This study evaluates an Empowerment Agency Training (EAT) intervention within the SPHERES programme that aims to strengthen personal agency among workers in primary healthcare centers (Puskesmas) in Indonesia. The intervention focuses on building self-efficacy, behavioural control, leadership, and intentional decision-making through structured training, follow-up action planning, observational support, and sustainability-oriented incentives. Strengthening personal agency is expected to improve the use of data for decision-making and the delivery of priority primary health services at the Puskesmas level.
None
PHC staff who decline to provide informed consent.
PHC staff who will not retain their employment until the end of the observation period.
Participants who are not in good physical and mental condition to attend the training intervention (for the intervention arm).
Sequential
Empowerment Agency Training (EAT)
BehavioralThe intervention comprises a behavioral training program focused on personal agency and empowerment. The curriculum follows the established frameworks developed by The Self-Empowerment and Equity for Change (SEE Change) Initiative at the Johns Hopkins Bloomberg School of Public Health. The training is followed by simple, practical "prescription", or action plans, for behaviour change in daily work. Implementation is supported through direct observation by facilitators (expert shadowing) and incentives, including advanced training opportunities and locally managed financial support.
Difference in clinical data quality between intervention and control arms, and changes in personal agency and health worker behaviour
Clinical data quality is determined by proportion of data entry in the digital health information system compared to the gold standard (legacy reporting system). Other metrics being the heaping index indicating digit preference in numeric clinical data input in various services, and also the proportion of biologically implausible values. Changes in personal agency and health worker behaviour is determined by the proportion of action derived from data-driven discussion, as well as the overall level of patient satisfaction from the care delivery.
Completeness of care in maternal and neonatal care
* of pregnant women with at least six timely ANC services (K1 - K6) * of pregnant women with complete services per ANC encounter * of newborn with at least three timely PNC services (Kn1 - Kn3) * of mothers with newborn with at least four timely PNC services (Kf1 - Kf4) Neonatal mortality rate Stillbirth rate All indicators will be measured using the SPHERES dashboard.
Completeness of care in tuberculosis treatment
* of TB suspect screened * of TB diagnosis from all screened suspects * of TB patients receiving medications * of TP patients being loss to follow-up * of TB patients with complete recovery All indicators will be measured using the SPHERES dashboard.
Completeness of care in hypertensive treatment
* of people screened for hypertension * of people with hypertension diagnosis * of hypertensive patient receiving medications * of hypertensive patient with controlled blood pressure All indicators will be measured using the SPHERES dashboard.
Completeness of care in diabetes treatment
* of people screened * of people with diabetes diagnosis * of diabetes patient receiving medications * of people with controlled HbA1c All indicators will be measured using the SPHERES dashboard.
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Oxford University Clinical Research Unit Indonesia
Lead sponsor
District Health Office of Purbalingga District, Indonesia
Collaborator
District Health Office of Lombok Barat District, Indonesia
Collaborator
The Self-Empowerment and Equity for Change (SEE Change) Initiative, The United States
Collaborator
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