Sustainability Capacity of HIV/AIDS Programmes in YOGYAKARTA, Indonesia

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

Sustainability Capacity of HIV/AIDS Programmes in Yogyakarta, Indonesia

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

Acceptability Notifikasi Wajib Tuberkulosis (TB) pada Dokter Praktik Mandiri dan Klinik Pratama Swasta di Kota Yogyakarta

Latar Belakang: Diperkirakan 68% kasus Tuberkulosis (TB) di Indonesia tidak dilaporkan atau tidak terdeteksi. TB merupakan penyakit yang harus dinotifikasi sejak dikeluarkannya Peraturan Menteri KesehatanNomor 67 Tahun 2016 tentang Penanggulangan Tuberkulosis. Berkaitan dengan notifikasi wajib kasus TB, dokter praktek mandiri dan klinik pratama swasta akan diwajibkan melaporkan kasus TB ke Puskesmas setempat. Pelibatan praktisi swasta memiliki dampak penting terhadap perbaikan program penemuan dan pengobatan TB dan pencegahan meluasnya kasus TB resisten obat. Kota Yogyakarta memiliki beban TB terbesar di DIY dan kepadatan penduduk yang tinggi dengan jumlah  praktisi swasta yang cukup besar. Belum terdapat penelitian yang menggali acceptability kebijakan notifikasi wajib TB pada dokter praktik mandiri dan klinik pratama swasta di Kota Yogyakarta.Tujuan: Mendeskripsikan acceptability kebijakan notifikasi wajib TB pada dokter praktik mandiri dan klinik pratama swasta di Kota Yogyakarta.Metode: Penelitian ini menggunakan rancangan kualitatif dengan metode deskriptif. Gambaran acceptability yang digunakan adalah acceptability prospektif dengan menggunakan kerangka Theorical Framework of Accceptability (TFA). Subjek penelitian adalah dokter praktik mandiri dan dokter klinik pratama swasta, beserta pimpinan klinik pratama swasta di Kota Yogyakarta, pemegang program TB Dinas Kesehatan Provinsi DIY dan Kota Yogyakarta, pemegang program TB Puskesmas, serta organisasi profesi (IDI). Metode pengumpulan data yang akan dilakukan adalah wawancara mendalam.Hasil: Gambaran acceptability (prospektif) kebijakan Notifikasi Wajib TB pada dokter praktik mandiri dan klinik pratama di Kota Yogyakarta dideskripsikan dalam sikap afektif, beban, etisitas, dan koherensi intervensi.Kesimpulan: Pendekatan awal yang tepat, pengenalan sikap afektif dan komunikasi berkelanjutan akan memperingan beban dan mengatasi masalah etisitas tentang notifikasi wajib TB. Selain itu pemahaman awal yang baik ditambah pemahaman lanjut yang komprehensif dan penguatan kapasitas menjadi modal penting bagi koherensi intervesi dalam acceptability notifikasi wajib TB pada praktisi swasta

Evaluasi Sumber Daya Manusia Dalam Program Pos Pembinaan Terpadu Penyakit Tidak Menular Di Kabupaten Tapin

Latar Belakang : WHO menyatakan bahwa 70% kematian di dunia saat ini disebabkan Penyakit Tidak Menular, hal ini merupakan masalah global. Sementara itu penelitian yang dilakukan Bapelitbangkes menunjukkan perkembangan Penyakit Tidak Menular di Indonesia kian menghawatirkan dan menyerap biaya terbesar dalam Jaminan Kesehatan Nasional. Pemerintah berupaya mengatasi masalah PTM dengan program Pos Pembinaan Terpadu (Posbindu PTM) yang sudah dikembangkan sejak tahun 2011 dan diatur dalam peraturan Menteri Kesehatan Nomor 71 Tahun 2015. Posbindu PTM merupakan program kesehatan yang melibatkan kesehatan (UKBM). Kabupaten Tapin merupakan wilayah Kalimantan Selatan dimana penanganan PTM masih rendah sehingga belum mencapai SPM kesehatan. Diketahui terdapat aspek – aspek yang dapat mempengaruhi implementasi pelaksanaan Posbindi PTM salah satunya sumber daya manusia yang memiliki peran penting dalam keberhasilan program Posbindu PTM. Dimana perilaku SDM akan mempengaruhi keberhasilan kinerja suatu organisasi.Tujuan Penelitian : untuk mengevaluasi manajemen SDM dalam pelaksanaan program Posbindu PTM di Kabupaten Tapin dalam upaya mencapai target SPM.Metode : Penelitian ini menggunakan metode penelitian kualitatif yang bersifat eksploratif, dengan purposive sampling untuk menentukan sampel. Informan dalam penelitan ini berjumlah 21 orang. Teknik pengambilan data menggunakan wawancara mendalam, observasi dan telaah dokumen.Hasil : Program Posbindu PTM di Kabupaten Tapin sudah berjalan sesuai dengan jiknis dan pedoman, namun belum memenuhi capaian SPM. SDM merupakan kunci keberhasilan sebuah program, namun di Kabupaten Tapin kebutuhan SDM di Puskesmas dan Dinas Kesehatan masih dirasa kurang. Hal ini menyebabkan kurang maksimalnya dalam menangani sebuah program dikarenakan terdapat kelebihan beban kerja yang dipegang oleh SDM di tingkat Puskesmas. Monitoring dan evaluasi SDM dalam menjalankan program dilakukan situasional, hanya monitoring dan evaluasi capaian program saja yang dilakukan berkala setiap bulan. Kebijakan pimpinan dalam masalah kekurangan SDM perlu mendapat perhatian khusus, sebab keberhasilan program merupakan cerminan keberhasilan pemerintah daerah itu sendiri.Kesimpulan : Pelaksanaan Pandu PTM di Puskesmas bergabung dengan pelayanan kuratif dikarenakan SDM yang terbatas. Pelaksanaan Posbindu PTM sudah sesuai dengan pedoman yang berlaku dan dilaksanakan seluruhnya oleh kader desa. Dalam upaya melaksanakan program dan mencapai target SPM, kepala Puskesmas menerapkan manajemen lapangan dan memanfaatkan tenaga sukarela. Pemerintah daerah perlu mencari solusi SDM kesehatan Bersama lintas sektor terkait yang di prakarsai oleh Bupati

Analysis of Policy Implementation of Minimum Service Standards in the Field of Health Indicators of Health Services for People with Diabetes Mellitus in Magelang Regency

In order to overcome diabetes, the government set some laws and regulations. One of them is Government Regulation Number 2 of 2018 concerning minimum service standards. SPM for Health is regulated in Permenkes number 4 of 2019. District / City Health SPM consists of 12 indicators. One of the indicators is health care in patients with diabetes mellitus according to the standard. Magelang regency is the third lowest Regency in 2020 with achievements of only 41.9 percent and 59.75 percent in 2021. Necessary analysis related factors inhibiting and supporting implementation. This study was conducted by the method of Qualitative content analysis. Using in-depth interview techniques, field observation and secondary data retrieval.The results of the study there are variations between the achievement of SPM Puskesmas. factors inhibiting the achievement of SPM in the field of health indicators of health services in patients with diabetes mellitus in Magelang regency is the lack of availability of budget, infrastructure and Human Resources, community characteristics and lack of understanding and knowledge both from the organizers and users. Supporting factors for the achievement of SPM in the field of health indicators of health services for people with diabetes mellitus in Magelang regency are leadership support and the chosen policy strategy

Koordinasi Pelayanan Kesehatan Pengungsi Bencana Gunung Merapi

Background: The eruption of Mount Merapi in Yogyakartahas caused dangerous impact to the people's health. It is importantto provide a good health care services during emergencyresponse. Maguwoharjo is a shelter with the largestnumber of refugees, but health care staff are not well distributed.The coordination on health care service is important toovercome the health problems during emergency response.Aim: To describe effetiveness of coordination of care providedfor the refugees.Methods: This was a qualitative study using in-depth interviewsmethod to collect data. The informants were representativesfrom Yogyakarta provincial health office, Sleman districthealth office, primary health care center of Depok, NonGovernment Office/NGO, and former refugees. To ensure thevalidity of data, triangulation was carried out.Results: The coordination of health care service to refugeesis studied from its communication and organization. The communicationwas done by regular meetings in the morning andin the afternoon involving shelter's coordinator, volunteer'scoordinator, and representative from both provincial and districthealth office. Not only by the regular meeting, but also byusing SMS gateway and skype (internet-based). There wasalso a hierarchial structure to organize all health care staffand their responsibilities during emergency response. Untilend of the evacuation, there was no outbreaks, incidence ofdisease was decreased, and infectious diseases were controlled.However, health care personels and adequate facilitieswere lacking, and standard operating procedure to providegood health services to refugees was not available.Conclusion: The coordination of health services for refugeesduring the emergency was effective but still needs toimprove information and use of SOP

Public Acceptance on Hypnotheraphy as a Complementary Alternative Health Service

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

Perspektif Stakeholder Terhadap Sustainability Program TB di Kota Semarang

ABSTRAK Latar Belakang: Missing case TB di Indonesia tahun 2017 mencapai 36%. Case Notification Rate (CNR) Kota Semarang ditahun 2017 mengalami kenaikan pesat sebesar 328 per 100.000 penduduk dengan Success Rate (SR) sebesar 80,38%, masih dibawah target nasional. Dukungan pendanaan terbesar pembiayaan program TB Kota Semarang tahun 2017 dari donor sebesar 71% sedangkan APBD hanya mencapai 29%.  Strategi penanggulangan TB di Kota Semarang mengacu pada RAD untuk kesinambungan Program TB. Ancaman sustainability Program TB terkait stabilitas pendanaan yaitu akan berakhirnya dana donor serta belum pernah dilakukanya monev RAD. Hal ini yang melatarbelakangi pentingnya mengetahui perspektif stakeholder terhadap sustainability Program TB di Kota Semarang.Tujuan: Penelitian ini bertujuan untuk mengeksplorasi perspektif stakeholder terhadap kapasitas sustainability terkait dengan stabilitas pendanaan dan strategi pembiayaan Program TB di Kota Semarang.Metode Penelitian: Penelitian ini merupakan jenis penelitian deskriptif dengan menggunakan rancangan pendekatan kualitatif. Penelitian menggunakan purposive sampling dengan subjek penelitian berjumlah 21 orang. Pengumpulan data dilakukan dengan wawancara mendalam dan analisis data dilakukan dengan content analysis.Hasil Penelitian: Temuan ini mengungkap stabilitas pendanaan untuk keberlanjutan program telah terlihat dari peningkatan alokasi APBD dan sebaran alokasi pendanaan ditingkat kecamatan. Pandangan negatif terkait belum konsistensi RKA dinkes dengan RAD TB dan adanya gap antara kebutuhan Program TB dengan ketersedian anggaran. Pandangan optimis kesinambungan pendanaan sebagai program prioritas, sedangkan pesimis disebabkan ketergantungan pada donor tinggi dan belum dilakukan monev pelaksanaan RAD TB. Strategi pengumpulan dana lebih focus pada sumber pendanaan pemerintah sedangkan strategi penganggaran dengan melakukan advokasi menjadi program prioritas dan penerbitan Perda TB.  Kesimpulan: Penelitian ini menunjukan stakeholder optimis telah terbentuk stabilitas pendanaaan meskipun tanpa dasar pelaksanaan fungsi monev. Strategi pengumpulan dana dengan mengoptimalkan APBD, memanfaatkan BOK dan integrasi ke sistem JKN. Strategi penganggaran memerlukan advokasi, penyusunan perencanaan efektif dan efisensi serta penguatan regulasi melalui Perda TB. Kata Kunci: Perspektif Stakeholder;Stabilitas Pendanaan; Sustainability; Program TB

KUALITAS LAYANAN TUBERKULOSIS MENURUT SUDUT PANDANG PASIEN DI RUMAH SAKIT PEMERINTAH DAN SWASTA DI JAKARTA UTARA

Background: Patient’s perspective on the quality Tuberculosis(TB) care has received more attentions nowadays. While DOTSstrategy has been expanded in Indonesian public and privatehospitals since 2000, the quality evaluation from the patients’perspective is lacking.Objectives: To measure the quality of TB service from thepatient perspective in public and private hospitals in NorthJakarta.Method: This was a cross-sectional study design in twohospitals. The sample of patients in public and private hospitalswere 156 and 68 respectively. Data were collected usingQuality of Care as seen through the Eyes of the Patient (QUOTETB)instrument and analyzed desciptively.Result:In both hospitals, seven aspects should be improved(i.e. waiting time, safe drinking water, cost for services,transport support, food aid,TB-HIV and HIV prevention) .Patients in the public hospital perceived discrimination ofservices. Moreover six aspects of service should be improvedin private hospital (i.e. consistency of service, opening hours,TB service availability, additional charges, TB-HIV as well asHIV testing and treatment).Conclusion: Quality improvements for TB service in hospitalare needed. Hospitals should provide better facilities andenvironment, conduct cost analysis, improve TB-HIV service,adhere to the TB service procedure and improve providerpatientrelationship.Keywords: tuberculosis, patient perspective, quali ty ofservice, QUOTE-T

How to optimize tuberculosis case finding: explorations for Indonesia with a health system model

BACKGROUND: A mathematical model was designed to explore the impact of three strategies for better tuberculosis case finding. Strategies included: (1) reducing the number of tuberculosis patients who do not seek care; (2) reducing diagnostic delay; and (3) engaging non-DOTS providers in the referral of tuberculosis suspects to DOTS services in the Indonesian health system context. The impact of these strategies on tuberculosis mortality and treatment outcome was estimated using a mathematical model of the Indonesian health system. METHODS: The model consists of multiple compartments representing logical movement of a respiratory symptomatic (tuberculosis suspect) through the health system, including patient- and health system delays. Main outputs of the model are tuberculosis death rate and treatment outcome (i.e. full or partial cure). We quantified the model parameters for the Jogjakarta province context, using a two round Delphi survey with five Indonesian tuberculosis experts. RESULTS: The model validation shows that four critical model outputs (average duration of symptom onset to treatment, detection rate, cure rate, and death rate) were reasonably close to existing available data, erring towards more optimistic outcomes than are actually reported. The model predicted that an intervention to reduce the proportion of tuberculosis patients who never seek care would have the biggest impact on tuberculosis death prevention, while an intervention resulting in more referrals of tuberculosis suspects to DOTS facilities would yield higher cure rates. This finding is similar for situations where the alternative sector is a more important health resource, such as in most other parts of Indonesia. CONCLUSION: We used mathematical modeling to explore the impact of Indonesian health system interventions on tuberculosis treatment outcome and deaths. Because detailed data were not available regarding the current Indonesian population, we relied on expert opinion to quantify the parameters. The fact that the model output showed similar results to epidemiological data suggests that the experts had an accurate understanding of this subject, thereby reassuring the quality of our predictions. The model highlighted the potential effectiveness of active case finding of tuberculosis patients with limited access to DOTS facilities in the developing country setting