Does Health Center Have Contextual Effect on Midwife Performance? Multilevel Analysis Evidence from East Kalimantan, Indonesia

Latifah Nur Rahmadani, Uki Retno Budihastuti, Eti Poncorini


Background: The maternal mortality rate (MMR) which is still high has now become the priority in order to find its solution. Midwives play a very significant role in making efforts to reduce MMR through antenatal care (ANC) services. The performance of midwives directly influences the quality of service and health outcomes in the public health centers. The performance of midwives in ANC can be seen based on the coverage of K1 and K4. This study aimed to determine the contextual effect of public health centers and other factors that influence the performance of midwives in antenatal care services.

Subjects and Method: This study was conducted using observational analytic with cross sectional approach. It was done in 25 health centers in Samarinda, East Kalimantan in April-May 2019. The number of samples was 180 midwives selected using the total sampling technique. The dependent variable is the performance of the midwife. The independent variables include age, knowledge, tenure, training, workload, incentive, supervision, and motivation. The data were collected by questionnaire and analyzed by multilevel multiple logistic regression.

Results: Midwife performance was influenced by age >45 years (b = -2.48; 95% CI = -4.53 to -4.34; p = 0.018), good knowledge (b = 1.35; 95% CI = 0.38 to 2.31; p = 0.006), tenure ≥13 years (b = 1.89; 95% CI = -0.07 to 3.86; p = 0.059), training ≥2 (b = 1.30; 95% CI = 0.29 to 2.30; p = 0.011), heavy workload (b = -1.30; 95% CI = -2.27 to -0.34; p = 0.008), incentive (b = 1.74; 95% CI = 0.30 to 3.18; p = 0.018), supervision (b = 1.12; 95% CI = 0.19 to 2.05; p = 0.017), and high motivation (b = 1.42; 95% CI = 0.45 to 2.38; p = 0.004). There was no contextual influence of public health center on the performance of midwives in antenatal care services (ICC = <1%).

Conclusion: Age, knowledge, tenure, training, workload, incentives, supervision, and motivation are associated with midwives performance. There is no contextual influence of public health centers on the performance of midwives.

Keywords: work performance, midwife, contextual effect, antenatal care

Correspondence: Latifah Nur Rahmadani. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Jawa Tengah. Email: Mobile: 085250118907.

Journal of Health Policy and Management (2019), 4(3): 150-160

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