Suchergebnisse

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

Background: Hospital activities produce waste that can be the medium of transmission of diseases and environmental pollution. The waste should be destroyed. RSUD Dr. H. Moch. Saleh Ansari Banjarmasin have solid medical waste destruction policy use incinerator. Many things qualify for solid medical waste management is good and does not cause adverse effects to workers, patients, the public and environment. Objective: To determine how the use of an incinerator, waste management procedures, the efforts made to minimize the risk arising from operational incinerator at RSUD Dr. H. Moch. Saleh Ansari Banjarmasin. Methods: This study is a qualitative using case study design. Result: RSUD Dr. H. Moch. Saleh Ansari Banjarmasin established the policy implementation as refers to the government regulations. Although the separation of medical and non-medical wastes has been done, but building an incinerator close to several building. This can cause negative effects, especially for staff working close to incinerator building. Ash disposal using open dumping system. Separation of medical and non medical waste has been done. Transportation using special trolley. Transporting and burning activities are recorded and reported. Utilization of solid medical waste is carried out by former utilization infusion bottles. Officer of the incinerator only one person, sometimes not fuel available, the capacity of the incinerator and sometimes less damage. Disturbance of operational incinerator fumes and odors, especially in the mental ward. Conclusion: Some things should be included in the planning of the hospital incinerator repositioning away from the room, routine monitoring and inspection of the quality of incinerator ash and gas, manufacturing waste incinerator ash landfills are safe and supervision is supported by the decisive and obvious regulations. Latar Belakang: Kegiatan rumah sakit menghasilkan berbagai limbah yang dapat menjadi media penularan penyakit dan sumber pencemaran lingkungan. Limbah tersebut harus dimusnahkan, salah satu caranya adalah dengan insenerator. RSUD. Dr. H. Moch. Ansari Saleh Banjarmasin menetapkan kebijakan pemusnahan limbah medis padat melalui pembakaran dengan insenerator. Banyak hal dipersyaratakan untuk pengelolaan limbah medis padat yang baik sehingga tidak menimbulkan dampak buruk bagi petugas, pasien, masyarakat dan lingkungan. Tujuan: Mengetahui bagaimana pemanfaatan insenerator, prosedur pengelolaan limbah, dampak serta upaya yang dilakukan untuk memperkecil resiko yang ditimbulkan dari operasional insenerator di RSUD. Dr. H. Moch. Ansari Saleh Banjarmasin. Metode: Merupakan penelitian kualitatif dengan rancangan studi kasus. Hasil: RSUD Dr. H. Moch. Saleh Ansari Banjarmasin menetapkan kebijakan pelaksanaan pengelolaan limbah yang mengacu kepa- da peraturan pemerintah. Walaupun pemisahan limbah medis dan non medis telah dilakukan, tetapi bangunan insenerator berdekatan dengan beberapa ruangan. Hal ini dapat menimbul- kan dampak buruk terutama bagi petugas yang bekerja dekat dengan bangunan insenerator apalagi pembuangan abu hasil pembakaran menggunakan sistem open dumping. Pengang- kutan menggunakan troli khusus, kegiatan pengangkutan dan pembakaran dicatat dan dilaporkan. Pemanfaatan limbah medis padat yang dilakukan adalah dengan memanfaatkan bekas botol infus. Kendala dalam pengelolaan limbah adalah jumlah operator insenerator hanya satu orang, bahan bakar kadang tidak tersedia serta kondisi insenerator yang mempunyai kapa- sitas pembakaran kurang dan kadang mengalami kerusakan. Gangguan yang ditimbulkan dari operasional insenerator berupa asap dan bau terutama di ruang perawatan jiwa Kesimpulan : Beberapa hal sebaiknya dimasukkan dalam perencanaan rumah sakit yaitu penempatkan insenerator yang jauh dari ruangan, pemantauan dan pemeriksaan rutin kualitas abu dan gas buangan insenerator, pembuatan tempat pembuangan abu yang aman serta pengawasan yang di dukung dengan peraturan pengelolaan limbah medis padat yang tegas dan jelas.

Background: In this era of decentralization , access and provision of drugs for people in the local area is the responsi- bility of local governments. Because the limitations of the local budget, the central government is obliged to guarantee the availability of drugs in the area. Financing sources of drugs from central and local government have not reached the stan- dard of WHO i.e. 2 dollars per capita. To cover demand of financing drug, a Specific Allocation Fund (DAK) proposed state budget that funds given to certain areas to fund special activities that are regional affairs and in accordance with na- tional priorities. General criteria to consider certain areas (re- gional fiscal capacity), specific criteria (regional characteris- tics) and technical criteria (policy formulation from Ministry of Health). Since drug financing is allocated in DAK in 2010, there is a need to evaluate the drug financing at the local level. The purpose: to evaluate the amount of DAK for Pharma- ceutical services in 2011 and 2012. Methods: The study used secondary data from 2010 and 2011 consist of 6 (six) factors: fiscal capacity, character of the area, population number, proportion of poverty , local bud- get for drugs and prediction for the remaining stock of the drug. The analysis statistics uses chi-square and multiple regression. Qualitative interviews is conducted with manag- ers of pharmacy in 2 districts with high financial capability. Results: Result from multiple regression test of the 6 factors used in the allocation of SAF 2011 and 2012 shows only 3 factors that really affects the allocation which are the number of population, the poor and the prediction of the remaining stock of the drug . However, the highest factor is the popula- tion. Result for qualitative with 2 respondents shows that since they got DAK they reduced local budget for drugs, because the drug financing is sufficient from DAK. Conclusion: local sense of ownership towards the health budget in the area is low resulting in reliance on the central health budget. The effeciency of the central budget causes reduction of health budget both in central and local level. Latar belakang: Dalam era desentralisasi ini, akses dan penyediaan obat bagi masyarakat di daerah menjadi tanggung jawab pemerintah daerah. Namun keterbatasan anggaran daerah maka pemerintah pusat berkewajiban menjamin ketersediaan obat di daerah. Sumber pembiayaan obat di daerah melalui APBN dan APBD belum mencapai standar WHO, 2 dol- lar per kapita. Untuk menutupi kekurangan pembiayaan obat, diusulkan DAK yaitu dana APBN yang diberikan kepada daerah tertentu untuk mendanai kegiatan khusus yang merupakan urusan daerah dan sesuai dengan prioritas nasional. Daerah tertentu mempertimbangkan kriteria umum (kemampuan fiskal daerah), kriteria khusus (karakteristik daerah) dan kriteria teknis (rumusan kebijakan Kementerian Kesehatan). Sejak kebijakan obat melalui DAK pada tahun 2010, perlu dilakukan evaluasi besaran DAK Bidang Kesehatan untuk Kefarmasian tahun 2011 dan 2012. Tujuan: tujuan penelitian ini adalah melakukan evaluasi besaran DAK Bidang Kesehatan untuk Kefarmasian 2011 dan 2012. Metode: Penelitian menggunakan data sekunder 2010 dan 2011 yang terdiri 6 faktor yaitu; kemampuan fiskal, karakter wilayah, jumlah penduduk, penduduk miskin, anggaran obat dalam APBD dan prediksi sisa stok obat untuk pengalokasian DAK 2011 dan 2012. Uji analisis menggunakan chi square dan multipel regresi. Kualitatif dengan wawancara pengelola farmasi di 2 kabupaten dengan kemampuan keuangan tinggi. Hasil: Dari uji multiple regresi terhadap 6 faktor yang digunakan dalam pengalokasian DAK 2011 dan 2012 hanya 3 yang mempengaruhi alokasi yaitu jumlah penduduk, penduduk miskin dan prediksi sisa stok obat. Namun yang paling tinggi adalah jumah penduduk. Untuk kualitatif pada 2 responden, sejak mendapat DAK terjadi pengurangan anggaran obat di APBD, karena pembiayaan obat cukup dengan DAK. Kesimpulan: daerah belum memahami ownership anggaran kesehatan di daerah sehingga masih mengandalkan anggaran dari pusat, dimana ketidakstabilan anggaran pusat dengan ef isiensi menyebabkan pemotongan merata anggaran kesehatan di pusat dan daerah.

Background: The Program of Community Health Insurance Scheme (Jamkesda) in Yogyakarta Municipality is organized by the Technical Unit Regional Health Insurance Provider (UPT PJKD) with funds from the municipal budget. The rules about membership, benefits and amount of Jamkesda are appointed in the Mayor Regulation. There has been no comprehensive research about benefits and the perceived difficulty when using Jamkesda. Therefore, this research aims to determine this issue. Methods: This was an observational study using quantitative and qualitative methods. The quantitative respondents (n= 154) were selected accidentally when the patients were being treated at two hospitals in Yogyakarta and were based on the recapitulation of the claims in the previous month. The qualitative respondents (n = 10) were selected by purposive sampling for patients with chronic illnesses and with very high claims. Data collection was taken by questionnaire and guide- line for in-depth interviews to Jamkesda participants who had been treated in the two hospitals. Results: The respondents perceived that Jamkesda was beneficial despite objecting to 51.30% of the cost sharing. Therefore, in in-depth interviews five respondents expressed that they had to borrow money to pay for it. A total of 61.04% respondents used a letter of recommendation from Department of Social, Labor and Transmigration (those with no health insurance). Difficulty in handling the identity of membership was only experienced by 16.23%, while 78.57% had no prob- lem in it. Those who found difficulty were looking for a solution to the government administrator as RT/RW, parliaments, NGOs and neighbors. Around 78.57% of respondents did not under- stand about the Jamkesda service limit; they only knew infor- mation relating to their current interests. A total of 89.61% respondents knew that Jamkesda was an aid. All respon- dents in in-depth interview and around 73.38% respondents paid the cost sharing more than 10% of total claims. From the total household expenditure, almost all (99.35 %) were cata- strophic as the health spent more than 40% of their household expenditure whereas 73.38% earned below the minimum wage income. Conclusion: High cost sharing can result in large catastrophic expenses. Therefore, there is a need for reassessing the Jamkesda benefit package in order that the financial protec- tion of household can be achieved.Latar Belakang: Program Jaminan Kesehatan Daerah (Jam- kesda) Kota Yogyakarta diselenggarakan oleh Unit Pelaksana Teknis Penyelenggara Jaminan Kesehatan Daerah (UPT PJKD) dengan sumber dana berasal dari APBD Kota Yogyakarta. Aturan tentang kepesertaan, benefit dan besarannya terdapat dalam Peraturan Walikota. Belum ada penelitian yang kompre- hensif tentang manfaat dan kesulitan yang dirasakan masya- rakat dalam menggunakan Jamkesda Kota Yogyakarta maka penelitian ini bertujuan untuk mengetahui hal tersebut. Metode: Penelitian ini adalah penelitian observasional dengan metode kuantitatif dan kualitatif. Responden kuantitatif (n=154) dipilih secara accidental ketika pasien sedang berobat di dua rumah sakit di Yogyakarta dan didasarkan pada rekapitulasi klaim pada bulan sebelumnya. Responden kualitatif (n=10) dipilih dengan purposive sampling yaitu pasien dengan penyakit kro- nis dan yang mempunyai klaim sangat tinggi. Pengumpulan data menggunakan kuesioner dan pedoman wawancara men- dalam kepada peserta Jamkesda yang sedang atau telah dira- wat di dua RS tersebut. Hasil: Responden merasakan manfaat Jamkesda walaupun 51,30% merasa keberatan dengan besar cost sharing, se- hingga sebagian responden pada wawancara mendalam me- nyatakan mengutang untuk membayarnya. Sebanyak 61,04% responden menggunakan surat rekomendasi Dinas Sosial Tena- ga Kerja dan Transmigrasi untuk berobat karena tidak memiliki jaminan kesehatan. Kesulitan dalam pengurusan identitas kepe- sertaan hanya dialami oleh 16,23%, sedangkan 78,57% merasa mudah dalam pemanfaatannya. Masyarakat yang merasa kesu- litan pada wawancara mendalam, mencari solusi kepada pe- ngurus RT/RW, anggota DPRD, LSM dan tetangga. Sekitar 78,57% responden tidak memahami batasan pelayanan Jam- kesda dan hanya mengetahui informasi yang berhubungan dengan kepentingan mereka saat itu. Sebanyak 89,61% res- ponden mengetahui bahwa Jamkesda hanya bersifat bantuan. Semua responden pada wawancara mendalam serta 73,38% responden membayar cost sharing lebih dari 10% total klaim dari pengeluaran rumah tangga, hampir semua (99,35% res- ponden) mengalami pengeluaran katastrofik yakni pengeluaran biaya kesehatan lebih dari 40% pengeluaran rumah tangga setelah dikurangi pengeluaran kebutuhan pokok padahal 73,38% masyarakat berpenghasilan di bawah UMR. Kesimpulan: Cost sharing yang besar dapat berakibat pe- ngeluaran katastrofik sehingga perlu dikaji kembali benefit pack- age Jamkesda agar perlindungan terhadap keuangan rumah tangga dapat dicapai.

Implementation of district level "four children better" family planning policy in MalinauPurposeThis study aimed to analyze the implementation of family planning program policy in Malinau.MethodsA case study was conducted through in-depth interviews with 18 participants.ResultsThe policy of the government in Malinau is 'four children are better'. Differences in perceptions between stakeholders, providers, and users about family planning affecting social, economic, cultural, beliefs have an impact on contraceptive use in Malinau. The use of contraception is not prohibited for people with medical indications for using contraception, but peo­ple should access the contraception independently in the private sector.ConclusionThe policy of the Ma­linau government to stop the supply of contraceptives to government health facilities since 2012 is an effort by local governments to increase the number of inland and border populations. The unavailability of con­traceptives in government health facilities and the limitations of family planning information, communica­tion and education lead to differences in perceptions between stakeholders, service providers, and users. Therefore, the researcher recommends that the relevant regional apparatus unit does advocacy to legislative and executive boards in Malinau. The local government shall ensure the availability and quality of family planning services for the community on the basis of reproductive health rights. ; Tujuan: Penelitian ini menganalisis pelaksanaan kebijakan program keluarga berencana di Kabupaten Ma­linau.Metode: Studi kasus melalui wawancara mendalam pada 18 responden.Hasil: Kebijakan pemerintah daerah Malinau adalah empat anak lebih baik. Perbedaan persepsi antara stakeholder, pro­vider dan user mengenai KB dapat mempengaruhi sosial, ekonomi, budaya, keyakinan berdampak ter­hadap penggunaan kon­trasepsi di Malinau. Penggunaan kontrasepsi tidak dilarang bagi masyarakat yang memiliki indikasi medis untuk ber KB, namun masyarakat harus mengakses kontrasepsi secara mandiri di sektor swasta.Implikasi praktis: Pemerintah daerah wajib menjamin ketersediaan dan pelayanan KB yang berkualitas bagi masyarakat atas dasar hak kesehatan reproduksi.Keaslian: Kebijakan pemerintah daerah Malinau dalam menghentikan suplai alokon ke fasilitas kesehatan pemerintah sejak tahun 2012 merupakan upaya pemerintah daerah untuk meningkatkan jumlah penduduk di wilayah pedalaman dan perbatasan. Ketidaktersediaan alat kontrasepsi di fasilitas kesehatan pemerintah dan terbatasnya pemberian KIE KB menimbulkan persepsi yang berbeda antara stakeholder, provider, dan user. SKPD perlu mengadvokasi kepada DPRD Malinau dan Bupati.

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.

INTRODUCTION: Indonesia has one of the highest male smoking rates in the world (67%) and secondhand smoke (SHS) exposure occurs in over 70% of households. To date, little research has investigated community recognition of the harms of secondhand smoke and support for a smoke-free homes (SFH) policy. This work discusses the development and implementation of a community-based SFH intervention attempting to establish SFH as a new social norm. METHODS: Research was conducted in Yogyakarta, Java. A proof-of-concept study ascertained the feasibility of mounting a community-based SFH initiative in urban neighborhoods. Educational materials on SHS were developed and pretested. An intervention was piloted and evaluated in the homes of 296 smokers residing in 4 communities. Health educators and community health volunteers were trained to implement SFH. RESULTS: Prior to the intervention, 11% of smokers did not smoke inside their home; post-intervention 54% of smokers did not smoke inside their home. The Yogyakarta District Health Office has supported large scale implementation of smoke-free homes. To date, 135 urban communities have declared themselves as having SFH. CONCLUSIONS: This is the first community-based SFH initiative to be carried out in South-East Asia. The SFH movement redefines smoking cessation as a health issue of women and children, ties family welfare to core cultural values, and offers women a leadership role in tobacco control. The sustainability of SFH in Yogyakarta has been achieved by working closely with multiple levels of government and has contributed to shifts in tobacco control policy in Indonesia.

By 2016, Member States of the World Health Organization (WHO) had developed and implemented national action plans on noncommunicable diseases in line with the Global action plan for the prevention and control of noncommunicable diseases (2013-2020). In 2018, we assessed the implementation status of the recommended best-buy noncommunicable diseases interventions in seven Asian countries: Bhutan, Cambodia, Indonesia, Philippines, Sri Lanka, Thailand and Viet Nam. We gathered data from a range of published reports and directly from health ministries. We included interventions that addressed the use of tobacco and alcohol, inadequate physical activity and high salt intake, as well as health-systems responses, and we identified gaps and proposed solutions. In 2018, progress was uneven across countries. Implementation gaps were largely due to inadequate funding; limited institutional capacity (despite designated noncommunicable diseases units); inadequate action across different sectors within and outside the health system; and a lack of standardized monitoring and evaluation mechanisms to inform policies. To address implementation gaps, governments need to invest more in effective interventions such as the WHO-recommended best-buy interventions, improve action across different sectors, and enhance capacity in monitoring and evaluation and in research. Learning from the Framework Convention on Tobacco Control, the WHO and international partners should develop a standardized, comprehensive monitoring tool on alcohol, salt and unhealthy food consumption, physical activity and health-systems response.