Related News:

Emerging issues related to gender and community health workers
27 March 2017

Women in the changing world of community health work
17 March 2017

What does trust have to do with Community Health Workers and the Sustainable Development Goals?
06 March 2017

Community health workers – optimizing the benefits of their position between communities and the health sector
23 February 2017

Achieving Equity: Women at the interface of community health systems
15 February 2017

REACHOUT at the Kampala Community Health Worker conference
11 February 2017

Online discussion on community health workers: Join in
04 January 2017

Community health workers: great potential for resilient and responsive health systems
28 November 2016

Indigenous knowledge and intersectionality: “Incremental radicalism” and front line health workers
23 November 2016

REACHOUT at the 2016 Global Symposium on Health Systems Research
23 August 2016

Exploring lessons learnt from Close-to-Community Health Worker Programmes: A symposium
20 June 2016

How equitable are Community Health Worker programmes?
31 May 2016

Working with what we’ve got – an(other) reflection on human resources for health
16 February 2016

Webinar: Community health workers - the gender agenda #HSGGENDER
08 February 2016

Panel on community health workers at the Prince Mahidol Award Conference
07 January 2016

Putting the politics into international public health
05 January 2016

Quality improvement cycles to strengthen close-to-community services: REACHOUT reflections
10 December 2015

A learning agenda and “NICE guys”: reflections on capacity
16 November 2015

Close-to-community providers and community action to address maternal health in Cianjur, Indonesia
09 November 2015

REACHOUT at the Canadian Conference on Global Health
03 November 2015

Alignment, engagement and collaboration: approaches to ensuring Quality Improvement is embedded
02 November 2015

REACHOUT holds Consortium meeting in Indonesia
26 October 2015

Why we use a group supervision approach in REACHOUT
22 September 2015

Global Strategy on Human Resources for Health: How can it support close-to-community providers?
10 September 2015

Kartini and women’s lives
11 May 2015

REACHOUT quality improvement cycle in Indonesia: Our work in pictures
09 April 2015

A REACHOUT update from Indonesia
04 December 2014

REACHOUT honourable mention in photo competition
20 October 2014

Close-to-community providers and maternal health in Indonesia
30 May 2014

Related Resources:

Find more resources relating to Indonesia

Indonesia: current situation

In 2001 Indonesia decentralised the health system, emphasising self-reliance and empowerment in community health with a focus on maternal and child health in rural areas. Midwives are the main close-to-community providers in Indonesia. They are involved with multiple health care tasks as well as obstetric work and work in village clinics (‘polindes) or in community health centres, where they also provide outreach care and home births.

Midwives and other close-to-community providers, such as family planning volunteers and traditional birth attendants, also run integrated health posts (‘posyandu’) at which the promotion of family planning, antenatal care, and point-of care-testing may be done; along with growth monitoring, health education, nutrition support, and immunisation. The deployment of midwives in the community has seen progress in maternal health indicators, yet Indonesia continues to lag behind other countries in the region with similar gross domestic product per capita. Further action is needed to attain the objectives of Millennium Development Goal 5 (MDG5) and the Indonesian strategic health plan.

 

Indonesia: health systems priorities and baseline knowledge gaps

Maternal and child health is a major health priority in Indonesia. Although the health infrastructure is well laid out many challenges persist. Many programmes run by community health centres in Indonesia have not been monitored or evaluated systematically. There is lack of management skills and central data collection; as well as interruptions in services at the community health facilities. These problems, plus the high workloads of midwives and poor referral systems, hamper quality of care and result in a loss of confidence in the capabilities of young midwives. As with other countries with limited resources or capacities, Indonesia needs to consider a coordinated approach to incentives and human resourcing for village midwives that can be monitored without the need for complex administrative systems.

Indonesia: initial baseline capacity assessment

Although the health structure is well developed to serve rural communities in Indonesia, many capacity gaps at the provider level need to be addressed. Since decentralisation the division of responsibilities at district level have been unclear. Shorter training for midwives and nurses to be sent to rural communities has meant that many now lack the experience and skills needed for the work.

At the policy maker level the evidence based decision making approach is not optimal. There are gaps in the design of comprehensive methods for systematic data collation and monitoring. As a result there is inadequate use of data for research or decision making. This, in turn, has resulted in inadequate monitoring and evaluation that affects the quality of care.

Indonesia: what REACHOUT research and capacity development will add

In Indonesia REACHOUT will focus on close-to-community provision of maternal health interventions in community health centres (‘puskesmas’) and by village midwives. We will assess the work burden of the midwives, who currently each cover three to four villages, to ascertain the extent to which human resource issues, such as high workload and the lack of regular further training and supervision, hamper the quality of service. The research will then respond to monitoring and evaluation needs and suggest ways to tackle these with sensitivity to local conditions and resource constraints. Based on existing experience, REACHOUT will build capacity in monitoring and evaluation through training. We will also include policymakers in training on evidence-based decision making using a public health research cooperation approach.

 

This project is funded by the European Union.
This project is funded by the European Union.