Hambali Hambali

Hambali is developing a community-based system for promoting reproductive health in rural Indonesia by helping villages establish their own clinics staffed by specially trained local women.

Hambali’s self-sustaining model of reproductive health services is a departure from top-down, under-staffed, and often corrupt services provided by the government because it works to staff local midwives in clinics owned and managed by villagers. Under a work contract, health providers agree to meet the service quality standards and tariffs that are determined by the villagers. They are now able to serve more than 60,000 women, men and adolescents across several districts in Jambi. Hambali has shifted the current centralized practices of the health department to a strategy that encourages participation among community members in providing health service. Community health clinics are now legal entities that meet national health service standards, resulting in improved quality of care and reduced costs. The community centers have also pressured the government into building roads and bridges and installing electricity to support their clinics, which has both improved access to care in villages, as well as significantly reduced travel costs. To ensure the efficacy and sustainability of the service, Hambali has created an education program to invest in human resources for the health sector. In addition to the scholarship he established, he has also partnered with national midwifery institutions to incorporate new modules that teach reproductive health from a gender perspective into the existing curriculum. Both the scholarship program and the new curriculum are being piloted in twelve midwifery schools across Java and Sumatra. Currently, there are 160 young girls from six provinces enrolled; twenty-five from Jambi, Riau, and Bengkulu provinces have just graduated and returned to their own villages to start work.

According to national data, the rate of maternal mortality in Indonesia is 307 per 100,000 live births: the highest in South East Asia. While most of the cases are due to complications in pregnancy and child birth, as well as chronic fatigue and a high prevalence of anemia, poverty, gender and cultural biases are the backdrop for which poor reproductive health outcomes play out.

Women, especially in rural areas, have been underserved by existing government-sponsored reproductive health services, which tend to be profit-oriented and based in large cities. At the village level, the health service system is not yet widely available, and people there are served through a few supporting community health centers or a monthly mobile clinic with very limited services. Reproductive health care was also once available through government programs such as village health posts, maternity huts, and midwives, but many of these are no longer available. At the sub-district level, there is at least one community health center that serves approximately 30,000 people and is managed by one doctor. In most cases, the service covers limited areas and populations, oftentimes neglecting remote villages.

Health service providers are the key to improving women’s maternal, reproductive and sexual health, especially in rural areas. However, both the state and local governments have been unable to maintain the deployment of village midwives, and when they are available, the quality of their services and ability to handle emergency obstetric care becomes a concern. Additionally, these midwives are mostly young graduates from urban areas who do not fully understand or appreciate the traditional values rural women follow. As a result, women in these areas tend to still favor using traditional birth attendants during their deliveries.

Rural women also face financial, social and political limitations in improving their reproductive and sexual health. Poverty perpetuates a cycle of low productivity and high infant and maternal mortality, as women cannot afford to pay for health care. Further, other social ills such as domestic abuse and gender discrimination exacerbate these obstacles. In addition, no policy or regulation ensures public funds to improve women’s reproductive and sexual health, and while attempts have been made by other parties to address maternal mortality, they tend to be project-based and do not take into account the social, economic, and political aspects central to improving women’s health.

The first objective of Hambali’s program is to train women to become practicing midwives in their communities. To accomplish this, he created a scholarship that gives local girls selected by his organization the opportunity to attend a midwifery academy and get trained formally. In order to be chosen, the girls must come from disadvantaged backgrounds, and be related to a traditional birth attendant, as to create trust amongst the villagers that these future midwives have inherited important traditional values from their elders.

To institutionalize the training program, Hambali partnered with other citizen organizations and several institutions for midwifery education in twelve provinces. In addition, he integrated new gender perspective reproductive health modules into the midwifery curriculum which touched on topics such as maternal care and women’s rights, reproductive health and counseling, law and professional ethics, women and child abuse, psychology, and management of maternal care. The pilot phase of the program was completed in 2007, and in the near future, Hambali plans to take his program to the Indonesia Midwives Association, which will replicate this new curriculum in all midwifery schools across the country.

Hambali’s second objective involves encouraging rural women to become agents of change by establishing community centers where they manage health care services for their people. He started by conducting a participatory rural appraisal in which women identified their reproductive health needs. From that, he helps communities develop different programs to resolve their concerns. Inevitably, activities expand to address other community problems such as those related to the general health of the village, domestic abuse, and policy change at the district level. These centers are funded by the women themselves through savings and loan activities, as well as co-op initiatives started with the intent of raising revenue to support the clinics. As such, the community centers are financially self-sufficient.

The presence of these community centers inspired neighboring villages to set up their own, and in 2003, thirteen centers were established through women’s alliances across Indonesia, many of which have also become the vehicle for women to advocate for policy changes. For example, the Merangin Women’s Alliance has been able to negotiate with the local government to fund the construction of bridges and roads to open access to rural villages. They also succeeded in getting electricity into the village, and helped raise the selling price of palm oil. These endeavors have helped village women become leaders at the local level, and one of the participating members now serves on the National Commission for Women.

Over fifty-four community centers have spread across provinces in Java and Sumatra, giving thousands of people in rural areas access to health care services they would not have received otherwise. The Women’s Alliances is currently advocating for health funding geared towards the deployment of health providers at the village level to support referral cases, and a health card based on a subsidy system for poor families.



Hambali has set up a sustainable resource based development through which the reproductive health care services and other programs are fueled. He strengthened women’s capacity to identify, mobilize, and generate local resources. He believes that women’s sexual and reproductive health empowerment cannot be separated from women’s sustainable livelihood. The women gain economic incentives, while they can sustain their reproductive health services, as well as strengthen their bargaining position in the family and society for the autonomy over their own bodies. Some community centers have set up women’s co-operatives, while others have invested in hectares of palm oil plantations. One of the many successful instances is the Sehat Mandiri Community Center. They developed a savings and loans fund and run productive activities with assets now valued at Rs.500M. Another instance is the Keluarga Harmoni Community Center in Tangkit Baru village, Muara Jambi District with a Patin fish cultivation centre well-known nationwide as the biggest in the country. Through the savings and loans activities, the members of the co-op have services in health savings and loans, health support fund, and access to capital for income generating activities. Moreover, they are able to pay half of the cost to construct the health clinic office. The health clinic manages its revenue, and is now financially self-sufficient. The District governments of Aceh Besar, Aceh Utara and Aceh Timur are replicating the model to improve the service quality of the Puskesmas /Puskesmas Pembantu.

Hambali is of Central Javanese origin but was born and raised in Perbaungan, North Sumatra. As a child he developed a keen interest in science and eventually majored in biology at the Education Science and Teaching Institute in Bandung. After finishing university in 1984, Hambali became a teacher in Perbaungan.

In 1986, Hambali volunteered at the Indonesia Family Planning Association (PKBI) of the North Sumatra Branch, and became very concerned about the high incidence of adolescent pregnancies. During that time, he found there was very limited information available for young people, since talking about reproductive and sexual health is considered taboo. To help deconstruct this barrier, he took on an approach of discussing the ways in which Islam espouses reproductive health, and was ultimately successful in bringing about meaningful change.

After moving to Jambi in 1996, Hambali took a position as the executive program director of the PKBI Jambi, and in 1997, he started the reproductive health program in rural areas by recruiting and training young volunteers to support his initiatives.

As he sent volunteers to live with and learn from villagers, he became increasingly aware of the many problems plaguing the government’s family planning program. Problems with reproductive health during pregnancy and adolescence were among the most common found among villagers, and with the support of the Ford Foundation he began establishing community centers as a means of giving a voice to rural communities.

In 2005, Hambali began working full-time on his reproductive health project, establishing his own organization, Mitra Aksi, to develop community-based health management. Following the success of the village midwife program, Hambali now hopes to create a scholarship scheme to support the education of village doctors.