Sustaining maternal and child health programs when donor funding ends: A case study of stakeholder involvement in Indonesia

There has been a dearth of evidence in exploring the role of stakeholders in making the transition process from donor to local responsibility successful in relation to maternal and child health programs to date. This study aimed to generate practical experiences concerning stakeholder involvement in sustaining maternal and child health programs when donor support ends, so as to lead systematic strategies for supporting the success of the post-transition process and capture critical challenges of the programme's sustainability. This study employed Focus Group Discussion (FGD) with district healthcare stakeholders such as hospital managers, district health officers, community health centres, community associations and local authorities. In-depth interviews one to one with the local authority, health staff, informal leaders, and traditional birth attendants were conducted. From the final research project sample of participants, we extracted the interviews to analyse their narratives. Content analysis revealed 5 main themes from the FGDs and interviews: (1) Stakeholders' collaborative culture and organisational capacity; (2) Stakeholders' commitment; (3) Challenges in partnership and coordination; (4) Barriers to sustainable local financial support (5) Policy for maintaining institutionalisation. Two areas of concern were the priorities for follow-up to sustain the maternal and neonatal care programme and factors responsible for the continuation when donor funding ends, specifically longevity of stakeholder engagement and commitment and internal resource capacity for long-term implementation. Recommendations include increased networking of active cooperation from all levels of administration, especially with a top-down approach involving the national, provincial, down to the district and community-based networks.