Factors Related to the Performance of Village Midwives in the Implementation of the Immunization Program in Pesawaran Regency
Abstract
Immunization programs are among the most effective public health interventions for preventing childhood infectious diseases. National immunization coverage in Indonesia reached only 86% in 2023, below the 93% national target. Pesawaran Regency similarly faces disparities in coverage across public health center working areas. This study aims to analyze factors associated with village midwives' performance in immunization program implementation in Pesawaran Regency, and to measure the strength of associations to inform evidence-based health policy. A quantitative cross-sectional study was conducted from February–March 2026 in Pesawaran Regency. Of 147 village midwives, 108 were selected via proportional random sampling (Slovin formula, 5% margin of error). Data were collected using validated Likert-scale questionnaires (Cronbach's alpha: 0.839–0.901). Bivariate analysis used the Chi-square test with cell frequency checks, effect sizes (Cramér's V), and 95% confidence intervals. Multivariate analysis employed binary logistic regression with multicollinearity checks (VIF) and Hosmer-Lemeshow goodness-of-fit. Significant associations were found between all four independent variables and midwives' performance: organizational culture (p=0.005, OR=5.12), compensation (p<0.001, OR=8.46), motivation (p<0.001, OR=9.67), and leadership (p<0.001, OR=6.67). Multivariate analysis identified compensation as the dominant factor (OR=7.660, 95% CI: 2.401–24.434), followed by motivation (OR=7.016, 95% CI: 2.252–21.851) and leadership (OR=4.246, 95% CI: 1.379–13.075). Organizational culture, compensation, motivation, and leadership significantly influence midwives' immunization program performance. Health authorities should prioritize equitable compensation structures and strengthen leadership capacity. Study limitations include potential social desirability bias from self-report data and cross-sectional design that limits causal inference.