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As developing countries work to provide universal access to healthcare, many are turning to Close-to-Community (CTC) care.
However, to achieve its full potential, health systems must be understood in terms of the context and conditions in which their services operate.
This is where the EU-funded REACHOUT project came in.
With coordination and oversight from the Liverpool School of Tropical Medicine, REACHOUT researchers worked to identify the best means for delivering Close-to-Community services in rural and urban slum areas of such countries as Kenya, Ethiopia, Bangladesh and Indonesia. Partners in each country ensured direct contact with the local authorities and policy-makers.
For Indonesia, the Eijkman Institute for Molecular Biology, an Indonesian research institute renowned for its state-of-the-art laboratories and field-based research in rural areas, was part of the consortium.
Focusing on the Posyandu
In line with the project’s focus on providing maternal healthcare to rural areas, the Eijkman Institute tackled the unique challenges facing Indonesian community health workers (CHWs).
“Health promotion is a major component of Indonesia’s primary health programme,” says country coordinator Rukhsana Ahmed. “Most of the country’s maternal health promotion happens in the Posyandu, or the monthly community integrated activities that are held in rural villages.”
As antenatal care is provided to village women in the Posyandu, it is vital to use these gatherings to promote healthy pregnancy and safe childbirth.
However, doing so first requires having staff knowledgeable in maternal health issues. As most of the staff working in the Posyandu are village midwives and community health volunteers, this can often be a challenge.
For instance, according to research conducted by the project, many of these CHWs have limited access to training opportunities, which often equates to a poor quality of service and limited retention and recruitment. In fact, many CHWs don’t receive any formal training whatsoever.
Although the Posyandu is an ideal setting in which to teach village women about modern and safe child birth, without properly trained CHWs, it is difficult – if not impossible – to overcome long-held cultural norms.
For example, the patriarchal nature of many rural villages significantly hinders pregnant women from being referred to a healthcare facility for delivery. “What we found is that many pregnant women are compelled to deliver their baby at home because her husband won’t permit her to deliver in a healthcare facility,” says Ahmed.
A need for training
In summary, what REACHOUT researchers, working with their Eijkman counterparts, concluded was that greater involvement by local leaders in recognising the work performed by volunteer CHWs and the provision of quality services is crucial to maternal and child health programmes in rural Indonesia.
“Having well-trained staff in the Posyandu is pivotal for the effective promotion of safe child birth and for pregnant women to value the advice given by Posyandu staff,” adds Ahmed.
To ensure this training, REACHOUT has developed a training manual designed specifically to meet the needs of Posyandu staff and, in particular, the volunteer CHWs. The manual is available via the District Health Office and various Community Health Centres.