Factors That Foster Collaboration Between Health Care Authorities and Community Health Workers in Rural Indonesia

Abstract

Background Indonesia's high maternal mortality rate remains a concern despite its growing economy. In 2017, Indonesia’s MMR was recorded at 177/100,000 live births, and it continues to be unacceptably high. In 2021, there were 7,389 maternal deaths, a 59.69% increase from the 4627 deaths in 2020. The SAKINA-Pemburu Bumil Risti program, implemented in the Sempu sub-district of Banyuwangi region, aims to reduce maternal mortality rates by collaborating with community health workers and multiple stakeholders. The program's successful implementation and sustainability have been attributed to effective collaboration. Community health workers have been identified as essential players in improving health outcomes for underserved communities. This study aims to determine the key elements that foster a collaborative relationship between community health workers and healthcare authorities in implementing the SAKINA program. Methods The study employs a qualitative method, where participants were divided into five groups, including full-time professionals, village community health workers, active case-finding community health workers, women with a history of high-risk pregnancy, and community leaders. Purposeful sampling was used to identify roughly equivalent numbers of participants from each village in the Sempu sub-district. In-depth interviews and focus group discussions were conducted with all participant groups, and participant observations were carried out during strategic activities. An inductive content analysis approach was used to analyze interview data. Results This study analyzed 34 participants, including healthcare authorities, community health workers, and non-healthcare authorities involved in the SAKINA-Pemburu Bumil Risti program. The study revealed four key findings that led to the development of the "Gas and Brake Management" model. The first three findings centered around a collaborative model that was used to develop the model. This model includes three phases, which are the Acceleration Phase, Refreshment Interval, and Re-Acceleration Phase, described as themes 1-3 below. Together, these phases form a pattern that creates a virtuous cycle of implementation, while the fourth finding highlights context-related enablers that consistently reinforce the Gas and Brake Management model. Conclusion The Gas and Brake Management model, with three phases forming a positive feedback loop, is an effective approach for implementing and scaling up healthcare programs. By emphasizing collaboration and integrating enabling factors, this model was able to overcome obstacles and ensure continuous improvement. It provides a structured approach for the program to adapt and align its agenda with the community's needs and outcomes. Keywords: Maternal Health. Collaboration. Implementation. Community health workers.