Multilevel Analysis of Factors Associated with Performance of Midwives in Integrated Antenatal Care Service in Pati, Central Java

ABSTRACT Background: In 2017, nearly 295,000 women died during and after pregnancy and childbirth. In low-resource situations, the vast majority of maternal death (94%) occurred, and most could have been avoided. This study aimed to analyze the factors associated with the performance of midwives in integrated antenatal care service in Pati, Central Java. Subjects and Method: This was a cross-sectional study carried out at 26 integrated health posts (posbindu) in Pati, Central Java. A sample of 130 midwives randomly was selected for this study. The dependent variable was work performance of midwives. The independent variables at level 1 were age, employment status, workload, working time, leadership perception, and healthcare facility. The independent variable at level 2 was posbindu. The data were collected using questionnaire. The data were analyzed by a multilevel linear regression. Results: Work performance of midwives increased with working time (OR= 0.19; 95% CI= 0.04 to 0.33; p= 0.012) and healthcare facility (OR= 0.26; 95% CI= -0.77 to 1.31; p = 0.610). Work performance of midwives decreased with age (b= -0.07; 95% CI= -0.05 to 0.13; p= 0.100), employment status (b= -0.87; 95% CI= -1.89 to 0.15; p= 0.096), workload (b= -0.22; 95% CI= -0.45 to 0.01; p= 0.058), leadership perception (b= -0.002; 95% CI= -0.08 to 0.07; p= 0.949). Posbindu had strong contextual effect on work performance of midwives with ICC= 8.60%. Conclusion: Work performance of midwives increases with working time and decreases with employment status and workload. The work performance associated with age, healthcare facility, and leadership perception, but it is statistically non-significant. Posbindu has strong contextual effect on integrated antenatal care (ANC) performance of midwives. Keywords: performance of midwives, contextual effect, antenatal care Correspondence: Siti Marfu’ah. School of Health Sciences Bakti Utama, Pati, Central Java. Email: marfuah@stikesbup.ac.id. Mobile: +6285729885380. DOI: https://doi.org/10.26911/the7thicph.01.30