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Sarah Widya Astuti; Shifa Nurria; Mukhlisin Nata Hudin; Syarifuddin Syarifuddin; Rani Oktapiani

This study aims to examine in depth Problem Based Learning (PBL) as a highly relevant solution for history learning in the 21st century. In the ever-evolving landscape of digital education, history learning is increasingly required to adopt innovative approaches in order to effectively improve student engagement and conceptual understanding. To achieve this goal, this study relies entirely on a systematic literature review method. This article carefully outlines the basic concepts of Problem Based Learning (PBL) from various theoretical and practical perspectives found in scientific literature. Furthermore, it specifically highlights the strong relevance of PBL to the essential characteristics of 21st century history learning, which emphasizes not only mastery of facts but also the development of critical thinking, collaboration skills, and problem-solving abilities. Based on an extensive analysis of various publications, the results of PBL implementation in the context of existing history learning are also discussed, showing the significant potential of this method in developing students' analytical and interpretive abilities. However, the literature review also identified that the implementation of PBL still faces a number of challenges that need to be overcome. In response to these findings, a comprehensive strategy is proposed, based on best practices and recommendations from previous research, to address these challenges.

Azizatun Fitriani; Arga Christian Sitohang

This study aims to analyze the influence of economic growth, population, and education on poverty in Sidoarjo Regency during the period 2014–2023, motivated by the persistently high poverty rate despite the region experiencing rapid economic growth and industrial development. Using secondary data from BPS and analyzed quantitatively through multiple linear regression with the assistance of SPSS, this study found that the three variables simultaneously have a significant effect on poverty, while partially, education is the most effective factor in reducing poverty compared to economic growth and population, which have a negative but not significant effect. These findings highlight the importance of equitable distribution and improvement in the quality of education as a primary strategy for poverty alleviation, as well as the need for more inclusive economic policies. Further research is recommended to include other variables such as income inequality, unemployment, and the quality of infrastructure to make the analysis of poverty determinants more comprehensive

Devianto, Yudo; Saragih, Rusmin; Cahyana, Yana

Journal of Information Technology and Computer Science 2026 International Forum of Researchers and Lecturers

This research benchmarks multiple machine learning (ML) algorithms for large-scale loan default prediction using a real-world dataset of 255,000 borrower records, where default cases represent only ~9–12% of total observations. The study addresses the persistent gap in comparative analyses of ML models that balance predictive accuracy, interpretability, and computational efficiency for credit risk assessment. Six algorithmic families were evaluated Logistic Regression, Random Forest, XGBoost, LightGBM, CatBoost, Artificial Neural Networks (ANN), and Stacked Ensemble—using standardized preprocessing, hybrid imbalance handling (SMOTE, class weighting, under-sampling), and comprehensive evaluation metrics (AUC, F1, Recall, Precision, PR-AUC, and Brier Score). Empirical results show Logistic Regression achieved the highest AUC of 0.732, outperforming nonlinear models under the baseline configuration, while LightGBM attained perfect recall (1.0) but low precision (0.116), indicating over-prediction of defaults. Gradient boosting models demonstrated robust calibration (Brier ≈ 0.114–0.116) and the best computational efficiency, with LightGBM showing the fastest training and lowest memory use. CatBoost exhibited strong recall but the slowest computation, and ANN underperformed on tabular data (AUC ≈ 0.56). The Stacked Ensemble delivered balanced results with AUC = 0.664 and improved overall stability. These findings confirm that boosting-based models, particularly LightGBM and CatBoost, offer superior scalability and calibration, whereas Logistic Regression remains a valuable interpretable baseline. The study concludes that effective default prediction requires integrating rebalancing, calibration, and threshold optimization to enhance recall and operational deployment reliability in large-scale credit ecosystems.

Novi Aisha

Ebisnis Manajemen 2026 Fakultas Ekonomi & Bisnis, Universitas Nusa Nipa

Micro, Small, and Medium Enterprises (MSMEs) are highly vulnerable to a wide range of business risks that may threaten their operational continuity and long-term sustainability. These risks include financial instability, market fluctuations, supply chain disruptions, regulatory changes, and limited managerial capacity. This study aims to describe the implementation of risk management practices in MSMEs by examining the processes of risk identification, analysis, evaluation, and control in accordance with the specific characteristics and limitations of MSME operations. The research applies a qualitative method using a document study approach to explore and analyze the phenomenon of risk management within MSMEs. The data utilized consist of secondary sources, including scholarly journal articles, previous empirical research findings, official publications from relevant institutions, government reports, and other publicly accessible documents related to MSME development. The findings reveal that although MSME actors generally recognize the existence of various business risks, the practical implementation of structured and systematic risk management remains suboptimal. Many MSMEs still apply informal, reactive, and experience-based strategies rather than comprehensive risk management frameworks, indicating the need for improved awareness, training, and institutional support.

Ilma Aulia; Makhdalena

Jurnal Praba : Jurnal Rumpun Kesehatan Umum 2026 STIKES Columbia Asia Medan

Pharmaceutical services initially focusing solely on drug management (Drug Oriented) to comprehensive services that include clinical pharmacy services and medication services aimed at improving patients' quality of life (Patient Oriented). Clinical pharmacy services in pharmacies are part of pharmaceutical services that are directly responsible to patients in relation to pharmaceutical preparations, medical devices, and disposable medical supplies. This study aims to determine the implementation of clinical pharmacy services in pharmacies in the Gedong Tataan District of Pesawaran Regency. The research approach used was quantitative descriptive with a simple random sampling technique. The sample in this study consisted of 16 pharmacies and pharmacy staff working in pharmacies in the Gedong Tataan District, Pesawaran Regency, who met the inclusion and exclusion criteria. Data collection was carried out by conducting with guided interviews using questionnaires and observation on the implementation of clinical pharmacy services by pharmacy staff. The results showed that the clinical pharmacy services implemented in pharmacies in Gedong Tataan District, Pesawaran Regency, were prescription assessment and services by 74% with a good category (61-80%), dispensing by 95% with a very good category (81-100%), and drug information services (PIO) obtained a percentage of 72% with a good category (61-80%). Clinical pharmacy services were mostly carried out by Pharmacy Vocational Personnel (TVF) at 37.5%. Clinical pharmacy services in pharmacies throughout the Gedong Tataan District of Pesawaran Regency have not been fully implemented in accordance with the standards of pharmaceutical services in pharmacies according to Permenkes No. 73 of 2016, as there are still several aspects that have not been carried out.

Diony, Diony Ahlul Fikri; Huda, Asri Nurul; Mashudi, Mashudi; Susilawati, Trinil; Susilawati, Trinil +2 more

JAPSI (Journal of Agriprecision and Social Impact) 2026 CV. Komunitas Dunia Peternakan

Small-scale beef cattle farming systems play an important role in rural livelihoods in developing countries. However, comprehensive analysis that integrates the socioeconomic characteristics of farmers with resource utilization patterns is still limited. This study aims to evaluate the socio-economic characteristics of farmers and resource utilization patterns in the beef cattle business in Dolokgede Village, Tambakrejo District, Bojonegoro Regency. Based on the results of the evaluation, it can determine and identify the potential for the development of livestock businesses and in this region. Quantitative descriptive research was carried out using a direct survey method on farmers through questionnaires and environmental analysis. The sample was determined by the Slovin formula with an error rate of 10%, resulting in 29 respondents who were selected by simple random sampling. Data were collected through structured interviews and analyzed using descriptive statistics. Farmers are dominated by the productive age of 31-60 years (72.41%) with the majority of elementary education (75.86%). The selection of 2-5 cattle dominates (65.52%) with the Peranakan Ongole type. The use of feed is integrated with the agricultural system through rice straw (96.55%) and corn waste (93.10%). Feed costs account for more than 60% of the total cost of production, but the R/C ratio shows a value above 1, indicating the economic viability of the business. The beef cattle business in Dolokgede Village has the potential for development through stronger plant-livestock integration, improved feed technology, and institutional support for market access and financing.

Yuliana, Fitri; Wulandari, Septi; Rupiarsieh

Jurnal Riset sosial humaniora, dan Pendidikan (Soshumdik) 2026 LPPM Universitas 17 Agustus 1945 Semarang

This study aims to describe the form of multi-stakeholder collaboration in the management of the Bojonegoro Geopark using the Pentahelix approach. This study employed a qualitative method with data collected through interviews, observations, and documentation, while informants were selected purposively to represent the government, academia, business actors, community groups, and media. The findings indicate that although the five helixes are involved, their roles have not yet been integrated into a systematic collaborative framework. The government contributes through infrastructure provision and regulatory support but lacks a coordinating institution dedicated to geopark management. Academics provide research input, yet it has not formed a comprehensive basis for geosite interpretation. Business actors grow predominantly in recreational destinations, while community groups play essential operational roles but with uneven capacities. The media participates in promoting activities, although it has not succeeded in building a consistent geopark identity. Overall, this study concludes that weak inter-helix integration remains the primary challenge in developing the Bojonegoro Geopark. Therefore, strengthening institutional coordination, improving community capacity, and establishing an integrated communication strategy are essential for achieving sustainable geopark governance.

Aviva Radja Najwa Amatullah; Rizky Aulia Sabrina Putri; Zulfayani; Rizya Amelia; Laeli Khusnaeni +1 more

Jurnal Riset sosial humaniora, dan Pendidikan (Soshumdik) 2026 LPPM Universitas 17 Agustus 1945 Semarang

This study aims to analyze the dynamics of the lives of indigenous Papuan communities and transmigrants, particularly in the social and economic context of Sota Village, Merauke Regency, South Papua. The study uses a qualitative approach with semi-structured interviews, documentation, and focus group discussions (FGDs). This study involved various parties to obtain a comprehensive view of the social interaction between indigenous peoples and transmigrants. Data were obtained through interviews with leaders and indigenous peoples of Sota Village. The results of the study show that the social relationship between indigenous peoples and transmigrants is harmonious, characterized by cooperation in social activities, mutual assistance, and joint economic development. The presence of transmigrants has had a positive impact on improving welfare, equalizing infrastructure, and introducing modern agricultural techniques to indigenous peoples. On the other hand, local wisdom such as Adat Sasi also plays a role in maintaining social harmony and ecological balance, while the traditional deliberation mechanism serves as a means of peaceful conflict resolution. Indigenous communities show openness to change but remain critical of the sustainability of the transmigration program due to land limitations. Overall, this study concludes that multicultural life in Sota reflects the success of social integration based on the values of tolerance, mutual respect, and cooperation in building a peaceful and sustainable society.

Robertus Imanuel; Maswadi; Wanti Fitrianti

Jurnal Riset Rumpun Ilmu Tanaman 2026 Pusat riset dan Inovasi Nasional

Oil palm plantations are often confronted with the problem of uncontrolled land expansion and suboptimal management, which potentially threaten the sustainability of the business from environmental, social, and economic perspectives for surrounding communities. This condition calls for a comprehensive evaluation of management practices implemented by independent smallholders. This study aims to determine the sustainability status of smallholder oil palm plantations in Parindu Subdistrict, Sanggau Regency, assessed from five main dimensions: ecological, economic, social, institutional, and technological. In addition, the study analyzes attributes that have sensitivity levels affecting the future sustainability of oil palm farming as a basis for formulating improvement strategies. A total of 36 respondents were selected using purposive sampling techniques and in-depth interviews. The research method employed was quantitative descriptive using the Rap-Palmoil approach and qualitative descriptive supported by kite diagrams to clarify the analysis results. The findings indicate that the management status of oil palm plantations falls into the moderately sustainable category, with MDS values of 53.61 for Embala Village and 55.75 for Maju Karya Village. The dimensions that require priority improvement in both villages are the ecological and technological dimensions.

Sonya Antika; Amelia Putri; Risma Anita Puriani

RISOMA : Jurnal Riset Sosial Humaniora dan Pendidikan 2026 Asosiasi Ilmuwan Pendidikan, Sosial, dan Humaniora Indonesia

Indiscipline in learning behavior is a form of problematic behavior that is commonly found in the school environment and has the potential to hinder the effectiveness of the learning process. This issue does not arise suddenly; rather, it develops gradually through processes influenced by various factors. This article aims to examine the problem of indiscipline in learning through a review and analysis of relevant research findings. The study uses a literature review method by collecting, examining, and analyzing journals and scientific references that discuss learning discipline and students’ indisciplined behavior. The results indicate that indiscipline in learning activities is influenced by both internal and external factors. Internal factors include low interest and motivation, poor study habits, weak values and morals, as well as students’ physical and psychological conditions. Meanwhile, external factors include family situations, peer influence, the school environment, the use of technology, and inconsistent enforcement of rules. The observable behaviors include arriving late, skipping school without clear reasons, violating school regulations, and showing a lack of responsibility. Therefore, addressing the problem of indiscipline in learning requires a comprehensive and sustainable approach involving both schools and families.

Fatimah Fazkiiyah; Luqman Effendi

Jurnal Siti Rufaidah 2026 PPNI UNIMMAN

Adolescence is a crucial transition phase from childhood to adulthood, characterized by significant development of the reproductive system and psychosocial changes. In this phase, adolescents are prone to deviant behavior, including premarital sexual behavior, especially if environmental factors and self-control are not properly managed. This study aims to identify the picture of premarital sexual behavior in adolescents through a case study at Pattimura High School Jakarta. The research method uses a quantitative approach with random sampling techniques based on Lemenshow calculations. Data analysis was carried out descriptively to obtain an overview of respondents' behavior. The results showed that there were 22 students (32.35%) who had risky premarital sexual behavior. These findings indicate an urgent need for comprehensive interventions. Preventive efforts can be carried out through reproductive health education, strengthening moral values, and improving communication between parents and children. Meanwhile, repressive efforts are needed to enforce school rules and provide educational sanctions. This research emphasizes the importance of collaboration between schools, families, and communities in tackling adolescents' premarital sexual behavior, so as to minimize risks that have an impact on their physical, psychological, and social health.  

Rindi Rama Saputra; Deni Erlansyah

Nusantara: Jurnal Pengabdian kepada Masyarakat 2026 Pusat Riset dan Inovasi Nasional

This community service activity aims to design a prototype of a web-based Intellectual Property Rights (IPR) registration information system at the South Sumatra Provincial Industry Office as an effort to support the improvement of public service quality. The main problem faced by partners is the manual registration and management process for IPR data, which has the potential to cause service delays, data recording errors, and difficulties in monitoring the status of IPR applications. This condition requires an information technology-based solution that can improve the efficiency, effectiveness, and transparency of services. The method used in this community service activity is the prototype method, which includes the stages of problem identification, user needs analysis, system design, and initial evaluation of the resulting prototype. The designed information system prototype includes features for online IPR registration, applicant and document data management, and application status monitoring. The results of the activity indicate that the IPR registration information system prototype is able to provide an overview of digital solutions that are in accordance with partner needs and have the potential to improve service efficiency and ease of data management. This activity is expected to become the basis for the development of a more comprehensive and sustainable IPR information system within the South Sumatra Provincial Industry Office.

Ibnu Khayath Farisanu; Indri Farradina; Achmad Aprianor Firdaus; Muhammad Akbar; Achmad Syahruddin +2 more

Kegiatan Positif : Jurnal Hasil Karya Pengabdian Masyarakat 2026 Asosiasi Riset Ilmu Manajemen Kewirausahaan dan Bisnis Indonesia

Stunting is a complex public health problem that requires a multisectoral approach in its management. This community service aims to increase the capacity of village officials and Village Consultative Body (BPD) in handling stunting through the strategic role of management higher education institutions. The method used is a participatory approach involving 18 participants consisting of village officials and BPD members. The activities were carried out through stages of needs analysis, stunting program management training, action plan development assistance, and monitoring evaluation. The results showed a significant increase in participants' understanding of stunting program management (from 45% to 85%), the formation of a stunting management working team at the village level, and the preparation of a comprehensive stunting management action plan. The social change that has been realized is increased cross-sectoral coordination in handling stunting and the formation of a data-based monitoring system at the village level. Management higher education institutions play a strategic role in building the managerial capacity of village officials to manage stunting programs effectively and sustainably.

Putri, Ni Komang Puspita Nadine Parisya

jurnal Riset Rumpun Agama dan Filsafat 2026 Pusat Riset dan Inovasi Nasional

This study explores emotional instability and its impact on happiness, focusing on Positive Psychology, Neurobiology, and Stoicism. It aims to identify factors influencing instability of happiness, including stress, social support, and neurobiological dynamics. The research seeks to develop effective strategies to enhance emotional stability and long-term well-being, contributing to theories and practices for fostering enduring happiness in individuals and society. This study employs a qualitative approach, combining in-depth interviews and document analysis to explore emotional instability and strategies for lasting happiness. Nine participants from psychology, neurobiology, and Stoicism fields share personal experiences through narrative analysis, identifying patterns in happiness fluctuations. A comprehensive literature review enhances findings, ensuring validity, credibility, and a holistic understanding of factors influencing emotional well-being.Research reveals happiness is multifaceted, influenced by psychology, neurobiology, and philosophy. Factors like stress, personality, and social support impact emotional stability. Positive psychology emphasizes gratitude, mindfulness, and cognitive restructuring. Stoicism focuses on self-control, acceptance, and living virtuously. Neurobiology highlights the role of brain chemistry and lifestyle factors like diet and exercise. By integrating these perspectives, individuals can cultivate resilience, manage emotions, and enhance overall well-being.This research examines emotional instability and its impact on happiness, combining insights from Positive Psychology, Neurobiology, and Stoicism. Key factors include stress, neurochemical imbalances, and social support. Strategies such as emotional regulation, mindfulness, and resilience-building enhance stability. The study highlights the integration of ancient wisdom and modern science to foster enduring happiness and improve overall well-being.

Gita Maria Rehulina Sembiring; Adri Sadewa Sirait; Roy Nanda Kesuma; Winda Windari Tarigan; Cherin Yorenta Tarigan +1 more

Discourse on Law and Society 2026 International Forum of Researchers and Lecturers

The advancement of information technology has rapidly transformed trading patterns in Indonesia, shifting from conventional transactions to online transactions through marketplace platforms. On one hand, this transformation provides convenience and efficiency for both businesses and consumers. On the other hand, it has also given rise to various legal issues, particularly regarding consumer protection. This article aims to examine how legal protection for consumers is implemented in electronic sales agreements on marketplaces, while also identifying the obstacles encountered during its implementation. The study employs a normative juridical approach, using conceptual analysis and legislative review, supplemented by empirical data obtained from interviews. As described, legal protection for consumers in electronic transactions in Indonesia remains suboptimal. Specifically, these challenges include biased law enforcement, low levels of consumer literacy, and ineffective dispute resolution mechanisms. In practice, marketplaces have incorporated consumer protection features such as escrow systems, refund mechanisms, and complaint centers; however, their implementation still suffers from limited transparency and effectiveness. Furthermore, existing regulations are slow to respond to the dynamics of cross-border transactions and ongoing digital innovations. Therefore, comprehensive regulatory reform, stronger enforcement, and enhanced legal and digital literacy among the public are necessary to ensure effective consumer protection.

Asna Safitri; Noviana Zara

Jurnal Inovasi Riset Ilmu Kesehatan 2026 Pusat Riset dan Inovasi Nasional

Herpes zoster is a skin infection caused by the reactivation of the varicella-zoster virus, characterized by unilateral skin lesions corresponding to dermatome distribution and complaints of pain or itching. This disease is more common in adults and the elderly, especially in individuals with reduced immunity due to stress or work overload. A case was reported of a 40-year-old woman who worked as a nurse and came to a primary health care facility complaining of itching and red spots on her right breast area that had spread to the surrounding area two weeks before the examination and had worsened in the last few days. Physical examination revealed unilateral red skin lesions in a dermatomal pattern without crossing the midline of the body, consistent with the early phase of herpes zoster. Management was comprehensive, including medication, patient education about the disease and skin care, prevention of complications, and family support. A holistic approach is necessary to improve the success of therapy and the patient's quality of life.

Wirya Musyafiil Qulub; Nurlathifah Thulfitrah B

Jurnal Pendidikan Dirgantara 2026 Asosiasi Riset Ilmu Pendidikan Indonesia

This study aims to evaluate the Quran Tahfidz program at Bahrul Hikmah Islamic Junior High School using the Context, Input, Process, and Product (CIPP) evaluation model introduced by Stufflebeam. The findings of the research are as follows: First, the evaluation of the context aspect indicates that the program objectives have been comprehensively formulated. Data analysis confirms that the program implementation is well-aligned with the established goals, placing it in the 'good' category. Second, the evaluation of the input component reveals that the managerial competence of the administrators and the pedagogical capabilities of the educators have met the expected standards. Nevertheless, the infrastructure aspects require further optimization to foster a more conducive learning environment for students. Third, regarding the process aspect, the program implementation has generally achieved the targeted outcomes. However, observations identified obstacles predominantly stemming from students' internal factors; this implies the crucial role of teachers in integrating motivational stimuli as a preventive measure against declining learning enthusiasm. Fourth, the product evaluation shows that the daily memorization targets are generally achieved, although some students require remedial sessions. Ultimately, students are capable of completing the memorization of three juz within the three-year period.

Ketut Yuliani Wijaya; Rokiah Kusumapradja; Muhammad Fachruddin Arrozi

International Journal of Management Science and Entrepreneurship 2026 International Forum of Researchers and Lecturers

Patient experience reflects patient’s comprehensive perceptions of service quality, the physical environment, and communication with healthcare providers. This study was motivated by the need to foster positive patient experience in the Pharmacy Installation of Graha Sehat Hospital, Probolinggo through improvements in service quality, servicescape, and effective communication. The objective of this research was to analyze the effects of service quality and servicescape on patient experience, with effective communication serving as an intervening variable. A quantitative approach was employed using Structural Equation Modeling (SEM) with AMOS. A total of 180 outpatient pharmacy patients were selected through voluntary sampling, with the sample size determined based on Hair’s method. The findings indicate that service quality, servicescape, and effective communication simultaneously exert a positive and significant effect on patient experience. Partially, service quality has a positive and significant effect on patient experience, while servicescape does not have a direct significant effect on patient experience. Effective communication, however, demonstrates a positive and significant influence on patient experience. Furthermore, effective communication significantly mediates the relationship between servicescape and patient experience, but it does not mediate the relationship between service quality and patient experience. The managerial implications for hospital management highlight the need to strengthen service quality improvement strategies, optimize spatial layout and environmental comfort in the pharmacy setting, and establish concise communication standards that include essential medication counseling points. Such measures are necessary to ensure that communication quality remains consistent, even during peak patient volume periods with limited-service time.

Desi heriyana; Musni Musni

Jurnal Siti Rufaidah 2026 PPNI UNIMMAN

Background: Suboptimal breast milk production during the postpartum period remains a major barrier to successful exclusive breastfeeding. Various non-pharmacological interventions have been developed to address this issue, including oxytocin massage, which is believed to stimulate the release of the oxytocin hormone and facilitate milk ejection. However, findings regarding its effectiveness remain varied, highlighting the need for a comprehensive synthesis of scientific evidence. Objective: This study aims to review and synthesize evidence on the effectiveness of oxytocin massage in increasing breast milk production among postpartum mothers. Methods: A literature review with a narrative review approach was conducted using articles from Google Scholar, PubMed, and Garuda databases published between 2021 and 2025. Keywords included oxytocin massage, breast milk production, and postpartum mothers. Inclusion criteria were original research articles involving postpartum mothers receiving oxytocin massage interventions with full-text access. Article selection followed the PRISMA flow, resulting in 12 eligible studies analyzed narratively. Results: Most studies reported that oxytocin massage improves breast milk production and milk flow, indicated by increased milk volume, improved let-down reflex, higher breastfeeding frequency, and adequate infant intake. The effect is associated with parasympathetic stimulation that promotes oxytocin release and maternal relaxation. Conclusion: Oxytocin massage is a safe and practical complementary intervention to support breast milk production, although further studies with stronger experimental designs are needed.

Ataniya Nazmu Naeda; Hafsah Habib Shodiq; Surni’ah Surni’ah

Jurnal Siti Rufaidah 2026 PPNI UNIMMAN

Maternal mortality remains a major global health concern and an important indicator of health system performance. The World Health Organization reported in 2023 that approximately 290,000 maternal deaths occurred worldwide, highlighting persistent challenges in maternal health services. In the ASEAN region, the maternal mortality rate in 2023 was recorded at 16.85 per 1,000 live births. In Indonesia, the Maternal Mortality Rate in 2023 reached 189 per 100,000 live births according to the Ministry of Health of the Republic of Indonesia. Significant progress has been observed in Central Java Province, where the rate decreased from the United Nations Sustainable Development Goals target of 226 per 100,000 live births to 88.11 per 100,000 live births in 2023. At the district level, Brebes Regency recorded 54 cases per 100,000 live births in 2023 and reported 54 maternal deaths in 2024. Meanwhile, the Kaliwadas Community Health Center reported no maternal deaths during 2023 and 2024, indicating relatively effective maternal health services at the local level.