an Eldis Resource
Midwifery provision in two districts in Indonesia: how well are rural areas served?
Redressing distributional inequity of midwives in Indonesia
Authors:
K. Makowiecka
Publisher:
Health Policy and Planning, 2007
Attention has focused recently on the importance of adequate and equitable provision of health personnel to raise levels of skilled attendance at delivery and thereby reduce maternal mortality. Indonesia has a village-based midwife programme that was intended to increase the rate of professional delivery care and redress the urban/rural imbalance in service provision by posting a trained midwife in every village in the country. In this paper, the authors argue that adequate provider density is an important factor in effective health care. Efforts should be made to redress this imbalance in provision, but this can only contribute to reducing maternal mortality in the context of a supportive professional environment and timely access to emergency obstetric care.
Findings are reported on the distribution of midwifery provision in the study area of two districts in Java, Indonesia:
- 10% of villages do not have a midwife but a nurse as a midwifery provider.
- There is a deficit in midwife density in remote villages compared with urban areas. Midwives are attracted to urban areas because they can generate viable and sustainable clinical practices.
- Those assigned to remote areas are less experienced. Apart from this, they also experience professional isolation, greater pressure from a traditional community and less opportunity for career development.
- Midwives manage few births and this may compromise their capacity to maintain professional skills.
- Over 90% of non-hospital deliveries take place in the woman’s (64%) or the midwife’s (28%) home. A policy shift from home to facility births may help establish a more supportive working environment for midwives.
- Three-quarters of midwives did not make regular use of the fee exemption scheme. Though the scheme represents a positive step, all countries that have reduced maternal mortality rates have done so in the context of free health care.
- Midwives who live in their assigned village spend more days per month on clinical work there
