Maintaining The Provision And Use Of Services For Maternal Newborn Child And Adolescent Health And Older People During The Covid 19 Pandemic Cambodia PDF Download

In Indonesia, particularly in rural areas, the majority of maternal and child health (MCH) service is provided at community-based integrated posts called Pos Pelayanan Terpadu (Posyandu). The COVID-19 pandemic has limited the provision of essential services in the community, including Posyandu. This has the potential to disproportionally affect the health of women and children. To better understand the impact of the COVID-19 pandemic on MCH service provision in Posyandu, we evaluated the barriers and facilitators to MCH service provision through Posyandu from one district in Indonesia. Methods: The study used a literature review, analysis of health system data on changes in Posyandu utilization indicators, and in-depth interviews (IDI) with 7 Posyandu community health workers (CHW) and 4 health workers from one sub-district health center (Puskesmas). A conventional content analysis approach was used to analyze qualitative data from the in-depth interviews. A mixed-method approach of quantitative and qualitative data was used to create a comprehensive description of service delivery in Posyandu during the COVID-19 pandemic. Results: The review of routine annual data found no substantial change in MCH services utilization during the COVID-19 pandemic. The majority of service indicators did not show a decrease from 2019 to 2020, except for coverage of complete childhood immunization which had been decreasing prior to 2019. Among the CHWs who participated in IDIs, the majority of Posyandu remained operational, with necessary adjustments to adhere to newly introduced COVID-19 control measures. Adjustments to service provision included mandating mask use, applying room maximum occupancy, physical distancing, and focusing efforts on home health visits. CHWs reported trying hard to keep Posyandu operational, feeling that it was their duty, as health workers, to provide these necessary services to their community even during a pandemic. CHWs from Posyandu that continued service provision cited individual CHW initiatives, support from local leaders, and good communication between Posyandu and Puskesmas as key facilitators. Despite goals of remaining operational, CHWs cited many barriers to continued service provision, including losing financial resources, opportunities for capacity building, and opportunities to advocate Posyandu needs to stakeholders. CHWs at Posyandu also described an overall lack of guidance from health workers at Puskesmas and the District Health Office (DHO). CHWs noted that while these barriers existed prior to COVID-19, they were exacerbated by the pandemic. Conclusion: Posyandu service availability during early COVID-19 varied, although the majority remained operational through individual CHW initiatives, communication between CHWs and health workers in Puskesmas, and support from local leaders. Given their importance in the community, particularly for women and children, there is a need to address barriers to Posyandu operation and ensure MCH service sustainability during health emergencies.