Analysis of Indonesia’s community health volunteers (kader) as maternal health promoters in the community integrated health service (Posyandu) following health promotion training

Abstract

Background: Maternal health promotion is a task allocated to the kader (community health volunteers) in the community integrated health services called Posyandu. Yet, they are inadequately trained to perform this task. We present an analysis of the kader as maternal health promoters after their health promotion training with use of counselling card. Methods: Between March-April 2015, 14 participatory workshops were conducted and 188 kader in four villages in Ciranjang sub-district were trained. Data were collected through in-depth interviews and focus group discussions from community members, health care providers and policy makers in the four villages. A total of 44 interviews were conducted prior to health promotion training and 48 interviews post- training. In 46 Posyandu, kader were observed during their practice of health promotion within 3 consecutive months of post training. Data was transcribed and analysed in NVivo 10. Results: Most kader acknowledged that health promotion training improved their knowledge of maternal health and counselling skills and changed their attitude towards pregnant women at the Posyandu. They could confidently negotiate health messages and importance of health facility delivery with antenatal women. The kader also found the counselling cards helped pregnant women understand the health messages more clearly. The participatory training method involving role play and direct discussions boost kader confidence to deliver health promotion. As a result, the kader gained community appreciation which enhanced their motivation about their job. Conclusions: Appropriate health promotion training, provided the kader with adequate knowledge and skills to become resourceful maternal health promoters in the community.