scholarly journals Regulating Midwives: Foreclosing Alternatives in the Policymaking Process in West Java, Indonesia

Author(s):  
Priscilla Magrath

AbstractPromotion of “skilled birth attendants” (SBAs) in global maternal health policy has prompted a range of policy responses to “traditional birth attendants” (TBAs). In Indonesia the response has been to develop a national policy of partnership between SBAs (bidan) and TBAs (dukun bayi). This policy aims to ensure the presence of an SBA at every birth yet offers a role for TBAs. In this chapter I examine the development of a district regulation on partnership, promoted within the context of decentralization policies enacted in Indonesia from 1999. The district regulation aimed to strengthen the national policy in a location in West Java where TBAs remain popular. Drawing on 10 months of fieldwork from 2012 to 2013 at a district health office and on observations of its outreach programs, I elucidate how the regulation on partnership was promoted through the policy entrepreneurship of certain key figures in the district health office. They argued that the partnership regulation was the fastest means to improve maternal health. But casting a spotlight on the relationship between SBAs and TBAs diverted attention away from other health system challenges including under-resourced medical facilities and a weak referral system. Three contexts played into this process of bringing the partnership issue to the fore: global policies promoting SBAs and sidelining TBAs; pressure to achieve the Millennium Development Goal (MDG) on maternal mortality; and the limited financial power and decision space afforded to districts under decentralization in Indonesia. In this context, the regulation offered a viable path for demonstrating commitment to improving maternal health outcomes, yet one that failed to address broader constraints in the health system that contribute to persistent high maternal mortality rates.

2020 ◽  
Vol 8 (2) ◽  
pp. 1019-1032
Author(s):  
Ela Rohaeni ◽  
Norma Mardiani

Kematian ibu adalah kematian seorang wanita terjadi saat hamil, bersalin, atau 42 hari setelah persalinan dengan penyebab yang berhubungan langsung atau tidak langsung terhadap persalinan. Dalam rangka mempercepat penurunan angka kematian ibu salah satunya adalah dengan memperkuat sistem rujukan. Dalam hal ini pengoptimalan kebijakan SMS Gateway. Tujuan penelitian ini adalah menyusun alternatif kebijakan operasional penggunaan SMS Gateway pada rujukan kegawatdaruratan maternal di Dinas Kesehatan Kabupaten Cirebon Tahun 2017. Penelitian ini merupakan penelitian kualitatif dengan pendekatan konfirmatori,  teknik pengumpulan data dengan menggunakan teknik purposive sampling, untuk memperoleh hasil dengan pemahaman mendalam tentang topik penelitian. Informan kunci dalam penelitian ini adalah bidan pelaksana berjumlah 6 orang pelaksana sedangkan informan pendukung yaitu kepala puskesmas, kepala bagian Yankes, kepala Dinas Kesehatan Kabupaten Cirebon. Temuan penelitian ini adalah kebijakan yang ada saat ini yaitu mengenai aspek penting dalam upaya menurunkan angka kematian ibu namun ditemukan dalam pengaplikasiannya belum optimal. Alternatif kebijakan operasional pada rujukan kegawatdaruratan maternal di Dinas Kesehatan Kabupaten Cirebon yaitu pembuatan SK Kepala Dinas tentang petunjuk teknis sistem SMS Gateways rujukan pelayanan kesehatan dan Standar Prosedur Operasional SMS Gateway rujukan kegawatdaruratan maternal dan neonatal.Kata kunci           :  Kebijakan Operasional, SMS Gateway, Rujukan, Kegawatdaruratan Maternal  ABSTRACTMaternal death is the death of a woman occurs during pregnancy, childbirth, or 42 days after delivery with a cause that is directly or indirectly related to labor. In order to accelerate the decline in maternal mortality one of them is by strengthening the referral system. In this case the SMS Gateway policy optimization. The purpose of this research is to formulate operational policy alternatives of SMS Gateway utilization on maternal emergency referral in Cirebon District Health Office 2017. This research is a qualitative research with confirmatory approach data collection technique using purposive sampling technique, to obtain result with deep understanding about research topic. Key informants in this research are midwife implementer is 6 executor while supporting informant is head of puskesmas, head of Yankes department, head of health office of Cirebon regency. The findings of this study are that the existing policy has been about important aspects in efforts to reduce maternal mortality but found in its application not yet optimal. Alternative operational policy on maternal emergency referral at Cirebon District Health Office is making SK Head of Service about technical guidance of SMS Gateways system of referral of health service and Standard of Operational Procedure SMS Gateway referral of maternal and neonatal emergency.Keywords             : Operational Policy, SMS Gateway, Referral, Maternal Emergency


2019 ◽  
Vol 34 (s1) ◽  
pp. s65-s65
Author(s):  
Madelina Ariani ◽  
Yurianto Achmad ◽  
Kamarruzzaman Kamarruzzaman ◽  
Ina Agustina ◽  
Bella Donna ◽  
...  

Introduction:Indonesia’s road traffic fatality rate stands at 15.3 per 100,000 people, compared to 17 in the Southeast Asia region. Traffic fatalities are predicted to increase by 50%, becoming the third leading contributor to the global burden of disease by 2020. Indonesian police reported that 575 people died and 2,742 road accidents occurred during Eid-al-Fitr 2015. The problem is increasing rapidly in Indonesia, particularly during Ramadan. Policy makers need to recognize this growing problem as a public health crisis to prevent mass casualty incidents.Aim:To assess the health system preparedness with regard to road traffic accidents during 2017 Eid-al-Fitr homecoming in West Java, Central Java, East Java, and Lampung.Methods:The project started with an interview and observation followed by stakeholder analysis to assess the level of preparedness. This qualitative and quantitative research was conducted one month prior to Eid-al-Fitr homecoming 2017. The instruments were evaluated for policy, organization, communication, procedure, contingency plan, logistics, facility and human resources, financing, monitoring, evaluation, coordination, and socialization.Results:The levels of preparedness were moderate (B) for West Java, East Java, and Lampung, but high (A) for Central Java. Levels of preparedness based on district health office indicators were high for coordination, but low for a contingency plan. Levels of preparedness based on hospitals and primary health care were high for logistics and human resources, but low for a contingency plan and financing.Discussion:The findings indicated a moderate level (B) of health sector preparedness. Benchmark information from this research will provide information for further training in contingency planning, particularly for the district health office.


2020 ◽  
Author(s):  
Mamothena Mothupi ◽  
Lucia Knight ◽  
Hanani Tabana

Abstract Objective : This study uses health and non-health sector data sources to select and assess available indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the adequacy approach established in another study to assess the multi-dimensionality of available indicators. Using adequacy and the process of assessment in the study, the comprehensiveness of the continuum of care for improving maternal health outcomes can be assessed. Results: We found 27 indicators of care utilization and access, linkages of care, and quality of care from the routine district health information system. The General Household Survey contained 11 indicators for the social determinants of health on the continuum of care framework. Indicator gaps include health promotion during and after pregnancy, maternal nutrition, empowerment and quality of care. At present, the available indicators measure about 74% of the interventions on the continuum of care framework. We make recommendations regarding improvements needed to better measure and monitor the continuum of care for maternal health. These involve actions within the health system and include integration of non-health system indicators.


Author(s):  
Mamothena Mothupi ◽  
Lucia Knight ◽  
Hanani Tabana

Abstract Objective This study assesses indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the emerging construct of adequacy of the continuum of care to assess multi-dimensionality of available indicators. Using adequacy and the process of assessment in the study, the comprehensiveness of the continuum of care for improving maternal health outcomes can be assessed. Results We found indicators along the adequacy dimensions of care utilization and access, linkages of care, and quality of care in the routine district health information system. The General Household Survey contained indicators for the social determinants of health on the continuum of care framework. Indicator gaps include health promotion during and after pregnancy, maternal nutrition, empowerment and quality of care. At present, the available indicators measure about 74% of the interventions on the continuum of care framework. We make recommendations regarding improvements needed to better measure and monitor the continuum of care for maternal health. These involve actions within the health system and include integration of non-health system indicators.


2020 ◽  
Author(s):  
Mamothena Mothupi ◽  
Lucia Knight ◽  
Hanani Tabana

Abstract Objective : This study uses health and non-health sector data sources to select and assess available indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the adequacy approach established in another study to assess the multi-dimensionality of available indicators. Using adequacy and the process of assessment in the study, the comprehensiveness of the continuum of care for improving maternal health outcomes can be assessed. Results: We found 27 indicators of care utilization and access, linkages of care, and quality of care from the routine district health information system. The General Household Survey contained 11 indicators for the social determinants of health on the continuum of care framework. Indicator gaps include health promotion during and after pregnancy, maternal nutrition, empowerment and quality of care. At present, the available indicators measure about 74% of the interventions on the continuum of care framework. We make recommendations regarding improvements needed to better measure and monitor the continuum of care for maternal health. These involve actions within the health system and include integration of non-health system indicators.


2016 ◽  
Vol 4 (3) ◽  
pp. 163-168
Author(s):  
Elzina De Fretes ◽  
Hardi Warsono ◽  
Ayun Sriatmi

Number of midwives in Fakfak District in 2012 was 108 persons. Number of Traditional Birth Attendants (TBAs) was 191 persons consisted of 79 (41%) trained TBAs and 112 (59%) untrained TBAs. The TBAs had an important role in delivery process because number of them was higher than number of midwives. Therefore, coverage of delivery process helped by health workers had not achieved the target. This research aimed to analyze the implementation of the partnership program between midwives and TBAs viewed from the aspects of input, process, and output at Fakfak District Health Office. This was qualitative research with descriptive-explorative approach by conducting indepth interview. Subjects were midwives and TBAs who had been partnering. Data were analysed using a content analysis. The input aspect showed that: 1) Implementers, midwives and TBAs only knew partnership in helping delivery; 2) Specific allocation funds for the program was not available. The funds was from Operational Support for Health but it was still not sufficient; 3) Specific means for the program was not available. The current means is from health center and village polyclinic but it is still limited. Furthermore, the process aspect revealed that: 1) Program planning, midwives and TBAs collected data of pregnant women, maternal, postpartum women, and number of TBAs; 2) The implementation was not good because midwives were not available when needed by TBAs and there was difficult to access. Socialization for cross-program (community leaders and religious leaders) and internship for TBAs had not been done yet due to insufficient fund; 3) Recording and reporting especially about partnership activities had not been done yet and only used a form on a Maternal and Child Health report. Regarding the output aspect, as many as 195 (89%) from 219 TBAs had not been partnered. Coverage of K1, K4, and delivery process helped by health workers from 2011 to 2012 decreased gradually. As a suggestion, District Health Office and Health Center need to maintain partnership by recruiting midwives, providing means, allocating fund, socializing to community leaders, and funding TBAs’ daughter or grandchild to study midwifery.


Author(s):  
Moses Mukuru ◽  
Suzanne N. Kiwanuka ◽  
Lucy Gilson ◽  
Maylene Shung-King ◽  
Freddie Ssengooba

Background: The persistence of high maternal mortality and consistent failure in low- and middle-income countries to achieve global targets such as Millennium Development Goal five (MDG 5) is usually explained from epidemiological, interventional and health systems perspectives. The role of policy elites and their interests remains inadequately explored in this debate. This study examined elites and how their interests drove maternal health policies and actions in ways that could explain policy failure for MDG 5 in Uganda. Methods: We conducted a retrospective qualitative study of Uganda’s maternal health policies from 2000 to 2015 (MDG period). Thirty key informant interviews and 2 focus group discussions (FGDs) were conducted with national policy-makers, who directly participated in the formulation of Uganda’s maternal health policies during the MDG period. We reviewed 9 National Maternal Health Policy documents. Data were analysed inductively using elite theory. Results: Maternal health policies were mainly driven by a small elite group comprised of Senior Ministry of Health (MoH) officials, some members of cabinet and health development partners (HDPs) who wielded more power than other actors. The resulting policies often appeared to be skewed towards elites’ personal political and economic interests, rather than maternal mortality reduction. For a few, however, interests aligned with reducing maternal mortality. Since complying with the government policy-making processes would have exposed elites’ personal interests, they mainly drafted policies as service standards and programme documents to bypass the formal policy process. Conclusion: Uganda’s maternal health policies were mainly influenced by the elites’ personal interests rather than by the goal of reducing maternal mortality. This was enabled by the formal guidance for policy-making which gives elites control over the policy process. Accelerating maternal mortality reduction will require re-engineering the policy process to prevent public officials from infusing policies with their interests, and enable percolation of ideas from the public and frontline.


2016 ◽  
Vol 6 (7) ◽  
pp. 51
Author(s):  
Nicholas Apreh Siaw ◽  
Samuel Kwofie

<p>The main objective of the study was to verify the effect of the free maternal care policy on maternal health in the New Juaben Municipality, Ghana. The population for the study encompassed women of the child bearing age (10-49) in the New Juaben Municipality. Both primary and secondary sources of data were employed for this study. Purposive and accidental sampling procedures were used to select the respondents. The sample size was two hundred (200). This study used trend analysis as its main approach of analyzing the available data. The findings show that antenatal attendance has been increasing over the years. This is attributed to the introduction of the free maternal health policy. However, quality of care remains a problem due to the enormous attendance. It was also recommended that there is still a great need to introduce other measures to reduce maternal mortality in the municipality. It was also recommended that quality of care must be addressed and also more efforts should be made in the services that have provided to the patients. It was concluded that, although the policy has not eradicated maternal mortality completely yet it has contributed to its significant reduction in the region.</p>


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