The COVID-19 pandemic has created urgent demand around the world for knowledge generation about a novel coronavirus, its transmission, and control, putting academic institutions at the frontline of politics. While many academic institutions are well poised to conduct research, there are well-documented barriers for these institutions, particularly in low- and middle-income countries (LMICs), to further conduct strategic synthesis and dissemination to promote knowledge utilization among policy-makers. These systemic barriers to knowledge translation (KT) pose significant challenges for academic institutions seeking to take advantage of unprecedented policy windows to inform evidence-based decision-making. Global health funding organizations should prioritize the support of academic institutions' activities along the KT pathway, including both knowledge generation and strategic dissemination, to improve knowledge uptake for decision-making to improve health. Institutional capacity-building initiatives for KT have the potential to profoundly impact responses to this and future pandemics.
Introduction: Chronic diseases have become a major cause of death in the world, and a major source of morbidity and misery. Approximately 80% of related deaths occur in developing countries. Chronic Disease Management Program (CDMP) is an integrative program aimed to control the prevalence of chronic diseases. Therefore, this study aimed to evaluate the interaction between context and process in CDMP services, and to determine how CDMP was implemented in developed and underdeveloped regions.Methods: This qualitative study used the Consolidated Framework for Implementation Research (CFIR). Subjects were selected by purposive sampling from CDMP organizers in Primary Health Centers for a commitment-based capitation assessment. Transcript data were analyzed thematically by summarizing and identifying major themes based on the CFIR domains.Results: The main activities of the CDMP (medical consultations, monitoring of health status, health educational, reminders, home visit and group activities/gymnastics) in developed regions were conducted according to the technical manual. However, in underdeveloped regions, some modifications were needed, i.e. the medical consultations, medical checkups and health education undertaken by a nurse in charge and not always conducted by a doctor; and, the services were conducted at the village meeting halls. Also, the reminders were delivered through socialization by local governments and direct invitation by team members when they met the participants on the roadway or in the neighborhood around the participants' homes.Conclusion: CDMP cannot fully be implemented in underdeveloped regions and some modifications were needed according to local conditions.
The Indonesian government has been implementing the National Health Insurance (Jaminan Kesehatan Nasional [JKN]) policy since 2014. This study aimed to evaluate JKN based on equity indicators, especially in skilled birth attendants (SBAs) use. The data were obtained from National Socio-Economic Survey of Indonesia during 2012 to 2016. To analyze the data, χ(2) and logistic regression tests were applied. The respondents were married mothers from 15 to 49 years who had delivered a baby. Deliveries by SBAs increased at the national level, but this achievement showed significant variation according to geographical location. The coverage of deliveries by SBAs in the eastern areas of Indonesia was still much lower than those in the western areas. All factors determining SBAs utilization (health insurance ownership, education, household economic status, and geography factor) indicated the positive correlation (P < .05). The inequity of SBA use in differences in geographical location and socioeconomic status continues to occur after the implementation of JKN.
The Indonesian government established the prevalence target of HIV <0.50% in 2019 to control the spreading of HIV through the National Medium Term Development Plan. To ensure the sustainability of this development plan, a study of the strategic capacity of HIV/AIDS programmes is needed to provide an overview so that the program can be sustained over time. This study aimed to explore the sustainability capacity of HIV/AIDS programmes in Yogyakarta. This was a descriptive study utilizing a qualitative approach. The study involved 42 participants as key informants selected by a purposive sampling technique, and the data were examined using content analysis. By setting priorities of the local government supported by the Provincial Health Office and with the coordination of the Yogyakarta Province AIDS Commission, the programs are able to maintain sustainable HIV and AIDS programmes in Yogyakarta. Funding capacity, evaluation, programme adaptation and communication have not been optimal to ensure the sustainability. Stability of funding is the main obstacle to achieving the sustainability of HIV and AIDS programs. However, with good planning, partnership structure and sufficient organizational capacity, this approach can ensure the HIV and AIDS programmes will continue with the targets set by the Yogyakarta Provincial Health Office. The government in Yogyakarta needs to increase funding capacity, and improve communication to ensure sustainability. The strategy should include adaptation and evaluation of programs through strengthening private sector financing, formulating a communication plan and improving the capacity to respond to change.
Background.: The problem of HIV in Indonesia today has become a major problem not only in health but also has led to problems of social, culture, economic and politic. Cases of HIV in Sorong District in 2007 reached 16 cases, but on 1 July 2014 at increased to 1.029 cases. Data from Sorong KPAD showed a huge increase in the periode of 7 years. Increase in the number of cases should be a considered serious concern by the local goverment in make commitments and allocating budgets particularly in reduction and prevention of HIV in Sorong. Objective: To determine the role of key stakeholders in the policy of reduction and prevention of HIV in District of Sorong, West Papua. Method: This is a qualitative research with case study de- sign. Case study approach is used for the purpose of techni- cal research, in principle is to answer "why there is no spe- cific policy of the local goverment in the response to HIV pre- vention and how the role of the key stakeholders in the reduc- tion and HIV prevention policy in health district of Sorong.This research is carried out in District Sorong, West Papua. The subjects of this study were BAPPEDA, DPRD,Sub-Dinas PP&PL, Health Office of Distrist Sorong and KPAD as the key stakeholders in policy making at the local level. Result : The result showed that the advocacy of the key stakeholders in prevention and reduction of HIV/AIDS by KPAD and Health Department has not gone well, which there are no reports to the key stakeholders as an policy makers, resulting in weak support for the allocation of funds in prevention and reduction of HIV /AIDS in Sorong District, West Papua. Until now there is no local regulation on HIV/AIDS. Conclusion. Advocacy of the key stakeholder in this regard KPAD and Health district of Sorong should be more active as a key policymakers to both the executive (BAPPEDA) and legis- lative (DPRD) so that the response to HIV/AIDS in Distrist Sorong can run optimally. Latar Belakang : Permasalahan HIV/AIDS pada saat ini telah menjadi masalah besar di Indonesia. Peningkatan Kasus HIV/ AIDS di Kabupaten Sorong mencapai 16 kasus tahun 2007 namun meningkat menjadi 1.029 per Juli tahun 2014. Data dari KPAD Kabupaten Sorong ini menunjukkan peningkatan yang sangat besar dalam periode 7 tahun terakhir. Peningkatan jumlah kasus ini merupakan masalah yang seharusnya menjadi perhatian serius oleh Pemda Kabupaten Sorong dalam membuat komitmen dan mengalokasikan anggaran dari APBD secara khusus dalam Kebijkan Penanggulangan dan Pencegahan HIV/ AIDS. Tujuan Penelitian : Untuk mengetahui peran Stakeholder Kunci dalam kebijakan penanggulangan dan pencegahan HIV/AIDS di Kabupaten Sorong Provinsi Papua Barat. Metode Penelitian : Jenis penelitian adalah penelitian kulaitatif dengan rancangan studi kasus. Pendekatan studi kasus digunakan karena tujuan penelitian ini pada prinsipnya adalah untuk menjawab mengapa (why) belum ada kebijakan secara khusus dalam kebijakan Pemerintah Kabupaten Sorong dalam upaya Penanggulangan dan Pencegahan HIV/AIDS dan bagaimana (how) Peran advokasi Stakeholder Kunci dalam Kebijakan Penanggulangan dan Pencegahan HIV/AIDS di Kabupaten Sorong. Penelitian dilakukan di Kabupaten Sorong Provinsi Papua Barat, subyek penelitian ini adalah BAPPEDA, DPRD, Subdin P2&PL Dinas Kesehatan, dan KPAD sebagai Stakeholder Kunci dalam membuat kebijakan di tingkat daerah Kabupaten Sorong. Hasil . Hasil penelitian menunjukkan bahwa advokasi dari stakeholder kunci dalam penanggulangan dan pencegahan HIV/AIDS oleh KPAD dan Dinas Kesahatan belum berjalan dengan baik, belum ada laporan ke stakeholder kunci pembuat kebijakan, membuat lemahnya dukungan alokasi dana dalam upaya pencegahan dan penangulangan HIV/AIDS di Kabupaten Sorong. Sampai saat ini belum ada Perda HIV/AIDS. Kesimpulan dan saran. Advokasi dari stakeholder kunci yaitu KPAD dan Dinas Kesahatan harus lebih giat dilakukan terhadap stakeholder kunci yang membuat kebijakan baik kepada eksekutif (BAPPEDA) maupun legislatif (DPRD) agar upaya penanggulangn dan pencegahan HIV/AIDS di kabuapen Sorong bisa berjalan dengan maksimal
HIV-AIDS is one of the world's health problems. Grobogan regency is one of the districts in Central Java with HIV number 4 and the discovery of new cases of HIV-AIDS number 3 in Central Java by 2015. Until 2017, HIV-AIDS cases are still fluctuating and tend to increase. Efforts were made to garner support and political commitment from the Grobogan Government and other stakeholders. The continuity of the program depends on political commitment and stakeholder policy support in the region. Conducting stakeholder analysis becomes important for the development of future strategic HIV / AIDS prevention plans. Objective this research to describe how local government strategic planning in HIV and AIDS prevention in Grobogan District. This research is descriptive research with qualitative approach. There were 20 informants in the study: Executive and Legislative officials, HIV / AIDS Caring NGO, VCT Clinic, community of PLWHA. The data was collected by observation, in-depth interview, and document review. Local government strategic planning on HIV / AIDS prevention efforts is still in the form of policy agenda and exit strategy. Although all stakeholders agree and support HIV / AIDS prevention efforts, stakeholder involvement in the formulation of policies and programs is lacking. Coordination of health offices with other stakeholders is also not working well, so the program is not integrated. The health department advocacy to local leaders is still weak. Health workers began to be evaluated for their performance, especially at sub-district level. Proposed alternatives to HIV / AIDS prevention budget from village funds. Unintegrated HIV / AIDS prevention efforts by stakeholders show weak communication and coordinative functioning. This problem is mainly caused by the key personnel dealing with reshuffle including the head of the health office in addition to the new bupati also not fully understand the case of HIV-AIDS that occurred.
BACKGROUND: Sustaining an effective evidence-based health intervention will maximize its impact on public health. Political and governmental reforms impacted on immunization program sustainability both positively and negatively. This study aims to explore the sustainability of polio immunization in a decentralized health system taking lessons learned from a polio eradication initiative in Indonesia. METHODS: We collected qualitative data through in-depth interviews with 27 key informants from various backgrounds at district, provincial, and national levels, consisting of frontline workers, managers, and Non-government Organizations (NGOs). We conducted thematic analysis and triangulated using document reviews. We also conducted member checking and peer debriefing to ensure trustworthiness. RESULTS: Competing priority was identified as the significant challenge to sustain government commitment for polio immunization and AFP surveillance during the transition toward a decentralized health system. Variation of local government capacities has also affected immunization delivery and commitment at the sub-national level government. The government reform has led to a more democratic society, facilitating vaccine rejection and hesitancy. The multi-sector partnership played a significant role in maintaining polio immunization coverage. Strong and continuous advocacy and campaign were essential to raising awareness of the community and policymakers to keep polio in the agenda and to maintain the high polio immunization coverage. CONCLUSION: Competing priority was the major factor affecting high polio immunization coverage during the decentralization transition. Strong advocacy is needed at every level, from district to national level, to keep polio immunization prioritized.
Despite the pros and cons, the practice of hypnotherapy is growing in Indonesia. How are the hypnotherapy clients aware about hypnotherapy? Is the process of acceptance in line with the pattern of adoption of the innovation? Theoretically, there are five stages of the process of adoption of an innovation: awareness, interest, evaluation, first-trial, and confirmation. This study was conducted in four major cities in Java. A sequential-explanatory mixed method was applied. There were two stages for this method, quantitative survey and then followed by qualitative study. The conclusion suggested that the acceptance of hypnotherapy by clients depended on its effectiveness in helping them to cope with their problems. The finding also corroborated and slightly added to the five-stages theory of the process of innovation adoption. The most effective communication channel in the process of adopting hypnotherapy was face-to-face and interpersonal, with the hypnotherapy clients as diffusion agents. The most important message in the context of developing the hypnotherapist profession was that hypnotherapy is an evidence-based professional service.
The Indonesian Government has issued various policies to fight Coronavirus Disease (COVID-19). However, cases have continued to fluctuate over a year into the pandemic. There is a need to assess the country's healthcare system's capacity to absorb and accommodate the varying healthcare demands. We reviewed the current capacity of Indonesia's healthcare system to respond to COVID-19 based on the four essential elements of surge capacity: staff, stuff, structure, and system. Currently available medical staffs are insufficient to deal with potentially increasing demands as the pandemic highlighted the human resources challenges the healthcare system has been struggling with. The pandemic has exposed the fragility of medical supply chains. Surges in the number of patients requiring hospitalization have led to depleted medical supplies. The existing healthcare infrastructure is still inadequate to deal with the rise of COVID-19 cases, which has also exposed the limited capacity of the healthcare infrastructure to manage medical waste. The COVID-19 pandemic has further exposed the weakness of the patient referral system and the limited capacity of the healthcare system to deliver essential health services under prolonged emergencies. The Indonesian Government needs to ramp up the country's healthcare capacity. A wide range of strategies has been proposed to address those mounting challenges. Notwithstanding, the challenges of increasing healthcare capacity highlight that such efforts could represent only one part of the pandemic response equation. Effective pandemic response ultimately requires governments' commitment to increase healthcare capacity and flatten the curve concurrently.
The Good Clinical Practices (GCP) codes of the WHO and the International Conference of Harmonization set international standards for clinical research. But critics argue that they were written without consideration for the challenges faced in low and middle income countries (LMICs). Based on our field experience in LMICs, we developed a non-exhaustive set of recommendations for the improvement of GCP. These cover 3 domains: ethical, legal and operational, and 8 specific issues: the double ethical review of 'externally sponsored' trials; the informed consent procedure in minors and in illiterate people; post-trial access to newly-developed products for the trial communities; the role of communities as key research actors; the definition of sponsor; and the guidance for contractual agreements, laboratory quality management systems, and quality assurance of investigational medicinal products. Issues not covered in our analysis include among others biobanking, standard of care, and study designs. The international GCP codes de facto guide national legislators and funding agencies, so the current shortcomings may weaken the regulatory oversight of international research. In addition, activities neglected by GCP are less likely to be implemented or funded. If GCP are meant to serve the interests of global society, a comprehensive revision is needed. The revised guidelines should be strongly rooted in ethics, sensitive to different sociocultural perspectives, and allow consideration for trial-specific and context-specific challenges. This can be only achieved if all stakeholders, including researchers, sponsors, regulators, ethical reviewers and patients' representatives from LMICs, as well as non-commercial researchers and sponsors from affluent countries, are transparently involved in the revision process. We hope that our limited analysis would foster advocacy for a broad and inclusive revision of the international GCP codes, to make them at the same time 'global', 'context centred' and 'patient centred'.
