Level and determinants of incentives for village midwives in Indonesia

Datos Bibliográficos

ID11492425
AutoresTim Ensor (0000-0003-0279-9576, University of Aberdeen, autor de correspondencia), Zahidul Quayyum (0000-0002-2276-4576, University of Aberdeen), Mardiati Nadjib (0000-0001-8676-7525, University of Indonesia), pK Sucahya (University of Indonesia)
Año2008
Volumen24
Número1
Páginas26-35
Fecha de publicación2008-11-12
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaHealth Policy and Planning (JOURNAL)
Identificadores de la revistaISSN: 0268-1080 • E-ISSN: 1460-2237
EditorialOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czn040
PMID19022855
OpenAlexW2123950156
IdiomaEN
Citas recibidas9
Referencias citadas8

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.

Attendance · Business · Competence (human resources) · Demographic economics · Distribution (mathematics) · Economic growth · Economics · Incentive · Rural area · Socioeconomics · Global Health Care Issues · Global Maternal and Child Health · Intergenerational Family Dynamics and Caregiving · Medicine · Psychology