This was part of a wider study, conducted under the REACHOUT consortium, which is investigating the effectiveness, efficiency, and equity of close-to-community providers of health care in six countries in Africa and Asia including Indonesia. Tests for anaemia, HIV and syphilis, all leading preventable causes of adverse pregnancy outcomes, are an essential component of antenatal care. Adverse pregnancy outcomes can include perinatal death, low birthweight, and prematurity. However, the provision of the appropriate treatment for these conditions during pregnancy significantly reduces the risks of these adverse outcomes for both mother and baby. Therefore, all three are key priorities in global health and have been the target of multiple campaigns to end preventable maternal mortality and eliminate mother-to-child transmission of HIV and syphilis.
The team in Indonesia and an LSTM Masters student worked to document and explore current practice in testing for anaemia, HIV, and syphilis as well as the barriers and challenges faced in the delivery of antenatal testing in the context of the decentralised health system in Indonesia.
Indonesia has an innovative and extensive network of village midwives, allowing women to have high quality health checks in pregnancy without having to leave their community. It was found that antenatal testing was limited and, when available, neither conducted nor reported in a systematic manner, and the authors exposed health system weaknesses as the main reason for this. Many women were unlikely to have received appropriate treatment for HIV, anaemia or syphilis. Among multiple barriers to testing, a lack of leadership, prioritisation, and accountability in the coordination of antenatal testing was identified at all levels of the decentralised health system.
Study lead Dr Miriam Taegtmeyer said: “Practical solutions such as revised registers, availability of point-of-care tests and capacity building of field staff is needed to be accompanied by both funding and political will to coordinate, prioritize and be accountable for testing in pregnancy.”
The team, therefore, made several recommendations involving both a bottom-up and top-down approaches to improve the health systems capacity for antenatal testing.
Dr Taegtmeyer continued: “We need to create a demand for antenatal testing by raising both community awareness and reducing stigma, but also increasing political will and district-level leadership alongside widespread testing availability. Furthermore, the roles and responsibilities for antenatal testing at all levels of the system should be defined and facilities to record antenatal testing, results and treatment should be made available.”
The addition of comprehensive antenatal testing to the decentralised village midwife programme would further strengthen this decentralised approach, empower village midwives and ensure that prevention opportunities are not missed.