The Study of Roles and Working Situation of Midwives and Village Midwives in North Sulawesi Province, Indonesia

Arifin, Andryansyah (1999) The Study of Roles and Working Situation of Midwives and Village Midwives in North Sulawesi Province, Indonesia. Project Report. Badan Penelitian dan Pengembangan Kesehatan.

Abstract

The objective of the Study of Roles and Working Situation of Midwives and Village Midwives in North Sulawesi Province, Indonesia is to know Indonesian community health policy and working situation of midwives and village midwives. Specifically is to know new community health policy of Indonesian government and the MOH, to know midwives and village midwives working condition and their consciousness of their work and to know relationship and information system among midwives and village midwives with community peoples at Bolaang Mongondow District, Noth Sulawesi, Indonesia. This study was conducted at Bolaang Mongondow District, North Sulawesi Province, Indonesia. The study design is a cross sectional study, with a simple random sampling. The number of the respondents are 191 midwives consist of : 24 health center midwives, 51 sub-health center midwives, 107 village’s midwives, 7 hospital midwives and 2 district health office midwives. Data was collected by using a set of structure questioner which consisted characteristic of respondent, working condition, income, experience as birth attendant, training and equipment and drugs availability. There were 4 Focus groups discussion among 40 village’s midwives (each group consist of 10 participants). Data collected was analyzed in frequency distribution, cross-tabulation and descriptively using SPSS statistical analysis. Based on data analysis mentioned above, it can be concluded as follows : 1. Indonesia government has policy to place midwive at village level to improve community health. The main task of midwive is to give maternal and child health service health promotion and strengthening community participation toward better understanding and to be able to have healthty live, beside administrative work. Midwive education system required one year training after graduation from 3 years at nursing school. Nursing school required graduation from secondary school. This education system of midwife is different with education system in Japan, where required graduation of senior high school plus 3 year schooling plus 3 year schooling and one year practice to be public health nurse. 2. Most of the midwives working at the village as temporary government employee for 3 years and can be extended when necessary. More than 50 % midwive has private practice in the field of mother and child health and family planning according to MOH regulation. The midwive a average official working time is 6.9 hours per day, and majority of midwive done extra work for about 10 hors a week. The proportion of time used per week for maternal and child health (37.68%), common disease exam and treatment (16.55%) infant health care (13.86%), under five years old health care (12.82%), case referred and death investigation (8.35%) health education (6.55%) and family planning (4.19%). 3. The first fifth rank of priority perceived by midwife are, pregnancy examination, delivery assistant, post natal care, health education and high risk mither care. There are some differences in priority setting of main activities among midwive at health center, sub-health center, village delivery post and district health office. This defferences may impact to activity chosen to be conducted when a conflict time occurs. Beside according to national policy to reduce maternal death the first priority should be high risk mother care and delivery care. When compared to the total time mention by respondent, the time used per week for main actives was 50.06%, for administrative work was 32,47% and for monitoring and supervision was 17.47%. It is indicated that midwive still spent much time for administrative. Also in priority setting for administrative work, monitoring and supervision, there are some differences among midwife at different working places. 4. Majority of delivery assisted or supervised by midwife, but still there is about 20% of delivery assisted by Traditional Birth Attendant alone. About 75% of TBA had already been trained, and the rest is untrained. And almost all midwife has good cooperation with TBA. 5. Most of the midwife think that they do not have sufficient knowledge and skills, due to shortage of training period and limited experience. But most of them have self learning habit and willing to have more training, particularly in the field of emergency care, family planning technic and communication skills for health promotion. These skills are needed for reduce their problem in serving and collaboration with community. 6. Limited number of medical equipment, drug and transportation facilities still become the main problems particularly at sub-health center and village delivery post. More than half of respondent felt satisfied with their job, while 40% of them was not satisfied. The main reasons is back to the limited facilities at their area, lack of communication or cooperation with local community and limited incomes. 7. All respondent stated that support that has been given by JICA is very helpful and they recommend to have regular monitoring or supervision meeting as well as expect to get continue support. It is recommended to have following activities in order to improve midwife knowledge and skills in conducting quality of services and in strengthening the collaboration with community : 1. Training in obstetric and neonatal emergency care that has been conducted recently need to be followed with sufficient equipment and drugs supply. Communication skills and tools need to be improve too for strengthening community participation. 2. MCH handbook can be used as a tools for improving maternal and child health promotion, so that the implementation of this book should be based on standard quality of serve procedure. In this case an on the job training need to be conducted for all midwives. 3. The need of a guidance in prioritizing activity in the field when conflicting in time. Administrative work need to be reduced by using one sheet integrated recording system for each target groups. For instance when mother and child cohort card already introduce, it is not necessary to have other recording system at health service units 4. A proper scheme in placement of village midwife need to be developed, the scheme may include, pre placement information to local community, introducing the new and role of midwife in formal meeting at village level and guideline of collaboration by upper level administrator. 5. To have experience in midwife activities which may impact to the improvement of quality serve, an exchange of local midwife with public health nurse from Japan or placement of junior experties at be considered.

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