To form coordinated data-driven maternal and newborn care and nutrition by FHW teams through active use of routine client data on OpenSRP mobile information systems to ensure complete coverage and continuity of care in 6 districts across Indonesia covering a population of 5 million persons, within 3 years.

The Adaptive Network for Care at Scale (ANCS) programme addresses the context in Indonesia, a nation with 262 million inhabitants undergoing rapid transitions related to urbanisation and health governance decentralisation across 514 districts. Current health gains across the country are uneven, with major gaps such as stagnant maternal mortality and minimal change in neonatal mortality.

The innovation is to create district-level systems that optimise synergy between existing resources and policies by creating a dynamic network that links practice and data to adapt to the needs of each client, region and time period. A core resource is frontline health workers (FHWs) in each primary health centre (PUSKESMAS) that includes midwives, vaccinators, nutritionists and community health workers (CHWs).

Their client data is recorded on paper-form registers, which precludes data-driven supervision and prevents assessment of FHW task completeness and quality for individual clients, hampers use of data on a frequent basis and limits data-driven action.

A second resource is the universal healthcare system called Jaminan Kesehatan National (JKN)-BPJS, introduced in 2014 and covering 203 million people. The system has improved health equity and service access but with gaps for enrolees in wealth quartiles 2 and 3 and in overall low coverage for maternal and newborn care. It has created a pathway for insurance payments to midwives for antenatal care (ANC) and postnatal care (PNC), but challenges in claim processing and a lack of needed service authentication limit its impact.

• Our goal is for governments at all levels to show improved use of integrated digital health information systems (for example, the Open Smart Register Platform (OpenSRP)) and active use of data for monitoring and action to enhance the health of pregnant women and newborns.

• Coordinated teams of FHWs will be established and supported with OpenSRP to have better coordination to jointly complete care plans for ANC, delivery, PNC, nutrition counselling, immunisation, micronutrient supplementation, Covid-19 screening and vaccination, and for newborn and infant tracking for Covid-19, and breastfeeding, according to the new government schedule, as part of a digital health service ecosystem.

• In January 2022, in OpenSRP active districts, FHWs and programme implementers will be provided with continuous training with digital and other job aids to provide better integrated services to improve training and performance.

• In January 2023, in OpenSRP active districts, FHW and support teams are formed who can provide ANCS networked care delivery.

• The innovation is available to provide performance-based assessment and to facilitate data-driven recognition and compensation of health workers.

• Continuously approach and engage government, at least twice a year, and involve the government in the ANCS programme so they have the commitment and capacity to use the innovations for care enhancement and decision-making.