Person centered maternity care (PCMC), or more simply person-centered care (PCC), has become an accepted component of quality care for the global public health community (Quality of Care Network, 2019). While a variety of terms are used with overlapping meanings to describe ideal maternity care from the client perspective, a consensus is emerging in the global health community around the concepts of person centered care (PCC) and the more specific term respectful maternity care (RMC).There is an emerging consensus that PCC consists of several components that together comprise a client’s experience of care – specifically, effective communication with the provider of care, treatment with respect and dignity, and provision of emotional support (and also continuity of care where relevant). The World Health Organization’s framework for the quality of maternal and newborn health care has included these three components among its total of eight components of quality of care (World Health Organization, 2016). In addition to being an end in itself, better treatment of women by facility staff has been associated with a greater likelihood that they will seek facility-based delivery care (Bohren et al., 2014). Consequently, focus among global health technical organizations and Ministries of Health has widened to include creation of an environment that is respectful of women, and is not just focused on technically competent providers (Afulani and Moyer, 2019). Patience Afulani and colleagues have developed standardized scales to measure RMC and PCMC in maternity care (Afulani, 2018). Using these scales, investigators have carried out studies in a number of countries that have characterized women’s experience of care for maternity services, both qualitatively and quantitatively.
Much of the work to date has focused on PCMC during labor and delivery. Much less is known about women’s experience of care during ANC services, but there has been some initial work in the last several years to develop an analogous scale to measure person-centeredness duing ANC (Afulani 2019). There have not been any large studies to date across countries nor specifically in Indonesia to characterize women’s experience of care in ANC.
Momentum Country and Global Leadership (MCGL) Indonesia will conduct as study which seeks to quantify the prevalence of various aspects of PCMC duing ANC, using a contextualized modification of the ANC tool developed by Afulani. There is a disparity in ANC careseeking and utilization between urban and rural areas of Indonesia. According to the 2018 Riskesdas (basic health population survey carried out by the Indonesia Agency of Health Research and Development), 61% of pregnant women in NTT went to a puskesmas (health center) for ANC and only 6% to a private clinic or private practice. In contrast, 18% of women nationwide received ANC from a puskesmas and 54% from a private provider, mainly midwives (Indonesia Riskesdas 2018). So this study will separately focus on one rural district (TTS) of NTT province where women are more likely to receive most or all ANC services from the public sector and one urban district (Sidoarjo) of East Java where women are more likely to seek a mix of care between public and private facilities. This study will also look at provider determinants and attitudes towards respectful care; and will query women and their partners in the community about their preferences for key aspects of ANC service provision. The findings from the study will form the basis for developing recommendations on how to enhance the experience of care as part of the Indonesia Ministry of Health’s ongoing redesign of ANC services. To conduct the study MCGL will involve Centre for Family Welfare, Faculty of Public Health, University of Indonesia.
General research aim:
This is a mixed methods study to characterize women’s experience of care during antenatal care (ANC) services in a rural district of East Nusa Tenggara (NNT) province, Timor Tengah Selatan (TTS) and an urban district (Sidoarjo) in East Java province, Indonesia.
Specific aims of the study:
- To quantify the prevalence of selected aspects of the experience of care during ANC services in TTS district, NNT province and Sidoarjo district in East Java province, Indonesia
- To characterize clients’ preferences for key aspects of ANC experience
- To characterize providers’ and managers’ views on women’s experience of care during ANC services
- To develop recommendations to enhance the experience of care as part of the Indonesia Ministry of Health’s redesign of ANC services
This study will utilize a mixed-methods approach. Quantitative data collection and analysis will be used to estimate the prevalence of aspects of the experience of care during ANC in a typical rural and a typical urban district of Indonesia, in terms of demographics and utilization of ANC services. We will complement this understanding with qualitative descriptions of actual experiences and visions of ideal care from women who recently gave birth, their partners, health providers and managers. This information will be collected through KIIs and FGDs with each of these respondent types in each district. All this information will be used to formulate recommendations for potential use in the MOH’s redesign of ANC services.
|Survey of women who gave birth in the last 12 months
|Women recruited from immunization clinics, family planning clinics, postpartum wards, who gave birth in the last 12 months
|In both NTT and East Java: 140 women
140 x 2 = 280 women
|Focus Group Disicussions (FGDs)
|FGD with women who gave birth in in the last 12 months
|Women recruited from among those who take part in the survey (who gave birth in the last 12 months)
|In both NTT and East Java: 1 FGD in each province
5-6 women/FGD x 2 FGDs = 10-12 women
|FGD with those whose spouse/partner gave birth in the last 12 months
|Spouses/partners of women who gave birth in the last 12 months
|In both NTT and East Java: 1 FGD with men whose spouses/partners gave birth in the last 12 months
5-6 men/FGD x 2 FGDs = 10-12 men
|Key Informant Interviews (KIIs)
|Health care provider (midwife) KII script
|Health workers in public and private facilities who provide ANC services (in the same facilities where women gave birth)
NOTE: Since 90+% of ANC services are provided by midwives, we will focus attention on them
|4-5 midwives in public and in private facilities, providing ANC services in each province.
8-10/district x 2 districts =
16-20 health care providers
|Supervisors KII script
|Supervisors in charge of ANC services in the facilities where health care providers are interviewed.
|2-3 supervisors in public and in private facilities, providing ANC services in each province.
4-6/district x 2 districts =
Scope of work, Deliverables and timeline
The research institution is expected to perform the following
|Involve in preparing the study protocol and tools (qualitative and quantitative) including piloting the tools
|Assist in obtaining IRB from local ethical board and permissions from study sites
|March week 2nd, 2023
|Data collector training
|Conduct data collection (qualitative and quantitative)
|Manage the data
|April – May 2023
|Summary tables (Quantitative)
Summary qualitative data (matrix by themes by informant)
|Brief narrative report
TTD District, NTT & Sidoarjo District, East Java
PERIOD OF PERFORMANCE
March 2023 – July , 2023
|Bid invitation advertised in Media Online
|March 13th , 2023
|Bid responses due to Jhpiego
|March 22nd , 2023
|March 27th , 2023
Proposal (included budget, timeline, and project team) and Compony profile submissions should be not later than March 22nd , 2023 and please send to Contract Committee, Jhpiego Corporation