“Redefining the Trust and

Perceptions of Indonesian Midwives”

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

WHY WE CONDUCT A HEALTHCARE PROFESSIONAL SURVEY?

• The implementation of universal health coverage as mandated by

the law Law No. 40/2004 on National Social Security (SJSN) and Law

No. 24/2011 on Social Security Providers (BPJS); massively expanding

the health market customer base, especially the basic primaryhealthcare.

• Shortage of qualified professionals is one of the greatest obstacles to

the growth of Indonesia’s healthcare sector.

• Decentralized healthcare system in Indonesia has led to varying

degrees of quality and provision of healthcare from region to region.

• Potential increase in healthcare state spending through the public

private partnership (PPP)

3

Edelman’s contribution to help better understand Indonesia’s healthcare industry

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

OUR GOALS ARE TO:

1. Measure midwives’ trust towards specific

channels and key institutions

2. Assess their perceptions towards specific issues

FOCUS TOPICS

6

Maternal Health

Pregnancy

Reproduction

Family Planning

Child Health

Nutrition

Exclusive Breastfeeding

HIV/AIDS PreventionPhoto: UNFPA

1

2

3

4

5

6

7

8

PROFILE OF RESPONDENTSMETHODOLOGY : 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

*) The number of respondents was set based on relative population size in each city; the minimum number of sample size required for statistical analysis

with a 4% margin of error

**) There are currently around 200,000 midwives in Indonesia, 42% of which are in Java – Bali and 52% outside Java-Bali, the rest are in remote areas.

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 institutions to 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

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%

0%

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%

O T H E R S

C O M P A N Y ' S W E B S I T E

N E W S P A P E R

S O C I A L M E D I A

M A G A Z I N E

P R E V I O U S L E C T U R E R

M I D W I V E S G U I D E

G O V E R N M E N T ' S G U I D E

T V

P E E R S / S E N I O R S

I N T E R N E T , N E W S P O R T A LMaternal health

Pregnancy

Child Health

Nutrition

Exclusive

Breastfeeding

Reproduction

Family Planning

HIV/AIDS

Prevention

WHERE MIDWIVES GET THEIR INFORMATION

9

Midwives in Indonesia choose peers/seniors, television, and internet/ news portal as the first go-toinformation, compared to midwives and government’s guides

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

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

RESPONSE TO CERTAIN COMMUNITY ISSUESMajority 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 healthcare

providers during labor/childbirth

People do not see the importance of periodical medical

check-up during pregnancy

People do not realize the importance of giving a complete

vaccination to infants and toddlers

People do not realize the importance of using

contraception as part of family planning

People do not see the importance of exclusive

breastfeeding for babies until 1 year old

People are less concerned with family nutrition fulfillment

People do not understand properly how HIV/AIDS is being

transmitted

People do not realize the disadvantages of early/young

marriage

Agree Indifferent Disagree

Q2c. I will read several statements. Please indicate how much do you agree/disagree to the statement. (5 point scale, 1=strongly disagree, 5=strongly disagree)

ISSUES THAT MATTER

12

42%

37%

42%

38%

38%

52%

51%

49%

Diseases during

pregnancy

Diseases

Nutrition problem

Side effect

Mother preference

Malnutrition

Transmission & increasing

prevalence

Inability to conceive

25%

30%

32%

41%

52%

53%

64%

65%

People put less priority to rely on

professional healthcare providers

during labor/childbirth

People do not see the importance

of periodical medical check-up

during pregnancy

People do not realize the

importance of giving a complete

vaccination to infants and toddlers

People do not realize the

importance of using contraception

device as part of family planning

People do not see the importance

of exclusive breastfeeding for

babies until 1 year old

People are less concerned with

family nutrition fulfillment

People do not understand properly

on how HIV/AIDS being transmitted

People do not realize the

disadvantages of early/young

marriage 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=strongly disagree, 5=strongly disagree)

Q2a. To your knowledge, what are the biggest issue with the biggest impact within the key topics (highest findings only)

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

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 JOBSThe midwives surveyed showed significant trust in pharmaceutical and nutrition companies. On par

with Ministry of Health (MoH), doctors’, NGOs are the least trustedM

ED

IAIN

DU

STR

YG

OV

TN

GO

IND

IV

Q3. How much trust do you place on these institutions in helping you doing your job as midwife (9 point scale, 1=do not trust at all, 9=highly trust)

Note: no specific company names were mentioned, only examples of product as illustration

TYPE OF NEGATIVE CASES MIDWIVES HAVE HEARD ABOUT MOSTMalpractice 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 verify it with?

TV is the main

driver of

popularity. 91%

heard of it the

first time from TV

and 80% used

TV to verify the

story

TRUSTED SPOKESPERSONWhile 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

TRUST TOWARDS CERTAIN MEDIAThe 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 not trust at all, 4=highly trusted)

Ma

tern

al

He

alth

Pre

gn

an

cy

Re

pro

du

ctio

n

Fa

mily

P

lan

nin

g

Ch

ild

He

alth

Nu

tritio

n

Ex

clu

siv

eB

rea

stfe

ed

ing

HIV

/AID

S

Pre

ve

ntio

n

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%

Government Guide 8% 6% 8% 17% 9% 8% 10% 20%

TRUSTED SOURCE MIDWIVES USE TO CONVINCE PATIENTSAmong 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

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 MOST if they want to find information on health or medical issues? Which one do you recommend as

the SECOND? Which is the THIRD? Base Total = 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

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

THANK YOU