Background: the results of National Sosio-economic Sun'ey or Susenas conducted in 2000 indicated that there was still significantly high Maternal Mortality Rate (MMR) in East Java province 168.2/100,000 Live Birth (LB), while the National rate for Indonesia was from 347/100,000 LB in 2000 to 307/ 100,000 LB in 2003. Based upon the results from other studies conducted at Dr. Soetomo Hospital in Surabaya, prior to Susenas, in 1976, 1979 and 1980, a Score-Card for problem identification was developed. The Score-Card has 5 functions: 1) problem identification, 2) monitoring during the pregnancy, 3) provide information education and empowering the pregnant women, husbands and their families for a safe delivery, 4) recording and reporting, and 5) data validation. This card was:further simplified, resulting in early detection of 20 risk factors and was used by Family Welfare Movement (PKK) in a field study in 1985 at neighboring sub-district of Sidoarjo to expedite safe pregnancy and delivery referral. Following this study, a scaled up study was conducted for referral of pregnant mothers with identified problem during pregnancy in Probolinggo district(1993). Based upon these studies, a Problem-based Family-based Maternal Health Care System was developed with Planned Referral within the District Comprehensive Integrated Referral System. In 1994 this system was adopted as a part of the Maternal, Child Health Program for the Provincial and District Health Service, and was replicated to 29 districts and 9 municipalities in East Java Province.
Objective: to reduce maternal and neonatal mortality to save mother and the newborns.
Method: monitoring the maternal health care with planned referral system that was conducted in three district: Nganjuk (1997-2000), Probolinggo (1998-2002) and Trenggalek (1998-2002) through collection of the Score-cards from village midwives, Village Health Centers, District Health Centers and Provincial Health Service in these district with total 52,252, 60, 718, and 38,486 cards respectively that represent more than 60% from the annual total number of deliveries. The score-card were finally brought to Safe Motherhood Centre in Dr. Soetomo Hospital for data entry and data analysis.
Result: There was significant decline in MMR in these districts: Nganjukfrom 112.6 to 93.9/
100,000 LB, Probolinggofrom 177.9 to 64,4/ 100,000 LB and Trenggalekfrom 95.2 to 62.,7/ 100,000 LB. There was also decline in IMR as well, in Nganjuk from 8.3 to 5.9/ 1,000 LB, Probolinggofrom 25.7 to 8.9/1,000 LB and 9.4 to 7.1/1,000 LB.