Report of the mid-term evaluation : expanding maternal and newborn survival (EMAS) program, USAID/Indonesia, April 6-May 7, 2014

Maternal mortality in Indonesia remains substantially higher than expected in comparison with other south Asian countries having similar economies and states of development. Also, despite progress in reducing mortality among older infants and children, during the past decade Indonesia has not substantially reduced mortality among newborns (the first month of life). As a result, the country is losing momentum in its in child survival. The purposes of the mid-term evaluation were to: (1) assess EMAS progress in achieving the goal, objectives and planned outputs as stated in the agreement's project description and in approved workplans; (2) provide recommendations to improve EMAS program effectiveness over the remaining 2-plus year life of project; and (3) provide recommendations for USAID to consider in the design of future projects aimed at improving maternal and neonatal health in Indonesia. The evaluation team concludes that the approaches developed and implemented by EMAS have important potential to improve the performance of Indonesia's health services in managing the complications that are the major causes of maternal and newborn morbidity and mortality. To realize this potential at scale, however, EMAS needs to address critical challenges. One is to identify the connection between the process changes that EMAS has succeeded in generating with improvement in patient outcomes. Equally important is strengthening communication and connection with the government of Indonesia (GOI) -- especially the Ministry of Health -- at the central level. EMAS also needs to work with USAID, the GOI, and other stakeholders to develop a strategy for implementation at scale that goes beyond its direct engagement, to link its results with national-scale initiatives and programs. (Excerpt, modified)