Strengthening the primary care workforce to deliver community case management for child health in rural IndonesiaAgus Setiawan A C and Angela Dawson B
A 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: firstname.lastname@example.org
C Corresponding author. Email: email@example.com
Australian Health Review - https://doi.org/10.1071/AH17092
Submitted: 29 March 2017 Accepted: 4 September 2017 Published online: 2 October 2017
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.
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