Using the Three Delays Model to Examine Civil Registration Barriers in Indonesia

PLoS One. 2016 Dec 19;11(12):e0168405. doi: 10.1371/journal.pone.0168405. eCollection 2016.

Abstract

The Three Delays Model has proven a useful framework for examining barriers to seeking obstetric care and preventing maternal and child mortality. This article demonstrates the applicability of the Three Delays Model to the case of civil registration in rural Indonesia and examines ways that efforts to strengthen civil registration services can draw on lessons from maternal and child health programming. Twenty focus group discussions were conducted using a participatory ranking exercise in four Indonesian districts. Focus groups were stratified into four groups: (1) government officials involved in civil registration, (2) civil society organization members that assist communities in civil registration, and (3) female and (4) male community members. Transcripts were analyzed using constant comparative method and thematic analysis, revealing barriers that communities commonly faced in accessing civil registration services. In examining the categories and themes related to these barriers, the research team found a significant overlap with the factors and phases of the Three Delays Model. Participants were delayed from seeking registration services by a range of sociocultural factors and by the perceived inaccessibility and poor quality of services. Once they decided to seek care, long distances to services and poor transportation options delayed their access to registration offices. Finally, a series of bottlenecks in service provision created extended delays once applicants reached registration offices. Ownership of civil registration documents in Indonesia remains exceptionally low, with just over half of children and youth possessing a birth certificate. To strengthen civil registration and health systems more generally, it is important to understand the factors that enable and constrain civil registration, how these factors relate to one another, and how they change over a child's life.

MeSH terms

  • Adult
  • Attitude to Health
  • Female
  • Focus Groups
  • Health Services Accessibility
  • Humans
  • Indonesia
  • Male
  • Maternal-Child Health Services / statistics & numerical data*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Pregnancy
  • Quality of Health Care
  • Records / statistics & numerical data*
  • Rural Health Services / statistics & numerical data*
  • Rural Population

Grants and funding

This research was supported by the Australian Government’s Australia-Indonesia Partnership for Justice (AIPJ) [grant number AC43600/AIPJ/PUSKAPA/SL-18-05-14]. The URL is http://www.aipj.or.id/en/main. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.