Does Health Center Have Contextual Effect on Midwife Performance? Multilevel Analysis Evidence from East Kalimantan, Indonesia

Abstract

Background:The maternal mortality rate (MMR) which is still high has now become the priority in order to find its solution. Midwives play a very significant role in making efforts to reduce MMR through antenatal care (ANC) services. The performance of midwives directly influences the quality of service and health outcomes in the public health centers. The performance of midwives in ANC can be seen based on the coverage of K1 and K4. This study aimed to determine the contextual effect of public health centers and other factors that influence the performance of midwives in antenatal care services. Subjects and Method: This study was conducted using observational analytic with cross sectional approach. It was done in 25 health centers in Samarinda, East Kalimantan in April-May 2019. The number of samples was 180 midwives selected using the total sampling technique. The dependent variable is the performance of the midwife. The independent variables include age, knowledge, tenure, training, workload, incentive, supervision, and motivation. The data were collected by questionnaire and analyzed by multilevel multiple logistic regression. Results: Midwife performance was influenced by age >45 years (b = -2.48; 95% CI = -4.53 to -4.34; p = 0.018), good knowledge (b = 1.35; 95% CI = 0.38 to 2.31; p = 0.006), tenure ≥13 years (b = 1.89; 95% CI = -0.07 to 3.86; p = 0.059), training ≥2 (b = 1.30; 95% CI = 0.29 to 2.30; p = 0.011), heavy workload (b = -1.30; 95% CI = -2.27 to -0.34; p = 0.008), incentive (b = 1.74; 95% CI = 0.30 to 3.18; p = 0.018), supervision (b = 1.12; 95% CI = 0.19 to 2.05; p = 0.017), and high motivation (b = 1.42; 95% CI = 0.45 to 2.38; p = 0.004). There was no contextual influence of public health center on the performance of midwives in antenatal care services (ICC = <1%). Conclusion: Age, knowledge, tenure, training, workload, incentives, supervision, and motivation are associated with midwives performance. There is no contextual influence of public health centers on the performance of midwives.

Are the Leadership Style and Motivation Influence the Work Performance of Health Center Personnel?

“…This study is in line with Rahmadani et al, (2019) which states that motivation has an influence on the performance of midwives and is statistically significant. Midwives who have high motivation perform better than midwives with low motivation.…”

“…This study is in line with Rahmadani et al, (2019) which states that tenure has an influence on the performance of midwives and is statistically important. Midwives with >13 years of service tend to have better performance than midwives with <13 years of service.…”