan, the chief of the World Health Organization, has proposed three solutions on polio eradication that Indonesia can adopt to meet the MDG targets for maternal mortality level.

First, is improving partnerships. The government should work with local residents on how to deal with maternal mortality because every area has its own customs and wisdom. Cooperation with local or religious leaders is mandatory, as is the use of sermons during Friday prayers or Sunday masses to spread public awareness of the maternal mortality issue and community participation in fighting maternal mortality.

Second, is a strategic improvement that encourages all pregnant mothers to have themselves registered. Community health centers (puskesmas) should have data on the number of local pregnant mothers, their prenatal care visitation schedule and status of their pregnancies. Healthcare workers need to recruit and train other to help them register pregnant mothers.

Last but not least is improving technology. Ideas of airlifting doctors to remote areas or floating hospitals are examples of the use of transportation technology as a way to reduce maternal mortality rates.

Reducing maternal mortality is a big task. By improving partnerships and strategies and using technology, however, we can expect significant progress.

The writer is a physician in Jakarta.