Early-age health, survival and inequity issues in a rural eastern district of Indonesia

Little is known about early-age health, survival and inequity issues at the sub-national level in the Eastern part of Indonesia. This study aims to explore these issues among families, local government officials and community leaders in the underdeveloped Ende district. Thirty-two mothers, fifteen fathers and five grandmothers participated in the in-depth interviews, and thirteen participants in the focus group discussions. Results show that most of the mothers were unable to identify basic childhood illness signs. A lack of midwives in the rural and remote areas was evident. Most of the fathers and all of the grandmothers had only very limited knowledge of the danger signs of childhood illness, and none had received child health-related information from local health staff. Male-dominated forms of decision-making in relation to infant health care were the norm found in this study. The unavailability of midwives and other health staff unavailability, discomfort during delivery and long distances to the closest community health centre remained as a challenge for mothers and fathers in this study. The government officials and local community leaders identified weak leadership, inefficient health management, and inadequate child health budgets as important issues. Midwifery graduates and village midwives were perceived as lacking motivation to work in rural areas. Local traditions were considered to be detrimental to child health. This thesis identifies a pressing need for improving child health education to be provided by midwives or related health staff to mothers, fathers and grandmothers, particularly basic information relating to childhood illness and its danger signs. This thesis suggests changes to policy relating to early-age health, survival and inequity issues in rural districts of Eastern Indonesia.