A user-fee system helped maintain the financial sustainability of a Maternal and Child Health Handbook Program in North Sulawesi Province, Indonesia

Abstract

A Maternal and Child Health(MCH)handbook was introduced in Indonesia in 1993 to improve the quality of MCH services. BolMong district in the North Sulawesi province, a pilot area for the Japan International Cooperation Agency, started a user-fee system for distributing the handbook. The purpose of this study was to describe the policy-making process, management system, implementation, and outcome of this system. In June 2000, the Local Government instituted a user-fee system; price was set at Rp. 3,500(40 yen). Through continuous efforts of district health officers, all the money collected was used only for reprinting. Midwives collected the money from mothers and turned it in to their health center on a monthly basis, who then sent it to the district office. District health officers monitored and supervised the distribution of the handbooks to maintain the integrity of the system. Payment rate was calculated by dividing the number of pregnant woman paying the book by the number of books distributed. Considering a non-payment rate of 31.8% and an increase in printing cost of 30%, only 47.7% of the initial order could be reprinted. The remaining cost was subsidized by local government. The following three factors were critical in sustaining a user-fee system: strong political commitment by local government, proper supervision of distribution and funds, and simple distribution and management methods.