Indonesia - Involving Professional Associations and Religious Groups
Publication date: 2006
ICEC Worldwide Case Study - Indonesia Involving Professional Associations and Religious Groups Collaboration with government and professional agencies and a prominent Islamic group has helped set the stage for an eventual product introduction in Indonesia. An estimated 750,000 to one million abortions are performed each year in Indonesia and a significant number of Indonesian women die from unsafe abortion each year. In an effort to reduce the morbidity and mortality associated with abortion, the Indonesia Consortium prepared for the introduction of a dedicated product by testing emergency contraception introduction strategies. The activities were coordinated initially by Pathfinder and then later by PATH. A 1997 baseline survey conducted from February to June found that fewer than five percent of clients had ever heard of emergency contraception. Further, knowledge among health care providers and policy makers (family planning program managers, members of professional associations, Ministry of Health officials, and religious and community leaders) was also very low (only 25 percent). In response to the low knowledge base, the Consortium coordinated a series of meetings and workshops with government organizations and NGOs and developed a range of educational publications for both clients and various types of providers. In 1998, providers were trained at 12 Indonesian Planned Parenthood Association (IPPA) sites. Educational materials for clients and providers were provided at the trainings. Uptake of emergency contraception distribution at these sites was low: only 186 units of Postinor-2 were provided to clients in the first nine months. Intense political turmoil and operational issues at the 12 initial introduction sites hampered the Indonesia Consortium's ability to carry out project activities as planned. Additionally, drastic devaluation of the Indonesia Rupiah also affected the project negatively. Approval Delays A local Indonesian distributor for Postinor-2 was appointed in mid-1997. The approval process was expected to take only nine months, but concerns on the part of the Ministry of Health and Indonesia's National Family Planning Coordinating Board (BKKBN) led to delays. During the demonstration project, the Consortium was permitted to dispense the product to participating clinics. When the demonstration project at the IPPA sites was completed, Postinor-2 had not yet received approval from regulatory authorities and thus was withdrawn from service delivery channels. Building Local Support Midway through the project, an important Islamic group, Muhammadiyah, approached the Consortium. The group was interested in offering emergency contraception through their extensive network of clinics. Because the approval of the Islamic Religious Leaders’ Council is essential to contraceptive registration in Indonesia, Muhammadiyah's support of emergency contraception served as a pivotal step in favor of Postinor-2 approval. The Indonesia Consortium also established ties with the Indonesia Society of Obstetrics and Gynecology (POGI) and, together with Muhammadiyah, collaborated to conduct seminars on emergency contraception for medical professionals. In addition, in 1999, the Consortium built an important connection with the Indonesian Midwives Association, which has a network of approximately 55,000 midwives throughout Indonesia. This establishment of local 1 support increased the number of clients significantly. The Consortium also reached out to Indonesian women's groups that address issues pertaining to women's rights, domestic violence, and rape. UPDATE 2006 In July 2003, the EC product Postinor-2 was finally registered. It is now available in FP clinics and at pharmacies with a prescription and midwives of IBI are authorized to prescribe and provide EC. PATH is collaborating with the distributor of Postinor-2 to expand EC access through pharmacies. In April and May 2005, PATH conducted six two-day training sessions for pharmacists and pharmacy staff in Jakarta. 2
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