Compliance to traditional birth practices and poor perception of formal health facility: exploring actions to social determinants of health and barriers to care access in indigenous “Suku Anak Dalam“ community

People living in isolated communities are vulnerable to suffering from illness because of their lack of access to available known effective treatment in health facilities around them, including in maternal and child issues. The goal of this in-depth interview and one month-direct observation living in the community is to explore the belief and available structure of local health-seeking behavior among the Suku Anak Dalam community. Our findings suggest that the community has its own traditional belief that explains their birth practices. Interpretation of concepts such as anak peranakan, taputangan, pekarom, and delom system are unique and inseparable from the interpretation of their ideal life and their trust in God. In the other side, their poor perception about public health facilities is influenced by their experience dealing with formal health facilities. When a community gets what they perceived as poor services, they will not believe and do not come back to seek help from formal health facilities. Our study confirmed that the cultural explanation of birth and belief related to traditional birth delivery services remain existent and practiced, which limits access to a government health facility. If the community is free to choose alternative care outside their traditional system, people may obtain effective treatments from the surrounding health facilities. SAD women feel comfortable with their cultural practices. They have a negative perception and feel uncomfortable about formal health facilities showed inadequate government efforts to bring services to a specific social group. Health workers in isolated areas with traditional belief should be prepared and paid under a contract basis, different from the regular workers. They need to improve the communication skills that allow them to engage with people from different cultures. They need to work with officers from other sectors, both in formal and informal settings.People living in isolated communities are vulnerable to suffering from illness because of their lack of access to available treatment and known to be effective in health facilities around them. Including in these categories is service access for pregnant women. The goal of this in-depth interview and one month-direct observation living in the community is to explore the belief and available structure of local health seeking behavior among Suku Anak Dalam community. Our findings suggest that the community has their own traditional belief that explains their birth practices. Interpretation of concepts such as anak peranakan, taputangan, pekarom, and “delom” system are unique and inseparable from their understanding of their believed ideal life and their trust in God. In other side, their poor perception about public health facilities is influenced by their experience dealing with formal health facilities. When community gets what they percerived as poor services, they will not believe and do not come back to seek help from formal health facilities. Our study confirmed that the cultural explanation of birth and belief related to traditional birth delivery services remain existent and practiced, which limits access of the interior at the health facility. If the community give a choice to their people to find alternative formal health care outside their traditional system, people will no longer suffer from conditions that effective treatments are available in the surrounding health facilities. Women in the community feel comfortable when they are with their traditional system and that they have a bad perception and uncomfortable about formal health facilities shows that inadequate government efforts to bring services to the population. Health workers working in community health centers in the isolated areas with strong traditional belief should be prepared and contracted in different way from the regular workers. They need training to improve their communication skills that allow them to talk and to engage with people from different cultures and to work with the community and people from other sectors both in formal and informal settings