Background The in-hospital stay following childbirth is a critical time for education and support of new mothers to establish breastfeeding. The WHO/UNICEF ‘Ten Steps to Successful Breastfeeding (Ten Steps)’ was launched globally in 1989 to encourage maternity services to educate and support mothers to breastfeed. The strategy is effective, however its uptake within health systems and facilities has been disappointing. We aimed to understand midwives’ and nurses’ experiences of implementing the Ten Steps in an Indonesian hospital. Methods This qualitative study was conducted in an Indonesian hospital which has been implementing the Ten Steps since the hospital’s establishment in 2012. Fourteen midwives and nurses participated in a focus group in January 2020. Data were analyzed using thematic analysis. Results We identified five themes that represented midwives’ and nurses’ experiences of implementing the Ten Steps in this Indonesian maternity unit: 1) Human rights of child and mother, 2) Dependency on precarious leadership, 3) Lack of budget prioritization, 4) Fragmented and inconsistent implementation of the Ten Steps across the health system, and 5) Negotiating with family, community and culture. The results highlighted a dependency on local hospital champions and a lack of budget prioritization as barriers to implementation, as well as health system gaps which prevented the enablement of mothers and families to establish and maintain breastfeeding successfully in Indonesian maternity services. Conclusions As Indonesia has one of the largest populations in South East Asia, it is an important market for infant milk formula, and health services are commonly targeted for marketing these products. This makes it especially important that the government invest strongly in Ten Steps implementation. Continuity of care within and across the health system and leadership continuity are key factors in reinforcing its implementation. The study findings from this Indonesian maternity care facility re-emphasize WHO recommendations to integrate the Ten Steps into national health systems and increase pre-service education on breastfeeding for health care professionals.
Background: Service quality at Kendangsari Merr Mother and Child Hospital is expected to compete with other private hospitals, especially maternity hospitals. Nevertheless, several months after its opening, the hospital received a few complaints from its patients. Aims: This study analyzed patient satisfaction to increase the service quality at Kendangsari Merr Mother and Child Hospital using RATER parameters. Methods: This study was an observational study that used a cross-sectional design. It was conducted at Kendangsari Merr Mother and Child Hospital from 27 to 31 October 2014. The respondents were taken from a total population of all inpatients and outpatients during the survey. The instrument used was a questionnaire using service quality indicators, such as Reliability, Assurance, Tangible, Empathy and Responsiveness (RATER) parameters. Results: The respondents' assessment of the service quality at Kendangsari Merr Mother and Child Hospital was good with an average score of 81%. In terms of assurance, tangible, and empathy factors, most of the patients assessed that they received better services than what they expected. Conclusion: Some other poor aspects of the service quality should be improved. They include the punctuality of doctor practice, doctors' skills, public facilities, politeness and awareness of staff pharmacists in treating patients' drugs as prescribed. waktu praktek dokter, kemampuan dokter, fasilitas umum, kesopanan petugas farmasi dalam melayani kebutuhan pasien.Kata kunci: harapan, kepuasan pasien, kualitas pelayanan, penilaian.
Background Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These were developed to ensure that maternity services remove barriers for mothers and families to successfully initiate breastfeeding and to continue breastfeeding through referral to community support after hospital discharge. While more than three in four births in Australia take place in public hospitals, in 2020 only 26% of Australian hospitals were BFHI-accredited. So what is the social return to investing in BFHI accreditation in Australia, and does it incentivize BFHI accreditation? This study aimed to examine the social value of maintaining the BFHI accreditation in one public maternity unit in Australia using the Social Return on Investment (SROI) framework. This novel method was developed in 2000 and measures social, environmental and economic outcomes of change using monetary values. Method The study was non-experimental and was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital with around 1000 births annually. This facility provided an opportunity to illustrate costs for maintaining BFHI accreditation in a relatively affluent urban population. Stakeholders considered within scope of the study were the mother-baby dyad and the maternity facility. We interviewed the hospital’s Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. Analysis was informed by the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. This information was supplemented with micro costing studies from the literature that measure the benefits of the BFHI. Results The social return from the BFHI in this facility was calculated to be AU$ 1,375,050. The total investment required was AU$ 24,433 per year. Therefore, the SROI ratio was approximately AU$ 55:1 (sensitivity analysis: AU$ 16–112), which meant that every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit. Conclusions Scaled up nationally, the BFHI could provide important benefits to the Australian health system and national economy. In this public hospital, the BFHI produced social value greater than the cost of investment, providing new evidence of its effectiveness and economic gains as a public health intervention. Our findings using a novel tool to calculate the social rate of return, indicate that the BHFI accreditation is an investment in the health and wellbeing of families, communities and the Australian economy, as well as in health equity.
Background: Exclusive breastfeeding is a problem of maternal and child health in Indonesia. With Breastfeeding Support Group, exclusive breastfeeding is expected to improve. Sugihwaras Village and Sumbergede Village have been initiating Breastfeeding Support Group program. However, the framework of Breastfeeding Support Group program and intervention methods for pregnant and breastfeeding mothers in both villages were different.Aim: It analyzed the effectiveness of forming Breastfeeding Support Group program and intervention programs for pregnant and breastfeeding mothers to improve exclusive breastfeeding in Sugihwaras Village and Sumbergede Village.Methods: This study used a case study approach to the formation of Breastfeeding Support Group program. Comparative analysis was done descriptively by selecting samples from the Fieldwork Report of Group 14 and 15 in the period of 2017/2018, Faculty of Public Health, Universitas Airlangga. This study applied total sampling technique and descriptive analysis by comparing community’s characteristics (as input), a form of intervention and program management (as a process), and results of evaluating the formation of Breastfeeding Support Group (as an output).Results: Community’s characteristics in both villages tend to be similar, and the average duration of each program was the same. Sumbergede Village focused on the readiness of forming cadres for Breastfeeding Support Group program, while Sugihwaras Village focused on breastfeeding mothers and their husbands. Indicator analysis of the program showed that Sumbergede Village (80.00% achieved) had a 5.71% higher percentage of attainment compared to Sugihwaras Village (85.71% achieved). Analysis of the program’s strengths and weaknesses pointed out that Sumbergede Village had more values and power in resources in its region.Conclusion: The intervention program in Sumbergede Village tends to be more effective. It has greater potential to be a sustainable program in the following year to improve 100% exclusive breastfeeding. Keywords: Breastfeeding Support Group, exclusive breastfeeding, intervention, effectiveness.
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