Evaluation of delivery service by village midwife during the implementation of delivery assurance in Salomekko Health Center of Bone district of South Sulawesi province in 2012

Background: The delivery assurance (Jampersal) issued from April 2011 aims to increase access to maternal delivery assistance by health workers in health facilities by providing financing guarantees. Delivery coverage by health workers in Bone District in 2011 was 76.67%. Delivery by health workers was only 60% done in health facilities and Salomekko Health Center had the lowest figure which was 25%. Objective: To evaluate service delivery by village midwives during the implementation of Jampersal in Salomekko Health Center of Bone District of South Sulawesi Province in 2012. Methods: This study was observational using a qualitative descriptive design that was evaluative in nature. The study subjects were 8 village midwives in the work area of Salomekko Health Center. The triangulation informants were the head and midwife coordinator of Salomekko Health Center and the head of MCH section of Bone Health office. Data was collected by in-depth interviews and analyzed by content analysis. Results: All midwives in the village did not perform service delivery well because most of them had not joined APN training. There was no Standard Operational Procedures (SOP), four village health post buildings in the four villages were not adequate (their width, no water or electricity and away from settlements), four other villages had not yet Poskesdes, and delivery equipment was also incomplete. The process of planning, implementation, monitoring and supervision of Jampersal was also not performed well. In 2011 and 2012 (January to April), all deliveries by health workers in the Salomekko Health Center were funded by Jampersal although deliveries took place in non-medical facilities. The culture of siri was expected to encourage mothers to give birth at home. The delivery rate by traditional birth attendants was still high. Although there was no necessity, the mothers should pay around 100,000 00 to midwives for consumables without the knowledge of the health office. The application procedure for Jampersal funds with certain administrative requirements was perceived to be quite complicated. Conclusion: Poskesdes needs to be built immediately in four villages and, for the other four villages that already have Poskesdes, the facilities need improving following the completeness of equipment. APN training and Jampersal SOP socialization should be improved and monitoring and supervision by the health center in the village should be increased. Levies should be removed and delivery by health workers not at the health facilities cannot claim Jampersal. Lastly, the claims of Jampersal process should be simplified