Health reporting system in two subdistricts in Eastern Indonesia: highlighting the role of village midwives

Objective: to describe the system of health reporting by village midwives and two rural clinics in eastern Indonesia and solve some of the problems in this system through consultation.

Design: participatory action research model where problems are identified by those most affected and solutions sought. Clinic staff were observed and interviewed regarding their work roles and reporting duties. Allocation of work time to various tasks was recorded by all clinic staff before and after the implementation of a new health recording system. Several information sessions and focus group discussions were held with village midwives and other health staff to identify and address problems.

Setting: Indonesia initiated a programme in 1989, aiming to place a midwife in every village, in response to high maternal mortality rates and low rates of births attended by trained birth assistants. Remote rural villages in eastern Indonesia have difficulty recruiting and retaining village midwives. These midwives play a crucial role in health reporting. During 2010 a new system of recording and reporting by clinics was implemented.

Participants: village and clinic health staff in two rural subdistricts in eastern Indonesia.

Findings: there was incomplete coverage by village midwives in the two subdistricts studied; 28% of villages had a resident midwife, 48% had a visiting midwife and 24% had only monthly visits by a mobile clinic. Village midwives performed duties additional to their official duties and training. Village midwives had problems associated with the reporting system including inconsistency in reporting, poor access to individual patient histories and poor access to clinics. These problems resulted in incompleteness and poor timeliness of data transfer.

Key conclusions: midwives in remote villages felt compelled to provide services for which they were not trained. Poor quality of data reporting resulted from inconsistent reporting methods. Local staff can successfully change and manage reporting systems if given appropriate support and training.

Implications for practice: socialisation of health reporting systems among all staff involved can lead to improved data consistency and completeness. Effective systems for data transfer and reporting may reduce time spent on these tasks by some staff. Improvements to accuracy of data and availability of individual patient histories have the potential to contribute to improved health care. Quality of health care by village midwives should be addressed by adequate training and improved transport.