Multilevel Model of Maternal Health Program Indicator (K4) in Health Center SOLHA ELRIFDA
[email protected]
Maternal death can be prevented with adequate antenatal care (ANC)
Antenatal care is very important
o Built mutual trust between clients and health providers o Obtained basic information about the health of the mother & her pregnancy
It can be pursued the best condition for both mother & fetus
not all pregnant women receive the adequate antenatal care mothers receive ANC from a skilled provider 83,8% (Riskesdas, 2010) 95,4% (Riskesdas, 2013) 96% (IDHS, 2012) pregnant women make four or more antenatal care visits during their pregnancy 83.5% (Riskesdas,2010) 95,6% (Riskesdas, 2013)
The study aimed to seek a multilevel model of maternal health program performance determinants (indicator K4/fourth antenatal visit) at the primary care level in Indonesia, and the policy options that can be implemented as an effort to improve the performance of the program
Mix Metods cross sectional to built predictive model Process: Review secondary data from “Indicators Achievement of Program Nutrition and MCH Strategic Plan 2012 in 8 provinces” survey, which has 2002 toddler's mother as a sample from 16 districts/cities, 64 health centers, and 128 selected villages in Indonesia
qualitative to explore the problems Process: indepth interview with stakeholders
No
Provinsi
1
Sumatera Selatan
2
Banten
3
Jawa Timur
4
Nusa Tenggara Barat
5
Nusa Tenggara Timur
6
Kalimantan Barat
7
Sulawesi Tengah
8
Maluku Utara
Kabupaten/Kota 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2.
Kabupaten Ogan Ilir Kota Palembang Kabupaten Lebak Kabupaten Serang Kabupaten Jember Kota Malang Kabupaten Lombok Utara Kota Bima Kabupaten Kupang KabupatenTimur Tengah Selatan Kabupaten Pontianak Kabupaten Sambas Kabupaten Donggala Kabupaten Parigi Moutong Kabupaten Halmahera Timur Kota Tidore
95,7% mothers receive ANC from a skilled provider, 79,2% of them make four or more antenatal care visits during their pregnancy 78.5% mothers of age 20-35 years old 63,5% have low education 83% mothers does’nt work 60% mothers has low economic level Only 56% of mothers very satisfied with ANC There is a relationship between all the individual level variables with maternal health program indicator (K4)
Low achievement of K4
pregnant women did’nt make antenatal visit to the health provider
back to the hometown, visit the TBA, high population mobility, poor knowledge, difficult access to the health facility
Maternal satisfaction to previous antenatal care contributes greatly to the performance of maternal health program
There are differences in maternal health program performance between health centers
The variabels that contribute to differences in performance between health centers are; resources, capacitation of human resources, planning, and customer focus
Satisfaction on previous ANC have contributed most to the performance of maternal health program (K4), after controlling others variabels
Mixed-effects logistic regression Group Variable: ID Puskesmas Kinerja K4 Umur Pendidikan menengah Pendidikan tinggi Bekerja tidak tetap Bekerja tetap Status ekonomi Puas Sangat Puas Pendidikan Menengah*Bekerja tidak tetap Pendidikan Menengah*Bekerja tetap Pendidikan Tinggi*Bekerja tetap Bekerja tidak tetap*Status ekonomi baik Bekerja tetap*Status ekonomi baik Sumber daya baik Sumber daya sangat baik Kapasitasi SDM baik Kapasitasi SDM sangat baik Perencanaan baik Perencanaan sangat baik Fokus pada pelanggan baik Fokus pada pelanggan sangat baik Constant Median Odds Ratio (MOR) 1,994 Median Odds Ratio (MOR) model GS 2,234 Perubahan MOR :12,036 %
Coef -0,349 0,070 -,0,122 -0,037 -0,409 0,497 1,997 2,231 -1,105 0,737 2,097 0,108 -0,195 0,795 0,471 0,494 0,124 0,748 1,039 -0,349 -0,311 -1,842
SE
P>lzl
0,148 0,194 0,521 0,299 0,383 0,191 0,218 0,218 0,686 0,578 0,767 0,316 0,673 0,278 0,314 0,655 0701 0,531 0,587 0,487 0,584 0,758
0,018 0,718 0,814 0,901 0,286 0,009 0,000 0,000 0,107 0,202 0,006 0,733 0,772 0,004 0,133 0,451 0,860 0,159 0,077 0,474 0,594 0,015
Number of observed: 2002 Number of group: 61 95% CI OR lower upper 0,705 0,527 0,942 1,072 0,734 1,569 0,885 0,319 2,455 0,963 0,536 1,731 0,664 0,313 1,407 1,644 1,131 2,389 7,368 4,802 11,306 9,312 6,078 14,268 0,331 0,086 1,269 2,091 0,673 6,497 8,146 1,813 36,614 1,114 0,599 2,070 0,823 0,220 3,076 2,214 1,283 3,819 1,602 0,866 2,965 1,638 0,454 5,912 1,132 0,286 4,477 2,111 0,745 5,983 2,825 0,894 8,927 0,705 0,272 1,832 0,733 0,233 2,299
95,7% mothers receive ANC from a skilled provider, 79,2% of them make four or more antenatal care visits during their pregnancy. The causes are: lack of knowledge, difficult access to the facility, and the socio-culture
Need to improve the health promotion, availibility of resources, and access to the facility
Mother’s satisfaction on previous ANC have contributed most to the performance of maternal health program (K4), after controlling others variabels
Need to improve the quality of ANC, make the regulation that support to the health centers to increasing customer focus effort
“THANK YOU…”
