Level and determinants of incentives for village midwives in Indonesia

Since the early 1990s Indonesia has attempted to increase the level of skilled attendance at birth by placing rural midwives in every village in an effort to reduce persistently high levels of maternal mortality. Yet evidence suggests that there remains insufficient incentive to ensure an equal dist...

Full description

Saved in:

Bibliographic Details
Published in:	Health policy and planning 2009-01, Vol.24 (1), p.26-35
Main Authors:	Ensor, Tim, Quayyum, Zahid, Nadjib, Mardiati, Sucahya, Purwa
Format:	Article
Language:	eng
Subjects:	Community Health Workers - economics Female Health Health administration Health care Health policy health workforce human resources for health Humans Incentives Indonesia Maternal & child health maternal care Midwifery Midwifery - economics Midwives Motivation Original articles Poverty Public sector Studies Surveys and Questionnaires Village midwives Villages
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Since the early 1990s Indonesia has attempted to increase the level of skilled attendance at birth by placing rural midwives in every village in an effort to reduce persistently high levels of maternal mortality. Yet evidence suggests that there remains insufficient incentive to ensure an equal distribution across areas while the poor in all areas continue to access skilled attendance much less than those in richer groups. We report on a survey that was conducted as part of a complex evaluation of the rural midwife programme in Banten Province, to better understand the effect of financial incentives on the distribution of midwives and use of services. Midwives obtain almost two-thirds of their income from private clinical practice. Private income is strongly associated with competence and experience. Multivariate analysis suggests that midwives are well able to earn a substantial private income even in remoter areas. Yet the study also found a high level of unwillingness to move posts to a more remote area for a variety of non-financial reasons. The results suggest that the access to skilled attendance of those unable to afford fees may be impaired by the dependence on fee income, a result supported by companion household studies. In addition, ensuring that staff live and work in remoter areas is only likely to be financially sustainable if midwives can be attracted to live in these areas early in their careers. Finally, the overall strategy of basing skilled attendance mainly on village services throughout the country may need to be re-visited, with alternative models offered in areas where it continues to be impractical even with a change in the incentive framework.
ISSN:	0268-1080 1460-2237