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LOCAL GOVERNMENT AND COMMUNITY LEADERS’ PERSPECTIVES ON CHILD HEALTH AND MORTALITY AND INEQUITY ISSUES IN RURAL EASTERN INDONESIA

Published online by Cambridge University Press:  29 April 2016

Jerico Franciscus Pardosi*
Affiliation:
School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia Department of Marketing and Management, Faculty of Business and Economics, Macquarie University, Sydney, Australia National Institute of Health Research and Development, Ministry of Health, Indonesia
Nick Parr
Affiliation:
Department of Marketing and Management, Faculty of Business and Economics, Macquarie University, Sydney, Australia
Salut Muhidin
Affiliation:
Department of Marketing and Management, Faculty of Business and Economics, Macquarie University, Sydney, Australia
*
1Corresponding author. Email: [email protected]

Summary

Since 2001 a decentralization policy has increased the responsibility placed on local government for improving child health in Indonesia. This paper explores local government and community leaders’ perspectives on child health in a rural district in Indonesia, using a qualitative approach. Focus group discussions were held in May 2013. The issues probed relate to health personnel skills and motivation, service availability, the influence of traditional beliefs, and health care and gender inequity. The participants identify weak leadership, inefficient health management and inadequate child health budgets as important issues. The lack of health staff in rural areas is seen as the reason for promoting the use of traditional birth attendants. Midwifery graduates and village midwives are perceived as lacking motivation to work in rural areas. Some local traditions are seen as detrimental to child health. Husbands provide little support to their wives. These results highlight the need for a harmonization and alignment of the efforts of local government agencies and local community leaders to address child health care and gender inequity issues.

Type
Research Article
Copyright
Copyright © Cambridge University Press, 2016 

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References

Acuin, C. S., Khor, G. L., Liabsuetrakul, T., Achadi, E. L., Htay, T. T., Firestone, R. & Bhutta, Z. A. (2011) Maternal, neonatal, and child health in southeast Asia: towards greater regional collaboration. The Lancet 377(9764), 516525.CrossRefGoogle ScholarPubMed
Adair, T., Pardosi, J., Rao, C., Kosen, S. & Tarigan, I. (2012) Access to health services and early age mortality in Ende, Indonesia. Indian Journal of Pediatrics 79(5), 612618.CrossRefGoogle ScholarPubMed
Agus, Y., Horiuchi, S. & Porter, S. E. (2012) Rural Indonesia women’s traditional beliefs about antenatal care. BMC Research Notes 5(1), 589.Google Scholar
Agus, Y. & Horiuchi, S. (2012) Factors influencing the use of antenatal care in rural West Sumatra, Indonesia. BMC Pregnancy and Childbirth 12(1), 9.CrossRefGoogle ScholarPubMed
Asante, A., Iljanto, S. & Rule, J. (2012) Strengthening health management and leadership at the district level: what we can learn from high performing districts in the West Java Province of Indonesia? Human Resources for Health Knowledge Hub. University of New South Wales, Sydney, Australia.Google Scholar
Baird, J., Ma, S. & Ruger, J. P. (2011) Effects of the World Bank’s maternal and child health intervention on Indonesia’s poor: evaluating the safe motherhood project. Social Science & Medicine 72(12), 19481955.Google Scholar
BAPPENAS (2005) Kajian Kebijakan Perencanaan Tenaga Kesehatan [Health Workforce Planning Policy Review]. National Development Planning Agency, Jakarta.Google Scholar
BAPPENAS (2009) Revitalization of Family Planning in Indonesia. National Development Planning Agency, National Family Planning Coordinating Board, Government of Indonesia, United Nation Population Fund, Jakarta.Google Scholar
BAPPENAS (2010) Family Planning Services Evaluation for Poor Families. National Development Planning Agency, Jakarta.Google Scholar
Beegle, K., Frankenberg, E. & Thomas, D. (2001) Bargaining power within couples and use of prenatal and delivery care in Indonesia. Studies in Family Planning 32(2), 130146.Google Scholar
Bergera, S. G., de Peeb, S., Bloema, M. W., Halatid, S. & Sembaa, R. D. (2008) Malnutrition and morbidity among children not reached by the national vitamin A capsule programme in urban slum areas of Indonesia. Journal of the Royal Institute of Public Health 122, 317378.Google Scholar
Bhutta, Z. A., Chopra, M., Axelson, H., Berman, P., Boerma, T., Bryce, J. et al. (2010) Countdown to 2015 decade report (2000–10): taking stock of maternal, newborn, and child survival. The Lancet 375(9730), 20322044.Google Scholar
Bhutta, Z. A., Gupta, I., de’Silva, H., Manandhar, D., Awasthi, S., Hossain, S. & Salam, M. (2004) Maternal and child health: is South Asia ready for change? British Medical Journal 328(7443), 816819.Google Scholar
Daly, P., Taylor, M. & Tinker, A. (2003) Integrating Essential Newborn Care into Countries’ Policies and Programs. Population Reference Bureau, Washington DC.Google Scholar
Dickson, K. E., Simen-Kapeu, A., Kinney, M. V., Huicho, L., Vesel, L., Lackritz, E. et al. (2014) Every newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries. The Lancet 384(9941), 438454.CrossRefGoogle ScholarPubMed
Duflo, E. (2011) Women’s empowerment and economic development. Journal of Economic Literature 50(4), 10511079.CrossRefGoogle Scholar
Eckermann, E. & Deodato, G. (2008) Maternity waiting homes in Southern Lao PDR: the unique ‘silk home’. Journal of Obstetrics and Gynaecology Research 34(5), 767775.Google Scholar
EDHO (2012) Profil Kesehatan Kabupaten Ende 2012 [The 2012 Ende District Health Profile]. Dinas Kesehatan Kabupaten Ende, Ende District.Google Scholar
EDHO (2013) Profil Kesehatan Kabupaten Ende 2013 [The 2013 Ende District Health Profile]. Dinas Kesehatan Kabupaten Ende, Ende District.Google Scholar
Ensor, T. & Cooper, S. (2004) Overcoming barriers to health service access: influencing the demand side. Health Policy and Planning 19(2), 6979.Google Scholar
Ensor, T., Quayyum, Z., Nadjib, M. & Sucahya, P. (2009) Level and determinants of incentives for village midwives in Indonesia. Health Policy and Planning 24(1), 2635.Google Scholar
Farnsworth, S. K., Böse, K., Fajobi, O., Souza, P. P., Peniston, A., Davidson, L. L. et al. (2014) Community engagement to enhance child survival and early development in low- and middle-income countries: an evidence review. Journal of Health Communication 19 (supplement 1), 6788.Google Scholar
Frankenberg, E., Suriastini, W. & Thomas, D. (2005) Can expanding access to basic healthcare improve children’s health status? Lessons from Indonesia’s ‘midwife in the village’ programme. Population Studies 59(1), 519.Google Scholar
Gabrysch, S. & Campbell, O. M. (2009) Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy and Childbirth 9(1), 34.CrossRefGoogle ScholarPubMed
Gipson, J. D., Koenig, M. A. & Hindin, M. J. (2008) The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Studies in Family Planning 39(1), 1838.CrossRefGoogle Scholar
Gwatkin, D. R., Bhuiya, A. & Victora, C. G. (2004) Making health systems more equitable. The Lancet 364(9441), 12731280.CrossRefGoogle ScholarPubMed
Haines, A., Sanders, D., Lehmann, U., Rowe, A. K., Lawn, J. E., Jan, S. et al. (2007) Achieving child survival goals: potential contribution of community health workers. The Lancet 369(9579), 21212131.Google Scholar
Harimurti, P., Pambudi, E., Pigazinni, A. & Tandon, A. (2013) The nuts and bolts of Jamkesmas: Indonesia’s Government Financed Health Coverage Program. Universal Health Coverage Studies (UNICO) Series No. 8. World Bank, Washington DC.Google Scholar
Hatt, L., Stanton, C., Makowiecka, K., Adisasmita, A., Achadi, E. & Ronsmans, C. (2007) Did the strategy of skilled attendance at birth reach the poor in Indonesia? Bulletin of the World Health Organization 85(10), 774782.Google Scholar
Haws, R. A., Thomas, A. L., Bhutta, Z. A. & Darmstadt, G. L. (2007) Impact of packaged interventions on neonatal health: a review of the evidence. Health Policy and Planning 22(4), 193215.CrossRefGoogle ScholarPubMed
Henderson, L. N. & Tulloch, J. (2008) Incentives for retaining and motivating health workers in Pacific and Asian countries. Human Resources for Health 6(1), 18.CrossRefGoogle ScholarPubMed
Hennessy, D., Hicks, C. & Koesno, H. (2006) The training and development needs of midwives in Indonesia: paper 2 of 3. Human Resources for Health 4(1), 9.Google Scholar
Heywood, P. & Choi, Y. (2010) Health system performance at the district level in Indonesia after decentralization. BMC International Health and Human Rights 10(3).Google Scholar
Hidayat, B., Thabrany, H., Dong, H. & Sauerborn, R. (2004) The effects of mandatory health insurance on equity in access to outpatient care in Indonesia. Health Policy and Planning 19(5), 322335.CrossRefGoogle ScholarPubMed
Hill, Z., Kirkwood, B. & Edmond, K. (2004) Family and Community Practices that Promote Child Survival, Growth and Development. WHO, Geneva.Google Scholar
Hodnett, E., Gates, S., Hofmeyr, G. & Sakala, C. (2013) Continuous support for women during childbirth. Cochrane Database of Systematic Reviews. The Cochrane Collaboration.Google Scholar
Holmes, R., Febriany, V., Yumna, A. & Syukri, M. (2010) The Role of Social Protection in Tackling Food Insecurity and Under-Nutrition in Indonesia: A Gendered Approach. Overseas Development Institute and the SMERU Research Institute, UK.Google Scholar
Kerber, K. J., de Graft-Johnson, J. E., Bhutta, Z. A., Okong, P., Starrs, A. & Lawn, J. E. (2007) Continuum of care for maternal, newborn, and child health: from slogan to service delivery. The Lancet 370(9595), 13581369.CrossRefGoogle ScholarPubMed
Ki-Moon, B. (2010) Global Strategy for Women’s and Children’s Health. United Nations, New York.Google Scholar
Kristiansen, S. & Santoso, P. (2006) Surviving decentralisation? Impacts of regional autonomy on health service provision in Indonesia. Health Policy 77(3), 247259.Google Scholar
Kruk, M. E., Porignon, D., Rockers, P. C. & Van Lerberghe, W. (2010) The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives. Social Science & Medicine 70(6), 904911.Google Scholar
La Vincente, S., Aldaba, B., Firth, S., Kraft, A., Jimenez-Soto, E. & Clark, A. (2013) Supporting local planning and budgeting for maternal, neonatal and child health in the Philippines. Health Research Policy and System 11(3).Google Scholar
Lassi, Z. S., Haider, B. A. & Bhutta, Z. A. (2010) Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database of Systematic Review, Issue 11, Art. No. CD007754, doi: 10.1002/14651858.CD007754.pub2 CrossRefGoogle ScholarPubMed
Lawn, J., Kerber, K., Enweronu‐Laryea, C. & Massee Bateman, O. (2009) Newborn survival in low resource settings – are we delivering? BJOG: An International Journal of Obstetrics & Gynaecology 116(s1), 4959.Google Scholar
Lawn, J. E., Kerber, K., Enweronu-Laryea, C. & Cousens, S. (2010) 3.6 million neonatal deaths – what is progressing and what is not? Seminars in Perinatology 6(34), 371386.Google Scholar
Lieberman, S. S., Capuno, J. J. & Van Minh, H. (2005) Decentralizing health: lessons from Indonesia, the Philippines, and Vietnam. In East Asia Decentralizes: Making Local Government Work. World Bank, Washington DC, pp. 155178.Google Scholar
Maitra, P. (2004) Parental bargaining, health inputs and child mortality in India. Journal of Health Economics 23(2), 259291.Google Scholar
Makowiecka, K., Achadi, E., Izati, Y. & Ronsmans, C. (2008) Midwifery provision in two districts in Indonesia: how well are rural areas served? Health Policy and Planning 23(1), 6775.CrossRefGoogle ScholarPubMed
Martines, J., Paul, V. K., Bhutta, Z. A., Koblinsky, M., Soucat, A., Walker, N. et al. (2005) Neonatal survival: a call for action. The Lancet 365(9465), 11891197.Google Scholar
Ministry of Education and Culture (2011) Potret Ketersediaan dan Kebutuhan Tenaga Bidan [Midwives availability and its potrait needs]. Health Professional Education Quality Project. Kementerian Pendidikan dan Kebudayaan, Jakarta.Google Scholar
Ministry of Health (2010) Pedoman Pemantauan Wilayah Setempat Kesehatan Ibu dan Anak (PWS-KIA) [Guidelines for Local Regional Monitoring of Maternal and Child Health]. Direktorat Jenderal Bina Kesehatan Masyarakat, Direktorat Bina Kesehatan Ibu, Jakarta.Google Scholar
Ministry of Health (2012) Pedoman Pelaksanaan Kemitraan Bidan dan Dukun [The Midwives and Traditional Birth Attendants Partnership Guidelines]. Direktorat Jenderal Bina Kesehatan Masyarakat, Direktorat Bina Kesehatan Ibu, Jakarta.Google Scholar
Mullany, B. C. (2006) Barriers to and attitudes towards promoting husbands’ involvement in maternal health in Katmandu, Nepal. Social Science & Medicine 62(11), 27982809.CrossRefGoogle ScholarPubMed
Mwambete, K. & Joseph, R. (2010) Knowledge and perception of mothers and caregivers on childhood diarrhoea and its management in Temeke municipality, Tanzania. Tanzania Journal of Health Research 12(1), 4754.Google Scholar
Nair, N., Tripathy, P., Prost, A., Costello, A. & Osrin, D. (2010) Improving newborn survival in low-income countries: community-based approaches and lessons from South Asia. PLoS Medicine 7(4), e1000246.CrossRefGoogle ScholarPubMed
NFPCB (2013) Districts TFR: Susenas Data 2010. National Family Planning Coordinating Board, Jakarta.Google Scholar
NIHRD (2012) Peran Sosial Budaya dalam Upaya Meningkatkan Pemanfaatan Program Jaminan Persalinan (Jampersal) [The Role of Social Culture in Improving the Utilization of Universal Maternity Benefit Program]. Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan, Jakarta.Google Scholar
Noerdin, E. (2014) Transport, health services and budget allocation to address maternal mortality in rural Indonesia. Transport and Communications Bulletin for Asia and the Pacific 84, 114.Google Scholar
NTT Provincial Health Office (2012) Pedoman Revolusi Kesehatan Ibu dan Anak (KIA) di Provinsi Nusa Tenggara Timur (NTT) [Guidance of Maternal and Child Health Revolution in East Nusa Tenggara Province]. Dinas Kesehatan Provinsi Nusa Tenggara Timur, Kupang.Google Scholar
O’Donnell, O. (2007) Access to health care in developing countries: breaking down demand side barriers. Cadernos de Saúde Pública 23(12), 28202834.Google Scholar
Pardosi, J. F., Adair, T., Rao, C., Kosen, S. & Tarigan, I. U. (2011) Measuring subnational under-5 mortality: lessons from a survey in the Eastern Indonesian District of Ende. Asia-Pacific Journal of Public Health 26(4), 367377.Google Scholar
Pardosi, J. F., Parr, N. & Muhidin, S. (2015) Inequity issues and mothers’pregnancy, delivery and early-age survival experiences in Ende District, Indonesia. Journal of Biosocial Science 47(6), 780802.Google Scholar
Piwoz, E. G., Huffman, S. L. & Quinn, V. J. (2003) Promotion and advocacy for improved complementary feeding: can we apply the lessons learned from breastfeeding? Food and Nutrition Bulletin – United Nations University 24(1), 2944.Google Scholar
Poerwanto, S., Stevenson, M. & de Klerk, N. (2003) Infant mortality and family welfare: policy implications for Indonesia. Journal of Epidemiology and Community Health 57(7), 493498.Google Scholar
Prytherch, H., Kagoné, M., Aninanya, G. A., Williams, J. E., Kakoko, D. C., Leshabari, M. T. et al. (2013) Motivation and incentives of rural maternal and neonatal health care providers: a comparison of qualitative findings from Burkina Faso, Ghana and Tanzania. BMC Health Services Research 13(1), 149.Google Scholar
Rosato, M., Laverack, G., Grabman, L. H., Tripathy, P., Nair, N., Mwansambo, C. et al. (2008) Community participation: lessons for maternal, newborn, and child health. The Lancet 372(9642), 962971.Google Scholar
Shefner-Rogers, C. L. & Sood, S. (2004) Involving husbands in safe motherhood: effects of the SUAMI SIAGA campaign in Indonesia. Journal of Health Communication: International Perspectives 9(3), 233258.Google Scholar
Shrestha, R. (2010) The village midwife program and infant mortality in Indonesia. Bulletin of Indonesian Economic Studies 46(2), 193211.Google Scholar
Simmonds, A. & Hort, K. (2013) Institutional Analysis of Indonesia’s Proposed Road Map to Universal Health Coverage. Noosal Institute for Global Health, University of Melbourne.Google Scholar
Singh, S., Sedgh, G. & Hussain, R. (2010) Unintended pregnancy: worldwide levels, trends, and outcomes. Studies in Family Planning 41(4), 241250.Google Scholar
Speizer, I. S., Whittle, L. & Carter, M. (2005) Gender relations and reproductive decision making in Honduras. International Family Planning Perspectives 31(3), 131139.Google Scholar
Statistics Ende District (2013) Hasil Sensus Penduduk 2010 Kabupaten Ende [The 2010 Ende District Population Census Results]. Badan Pusat Statistik, Kabupaten, Ende.Google Scholar
Statistics Indonesia (2013) Indonesia Demographic and Health Survey 2012. Statistics Indonesia, National Population and Family Planning Board, Ministry of Health, MEASURE DHS, ICF International, Jakarta.Google Scholar
Statistics Nusa Tenggara Timur (2011) Nusa Tenggara Timur dalam Angka [East Nusa Tenggara in Figures]. Badan Pusat Statistik Provinsi Nusa Tenggara Timur (NTT), Kupang.Google Scholar
Stewart, D. W., Shamdasani, P. N. & Rook, D. W. (2006) Focus Groups: Theory and Practice. SAGE Publications, Thousand Oaks, CA.Google Scholar
Suryawati, C. (2007) Faktor sosial budaya dalam praktik perawatan kehamilan, persalinan, dan pasca persalinan (studi di kecamatan bangsri kabupaten jepara) [Socio-cultural factors in prenatal care, delivery and postpartum (study in Bangsri sub-district, Jepara district)]. Jurnal Promosi Kesehatan Indonesia 2(1), 2131.Google Scholar
Titaley, C. R., Hunter, C. L., Dibley, M. J. & Heywood, P. (2010) Why do some women still prefer traditional birth attendants and home delivery? A qualitative study on delivery care services in West Java Province, Indonesia. BMC Pregnancy and Childbirth 10(1), 43.CrossRefGoogle ScholarPubMed
Trisnantoro, L., Soemantri, S., Singgih, B., Pritasari, K., Mulati, E., Agung, F. H. & Weber, M. W. (2010) Reducing child mortality in Indonesia. Bulletin of the World Health Organization 88(9), 642642.Google Scholar
Tsui, A. O., McDonald-Mosley, R. & Burke, A. E. (2010) Family planning and the burden of unintended pregnancies. Epidemiologic Reviews 32(1), 152174.Google Scholar
Tweheyo, R., Konde-Lule, J., Tumwesigye, N. M. & Sekandi, J. N. (2010) Male partner attendance of skilled antenatal care in peri-urban Gulu district, Northern Uganda. BMC Pregnancy and Childbirth 10(1), 53.Google Scholar
UNDP (2011) Indonesia: Progress Report on the Millennium Development Goals. BAPPENAS, Government of Indonesia, Jakarta.Google Scholar
UNICEF (2013) Levels and Trends of Child Mortality. Estimates developed by the UN Inter-Agency Group for Child Mortality Estimation, New York, Washington and Geneva.Google Scholar
Utomo, B., Sucahya, P. K. & Utami, F. R. (2011) Priorities and realities: addressing the rich–poor gaps in health status and service access in Indonesia. International Journal of Equity in Health 10(47), 114.Google Scholar
Utomo, I. D., McDonald, P., Reimondos, A., Utomo, A. & Hull, T. H. (2014) Do primary students understand how pregnancy can occur? A comparison of students in Jakarta, West Java, West Nusa Tenggara and South Sulawesi, Indonesia. Sex Education 14(1), 95109.Google Scholar
Victora, C. G., Wagstaff, A., Schellenberg, J. A., Gwatkin, D., Claeson, M. & Habicht, J. P. (2003) Applying an equity lens to child health and mortality: more of the same is not enough. The Lancet 362(9379), 233241.CrossRefGoogle ScholarPubMed
Williams, C. P. & Widodo, A. (2009) Circulation, encounters and transformation: Indonesian female migrants. Asian and Pacific Migration Journal 18(1), 123142.CrossRefGoogle Scholar
WHO (2007) Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for Action. World Health Organization, Geneva, Switzerland.Google Scholar
WHO (2008) WHO Country Cooperation Strategy 2007–2011 – Indonesia. World Health Organisation Country Office for Indonesia.Google Scholar
Wulandari, L. P. L. & Whelan, A. K. (2011) Beliefs, attitudes and behaviours of pregnant women in Bali. Midwifery 27(6), 867871.CrossRefGoogle ScholarPubMed
Yanikkerem, E., Ay, S. & Piro, N. (2013) Planned and unplanned pregnancy: effects on health practice and depression during pregnancy. Journal of Obstetrics and Gynaecology Research 39(1), 180187.Google Scholar
Yinger, N. V. & Ransom, E. I. (2003) Why Invest in Newborn Health? Population Reference Bureau, Washington.Google Scholar