Evaluating The Telemedicine Kotak Dokter Implementation for High-Risk Pregnant Women in Rural Maternal Care in Garut District, Indonesia
Ana Mariana, Alamsyah Azis, Achmad Kemal Harzif, Victor Santawi, Nadeem Kasmani, Byron Good

1. Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Jenderal Achmad Yani, Cimahi, Indonesia

2. Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, RSCM – FKUI, Indonesia

3. Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Padjajaran, RSHS – FK UNPAD, Indonesia

4. Department of Global Health and Social Medicine, Harvard Medical School

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Objectives

• To explore the experiences and challenges faced by high-risk pregnant women in accessing rural maternal health services in Garut District, Indonesia.

• To assess the satisfaction and acceptability of the Kotak Dokter telemedicine trial among patients and providers.

• To identify key barriers and facilitators in the implementation of Kotak Dokter in rural maternal care.

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Introduction
High-risk pregnancies—particularly among women <20 or >35 years, with short birth intervals or medical complications—significantly contribute to maternal and neonatal morbidity and mortality. These risks are amplified in rural and low-resource settings due to limited access to antenatal care. The COVID-19 pandemic further disrupted maternal health services globally. Over half of countries reported interruptions in facility-based maternal care, contributing to rising mortality. In Indonesia, maternal deaths increased from 4,627 in 2020 to 7,389 in 2021, with nearly 3,000 related to COVID-19. West Java and Garut District also experienced significant increases, largely due to complications in high-risk pregnancies. To address access gaps, the World Health Organization promotes telemedicine as a solution. Kotak Dokter is a telehealth initiative enabling online consultations between rural midwives and physicians. This study explores the implementation of Kotak Dokter in rural Garut District, Indonesia, focusing on its use especially for high-risk pregnant women.

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Methods
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Results
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Conclusions

• Telemedicine through Kotak Dokter provided significant benefits for high-risk pregnant women in rural areas, despite implementation challenges.

• Providers reported changes in clinical care following teleconsultations, and both patients and providers expressed high satisfaction with Kotak Dokter implementation.

• Several barriers to implementation were identified, including challenges related to patients, healthcare providers, technology, and health systems.