Human Resources for Health

Background: There is a shortfall in midwives in Indonesia (an estimated 26 per 100 000 people),
which means that the quality of antenatal, perinatal and postnatal care varies widely. One
consequence of this is the high rate of maternal and perinatal mortality, which has prompted a
number of health initiatives. The current study was part of a review of the existing complex system
of midwifery training and the development of a coherent programme of continuing professional
development, tighter accreditation regulations and clearer professional roles. Its aims were to
identify the occupational profiles and development needs of the participating midwives, and to
establish whether any differences existed between grades, geographical location and hospital/
community midwives.
Methods: A psychometrically valid training-needs instrument was administered to 332 midwives
from three provinces, covering both hospital and community staff and a range of midwifery grades.
The instrument had the capacity to identify occupational roles and education/training needs of the
Results: The occupational roles of the midwives varied significantly by province, indicating regional
service delivery distinctions, but very little difference in the roles of hospital and community
midwives. The most educated midwives attributed more importance to 35 out of the 40 tasks,
suggesting an implicit role distinction in terms of level of activity. All midwives reported significant
training needs for all 40 tasks. The most-educated midwives recorded training needs for 24 tasks,
while the less-educated had training requirements for all tasks, which suggests that new training
programmes are effective. Few differences in training needs were revealed between hospital and
community midwives
Conclusion: The results from this survey suggest important regional differences in how the
midwife’s role is discharged and underline the importance of this sort of research, in order to
ensure the suitability of basic and postbasic educational provision. The study also highlights the
need for further development and training of midwives in a wide range of tasks. These results
provide a systematic and reliable overview of current midwifery roles and development needs and
could serve to inform future training.


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