IJPHCS International Journal of Public Health and Clinical Sciences

Open Access: e-Journal e-ISSN : 2289-7577. Vol. 3:No. 3

May/June 2016

IMPACT OF HEALTH VOLUNTEER TRAINING TO

IMPROVE UTILIZATION OF MATERNAL CHILD HEALTH
(MCH) BOOK IN KALIBAGOR INDONESIA

Colti Sistiarani1* , Arif Kurniawan1, Endo Dardjito1

1
Department Of Public Health, Health Sciences Faculty, Jendral Soedirman University

*Corresponding author: Email: coltisistiarani@yahoo.co.id

ABSTRACT

Backgroud: Health volunteer role in utilization of Maternal Child Health Book is simply to
fill health card for children to appraisal nutritional status. Utilization MCH Book by health
volunteers have to included detection of high risk pregnant women, and birth planning
programs and the prevention of complications, but its not yet maximized.The purposes of the
study are to improve the knowledge and skills of utilization MCH Book on health volunteers.

Methods: This research is quasi experiment study designed to be applied for a group, tested
before and after gave training. The group selected for this study includes 61 health volunteer
in Kalibagor village. The sampling was done by using simple random sampling. Techniques
of data collection was done by interview using a questionnaire that has been tested for validity
and reliability. Skills utilization MCH Book measurement done by observation using
observation sheet

Results: Statistical test analysis showed significan difference between knowledge and skills
utilization MCH Book (p=0.000). Evaluation is done by providing pre-test and post-test
showed knowledge about the function of the utilization of MCH Book increased 30.60%.
Utilization achivement of MCH Book on skills among health volunteer increased by 23.13%,
skills views in charge health card for children to appraisal nutritional status, detection of high
risk pregnant women, delivery planning and complication prevention program

Conclusion: There is increasing knowledge and skills health volunteer for utilization MCH
Book. Suggestion trained health volunteer can provide information and maximize skills
utilization MCH Book

Keywords: utilization MCH books, health volunteer, knowledge, skills

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IJPHCS International Journal of Public Health and Clinical Sciences
Open Access: e-Journal e-ISSN : 2289-7577. Vol. 3:No. 3
May/June 2016

1.0 Introduction
Various programs undertaken by the district health center in Banyumas Indonesia to improve
the health status of mothers and child have been carried out. Maternal Child Health (MCH)
programs include integrated antenatal care, resource midwife optimization, the optimization
MCH program, optimization of MCH coverage, village guard ready program. Apliication
program are also strengthening essensial obstetric maternal and neonatal in community health
centers and comprehensive obstetric village health forum, the increase of family planning,
Expanding Maternal Neonatal Survival (EMAS) Programs (1).

The number of cases of maternal mortality in the Banyumas district calculate maternal
mortality until 34 cases. Sourced data from maternal and child health in the region’s of
Banyumas district is Kalibagor subdistrict, 5 a number of cases maternal mortality . Pregnant
women to detect high risk reached 197 cases (22,43%), referral to hospital are 245 cases of
high risk pregnancy (27,90 %). These data indicate that the number of pregnant women
belonging to the category of high risk pregnancies, still found babies born with low birth
weight remains a problem of maternal and child health (2). Results of research on health
volunteer in Kalibagor, showed relationship between knowledge health volunteer with the
utilization MCH book. The role of health volunteer to utilization MCH book is not
maximized, role health volunteer to give information about early detection of danger signs of
pregnancy and postpartum (35.9%), role to providing information on delivery planning and
prevention complications (3).

The functions of MCH Book are including function of recording, education and
communication (4). Research results was found that the recording function of recording MCH
Book is still not complete, namely regarding service records postpartum (82.4%), family
planning services (100%), stickers delivery planning and prevention complications not filled
and labeled (58%). Educational function which has not been made suggestions sticking
stickers (42.95%), delivery assistance with planning recommendations childbirth and
prevention of complications (25.31%). Communication functions are still rarely carried out,
namely utilization MCH Book by health volunteer as an effort to improve MCH (12.1%).
Recording function in the utilization of MCH Book that can be done by a health volunteer of
helping activity recording maternal and child health status after examination by midwife,
provision of vitamin A recording status, recording status and the immunization record of
growth and development in children. Recording function can also be done by checking the
completeness of book entries and the MCH book ownership status. Health volunteer also can
perform monitoring of the delivery assistance and prevention of complications program (5)

Integrated Health Center (IHC) is one approach to community participation in the health
sector. IHC is managed by a health volunteer who have received training by the trained
midwife. Health volunteer task in the activities of the Maternal and Child Health (MCH) was
doing registration, weighing, noting the mother and child care in the MCH Book and
utilization of MCH Book as an extension materials, to report the maternal and chlid health
status to midwife. Health volunteer allowed to perform charging and checking MCH Book.
Things to do, among others, help the administration records related matters identity of the
mother and child, delivery planning and complication prevention program, charging health
card for children to appraisal nutritional status on MCH book. The role of health volunteer in
charging MCH book are intended to assist midwiferole in getting the complete recording in

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Open Access: e-Journal e-ISSN : 2289-7577. Vol. 3:No. 3
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the MCH book. The purpose of the research-based service activities such as increasing the
knowledge and skills of health volunteer regarding the utilization of MCH book.

2.0 Materials & Methods

This research is quantitative research. Design research using quasi experimental method. The
approach used to pretest and posttes without control groups. Evaluation design used
instrument, questionary to determine in knowledge about utilization MCH book, and checklist
to determine in sklill about utilization MCH book The evaluation of a pre-test and post-test.
collective data using inquiry package filled by health volunteer.Structured questionnaire with
precoded closed and open ended questions about utilization of maternal and child health book
were used before and after gave training to health volunteer. Instrument to determine the
achievement skills utilization maternal and child helath book using observation checklist.

The validity of which is used in this study using the construct validity. This questionnaire is
done on the validity to be analyzed using product moment correlation. Validity testing is done
by comparing the test result with p value. This results using indicators p valuesince the value
of p <0.05, so it can be valid.Reliability testing is done by comparing the test results with
Cronbach alpha values. Questionnaire reliable if the alpha value of at least 0,7(6).

Ethical considerations of research carried out by explaining the study to health volunteer
selected as the study sample. Subsequently asked to approve a health volunteer interviewed
and observed on utilization MCH book. Health volunteer prove this willingness in research
activities by means of signed informed consent after receiving explanations. Explanation of
health volunteer carried out the study to include the confidentiality of research results. This
study also does not give a negative impact to health volunteer.

The research was used both univariate and bivariate analysis. Univariate analysis was used to
evaluated the level of knowledge and skills about utilization MCH Book. Bivariate analysis to
determine the effect of health education using the training methode against the health
volunteer knowledge and skills about utilization of MCH book. The statistical analysis is
using wilcoxon rank test. This results using indicators p value <0.05, so that it can be shown
significant differences in knowledge and skills about utilization MCH book among health
volunteer.

3.0 Results
The characteristics of health volunteers included; 36 (59%) aged 31-40 years old, duration of
working more than 10 years 32 (52,5%), education level was senior high school 33 (54,1%).
Table 1 displayed the demographic characteristics of participant.

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Open Access: e-Journal e-ISSN : 2289-7577. Vol. 3:No. 3
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Table 1: Demographic Characteristics of Participant

No Variable Classification Frequency Percentage
(n) (%)
1. Age 20-30 years 6 9,8
31-40 years 36 59,0
41-50 years 10 16,4
More than 50 years 9 14,8
Total 61 100,0
2 Duration of working 0-10 years 29 47,5
More than 10 years 32 52,5
Total 61 100,0
3 Education Level Primary school 13 21,3
Junior high school 13 21,3
Senior high school 33 54,1
Diploma/Academy 2 3,3
Total 61 100,0

Increased knowledge and skills about utilization MCH book based on the results of pre-test
mean score and post-test mean score. Increased health volunteer knowledge and skills are
calculated as follows:

Postest-pretest X 100% = Score health volunteer knowledge and skill

pretest

From the knowledge of utilization MCH bookresults, an increase of 1.72 points (Figure 1),
the percentage increase in knowledge of utilization MCH book are 30.60%. From the skills
results, an increase of 1.52 points (Figure 2)The percentage increase in skills are 23.13%.

10
5.62 7.34
5

knowledge pretest
knowledge posttes

Figures 1: Achievement Knowledge about Utilization MCH Book

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Open Access: e-Journal e-ISSN : 2289-7577. Vol. 3:No. 3
May/June 2016

10
5.05 6.57
5

skills pretest
skills posttes

Figures 2: Achievement Skills about utilization MCH Book

Results of statistical test analysis showed difference between knowledge and skills about
utilization MCH Book of pre test and post test, because the value of p = 0.000, since the value
of p <0.05. The analysis showed significant differences about knowledge and skills about
utilization MCH Book. (Table 2 and 3)

Table 2: Result test different grade pre-post test knowledge utilization MCH Book
Grade Mean Score Test P value Alpha conclusion
analysis value

Pre-Post test 5,62-7,34 wilcoxon 0,000 0.05 There is difference knowledge

The results showed that there is an increase in the average score of knowledge between pre-
test to post-test of 5.62 to 7.34. Analysis to examine the difference in average scores this
knowledge using the Wilcoxon test. The results obtained are found differences in knowledge
before and after training about utilization MCH book on health volunteers

Table 3: Result test different grade pre-post test s utilization skills MCH book
Grade Mean Score Test P value Alpha conclusion
analysis value

Pre-Post test 5,05-6,57 Wilcoxon 0.000 0.,05 There is difference skills

The results showed that there is an increase in the average score of skills between pre-test to
post-test of 5.05 to 6.57. Analysis to examine the difference in average scores this knowledge
using the Wilcoxon test. The results obtained are found differences in skills before and after
training about utilization MCH book on health volunteers

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4.0 Discussion
The results characteristics analysis of the respondents described 59% respondents age 31-40
years. In general these characteristics are included in the middle adulthood stage, where the
intellectual abilities well. Education level of respondents are 54,1% senior high school.
Health volunteer should have a sufficient level of education. Health volunteer must have an
adequate educational background so that the training provided is acceptable and
understandable. Based mostly educational background health volunteer who have high school
education level, the activities of this training have good results to improve the ability of health
volunteer in the use MCH Book.

Defining voluntering is only formal volunteering, which we take to mean unpaid work that
benefits others to whom one owes no obligation (7).We do not focus on health trainers in this
review on the basis that most health trainers are paid for their services rather than working on
a voluntary basis. The Community Health Volunter (CHV) often consist of people living in
the community who contribute to primary health care (PHC) in order to improve health
outcomes. Their roles were depending on the level of training (8).

The roles health volunteer are participation in planning, consultation, advice and research in
health, service delivery, structured behaviour change intervention, supporting clients through
lifestyle changes – giving people the skills to set their own behavioural goals, acting as a
lifestyle coach, motivator, knowledge giver, practical demonstrator counselling, advocacy and
advice,respite support, accompaniment, supporting families, fundraising and
administration.The most commonly cited settings for volunteer support were community
settings (9,10,11,12,13).

Based of result showed an increase in knowledge utilization MCH book among health
volunteer. The results study appropriate literatur review about the training will increase the
skills for preparing Community Health Volunteers(CHV) to become active contributors in
life-saving in emergency caretraining and education are essential parts of preparedness and to
gained skills for CHVs while handling a disaster response (14). This study may be the initial
stage in which health volunteer can play an active role in improving the quality of utilization
MCH book in health services. Improving the quality of utilization MCH book can be to
prevent complication obstetri in women with high risk pregnancy and child health status.

Health volunteer who have long time working years may gain more experience and mastery
on knowledge and skills related to emergency care (15). Similarly, a study conducted by
Maulidar (16) knowledge regarding disaster nursing management and duration of working in
a disaster was correlated with improvement in skills of health care providers, health volunteer
will act more adequately than those who had less duration of working. This research as many
52,5% included duration of working more than 10 years. The results of the health volunteer
have long experience so that they have understanding of the utilization of MCH book. They
have been accustomed to understand things related to maternal and child health in integrated
health community.

Based of Wonorejo, Samarinda research on incentives and health volunteer performance

showed that variables related to the performance of health volunteer are gift operational
assistance, charter, transport aid and training (17). Health volunteer have supports of training
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about utilization MCH book and training purpose to increase the performance health
volunteer on efforts to utilization MCH book.Health volunteer can also drop out to increase
utilization MCH Book. Drop out can also be caused due to incentives money is too small, less
support facilities and infrastructure, the lack of training (18,19).

Improving only knowledge is not enough, but there are other things that must be considered is
the difficulty directing health volunteer to actively. Difficulties can lead to volunteers
becoming demotivated, including not being able to meet pregnant women and child
expectations, poor quality, volunteering opportunities, and burnout. volunteering has the
potential to play a number of important roles.

The conclusions of research in Tegal is there a difference health volunteer skills in

anthropometric measurements before and after training (19). Provision of refresher training,
community support and health care workers professional and apparatus government that
support performance improvement health volunteer (20,21). Training to increase skills
utilization MCH Book most important because improve awareness health volunteer primary
utilization MCH Book.

There is a relationship training with the performance of health volunteer. Perez et aland
Herman et al says that training and adequate supervision can as an incentive to improve
performance health volunteer in rural areas. Pittman et alstates that midwives given the
motivation in training, will be able toimprove the quality of health services. (22,23,24). The
lack of skills and training often an effective barrier in performance. Training community
health worker can provide the opportunity for learn skills, receive education and interact with
professional staff higher. Training not only provides preventive, curative, or other relevant
services to the public, but also to teach and communicating with the local communities.
Therefore, the need for a program innovative training. Utilization MCH Book training is the
way to maximaze utilization MCH Book quality.

5.0 Conclusion
There is an increasing health volunteer knowledge and skills about the utilization MCH
Book. There is an increase of utilization MCH book skills especially about charging child
health card in the MCH Book, delivery assistance and prevention of complications program.
Conclusion essensial needed to prepare health volunteer for utilization MCH Book on
pregnant women and child. Moreover, midwives need to develop utilization MCH Book
trough monitoring utilization MCH Book on themselves.

Acknowledgement
This research was funded from DIPA 2013 Jendral Soedirman University. We are grateful to
all respondents who had been involved in this research.

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References
1. Dinas Kesehatan Kabupaten Banyumas. Profil Kesehatan Kabupaten Banyumas.
Purwokerto Indonesia. 2012

2. Puskesmas Kalibagor. Profil Puskesmas Kalibagor. Kabupaten Banyumas. Purwokerto,

Indonesia. 2012

3. Sistiarani, C.Nurhayati, N, Suratman.Faktor yang berhubungan dengan Peran Kader

dalam Penggunaan Buku KIA.Jurnal Kemas.2013 Bulan Januari Volume 8 (2) : 161-77

4. Syafiq, Ahmad, Fikawati, Sandra. Kepemilikan Buku Kesehatan ibu dan Anak (KIA) dan
Pelayanan KIA. FKM-UI, Jakarta. 2007

5. Sistiarani, C. Gamelia, E. Purnamasari, D.U. Fungsi Pemanfaatan Buku KIA terhadap

Pengetahuan Ibu Anak pada Ibu. Jurnal Kesehatan Masyarakat Nasional. 2014 Bulan Mei
Volume 8 (80) : 358-353

6. Riwidikdo, H. Statistik Kesehatan. Mitra Cendekia Press. Yogyakarta. 2007

7. Gottlieb, B.H. and Gillespie, A.A. Volunteerism, Health, and Civic Engagement among
Older Adults. Canadian Journal on Aging, 2008 (27) 399-406.
http://dx.doi.org/10.3138/cja.27.4.399

8. Lehmann, U., & Sanders, D. Community health workers - what do we know about them?
The state of the evidence on programmer, activities, costs and impact on health outcomes
of using community health workers. World Health Organization, 2007 (2) 1-42.

9. Buman M, Giacobbi P, Dzierzewski J, Aiken M, McCrae C, Roberts B, Marsiske M.

‘Peer volunteers improve long-term maintenance of physical activity with older adults: a
randomized controlled trial’. Journal of Physical Activity & Health, 2011 vol 8 suppl 2,
pp S257–S266.

10. Paylor J. Volunteering and Health: Evidence of impact and implications for policy and
practice. London: Institute for Volunteering Research. 2011

11. Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Richardson G, Gardner C, Gately

S, Rogers A. ‘The effectiveness and cost effectiveness of a national lay-led self care
support programme for patients with long-term conditions: a pragmatic randomised
controlled trial’. Journal of Epidemiology and Community Health, 2007 vol 61, no 3, pp
254–61.

12. Akister J, O'Brien N, Cleary T. CSV Volunteers in Child Protection (ViCP): An

assessment of its impact and effectiveness: Executive summary. London: CSV. 2011

13. Casiday R, Kinsman E, Fisher C, Bambra C. Volunteering and Health: What impact does
it really have? Report to Volunteering England. London: Volunteering England. 2008

Colti Sistiarani , Arif Kurniawan, Endo Dardjito 110

IJPHCS International Journal of Public Health and Clinical Sciences
Open Access: e-Journal e-ISSN : 2289-7577. Vol. 3:No. 3
May/June 2016

14. Anda Kamal , Praneed Songwathana , Wipa Sae Sia. Knowledge and skills of Emergency
Care During Disaster For Community Health Volunteers: A Literature Review. Nurse
Media Journal of Nursing, 2012 (2), 2, page 371-381

15. Williams, J., Nocera, M., & Casteel, C. The effectiveness of disaster training for health
care workers: A systematic review. Annals of Emergency Medicine, 2008 (52), 211- 222

16. Maulidar, Hatthakit, U., & Chaowalit, A. A comparative study of knowledge and
perceived skills regarding tsunami disaster nursing during recovery phase between public
health nurses working in tsunami affected and non-affected area in Indonesia. Prince of
Songkla Universiti, Hatyai. 2010

17. Wirapuspita, Ratih. Insentif dan Kinerja Kader Posyandu. Jurnal Kemas 2013 (9 ,1) page
58-65

18. Faisal, A. 2010. High participation in the Posyandu nutrition program improved children
nutritional status. Nutr Res Pract., 2010, 4(3): 208- 214

19. Hida, F.M. & Mardiana. Pelatihan terhadap Keterampilan Kader Posyandu. Jurnal
Kemas, 2011, 7(1): 22-27

20. Sadah, A.E. Attitude of Health-Care Workers to HIV/AIDS. African Journal of

Reproductive Health, 2006, 10(1): 39-46

21. Suchitra, J.B. Impact of education on knowledge, attitudes and practices among various
categories of health care workers on nosocomial infections. Indian Journal of Medical
Microbiology, 2007, 25(3): 181-187

22. Perez, F., Ba, H., Dastagire, S.G., & Altmann, M. Th e Role of Community Health
Workers in Improving Child Health Programmes in Mali. BMC International Health and
Human Rights, 2009, 9(28)

23. Hermann, K., Damme, W.V., Pariyo, G.W., Schouten, E., Assefa, Y., Cirera, A. &
Massavon, W. Community Health Workers for ART in SubSahara Africa: Learning From
Experience– Capitalizing on New Opportunities. Human Resources for Health. 2009,
7(31)

24. Pittman, P., Blati, G., & Rodriguez, P. An Assessment of the Impact of Health Workers
for Change in Avellaneda, Province of Buenos Aires, Argentina. Health Policy and
Planning: 2001,16 Suppl 1, S40-6

Colti Sistiarani , Arif Kurniawan, Endo Dardjito 111