
	The rate of neonatal and infant mortality in Indonesia remained rather static for the last ten years.  While the country is on track to meet many of the Millennium Development Goals, such as the water and sanitation targets, the rates of improvement for child and maternal health are woefully short of the improvements needed to meet their target goals by 2015.  The multiple reasons for these shortcomings will be discussed below, and point to a need to strengthen the health system rather than focus on programmatic interventions.
	Indonesia has made improvements in the number of births with a skilled health worker attending, with 72% of births now meeting this target.  That being said, this category still includes traditional workers, such as midwives, who cannot provide medical interventions should the pregnancy be complicated (hence the large percentage of maternal deaths caused by hemorrhage).  In other words,  the improvements made in this particular indicator are somewhat misleading and there is still much work to be done.  In addition, there has been a decline in the percentage of diarrheal cases in children under five years treated by a health professional.  While data on postnatal care is incomplete, it is clear that this area is also of concern, with low rates across the country.
	Cesarian-section rates are still lower than should be expected, around 4%.  The c-section rates additionally point to another concerning issue.  While the rate of c-section is 7% in urban settings, it is only 2% in rural.  This points to the problem of equity of coverage across the country.  Clearly access to healthcare services is focused around urban areas.  Another issue of access concerns vertical equity.  There is a 27% gap in service utilization between the poorest and richest quintiles.  Clearly the poor are finding it much more difficult to access healthcare services, likely due to out of pocket costs.
	In discussing next steps towards improving neonatal and maternal care indicators, the most basic question is how to most effectively address the lack of service.  Specifically, should Indonesia develop program-specific approaches or strengthen the overall health system without focusing on pre and post-pregnancy care for the mother and child.  There is no question that programmatic approaches to solve the problems outlined above are attractive.  Not only do “vertical approaches” that target one sector of improvements have much more targeted, manageable objectives, they also generally generate faster results.  There are some drawbacks to keep in mind, however.  One major drawback is that investing heavily in programming for one particular area of the health sector often means that funding for other areas suffers and human resources will flock towards working in that area that has more resources (the effect of international funding to HIV/AIDS and its effect on the family planning sector is one example).  In addition, running multiple parallel programs for one area results in duplication of services that are also uncoordinated between programs.  This leads to an increase in forms and paperwork for supplies and funding. 