Analysis of Indonesia’s community health volunteers (kader) as maternal health promoters in the community integrated health service (Posyandu) following health promotion training

Authors

  • Patricia Tumbelaka Eijkman Institute for Molecular Biology, Jakarta, Indonesia
  • Ralalicia Limato Eijkman Institute for Molecular Biology, Jakarta, Indonesia
  • Sudirman Nasir Faculty of Public Health, Universitas Hasanuddin, Makassar, Indonesia
  • Din Syafruddin Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Faculty of Public Health, Universitas Hasanuddin, Makassar, Indonesia
  • Hermen Ormel Royal Tropical Institute, KIT Health, Amsterdam, Netherlands
  • Rukhsana Ahmed Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20180462

Keywords:

Health promotion, Participatory training, Community health volunteers, Kader, Maternal health, Indonesia

Abstract

Background: Maternal health promotion is a task allocated to the kader (community health volunteers) in the community integrated health services called Posyandu. Yet, they are inadequately trained to perform this task. We present an analysis of the kader as maternal health promoters after their health promotion training with use of counselling card.

Methods: Between March-April 2015, 14 participatory workshops were conducted and 188 kader in four villages in Ciranjang sub-district were trained. Data were collected through in-depth interviews and focus group discussions from community members, health care providers and policy makers in the four villages. A total of 44 interviews were conducted prior to health promotion training and 48 interviews post- training. In 46 Posyandu, kader were observed during their practice of health promotion within 3 consecutive months of post training. Data was transcribed and analysed in NVivo 10.

Results: Most kader acknowledged that health promotion training improved their knowledge of maternal health and counselling skills and changed their attitude towards pregnant women at the Posyandu. They could confidently negotiate health messages and importance of health facility delivery with antenatal women. The kader also found the counselling cards helped pregnant women understand the health messages more clearly. The participatory training method involving role play and direct discussions boost kader confidence to deliver health promotion. As a result, the kader gained community appreciation which enhanced their motivation about their job.

Conclusions: Appropriate health promotion training, provided the kader with adequate knowledge and skills to become resourceful maternal health promoters in the community. 

 

References

World Health Organisation. Health in 2015: from MDGs to SDGs. 2015. Available at http://apps.who.int/iris/bitstream/10665/200009/1/9789241565110_eng.pdf?ua=1. Accessed on 19 December 2017.

Heywood P, Choi Y. Health system performance at the district level in Indonesia after decentralisation. BMC Int Health Hum Rights. 2010;10(3).

Nasir S, Ahmed R, Kurniasari M, Limato R, De Koning, K, Tulloch O, et al. Context analysis: close-to-community maternal health providers in South West Sumba and Cianjur, Indonesia. REACHOUT linking communities and health system, 2014. Available at: http://www.reachoutconsortium.org/ media/1831/indonesiacountryanalysisjuly2014compressed.pdf. Accessed on 29 September 2017.

Kementerian Kesehatan Republik Indonesia. Pedoman umum pengelolaan Posyandu. 2011. Available at: https://www.google.co.id/url?sa=t&rct =j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwi4zpGZq9HWAhVJX5QKHQDlBJ4QFggoMAA&url=http%3A%2F%2Fperpustakaan.depkes.go.id%3A8180%2Fbitstream%2F123456789%2F1649%2F2%2FBK2011-170912-4.pdf&usg=AOvVaw0amk827CK2qpDam4gTMT-y. Accessed on 2 October 2017.

Kementerian Kesehatan Republik Indonesia. Kurikulum dan modul pelatihan kader Posyandu. 2012. Available at: https://slidedokumen.com/ kurikulum-dan-modul-pelatihan-kader-posyandu_59fca5d31723dd9e40a32e01.html. Accessed 29 September 2017.

Nasir S, Magdalena A, Limato R, Tumbelaka P, Syafrudin D, Ahmed R. Impact of health promotions training of community health providers on community maternal health services in Cianjur, Indonesia. Presented at: 4th Global Symposium on Health Systems Research; November 16, 2016; Vancouver, Canada. Available at: http://www.reachoutconsortium.org/media/9993/pac00288_impact-of-health-promotion-trainings-of-community-health-providers.pdf. Accessed on 29 September 2017.

Badan Pusat Statistik Kabupaten Cianjur. Kabupaten Cianjur dalam angka. 2015. Available at https://cianjurkab.bps.go.id/index.php/publikasi/85. Accessed 10 August 2017.

Dinas Kesehatan Kabupaten Cianjur. Laporan Akhir Tahun Kesehatan Ibu Kabupaten Cianjur. 2015.

Nasir S, Ahmed R, Kurniasih M, Limato R, Tulloch O, Syafruddin D, et al. Challenges that hinders parturients to deliver in health facilities: a qualitative analysis in two districts of Indonesia. Makara J Health Res. 2016;20(3):79-87.

REACHOUT Consortium. New maternal health promotion resources from Indonesia. 2017. Available at: http://reachoutconsortium.org/news/ new-maternal-health-promotion-resources-from-Indonesia/. Accessed on 15 January 2018.

Pope C, Mays N. Qualitative research: reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ. 1995;3(11):42–45.

Mack N, Woodsong C, MacQueen KM, Guest G, Namey E. Qualitative research methods: a data collector’s field guide. 2005. Family Health International. https://www.fhi360.org/sites/default/ files/media/documents/Qualitative%20Research%20Methods%20-%20A%20Data%20Collector%27s% 20Field%20Guide.pdf. Accessed 19 December 2017.

Ritchie J, Spencer L, O’Connor W. Carrying out qualitative analysis. In: Ritchie J, Lewis J, eds. Qualitative Research Practice: A Guide for Social Science Students and Researchers. London: SAGE; 2003: 219-261.

Kok MC, Dieleman M, Taegtmeyer M, Broerse JEW, Kane SS, Ormel H, et al. Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy Plan. 2015;30:1207-27.

Kok MC, Kane SS, Tulloch O, Ormel H, Theobald S, Dieleman M, et al. How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature. Health Res Policy Syst. 2015;13:13.

Dixon-Woods M. Using framework-based synthesis for conducting reviews of qualitative studies. BMC Med. 2011;9:39.

Charmaz K. Constructing grounded theory. 2nd ed. London: SAGE; 2014.

Limato R, Ahmed R, Magdalena A, Nasir S, Kotvojs F. Use of most significant change (MSC) technique to evaluate health promotion training of maternal community health workers in Cianjur district, Indonesia. Evaluation and Program Planning. 2017;66(2018):102-10.

Gunanti IR, Devi SR, Adriani M. Pemberdayaan kader posyandu melalui penerapan metode konseling gizi dalam upaya meningkatkan kualitas pembinaan program keluarga sadar gizi (KADARZI). Buletin Penelitian Sistem Kesehatan. 2005;8(1):47-58.

Sukiarko E. Pengaruh pelatihan dengan metode belajar berdasarkan masalah terhadap pengetahuan dan keterampilan kader gizi dalam kegiatan Posyandu: studi di kecamatan Tempuran kabupaten Magelang. Masteral thesis, Universitas Diponegoro Semarang. 2007.

Kermode M, Herrman H, Arole R, White J, Premkumar R, Patel V. Empowerment of women and mental health promotion: a qualitative study in rural Maharashtra, India. BMC Public Health. 2007;7:225.

Setiyarini T. Efektivitas Pendidikan kesehatan menggunakan media leaflet dan penyuluhan individual terhadap pengetahuan pencegahan kekambuhan asma. Bachelor thesis, Universitas Muhammadiyah Surakarta. 2016.

Yustisa PF, Aryana IK, Suryasa ING. Efektivitas penggunaan media cetak dan media elektronika dalam promosi kesehatan terhadap peningkatan pengetahuan dan perubahan sikap siswa SD. Jurnal Kesehatan Lingkungan. 2014;14(1):29-39.

Widagdo L, Husodo BT. Pemanfaatan buku KIA oleh kader Posyandu: Studi pada kader Posyandu di wilayah kerja Puskesmas Kedungadem Kabupaten Bojonegoro. Makara J Health Res. 2009;13(1):39-47.

Sistiarani C, Nurhayati S, Suratman. Peran kader dalam pengunaan buku kesehatan ibu dan anak. Kemas. 2013;8(2):99-105.

Fu C, Zhu M, Yu TSI, He Y. Effectiveness of participatory training on improving occupational health in small and medium enterprises in China. Int J Occup Environ Health. 2013;19(2):85-90.

Tripathy P, Nair N, Barnett S, Mahapatra R, Borghi J, Rath S et al. Effect of a participatory intervention with women’s groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: a cluster-randomised controlled trial. Lancet. 2010;375:1182-1192.

Hien LTT, Takano T, Seino K, Ohnishi M, Nakamura K. Effectiveness of a capacity-building program for community leaders in a health living environment: a randomized community-based intervention in rural Vietnam. Health Promot Int. 2008;23(4):354-364.

Javanparast S, Baum F, Labonte R, Sanders D, Rajabi Z, Heidari G. The experience of community health workers training in Iran: a qualitative study. BMC Health Serv Res. 2012;12:291.

Kaysin A. Empowerment of community health workers as agents of change. Masteral thesis, Johns Hopkins Bloomberg School of Public Health, Baltimore. 2010.

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Published

2018-02-24

How to Cite

Tumbelaka, P., Limato, R., Nasir, S., Syafruddin, D., Ormel, H., & Ahmed, R. (2018). Analysis of Indonesia’s community health volunteers (kader) as maternal health promoters in the community integrated health service (Posyandu) following health promotion training. International Journal Of Community Medicine And Public Health, 5(3), 856–863. https://doi.org/10.18203/2394-6040.ijcmph20180462

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Original Research Articles