Community participation for maternal and neonatal health in Sukoharjo Regency, Central Java, Indonesia: a qualitative 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 process of CPM within the Desa SIAGA initiative. Objectives: To explore the role of CPM using the exemplar of Desa SIAGA in preparing women for birth and that improving MNH. Methods: A qualitative case study with 23 in-depth interviews was conducted with women and key stakeholders in two cases. Interview data were analysed using thematic analysis. Interpretation was strengthened by non-participant observation, fieldnotes, documentary analysis and cross-case synthesis. Findings: The Desa SIAGA initiative had a potential to improve MNH outcomes. However, several facilitators and barriers influenced its delivery and implementation. Limited empowerment affected the extent to which women and the community participated to succeed the initiative. Unclear roles, workload, and minimal training were identified to affect the key actors in performing their tasks. Meanwhile, support from government and clear guidance appeared to be lacking. Social capital was a motivating factor for the community however, factors such as gender roles hindered effective delivery and implementation of the CPM. Sociocultural and religious beliefs emerged as a cross-cutting theme. Conclusion: Community participation is a complex phenomenon and context specific. Its delivery and implementation need to consider the micro, meso and macro elements that underpin the complexity of MNH. Empowering women and the community are the central of the initiative. A sensitive approach to sociocultural and religious beliefs is needed to allow women and community to accept the importance of a CPM to address MNH problems. Health care system strengthening is essential to deliver and implement the initiative. A strong policy, commitment and cross-sectoral partnership is required to enable the initiative going forward.