Better nurses means better health care

Better nurses means better health care

The meeting hall of the orphanage in the Yogyakarta district of
Gunung Kidul -- one of the poorest districts of the country only
a decade ago -- was full of men and women in brown uniforms.

They were doctors and health officials, directors and heads of
the local hospitals and public health centers (Puskesmas),
gathered to be informed by several experts that their nurses and
midwives were woefully below professional par in their standard
of service.

"Remember the woman from Bogor who fell into a coma following
a caesarean and whose husband is now asking that she be
euthanized?" a district administration officer asked rhetorically
when opening the event, designed to endorse the concept of the
Ministry of Health and the World Health Organization (WHO) of
quality assurance for nurses and midwives.

It was his teasing way of chiding the participants into
changing.

Dr. Arida, an official at the Yogyakarta provincial health
office, who was attending the meeting in her capacity as guest
lecturer, told the audience: "I would have taken offense had the
chiding been directed toward me."

Stifled laughter and some sniggering met her remarks.

"Don't you want to be known for good quality service in your
clinics and hospitals?"

More uneasy laughter was heard.

Arida and Dr. Tri Djoko Hadianto, another lecturer, recounted
how campaigns to convince health officials to provide training
sessions for their nurses and midwives often meet with resistance
from among managers of clinics and hospitals.

"Change is difficult," Arida said. "You want to upgrade the
nurses and midwives, but in order to do that you have to convince
their superiors first, and this is where resistance often
appears."

The CPDMS training sessions for nurses and midwives have the
full support of the health ministry and the WHO and donor
agencies because they have been proven to improve nursing
quality, but dissemination of the concept takes a lot of effort
on the part of its consultant and trainers.

"We often meet nurses and midwives who are eager to learn and
participate in training, which means time away from work, but we
need a commitment and managerial support before they can be
carried out," Tri said.

"We need a special training in CPDMS for leaders (of health
clinics and hospitals) so they could, in turn, lead their
subordinates to achieve in certain training programs."

When CPDMS education and training for nurses and midwives has
taken place, however, the progress more than makes up for the
hard work.

"Education can change the mindset and attitude of the nurses
and midwives, so the quality of health care in general can
improve," said Dr. Sunartono, the head of Sleman district health
office in Yogyakarta.

One of the Yogyakarta village health clinics (Puskesmas)
applying CPDMS has just been awarded an ISO compliance
certificate for quality service.

Sleman is a good example of how attitude change means
improvement in health service and economic returns.

"People used to think that you went to Puskesmas because you
had to, because you did not have the money for better care," said
Sunartono.

"We are slowly changing that perception. We are trying to
convince the public that Puskesmas is an alternative health care
provision to hospitals. Patients come to the cheaper Puskesmas
despite having the means to pay for more expensive care."

One of the ways to introduce the change, Sunartono said, is by
returning 100 percent of a Puskesmas' income so it develops into
a self-sufficient business unit which will suffer financially
unless it provides quality service. More funding and equipment is
allotted.

Financial and human resource management is improved, including
the participation of nurses and midwives in CPDMS training.

"Nurses and midwives are more focused on their work following
the training and stick to operational standards, which even
includes the simple but important routine of washing hands before
and after tending to a patient," he said.

More residents of Sleman chose to seek the services of
Puskesmas, and it meant better income for staff members of the
because more money comes in.

"We time our service, from the moment a patient is received
up until they leave the clinic," said Markus Subadio, a nurse for
13 years. "We try to remember that we should smile when tending
to the patients!

"We also have this weekly session where we discuss difficult
cases and how they are handled, where we fail and where we
succeed. It gives us a sense of keeping up with health care
developments."

Tri Djoko is optimistic that training for the nursing
profession such as CPDMS will in the longer term help introduce
improvement in the overall health sector in Indonesia.

"I'd like to think that one day patients, even relatives of
doctors, would feel safe and sure of a quality service wherever
they go, Puskesmas or hospitals," he said.

-- Santi W.E. Soekanto and Ratih Sayidun