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Akhir-akhir ini, keterlibatan pria dalam kesehatan reproduksi secara umum mulai banyak mendapat sorotan. Tulisan ini terutama membahas apakah keterlibatan tersebut berartimempersempit kesenjangan antara pria dan wanita secara umum. Dengan perspektif gender, keterlibatan pria dan wanita dianalisis dalam 3 tingkatan, yaitu pada tingkat kebijakan internasional, tingkat program dan tingkat individu. Hasil studi pustaka ini menunjukkan bahwa proses pembuatan keputusan yang berkaitan dengan keluarga berencana belum banyak dibahas, berbeda halnya dengan jenis keputusan dan pembuat keputusan. Untuk menyatakan bahwa keterlibatan pria berakibat positif terhadap kesetaraan gender (gender equality), diperlukan pemahaman yang lebih mendalam mengenai proses pembuatan keputusan sebagai titik kritis ke arah kesetaraan jender.

Introduction : Indonesia is one of the countries with high Maternal Mortality Rate that result partially from in management inefficiency, causing in obstruction of flow, underutilized resources, and imbalance between the number of patients with the availability of care facilities and the alternative care strategies. One of the strategies that can be applied to reduce lead time is Lean Six Sigma (LSS). Therefore, the purpose of this study was to evaluate the impact of Lean Six Sigma (LSS) methodology on patient lead time in Maternal Emergency of district government hospital.Methods: Researcher and the participants were involved in planning, gathering data, analyzing, and choosing the best solutions. The participants were trained on LSS methods, its implementation tools and procedures. Evaluations were conducted using lead time observation before and after implementation, and midwives were interviewed about their perceptions. The analysis was based on Value Stream Mapping tools. Results: Patients' lead time from being admitted in emergency unit definitive diagnosis was decreased by 26.04 minutes or 16.4% in Caesarean Section (CS) and 15.25 minutes or 21.7% in other maternal high risk. For emergency CS, the improvement was 33.06 minutes or 26% from decision until incision. The benefit of LSS implementation was primarily in accelerating service processes and improving communication and team work. Conclusion: This study showed that the implementation of LSS had great potential benefit in a maternal emergency unit. Participation of the midwives is crucial for successful implementation of LSS to reduce patients lead time.

ABSTRACT: BACKGROUND: Childhood tuberculosis (TB) has been neglected in the fight against TB. Despite implementation of Directly Observed Treatment Shortcourse (DOTS) program in public and private hospitals in Indonesia since 2000, the burden of childhood TB in hospitals was largely unknown. The goals of this study were to document the caseload and types of childhood TB in the 0-4 and 5-14 year age groups diagnosed in DOTS hospitals on Java Island, Indonesia. METHODS: Cross-sectional study of TB cases recorded in inpatient and outpatient registers of 32 hospitals. Cases were analyzed by hospital characteristics, age groups, and types of TB. The number of cases reported in the outpatient unit was compared with that recorded in the TB register. RESULTS: Of 5,877 TB cases in the inpatient unit and 15,694 in the outpatient unit, 11% (648) and 27% (4,173) respectively were children. Most of the childhood TB cases were under five years old (56% and 53% in the inpatient and outpatient clinics respectively). The proportion of smear positive TB was twice as high in the inpatient compared to the outpatient units (15.6% vs 8.1%). Extra-pulmonary TB accounted for 15% and 6% of TB cases in inpatient and outpatient clinics respectively. Among children recorded in hospitals only 1.6% were reported to the National TB Program. CONCLUSION: In response to the high caseload and gross under-reporting of childhood TB cases, the National TB Program should give higher priority for childhood TB case management in designated DOTS hospitals. In addition, an international guidance on childhood TB recording and reporting and improved diagnostics and standardized classification is required. ; The project was supported by the Sub Directorate of Tuberculosis, Ministry of Health Republic of Indonesia and funded by the Department for International Development, UK Government, through WHO Indonesia, project no. INO TUB 002 XW 06 EC0. P01. A01.

Purpose: Implementation of national health coverage contributes to the increasing number of outpatient visits in Obstetrics and Gynecology Department, Dr. Cipto Mangunkusumo Hospital. It may be caused by improper referral system or number of government insurance patients called as BPJS patients. Therefore, this study aims to analyse the pattern and quality of referral system in the implementation of national health coverage.Method: The quasi experimental study was conducted using pre and post analysis of the cases pattern and referral quality. It included accuracy of referred case diagnosis, accuracy of referring health facility, and consistency of referred case diagnosis.Results: There was an increasing number of referral visits in the early implementation of national health program; however, it declined overtime. There was reduction of general obstetrics and gynaecology cases and increase of sub-specialistic cases. It was in appropriate to the role of centre referral hospital in Indonesia. Around 98% referral diagnosis was correct to be referred, 82% cases came from correct health facility, and 98% referral diagnosis was consistent to Dr. Cipto Mangunkusumo hospital.Conclusion: The quality referral cases improves with the implementation of national health coverage program.