Effects of Decentralized Health-Care Financing on Maternal Care in Indonesia

Hartwig, Renate; Sparrow, Robert; Budiyati, Sri; Yumna, Athia; Warda, Nila; Suryahadi, Asep; Bedi, Arjun S.

doi:10.1086/698312

Cited by 4 publications

(3 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(Johar et al, 2018) (Kamal et al, 2016) These ndings made sense as the availability of human resources and facilities is still much lower in Eastern Indonesia compared to other regions. (Hartwig et al, 2019) (Teplitskaya and Dutta, 2018) (Nababan et al, 2018) Poor accessibility was also a key barrier, such as distance to health facilities and poor referral system. The previous nding suggested that distance to health facilities was the primary factor for pregnant women in selecting delivery services.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Health Insurance on Maternal Health Care in Indonesia: A Systematic Review

Hamzah

Afladhanti

Rafika

et al. 2023

Preprint

View full text Add to dashboard Cite

Background Indonesia still has the highest maternal mortality rate (MMR) compared to other countries in Southeast Asia. In Indonesia, most maternal deaths occur before, during, or after delivery. Therefore, Indonesia’s government has rolled out various health insurance schemes so they have access to maternal healthcare services. This review aims to evaluate the impact of health insurance on maternal health care in Indonesia.Methods All searches for relevant studies were performed in PubMed, Science Direct, Cochrane, and Garuda databases. This review focuses on RCT or observational study, and only articles written in English and Indonesian were retrieved. The main outcome was the utilization of maternal services and patient satisfaction.Results A total of 140,555 participants were enrolled with ten studies that met the inclusion criteria. Of these, seven studies reported on National Health Insurance (NHI) and the remaining reported on Local Health Insurance (LHI). Both NHI and LHI studies showed that insurance increases the use of maternal health care services significantly, including antenatal, delivery, and postnatal care services. Only two studies reported patient satisfaction. The LHI study showed that insurance increases the patient’s level of satisfaction significantly. On the other hand, the NHI study showed there is no difference between NHI and non-NHI patients’ levels of satisfaction. This was due to complicated procedures and long examination times for NHI users.Conclusion The implementation of health insurance appears to increase the utilization of maternal health care services, although the result on patients’ satisfaction is inconsistent between NHI and LHI studies.

show abstract

Section: Discussionmentioning

confidence: 99%

The Impact of Health Insurance on Maternal Health Care in Indonesia: A Systematic Review

Hamzah

Afladhanti

Rafika

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Maternal health care is an integral part of the MDGs. However, most developing countries have been experimenting with different types of interventions to increase access and utilization of maternal care services, including, subsidies, vouchers and decentralization (Hartwig et al, 2015). As such, devolution has been advocated as a response to most healthcare ills, and nations around the world have increasingly adapted it as a strategy to improve governance and remedy institutional deficiencies which highly centralized governments have experienced (Mabonga, 2017).…”

Section: Statement Of the Problemmentioning

confidence: 99%

Effects of Devolution on Maternal Health Care: The Case of Level Four Hospitals in Nairobi City County, Kenya

Bulinda¹,

Kiruthu²

2019

IJCAB

View full text Add to dashboard Cite

Maternal healthcare is an integral part of the Millennium development goals. However, most developing countries have been experimenting with different types of interventions to increase access and utilization of maternal care services. Health care devolution was greeted with great anticipation in Kenya as a means of bringing services closer to the people. However, since the implementation of the recent devolution reforms, criticism has mounted, with evidence of corruption, poor management, late payment of county staff and considerable disaffection among service providers, especially health professionals. Thus, this study assessed the effects of devolution on maternal health care in Nairobi City County in Kenya. Particularly, the study examined the situation of maternal healthcare before and after devolution and how devolution as affected provision of maternal healthcare in Nairobi City County. The study also assessed how devolution affected maternal health care programs implementation and the challenges facing the devolved maternal health care in Nairobi City County. The study adopted the systems approach and the decentralization theorem. This study employed a descriptive research design and the population of the study was made up of the 4 level four hospitals in Nairobi County and all the 189 selected medical health workers in the hospitals. A sample of 57 respondents was selected through simple random sampling. Additionally, the study used questionnaires and an interviews guide to collect data. The questionnaires were administered to the sampled medical workers and the interviews schedules were administered to the key informants who comprised of the medical superintendent from every hospital. Quantitative data was collected through the use of the questionnaires was analyzed using descriptive statistics with the aid of the Statistical Package for Social Sciences. Qualitative data was analyzed using content analysis. The study found that the status of maternal healthcare infrastructure under devolution of health services in Nairobi was good. The findings also established that most health workers preferred that the national government should manage maternal health care infrastructure as opposed to county governments. The study further revealed that county governments had not instituted and implemented effective maternal healthcare programs formulated by the national government. Finally, the study concludes the major challenges influencing the implementation of maternal healthcare services include attitude and perception of health professionals, resistance of devolution by health workers, strikes by health workers, shortage of healthcare workers corruption and tribalism, increased pressure on hospital equipment and infrastructure and stock outs of essential commodities in the facilities affect devolved maternal health care. The study recommended that both the county and national government should work together and combine their efforts to enhance the devolved systems of healthcare so that they can enhance maternal healthcare. This is an open-access article published and distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License of United States unless otherwise stated. Access, citation and distribution of this article is allowed with full recognition of the authors and the source.

show abstract

“…In 2012, MMR was reported as 359/100,000 live births [ 6 ]. The maternal health programs focused on increasing the number of skilled personnel and promoted facility based births [ 7 ]. For example, in East Kalimantan province, where about 90% of women receive antenatal care (ANC) from skilled midwives and more than 84% of women have access to a skilled birth attendant at delivery, the MMR was still high at 175/100,000 [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors

Mahmood

Mufidah

Scroggs

et al. 2018

BioMed Research International

View full text Add to dashboard Cite

Background Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Method Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. Findings The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. Conclusion There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped.

show abstract

Effects of Decentralized Health-Care Financing on Maternal Care in Indonesia

Cited by 4 publications

References 24 publications

The Impact of Health Insurance on Maternal Health Care in Indonesia: A Systematic Review

The Impact of Health Insurance on Maternal Health Care in Indonesia: A Systematic Review

Effects of Devolution on Maternal Health Care: The Case of Level Four Hospitals in Nairobi City County, Kenya

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors

Contact Info

Product

Resources

About