Barriers and enablers to the provision of postnatal newborn care at community health centres in Sikka district, East Nusa Tenggara province, Indonesia

Abstract

ObjectiveThis study examined routine newborn care practices provided in the postnatal ward of primary health care facilities, known as Puskesmas, in Sikka District of eastern Indonesia The newborn mortality rate in this region is higher than the national rate despite an increasing proportion of facility based births, suggesting suboptimal quality of newborn care. DesignWe employed a mixed methods study combining qualitative and quantitative approaches, in four purposively sampled Puskesmas. Nine mothers, twelve midwives, and four key informants were interviewed on the provision and experience of postnatal care, and an audit of postnatal care processes, including observation of routine postnatal check-up was conducted. The data were analyzed using framework analysis and standard descriptive statistics. FindingsDespite appropriate regulation, national guidance on postnatal care and adequate financing that supported continuity of supplies and equipment, postnatal care practices, including counselling around newborn danger signs, did not meet the national guidelines in any of the Puskesmas in this study. Postnatal care was a low priority, the responsibility often given to new graduates on voluntary placements with little job security, who were insufficiently trained or supervised. In addition, inadequate water and sanitation in postnatal care wards deterred women from staying for the recommended postnatal observation period. ConclusionDespite strong support for postnatal care at the policy level, at the implementation level postnatal newborn care is not prioritised by midwives. Under-functioning infrastructure and inadequate planning and budgeting for postnatal check-ups are major challenges to the provision of care in the postnatal wards.