Understanding community health worker employment preferences in Malang district, Indonesia, using a discrete choice experiment.

BACKGROUND: Community health workers (CHWs) play a critical role in supporting health systems, and in improving accessibility to primary healthcare. In many settings CHW programmes do not have formalised employment models and face issues of high attrition and poor performance. This study aims to determine the employment preferences of CHWs in Malang district, Indonesia, to inform policy interventions. METHODS: A discrete choice experiment was conducted with 471 CHWs across 28 villages. Attributes relevant to CHW employment were identified through a multistage process including literature review, focus group discussions and expert consultation. Respondents' choices were analysed with a mixed multinomial logit model and latent class analyses. RESULTS: Five attributes were identified: (1) supervision; (2) training; (3) monthly financial benefit; (4) recognition; and (5) employment structure. The most important influence on choice of job was a low monthly financial benefit (US$~2) (ß=0.53, 95% CI=0.43 to 0.63), followed by recognition in the form of a performance feedback report (ß=0.13, 95% CI=0.07 to 0.20). A large monthly financial benefit (US$~20) was most unappealing to respondents (ß=-0.13, 95% CI=-0.23 to -0.03). Latent class analysis identified two groups of CHWs who differed in their willingness to accept either job presented and preferences over specific attributes. Preferences diverged based on respondent characteristics including experience, hours' worked per week and income. CONCLUSION: CHWs in Malang district, Indonesia, favour a small monthly financial benefit which likely reflects the unique cultural values underpinning the programme and a desire for remuneration that is commensurate with the limited number of hours worked. CHWs also desire enhanced methods of performance feedback and greater structure around training and their rights and responsibilities. Fulfilling these conditions may become increasingly important should CHWs work longer hours.

The role of primary healthcare physicians in violence against Women intervention program in Indonesia.

BACKGROUND: Violence against women (VAW) has many impacts on health, but the role of the primary healthcare physicians in the intervention program is lacking. This research aimed to explore the primary healthcare physician role in a comprehensive intervention program of VAW in Malang City, Indonesia. METHODS: This qualitative research was conducted using a phenomenology approach. A focused group discussion followed by in-depth interviews were carried out involving six primary healthcare physicians in Puskesmas (Primary Healthcare Center) and two stakeholders. Legal document related to VAW was reviewed to measure up the role of the primary healthcare physicians. RESULT: Our study revealed that the role of physicians in primary healthcare centers on the VAW intervention program was limited. This was due to the insufficient knowledge of the physicians on the VAW program, physicians' constraint on counseling skill, unsupportive infrastructure, and a limited number of physicians in Puskesmas. Some barriers related to the VAW program management were also discovered and needed intervention at the decision-maker level. CONCLUSION: The role of primary healthcare physicians in the comprehensive intervention of the VAW program is not optimum. The source of the problem involves the physician capability and program management aspects in all levels of decision-makers. Local government awareness and commitment are needed to improve the overall management of the VAW intervention program in this city.