Codesigning improvements for primary maternity care in Indonesia under the Covid-19 pandemic

ABSTRACT

Background: Primary maternity care in Indonesia faces significant challenges during the COVID-19 pandemic. The pandemic has exposed the fragility of primary care practice. The setting is pushed to help prevent the spread of the infection while maintaining care for pregnant women, however, with limited available guidance and support in practice. Aim/Objectives: To seek consensus on key recommendations and design a model for improving primary maternity care in Indonesia under the Covid-19 pandemic. Method(s) Four online co-design workshops and interviews were conducted with general practitioners (GPs), midwives, nurses, obstetricians, and patients. The first workshop discussed the way current maternity care was provided and the participants' expectations for improving the service in primary care. The second workshop discussed potential improvements for maternity care identified from a review of international recommendations, as well as discussing opportunities and potential challenges for implementing the recommendations in practice. The third and fourth workshops designed and finalised the maternity care model under the Covid-19 pandemic. Individual substitute interviews were also available for participants who could not attend the workshops. The participants' responses and suggestions were analysed using thematic analysis. Finding(s) Twenty-three participants were recruited, and 23, 20, 17, and 18 participants participated in the first-fourth workshops or substitute interviews. Key recommendations identified from the review and agreed upon in the workshops were health screening, maintaining antenatal-postnatal breastfeeding care, limiting visitors, and using telemedicine. A model of care for improving primary maternity care, covering arrangements for patients' encounters and referral plans, was also agreed and received suggestions from the participants. Potential challenges to the recommendation implementation include the available clinical resources and negotiating providers' authority. Implications Recommendations and models of care would benefit for improving primary maternity care in Indonesia under the Covid-19 pandemic. Further research includes exploring the acceptability of the recommendations' implementation in practice.