A systematic review of the types, workload, and supervision mechanism of community health workers: lessons learned for Indonesia.

BACKGROUND: Community health workers (CHWs) have demonstrated capability to improve various health indicators, however, many programmes require support in meeting their objectives due to subpar performance and a high rate of CHW attrition. This systematic review investigated the types of CHWs, their workloads, and supervision practices that contribute to their performance in different countries. METHODS: The search was carried out in November 2022 in Medline, Embase, and Neliti for studies published in Indonesian or English between 1986 and 2022 that reported public health services delivered by CHWs who live and serve the community where they live but are not considered health professionals. The findings were synthesised using a thematic analysis to assess key factors influencing the performance of CHWs. RESULTS: Sixty eligible articles were included in this review. CHWs were responsible for more than two diseases (n = 35) and up to fifteen, with more than eighteen activities. Their roles covered the human life cycle, from preparation for pregnancy, care for newborns, health for children, adolescents, and productive age to elderly individuals. They were also involved in improving environmental health, community empowerment, and other social issues hindering access to health services. They carried out promotive, preventive, and curative interventions. The CHW-population ratio varied from eight to tens of thousands of people. Some CHWs did not have a clear supervision system. Challenges that were often faced by CHWs included inappropriate incentives, inadequate facilities, insufficient mentoring, and supervision, many roles, and a broad catchment area. Many studies revealed that CHWs felt overburdened and stressed. They needed help to balance their significant work and domestic tasks. CONCLUSIONS: Effective planning that considered the scope of work of CHWs in proportion to their responsibilities and the provision of necessary facilities were crucial factors in improving the performance of CHWs. Supportive supervision and peer-supervision methods are promising, however, any CHW supervision required a detailed protocol. This systematic review emphasised the opportunity for CHW management system improvement in Indonesia.

Effects of family planning service utilization determinants on unmet need incidents with generalized structural equation modeling.

BACKGROUND: One of the reasons for the lack of optimal achievement in terms of contraceptive use in Indonesia is the unmet need for family planning that has not been fully addressed. OBJECTIVE: This study aimed to determine the direct, indirect, and total effect of the determinants of family planning services utilization on the incidence of unmet need spacing and limiting in Indonesia to provide a basis for appropriate and effective program recommendations. STUDY DESIGN: This study used secondary data from the 2017 Indonesian Demographic and Health Survey with a cross-sectional design with 33,635 respondents who were married women aged 14 to 49 years. RESULTS: The results of the generalized structural equation modeling showed that the incidence of unmet need in Indonesia was 11.68%, consisting of unmet need spacing (4.86%) and unmet need limiting (6.82%). The quality of family planning services had a positive indirect effect on the incidence of unmet need spacing. The quality of family planning services also had a positive direct, indirect, and total effect on the incidence of unmet need limiting. Socioeconomic and demographic status variables had a negative direct effect on the incidence of unmet need spacing, whereas the indirect and the total effect were positive. The direct and total effect of socioeconomic and demographic status variables on the incidence of unmet need limiting were positive. The women's autonomy variable had a positive direct, indirect, and total effect on the incidence of unmet need spacing. Women's autonomy had positive indirect and total effect on the incidence of unmet needs limiting. The variable of access problems did not have a significant effect on the incidence of unmet need spacing and unmet need limiting. The ideal number of children had a negative direct and total effect on the incidence of unmet need spacing and unmet need limiting in Indonesia. CONCLUSION: The variables that have been shown to have a significant effect on the incidence of unmet needs were the quality of family planning services, socioeconomic and demographic status, women's autonomy, and the ideal number of children.

Inclusivity of Persons With Disabilities in the Work Sector During the Covid-19 Pandemic in Indonesia.

Introduction: The COVID-19 pandemic has had a significant impact on all levels of society, including people with disabilities, who in the pre-pandemic period faced obstacles in various sectors of life that affected efforts to fulfill basic living needs due to difficulties in accessing employment. Objective: The objective of this study was to identify various factors and causal interaction patterns that affect the inclusiveness of workers with disabilities in pandemic situations, a dynamic system is needed to capture causal interaction patterns related to the inclusiveness of workers with disabilities in pandemic situations. Method: This study used a causal loop diagram approach, which is part of a dynamic system that begins with determining the interaction of causal variables. The process of identifying and extracting data was carried out through a literature review and in-depth interviews with informants who met the principles of appropriateness and adequacy criteria. Result: The interaction pattern between the factors that influence the inclusiveness of disabled workers was depicted in three causal loop diagrams covering three major domains, namely social, educational, and economic aspects. The three causal loop diagrams showed an increasingly dynamic interaction pattern during the COVID-19 pandemic, considering that workers with disabilities have greater vulnerability, which impacts their level of acceptance and inclusiveness at work. Recommendation: There needs to be a specific policy to expand the acceptance of workers with disabilities by strengthening cross-sectoral collaboration and company commitments. The existence of a policy that prioritizes education, increases the budget, and procures adequate infrastructure for people with disabilities is a government commitment that is demanded to be fulfilled during the COVID-19 pandemic.