Community health workers are the key to reducing infant and maternal mortality rates in areas of the country not served by doctors, but they need more support in carrying out their jobs, according to leading experts.
These health workers, most of whom are trained midwives or nurses, typically serve in community health centers, or posyandu , in remote and rural communities that do not have hospitals.
Robert E. Black, a public health professor from the Johns Hopkins Bloomberg School of Public Health, concluded in his study on community health workers that they could play an even greater role in remote areas that doctors could not reach.
He said community health workers could educate residents about the need for proper sanitation and other preventative health measures such as the distribution of mosquito nets to prevent dengue fever and malaria.
Black said these workers also played a significant role in child birth in rural areas, both in the prenatal and postpartum stages, through their regular home visits to expectant mothers.
Ben Phillips, director of strategy at the Save the Children Asian regional office, said community health workers were indispensable in remote areas, where they could teach mothers to recognize the symptoms of diarrhea, pneumonia and other often overlooked diseases that could lead to child deaths.
“The health workers will tell the mothers when the right time to visit the hospital is, and those are the cases where we can prevent deaths,” he said.
Phillips said a large number of children in Indonesia and other Asian countries died from easily preventable diseases, and that community health workers could save lives by teaching people about proper nutrition and hygiene.
“Community health workers do an enormous amount of [work],” he said. “They prevent people from getting sick in the first place and they work with the community.”
He said if more community health workers helped raise awareness about things like nutrition and breast-feeding, Indonesia could attain the Millennium Development Goals on reducing infant and maternal mortality rates by 2015.
The country’s maternal mortality rate is 228 out of every 100,000 births — one of the highest in Asia. Under the MDGs, it should be slashed to 102 per 100,000 births by 2015.
Utami Roesli, chairwoman of the Indonesian Breast-feeding Center, said her organization had worked closely with more than 4,000 community health workers across Indonesia. She said rural communities tended to trust them more than they did doctors or health activists from big cities.
“They know the workers personally, they feel the connection and they can relate to them. It’s easier for them to trust the workers,” Utami said.
She added that campaigning by community health workers to get more mothers to breast-feed their newborn babies had already had a significant impact.
Tritarayati, director of human resources management at the Health Ministry, said the government was conducting different programs to support community health workers.
“We send many nutritionists and other workers to remote places such as border areas and outlying islands,” she said.
To ensure health workers continue to serve their communities, Tritarayati said, the ministry had rolled out special incentives for them, including scholarships for further studies and a chance to get fast-tracked to civil servant status, which would entitle them to benefits such as health insurance and a pension.
Tritarayati said the 2010 National Basic Health Study (Riskesdas) showed that areas with a sufficient number of community health workers managed to successfully implement a wide variety of effective preventive health measures.