Work Environment Mediates the Association Between Work Facilities and Midwives' Performance

Abstract

Exclusive breastfeeding coverage remains below target in many settings, while evidence on whether physical work facilities directly improve midwives' performance is inconclusive. Organisational conditions may determine whether available facilities are translated into better service delivery. To examine the association between work facilities and midwives' performance and test whether the work environment mediates that relationship in the exclusive breastfeeding programme. A cross-sectional survey included 119 midwives from 19 public health centres in Muna Regency, Indonesia. Work facilities, work environment and programme performance were measured with five-point Likert scales. The reported coefficients were estimated in the complete dissertation model using partial least squares structural equation modelling and bootstrapping in SmartPLS 4. Work facilities were not directly associated with performance (β = 0.058; p = 0.488). Facilities were positively associated with the work environment (β = 0.479; p < 0.001), and the work environment was positively associated with performance (β = 0.460; p = 0.006). The indirect facilities-work environment-performance path was significant (β = 0.220; p = 0.014). Facilities functioned as enabling resources whose performance value depended on the environment in which they were used. Facility investment should therefore be combined with clear work organisation, supportive supervision, teamwork, communication and reliable logistics.