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Health Policy and Planning Advance Access published online on October 30, 2007
Health Policy and Planning, doi:10.1093/heapol/czm036
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2007; all rights reserved.

Midwifery provision in two districts in Indonesia: how well are rural areas served?

Krystyna Makowiecka1,*, Endang Achadi2, Yulia Izati2 and Carine Ronsmans1

1Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
2Centre for Family Welfare, University of Indonesia, Depok, West Java, Indonesia.

*Corresponding author. Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Tel: +44 (0) 20 7927 2812. Email: krystyna.makowiecka{at}lshtm.ac.uk

Attention has focused recently on the importance of adequate and equitable provision of health personnel to raise levels of skilled attendance at delivery and thereby reduce maternal mortality. Indonesia has a village-based midwife programme that was intended to increase the rate of professional delivery care and redress the urban/rural imbalance in service provision by posting a trained midwife in every village in the country. We present findings on the distribution of midwifery provision in our study area: 10% of villages do not have a midwife but a nurse as a midwifery provider; there is a deficit in midwife density in remote villages compared with urban areas; those assigned to remote areas are less experienced; midwives manage few births and this may compromise their capacity to maintain professional skills; over 90% of non-hospital deliveries take place in the woman's (64%) or the midwife's (28%) home; three-quarters of midwives did not make regular use of the fee exemption scheme; midwives who live in their assigned village spend more days per month on clinical work there. We conclude that adequate provider density is an important factor in effective health care and that efforts should be made to redress the imbalance in provision, but that this can only contribute to reducing maternal mortality in the context of a supportive professional environment and timely access to emergency obstetric care.

Key Words: Midwife, Indonesia, maternal health, workforce, workload, delivery, distribution, density, equity

Accepted for publication 13 August 2007.


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