Multilevel Model of Maternal Health Program Indicator (K4) in Health Center. SOLHA ELRIFDA

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Yulia Kurnia
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1 Multilevel Model of Maternal Health Program Indicator (K4) in Health Center SOLHA ELRIFDA

health providers o Obtained basic information about the health of the

3 Maternal death can be prevented with adequate antenatal care (ANC) Antenatal care is very important o Built mutual trust between clients and health providers o Obtained basic information about the health of the mother & her pregnancy It can be pursued the best condition for both mother & fetus

4 not all pregnant women receive the adequate antenatal care mothers receive ANC from a skilled provider 83,8% (Riskesdas, 2010) 95,4% (Riskesdas, 2013) 96% (IDHS, 2012) pregnant women make four or more antenatal care visits during their pregnancy 83.5% (Riskesdas,2010) 95,6% (Riskesdas, 2013)

5 The study aimed to seek a multilevel model of maternal health program performance determinants (indicator K4/fourth antenatal visit) at the primary care level in Indonesia, and the policy options that can be implemented as an effort to improve the performance of the program

Mix Metods cross sectional to built predictive model Process: Review secondary data from Indicators Achievement of Program Nutrition and MCH Strategic Plan 2012 in 8 provinces survey, which has

6 Mix Metods cross sectional to built predictive model Process: Review secondary data from Indicators Achievement of Program Nutrition and MCH Strategic Plan 2012 in 8 provinces survey, which has 2002 toddler's mother as a sample from 16 districts/cities, 64 health centers, and 128 selected villages in Indonesia qualitative to explore the problems Process: indepth interview with stakeholders

7 No Provinsi Kabupaten/Kota 1 Sumatera Selatan 1. Kabupaten Ogan Ilir 2. Kota Palembang 2 Banten 1. Kabupaten Lebak 2. Kabupaten Serang 3 Jawa Timur 1. Kabupaten Jember 2. Kota Malang 4 Nusa Tenggara Barat 1. Kabupaten Lombok Utara 2. Kota Bima 5 Nusa Tenggara Timur 1. Kabupaten Kupang 2. KabupatenTimur Tengah Selatan 6 Kalimantan Barat 1. Kabupaten Pontianak 2. Kabupaten Sambas 7 Sulawesi Tengah 1. Kabupaten Donggala 2. Kabupaten Parigi Moutong 8 Maluku Utara 1. Kabupaten Halmahera Timur 2. Kota Tidore

9 95,7% mothers receive ANC from a skilled provider, 79,2% of them make four or more antenatal care visits during their pregnancy 78.5% mothers of age years old 63,5% have low education 83% mothers does nt work 60% mothers has low economic level Only 56% of mothers very satisfied with ANC There is a relationship between all the individual level variables with maternal health program indicator (K4)

11 Low achievement of K4 pregnant women did nt make antenatal visit to the health provider back to the hometown, visit the TBA, high population mobility, poor knowledge, difficult access to the health facility

13 Maternal satisfaction to previous antenatal care contributes greatly to the performance of maternal health program There are differences in maternal health program performance between health centers The variabels that contribute to differences in performance between health centers are; resources, capacitation of human resources, planning, and customer focus Satisfaction on previous ANC have contributed most to the performance of maternal health program (K4), after controlling others variabels

14 Mixed-effects logistic regression Number of observed: 2002 Group Variable: ID Puskesmas Number of group: 61 95% CI Kinerja K4 Coef SE P>lzl OR lower upper Umur -0,349 0,148 0,018 0,705 0,527 0,942 Pendidikan menengah Pendidikan tinggi 0,070 -,0,122 0,194 0,521 0,718 0,814 1,072 0,885 0,734 0,319 1,569 2,455 Bekerja tidak tetap Bekerja tetap -0,037-0,409 0,299 0,383 0,901 0,286 0,963 0,664 0,536 0,313 1,731 1,407 Status ekonomi 0,497 0,191 0,009 1,644 1,131 2,389 Puas Sangat Puas 1,997 2,231 0,218 0,218 0,000 0,000 7,368 9,312 4,802 6,078 11,306 14,268 Pendidikan Menengah*Bekerja tidak tetap Pendidikan Menengah*Bekerja tetap Pendidikan Tinggi*Bekerja tetap -1,105 0,737 2,097 0,686 0,578 0,767 0,107 0,202 0,006 0,331 2,091 8,146 0,086 0,673 1,813 1,269 6,497 36,614 Bekerja tidak tetap*status ekonomi baik Bekerja tetap*status ekonomi baik 0,108-0,195 0,316 0,673 0,733 0,772 1,114 0,823 0,599 0,220 2,070 3,076 Sumber daya baik Sumber daya sangat baik 0,795 0,471 0,278 0,314 0,004 0,133 2,214 1,602 1,283 0,866 3,819 2,965 Kapasitasi SDM baik Kapasitasi SDM sangat baik 0,494 0,124 0, ,451 0,860 1,638 1,132 0,454 0,286 5,912 4,477 Perencanaan baik 0,748 0,531 0,159 2,111 0,745 5,983 Perencanaan sangat baik 1,039 0,587 0,077 Fokus pada pelanggan baik -0,349 0,487 0,474 Fokus pada pelanggan sangat baik -0,311 0,584 0,594 Constant -1,842 0,758 0,015 Median Odds Ratio (MOR) 1,994 Median Odds Ratio (MOR) model GS 2,234 Perubahan MOR :12,036 % 2,825 0,705 0,733 0,894 0,272 0,233 8,927 1,832 2,299

15 95,7% mothers receive ANC from a skilled provider, 79,2% of them make four or more antenatal care visits during their pregnancy. The causes are: lack of knowledge, difficult access to the facility, and the socio-culture Need to improve the health promotion, availibility of resources, and access to the facility

16 Mother s satisfaction on previous ANC have contributed most to the performance of maternal health program (K4), after controlling others variabels Need to improve the quality of ANC, make the regulation that support to the health centers to increasing customer focus effort

17 THANK YOU

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