REFLECTION

Health 26 August 2016 Yayasan SHEEP Indonesia

Building Synergy in Health Services in Sabu Raijua

Rate this item
(0 votes)

The District of Sabu Raijua is one target area for YSI program in April 2015. Four villages are included: Jiwuwu and Eimadake in Sabu Tengah Sub-district, and Ledetalo and Mehona in Sabu Liae Sub-district.

It takes four hours by speed boat or 12 hours by ferry to cover the 194km distance across Savu Sea between Kupang and Sabu. The District of Sabu Raijua, with its centre in Menia, covers an area of 461 km2, surrounded by Savu Sea in the north, west and east, and the Indian Ocean in the south.

YSI implements ‘Building Community Resilience’ Program in Sabu Raijua, through community capacity building in health.  Training involves community members, as reflected in basic health and infectious disease control training of village health cadres, traditional healers and midwives on 8 - 11 August 2016. The training aims to build synergy in women’s and child health services. Training proceeds in two locations – Community Health Centre in Eimadake and Civic Centre Building in Ledetalo, involving 42 health volunteers, 4 traditional birth attendants, 1 traditional medicine practitioners, 11 midwives orang and nurses from 2 community health centres.

The high annual maternal and child mortality, birthing by unqualified personnel (outside of designated facilities) and low levels of pregnancy checks at designated facilities are real issues in Sabu Raijua. The Health-Conscious Boards or Dewan Peduli Kesehatan Masyarakat (DPKM) charged with coordination and monitoring in each village are not active. The community health centres are not yet promoting synergy with other health providers/workers, which explains low visits at community health centre. Now people in Sabu Raijua are coming more and more to designated health facilities, but still significant number of people maintain their preference for traditional healers and birth attendants either for pregnancy and birthing or general medical problems. One major impediment for people to visit the community health centres is the perception that the latter is not well prepared, in terms of facilities and equipment, to provide expected level of services to the people.  Community health centres only conduct information dissemination, but hardly make proper preparation for public services.

During accompaniment, YSI approaches all parties (health workers, health volunteers, traditional birth attendants and traditional healers) and get them together to promote synergy and partnership. YSI conducts training with them to encourage mutual cooperation and supports.

Building synergy is not easy, as it needs time to forge common understanding, particularly for people in Sabu who maintains their traditional culture and belief system. Culturally, parents are proud when their daughters get pregnant out of wedlock. It is a gift to have additional family member and this is responsible for the high rate of pregnancy outside of wedlock.

At junior high school (SMP), 1-2 female students get pregnant annually outside of wedlock, while in senior high school (SMA) 5-6 female students get pregnant outside of wedlock. The revelation unsettles health workers, particularly about the number of pregnancy checks and birthing unattended by qualified personnel, and the risks of sexually-transmitted diseases that follow unsafe sexual relationship. It is rare for (young) women who get pregnant outside of wedlock to visit medical facilities for pregnancy checks of delivery by qualified midwives. This is responsible for many maternal and child deaths because there is no way of checking the women’s and baby’s health  or of providing proper medical attention should there be complication in pregnancy and/or birthing, while referral is often too late.

The above poses major challenge for health promotion in communities, particularly in relations to reproductive health. Key stakeholders have a chance to express their views and the challenges they face during training and discussions, and to contemplate action plans to address them. For Mrs Sarce, the midwife coordinator at community health centre in Eimadake, “training that involves all key stakeholders offers important momentum for such dialogue, and for capacity building of health volunteers and traditional birth attendants, because local community health centres rarely conduct such events”.

One action plan involves health promotion about the importance of pregnancy checks at designated health facilities (midwives/community health centre), and discussions with community health centres about their preparedness. There is commitment amongst midwives, health volunteers and birth attendants about role sharing in pregnancy checks, birthing services and integrated health posts. Traditional birth attendants have close relationship with and significant influence on local people, hence their important part in pregnancy checks and birthing service at designated health facilities. The midwives are tasked with medical and birthing services, while the health volunteers have roles in promotion and prevention.

Synergy and mutual understanding are important to meet the challenge ahead, in order to bring about expected changes in community (Tina).

Read 39136 times
Last modified on 25 October 2016