Women in the changing world of community health work
17 March 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
Webinar: Community health workers - the gender agenda #HSGGENDER
08 February 2016
Putting the politics into international public health
05 January 2016
A learning agenda and “NICE guys”: reflections on capacity
16 November 2015
REACHOUT at the Canadian Conference on Global Health
03 November 2015
REACHOUT holds Consortium meeting in Indonesia
26 October 2015
Why we use a group supervision approach in REACHOUT
22 September 2015
Kartini and women’s lives
11 May 2015
A REACHOUT update from Indonesia
04 December 2014
REACHOUT honourable mention in photo competition
20 October 2014
Find more resources relating to Indonesia
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.
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.
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.
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.