A Confirmatory Factor Analysis of Environmental Welfare and Maternal Health Performance: Macro-Regional Evidence from North Sumatra, Indonesia

Abstract

Regional development strategies increasingly prioritize the integration of physical infrastructure and public health outcomes. However, structural evidence linking environmental welfare to maternal health performance at the macro-regional level remains scarce, particularly in diverse archipelagic provinces. This study aims to validate the structural relationship between environmental welfare—comprising housing quality, sanitation, and water access—and maternal health intervention performance across the 33 municipalities of North Sumatra, Indonesia.

Utilizing a census-based macro-dataset, this research employs a Confirmatory Factor Analysis (CFA) within a Structural Equation Modeling (SEM) framework. The model’s structural integrity was rigorously tested using goodness-of-fit indices to evaluate the latent constructs of environmental welfare and health service delivery.

The CFA validated a robust two-factor model with excellent fit indices (chi² = 21.937, df = 15, p = 0.109; CFI = 0.972; TLI = 0.948; SRMR = 0.066). The findings reveal that environmental welfare is most dominantly indicated by access to clean water (l = -0.916) and decent housing (l = -0.909). Concurrently, the performance of maternal health services is most significantly represented by the coverage of Iron-Folic Acid (IFA) supplementation (l = 1.000), which outperformed clinical visit frequency as a structural indicator. The study confirms a significant structural linkage between macro-environmental conditions and maternal health outcomes in North Sumatra. The results suggest that achieving maternal health targets requires a synchronized policy that integrates basic infrastructure development with community-based nutritional interventions. This research provides a parsimonious validated framework for regional governments to monitor development progress through high-impact macro-indicators.