Strengthening the primary care workforce to deliver community case management for child health in rural Indonesia
Agus Setiawan A C and Angela Dawson BA Department of Community Health Nursing, Faculty of Nursing, Universitas Indonesia, Kampus Universitas Indonesia Depok, West Java 16424, Indonesia.
B The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, 15 Broadway Ultimo NSW 2007, Australia. Email: angela.dawson@uts.edu.au
C Corresponding author. Email: agus.setiawan.ui@gmail.com
Australian Health Review 42(5) 536-541 https://doi.org/10.1071/AH17092
Submitted: 29 March 2017 Accepted: 4 September 2017 Published: 2 October 2017
Abstract
Objectives The aim of the present study was to report on the implementation of community case management (CCM) to reduce infant mortality in a rural district, namely Kutai Timur, Kalimantan Indonesia.
Methods An interpretive qualitative methodology was used. In-depth interviews were conducted with 18 primary healthcare workers (PHCWs), and PHCWs were observed during a consultation with mothers to gain insight into the delivery of the new protocol and workforce issues. The field notes and interview transcripts were analysed thematically.
Results PHCWs reported that their performance had improved as a result of increased knowledge and confidence. The implementation of CCM had also reportedly enhanced the PHCWs’ clinical reasoning. However, the participants noted confusion surrounding their role in prescribing medication.
Conclusions CCM is viewed as a useful model of care in terms of enhancing the capacity of rural PHCWs to provide child health care and improve the uptake of life-saving interventions. However, work is needed to strengthen the workforce and to fully integrate CCM into maternal and child health service delivery across Indonesia.
What is known about the topic? Indonesia has successfully reduced infant mortality in the past 10 years. However, concerns remain regarding issues related to disparities between districts. The number of infant deaths in rural areas tends to be staggeringly high compared with that in the cities. One of the causes is inadequate access to child health care.
What does this paper add? CCM is a model of care that is designed to address childhood illnesses in limited-resource settings. In CCM, PHCWs are trained to deliver life-saving interventions to sick children in rural communities. In the present study, CCM improved the capacity of PHCWs to treat childhood illnesses.
What are the implications for practitioners? CCM can be considered to strengthen PHCWs’ competence in addressing infant mortality in areas where access to child health care is challenging. Policy regarding task shifting needs to be examined further so that CCM can be integrated into current health service delivery in Indonesia.
Additional keyword: primary health care workers.
References
[1] United Nations Children’s Fund (UNICEF). UNICEF Data: Monitoring the Situation of Children and Women. 2015. Available at: https://data.unicef.org/topic/child-survival/under-five-mortality/ [verified 16 September 2017].[2] United Nations. Sustainable development goals: 17 goals to transform our world. Goal 3: ensure healthy lives and promote well-being for all at all ages. 2016. Available at: http://www.un.org/sustainabledevelopment/health/ [verified 16 September 2017].
[3] The World Bank. Mortality rate, infant (per 1,000 live births). 2016. Available at: http://data.worldbank.org/indicator/SP.DYN.IMRT.IN [verified 16 September 2017].
[4] Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Pediatrics 2005; 115 519–617.
| Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence.Crossref | GoogleScholarGoogle Scholar |
[5] Mason E, Scherpbier R, Lawe-Davies O. WHO position statement on IMCI. Lancet 2009; 374 782–3.
| WHO position statement on IMCI.Crossref | GoogleScholarGoogle Scholar |
[6] Ahmed HM, Mitchella M, Hedta B. National implementation of integrated management of childhood illness (IMCI): policy constraints and strategies. Health Policy 2010; 96 128–33.
| National implementation of integrated management of childhood illness (IMCI): policy constraints and strategies.Crossref | GoogleScholarGoogle Scholar |
[7] Horwood C, Voce A, Vermaak K, Rollins N, Qaz S. Experiences of training and implementation of integrated management of childhood illness (IMCI) in South Africa: a qualitative evaluation of the IMCI case management training course. BMC Pediatr 2009; 9 62
| Experiences of training and implementation of integrated management of childhood illness (IMCI) in South Africa: a qualitative evaluation of the IMCI case management training course.Crossref | GoogleScholarGoogle Scholar |
[8] Kalimantan Timur Province Health Office. Kalimantan Timur health profile 2014. Samarinda: Kutai Timur Province Health Office; 2015.
[9] Marsh D, Aakesson A, Anah K, Bartlett A, Bolles K, Blackett-Dibinga K, Briggs J, Bryce J, Chaney S, Crystal P, Dawson P, d’Harcourt E, Ellis A, Haxall K, Harrigan P, Hilari C, Houston R, McGorman L, Morales L, Paredes P, Pooley B, Tsuma L, Reilly E, Ricca J, Rosales A, Siegel A, Silimperi D, Stanley J, Starbuck E, Swedberg E, Thiam A, Thumm M, Wansi E, Winch P, Wolfheim C. Community case management essentials. Treating common childhood illnesses in the community. A guide for program managers. 2009. Available at: http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/CCM-Essentials-PM-Guide_Final-Sept-2009.pdf [verified 16 September 2017].
[10] Setiawan A, Dignam D, Waters C, Dawson A. Improving access to child health care in Indonesia through community case management. Matern Child Health J 2016; 20 2254–60.
| Improving access to child health care in Indonesia through community case management.Crossref | GoogleScholarGoogle Scholar |
[11] Rasanathan K, Muñiz M, Bakshi S, Kumar M, Solano A, Kariuki W, George A, Sylla M, Nefdt R, Young M, Diaz T. Community case management of childhood illness in sub-Saharan Africa – findings from a cross-sectional survey on policy and implementation. J Glob Health 2014; 4 020401
[12] Bappeda Kabupaten Kutai Timur. Profil Daerah Kabupaten Kutai Timur [In Indonesian]. 2015. Available at: http://bappeda.kutaitimurkab.go.id/bappeda-kutim/imgs/download/211838044316-Profil-Kutai-Timur-2015. pdf / [verified 16 September 2017].
[13] Kutai Timur District Health Office. Kutai Timur health profile. Sangatta: Kutai Timur District Health Office; 2010.
[14] Kutai Timur District Health Office. MCHIP. District Team Problem Solving to reduce infant mortality and improve maternal health. Sangatta: Kutai Timur District Health Office; 2011.
[15] World Health Organization. Human Resource for Health country profile Indonesia. 2012. Available at: http://www.searo.who.int/entity/human_resources/data/ino_profile.pdf [Verified 1 October 2016]
[16] Ministry of Health. Guidelines for managing health service for older people. Jakarta: Ministry of Health; 2003.
[17] Atkinson R, Flint J. Accessing hidden and hard-to-reach populations: snowball research strategies. Soc Res Update 2001; 33. Available at: http://sru.soc.surrey.ac.uk/SRU33.pdf [verified 12 September 2017]
[18] Temple B, Young A. Qualitative research and translation dilemmas. Qual Res 2004; 4 161–78.
| Qualitative research and translation dilemmas.Crossref | GoogleScholarGoogle Scholar |
[19] Freshwater D, Rolfe G. Critical reflexivity: a politically and ethically engaged research method for nursing. NT Research 2001; 6 526–37.
| Critical reflexivity: a politically and ethically engaged research method for nursing.Crossref | GoogleScholarGoogle Scholar |
[20] Morse JM. Emerging from the data: the cognitive processes of analysis in qualitative inquiry. In: Morse JM, editor. Critical issues in qualitative research methods. Thousand Oaks: Sage; 1994. pp. 23–43.
[21] Peshkin A. The nature of interpretation in qualitative research. Educ Res 2000; 29 5–9.
| The nature of interpretation in qualitative research.Crossref | GoogleScholarGoogle Scholar |
[22] The World Bank. World Bank country and lending groups. 2012. Available at: http://data.worldbank.org/about/country-classifications [verified 4 September 2015].
[23] Nguyen DTK, Leung KK, McIntyre L, Ghali WA, Sauve R. Does integrated management of childhood illness (IMCI) training improve the skills of health workers? A systematic review and meta-analysis. PLoS One 2013; 8 e66030
| Does integrated management of childhood illness (IMCI) training improve the skills of health workers? A systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXhtVanu7zN&md5=58649ba08591e0b1425802d52b0b033aCAS |
[24] Bosch–Capblanch X, Marceau C. Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: a scoping review of programmatic evidence. J Glob Health 2014; 4 020403
| Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: a scoping review of programmatic evidence.Crossref | GoogleScholarGoogle Scholar |
[25] Capper C. Confidence. In: Mason-Whitehead E, Mcintosh A, Bryan A, Mason T, editors. Key concepts in nursing. London: Sage; 2008. pp. 79–83.
[26] Brown B, O’Mara L, Hunsberger M, Love B, Black M, Carpio B, Crooks D, Noesgaard C. Professional confidence in baccalaureate nursing students. Nurse Educ Pract 2003; 3 163–70.
| Professional confidence in baccalaureate nursing students.Crossref | GoogleScholarGoogle Scholar |
[27] Holland K, Middleton L, Uys L. Professional confidence: a concept analysis. Scand J Occup Ther 2012; 19 214–24.
| Professional confidence: a concept analysis.Crossref | GoogleScholarGoogle Scholar |
[28] Dekel R, Hantman S, Ginzburg K, Solomon Z. The cost of caring? Social workers in hospitals confront ongoing terrorism. Br J Soc Work 2007; 37 1247–61.
| The cost of caring? Social workers in hospitals confront ongoing terrorism.Crossref | GoogleScholarGoogle Scholar |
[29] Crooks D, Carpio B, Brown B, Black M, O’Mara L, Noesgaard C. Development of professional confidence by post diploma baccalaureate nursing students. Nurse Educ Pract 2005; 5 360–7.
| Development of professional confidence by post diploma baccalaureate nursing students.Crossref | GoogleScholarGoogle Scholar |
[30] Simmons B. Clinical reasoning: concept analysis. J Adv Nurs 2010; 66 1151–8.
| Clinical reasoning: concept analysis.Crossref | GoogleScholarGoogle Scholar |
[31] Rowe AK, de Savigny D, Lanata F, Victora CG. How can we achieve and maintain high-quality performance of health workers in low-resource settings? Lancet 2005; 366 1026–35.
| How can we achieve and maintain high-quality performance of health workers in low-resource settings?Crossref | GoogleScholarGoogle Scholar |
[32] Mathauer I, Imhoff I. Health worker motivation in Africa: the role of non-financial incentives and human resource management tools. Hum Resour Health 2006; 4 24
| Health worker motivation in Africa: the role of non-financial incentives and human resource management tools.Crossref | GoogleScholarGoogle Scholar |
[33] Victora CG, Hanson K, Bryce J, Vaughan JP. Achieving universal coverage with health interventions. Lancet 2004; 364 1541–8.
| Achieving universal coverage with health interventions.Crossref | GoogleScholarGoogle Scholar |
[34] Widayati A, Suryawati S, de Crespigny C, Hiller JE. Beliefs about the use of nonprescribed antibiotics among people in Yogyakarta City, Indonesia: a qualitative study based on the theory of planned behavior Asia Pac J Public Health 2015; 27 NP402–13.
| Beliefs about the use of nonprescribed antibiotics among people in Yogyakarta City, Indonesia: a qualitative study based on the theory of planned behaviorCrossref | GoogleScholarGoogle Scholar |
[35] Idris F. Task delegation versus task shifting in the Indonesian health service. World Med J 2011; 57 62–4.
[36] Trisnantoro L, Soemantri S, Singgih B, Pritasari K, Mulati E, Agung FH, Weber MW. Reducing child mortality in Indonesia. Bull World Health Organ 2010; 88 642
| Reducing child mortality in Indonesia.Crossref | GoogleScholarGoogle Scholar |
[37] Kane SS, Gerretsen B, Scherpbier R, Poz MD, Dieleman M. A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries. BMC Health Serv Res 2010; 10 286
| A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries.Crossref | GoogleScholarGoogle Scholar |
