Other

From Village Financing to Household Practice: A Multilevel Evaluation of an Integrated Community Health Financing and Capacity-Building Model for Indonesia’s Posyandu Network

Harjana NPA, Basuki AD, Miranda AV, Mufida R, Sophiani L et al. · 9 Sept 2026

Abstract

Abstract Indonesia’s Posyandu network delivers maternal, child health, and nutrition services through an almost entirely female village-based volunteer community health workers (CHWs/kader), financed by a mix of external programme budgets and discretionary village government co-financing (“cost-sharing”). Whether this financing model produces measurable benefit further along the delivery chain, to CHW capability, facility implementation, and household knowledge and behaviour, has rarely been examined within one linked dataset. We conducted a cross-sectional, multilevel analysis of five monitoring datasets from a programme operating in six Indonesian districts, consisted of village financing records (n = 110 villages), a CHW survey (n = 660), a Posyandu facility dataset (n = 551), a household survey (n = 1,497), and a paired pre/post training assessment (n = 126) from two further districts. Records were linked to village financing via an exact village-code match, with district-level financing used for sensitivity analyses. Programme budget per CHW varied nearly four-fold across districts and was positively associated with cadre tenure (β = 1.18 years per million Rupiah, 95% CI 0.21–2.15, p = 0.018). Training produced a large knowledge gain (median score 12 to 16 of 19; p < 0.001). Posyandu implementation completeness was uniformly high and unrelated to financing. At household level, financing exposure showed no consistent benefit and was linked to lower service utilization in cost-sharing villages, whereas direct household exposure to the programme stunting-education smartchart/“poster pintar” was robustly associated with better knowledge, hygiene practice, service use, and perceived behavioural change. A sub-analysis segregating village financing by MoU contract period (Awal/start vs Akhir/end cohorts) found that per-CHW financing intensity, expressed as monthly and annual rates, varied significantly by when a village’s MoU began or ended, while CHW-level outcomes did not differ significantly between cohorts; a dose-response model exploring the monthly incentive associated with the best CHW outcomes did not identify a statistically confirmed optimum. These findings suggest that sustaining per-cadre financing, continuing structured training, and monitoring whether materials reach households may be more productive levers than financing arrangement or aggregate budget alone.