Study Overview
Using a representative cross-section of health care providers in Indonesia, we describe variations in prenatal, child, and adult care quality. Quality is measured as knowledge about clinical guidelines. Public health centers offer above-average-quality prenatal care, and private physicians provide high-quality curative care. Private nurses offer below-average care, as do most providers in the more remote regions of Outer Java-Bali. The poor and wealthy have access to the same levels of quality; however, the poorest women report receiving fewer prenatal procedures. Recommendations include improving the professional development of nurses in private settings, testing quality improvements in Outer Java-Bali, and investigating wealth disparities in quality received.
Study Results
There is increasing recognition that low quality contributes to poor health status in low- and middle-income settings. Variations in clinical quality reflect knowledge, but they are also a manifestation of the overarching educational, policy, and regulatory frameworks upon which the health system is based. Training could address quality deficiencies related to skills. Because nurses are a prominent source of health care, strengthening their professional development and regulation would likely have a large impact on quality