title: The training and development needs of midwives in Indonesia: paper 2 of 3.
abstract: BACKGROUND
  There is a shortfall in midwives in Indonesia (an estimated 26 per 100,000 people), which means that the quality of antenatal, perinatal and postnatal care varies widely. One consequence of this is the high rate of maternal and perinatal mortality, which has prompted a number of health initiatives. The current study was part of a review of the existing complex system of midwifery training and the development of a coherent programme of continuing professional development, tighter accreditation regulations and clearer professional roles. Its aims were to identify the occupational profiles and development needs of the participating midwives, and to establish whether any differences existed between grades, geographical location and hospital/community midwives.
  
  
  METHODS
  A psychometrically valid training-needs instrument was administered to 332 midwives from three provinces, covering both hospital and community staff and a range of midwifery grades. The instrument had the capacity to identify occupational roles and education/training needs of the respondents.
  
  
  RESULTS
  The occupational roles of the midwives varied significantly by province, indicating regional service delivery distinctions, but very little difference in the roles of hospital and community midwives. The most educated midwives attributed more importance to 35 out of the 40 tasks, suggesting an implicit role distinction in terms of level of activity. All midwives reported significant training needs for all 40 tasks. The most-educated midwives recorded training needs for 24 tasks, while the less-educated had training requirements for all tasks, which suggests that new training programmes are effective. Few differences in training needs were revealed between hospital and community midwives
  
  
  CONCLUSIONS
  The results from this survey suggest important regional differences in how the midwife's role is discharged and underline the importance of this sort of research, in order to ensure the suitability of basic and postbasic educational provision. The study also highlights the need for further development and training of midwives in a wide range of tasks. These results provide a systematic and reliable overview of current midwifery roles and development needs and could serve to inform future training.
authors.affiliation: School of Health Sciences, University of Birmingham, Birmingham, UK. deb.hennessy@btinternet.com
authors.forename: Deborah
authors.initials: D
authors.lastname: Hennessy
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hicks
authors.forename: Harni
authors.initials: H
authors.lastname: Koesno