Reducing Maternal and Neonatal Mortality in Indonesia: Saving Lives, Saving the Future by Joint Committee on Reducing Maternal & Neonatal Mortality in Indonesia

Author:Joint Committee on Reducing Maternal & Neonatal Mortality in Indonesia
Language: eng
Format: epub
Tags: ebook
Publisher: The National Academies Press
Published: 2014-01-15T00:00:00+00:00

In Indonesia, nurses are considered competent in neonatal care only when it is connected to the Ministry of Health program and training. In basic delivery care, the delivery and neonatal resuscitation caregiver is the midwife. The midwife could have learned neonatal resuscitation in a midwifery school and trained to be competent in the anatomic model in basic delivery care or basic emergency neonatal care with the JNPK (JNPK, 2010, 2012; Ikatan Bidan Indonesia, 2012).

The basic emergency obstetric and newborn care (BEmONC) concept is not included in the curriculum of the school of nursing or of the midwifery academies. It is a Ministry of Health program, and the nurse or midwife must attend a BEmONC training program to have this competency. At a BEmONC health center, the health care team consists of a general practitioner, a midwife, and a nurse. But they do not have equal roles in providing services because the birth attendant must be the midwife while the nurse serves as the provider of neonatal resuscitation (Ikatan Bidan Indonesia, 2012).

General Practitioners

In Indonesia, senior high school graduates must attend a five-year or 10-semester course of study to attain a degree as a medical doctor. These requirements were expanded in 2011 to include completion of a one-year internship before qualifying for licensure as a general practitioner (Konsil Kedokteran Indonesia, 2005).

Although the system has gradually been improved, the qualifications of the current graduates are not on a par with those associated with the medical education system before 1979. The 1995 list of medical doctor competencies has been reduced in both number and competency level required. In 1995 the level of skills needed to manage a normal delivery was “competency level.” In 2010 it was reduced to “acquisition level.” This level is lower than that required for professional midwives, who must be “competent” to attend a normal delivery (Konsil Kedokteran Indonesia, 2005; Ikatan Dokter Indonesia, 2007).

The mandatory postgraduate internships and lower grade of competencies required reflect a distortion of the learning process for medical students. A medical faculty considers the completion of a one-semester unit equal to one level of competency. This assumption is incorrect, however, because the topic in a curriculum relates only to the theoretical aspect, whereas competency in a skill requires a psychomotor aspect that builds only after practice and frequent repetition of a procedure related to several topics in the curricula (Konsil Kedokteran Indonesia, 2005; Ikatan Dokter Indonesia, 2007; JNPK, 2010). Some medical faculty graduates improve their competency through in-service training for subdistrict deployment, self-preparation, or participation in an obstetrics-gynecology (ob-gyn) specialist training program. The clinical training provides more opportunities for intensive coaching and practice with real obstetric patients, which is not possible in the medical education setting. Thus many general practitioners do not appear to have as much experience or skill in managing labor as a midwife (Ministry of Health, 2010a).

Specialists in Obstetrics and Gynecology

In Indonesia, to become a specialist in obstetrics and gynecology a graduate of a medical faculty must complete 10 semesters or five years of training.

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