Research implementation and evaluation of the maternity waiting home program for enhancing maternal health in remote area of Indonesia

Background: The limited accessibility of healthcare facilities contributes to delays, resulting in an increased risk of maternal mortality. One crucial strategy for improving access to care is the implementation of standardized Maternity Waiting Homes (MWH). This study aims to identify strategies for enhancing the MWH program's effectiveness in remote areas. Methods: This research is implementation research using a mixed-method approach. Focus group discussions and in-depth interviews were conducted among stakeholders and health workers to explore barriers and attitudes in implementing MWH. The quantitative data collection with a cross-sectional design was conducted to identify the use of MWH by pregnant women and families. A quasi-experimental method with a pre-test and post-test control group design was performed to implement a collaborative empowerment model of Community Health Workers (CHW) and midwives. Results: This study revealed that the utilization of the MWH program by the community was deficient. This was attributed to the lack of knowledge regarding MWH among pregnant women and families, the distances between residences and the MWH, high costs, and a shortage of MWH healthcare providers. After implementing a collaborative model, there were three times improvements in knowledge (Rs = 0.26, P-value = 0.032) and willingness to utilize MWH (P-value = 0.037) among pregnant women in the intervention group. Conclusion: Implementing a collaborative empowerment model of CHW and midwives has enhanced knowledge acquisition and utilization of MWH among pregnant women. This approach ought to be utilized to improve MWH or health facility utilization, particularly in specific locations