Impact of the sister hospital program on maternal mortality and neonatal mortality in Nusa Tenggara Timur Province, Indonesia

The province of Nusa Tenggara Timur (NTT) in the eastern part of Indonesia is known for high maternal mortality ratios (MMRs) and neonatal mortality eates (NMRs). Sister Hospital is a multicenter program, which aims to lower MMRs and NMRs in the deprived areas of Indonesia by providing comprehensive emergency services for maternal and newborn care. In this study, we evaluated the impact of the Sister Hospital program on MMRs and NMRs in 2009–17. We used linear mixed-effects models to analyze the program’s effects. Study results suggested that in general, the Sister Hospital program reduced MMRs by 1.14/100 000 live births after adjusting for other sociodemographic factors. This study also found that the program effects varied by island, and the highest reduction in MMRs, were found on Sumba Island in which the log of MMRs decreased from 2.23 in 2009 to 2.01 in 2017. However, no effects on NMR outcomes by the program were found. These findings suggest that the Sister Hospital program can be a practical solution for lowering MMRs in rural Indonesia.