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JSI Research and Training Institute Inc entered into a Cooperative Agreement with USAID/ Indonesia in April 2005 to implement USAID’s integrated decentralised maternal, newborn and child health (MNCH) activity – the Health Services Program (HSP). This is the flagship health activity under USAID’s Basic Human Services program in Indonesia, which encompasses other, smaller health initiatives in avian influenza, HIV/AIDS and TB, plus point-of-use water chlorination, environmental and water services and a Title II food program. The BHS results framework indicates that USAID is seeking results from the program on advocacy, service delivery and behavior change.

HSP exists because priority needs in maternal and child health care in Indonesia remain unmet. Maternal mortality at 307 per 100,000 live births remains one of the highest in ASEAN. The child mortality ratio is better but the large number of children in the population means that 450,000 under-5 children die each year. Neonatal mortality is a large and rising proportion of child deaths. Both maternal and neonatal mortality rates can be traced in part to the continuing high proportion of births not attended by a skilled provider (34%) and the fact that 59% of births still occur at home. Another big killer of young children is diarrheal disease, caused by a lack of safe water, poor sanitation and weak hygiene practices. And this in turn contributes to malnutrition: WHO estimates that 40% of the under-5 deaths can be attributed to poor nutrition. While overall progress on micronutrient supplementation is creditable, breastfeeding practices need further strengthening and iron folate supplementation for mothers is not adequate.