Cross Sector Planning to Respond to a Public Health Crisis

Developing a Whole System Response


By early 2000/2001, it was clear to all that Indonesia had one of the highest rates of maternal mortality in the developing countries of southeast Asia. There were many contributing factors including the limited availability of clinics and trained health workers. Across many small villages, girls or young women were married and began having babies at a very young age. They were expected to have many babies. Prenatal care was generally unavailable and when travel to a clinic was needed it required the permission of the husband. Traditional birth attendants had filled the gap of service, but were not recognized or supported by the medical establishment. Society as a whole was not devoting significant attention to improving this situation.


UNICEF convened a meeting of key stakeholders, including medical leaders, nurses, traditional birth attendants, NGOs, religious and community leaders, and women from several (representative) villages. Over 100 people met for three days to create a set of action plans for changing the country’s approach to lowering maternal mortality rates. Rick co-facilitated the meeting using a process known as Future Search that enabled all perspectives to be heard and contribute to the final outcomes. By the end of the meeting, a clear set of outcomes and next steps was achieved. These outcomes called upon medical professionals, NGOs, press and religious leaders to work together in new ways to address all aspects of the problem. As one senior medical officer commented: “Usually I come to these meetings to present and be heard. But this time I spoke little and learned a lot.”