Public funding for community-based skilled delivery care in Indonesia: to what extent are the poor benefiting?

Since the early 1990s, the Government of Indonesia has addressed high maternal mortality by attempting to ensure skilled attendance at delivery through access to trained village midwifery services in every village. Yet access to skilled services at delivery continues to prove problematic, with low levels of skilled attendance and high mortality. Making use of a funding flow analysis and population-based survey in two districts, we investigate to what extent funding allocated for maternal services enables access to skilled services by rich and poor households. The results suggest that, although resources reach remote poor areas, the poor obtain unequal access to skilled delivery services. Because rural midwives must earn a significant fraction of their income from private fees this acts to deter women from seeking their help. A new system of targeting poor women utilising the existing state insurance company (ASKES) is an important step in helping to reduce these barriers, but may not be sufficiently generous to protect all those that are considered vulnerable.