Groundwork for Strengthening the Rural Health System: How to Revitalize the Roles of Village Midwives?
The establishment of Village-based Midwife Program (VBMP) is anticipated to improve access to, equity and coverage of, PHC especially for mother and child living even in the remote areas. However, problems on its performance had been reported, while the root of the problems was limitedly studied. This study was then focused on the MOA (management-organization-administration) of VBMP which was related to the VMs‟ capacity in delivering PHC. This is reporting the results of formative research prior to the development of a comprehensive VBMP plan in Area Development Program (ADP) of Wahana Visi Indonesia at Nias District. Supportive objectives such as assessing the potential determinants of VMs‟ performance in delivering VBMP, community acceptance, participation, and utilization of VBMP at rural Nias were also carried out. The study was conducted in 3 sub-districts namely Hiliduho, Botomuzoi and Hiliserangkai from August 2011 to March 2012. Following two conceptual models: Health System Model at meso and micro levels (Kielmann, 2008) and Organizational Behavior Model (Wibowo, 2009), data were gathered using mixed (quantitative and qualitative) methods from various sources. The utilization of VBMP was considerably low (66%) relative to its acceptance (96%) by mothers. This was attributed to some factors, but mainly its accessibility because most of the VMs did not reside in the village (71%). The fact that no such responsive monitoring system to detect and immediately correct the program fallacies might indicate the poor comprehension on the pre-designed VBMP master plan as well as the inexistence of its detail operational plan at the district level and below. In such affected the clarity on management responsibilities of each institution and its individual stakeholders within it. With no predesigned management system to ensure the proper implementation and evaluation of the program, what had been performed so far was still relied mainly on personal initiative rather than resultant of a well established system. This was reflected on the patchiness, loss of continuity, inefficiency, and unsustainable approaches in running the program.