REACHOUT at the Global Symposium on Health Systems Research
01 October 2018
New maternal health promotion resources from Indonesia
03 January 2018
Towards a Community Health Worker Gender Action Framework
09 November 2017
Is my job worthwhile? A story of an Indonesian village midwife
20 September 2017
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.