Table 2 shows the characteristics of the health workers’ demographic variables as participants in the study. Health workers’ personal opinions are described in the perception of the factors and efforts that have been taken to improve the quality of health care for children under five years old.
Health workers’ perception is part of the section on the significance of health workers in delivering health care services to children under five years old. Six health workers describe the meaning of delivering health care, which they see as part of their responsibilities and their efforts to prevent the death of children under five years old. The health workers realize that delivering health care for children under five is part of their main duty, and they function as health care professionals.
One of the health workers reiterates the perception with regard to delivering health care for children under five years old by acknowledging the patient’s right to receive the best care possible.
“Provide the best service…until the family understands what they should or should not do to the patient (children under five)”, (P2, a doctor).
Health workers acknowledge that delivering health care for children under five years old means providing information on how to access health services to the parents.
“Caring for them or satisfying their needs for information”, (P7, a midwife).
The viewpoint of these two workers with regard to health care services to children under five years old should be seen as an effort in early detection. Health workers assigned to a community health center are aware that health services to children under five years old at a community health center are part of the preventive measures to minimize the occurrence of severe illness and child mortality in a specific area.
“We are making a judgment call, we can assess whether something is wrong with a child or not”, (P1, a nurse).
The perspective of the health workers with regard to the factors affecting the quality of health care for children under five years old is to provide professional care with supporting facilities. Professional services are delivered as follows: (1) the services shall be delivered in accordance with standard operating procedures; (2) the flow of services (from registration all the way down to the queuing process to have their prescription filled) should be clear and easily understood; (3) establishing priority services for patients under five years old; (4) aspects associated with health workers’ competence; and (5) health workers’ commitment to improve the quality of health care for children under five years old.
According to the health workers, an aspect of the standard operating procedures, which is also a factor in the delivery of health care for children under five years old, is the wait before a patient receives the care he/she needs.
“Quality service…waiting hours”, (P2, a doctor)
Operational standards should also encompass wide-ranging and comprehensive services. Moreover, it is crucial that the health workers possess the necessary competency when providing health care for children under five years old.
“Children health care is holistic in nature”, (P8, a doctor).
“Competent health workers”, (P7, a nurse)
Evaluating the patients by providing clear information during the patient’s visit to the community health center is an important factor in the effort to improve the quality of health care for children under five.
“He should be monitored, he should see the doctor every two weeks”, (P10, a doctor).
Professional services are a form of obligation for every health worker in carrying out their duties. One part of a professional service is creating a clear service path.
“Should be here (showing where the path should be), yes, that is the effect of service path” (P6, a nurse).
Health workers are aware that child health care should be a priority. This is one of the factors that must be considered in improving the health of children under five years old.
“We must stay in course…we must put the interest of the child first”, (P9, a nurse).
Good commitment from the health workers is part of the efforts to improve the quality of health care for children under five years old.
“If you could manage it well (i.e. delivering a good care), actually if you were committed, then everything would be all right”, (P8, a doctor).
The commitment itself is a factor in improving the quality of health care for children under five years old, which is shown by collaboration between health workers.
“Perfect collaboration (i.e. collaboration between health workers)”, (P9, a nurse)
The qualities of health care for children under five years old at the community health centers do not only depend on the competence of the health workers, but they are also affected by other factors. These factors include facilities that support the delivery of quality health care for children under five years old. From the perspective of the health workers, these supporting facilities may include setting up children’s playroom in the primary health center/community health center.
“Build a children’s play room, with books and toys for them” (P9, a nurse).
Some of the examination rooms for children at the primary health centers in Indonesia are not separated from other facilities. The health workers are all in favor for establishing separate examination facilities for children under five years old to prevent contamination or transmission of viruses and bacteria from adult patients while the children are waiting to be examined.
“The children should have their own examination room equipped with facilities to measure their height and weight, everything should be there”, (P12, a nurse).
Nursing room is one of the important facilities in improving the quality of health care for children under five years old.
“There should be a nursing room located close to the examination room”, (P10, a doctor).
One of the health workers realizes the importance of feedback from the patients with regard to their satisfaction. Therefore, health care facilities should provide suggestion boxes so the patients could provide their feedback with regard to the services they have received.
“There should be a suggestion box”, (P9, a nurse).
The health workers have taken numerous efforts to improve the quality of health care for children under five years old. Their involvement in the care of these children covers, among others, providing education, coordinating, and actively participating in training programs. Speaking of education, most of the time, it is delivered through a method most commonly used by health care professionals, i.e. through counseling.
“We held a counseling session every Wednesday and Thursday, right here in the building (inside the community health center)”, (P11, a doctor).
Patient counseling is not only done on location, but some of the health workers also provide counseling outside the building.
“For the public, we go to posyandu (integrated health services), for weighing and immunization, which may be done outside the building, every month”, (P3, a midwife).
Some of the health workers admit that sometimes they are overwhelmed by their duties, so when it comes to providing education, it is mostly limited to handing out leaflets. However, in addition to the traditional printed media, some health workers also use social media to disseminate health information to the public.
“We use communication media, we often hand out leaflets to the public”, (P12, a nurse).
“We provide information (health information)…through the media…we use Facebook”, (P6, a nurse).
One way to improve the quality of health care for children under five years old is through coordination. Coordination is set up between the relevant parties who are involved in the efforts to improve health care for children under five years old. For example is coordination between the various stakeholders, including community figures, cadres, and local hospitals.
“We are collaborating with community figures, involving community figures, especially the mothers, they in a sense are cadres”, (P6, a nurse).
Another form of cooperation is also formed with the local health workers, in this case the midwives. This type of cooperation is quite effective as a medium for disseminating information on issues related to public health or medical emergency involving a child under five years old in a specific area.
“We have an area of responsibility, so when a medical emergency occurs, we will refer to the appropriate department”, (P5, a doctor).
Coordination is also carried out across programs that generally require collaboration from other departments to manage health related issues involving children under five years old.
“When a child is suffering from malnutrition, we will refer that child to a nutritionist consultant”, (P12, a nurse).
Good coordination is not limited to inter profession or across programs, but it should also include coordination with leaders or heads of departments in charge of delivering health care for children under five years old. Such coordination is usually in the form of supervision and coaching.
“There will be a coaching session with the department’s head”, (P8, a doctor).
In the effort to improve the quality of the health workers, they should be allowed to attend the relevant training on health care for children under five years old.
“A medical worker should keep his/her knowledge and skills up to date” (P11, a doctor).