Indonesia’s Community Health Workers (Kaders)

By: Apriani Oendari and Jon Rohde

In Indonesia, a Posyandu is a health post established in each village that employs volunteer community health workers known as Kaders. In addition to various other tasks, Kaders conduct monthly welfare sessions at the Posyandus where they provide services such as immunizations, family planning, and nutritional supplements, to name a few. In 2014, the Ministry of Health reported that 87% of children had received their basic immunizations, and an increase in life expectancy was partly owed to the Kaders’ work.

Background
Built on the national women’s Family Welfare Movement (Pemberdayaan Kesejahteraan Keluarga, PKK) of the 1970s, volunteers called Kaders were trained to conduct health and nutrition promotion activities in each village. In the mid-1980s, the Pos Pelayanan Terpadu (Posyandu) program was formally recognized by the Ministry of Health (MOH). For more than 35 years, this community-driven program has continued to thrive.

Implementation
A Posyandu is a health post in the community that is staffed by Kaders. Each Posyandu serves approximately 100 children younger than five years of age or about 700 persons in the community. In 2018, there were more than 173,000 active Posyandus and more than 500,000 trained Kaders across the country, almost exclusively women. While the ideal Posyandu is run by five or more Kaders, many are still struggling to reach this desired number. Sessions of the Posyandu are held monthly, at which time mothers and infants receive services at five tables: (1) for registration, (2) for weighing, (3) for result recording, (4) for advice and counseling on growth and development, and (5) for health services (such as immunization, family planning commodity resupply, supply of take-home oral rehydration packets, and iron tablets).

Roles/responsibilities
Kaders conduct the monthly Posyandu sessions. Outside of the Posyandu sessions, Kaders carry out follow-up visits in the community, attend community committee meetings, and update Posyandu target and utilization data. Kaders work about 10–20 hours monthly.

Training
Kaders receive less than one week of formal training, but over time they continue to develop their skills. Many are trained by more experienced Kaders “on-the-job.”

Supervision
While the nearest community health center (Puskesmas) provides technical guidance and support, the real accountability of the Kaders is to the village committee that appointed and supports them in their work. Kaders undertake to do “welfare work” for their community, and the monthly Posyandu session is seen as an important function and contribution to the welfare of the community.

Incentives and remuneration
Kaders provide voluntary service without financial compensation, except for small reimbursements for their transportation expenses. However, Kaders may receive informal types of compensation, such as free medical treatment from higher levels in the health system. There is a high cultural value placed on doing something for one’s neighbors, so volunteering as a Kader is highly esteemed.

Impact
The latest 2014 figures from the Indonesia MOH indicate that 81% of under-five children had been weighed and 87% had received their complete set of basic immunizations. The MOH has stated that the decreases in maternal and child mortality as well as the increase in life expectancy in Indonesia are partly attributable to the work of the Posyandus and Kaders in the community.

Author Affiliations

• Apriani Oendari works at the Center for Community Health Education Research and Service (CCHERS).
• Jon Rohde works at the James P. Grant School of Public Health, BRAC University.

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