Case Study on the Needs and Opportunities of Delivering Nurturing Care through Public Health Platforms in Indonesia

• In Event: Promoting Nurturing Care to Improve Early Childhood Development through Health and Nutrition Services

Proposal

Background:
In Indonesia, 45 percent of children under five years are at risk of poor health, growth, and development. In response to this need, the Government of Indonesia launched the Holistic and Integrative Early Childhood Education and Development (HI-ECD) to integrate and strengthen coordination across various critical services. However, in Manggarai Barat, the district where this case study was conducted, infant mortality continues to be a concern. Willa and Mading (2014) identified several factors contributing to infant mortality in Manggarai Barat, including maternal nutritional deficiency, presence of infectious diseases, access to health services, reliance on non-medical staff, and inadequate knowledge of childcare needs. Some of these factors could be addressed during antenatal (ANC) care and postnatal (PNC) care visits. This case study examined the needs and opportunities of delivering nurturing care during ANC and PNC visits, as well as sick child visits and well child clinics at community health centers (Puskemas), and during community outreach during Posyandu visits.

Methods:
The case study employed in-depth interviews, observations, and focus group discussions targeting lactating mothers, fathers, secondary caregivers, health workers, community kaders, traditional birth attendants (TBAs), and government officials. Secondary data analysis included project documents, academic findings, reports, guidelines, statistics, and policy papers. Data were collected from three villages and three Puskemas that met criteria, including urban, semi-urban, and with or without in-patient facilities. Influenced by human centered design, the qualitative approach examined the enabling environment for nurturing care; current counseling practices, including the utilization of the Maternal and Newborn Health (MNH) book; the impact of COVID-19 on service delivery; and the continuum of care through referrals between Puskemas and Posyandus.

Results: Preliminary findings suggest inadequate knowledge among frontline health workers to counsel on responsive care and early learning, limited use of the MNH book, long wait times at ANC and PNC visits, and local myths on maternal and child feeding practices. Particularly at the village level, midwives and TBAs knowledge on child development was limited to nutrition and growth and little to no knowledge on responsive care and early learning aspects of nurturing care. Lactating mothers, fathers, and secondary caregivers acknowledged they mainly receive information regarding their child’s development from relatives, social media, Google, and YouTube. They expressed the challenges to receive information from community kadres due to heavy routine workloads and their lack of training on counseling on nurturing care.

Conclusions: Findings from this case study can inform the effective delivery of nurturing care through public health delivery platforms in Indonesia, particularly counseling on responsive care and early learning through health services.

Author

• Romilla Karnati, Save the Children