Research as an Instrument for Community Health Development

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Research as an Instrument for Community Health
Development

• By
• Dewi Irawaty (FIK-UI)
• Shirley M. Solberg (MUNSON)

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Introduction

• Indonesia has a long history of projects aimed at
  addressing the health of women and children
• Government through primary health care centres
  (Puskesmus), child health post (Posyandu), and
  village midwives
• NGOs through infant food supplement and family
  planning

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Rationale for Project

• Community health nursing needed to promote health
  and help women and children with common health
  problems at the village level
• Also needed is the presence in the village of
  health care workers who could engage in community
  outreach and development

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Purpose of Presentation

• Demonstrate importance of research to overall
  success of the project
• Explore some of the challenges encountered in the
  project
• Discuss how we addressed the challenges and what
  we attributed to our success

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The Project

• Title Nursing, Womens Health and Community
  Outreach in Indonesia
• Further capacity building in the Faculty of
  Nursing at the University of Indonesia in
  community health nursing
• Develop a comprehensive model of womens health
  and community health nursing for rural Indonesia

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Approach to Project

• Research orientation - participatory action
  research (PAR)
• PAR attributes mutuality, participation, and
  systematic inquiry immediacy, relevance and
  usefulness and action, skill development, and
  learning.
• Rasmussen, 1997, p. 254

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Three Major Impacts

• Effective health promotion interventions designed
• Development of a centre for community health,
  education, research and practice (CHERP)
• Use of research findings to effect policy among
  stakeholders in Indonesian health delivery
  sectors

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Effective Health Promotion

• Systematic needs assessment of villages
• Use of a local advisory committee
• Supervised data collection involving village
• Worked with villages to identify areas for
  further development
• Research preparation of junior faculty

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Successes from Interventions

• Childhood diarrhea reduced by 22
• Increase in tetanus immunization for women in the
  antenatal period from 74 to 97 (first
  injection) and 51 to 80 (second injection)
• A 42 increase in iron supplementation during
  pregnancy

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Development of CHERP

• Responsive to community needs and based on
  principles of health promotion
• Supportive environment
• Strengthened community action
• Development of personal skills
• Reorienting health services

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Broadening Policy

• Systematic approach to development used to
  prepare policy paper (documented research
  findings from interventions)

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Broadening Policy

• Presented at a workshop with nurses from
  academic institutions, practice, and
  administration
• Used feedback from workshop to further develop
  policy paper

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Challenges

• Uncertainty related to developing model that was
  a good fit with beliefs and values and best
  suited to the needs of people in the villages
• Pressure to address acute care needs of people in
  the village
• A need to change orientation of people in village
  towards health promotion

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Addressing Challenges

• Ensuring relevancy and skill development among
  students, faculty, kadres, and people living in
  the village
• Open communication about problems and creating
  workable solutions
• Presence in the village and engaging people there
  helped create more of a health culture

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Contributors to Success

• Parallel development and assistance from the
  Indonesian National Nurses Association
• Research requirements of junior faculty in their
  MN program
• Commitment, relationships and understanding among
  team members

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Acknowledgements

• Indonesian team - Dr. Yani Hamid (Project
  Director 1998-2001) Dr. Junati Sahar (Project
  Director 2002-2004) Profs. Tien Gartner, Yati
  Afiyanti, Sigit Molyono, Nani. Nurhaeni, Yuni
  Astuti, and Wiwin Wiarsih.
• Dean of Nursing (FIKUI) Dean Elly Nurachmah and
  other faculty who worked on needs assessment and
  curriculum development

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Acknowledgements

• Canadian team Prof Kay Matthews (team leader),
  Drs. Sandra LeFort, Donna Moralejo, Marilyn
  Porter, and Prof. Karen Webber, Ms. Shannon Muir.
• Canadian MN students who worked with the
  Indonesian students while in Canada

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Acknowledgements

• University Partnerships in Cooperation and
  Development Program Tier 2 grant
• Association of Universities and Colleges of
  Canada and The Canadian International Development
  Agency for guidance and financial support

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