Multilevel Analysis on the Contextual Effect of Community Health Center on Health Workers Performance


  • Anindyah Tri Lhaksmi Kusuma Wardhani Masters Program in Public Health, Universitas Sebelas Maret
  • Didik Tamtomo Faculty of Medicine, Universitas Sebelas Maret
  • Uki Retno Budihastuti Department of Obstetrics and Gynecology, Dr. Moewardi Hospital, Surakarta


Background: One of the high maternal mortality rates is caused by bleeding factors. The imple­mentation of preventive effort that is less than optimal as well as the ability, understanding, and compliance of health personnel with Standard Operating Procedures (SPO) is still lacking and not in accordance with professional standards, allegedly a factor that affects the Maternal Mortality Rate (MMR). The performance of midwives in accordance with the SPO would have an impact on reducing mortality and improving the welfare of mothers and babies. This study aimed to analyze the factors that influence the performance of midwives in the early detection of bleeding.

Subjects and Method: This was a cross sectional study conducted at 25 public health centers in Banyuwangi, East Java, from February to May 2019. A total sample of 200 midwives was selected for this study by simple random sampling. The dependent variable was midwife performance. The independent variables were training, skill, leadership style, incentive, work motivation, age, and human source. The data were collected by questionnaire and analyzed by a multilevel multiple logistic regression run on Stata 13.

Results: Midwife performance increased with training (b= 1.46; 95% CI= 0.48 to 2.42; p= 0.003), skill (b= 2.32; 95% CI= 1.28 to 3.36; p= 0.001), high motivation (b= 1.66; 95% CI= 0.71 to 2.61; p= 0.001), incentive >Rp 1,000,000 (b= 2.59; 95% CI= 1.53 to 3.65; p= 0.001), positive leadership style (b= 1.95; 95 % CI= 0.93 to 2.96; p= 0.001), and human source>8 midwives (b= 1.05; 95% CI= 0.08 to 2.02; p= 0.033). Midwife performance decreased with age ≥35 years (b= -1.16; 95% CI= -2.16 to -0.16; p= 0.023). Community health center had strong contextual effect on midwife performance with ICC= 25.74%.

Conclusion: Midwife performance increases with training, skill, high motivation, incentive >Rp 1,000,000, positive leadership style, and human source>8 midwives. Midwife performance decreases with age ≥35 years. Community health center has strong contextual effect on midwife performance.

Keywords: work performance, midwives, multilevel analysis

Correspondence: Anindyah Tri Lhaksmi Kusuma Wardhani. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: anin­dyah­tri@­ Mobile: +6285258917339.

Journal of Health Policy and Management (2019), 4(3): 182-194


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How to Cite

Wardhani, A. T. L. K., Tamtomo, D., & Budihastuti, U. R. (2019). Multilevel Analysis on the Contextual Effect of Community Health Center on Health Workers Performance. Journal of Health Policy and Management, 4(3), 182–194. Retrieved from