Previous studies on maternal health have highlighted the need to improve health literacy, particularly among women from lower socioeconomic backgrounds. Some crucial factors for improving maternal health literacy are midwife capacity and systems support that can help ensure women's ability and motivation to access timely health services. However, the extent of roles midwives need and the system that must be developed require further elaboration. The aim of this systematic review was to investigate approaches for enhancing maternal health literacy in low-income pregnant women. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the systematic search was conducted on two databases: PubMed and ScienceDirect. All English articles published from 2011 to 2023 were searched using the keywords pregnant, antenatal, prenatal, perinatal, midwife, health literacy, midwife-led care, helpline, and photo novel. Of the 1539 articles, 15 were included for final assessment. The results suggest that improving maternal health literacy among low-income pregnant women is related to empowering these women, midwives as frontline care providers engaging with them, and the health care system as a health literacy organization. In conclusion, improving the healthcare system and strengthening midwives' leadership as proximal caregivers is crucial for improving maternal health literacy among low-income pregnant mothers. These efforts could be realized with support from government roles, educational institutions, and professional associations.

Purpose: This study aims to examine how an educational intervention, using the lens of the LEADS framework, can influence the development of primary care doctors’ leadership skills in Aceh, Indonesia. In order to persevere in the face of inadequate resources and infrastructure, particularly in rural and remote settings of low- and middle‐income countries, physicians require strong leadership skills. However, there is a lack of information on leadership development in these settings. Design/methodology/approach: This study applied an educational intervention consisting of a two-day workshop. The authors evaluated the impact of the workshop on participants’ knowledge and skill by combining quantitative pre- and post-intervention questionnaires (based on Levels 1 and 2 of Kirkpatrick’s model) with qualitative post-intervention in-depth interviews, using a phenomenological approach and thematic analysis. Findings: The workshop yielded positive results, as evidenced by participants’ increased confidence to apply and use the information and skills acquired during the workshop. Critical success factors were as follows: participants were curiosity-driven; the use of multiple learning methodologies that attracted participants; and the use of authentic scenarios as a critical feature of the program. Originality/value: The intervention may offer a preliminary model for improving physician leadership skills in rural and remote settings by incorporating multiple teaching approaches and considering local cultural norms.

Background: Stunting is impaired growth and cognitive development that could decrease learning ability and productivity and increase morbidity and mortality. In 2018, 30.8% of children under the age of five in Indonesia were stunting. Chronic lack of nutrition as a cause of stunting is well known. However, the type of food that causes differences in the conditions between stunting and non-stunting children still needs further investigation. Dietary diversity is an indicator to identify the type and quality of food consumed. Objectives: Analyzing the relationship between dietary diversity and stunting and determinants of stunting in children aged 24-59 months in Indonesia. Methods: This was an observational study using a cross-sectional design. Secondary data from the (IFLS) 5 was used. Bivariate analysis was conducted using the chi-square test. Multivariate analysis used the logistic regression test. The subjects in this study were 2421 children aged 24-59 months. Results: Bivariate analysis showed a significant relationship between dietary diversity and stunting. Significant relationships were found between meat, eggs, milk and its products, and vitamin A-rich vegetables and stunting. Multivariate analysis showed LBW, economic status, area of residence, and maternal education are predictors of stunting. Conclusions: Dietary diversity, especially consumption of animal protein such as eggs, meat, fish, and milk could improve the quality of children’s diets. Improving the quality of diets could potentially reduce the risk of stunting. Therefore, efforts and strategies are needed to increase accessibility to various foods and increase nutritional knowledge.

ABSTRAK Latar Belakang: Salah satu penyebab tingginya Angka Kematian Bayi dan Angka Kematian Ibu adalah karena kurangnya pengetahuan tentang penanggulangan dan komplikasi-komplikasi penting dalam kehamilan, persalinan, dan nifas. Konseling adalah upaya menggali dan memberikan informasi guna mendapatkan apa yang dibutuhkan dan membantu ibu hamil dalam mengambil keputusan. Bidan Praktik Swasta dan Puskesmas adalah organisasi pelayanan kesehatan yang memberikan pelayanan pada ibu hamil termasuk konseling. BPS adalah organisasi pelayanan kesehatan swasta yang dikelola secara mandiri, sedangkan Puskesmas adalah organisasi pelayanan kesehatan yang di kelola oleh pemerintah. Tujuan: Tujuan penelitian ini adalah untuk mengetahui pelaksanaan konseling pada ibu hamil yang meliputi: praktik konseling, waktu, tempat, alat bantu, materi, cara mengatasi hambatan, upaya peningkatan ketrampilan, dan bentuk pengajaran ketrampilan konseling di pendidikan di BPS dan puskesmas di Kabupaten Bantul. Metode: Metode penelitian adalah metode kualitatif dengan rancangan studi kasus dan bersifat deskriptif. Unit analisis adalah ibu hamil, bidan pelaksana di BPS dan puskesmas. Data diambil secara purposive sampling melalui wawancara mendalam dan lembar pengamatan konseling serta penelusuran dokumen. Hasil: Praktik konseling di BPS dan puskesmas dalam bentuk pemberian informasi. Waktu yang digunakan dalam proses konseling masih kurang yaitu di bawah 20 menit. Tempat yang digunakan untuk proses konseling menjadi satu dengan tempat yang digunakan untuk periksa kehamilan, dan banyak orang yang ada dalam ruangan periksa. Alat bantu yang digunakan untuk konseling sebatas buku KIA dan belum menggunakan alat bantu yang lain. Informasi yang diberikan sebatas pada keluhan yang disampaikan oleh ibu hamil. Jika ibu hamil tidak menyampaikan keluhan, bidan tidak berusaha menggali permasalahan atau memberikan informasi. Hambatan yang paling sering ditemui bidan adalah sulitnya ibu hamil memahami informasi yang diberikan bidan. Cara penyelesaian hambatan dengan cara melibatkan suami dalam proses konseling. Upayapeningkatan ketrampilan konseling secara resmi seperti pelatihan-pelatihan belum ada. Upaya yang dilakukan selama ini adalah dengan membaca buku-buku dan belajar dari teman. Bentuk pengajaran ketrampilan konseling di pendidikan dengan metode roleplay, dilaksanakan dikelas, dan dilakukan dengan teman sendiri. Kesimpulan: Proses konseling pada ibu hamil yang dilakukan oleh bidan pada umumnya tidak berjalan sebagaimana mestinya, yaitu tidak sesuai dengan pedoman yang ada dalam standar pelayanan kebidanan. Dampaknya adalah ibu hamil belum paham dengan segala hal yang berkaitan dengan kehamilan. COUNSELING FOR PREGNANT WOMEN AT MIDWIFE PRACTICE AND COMMUNITY HEALTH CENTER In BANTUL DISTRICT Background: One of the factors of Maternal and Neonatal Mortality is the lack of knowledge on the cause and how to deal with important complications during pregnancy, labor, and post natal. Counseling is an effort to dig and give useful information in order to help pregnant mother to take decisions. Midwife practice and Community Health Center is an organization which aims at giving service to pregnant mother including counseling. Midwife practice an independent organization which is managed privately, whereas Community Health Center is an organization which belongs and runs by the government. Objectives: The objective of the research is to find out the implementation of counseling on pregnant mother which includes, time, places, instruments, materials, problem solving, training efforts, and form of teaching counseling skill on midwife practice and Community Health Center in Bantul district. Method: Research method used in this research is qualitative research method with case study and descriptive method. The analysis unit is the pregnant mother, midwife in charge in midwife practice and in Community Health Center. The data was taken using purposive sampling through interview, observation and library study. Result: Counseling implementation in midwife practice and Community Health Service is done through giving information. The time done for counseling is under the standard which was below 20 minutes. The counseling process is undergone in one place along with the other services, and there are many patients in the room. The instruments used for counseling is just KIA book and there are no other instruments, the information given is merely on the problems which are shared by the pregnant mother. If the pregnant mother doesn’t share her problem, the midwife will not give counseling. The problem which is often faced by the midwife is that pregnant mother has difficulties in intrepreting information given. Problem solving is done through the participation of the husband during the counseling service. Training efforts to increase the counseling skill has not been done officially. The efforts taken so far is by reading books or learn from other coleagues. The form of teaching counseling skill is using roleplay, done in pairs and not more than 45 minutes. Conclusion: The implementation of counseling for pregnant mother is done inappropriately, which is not the same as it is stated in the Standart Service of Midwifery. It makes pregnant mother doesn’t have the necessary information dealing with the pregnancy. Keywords: Counseling, Pregnancy, Midwife

Background: During a national health insurance implementation, efficiency improvement becomes an important issue as a result of the change of a payment method from free for service to fixed pricing mechanism of INA CBG's by containing cost and improving quality. Inefficiency occurs when a psychiatric hospital uses an excessive input resource to produce a given level output. Objective: This study aimed to measure the level of efficiency of government psychiatric hospitals in the provinces of Central Java and Yogyakarta before and after the implementation of JKN. Methods: A descriptive quantitative study was conducted using two-stage data envelopment analysis (DEA). The first stage was to measure hospital efficiency. Second stage used paired samples t-test to analyze different mean of BOR, LOS, BTO, TOI and cost efficiency score. This study used secondary data from financial report, human resources report, hospital patient visit report of 5 psychiatric hospitals in central java and DIY province, period 2010 until 2014. Results: Efficiency measurement using DEA CRS inputoriented model obtained the mean of cost efficiency score was 0,896. Mean of efficiency score decreased during a transition period of national health insurance implementation from 0,947 in 2013 became 0,866 in 2014. Soedjarwadi hospital was the only one of a psychiatric hospital that achieved cost efficiency in 2014. Paired samples t test analysis showed that there was no difference of mean of BOR, LOS, BTO, TOI and score cost efficiency before and after efficiency improvement in 2013 from 2010. There was no difference of mean of BOR, LOS, BTO and score efficiency before and after implementation of national health insurance. The only one variable had difference of mean before and after implementation of national health insurance was TOI. Conclusion: Most psychiatric hospital in this study are still inefficient. National health insurance has not been able to improve efficiency in the early implementation period. Decreasing of efficiency score happened because of the decreasing of hospital output.