Suchergebnisse

Policies to encourage childbirth in health care facilities were emphasized to reduce maternal mortality rates that are still high in Indonesia. The study was aimed at analyzing population, socio-economic, and resource input variables related to childbirth in health care facilities. This study used an ecological study approach (an aggregate study) sourced from the 2018 Indonesia Health Profi le. Bivariate analysis was performed using scatter plots and Pearson correlation tests. The results showed a wide disparity in terms of childbirth in health care facilities coverage. Maluku was the province with the lowest coverage (45.18%), while the highest coverage was achieved by DKI Jakarta (100%). The results of scatter plots and bivariate tests showed that the more population in a province, the higher the coverage of delivery in health care facilities, the deeper and worse the poverty in a province, the lower the coverage of delivery in health care facilities. The more obstetrician and hospitals in a province, there was a tendency for coverage of births in health care facilities to be higher. In conclusion, population, the ratio of obstetricians, and the ratio of hospitals have a positive relationship with deliveries in healthcare facilities. In contrast, the Poverty Depth and Severity Index has a tendency to had a negative relationship with the coverage of deliveries in health care facilities. It was recommended that the government formulate specifi c policies to target regions with a small population, poor and have a small number of obstetricians and hospitals. Abstrak Kebijakan mendorong persalinan di fasilitas pelayanan kesehatan ditekankan untuk menurunkan angka kematian ibu yang masih tinggi di Indonesia. Studi ditujukan untuk menganalisis variabel kependudukan, sosial-ekonomi dan input sumber daya yang berhubungan dengan persalinan di fasilitas pelayanan kesehatan. Desain studi menggunakan pendekatan studi ekologi (studi agregat) bersumber data Profi l Kesehatan Indonesia Tahun 2018. Analisis bivariat dilakukan dengan menggunakan scatter plot dan uji korelasi Pearson. Hasil penelitian menunjukkan disparitas persentase cakupan persalinan ke fasilitas pelayanan kesehatan yang sangat lebar, Provinsi Maluku memiliki cakupan paling rendah (45,18%), sementara cakupan tertinggi dicapai Provinsi DKI Jakarta (100%). Hasil scatter plot dan uji bivariat menunjukkan bahwa semakin banyak jumlah penduduk pada suatu provinsi maka ada kecenderungan cakupan persalinan di fasilitas pelayanan kesehatan menjadi semakin tinggi. Semakin dalam dan parah kemiskinan pada suatu provinsi maka ada kecenderungan cakupan persalinan di fasilitas pelayanan kesehatan menjadi semakin rendah. Semakin banyak dokter spesialis obgyn dan rumah sakit pada suatu provinsi maka ada kecenderungan cakupan persalinan di fasilitas pelayanan kesehatan menjadi semakin tinggi. Disimpulkan bahwa jumlah penduduk, rasio dokter spesialis obgyn dan rasio rumah sakit (RS) memiliki hubungan positif, sementara Indeks Kedalaman dan Keparahan Kemiskinan memiliki kecenderungan hubungan negatif dengan cakupan persalinan di fasilitas pelayanan kesehatan. Disarankan pemerintah menyusun kebijakan khusus pada sasaran wilayah dengan jumlah penduduk sedikit, miskin dan memiliki dokter spesialis obgyn dan RS yang sedikit.

The Government of Indonesian implemented maternal health service programs to minimize at-home childbirth services and increase mothers' utilization of its services. There is not enough evidence these policies are effectively decreasing the maternal mortality rate. Hence, this study aimed to analyze the predictors of each specific childbirth services in Indonesia. This study used the secondary dataset of the 2012 Indonesian demographic data survey (IDHS). The sample was 17,769 women ages 15 to 49 years old. We performed logistic regression for the multivariate case to identify the predictors of childbirth service. Geographical, education, and economic condition significantly predict childbirth services. Women who are not residents tend to use a community-based facility than institutionalized health. Women with higher parity, inadequate knowledge on pregnancy danger signs, lower antenatal care visits, and never had any discussion with their husbands about the planned place of giving birth tend to prefer giving birth at home than health facilities. Women's decision to use a safe childbirth service is hindered by demanding access to reach institutionalized healthcare. Our findings highlighted the importance of women empowerment to enable women to utilize safe labor in a health facility.

BACKGROUND: The government is obliged to guarantee equal access to antenatal care (ANC) between urban and rural areas. This study aimed to analyze urban-rural disparities in ≥4 ANC visits during pregnancy in the Philippines and Indonesia. METHODS: The study processed data from the 2017 PDHS and the 2017 IDHS. The analysis unit was women aged 15–49 years old who had given birth in the last 5 years. The weighted sample size was 7992 respondents in the Philippines and 14,568 respondents in Indonesia. Apart from ANC as the dependent variable, other variables analyzed were residence, age, husband/partner, education, parity, and wealth. Determination of urban-rural disparities using binary logistic regression. RESULTS: The results show that women in the urban Philippines are 0.932 times more likely than women in the rural Philippines to make ≥4 ANC visits. On the other side, women in urban Indonesia are more likely 1.255 times than women in rural Indonesia to make ≥4 ANC visits. Apart from the type of residence place (urban-rural), five other tested multivariate variables also proved significant contributions to ANC's use in both countries, i.e., age, have a husband/partner, education, parity, and wealth status. CONCLUSIONS: The study concluded that disparities exist between urban and rural areas utilizing ANC in the Philippines and Indonesia. Pregnant women in the rural Philippines have a better chance of making ≥4 ANC visits. Meanwhile, pregnant women in urban Indonesia have a better chance of making ≥4 ANC visits.

The elderly are one of the most vulnerable groups with very high dependency rates. This condition has the potential to cause other problems for the caregiver or his family. The elderly also has the potential to suffer from catastrophic diseases that have costly consequences. This research is a further analysis of Riskesdas 2013 data, that presented in descriptive quantitative. The results showed that elderly people living in urban as well as rural areas have a tendency of moderate access barrier to Puskesmas. There are still 15% of very poor elderly people who have major access barrier to Puskesmas. This study concludes that although elderly access to Puskesmas is quite good, but the access of very poor elderly is still need more attention. The government needs to provide basic health care facilities in more rural areas. The government also needs to realize a National Health Insurance with tax-based funding, to ensure universal coverage regardless of the ability to pay the community. Abstrak Lansia adalah salah satu kelompok rentan yang memiliki angka ketergantungan sangat tinggi. Kondisi ini berpotensi menimbulkan masalah lain bagi yang merawat atau keluarganya. Lansia juga berpotensi menderita penyakit katastropik yang menimbulkan konsekuensi biaya yang mahal. Penelitian ini merupakan analisis lanjut data Riskesdas 2013, yang disajikan secara deskriptif kuantitatif. Hasil penelitian menunjukkan bahwa lansia yang tinggal di perkotaan maupun perdesaan mempunyai kecenderungan hambatan akses sedang untuk ke Puskesmas. Masih ada 15% lansia sangat miskin yang memiliki hambatan besar ke Puskesmas. Penelitian ini menyimpulkan bahwa meski akses lansia ke Puskesmas sudah cukup baik, tetapi akses lansia yang sangat miskin masih perlu mendapat perhatian lebih. Pemerintah perlu menyediakan fasilitas pelayanan kesehatan dasar di wilayah perdesaan yang lebih banyak. Pemerintah juga perlu mewujudkan sebuah Jaminan Kesehatan Nasional dengan pendanaan berbasis pajak, untuk memastikan cakupan secara universal dengan tanpa menghiraukan kemampuan membayar masyarakat.

Background: The medical doctor ratio in the Regency of Blitar is far below the normative ratio (1: 2,500). From the number of physicians working in health institutions, it is clear that not only the present ratio (1: 12,125) but the distribution in every dis- trict is also uneven. Based on these two findings, this re- search aims to formulate a manpower policy draft for medical doctors in Blitar Regency. With reference to regency and na- tional level policy, the draft will take into consideration: the community demographic characte-ristics, the number of Puskesmas visitation, the number of Puskesmas, geographic characteristics, infrastructure, health programs of Blitar Re- gional Health Office, the availability of medical doctors and the fiscal potency of Blitar Regency. Methods: This is a policy research consisted of several stages i.e. identifying public issues, formulating public issues, analyzing public issues, deciding criteria and alternative poli- cies, and forecasting and determining target and priority. Con- ducted from February until June 2008, the research location was the Blitar Regency. Information sources are regency and national level policy documents and also policy actors (policy- makers and policy-implementers). Results: The result shows four basic estimations for medical doctors' manpower requirement which can be applied in Blitar Regency. Those are the number of population, the number of Puskesmas, the number of districts and the total visitation of each Puskesmas. It was settled and approved by all policy actors that the population number should be the basis for estimating medical doctor's manpower requirement. Pursuant to this calculation, 454 medical doctors are projected for the year 2009, up to 470 physicians in the year 2018. Blitar Re- gency policy actors predict the increasing fiscal potency of the regency following the trend of the past five years. The prediction includes the increasing percentage of health bud- get. Derived from the Focus Group Discussion, the policy ac- tors stated only 10 medical doctors for every two years could be provided by the Blitar regional government. Conclusion: The recommendations are: formulating medical doctor's policy implicitly should include medical doctor's facilitatiye character; using ideal ratio adapting to Blitar regency's recent condition and fiscal ability; using a strategy of appointing medical doctor's from the regency's PTT (tempo- rary assigned doctors) and making an incentive pattern with regard to Blitar Regency region mapping.Latar Belakang: Rasio dokter di Kabupaten Blitar adalah masih jauh di bawah rasio normatif (1:2,500). Dari jumlah dokter yang bekerja di lembaga kesehatan, terlihat jelas bahwa tidak hanya rasio saat ini (1:12,125) tetapi distribusi di setiap kecamatan juga tidak merata. Berdasarkan dua temuan ini, penelitian ini bertujuan untuk merumuskan rancangan kebijakan tenaga dok- ter di Kabupaten Blitar. Mengacu pada kebijakan tingkat kabupaten dan nasional, rancangan ini akan mempertimbang- kan: karakteristik demografi masyarakat, jumlah visitasi Pus- kesmas, jumlah Puskesmas, karakteristik geografis, infrastruk- tur, program kesehatan Dinas Kesehatan Kabupaten Blitar, ke- tersediaan dokter dan potensi fiskal Kabupaten Blitar. Metode: Penelitian ini merupakan penelitian kebijakan yang terdiri dari beberapa tahap, yaitu mengidentifikasi isu-isu publik, merumuskan isu-isu publik, menganalisis isu-isu publik, memu- tuskan kriteria dan alternatif kebijakan, serta meramalkan dan menentukan target dan prioritas. Lokasi penelitian adalah di Kabupaten Blitar yang dilaksanakan mulai Februari hingga Juni 2008. Sumber informasi adalah dokumen kebijakan di tingkat kabupaten dan nasional serta pelaku kebijakan (pembuat kebi- jakan dan pelaksana kebijakan). Hasil: Penelitian ini menunjukkan empat estimasi dasar untuk kebutuhan tenaga dokter yang dapat diterapkan di Kabupaten Blitar. Empat estimasi dasar tersebut adalah jumlah penduduk, jumlah Puskesmas, jumlah kecamatan dan visitasi total di setiap Puskesmas. Semua pelaku kebijakan telah menyelesaikan dan menyetujui bahwa jumlah penduduk harus menjadi dasar untuk memperkirakan kebutuhan tenaga dokter. Berdasarkan perhi- tungan ini, 454 dokter telah diproyeksikan untuk tahun 2009, hingga 470 dokter yang diproyeksikan pada tahun 2018. Pelaku kebijakan di Kabupaten Blitar memprediksi meningkatnya poten- si fiskal Kabupaten yang mengikuti tren dari lima tahun terakhir. Prediksi tersebut meliputi peningkatan persentase anggaran kesehatan. Berdasarkan hasil dari diskusi kelompok terarah, pelaku kebijakan menyatakan bahwa untuk setiap dua tahun hanya 10 dokter dapat disediakan oleh pemerintah daerah Kabupaten Blitar. Kesimpulan: Rekomendasi yang diajukan dalam penelitian ini adalah: secara implisit merumuskan kebijakan dokter harus mencakup karakter fasilitas dokter, menggunakan rasio yang ideal yang sesuai dengan kondisi dan kemampuan fiskal Kabu- paten Blitar sekarang, menggunakan strategi penunjukkan dok- ter PTT dan membuat pola insentif yang berkaitan dengan pemetaan wilayah Kabupaten Blitar.

BACKGROUND: Even though the Indonesian government have set regulations for maintaining exclusive breastfeeding practices, the coverage remains low. The study aims to analyze the effects of mother's education level on the coverage of exclusive breastfeeding in Indonesia. METHODS: This study used data from the 2017 Nutrition Status Monitoring Survey. It covered data of 53,528 children under 5 years old (7–59 months) as the samples. Variables included exclusive breastfeeding status, mother's education level, mother's age, marital status, employment status, gender, residence, under five's age and gender. A binary logistics regression was performed in the final test. RESULTS: Mothers who graduated from elementary school were 1.167 times more likely to perform exclusive breastfeeding compared to mothers who never attended schools. Additionally, those who graduated from junior high school had 1.203 times possibilities to give exclusive breastfeeding compared to mothers without educational records. While, mothers who graduated from high school were 1.177 times more likely to perform exclusive breastfeeding compared to those without educational records. Mothers who graduated from tertiary education had 1.203 times more possibilities to perform exclusive breastfeeding compared to mothers who were never enrolled to schools. Other variables also became affecting predictors on exclusive breastfeeding, such as mother's age, mother's employment status, child's age, and residence. CONCLUSIONS: The mother's education level positively affects exclusive breastfeeding practice in Indonesia.

BACKGROUND: The government must ensure equality in health services access, minimizing existing disparities between urban and rural areas. The referral system in Indonesia is conceptually sound. However, there are still problems of uneven service access, and there is an accumulation of patients in certain hospitals. The study aims to analyze the urban–rural disparities in hospital utilization in Indonesia. METHODS: The study used secondary data from the 2018 Indonesian Basic Health Survey. This cross-sectional study gathered 629,370 respondents through stratification and multistage random sampling. In addition to the kind of home and hospital utilization, the study looked at age, gender, marital status, education, occupation, wealth, and health insurance as control factors. The research employed multinomial logistic regression to evaluate the data in the final step. RESULTS: According to the findings, someone who lives in an urban region has 1.493 times higher odds of using outpatient hospital services than someone in a rural area (AOR 1.493; 95% CI 1.489–1.498). Meanwhile, someone who lives in an urban region has 1.075 times higher odds of using an inpatient facility hospital than someone who lives in a rural one (AOR 1.075; 95% CI 1.073–1.077). Furthermore, someone living in an urban region has 1.208 times higher odds than someone who lives in a rural area using outpatient and inpatient hospital services simultaneously (AOR 1.208; 95% CI 1.204–1.212). CONCLUSION: The study concluded there were urban–rural disparities in hospital utilization in Indonesia.

Access to health services is often seen only from the provider perspective, while from the community side as a user isless noticed. Improving the quality of health services access requires a complete perspective on two diff erent sides. Thisresearch is designed descriptively qualitative. Data were collected by Focus Group Discussion (FGD), in-depth interviewand observation. The research was conducted in Malang Regency in June-August 2018. The study results showed healthservices access generally the community believes that there are still perceived defi ciencies. Especially on the aspectof physical access, due to poor facilities and infrastructure. In addition, social access was also considered inadequate,because there were still health workers who served with less friendly. This study concludes that people still feel accessto physical and social aspects is still diffi cult. It should be recommended to the local government for eff orts to improvephysical access, and the Health Offi ce to disseminate health information about the rights of patients to the community. Abstrak Akses pelayanan kesehatan seringkali dilihat hanya dari perspektif pemberi pelayanan saja, sementara akses dari sisimasyarakat sebagai pengguna kurang terperhatikan. Perbaikan kualitas pelayanan kesehatan dari sisi akses memerlukanperspektif yang lengkap dari dua sisi yang berbeda. Penelitian ini didesain secara deskriptif kualitatif. Data dikumpulkandengan Focus Group Discussion (FGD), wawancara mendalam dan pengamatan. Penelitian dilakukan di KabupatenMalang pada bulan Juni–Agustus 2018. Hasil penelitian menunjukkan aksesibilitas pelayanan kesehatan yang ada, secaraumum masyarakat berpendapat bahwa masih ada kekurangan yang dirasakan. Terutama pada aspek akses secara fisik,dikarenakan sarana dan prasarana yang kurang baik. Selain itu akses secara sosial juga dirasa kurang, karena masih adatenaga kesehatan yang melayani dengan kurang ramah. Penelitian ini menyimpulkan bahwa masyarakat masih merasaakses dari aspek fisik dan sosial masih sulit. Perlu direkomendasikan pada pemerintah daerah setempat untuk upayaperbaikan akses secara fi sik, dan Dinkes untuk mendiseminasikan informasi kesehatan mengenai hak pasien kepadamasyarakat.