Descriptive Study of Person-Centered Care during Antenatal Care in NTT and East Java Provinces, Indonesia 160 views

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Introduction

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.

OBJECTIVES

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:

  1. 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
  2. To characterize clients’ preferences for key aspects of ANC experience
  3. To characterize providers’ and managers’ views on women’s experience of care during ANC services
  4. To develop recommendations to enhance the experience of care as part of the Indonesia Ministry of Health’s redesign of ANC services

Study methodology

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.

Study sample

Tool #ToolRespondent TypeSample size
QUANTITATIVE
Survey
1Survey of women who gave birth in the last 12 monthsWomen recruited from immunization clinics, family planning clinics, postpartum wards, who gave birth in the last 12 monthsIn both NTT and East Java: 140 women

140 x 2 = 280 women

QUALITATIVE
Focus Group Disicussions (FGDs)
2FGD with women who gave birth in  in the last 12 monthsWomen 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

3FGD 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)
4Health care provider (midwife) KII scriptHealth 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

5Supervisors KII scriptSupervisors 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 =

8-12 supervisors

Scope of work, Deliverables and timeline

The research institution is expected to perform the following

No.TasksDeliverable Timeline
1.Involve in preparing the study protocol and tools (qualitative and quantitative) including piloting the toolsStudy protocol

Study tools

March, 2023
2.Assist in obtaining IRB from local ethical board and permissions from study sitesIRB approval

Local permissions

March week 2nd, 2023
3.Data collector trainingActivity reportMarch 2023
4.Conduct data collection (qualitative and quantitative)Raw dataApril 2023
5.Manage the dataClean dataApril – May 2023
6.Data analysisSummary tables (Quantitative)

Summary qualitative data (matrix by themes by informant)

May 2023
7.Report writingBrief narrative reportJune 2023

LOCATION

TTD District, NTT & Sidoarjo District, East Java

PERIOD OF PERFORMANCE

March  2023 –  July , 2023

TIMELINE

 Due Date
Bid invitation advertised in Media OnlineMarch 13th  , 2023
Bid responses due to JhpiegoMarch 22nd , 2023
Award bidMarch 27th ,  2023

SUBMISSION REQUIREMENTS

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

Email: ID-Contracts@jhpiego.org

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