Kajian Kebijakan dan Penanggulangan Masalah Gizi Stunting di Indonesia

Stunting prevalence in Indonesia has been almost stagnant at 37% from year 2007 to 2013. With the cutoff point greater than 20%, WHO classified Indonesia has a public health problem. The purpose of this review is to analyze policy related problems and gaps that could be filled as a policy option. Policy analysis was conducted through searching and analyzing legal documents, policy as well as programs following the policy formulation. Finally, round table discussion inviting experts was conducted to construct a recommendation. Stunting prevalence has barely reducing within the last ten year which was only 4% from 1992 to 2013, though programs and budget allocation has been made, even scaling up nutrition is mentioned in Presidential Regulation no.42/2013 through National Movement of First Thousand Days of Life. Stunting has a long term effect that bring about non communicable diseases causing economic burden, although stunting can be corrected. Serious integrated effort should be taken into account at all levels as a policy recommendation. Mothers or future brides should be given information of healthy pregnancy and nutrition. Exclusive breast feeding should be done mandatory to healthy delivery mothers. In addition, proper complementary feeding should be well understood by mothers and health workers

Pengetahuan, Sikap dan Perilaku Ibu Bayi terhadap Pemberian Asi Eksklusif

Latar Belakang: Survei Sosial Ekonomi Nasional (Susenas) menunjukkan grafi k ibu menyusui yang mengalamipenurunan selama tiga tahun terakhir. Tahun 2006, 64,1% ibu memberikan ASI eksklusif kepada bayinya, kemudian tahun2007 turun menjadi 62,2%, dan tahun 2008 menjadi 56,2%. Faktor yang menyebabkan pemberian ASI eksklusif tidakoptimal, antara lain karena faktor si ibu sendiri, tenaga kesehatan, dan produsen susu formula. Metode: Penelitian inimerupakan penelitian kualitatif dengan disain studi kasus, di mana peneliti menggali secara natural tentang pengetahuan,sikap, dan perilaku ibu bayi dalam pemberian ASI Eksklusif. Faktor pemicu (predisposing), faktor pemungkin (enabling)dan faktor penguat (reinforcing) untuk menggambarkan dan memberikan informasi rinci tentang menyusui eksklusif padabayi. Hasil: Hasil penelitian antara lain faktor pemicu dalam pemberian ASI Eksklusif kepada bayi adalah pengetahuan,sikap, dan perilaku ibu, di mana sebagian besar ibu masih belum paham tentang manfaat pemberian ASI Eksklusif. Faktorpekerjaan, pendidikan, dan Balita juga sebagai pemicu untuk terjadinya pemberian ASI Eksklusif kepada bayinya. Faktorpemungkin dalam pemberian ASI Eksklusif adalah Inisiasi Menyusu Dini, tempat melahirkan, dan ketersediaan ruanganuntuk menyusui. Status kesehatan ibu, dukungan keluarga dan petugas yang menolong persalinan sebagai faktor penguatuntuk pemberian ASI Eksklusif kepada bayi. Saran penelitian ini antara lain meningkatkan pengetahuan, sikap, dan perilakuibu dalam pemberian ASI Eksklusif kepada bayi, Kementerian Kesehatan harus mempromosikan tentang ASI Eksklusiflebih intensif, dan membuat pesan dan informasi yang sederhana namun mudah dicerna dan dipahami oleh masyarakat awam; memonitor fasilitas kesehatan dalam mendukung program ASI Eksklusif dan menegakkan disiplin kepada petugaskesehatan yang terlibat mempromosikan susu formula atau makanan padat lainnya dengan sangsi yang tegas. Saran:Kementerian Kesehatan harus menindak tegas Perusahaan yang memproduksi susu formula dan makanan tambahanlainnya yang melanggar peraturan yang sudah ditetapkan; pemerintah menegakkan peraturan tentang penyediaan ruangmenyusui di tempat kerja dan memfasilitasi ketersediaan ruangan menyusui di tempat umum

Perilaku Ibu Hamil dalam Memeriksakan Kehamilan Trimester Pertama di Puskesmas Pasanggrahan, Jakarta Selatan

Background: First antenatal visit during at early pregnancy is very important. According to Riskesdas 2010, access of pregnant women for the first antenatal visit was 72.3%. Indeed a proper visit of four times during pregnancy was only achieving 61.4%. This study was conducted to understand the reasons behind such situation. Methods: This study has a qualitative design implementing in-depth interviews to ward the informans. Interview with the key informant was done in the purpose of information triangulation. This study was conducted at Pasanggrahan Health Center in South Jakarta. Informans who are 10 pregnant women were selected purposively Results: The results showed, as a predisposing factors, mothers\u27 age, education, occupation and number of pregnancy have no affluence to mother\u27s behavior to seek antenatal care at a proper time. Mothers\u27 knowledge of health and pregnancy bring about better behavior towards self care, good food and seeking antenatal care earlier, though they did it in the other health care facilities instead. Inconversely, lacking knowledge of breasfeeding attributed mothers having negative perception, hence did not breastfed exclusively Conclusion: The enabling factors enforcing mothers late to visit the health center for her pregnancy were the availability of other health care facilities such as private midwive and c1inics closer to their residence. In addition, mothers came to health center when their pregnancy almost due as for delivery preparation and reason for cheaper in cost. Finally, it is recommended that there should be sunction implemented to the health care providers who did not gave mother the \u27KIA\u27 maternal booklet due to the reasons that the first visit done by the mother can be proved by owing the book. Other recommendation is that education about the risks of pregnancy as a consequence of married should be begun early before time to pregnancy or at younger age. Scientific recommendation is, similar study need to be conducted for the rural setting presumably worse condition may more possible

Iodine Salt Consumption in Indonesian Households: Baseline Health Survey 2007

Background: Iodine Deficiency Disorder (100) reduction program has been implemented since 1976. According to the National Economic Survey 2002, the average consumption of iodized salt was 6. 26 grams. The results of Iodine Salt Survey (SGY) 2003 showed that the consumption of iodine salt at the household level was 73.2%, meanwhile, the baseline health survey (Riskesdas) 2007 showed there was reduction of iodine salt consumption towards 60.2%. Methods: Type of study was secondary data analysis with cross-sectional design utilizing the Riskesdas 2007's data. Sample was selected purposively according to the previous SGY's survey based on the endemically criteria namely highly endemic, mediocre and non endemic. Results: The results of the analysis were there was discrepancy of iodine salt consumption among urban and rural areas as well as mother's education level. The iodine salt consumption was higher in the urban area (65.5%) compare to the rural area (52.9%). The higher the education of mothers the better the iodine salt consumed. The USAge of iodine salt in the households based on salt quick test was 60.2%, meanwhile, according to the salt titration it was only 23.4%. The results of Excretion Iodine Urine showed that the iodine intake among the school children (age of 6-12 years old) was 12.8% and was still below the cut-off point prevalence, which is greater than 50%. The conclusion of this analysisis that there was evidence of iodine salt reduction consumed at the household level. Conversely, there was inclination of the percentage of iodine urine level among the school children in Indonesia in the year 2007. It is recommended that policy analysis need to be conducted due to the achievement of the Universal Salt iodization target, especially in the endemic areas to asses the existence of the IDO prevalence

Penerapan European Foundation For Quality Management (Efqm) di Dinas Kesehatan Kabupaten/kota untuk Meningkatkan Kinerja Dinas

Since 2001, Indonesia has entering its new era of democratization called decentralization in all sectors, including health. From now and then, the District Health Office has been forced to be able to implement its health policy and function such as 1) stewardship, 2) health resources management, 3) health financing, and 4) health services provision. Basic function of health system is needed to achieve the health purpose that shown the performance of the health offices and its structure. The performance is related to the quality of management. European Foundation for Quality Management (EFQM) is a tool to quantify and assess the quality of management in an institution, so that it will be understood what is the weakness and the strength of the institution. EFQM was developed in Europe that has been proved that it can formulate an excellent management and performance by then. This study implements the EFQM model towards performance improvement model development in district/municipality health office. The objective of the study is implement EFQM model in improving health system performance in district/municipality. Type of study is a health system research with a cross sectional design in three selected district health office based on Human Development Index criteria, that is high, medium and low. Analysis has been done implementing the EFQM method called RADAR. The study location were Tabanan district (Bali), Bandar Lampung Municipality (Lampung), and Belu District (East Nusa Tenggara). The qualitative analysis was quantified using the RADAR for the nine pillars in the method. The nine criteria were grouping into enables and results criteria, such as 1) enables criteria of leadership, policy and strategy, employment, partnership and resources as well as process; 2) results criteria were: clients satisfaction, staff satisfaction, social results of the community as well as the main key. Each criteria has some sub-criteria. Each sub-criteria then be valued using the RADAR, and quantified ranged from 0-10 as no prove and anecdote only; 15-35 as there are some prove; 40-60 as proved; 65-85 as strongly proved, and 90-100 as completely proved. The final evaluation of each pillars done by counting the average values of the sub-criteria multiplied by each weight of the pillars that already formatted. The formatted weight was 1.0 for the leadership; 0.8 for the policy and strategy, 0. 9 for the employment; 0. 9 for the resources and partnership; 1.4 for process; 2. 0 for clients satisfaction; 0. 9 for staffs satisfaction; 0.6 for community social satisfaction and the 1.5 for the key indicator, with a total weight of 10. Results showed that the final results of the health office performance were Tabanan has the highest of 250, Bandar Lampung Municipality 239, and Belu 217. This scoring seems directly reflects the management achievement level of District Health office that correlate to the HOI Index. The EFQM method can be used as a model to improve staff performance in the district health office by maintaining the weaknesses found in the field as constraints

Analisis Pembiayaan Program Kesehatan Ibu dan Bayi di Kabupaten/kota

The Ministry of Health had set target it and obligatory for minimum health standard (KW-SPM) that has to be implemented in each district/municipality. Maternal and neonatal health (MNH) services is one of the services in district health system that has to be delivered by puskesmas to improve the maternal and neonatal health towards reducing the maternal and neonatal mortality. It was a cross sectional study on health policy and financing. The study was conducted in three districts/municipality, namely Badung District, Bali; Tanah Datar District, West Sumatera and Kupang Municipality in East NusaTenggara. Time of the study was February to November 2006. Results showed that the highest allocation of budgetting according to the district health competency was for basic health services, the preventions of communicable diseases, and nutrition program. Budget allocation for investation in maternal and neonatal health was relatively low, only 2-7%. except for Badung District that was 47.2%. The allocated budget for the basic health services has a similar pattern among theareas under study, except for Tanah Datar District, the proportion of operational costs for immunization seem lower than two other districts. There gap between budget allocation and budget necessity. The budget was hardly used to serve the community. Indirect budget, most of provided for staff trainings, building capacity, as well as facility improvements. Per capita allocation for MNH varied among the districts/municapality. Badung District got the lowest (Rp. 20,000) per capita allocation, albeit it had the highest fiscal capacity; meanwhile Tanah Datar District, the middle fiscal capacity had the highest (Rp. 47,000). Kupang Municipality. the lowest fiscal capacity had the middle per capita allocation, which was Rp. 40,000. According to the health services function, the proportion allocating for training was the highest, more than 70% (Kupang and Tanah Datar Districts), and basic health services achieving 50% of the budget was in Badung. In conclusion, budget allocation was varied among the districts, the proportion was burden to public administration and only small part for the operational. Of the total health budget, the highest proportion or 30-35% was financing to the MNH programs. Unfortunately, the allocalton was not so specified, distributed to other programs and tended for routine activites

Analisis Situasi dan Upaya Perbaikan Gizi Balita di Tingkat Kabupaten: Studi Kasus Kabupaten Garut Tahun 2008

Background: Malnutrition is the major public health problem among the underfive years old children as a predisposing cause of child mortality especially at the district of Garut, West Java. Malnutrition and diseases are inter-rela ting factors affecting children nutritional status and mortality This study was done to analyze public health problems focusing on mothers and children\u27s health related determinants in the district of Garut, West Java. Methods: The design of the study is explorative design through interview and secondary data collection, problems solving and analysis of policy implementation. Results: The results of the study were, the prevalence of severe malnutrition is high, namely 5.7 compared to West Java (3.7) and lndonesia (5.4) per 100 underfive children. Based on the three nutrition indicators called weight/age, height/age and weight/height, Garut facing the acute (Weight/age is above 10% of UNHCR standard) as well as chronic (TB/U is above the national prevalence) malnutrition problems. Factors related to the cause of children mortality and severe malnutrition were among others: 1) environment and sanitation (including low birth weight and infectious diseases); 2) behavior (hygiene and immunization), 3) health services provision (eady detection, ca se management, monitoring of child\u27s nutrition and budget allocation for nutrition programs). Conclusion: Problem solving for nutrition program has to be innovatively developed at the district level referring to the national goals and strategy Nutrition intervention to the children only is not enough, but pregnant mothers who are chronically malnourished has to be intervened to prevent low birth weight babies. Indirect intervention at the district level is recommended through strengthening the health and nutrition system involving community, local government as well as inter sectors; as the root of malnutrition problem is broaden over poverty and cultural