 In addition, service-specific strategies mean healthcare professionals can be trained or separately for multiple different vertical programs, reducing the time available to treat patients.  As can be seen vertical programs cause redundancies that often lead to a decrease in health sector efficiency.
	Health system responses, on the other hand,  have the benefit of strengthening the framework by addressing underlying issues affecting access, quality, and efficiency across the healthcare system.  When these sorts of root problems are addressed, improvements can be seen in all aspects of health services delivery, rather than one specific, focused area.  This approach has limitations as well, primarily fact that goals are much less focused and require much more coordination among stakeholders.  In addition, the lack of clear, direct goals lead to discouragement among actors.  These difficulties, though, are not surmountable, and the long-term strengthening benefits of health-systems wide approaches make this preferable to programmatic interventions.
	In defining next steps in improving neonatal and maternal healthcare in Indonesia, one must discuss the ability of the government to make changes that will improve services and service utilization.  Of particular concern is the fact that the current system is largely decentralized and underfunded, with the vast majority of Indonesian citizens lacking insurance, almost 74%.  Healthcare funding is largely done on the community level, with federal funding being doled out and the implementation and management of those funds left on the community level.  It has been shown that many of the poorer districts have seen their healthcare grants increase, but have not had the ability to increase services due to the infrastructure.  
	In addition, the majority of the payment mechanisms in Indonesia are fee-for-service, with some capitated payments thrown in.  There are no incentives for providing services towards the MDG goals.  As a result, the recommendation for Indonesian health systems strengthening are two-fold:  An increased federal investment in a social insurance scheme and the development of a pay for performance bonus system for certain services offered.
	Developing a social insurance mandate has occurred somewhat for federal employees, with the employees and employers paying a percentage of the premium.  Continuing to develop a system with a wider reach, much like Thailand developed, should help solve a number of the access issues.  In addition, expanding federal insurance coverage for the poor should help ensure a more equitable distribution of care.  In addition, ensuring that social insurance is available for all employed citizens (with an additional federal or federally subsidized program for the unemployed and indigent) ensures that there is accountability, rather than throwing more money at district governments than they know what to do with.
	In addition, the development of a “bonus” system for providing antenatal and postnatal care should provide an incentive for doctors to continue care for both mother and child.  Perhaps offering bonuses for meeting certain thresholds, such as number of births attended or mean number of visits with children under five years.  This practice can also be extended to other health sector performance issues.
