By Patricia Tumbelaka

Cianjur is one of the districts in West Java, Indonesia with high maternal death cases and one of the contributing factors is the service quality delivered by the CTC (close-to-community) providers. REACHOUT, a five-year research project involving six countries focusing on the equity, effectiveness and efficiency of CTC services in rural area, collaborated with the District Health Office to address this issue. In 2015, REACHOUT conducted the first Quality Improvement (QI) cycle in four villages which targeted the village midwives and kader (volunteer community health workers) who worked closely with the community in providing health services, specifically maternal and child health services. Two interventions were conducted, health promotion training and supportive supervision training, which aimed to improve the communication skills in providing information on maternal issues and to enable supportive supervision amongst the CTC providers.

Seven village midwives and 188 kader were involved in this training and this story of one village midwife captures her experiences in improving her skills.  

“My name is Rose (not her real name) and I would like to share my story on how REACHOUT has influenced my career. I am a village midwife in one of the villages in Cianjur district in Indonesia. I have been working as village midwife for more than 20 years and my main task is to provide service in maternal and child health, family planning, and nutrition. Being a round-the-clock village midwife is not an easy profession. I faced several challenges, such as waking up in the middle of the night to attend delivery and during rainy season, the road becomes muddy and difficult to access. The community also demand that I provide general health care, specifically care for the elderly which is beyond my job description.

As the only health care provider in the village, not all of the community members accept and respect me. Some of the mothers rarely shared their problems with me, probably because they think I am not friendly. On top of that, I also need to deal with the issue of high maternal death cases in the village, which the community blame on me. Having these many responsibilities, tasks, and demands from the community made me feel unhappy, tired, and unmotivated to work.

When REACHOUT came to the village and introduced quality improvement programme, I was reluctant to take part because I thought the training was not suitable for me as a village midwife. However, after the aim of the training was explained, I agreed to be involved. I made the right decision to participate in the training. There are many benefits that useful for me. I learned better communication skills to talk with the mothers. I learned how to supervise and give feedback to the kader. Before, I never evaluated their work, but now I gathered all the kader at the end of Posyandu (health integrated post at the village) and talk to them. I feel my workload lessened and my motivation increase to give a better health service to the community.”

The impact of REACHOUT was truly beneficial to the CTC providers, particularly the village midwives. Changes in their attitude and motivation were clearly seen across the seven village midwives who participated in the training. They are motivated to perform a better health service in the community. One of the success factors was the participatory approach of the training which allowed the participants to interact actively during the process. It also provided the opportunity to be directly involved in the learning process.

Based on the experience of Rose and her fellow midwives the REACHOUT team recommends the Puskesmas (community health centres) adapt the training approach and implement it on a larger scale with different participants from other villages. Furthermore, constant monitoring from the health managers in the Puskesmas level is needed to ensure that the supervision processes in the Posyandu are sustainable. 

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