Learning & Innovating in Complex Situations: Maternal and Newborn Health in Indonesia

Indonesia faces stubbornly high levels of maternal and newborn mortality. Recognizing that traditional approaches were yielding decreasing returns, USAID/Indonesia designed the Jalin activity to co-create and test a limited number of innovations to improve maternal and newborn health (MNH) outcomes. Because of the dynamic socio-economic factors that influence MNH, USAID paired Jalin with a developmental evaluation, a type of evaluation designed to work with complex challenges and unpredictability.

The developmental evaluation used stakeholder feedback to strengthen external collaboration and inform decisions by USAID, the Ministry of Health (MOH), and Jalin about which MNH innovations to test and then later which to replicate and scale. The developmental evaluation's ability to provide real time input from over 350 subnational stakeholders in six provinces proved crucial in determining which innovations had the local ownership and uptake necessary to leverage change at scale. As a result, 72 potential solutions were narrowed down to eight innovations with demonstrated causal pathways to reduce mortality, which the MOH and its partners are now replicating and scaling nationally.

Enhanced external collaboration broadened USAID/Indonesia’s relationships, while stakeholder involvement in decision-making focused the process on where assistance would be most effective. This approach required being honest about which innovations were working and which were not and conveying a message that it was acceptable for innovations to fail.