The COVID-19 global pandemic : a review of the Vietnamese Government response

The profound effect of COVID-19 pandemic has not eluded Vietnam, a lower-middle-income country that borders China, the country where the outbreak originated. Currently facing a second wave, Vietnam experienced several months of insignificant community-transmission, when the epidemic was effectively under control. This paper provides an account of the policies developed by the national COVID-19 response team during the first wave, from January to July 2020. Three key components were identified, including (i) the timely and decisive responses from the national and local authorities in the early phase of the pandemic, (ii) a society-wide approach, supported by an effective risk communication strategy which managed to gain the public trust, and (iii) an effective preventive medicine and infectious disease control system, residing in early case identification, strict isolation, effective contact tracing and compulsory quarantine of close contacts. While several other important components of the health system, such as financing and human resources remain largely under-explored, the results of this study show that a mixture of measures may lead to an effective epidemic management

An Exploration study into Good Governance and Equity Aspects of JKN Program in Cardiovascular Care Services in Central Java, Indonesia

To achieve equitable access of its citizen to health care, since 2014, the Government of Indonesia has implemented the national health insurance scheme, namely JKN. However, equal access to specialistic health care is still challenging. Using a convergent parallel mixed-method approach, and the utilization of cardiovascular services as an example, this study aims to evaluate the good governance and equity aspects of the JKN program in Central Java, a province in Indonesia which records a high poverty rate above the national rate. Based on IHME, Central Java has the highest proportion of mortality associated with cardiovascular diseases among the provinces in Indonesia. This study found that most of the districts in this province are struggling to achieve the 2019 JKN roadmap target in terms of JKN participation coverage.  Unequal distribution of health facilities and human resources is recorded affecting access to and utilization of cardiovascular care services. More contribution from the district and provincial government as well participation from private sectors (the employers) to fund the JKN program is essential to ensure the availability of specialistic care services in rural areas to narrow the gaps in cardiovascular care services. 

ANALISIS IMPLEMENTASI LAYANAN JANTUNG PROGRAM JKN DI PROVINSI NTT TAHUN 2019 (Analysis of cardiovascular services utilization in the JKN program in NTT Province in 2019)

Keterbatasan fasilitas kesehatan dan tenaga kesehatan yang terjadi di NTT berdampak pada penyerapan dana JKN yang semakin kecil. Adanya ketimpangan rasio dokter juga berpengaruh terhadap mutu layanan kesehatan. Artikel ini bertujuan untuk melihat implementasi JKN di NTT dilihat dari: 1) tata kelola; 2) sisi ketersediaan dan mutu layanan jantung. Penelitian ini merupakan penelitian evaluative dengan design mix methods di mana menggabungkan design kualitatif dan kuantitatif. Hasil penelitian menunjukan bahwa kelompok PBI yang menjadi sasaran program JKN sudah dapat menggunakan layanan. Namun secara umum, jika dilihat dari angka absolut penggunaan layanan mungkin masih jauh dari kebutuhan. Data BPS menunjukkan bahwa 84% kematian terjadi di rumah. Selain itu, pada aspek tata kelola, transparansi dalam JKN belum terwujud. Implementasi JKN dari aspek tata kelola dan ekuitas khusus pada layanan jantung di Provinsi NTT belum berjalan optimal The limitations of health facilities and health workers in NTT province have an impact on the limited absorption of JKN funds in this region. The ratio of doctor specialist also affects the quality of health services. This is an analysis of the utilization of cardiovascular services in NTT. Using a mixed-method study, this study aims to evaluate the implementation of JKN in a rural area in terms of governance, availability, and quality of cardiovascular services.  This study found that the PBI groups (poor), the main target of the JKN program, has been able to access cardiovascular services. However, based on the absolute figures, underutilization of cardiovascular care services is recorded which is likely far below the actual needs.  Transparency in JKN policy remains a significant issue. In conclusion, the implementation of JKN  has not run optimally to achieve its objective to promote good governance and equity in cardiovascular in NTT province. 

Evaluasi Implementasi JKN pada Studi Kasus Layanan Operasi Caesar Di Provinsi Jawa Timur (Evaluation of the JKN program implementation: a case study of sectio caesarean in East Java Province, Indonesia)

Tingginya pembiayaan untuk prosedur layanan kesehatan tertentu termasuk operasi seksio menjadi ditengarai menjadi penyebab defisit anggaran JKN pada periode 2015 - 2020. Selain itu, berbagai studi menemukan bahwa adanya pemanfaatan layanan operasi caesar yang tidak perlu pada kelompok tertentu, sekaligus tidak tersedianya akses ke pelayanan operasi caesar pada kelompok masyarakat lainnya. Dengan menggunakan studi kasus layanan operasi seksio di Jawa Timur, penelitian ini mengkaji aspek ekuitas dari implementasi JKN. Penelitian ini menggunakan pendekatan kuantitatif dengan menganalisis data survei Pemerintah (SUSENAS dan RISKESDAS) serta data sampel BPJS 2015 – 2018. Data dianalisis secara deskriptif dan disajikan dalam bentuk proporsi dan absolut. Studi ini memberikan gambaran bahwa telah terjadi ketimpangan utilisasi layanan operasi caesar berdasarkan segmen kepesertaan di mana 86% pelayanan operasi caesar dinikmati oleh segmen kepesertaan PPU dan PBPU dibandingkan dengan segmen sasaran utama program JKN yaitu segmen PBI. Selain itu, layanan dokter spesialis kebidanan dan kandungan hanya terkonsentasi di wilayah kotamadya di Provinsi Jawa Timur. Sistem single pool dan belum optimalnya tanggung jawab pemerintah dan pemerintah daerah dalam pemerataan fasilitas kesehatan di Jawa Timur telah menjadikan masyarakat miskin Jawa Timur justru mensuplai golongan yang mungkin tidak perlu mendapatkan bantuan akses ke layanan kesehatan, termasuk layanan operasi caesar. The increasing trend in section caesarean procedure has been associated with the deficit of health insurance program in Indonesia. Previous studies highlighted that both underutilisation and overutilisation of SC procedure are present.  Using SC as a case study, this research analyzes the equity of the implementation of the Indonesia Health Insurance Program, namely JKN. This study used a quantitative approach to analyse the government survey ( SUSENAS and RISKESDAS) and the data sample of BPJS. This study provides an inequity in SC services where 86% of the SC procedure were used by the secondary target of the NHI program, PPU and PBPU group compared to the targeted group, the PBI. Besides, there is a gap in the distribution of the obstetric gynaecologists, where most of the doctors are in the city. To conclude, the existing single pool system and suboptimal role of national and local government to provide more equitable access to health facility have widen the inequality as currently the poor is supplying the wealthier groups, including access to SC procedure