Setiawan Agus, Dawson Angela
Department of Community Health Nursing, Faculty of Nursing, Universitas Indonesia, Kampus Universitas Indonesia Depok, West Java 16424, Indonesia.
The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, 15 Broadway Ultimo NSW 2007, Australia. Email.
Aust Health Rev. 2018 Sep;42(5):536-541. doi: 10.1071/AH17092.
Objectives The aim of the present study was to report on the implementation of community case management (CCM) to reduce infant mortality in a rural district, namely Kutai Timur, Kalimantan Indonesia. Methods An interpretive qualitative methodology was used. In-depth interviews were conducted with 18 primary healthcare workers (PHCWs), and PHCWs were observed during a consultation with mothers to gain insight into the delivery of the new protocol and workforce issues. The field notes and interview transcripts were analysed thematically. Results PHCWs reported that their performance had improved as a result of increased knowledge and confidence. The implementation of CCM had also reportedly enhanced the PHCWs' clinical reasoning. However, the participants noted confusion surrounding their role in prescribing medication. Conclusions CCM is viewed as a useful model of care in terms of enhancing the capacity of rural PHCWs to provide child health care and improve the uptake of life-saving interventions. However, work is needed to strengthen the workforce and to fully integrate CCM into maternal and child health service delivery across Indonesia. What is known about the topic? Indonesia has successfully reduced infant mortality in the past 10 years. However, concerns remain regarding issues related to disparities between districts. The number of infant deaths in rural areas tends to be staggeringly high compared with that in the cities. One of the causes is inadequate access to child health care. What does this paper add? CCM is a model of care that is designed to address childhood illnesses in limited-resource settings. In CCM, PHCWs are trained to deliver life-saving interventions to sick children in rural communities. In the present study, CCM improved the capacity of PHCWs to treat childhood illnesses. What are the implications for practitioners? CCM can be considered to strengthen PHCWs' competence in addressing infant mortality in areas where access to child health care is challenging. Policy regarding task shifting needs to be examined further so that CCM can be integrated into current health service delivery in Indonesia.
目标 本研究旨在报告社区病例管理（CCM）在印度尼西亚加里曼丹省库泰蒂穆尔农村地区降低婴儿死亡率方面的实施情况。方法 采用解释性定性方法。对18名初级卫生保健工作者（PHCW）进行了深入访谈，并在其与母亲的咨询过程中进行观察，以深入了解新方案的实施情况和劳动力问题。对实地记录和访谈记录进行了主题分析。结果 PHCW报告称，由于知识和信心的增强，他们的表现有所改善。据报道，CCM的实施还增强了PHCW的临床推理能力。然而，参与者指出在开药方面对自身角色存在困惑。结论 就提高农村PHCW提供儿童保健服务的能力以及增加救生干预措施的采用率而言，CCM被视为一种有用的护理模式。然而，需要开展工作以加强劳动力队伍，并将CCM全面纳入印度尼西亚的母婴健康服务提供体系。关于该主题已知的情况是什么？印度尼西亚在过去10年中成功降低了婴儿死亡率。然而，对于地区间差异相关问题仍存在担忧。与城市相比，农村地区的婴儿死亡人数往往高得惊人。原因之一是获得儿童保健服务的机会不足。本文补充了什么内容？CCM是一种旨在解决资源有限环境中儿童疾病问题的护理模式。在CCM中，PHCW接受培训，为农村社区患病儿童提供救生干预措施。在本研究中，CCM提高了PHCW治疗儿童疾病的能力。对从业者有何启示？在获得儿童保健服务具有挑战性的地区，CCM可被视为增强PHCW应对婴儿死亡率能力的一种方式。需要进一步审视关于任务转移的政策，以便将CCM纳入印度尼西亚当前的卫生服务提供体系。
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