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This article is part of the supplement: Proceedings of the 6th Postgraduate Forum on Health Systems and Policies

Open Access Meeting abstract

Health system for maternal health – a case study from Papua, Indonesia

Tiara Marthias* and Laksono Trisnantoro

  • * Corresponding author: Tiara Marthias

Author Affiliations

Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia

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BMC Public Health 2012, 12(Suppl 2):A24  doi:10.1186/1471-2458-12-S2-A24

The electronic version of this article is the complete one and can be found online at:

Published:27 November 2012

© 2012 Marthias and Trisnantoro; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


In relation to health status, Papua Province is one of the most alarming parts of Indonesia, especially in maternal health. Papua Province maternal mortality ratio is disconcertingly higher than the national average. This within country disparity may be caused by the inequality in socioeconomic status, but perhaps more in the health system. This study aims to explore the factors within the health system associated with poor maternal outcome in Jayawijaya district, Papua, Indonesia.

Materials and methods

A case study was conducted for Jayawijaya district, which is one the districts in Papua with high maternal deaths. Bottleneck analyses were used, using the WHO’s Health System and the Tanahashi’s health system Framework. Secondary data from available national surveys and government reports were analyzed, combined with direct observations on Jayawijaya’s health system to identify bottlenecks that may impede the success in improving maternal health.


Prominent causes for limited success in maternal health care were both in the demand and supply sides of the health system. The poor distribution of health workforce and the low utilization rate for essential obstetric intervention lowered the overall quality of service delivery. Information on health care coverage and basic epidemiology were limited and largely undocumented, leading to poor health financing allocation and health planning in general. Strong leadership, managerial skills, and political commitment are still lacking in Jayawijaya district.


Jayawijaya district, and potentially Papua Province at large, still needs to improve its health system’s commodities. Lack of skilled staff, inadequate infrastructure, and poor monitoring as well as limited information system have led to the slow progress health. Strong political commitment and local leadership should be encouraged in order to improve the overall health system.