Meningkatnya Risiko Disabilitas Pada Penduduk Dengan Penyakit Tidak Menular: Analisa Lanjut Riskesdas 2013

Intersectoral approach is essential to develop program for people with disability in Indonesia. Coordination across ministries are necessary to manage this issue. The planning, provision and monitoring of medical and support services as well as program for population groups with disability may require assessment. Purpose of this study is to assess disability in Indonesia. Methods: performing analysis of disability data from 2013 Indonesian Household Health Survey known as Riskesdas. Level of disability obtained from two main population groups: those with and without non communicable disease (NCD). They then divided by age. The World Health Organization Disability Assessment Schedule II (WHODASII) was used to measure disability. Results: contribution of NCD on disability is obvious among older age indicated by higher proportion of disability with NCD. While risk of disability among younger age is unclear, since disability with NCDproportion is lower than disability without NCD. Probably risk of disability among younger age is other than NCD. None of the groups had members with extreme disability on their global WHO-DASII scores. The analysis identifi es target groups for each stakeholder to develop program for people with disability to reach their maximum potential. Abstrak Penanganan penduduk dengan disabilitas membutuhkan keterlibatan lintas kementerian. Diperlukan informasi besar masalah penduduk dengan disabilitas di Indonesia. Analisa bertujuan mengetahui besaran masalah. Metode: analisa deskriptif univariat dan bivariat data disabilitas Riskesdas 2013 untuk memperoleh Informasi disabilitas seluruh penduduk. Selanjutnya dilakukan analisa besaran disabilitas pada penduduk dengan dan tanpa Penyakit Tidak Menular (PTM). Kelompok ini kemudian digolongkan menurut umur. Instrumen The World Health Organization Disability Assessment Schedule II (WHO-DASII) digunakan untuk mengukur disabilitas. Hasil: 18% penduduk Indonesia mengalami disabilitas. Informasi lebih rinci 8,2% mengalami kesulitan ringan, 6,8% kesulitan sedang dan 3% kesulitan berat. Kontribusi PTM terhadap disabilitas terlihat jelas pada kelompok usia 45 tahun atau lebih ditunjukkan dengan lebih tingginya proporsi disabilitas dengan PTM. Sedangkan risiko disabilitas pada kelompok usia sebelum 45 tahun bukan PTM, karena proporsidisabilitas dengan PTM lebih rendah

Risks of Plasmodium Falciparumparasitemia Among 10 Years or Below Children in Indonesia: a 2010 National Study

Background:In 2007, in Indonesia 80% of a total 495 districts/municipalities was malaria endemic. Most malaria parasitemia is P. falciparum, and it is related to several risk factors. This analysis aimed to identify dominant risk factors related to P. falciparummalaria parasitemia among children 10 years or below.Methods: This analysis used a part of Basic Health Research year 2010 data. A total of 72,105 people were examined parasitemia using Rapid Diagnostic Test Nusa Tenggara Barat (RDT Brand NTB). They were 16,666 children aged 10 years old and below. We used logistic regression analysis to identify determinant risk of positive P. falciparum.Results:The prevalence of positive P. falciparumwas 1.1%. Compared with urban children, rural children had 3.3-fold higher risk to be positive P. falciparum parasitemia [adjusted odds ratio (ORa)=3.34; 95% confidence interval (CI) = 2.23–5.02].Conclusion:Rural than urban under 10 years children had higher risk to be positive P. falciparum. (Health Science Indones 2012;2:xx-xx

Studi Pemanfaatan dan Keamanan Kombinasi Metformin dengan Ekstrak Campuran Andrographis Paniculatadan Syzygium Polyanthum untuk Pengobatan Diabetes Mellitus (Preliminary Study)

Background: Use of Andrographis paniculata and Syzigium polyanthum have been used widely, on the contrary the benefit and safety have not been scientifically proven. This study aimed to overview and analyze benefit and safety the extract of Andrographis paniculata and Syzigium polyanthum mixture to decrease blood glucose concentration. Methods: It was an experiment study among intervension and control groups by a block random sampling with pre-post test design. Data were collected by questionnaires and also data among intervension group, therapy of conventional antidiabetic of metformin in combination to the herbal extract of Andrographis paniculata and Syzigium polyanthum mixture (1: 1) with among control group, of metformin. A total samples of 30 Diabetes Mellitus respondents were selected among males or females, aged 40-60 years with blood glucose concentration of 140-220 mg/dl, has no history of hypertension or has mild hypertension. The samples were devided in 2 groups composed of 15 persons among intervsion and 15 persons among control groups, respectively The intervension group was given metformin 500 mg once a day in the morning taken 15 minutes after breakfast in combination to the extract of Andrographis paniculata and Syzigium polyanthum mixture (1: 1) of 700 mg. The control group was given metformin 500 mg on ce a day in the morning taken 15 minutes after breakfast in combination to placebo. The duration of therapy was 4 weeks. Data were taken by anamnesa, physical diagnose, laboratory examination offasting blood glucose and Oral Glucose Tolerance Test (OGTT) in every week. Meanwhile for examination side effects on liver and run function test in every 2 (two) week. The data were analyzed descriptively and t test. Results: Results showed that the intervension group given metformin in combination to the extract of Andrographis paniculata and Syzigium polyanthum mixture (1:1) of 700 mg could significantly decrease fasting blood glucose but could not significantly decrease OGTT in comprasion to control group given metformin with placebo. There were no side effects on liver and kidney function test in the therapy of herbal extract of Andrographis paniculata and Syzigium polyanthum mixture in duration of 4 we eks. It concluded that the herbal extract of Andrographis paniculata and Syzigium polyanthum mixture is safe

Analisis Implementasi Kebijakan Eliminasi Malaria di Provinsi Bali

Background: ln ASEAN, lndonesia is one ofthree countries with the highest malaria morbidy ln lndonesia 396 (80%) of the total 495 districts/municipalities year 2007 were malaria endemie areas. In malaria control program, the Ministry of Health decreed Number 293 year 2009 on Malaria Eliminanition. It aimed to assess the implementation Ministry of Health decreed Number 293 year 2009 on Malaria Eliminanition in Bali Province, with specific objectives to assess understanding, implementation, innovation, budgetting and roles of government to support malaria elimination in Province Bali. Methods: It was observational study with cross sectional design, carried out in Bali Province and Karangasem District. Data were collected in September year 2011 by focus group discussion either in provincial and district level at Health Offices, District Planning Beureau, interrelated sectors (Department of Fisheries and Marine Resources, Department of Tourism, Department of Public Development, Department of Forestry, Department of Agriculture, Port Health Office, Department of Education, Department of Information and Communication, hospital), Health Centers (for district level) as well as document study Data were analyzed by content analysis. Data were validating by triangulation among provincial and district health office staffs, health policy expert and researchers. Results: The understanding of Ministry of Health decreed Number 293 year 2009 on Malaria Eliminanition in Bali at Provincial Health Office was good, but at interrelated sectors had not knew on the policy The policy implementation that the Governor issued Governor Regulation Number 10 year 2010 on activities in implementing malaria elimination in Bali Province and Karangasem District Regulation Number 2 year 2010 on malaria elimination in Karangasem District. The implementation of malaria elimination policy in Bali Provincial Health Office and Karangasem District Health Office were in accordance to Ministry of Health strategy Interrelated sectors activities were directly or indirectly in synergy with malaria elimination policy Innovation strategy activities in supporting the malaria elimination had be en developed in the district. The budgetting for malaria elimination policy in Bali Province and Karangasem District still depend local budget. The roles of local governments to support policies are by issueing policies/regulations, financing and socialization activities. Treatment should be based on new treatment strategies using artemisinin or ACT to prevent primary drug resistance of malaria. The budgetting for malaria program in Bali Province should be increased, either the total or the source. Then, it needs to develop Malaria Working Group both at the provincial and district levels so interrelated sector activities could be coordinated and integrated with the Health Offices activities to achieve malaria elimination by year 2012

Persepsi Sehat-sakit dan Pola Pencarian Pengobatan Masyarakat Daerah Pelabuhan (Kajian Kualitatif di Daerah Pelabuhan Tanjung Perak)

The problems of urban health should be concerned because of the rapid development of cities, especially in highly populated areas as in ports and industry centers. The study aimed to identify people seeking behaviors in the port areas, the perception on health-sick in the port communities, and the responses to health center's services. This was a qualitative study. Respondents were selected by local Rukun Tetangga (Households Leaders) or Rukun Warga (administrative unit at the next-to-lowest level in city) based on the income in each areas which categorized as not enough. Selected respondents were divided in 2 (two) groups, men workers and fertile aged women. The location of the study were at Rukun Warga 9 and 6 of Kelurahan Perak Utara (North Perak Kelurahan) and at Rukun Warga 2 of Kelurahan Perak Utara (North Perak Kelurahan) in Pabean Cantikan Sub-district, Tanjung Perak port areas. Data were collected by focus group discussion (FGD) in 3 (three) sub-groups of men workers and fertile aged women, respectively. There were 8-10 respondents in each sub-groups. The data were analyzed by content analysis methods. Results showed the perception on health-sick in men workers was wider in comparison to fertile aged women because if they were having influenza but still could work then they considered not sick, meanwhile for the fertile aged women if they were feeling differences in their bodies then they consider as sick. But both groups had the same perception on health­ sick for their children, there were "healthy children if they were not fusser, not weak, moving, actively play. The groups were also had the same perception on dental sick that was a severe sick. Furthermore, the majority mentioned that if getting sick, they did self medication firstly then if not getting better they visit health workers. But for their children if getting sick, they were directly sent to health workers. The responses for health center services varied in both groups. The selection to health center was merely because of cheap although mostly said that they were not free enough to express their concerns, medication was not good and examiners were not doctors. It concludes there was a wider perception on health among man worker groups and the pattern of health seeking behavior was by self medication at first, then if not better to health workers. The community still used traditional treatments. The health center services were not a good choice because the people were not sure for the quality and the kind of medication, beside was the open time was limited

RISET EVALUASI PELAYANAN KESEHATAN JAMINAN KESEHATAN DAERAH DI KABUPATEN KUTAI KARTANEGARA, PROVINSI KALIMANTAN TIMUR

The implementation of District Health Insurance (the Jamkesda) in Kutai Kartanegara District since the Decree of Kutai Kartanegara District Number 180.188/HK-782/2008 on the initial target of the Jamkesda program in Kutai Kartanegara District 2008, followed by Kutai Kartanegara District Decree Number 1/SK-Bup/HK/2011 on target of the Jamkesda Program Target member in Kutai Kartanegara District. The study aimed to evaluate implementation of the Jamkesda in Kutai Kartanegara District that operating from 2009 to 2013. It was an observational study with a cross sectional design. The total samples were 6.635 people in Kutai Kartanegara District. The study was conducted from August to November 2013. Data collection were by interview. Bivariate data were analyzed by chi square test. Characteristics of members the Jamkesda program in Kutai Kartanegara District were mostly of 50.5% ≥ 41 years old; 26.6% high school educated, 29.1% of farmers; 48.5% with low income of Rp.1.000.0000, - or less; 53.2% had 3–4 family members. For the Jamkesda health services, the majority 90.6% knew about the Jamkesda and 69.4% used the services. People aged ≥ 41 years old, mostly farmers and fi shermen, lower family income, higher family members, and living near to health facilities were associated with utilization of the health services. Education was not associated with utilization of the Jamkesda health services. But the higher education, the higher knowledge on utilization of the Jamkesda (p = 0.000), likely they understood information on the Jamkesda health services. Conversely according to level of satisfaction, the lower education the more satisfi ed to the Jamkesda health services (p=0,029). It needs to socialize the health insurance in providing qualifi ed health services for all patients and its sustainability within the framework of national health scheme to achieve universal health coverage.   ABSTRAK   Pelaksanaan Jaminan Kesehatan Daerah (Jamkesda) di Kabupaten Kutai Kartanegara sejak Keputusan Bupati Kutai Kartanegara Nomor 180.188/HK-782/2008 tentang sasaran awal program Jamkesda kabupaten Kutai Kartanegara tahun 2008, diikuti Keputusan Bupati Kutai Kartanegara Nomor 1/SK-Bup/HK/2011 tentang Penetapan Sasaran Kepesertaan Program Jamkesda Kabupaten Kutai Kartanegara. Penelitian ini bertujuan melakukan evaluasi terhadap pelaksanaan Jamkesda di Kabupaten Kutai Kartanegara yang berjalan dari tahun 2009 sampai 2013. Jenis penelitian adalah observasional dengan desain potong lintang. Total sampel sebanyak 6.635 orang di wilayah Kabupaten Kutai Kartanegara. Waktu penelitian pada bulan Agustus sampai dengan November 2013. Pengumpulan data dengan wawancara. Analisis data bivariat dengan chi square test. Karakteristik masyarakat Kabupaten Kutai Kartanegara peserta program Jamkesda yang terbanyak 50,5% berumur ≥ 41 tahun; 26,6% berpendidikan tamat SMA, 29,1% petani, 48,5% dengan penghasilan rendah yaitu Rp.1.000.0000,- atau kurang, 53,2% memiliki 3-4 anggota keluarga. Pelayanan kesehatan Jamkesda menunjukkan 90,6% masyarakat mengetahui tentang Jamkesda dan 69,4% yang memanfaatkan pelayanannya. Masyarakat dengan umur semakin tua, ≥ 41 tahun, jenis pekerjaan terutama petani dan nelayan, berpenghasilan rendah, jumlah anggota keluarga banyak, dan bertempat tinggal dekat dengan fasilitas kesehatan berhubungan dengan pemanfaatan pelayanan kesehatan Jamkesda. Pendidikan tidak berhubungan dengan pemanfaatan pelayanan kesehatan Jamkesda. Tetapi semakin tinggi pendidikan masyarakat maka semakin tinggi pengetahuannya terhadap pemanfaatan pelayanan kesehatan Jamkesda (p = 0,000). Tampaknya mereka paham terhadap informasi pelayanan Jamkesda. Sebaliknya menurut tingkat kepuasannya, semakin rendah pendidikannya maka semakin puas terhadap pelayanan kesehatan Jamkesda (p = 0,029). Perlu sosialisasi tentang jaminan kesehatan untuk memberikan pelayanan jaminan kesehatan yang berkualitas kepada semua pasien dan keberlangsungannya dalam kerangka jaminan kesehatan nasional guna mencapai universal health coverage

Analisis Biaya Obat Unit Rawat Jalan pada Rumah Sakit Badan Layanan Umum (BLU)/ Badan Layanan Umum Daerah (BLUD) di Indonesia

Drugs expenditure is the highest proportion in health services budget. financing for health services in National Universal Health Coverage era is carried out by BPJS payed to referral health facilities namely hospitals. The medicine cost at public service agency/District or Province public service agency is unknown certaintly. This descriptive study was advanced analyzes of the secondary data of 84 hospitals from health financing research in the year of 2016. The result showed that there were problems of drug availability in class B 94,6%, C 78,9% and A 77,8%. The highest proportion of generic drugs cost to total drug cost is class C hospital, followed by B class and A class hospitals i.e 40,57%, 37,83% dan 23,74% respectively. The cost of non generic drug compared to generic drugs at A, B and C class is 2,22 times, 1,15 times and 0,86 times respectively. The highest cost of generic drug is in outpatient specialist services in all class of hospitals. The cost of the drugs was increasing higher as well as the hospital class. Conclusion: The non generic drugs cost dominated in A and B class hospital while C class was generic drug cost. Generic drug use policy should be socialyzed by government and to be considered by management in order to be able to carried out cost efficiency

ANALISIS SUBSISTEM DALAM PELAYANAN KESEHATAN IBU DI PUSKESMAS PERAWATAN KABUPATEN MALANG, PROVINSI JAWA TIMUR

In Indonesia the Maternal Mortality Rate (MMR) increased from 228 per 100,000 to 359 per 100,000 live births. East Java province is one of 9 provinces faces high maternal deaths. Programs to support decreasing the MMR has been done and currently, the Ministry of Health policy on maternal health services is delivery assisted by health personnel at health facilities. It is an observational study with a cross sectional design. The study was conducted inMalang District, East Java Province which has the highest MMR in East Java Province year 2012. Analysis are for 7 subsystem of the maternal health services. Respondents are Head of in patient Primary Health Centers / Programmers of maternal health at In patient Primary Health Centers with their which location are relatively near, middle and far from the Kanjuruhan Distrcit Hospital in Kepanjen. Data were analyzed descriptively. For the implementation of Malang District regulation on the Gerakan Sayang Ibu for maternal health so sub-system analysis shows deficiencies such as midwifes in Inpatient PHC mostly had normal delivery training guide, and only 3 midviwes had obstetric complication training; there is a vacuum of RL fluid in one of the Inpatient PHC under study, ambulance driver is only one so sometimes there is vacancy for standby 24 hours, relatively many traditional birth attandance in Ketawang PHC who likely to help delivery, District Health Office fund for  maternal health program is relatively small. To strengthen system for maternal health program in line with the BPJS Program, midwives at inpatient PHC should have obstetric complication training, improved management the availability of fluid, ambulance driver standby 24 hour, all villages have midwives living, and increase distict health office funds for maternal health program as the coverage areas. ABSTRAKAngka Kematian Ibu (AKI) meningkat dari 228 per 100.000 KH menjadi 359 per 100.000 KH. Provinsi Jawa Timur merupakan satu dari 9 provinsi yang bermasalah dalam kematian ibu. Program-program mendukung penurunan AKI sudah dilakukan dan saat ini, kebijakan Kementerian Kesehatan dalam pelayanan kesehatan ibu adalah persalinan oleh tenaga kesehatan di fasilitas kesehatan. Jenis penelitian adalah observasional dengan desain potong lintang. Penelitian dilakukan di Kabupaten Malang, Provinsi Jawa Timur dengan AKI tertinggi di Provinsi Jawa Timur pada tahun 2012. Analisis dilakukan terhadap 7 subsistem dari pelayanan  kesehatan ibu. Responden adalah pelaksana kebijakan di Puskesmas yaitu Kepala Puskesmas/Pemegang Program KIA di Kabupaten Malang pada Puskesmas Perawatan yang lokasinya relatif dekat, pertengahan dan jauh dengan RSUD Kanjuruhan di Kepanjen. Analisis data secara deskriptif. Dalam pelaksanaan regulasi Pemerintah Kabupaten Malang yaitu gerakan sayang ibu dalam pelayanan kesehatan ibu pada analisis sub- sistem kesehatan terdapat kekurangan-kekuranganseperti tenaga bidan di mana pelatihan kompetensi di Puskesmas Perawatan terutama APN, dan hanya 3 orang yang mendapat pelatihan komplikasi kebidanan; terjadi kekosongan cairan RL di salah satu Puskesmas Perawatan studi, sopir ambulans hanya seorang sehingga kadang terjadi kekosongan untuk standby 24 jam, relatif banyak dukun di Puskesmas Ketawang yang kemungkinan menolong persalinan, dana Dinas Kesehatan Kabupaten untuk pembinaan pelayanan kesehatan ibu relatif kecil. Untuk menguatkan program kesehatan ibu sejalan dengan Program BPJS maka bidan di Puskesmas Perawatan perlu mendapat pelatihan komplikasi kebidanan, perbaikan manajemen ketersediaan cairan, adanya sopir yang standby 24 jam, semua desa tinggal bidan yang membina, dan penambahan dana Dinas kesehatan untuk program kesehatan ibu sesuai luas wilayahnya

Analisis Hubungan Status Otonomi Puskesmas dengan Motivasi Karyawan di Kabupaten Sleman, Pasuruan dan Kota Blitar

Backgrounds: Since decentralization year 2001, various innovations have been made by the districts or municipalities, especially on delegating broader decision space for management of community health centers to meet demands for qualified medical care. Objective: This study aimed to determine the relationship on autonomy level at health centers (decision space) of employee motivation. The motivation of employees was related to the concept of Motivating Potential Score, that composed of Skill Variety, Task Identity, Task Significance, Autonomy, and Job Feedback. Methods: tt was an observational study with a cross sectional design, carried out at Puskesmas Depok /I (150 type), Sleman District, Yogyakarta Province and at Puskesmas Bangil (self-management type), Pasuruan District, and Puskesmas Karangsari (free type), Blitar Municipality both in East Java Province. The study was done from May to December 2009. Respondents were employees at public health centers taken by random sampling to proportional size. Analysis were to assess the status of autonomy relationship with employee motivation at public health centers, tested by anova and combined with qualitative analysis from in-depth interviews to heads of the centers. Results: Results showed that most employeer motivation at each type of health centers was cathegorized as fairly autonomy status for public health center with 150 (62.5%), self-management (72%) and free type (75.7%). The Anova test were F = 1.450 at p-value = 0.240 (p > 0.05). Hence, it could be said there was no difference on employee motivation at health center type, 150, self-managed and free type. Recommendations: This study recommends that heads of community health centers should be able to encourage development of intrinsic motivation to create leadership to give inspiration for employees and supportive work environment, empowering employees, delegating meaningful work and enhancing employee competenc