Desa SIAGA, a community participation model for maternal and neonatal health in Indonesia, barriers and facilitators to implementation: findings from a comparative case study design

Background ‘Desa SIAGA’ (alert village) is a community participation model (CPM) aiming to improve maternal and neonatal health (MNH) outcomes by empowering communities to prepare women for safe birth in Indonesia. However, there is limited evidence exploring the implementation of CPM within the Desa SIAGA programme. This study aimed to explore the implementation of Desa SIAGA in preparing women for birth and the potential to improve MNH in practice.

Methods A qualitative comparative case study with 23 in-depth interviews was conducted involving pregnant and post-natal women, village midwives, cadres and key stakeholders in two cases in Central Java, Indonesia in 2019. Interview data were analysed using thematic analysis approach. The interpretation was strengthened by non-participant observation of essential community meetings, fieldnotes, documentary analysis and cross-case synthesis. All relevant ethical approvals were obtained.

Results Five key facilitators and barriers were found to influence the effective implementation and potential of the Desa SIAGA programme to improve MNH outcomes, these included: lack of empowerment in decision making, knowledge, and economic constraints; lack of clearly defined roles; workload; and social, cultural, and religious values.

Conclusions The Desa SIAGA programme could bring benefits to improve MNH outcomes through the active participation of the community, but this will remail limited unless its delivery and implementation is underpinned by strong policy and supported by key actors. The findings of this study provide important evidence for policymakers in similar context in constructing policy towards the delivery and implementation of community participation programme.