Suchergebnisse

There have been many dissappointed tendencies that health services are currently biased to the more wealthy groups in the society. Corporatisms, competitions, and the emanation of more profit-oriented health institutions have put aside the public health service for the poor. Unfortunately, even the Department of Health have failed to stand for its fundamental functions in maintaining the public health and protecting the unfortunate people. The Department have been unable to respond the competitive environment and prevent the brain drain of qualified doctors from the public hospitals to the private institutions. It is suggested that the Department of Health should reorient its mission and tasks by applying strategic management approach. This new approach should also be accompanied with stronger external control of the public through the parliament and other pressure group; 'in the society. The author points out the importance of two elements of the society which would be effective as the control: 1) the researchers, who should be more assertive in contending the inequality of public health services; and 2) the NGO activists, who should be more sensitive and susceptible to various issues in public health. Finally, it is very important that the Department of Health has to comply with the public accountability so that their programmes would be more focused on objective issues of public health.

Jika mempelajari policy making process, kita belajar tentang rational choice theory - bahwa setiap individu dalam organisasi akan mengutamakan kepentingan pribadi mereka. Dalam implementasi, kepentingan dari penduduk sering dikalahkan oleh kepentingan pribadi dari penyelenggara layanan. Jadi implementasi kebijakan sering gagal karena adanya kepentingan pribadi dari penyelenggara layanan. Implementasi kebijakan bagian penting dari policy analysis. Jika kebijakan berhasil dibuat dengan susah payah, tidak selalu berarti kebijakan itu akan terimplementasi begitu saja. Ada banyak tantangan yang membuat kebijakan itu tidak berarti apa-apa - kebijakan di atas kertas - tidak ada implementasinya. Kebijakan yang gagal jika implementasinya tidak ada. Kegagalan implementasi adalah termasuk kegagalan kebijakan. Implementasi adalah ranah dari manajer program. Jika kebijakan ingin berhasil, ia membutuhkan manajer yang efektif. Mereka membuat kebijakan menjadi operasional dan dapat menyajikan layanan kepada penduduk yang membutuhkannya.

Purpose: Water refill depots have increased in all areas of Indonesia. Many studies have reported concerns about the bacteriological quality of drinking water at refill depots. However, limited studies have focused on ensuring the safety and quality of drinking water in refill depots, particularly for small-scale depots. This paper examines water microbiological quality at the refill depots and their depot production inspections from the local public health authority.Method: This survey used 60% of depots (47 out of 77 depots in the district) from April 4th to May 31st, 2016, in the North Luwu District of Central Sulawesi. Water samples were taken for E. coli and coliform examination. In-depth interviews were conducted with environmental health officers at the local health authority, depot owners, and workers.Results: Almost half of the total depots (49%) failed to meet the hygiene standard. Site observation found that depots were with poor sanitation and poor water handling. Depot owners found the cost of two times a year of the bacteriological examination was too expensive, including the transportation cost of water samples to the available closest laboratory in the provincial capital.Conclusion: Depots with non-standard bacteriological quality were still high. Supervision of the depot by the district health office was very loose. Efforts to advocate the district health office to take a more assertive position are critical. Community organizations and refill water depot associations should be involved so that public health interests get attention from the local government.

Purpose:To analyze the factors influencing the implementation of regulation on the existence of Artisanal Small Scale Gold Mining (ASGM) in Alas District, Sumbawa Regency, West Nusa Tenggara Province.Method: This research is qualitative descriptive research with the determination of informants using snowball sampling. Data analysis using data analysis from Miles & Huberman.Results:Factors driving the number of unlicensed gold mining at Alas are economic factors. The availability of insufficient jobs and low economic status is the reason (ASGM) perpetrators retain jobs as illegal miners. Another factor is weak regulation. The government has not set the People Mining Area as a condition of issuing the Mining Permit for the People so that (ASGM) operations are still operational.Conclusion: The dominant factor causing PETI sustainability in Alas sub-district is the economic factor. Policies on the existing mineral mining can not function properly because Alas sub district has not been determined by the mining area of the people so that people do not get the permits of the people's mining ; Tujuan: Melindungi penduduk, terutama yang miskin, dari zat berbahaya di lingkungan mereka hidup menjadi tugas utama dari lembaga public health, Meski demikian, pemerintah daerah masih mengabaikan praktik penambangan rakyat yang membahayakan lingkungan di wilayah tempat penduduk tinggal. Penelitian ini mendokumentasi satu penamabngan liar di sebuah kabupaten dengan status ekonomi dan lapangan kerja yang rendah di Nusa Tenggara Barat.Metode:Data berasal dari 18 responden yang dianggap mengetahui tentang aktivitas PETI dan kebijakan mengenai PETI di Kecamatan Alas Kabupaten Sumbawa. Mereka adalah penambang liar dan anggota masyarakat yang tinggal di sekitar penambangan di Kecamatan Alas, pejabat di Balai Energi dan Sumber Daya Mineral, Dinas Lingkungan Hidup, Dinas Kesehatan, polisi sektor Alas, Camat, Puskesmas dan Kepala Desa. Hasil: Pertambangan emas tanpa izin terjadi karena lapangan kerja yang kurang dan status ekonomi yang rendah. Kedua hal ini mendorong toleransi dalam pembuatan dan apa lagi penegakan regulasi. Karena pemerintah tidak menetapkan daerah tambah sebagai wilayah penambangan rakyat, maka rakyat pun tidak bisa memiliki izin untuk menambang. Upaya tim operasi gabungan yang dibuat oleh pemerintah daerah untuk mensosialisasi tentang dampak yang dapat timbul akibat keberadaan PETI merupakan instrumen yang lemah dalam upaya melindungi perusakan lingkungan yang merugikan public health. Simpulan: Studi kasus ini menunjukkan lemahnya stakeholder pemerintah daerah dalam memperjuangkan kepentingan public health. Harus ada tekanan kepada pemerintah daerah mencari solusi dalam kesempatan kerja dan menjadikan daerah tambah sebagai tempat yang mendapat izin untuk masyarakat mencari pekerjaan dan aman bagi public health. Artisanal Small Scale Gold Mining in Alas of Sumbawa District of Nusa Tenggara Barat: a Qualitative Study in Alas of West Nusa TenggaraPurpose. Protecting people's health, in particular the poor, from harmful substances in their living environment is the main task of public health institutions. However, local governments pay little attention to the practice of community mining which endangers the environment in the area people lives. This study documents illegal mining in a district with low economic status and lack of employment in West Nusa Tenggara.Method: Data came from 18 respondents who were considered to know the practices and policies regarding PETI in Alas of Sumbawa Regency. They are illegal miners and community members who live around the mining in Alas Subdistrict, officials at the Energy and Mineral Resources Office, Environment Agency, district health office, local police, subdistrict head, public health centres, and village administrators.Results: Gold mining without permission occurs due to lack of employment and low economic status. Both of these encourage tolerance in manufacturing and what else is regulatory enforcement. Because the government does not stipulate additional areas as a community mining area, the people cannot have permission to mine. The efforts of the joint operations team made by the local government to socialize the impacts that could arise due to the presence of PETI are a weak instrument in an effort to protect environmental destruction that is detrimental to public health.Conclusion: This case study shows the weakness of local government stakeholders in promoting people's public health when dealing with income generating activities with negative long-term public health consequences. Environmental activist should help the local government to find solutions for the poor to be able to get income legally and at the same time create a safe place for people living around the gold mining area.

PurposeThe aim is to examine the suitability of the educational process in place with the expected professional development.MethodWe conducted in-depth interviews with (a) 16 third-year student who recently completed 2-month clinical rotation in the hospital and (b) four teachers.ResultsEvidence from this study indicate weak learning environment. Clinical instructor only has a limited time to meet with students, so that students rarely get the guidance and direct supervision. Students more often obtain "lessons" of the young staff, which many of them indifferent in providing guidance. Students feel insecure and fear in communicating with senior staff from both the nursing and medical professions. Academic lecturers provide minimum learning support. Their supervision does not allow students to reflect on their experiences.ConclusionProfessional development as reflected in clinical rotations in hospitals is still very limited. The government must monitor more strictly, especially for the medical school located in the district, where professional educators are very limited.

Background: Medicine is an integral part of community healthservice. Therefore it must be available in sufficient quantity,types and adeqaute quality, properly distributed and accessiblefor community when its needed. In order to meet thecommunity's need for medicine and to guarantee medicineaccessibility, the government released generic medicine policy.Although the price of the generic medicine has already beenset up and fixed by government, there are variety of the pricestill can be found on implementation of the generic medicinesold in the pharmacy store or in the market, and can causeprice uncertainty for community in finding medicine they need.That is why a research needs to be conduct towardimplementation of the generic medicine price policy on thedistribution channel especially at the pharmacy store.onPelalawan District in Riau Province.Method: This research is non experimental/observationalresearch with qualitative and quantitative method using crosssectional design, data analyzed descriptively.Result: Research result indicates that access to genericmedicine at pharmacy store for available medicine are 99,3%,for un available medicine are 0,7% and for replaced medicineare 0,5%. Average availability of the medicine at the pharmacystore are 4-7,3 months. Highest availability rate for medicine isHidrocortison cream 2,5% for 7,3 months and the lowest isPirazinamid tablet 500 mg for 4 months. Pharmacy store thathave an expired medicine are PR (0,7%) and KH (2%). Everypharmacy store have no damaged medicine, 0% percentage.Almost all pharmacy store experiencing out of supply formedicine between 4 to 90 days. Price of the medicine soldaveragely increasing from its pharmacy store Highest RetailPrice (HRP). But there are several medicine that sold under theHRP The highest price medicine that are sold higher than itsHRP is Clorfeniramin Maleat (CTM) tablet by 515,4% increaseand Dexametason tablet is the lowest price sold under HRP by65,2%. Even so they are Alopurinol, Digoksin, and Ranitidin.From in depth interviews with patients, can be learn that theyhave a purchase ability for generic medicine.Conclusion: Implementation of generic drug price on Pelalawandistrict is good. It can be seen from generic medicine accessby community that are high after the release of regulation fromHealth Department of Republic Indonesia, the level of availabilityof generic medicine on pharmacy store at Pelalawan Districtare low but there are no expired or damaged medicine. Theprice of generic medicine at Pelalawan District are variable butthe community still can afford to buy them.Keyword: Generic medicine, availability and affordability.

Background: Maternal, neonatal and child health (MNCH)program is a national priority programs in health development.In 2006 the Ministry of Health to provides the largest budgetallocation to the KIA programs. This policy was taken in orderto accelerate the decline in maternal mortality and infant throughthe implementation of the making pregnancy safer strategy(MPS) with focus on some activities that are considered to becost effective. MNCH sustainability of the program dependson political commitment and support from stakeholders in theregion. Therefore, stakeholder analysis is important for theimplementation of policy to support the MNCH program.Objectives:Assessing the political commitment of the localgovernment to MNCH program in Kepahiang Regency.Methods: This research is a descriptive, qualitative designwith a case study. Unit of analysis is a research MNCH programstakeholder. How do the data with the brainstorming, depthinterviews, reports and documents, and direct observation.Results: Political commitment of the local government tomaternal, neonatal and child health program is still low, this isevidenced by the lack of budget allocation maternal, neonataland child health program. Essentially all stakeholders agreeand support the program. The involvement of local stakeholdersin the process of planning and budgeting programs is still lacking.Coordination among health agencies with key stakeholders inthe planning and budgeting also are not running well, so oftenthere are differencesin understanding the program. Besidesthe quality planning activities are still considered low, and thereis still weak advocacy capacity of health district office.Conclusion: The small budget allocation for the programshows the commitment to maternal, neonatal and child healthprogram of the local government is still low. This problem wasmore due to the quality of the program planning (design) that isnot well-developed. Also the role and involvement ofstakeholders in the planning process is still lacking.Keywords: Stakeholder, MNCH policy

Background: Professional service in isolated areas is verylimited because the policy on the placement of doctors tendsto put priority on urban areas. Nurses are health staff mostcommonly available at isolated areas and utilized by thecommunity as medical staff in Indonesia for a long time. Theyhave been working on mobile basis from one village to anotherbecause the community needs express and affordableservices. Legally, mobile nurses have infringed regulationsbecause they do not have permit for their practice and theyprovide services beyond their expertise. Meanwhile, thepresence of mobile nurses greatly helps the government insolving health problems in the community.Objective: The study aimed to describe health servicesprovided by mobile nurses at District of Indragiri Hulu.Method: This case study was carried out in February – April2008. Data were obtained through participative observationand in depth interview. The researcher followed the nursesobserved with open agreement from respondents and studiedthe activities they carried out in their work.Result: The result of the study showed that types of servicesprovided by mobile services at District of Indragiri Hulu wererelatively complete, comprising service of care to medication.The service was accessible and inexpensive and paymentmethod was flexible. These nurses were willing to providehealth services as demanded by patients. They provided mobileservice because health staff available in marginal areas wasnurses. This caused high demand for health service providedby nurses; however this mobile service was not protected byregulations because so fan there was no regulation whichconcerned with practicing nurses at District of Indragiri Hulu.The only regulation that protected them was issued by nationalassociation of nurses. Absence of regulation on nurses causedcontrol to practice of mobile nurses could not be enacted. Thecontrol was needed to protect the community and the serviceof mobile nurses itself.Conclusion: The study proved that unavailability of doctorshad put nurses in a central position as medication providers inisolated areas. Besides, proactive approaches made by thenurses had become major factor of acceptance to theirpresence in the community. Considering their control role, itwas suggested that the government issued administrative andprofessional act on nurses order that control to quality ofnurses could ensured.Keywords: availability of health staff, mobile nurses, socialmotivation, isolated areas

Ignasius Luti1, Mubasysyir Hasanbasri2, Lutfan Lazuardi21 Dinas Kesehatan Kabupaten Lingga, Kepulauan Riau2 Program Studi Ilmu Kesehatan Masyarakat, Fakultas Kedokteran,Universitas Gadjah Mada, YogyakartaABSRACTBackground: One of the critical issues in the development ofnational health care is the limited accessibility to health services.Such problems also occur in Linga District of KepulauanRiau Province. It is caused by many factors, such as geographicallocation, cost, number of health personnel and conditionof health care facilities, such as health centers and theirnetworks which are not accessible to the public. Several attemptshave been made, for example, by improving the statusof sub-health centers to be health centers, health centers tobe treatment centers, assinging health workers both medicaland paramedical, improving health financing and making budgetpolicies. However, its implementation has not been maximal.In accordance with the above background, it would requirea study on the role of local government policy in improvingthe referral system which is useful to know the problemsin the field, so that in the future a variety of improvement canbe done.Objective: To determine the referral system in the islandsarea of Linga District.Methods: This was a case-study research. The researchsubjects were head of health centers / health center doctors,nurses/midwife assistants, ambulance drivers/sea ambulancedrivers, patient families, community figures, jamkesmas/Jamkesda managers, head of health care section/head ofhealth office, director of local hospital/mobile hospital and emergencyroom nurses. The variables in this study were independentvariable (referral system) and dependent variable (ambulanceservice). The research location was in Linga Districtof Kepualauan Riau Province.Results: The results showed that policy efforts of the LingaGovernment District in improving the referral system had existed.The existing financing policy had encompassed twoaspects both from the demand side (medical expenses) andfrom the supply side (a system that supported health care).The process of referral from primary care to advanced serviceshad been going well although there was still lack as theunavailability and completeness of services. Most of the healthworkers had received training; there were also specialist doctors(in collaboration with the faculty of medicine), but networkingin the referral process was done partially and notintegrated.Conclusion: The health referral system in Linga District hadrun pretty well, but did not fully involve community participationin an integrated service system. The local government in thiscase Linga District Health Office needs to revitalize as well asaccelerate the development of Desa Siaga (alert villages) readinessto increase community participation in the developmentof a referral system.Keywords: policy, referral systems, islands, ambulance service

Background: Global commitments for developing countries contained in the Millennium Development Goals (MDGs) by 2015, where the target MMR 102 per 100,000 live births and IMR 23 per 1,000 live births. In connection with this mother and child health program should be a concern. Lingga Health Authority supports the achievement of MDGs with budget support and adequate human resources and the commitment of policy makers. Goal of Research: To find out the budgeting maternal and child health program priorities Lingga Health Authority. Methods of Research: The design of this study using a case study design is descriptive with qualitative methods. Researchers analyzed the budget maternal and child health program in Lingga Health Authority Kepulauan Riau Province 2009-2010. Research Result: The low budget of MCH programs and programs that have not implemented effectively viewed from maternal and child mortality is still high. MPS implementation of the strategy aimed to emergency service only focused on improving access and coverage, while the increase in family and community participation, use of co-operation, and management support is not implemented consistently. There is no prioritization of MCH program activities and budget refers only to the previous year's budget is based on data or the strengthening of the program. Weak commitment to decision makers and advocacy that have an impact on the budgets MCH program of low. Conclusions: Local builders index is determined by success in reducing maternal mortality. MCH program budget allocation should be based on evidence based and consider the magnitude of maternal mortality can be reduced. Priority setting is needed to determine which program activities over the allocated budget priorities so that more effective. The need for advocacy to local government and is committed to implement the priority programs so that programs are implemented more useful. Latar belakang: Komitmen global bagi negara berkembang tertuang dalam Millenium Development Goals (MDGs) tahun 2015, dimana target AKI 102 per 100.000 kelahiran hidup dan AKB 23 per 1.000 kelahiran hidup. Sehubungan dengan hal itu program kesehatan ibu dan anak harus menjadi perhatian. Dinas Kesehatan kabupaten Lingga mendukung pencapaian target MDGs dengan dukungan anggaran dan sumber daya manusia yang memadai serta komitmen para pembuat kebijakan. Tujuan penelitian: Untuk mengetahui anggaran program prioritas kesehatan ibu dan anak di Dinas Kesehatan Kabupaten Lingga. Metode Penelitian: Rancangan penelitian ini adalah studi kasus yang bersifat deskriptif dengan metode kualitatif. Peneliti menganalisis anggaran dan program prioritas kesehatan ibu dan anak di Dinas Kesehatan Kabupaten Lingga Propinsi Kepulauan Riau Tahun 2009-2010. Hasil Penelitian: Rendahnya anggaran program KIA dan program yang telah dilaksanakan tidak efektif dilihat dari angka kematian ibu dan anak yang masih tinggi. Penerapan strategi MPS yang diarahkan untuk pelayanan kegawatdaruratan hanya terfokus pada peningkatan akses dan cakupan pelayanan, sedangkan peningkatan partisipasi keluarga dan masyarakat, pemanfaatan kerjasama, dan manajemen support tidak dilaksanakan dengan konsisten. Tidak ada penetapan prioritas untuk kegiatan program KIA dan penyusunan anggaran hanya mengacu pada anggaran tahun sebelumnya tidak berdasarkan data atau penguatan dari program. Lemahnya komitmen dan advokasi pengambil keputusan yang berdampak pada anggaran program KIA rendah. Kesimpulan: Indeks pembangun daerah sangat ditentukan oleh keberhasilan dalam menurunkan angka kematian ibu. Pengalokasian anggaran program KIA harus berdasarkan evidence based dan mempertimbangkan besaran angka kematian ibu dapat diturunkan. Penetapan prioritas sangat perlu dilakukan untuk menentukan kegiatan program yang lebih prioritas sehingga anggaran yang dialokasikan lebih efektif. Perlunya advokasi terhadap pemerintah daerah dan mempunyai komitmen untuk melaksanakan program prioritas sehingga program yang dilaksanakan lebih bermanfaat.

Background: The effectiveness of treatment at government health facilities is largely determined by the availability of the drug. In addition to essential drugs, doctors and the public can choose medications that are considered more suitable for medical needs. Bureaucratic rigidity and lack of funds the government plans to make the supply of medicines in health centers to be minimalist in terms of number and variety of drugs. Such inflexibility encourage minimalist prescribing behavior among primary care physicians and health workers. Objective: This study want to learn management practices that deal with drug supply and its distribution in government owned primary health care facilities. It specifically tried to identify strategies at health center level that allow the provision of more drugs in accordance with the medical needs and rational drug use practices. Method: Data were collected by observation report drug use and demand for health facilities in January-June 2010 and in- depth interview of chief health official, the head of pharmacy department, 7 of pharmacy main health centers and 11 midwives/nurses extending health center, village health clinic and village health post. Results: This case illustrates a successful story about making drugs available at primary health care facilities. Five main health centers, four extending health centers, and ten village health clinic and village health posts are classified as "safe" based on MOH standard. This success reflects human resource capacity and decentralized management of drug supply. Pharmacists and pharmacy assistants throughout the Bangka Barat Regency has already trained in drug supply management. The study also found that the procurement of drugs has been based on bottom-up planning. Although under the coordination of district level pharmacy unit, health care centers has broader authority to determine their drug needs. They also have their own drug procurement budget that are part of district budget that can be used for unexpected situations. Conclusion: This study attempted to show effort to change local government health sector bureaucracy in decentralization era. This case study shows the involvement and bigger participation of primary care facilities in the planning and implementation of drug supply. Health centers have a greater authority in managing the medication needs to circumstances beyond expectations. Communication, information and education to doctors about the drug delivery mechanism will allow doctors to prescribe drugs according to the medical needs of patients and drug development, and because it makes health care facilities into place an effective treatment. Latar Belakang: Efektivitas pengobatan di fasilitas kesehatan pemerintah sangat ditentukan oleh ketersediaan obat. Di samping obat esensial, dokter dan masyarakat dapat memilih obat-obat yang dipandang lebih cocok untuk kebutuhan medik. Kekakuan birokrasi perencanaan dan keterbatasan dana pemerintah membuat penyediaan obat di puskesmas menjadi minimalis dari sisi jumlah dan variasi obat. Kekakuan seperti itu mendorong praktik peresepan minimalis yang diragukan manfaat terapetiknya. Tujuan: Penelitian ini mempelajari manajemen penyediaan obat dan distribusinya di fasilitas kesehatan dasar. Ia secara khusus berusaha menemukan strategi-strategi di tingkat puskesmas yang membuat penyediaan obat lebih sesuai dengan kebutuhan lapangan dan pengobatan rasional. Metode: Data dikumpulkan dengan observasi laporan pemakaian dan permintaan obat sarana kesehatan bulan Januari-Juni 2010 dan wawancara mendalam terhadap kepala dinas kesehatan, kepala instalasi farmasi, 7 pengelola obat puskesmas dan 11 bidan/perawat pustu, polindes serta poskesdes. Hasil: Penelitian ini menunjukkan bahwa lima puskesmas, empat puskesmas pembantu, dan sepuluh polindes dan poskesdes berhasil merencanakan dan menyediakan obat hingga pada tingkat yang "aman". Keberhasilan ini merupakan bukti dari kapasitas tenaga yang memadai. Apoteker dan seluruh pengelola obat puskesmas Kabupaten Bangka Barat sudah memiliki mengikuti pelatihan manajemen pengelolaan obat. Penelitian juga menemukan bahwa pengadaan obat telah berbasis desentralisasi dan mencerminkan perencanaan bottom up. Meski di bawah koordinasi instalasi farmasi kabupaten, puskesmas memiliki kewenangan menentukan kebutuhan. Mereka juga memiliki fleksibilitas pengadaan obat sendiri untuk situasi di luar dugaan. Kesimpulan: Penelitian ini berusaha memperlihatkan upaya perubahan birokrasi di bidang kesehatan dalam era desentralisasi. Studi kasus dalam penyediaan obat esensial di Kabupaten Bangka Barat menunjukkan keterlibatan dan partisipasi puskesmas yang lebih besar dalam perencanaan dan implementasinya. Puskesmas juga memiliki kewenangan lebih besar dalam mengelola kebutuhan obat untuk situasi di luar dugaan. Komunikasi, informasi dan edukasi kepada dokter tentang mekanisme penyediaan obat akan memudahkan dokter meresepkan obat sesuai dengan kebutuhan medik pasien dan perkembangan obat, dan karena itu membuat fasilitas kesehatan menjadi tempat pengobatan yang efektif.

Background: Social health insurance in Indonesia is carried by social insurance mechanism aims to provide social security protection to the community so their basic health needs can be met adequately. Social insurance is expected to increase access and utilization of health services as well as reducing the risk of out-of-pocket expenditure (OOP) that resulting in catastrophic expenditures and poverty. Objective: To analyze the utilization of inpatient care, health insurance and hospitalization OOP expense ratio based on living area, type of health facility and type of social health insurance in Eastern Indonesia. Methods: This study uses secondary data analysis using Indonesian Family Life Survey East 2012 data. This is a quantitative approach using cross-sectional design, and multivariate analysis using linear regression at 95% confidence level. Results: The use of hospitalization in Eastern Indonesia by insurance users is 54.6%, while those who do not use insurance is 45.4%. A total of 24.6% insurance owner do not use insurance at the time of hospitalization. Multivariate analysis showed no significant difference in the cost of hospitalization OOP based living area and type of health facility. OOP costs of hospitalization for Jamsostek/other members were higher than Askes and Jamkesmas members. Conclusion: The government needs to implement a social health insurance system that is of a better quality and comprehensive in order to protect users from the burden of high health care cost. Latar belakang: Jaminan kesehatan sosial di Indonesia dilakukan dengan mekanisme asuransi sosial bertujuan untuk memberi jaminan perlindungan sosial kepada masyarakat agar dapat terpenuhi kebutuhan dasar hidupnya secara layak, khususnya di bidang kesehatan. Asuransi sosial diharapkan dapat meningkatkan akses dan utilisasi pelayanan kesehatan serta mengurangi resiko pengeluaran biaya out of pocket (OOP) yang bisa berdampak pada pengeluaran katastropik serta kemiskinan. Tujuan: Menganalisis pemanfaatan rawat inap, asuransi kesehatan dan perbandingan biaya OOP rawat inap berdasarkan area tinggal, jenis fasilitas kesehatan dan jenis asuransi kesehatan sosial di Indonesia Timur. Metode: Penelitian ini menggunakan metode analisis data sekunder dengan sumber data Indonesian Family Life Survey East 2012. Pendekatan kuantitatif dengan rancangan cross sectional. Analisis multivariat menggunakan regresi linier pada tingkat kepercayaan 95%. Hasil: Pemanfaatan rawat inap di Indonesia Timur oleh pengguna asuransi sebesar 54,6% sedangkan yang tidak menggunakan asuransi sebesar 45,4%. Sebanyak 24,6% pemilik asuransi tidak menggunakan asuransinya pada saat kunjungan rawat inap. Hasil analisis multivariat menunjukkan tidak ada perbedaan biaya OOP rawat inap yang signifikan berdasarkan area tinggal dan jenis fasilitas kesehatan. Biaya OOP rawat inap pengguna Jamsostek/lainnya ternyata lebih tinggi dari pengguna Askes dan Jamkesmas. Kesimpulan: Pemerintah perlu menerapkan sistem asuransi kesehatan sosial yang lebih bermutu dan komprehensif agar dapat melindungi penggunanya dari beban biaya kesehatan yang tinggi, agar utilisasi asuransi kesehatan lebih berkualitas di masa mendatang.

Background: The objective of health development is improving community health status through increasing public access to health services. One of strategy is by supporting facilities forhealth service by developing auxiliary health center for all remote district at Central Kalimantan Province. Central Kalimantan Province with 1,9 million of population, consisted of 14 district, 1348 villages, 805 auxiliary health center. It means that only 59% village have facilities for health service such as auxiliary health center.Objectives: This research aimed to know how formulation process and implementation of policy of developing auxiliary health center by using provincial funds.Method: It was descriptive case study using mainly method qualitative designed by semi structured in-depth interview and document study. Research subject is stakeholder at levelprovince and chosen district. This research executed in Province Public Health Service of Central Kalimantan and one chosen district.Result: Development of secondary health center in Central Kalimantan Province is the realization of Central Kalimantan Province local decree number 12 and 13 year 2005 fulfilmenton RPJPD and RPJMD. Initially, the budgeting concept was planned by Tugas Pembantuan mechanism, but this mechanism was not agreed. This scheme was a top down program fromprovince government. Problems occurred in the implementation are 1). Bad monitoring, 2). Lack of reporting by developer, 3). Remote location of, 4). Varieties in cost of production, 5). Shortage health care workforce, 6). Equipments unmatched the need of health care provider. Evaluation is executed, but only concerning physical progress problem. In the meantime, there was increased allocation of DAK fund in each district.Conclusion: Development of auxiliary health center in Central Kalimantan Province which funded by province fund, is not required by district. There was no agenda surrounding development of auxiliary health center. The role of stakeholder in compilation of agenda setting for this policy was only a normative role.

Purpose: Physical restraint of mental illness (pasung) has been widely documented in Indonesia. However, there is still a lack of studies exploring the role of puskesmas in eliminating pasung. This study aims to document the head of the puskesmas in advocating for and working with local administrators to build a positive climate of involving people with mental illness in productive activities so that they have no reason to be confined at home.Methods: This case study was based on in-depth interviews of 19 community health center workers and community personnel, field observations, and document review.Results: Periodic, regular communication organized in simple meetings and field visits with local stakeholders can open up stakeholders and have the same vision in public health. With hospitable visits of respected local officials and health workers, families and communities, who at first were ashamed and isolated their mentally ill family members, are now becoming open-minded and participating in programs for persons with mental illness.Conclusion: Communication and public health leadership skills from the head of puskesmas are essential skills in inviting local administrators to work together for public health. ; Latar Belakang : Masalah kesehatan jiwa atau gangguan mental erat kaitannya dengan kejadian pemasungan. Pemasungan pada penderita gangguan jiwa atau mental dikarenakan informasi yang kurang terkait kesehatan jiwa, kondisi ekonomi yang rendah sehingga mengakibatkan keluarga tidak mampu mengakses pelayanan kesehatan jiwa, akses dan pelayanan kesehatan jiwa yang belum memadai terutama di daerah pedesaan dan untuk menghindari dan menahan tindakan agresif sari pasien agar tidak membahayakan anggota keluarga maupun masyarakat. Partisipasi atau peran stakeholder terhadap program kesehatan jiwa merupakan salah satu faktor penentu berjalan atau berhasilnya upaya penanggulangan pasung pada orang dengan gangguan jiwa (ODGJ). Tujuan : Penelitian ini bertujuan untuk mengetahui dan mengeksplorasi peran stakeholder terhadap program kesehatan jiwa dalam penanggulangan pemasungan pada orang dengan gangguan jiwa (ODGJ) di Kecamatan Moyudan Kabupaten Sleman.Metode : Penelitian ini merupakan adalah penelitian deskriptif dengan metode kualitatif. Adapun rancangan penelitian yang digunakan adalah studi kasus untuk mengidentifikasi dan mengeksplorasi peran dari masing – masing stakeholder dalam penanggulangan pemasungan pada ODGJ di Kecamatan Moyudan Kabupaten Sleman. Penelitian menggunakan purposive sampling dengan subjek penelitian berjumlah 19 orang. Pengumpulan data dilakukan dengan wawancara mendalam dan menggunakan analisis data kualitatif.Hasil : Seluruh stakeholder telah berperan dalam program kesehatan jiwa dalam upaya penanggulangan pasung pada orang dengan gangguan jiwa (ODGJ). Salah satu peran yang dilakukan oleh stakeholder adalah advokasi. Advokasi yang dilakukan stakeholder kunci yaitu puskesmas berupa komitmen poiltik dari pemerintah daerah, dukungan kebijakan dari Dinas Kesehatan, Dinas Sosial, Rumah Sakit Jiwa Grahasia, Kecamatan Moyudan dan Pemerintah Desa. Namun pada perjalananya pelaksanaan proses advokasi tidak selalu berhasil, stakeholder utama dalam hal ini keluarga menolak advokasi yang dilakukan puskesmas. Stigma negatif tentang kesehatan jiwa menjadi salah satu permasalahan yang masih susah ditangani di masyarakat sehingga hal ini menghambat peran stakeholder dalam proses advokasi.Kesimpulan : Stakeholder telah berperan sesuai dengan fungsi, tugas dan wewenang masing – masing terhadap pelaksanaan program kesehatan jiwa dalam upaya penanggulangan pasung pada orang dengan gangguan jiwa (ODGJ). Peran puskesmas dalam proses advokasi menghasilkan komitmen politik dan dukungan kebijakan dari setiap stakeholder.

People living in isolated communities are vulnerable to suffering from illness because of their lack of access to available known effective treatment in health facilities around them, including in maternal and child issues. The goal of this in-depth interview and one month-direct observation living in the community is to explore the belief and available structure of local health-seeking behavior among the Suku Anak Dalam community. Our findings suggest that the community has its own traditional belief that explains their birth practices. Interpretation of concepts such as anak peranakan, taputangan, pekarom, and delom system are unique and inseparable from the interpretation of their ideal life and their trust in God. In the other side, their poor perception about public health facilities is influenced by their experience dealing with formal health facilities. When a community gets what they perceived as poor services, they will not believe and do not come back to seek help from formal health facilities. Our study confirmed that the cultural explanation of birth and belief related to traditional birth delivery services remain existent and practiced, which limits access to a government health facility. If the community is free to choose alternative care outside their traditional system, people may obtain effective treatments from the surrounding health facilities. SAD women feel comfortable with their cultural practices. They have a negative perception and feel uncomfortable about formal health facilities showed inadequate government efforts to bring services to a specific social group. Health workers in isolated areas with traditional belief should be prepared and paid under a contract basis, different from the regular workers. They need to improve the communication skills that allow them to engage with people from different cultures. They need to work with officers from other sectors, both in formal and informal settings. ; People living in isolated communities are vulnerable to suffering from illness because of their lack of access to available treatment and known to be effective in health facilities around them. Including in these categories is service access for pregnant women. The goal of this in-depth interview and one month-direct observation living in the community is to explore the belief and available structure of local health seeking behavior among Suku Anak Dalam community. Our findings suggest that the community has their own traditional belief that explains their birth practices. Interpretation of concepts such as anak peranakan, taputangan, pekarom, and "delom" system are unique and inseparable from their understanding of their believed ideal life and their trust in God. In other side, their poor perception about public health facilities is influenced by their experience dealing with formal health facilities. When community gets what they percerived as poor services, they will not believe and do not come back to seek help from formal health facilities. Our study confirmed that the cultural explanation of birth and belief related to traditional birth delivery services remain existent and practiced, which limits access of the interior at the health facility. If the community give a choice to their people to find alternative formal health care outside their traditional system, people will no longer suffer from conditions that effective treatments are available in the surrounding health facilities. Women in the community feel comfortable when they are with their traditional system and that they have a bad perception and uncomfortable about formal health facilities shows that inadequate government efforts to bring services to the population. Health workers working in community health centers in the isolated areas with strong traditional belief should be prepared and contracted in different way from the regular workers. They need training to improve their communication skills that allow them to talk and to engage with people from different cultures and to work with the community and people from other sectors both in formal and informal settings.