REDEFINING THE TRUST AND PERCEPTIONS OF INDONESIAN MIDWIVES

1. “Redefining the Trust and Perceptions of Indonesian Midwives”

2. HEALTHCARE PROFESSIONAL SURVEYS OVER THE YEARS
2
DEEPER ENGAGEMENT THROUGH LEVERAGING DIGITAL SHARED ASSETS
Empower your stakeholders to improve quality of engagement with HCPs by strengthening digital presence.
421 MDs (GPs and Specialists) in 4 cities (Jakarta, Bandung, Surabaya, Medan)
2
THE RISE OF THE INTERNET AS A TRUSTED SOURCE OF INFORMATION
Emergence of online media that has in turn forced MDs to improve the way they communicate with their patients
300 MDs (GPs and specialists) in Greater Jakarta area (Jakarta, Bogor, Depok, Tangerang, and Bekasi) REDEFINING THE TRUST AND PERCEPTIONS OF INDONESIAN MIDWIVES
600 midwives in 7 cities (Jakarta, Bandung, Medan, Jogjakarta, Surabaya, Makassar, Denpasar)
2010
2013
2014

3. WHY WE CONDUCT A HEALTHCARE PROFESSIONAL SURVEY?
•TheimplementationofuniversalhealthcoverageasmandatedbythelawLawNo.40/2004onNationalSocialSecurity(SJSN)andLawNo.24/2011onSocialSecurityProviders(BPJS);massivelyexpandingthehealthmarketcustomerbase,especiallythebasicprimaryhealthcare.
•ShortageofqualifiedprofessionalsisoneofthegreatestobstaclestothegrowthofIndonesia’shealthcaresector.
•DecentralizedhealthcaresysteminIndonesiahasledtovaryingdegreesofqualityandprovisionofhealthcarefromregiontoregion.
•Potentialincreaseinhealthcarestatespendingthroughthepublicprivatepartnership(PPP)
3
Edelman’s contribution to help better understand Indonesia’s healthcare industry

4. STATE OF HEALTHCARE AND MIDWIVES IN INDONESIA
In 2012, there are 359 Maternal Mortality Ratio per 100,000 live birth. Emphasized a reversal of progress since 2007.

5. 5
OUR GOALS ARE TO:
1.Measure midwives’ trust towards specific channels and key institutions
2.Assess their perceptions towards specific issues

6. FOCUS TOPICS
6
Maternal Health
Pregnancy
Reproduction
Family Planning
Child Health
Nutrition
Exclusive Breastfeeding
HIV/AIDS Prevention
Photo: UNFPA
1
2
3
4
5
6
7
8

7. PROFILE OF RESPONDENTS
METHODOLOGY: FACE-TO-FACE INTERVIEW
TOTAL RESPONDENTS: 600 MIDWIVES
PERIOD: JANUARI’14 –APRIL’14
Private Clinic 57%
> 5 years 71%
Urban 61%
JKT 25%
Community Clinic 43%
2 –5 years 29%
Rural 39%
BDG 13%
SBY 15%
MDN 15%
JGJ 13%
MKS 13%
DPS8%
Working for
Years of practice
Area
Cities
*)Thenumberofrespondentswassetbasedonrelativepopulationsizeineachcity;theminimumnumberofsamplesizerequiredforstatisticalanalysiswitha4%marginoferror
**)Therearecurrentlyaround200,000midwivesinIndonesia,42%ofwhichareinJava–Baliand52%outsideJava-Bali,therestareinremoteareas.

8. TOPLINE FINDINGS
The growing power of mass media, especially television and the Internet, with midwives taking content presented at face value
Pharmaceutical and Nutrition companies are trusted institutionsto help in midwifery, not individual sales representatives
There is an ongoing concern on national nutrition, though the topic is considered a low priority among midwives

9. 1%
2%
3%
5%
8%
9%
9%
9%
17%
18%
21%
4%
3%
2%
4%
7%
10%
11%
10%
11%
22%
17%
5%
1%
2%
4%
7%
9%
10%
10%
13%
18%
19%
7%
2%
2%
3%
5%
9%
10%
11%
14%
15%
0%
7%
3%
8%
3%
8%
7%
12%
9%
0%
18%
5%
3%
3%
3%
6%
9%
11%
11%
12%
18%
20%
5%
3%
2%
2%
3%
11%
0%
9%
13%
19%
13%
5%
1%
2%
4%
7%
9%
10%
10%
13%
18%
19%
OTHERS
COMPANY'S WEBSITE
NEWSPAPER
SOCIAL MEDIA
MAGAZINE
PREVIOUS LECTURER
MIDWIVES GUIDE
GOVERNMENT'S GUIDE
TV
PEERS/SENIORS
INTERNET, NEWS PORTAL
Maternal health
Pregnancy
Child Health
Nutrition
ExclusiveBreastfeeding
Reproduction
Family Planning
HIV/AIDSPrevention
WHERE MIDWIVES GET THEIR INFORMATION
9
MidwivesinIndonesiachoosepeers/seniors,television,andinternet/newsportalasthefirstgo-toinformation,comparedtomidwivesandgovernment’sguides
Q1b. When you are looking for information to update your knowledge related to the key topics, what kind of information channels do you go to for the first time?
Power of mass media for midwives

10. WHERE MIDWIVES GO TO VERIFY INFORMATION
Q1c. What is your most trusted source to verify information concerning these key topics? (open ended)
A large percentage of midwives surveyed do not verify information and accept the first go-to source of information

11. RESPONSE TO CERTAIN COMMUNITY ISSUES
Majority of midwives agree that people lack understanding towards “disadvantages of early marriage” and “HIV/AIDS transmission”
25%
30%
32%
41%
52%
53%
64%
65%
11%
13%
18%
18%
18%
22%
17%
17%
64%
57%
51%
40%
30%
24%
20%
18%
People put less priority to rely on professional healthcareproviders during labor/childbirth
People do not see the importance of periodical medicalcheck-up during pregnancy
People do not realize the importance of giving a completevaccination to infants and toddlers
People do not realize the importance of usingcontraception as part of family planning
People do not see the importance of exclusivebreastfeeding for babies until 1 year old
People are less concerned with family nutrition fulfillment
People do not understand properly how HIV/AIDS is beingtransmitted
People do not realize the disadvantages of early/youngmarriage
Agree
Indifferent
Disagree
Q2c. I will read several statements. Please indicate how much do you agree/disagree to the statement. (5 point scale, 1=stronglydisagree, 5=strongly disagree)

12. ISSUES THAT MATTER
12
42%
37%
42%
38%
38%
52%
51%
49%
Diseases duringpregnancy
Diseases
Nutrition problem
Side effect
Mother preference
Malnutrition
Transmission & increasingprevalence
Inability to conceive
25%
30%
32%
41%
52%
53%
64%
65%
People put less priority to rely onprofessional healthcare providersduring labor/childbirth
People do not see the importanceof periodical medical check-upduring pregnancy
People do not realize theimportance of giving a completevaccination to infants and toddlers
People do not realize theimportance of using contraceptiondevice as part of family planning
People do not see the importanceof exclusive breastfeeding forbabies until 1 year old
People are less concerned withfamily nutrition fulfillment
People do not understand properlyon how HIV/AIDS being transmitted
People do not realize thedisadvantages of early/youngmarriage
REPRODUCTION
HIV/AIDS
NUTRITION
EXCL. BREASTFEED
FAMILY PLANNING
CHILD HEALTH
PREGNANCY
MATERNAL HEALTH
Agree with the statement
Biggest issue with the topic…
Q2c. I will read several statements. Please indicate how much do you agree/disagree to the statement. (5 point scale, 1=stronglydisagree, 5=strongly disagree)
Q2a. To your knowledge, what are the biggest issue with the biggest impact within the key topics (highest findings only)

13. Q1a. Looking at these key topics related to midwifery, which one is the most important based on your opinion
•Prompted answers came from responses to a given list and indicate all that the midwife agreed with
•Unprompted answers add up to 100%: single most important
VIEWS ON 8 KEY TOPICS

14. 79
91
92
96
62
79
83
86
61
67
85
92
94
10
6
5
3
13
10
6
8
16
12
7
4
3
11
3
4
2
25
11
11
6
24
21
9
5
3
BPJS
BKKBN
Ministry of Health
Doctor
Radio
Magazine/Newspaper
Internet
TV
NGO
Insurance Company
FMCG Company
Nutrition Company
Pharma Company
Trust
Indiferent
Distrust
MIDWIVES’ TRUST IN INSTITUTIONS TO HELP THEM DO THEIR JOBS
The midwives surveyed showed significant trust in pharmaceutical and nutrition companies. On par with Ministry of Health (MoH), doctors’, NGOs are the least trusted
MEDIA
INDUSTRY
GOVT
NGO
INDIV
Q3. How much trust do you place on these institutions in helping you doing your job as midwife (9 point scale, 1=do not trustatall, 9=highly trust)
Note: no specific company names were mentioned, only examples of product as illustration

15. TYPE OF NEGATIVE CASES MIDWIVES HAVE HEARD ABOUT MOST
Malpractice cases involving doctors resonates the most, with dr. Ayu’s malpractice case mentioned by more than half (53%) of respondents.
13%
20%
40%
51%
62%
82%
Malfunction of medical devices
Contaminated medicine
Contaminated beverage
Contaminated food
Contaminated milk
Doctor's malpractice
81%
cannot recall the brand name(s)
Q10abc. Have you ever heard of these type of cases? Which sources did you hear it for the first time? Who/what did you verifyitwith?
TV is the main driver of popularity. 91% heard of it the first time from TV and 80% used TV to verify the story

16. TRUSTED SPOKESPERSON
While pharmaceutical and nutrition companies are trusted, as institutions, their sales representatives and company executives are the lowest on the trust scale. Spokespersons with medical background are preferred
19%
33%
35%
37%
43%
53%
63%
85%
90%
90%
11%
7%
6%
3%
7%
9%
4%
1%
1%
1%
70%
60%
60%
60%
50%
39%
34%
14%
10%
10%
NGO Representative
Village Head (Lurah)
Company Executive
Sales Representative
Mayor
Religious Leader
Consumer
MoH Representative
IBI Representative
Academician/Doctor
Trust
Indifferent
Distrust
Q9. Among these individuals, who do you think is the trusted spokesperson to deliver information/message (4 points scale, 1=do not trust at all, 4=highly trusted)
1 IBI : Ikatan Bidan Indonesia (Indonesian Midwives Associations
2 MoH: Ministry of Health
1
2

17. TRUST TOWARDS CERTAIN MEDIA
The Internet and TV have had a huge influence over the midwives surveyed
35%
42%
45%
47%
59%
9%
2%
3%
1%
4%
56%
56%
53%
52%
37%
Radio
Newspaper
Magazine
TV
Internet
Trust
Indifferent
Distrust
Q9. Among these media sources, what do you think is the trusted channel to deliver information/message (4 points scale, 1=do nottrust at all, 4=highly trusted)

18. Maternal Health
Pregnancy
Reproduction
Family Planning
Child Health
Nutrition
ExclusiveBreastfeeding
HIV/AIDS Prevention
TV
53%
52%
49%
55%
54%
52%
54%
58%
Medical Doctors (MD)
60%
56%
60%
32%
61%
56%
38%
65%
Midwives Guide
33%
37%
28%
37%
25%
19%
39%
6%
Internet
25%
23%
27%
22%
24%
23%
21%
24%
Magazine
16%
17%
15%
14%
16%
18%
18%
8%
GovernmentGuide
8%
6%
8%
17%
9%
8%
10%
20%
TRUSTED SOURCE MIDWIVES USE TO CONVINCE PATIENTS
Among respondents, TV and Medical Doctors are the most trusted sources to convince their patients.
Q12a. What is your main source to convince patients in the key topics? (multiple response)
Majority of midwives are available in rural areas which limits their access to internet

19. HCPS BEHAVIOUR: REFER PATIENTS TO ONLINE AND PEERS
19
Results from Healthcare Professionals Survey 2013
2
7
21
32
38
3
7
20
31
39
2
6
23
32
37
Broadcast media
Print media
Books/journal
Health professional
Internet/web/ blog/forum
Specialist
GP
Total
Q5: Which of the following sources of information do you recommend to your patients MOSTif they want to find information on health or medical issues? Which one do you recommend as the SECOND? Which is the THIRD? BaseTotal =421; GP = 279, SP = 142
Our 2013 Healthcare Professional Survey found that healthcare practitioners’ use of the Internet to convince patients is the exact opposite of midwives

20. MOVING FORWARD
Mass media, especially television and internet, are important and effective means to communicate with midwives
•Health institutions to monitor data accuracy,
•Perform rapid response to mis-interpreted message
•Provide direct and tactical interpretation to message
Tripartite collaboration, leveraging trust in pharmaceutical institutions and authoritative role of government and doctors is the way forward
•Private health institutions to build capacity of the Ministry of Health and doctors
•Ministry of Health to build capacity of other health institution in performing a campaign

21. THANK YOU