Evaluasi Sistem Surveilans Ibu Hamil, Bayi dan Balita di Puskesmas Unit I, Puskesmas Moyo Hulu dan Dinas Kesehatan Kabupaten Sumbawa (Evaluation Of Pregnant Women, Infant, Underfive Children Surveillance System At PHC Unit I, PHC Moyo Hulu And Health Di

Background: District Sumbawa is one of the underdeveloped district (DBK), the ratings are based on indicators that include the concerns of pregnant women, infants and toddlers, from the existing data gaps in other words surveillance system implemented may not produce outputs that have high leverage the prevention of health problems. The purpose of this study is to identify issues and priorities the strengthening of the surveillance system of pregnant women, infants and toddlers in Sumbawa, Provinsi NTB. Methods:research conducted at PHC Unit I, PHC Moyo Hulu and Sumbawa District Health Office. Data were collected by observing to see the weaknesses or lacks of a surveillance system, then make alternative reinforcement through the Focus Group Discussion to get the most ideal reinforcement priorities to be implemented. Results: There is a difference between health districts profile data, Health Center profile data and the program data. The difference begins from the data source occurs pregnant women infants and toddlers: which at the time of data collection, at the time of recording and reporting, and at the time of publishing information. Strengthening alternative system that has been identified is building a database, simple data analysis, increased monitoring and evaluation, formation and repair forums verivication of the data storage system. The calculation of priority the strengthening of the surveillance system was decided the a simple data analysis is the most likely alternative. Conclusion: Problems surveillance of pregnant women, infants and toddlers is a process and output activities. Priority strengthening surveillance systems of pregnant women, infants and toddlers are most likely to be implemented is a simple data analysis to interpret the resulting figures

Analisis Kebijakan Pembiayaan Kesehatan di Kabupaten Kepulauan Aru (Policy Analysis: Health Financing In Aru Island)

Background: The calculation of Community Health Development Index (IPKM) of Aru Islands is in rank 352, of alldistricts/cities in Indonesia. This low in IPKM rank was suspected to be the result of the ineffectivity and ineffi ciency on health budgeting. Various problems can be detected and identifi ed through the implementation of the District Health Accounts (DHA) in the district/city level. The objectives of this research is mapping district health account, which consist of resources, organizer, activity and program. Method: This method applied was cross sectional design, and was conducted in 2012. The analysis unit was health district offi ce and a cross- sector health agencies ho had health funding allocation (Hospital, Department of Population and Family Planning, Regional Development Planning Board, Social Services). Results: The results showed that the largest source of funding comes from the Aru Islands government is 91.95% (81.60% APBD and APBN 9.31%). Most budget management is dominated by the government (94.42%). Most of the archipelagic Aru District budgets are used for activities that 54.67% indirect and direct activities amounted to 45.33%. Besides, fi nancing mapping results also indicate that public health programs Aru district absorb 11.25% of the total budget, 18.36% for individual health program efforts and the remaining 70.39% for program support. Conclusions: Health budget in District Aru largely sourced from the government (central, provincial and district levels). Indirect activities absorb more budget than Important government programs such as HIV / AIDS, tuberculosis, malaria, etc. Recomendations: The government should provide more funds to implement important programs of the government. Health District Offi ce should also be able to allocate substantial funds for essential government programs

Persiapan Puskesmas Bandarjaya Menjadi Unit Swadana

Health Center is one of health organization in district level that have compre­hensive and holistic health care system in the society, as a point to improving health status program. Because of that, improving quality ofservices is very important. Many perspectives of quality, two of them are about improving quality of manpower and financing. Swadana conceps may give the answer for the many problems in the health centers. This study was a cross sectional study in Puskesmas Bandarjaya, Lampung. The study had 3 steps analysis, they were; (1) situation analysis before to be Swadana Units, (2) Cost Analysis. and (3) Tariff Simulation. The study showed that human resources in Puskesmas Bandarjaya was very limited, visite rate in many services was high, equipment and building in Puskesmas Bandarjaya were in good condition, the population around Puskesmas Bandarjaya area and the government gave a positive support for the Swadana program. Cost analysis showed that the actual tariff for all services was very lower or under the unit cost and the CRR of all services in Puskesmas Bandarjaya was very low or under 100% for 3 scenarios (excepcion Laboratory Unit). The tariff stimulation showed that Puskesmas Bandarjaya had profit financing if the tariff would be taken about Rp. 2.500,00-Rp.3.000,00. All facts showed that Swadana concept would be necessary to accepted for Puskesmas Bandarjaya to get improving performance and quality. The study recommends that Puskesmas Bandarjaya must regulate the administration to be the holistic pay system, improving quality and quantity of human resources, regulate financing report and system and to adjust the old tariff with the new one after cost analysis in actual scenario

Gambaran Cakupan Pelayanan Kesehatan Maternal dan Neonatal pada Peserta Jaminan Kesehatan Masyarakat Miskin di Provinsi Jawa Barat (Analisis Data Pws Kia dan Jpsbk Tahun 2004)

The Maternal Mortality Rate in Indonesia was 373/100.000 per live birth (SDKI 2002). It is the highest in South East Asia. The Infant Mortality Rate was 40/1000 per live birth, the highest compared among ASEAN countries. The Human Development Index In West Java year 2002 was 0.658 and at 17th rank out of 30 provinces which was better than East Java in which at 25th. But rank was higher compared with others provinces in Java-Bali: Banten, Bali, Central Java, DI Jogjakarta, and DKI Jakarta. The Jaminan Kesehatan Masyarakat Miskin (JKMM) is an intervention program to increase economic gap and to achieve higher coverage of childbirth care by midwives for the poor families. In the other side, there was no information on the influence of JKMM to coverage of childbirth care by midwives for the poor families, esspecially the information about moving up of childbirth care from traditional birth attendants (TBA) to midwives. The research was an evaluation study with across sectional approach. The research was done at 3 Districts in West Java (Garut, Sumedang and Sukabumi). The data consist of secondary data (PWS KIA) and primer data (by in-depth interview). The Bivariate Analysis was done on the secondary data to determine factors that related between independent variable and dependent variable. Results of the research showed that there were no significant different between coverage of childbirth care by midwives (LINAKES) at health centers with the higher poor proportion people and the lower poor proportion people groups. It showed that the JKMM program not different in the coverage childbirth care by midwives between the poor people and the non­ poor people. The geographic factors (longer distance, cost of transportation, longer time from village to health center) were significant different in childbirth care by midwives. The health centers with good geographic conditions had better coverages of childbirth by midwives compared with the health center with hard geographic situation (p < 0.01)

Effect of Child Growth and Development Training on The Knowledge and Attitude among Community Health Workers in Semarang, Central Java

Background: Measuring and monitoring a child’s growth is important to judge the adequacy of diets or supplementary food being given. Monitoring child's development is critical to find out if a child's development is on track. It is important to act early if there are signs of potential development delay because early treatment is so important for improving a child's skills and abilities. This study aimed to determine effect of child growth and development training on the know¬ledge and attitude among community health workers in Semarang, Central Java. Subjects and Method: This study was a quasi-experimental with pretest and posttest with no control design conducted at Rowosari Puskesmas (community health center), Semarang, Central Java. The study subjects involved 62 community health workers (CHWs). The dependent variables were knowledge and attitude about child growth and development. The independent variable was training on how to measure and monitor child growth and development. The data were collected by questionnaire, and analyzed by Wilcoxon test. Results:Knowledge was higher after training (Mean= 77; SD= 9.8) than before (Mean= 68; SD= 11.2), and it was statistically significant (p= 0.001). Attitude was higher after training (Mean= 80; SD= 12.8) than before (Mean= 70; SD= 10.1), and it was statistically significant (p= 0.001). Conclusion: Training is effective in improving knowledge and attitude about child growth and development monitoring among CHWs. Keywords: knowledge, attitude, growth,development, monitoring, children, community health workers

Effect of “Contraceptive Technology Update” Pre-Service Training on the Knowledge and Skill of Medical Student

Background: Contraception is an effective method of lowering the population rate. However, anecdotal evidenceshowed that generally doctors were unable to provide IUD and implant contraceptive installation services. This study aimed to determine the effect of Contraceptive Technology Update (CTU) pre-service training on the knowledge and skill of the medical college students. Subjects and Method: This was a quasi experiment using one group before and after with no comparison design. A sample of 50 college students from the medical college was selected for this study. All of the study subjects received CTU training for 5 days, comprising 3 days of in-class training using mannequin, and 2 days of practical training with patients. The independent variable was CTU pre-service training. The dependent variables were knowledge and skill. The knowledge data were measured by questionnaire. IUD and implant fixing skills were observed using MiniCEX. The data were analyzed by Wilcoxon test. Results: Knowledge after CTU training (median= 77.5) was higher than before CTU training (median= 62.5) with p= 0.001. IUD fixing skills after CTU training (median= 13.0) was higher than before CTU training (median= 10.0) with p= 0.001. Conclusion: CTU pre-service training significantly improves both knowledge and skills of IUD and implant fixingof medical college students. Keywords: CTU pre-service training, contraceptive, medical college studen

The state of health in Indonesia's provinces, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Analysing trends and levels of the burden of disease at the national level can mask inequalities in health-related progress in lower administrative units such as provinces and districts. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to analyse health patterns in Indonesia at the provincial level between 1990 and 2019. Long-term analyses of disease burden provide insights on Indonesia's advance to universal health coverage and its ability to meet the United Nations Sustainable Development Goals by 2030. Methods We analysed GBD 2019 estimated cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 286 causes of death, 369 causes of non-fatal health loss, and 87 risk factors by year, age, and sex for Indonesia and its 34 provinces from 1990 to 2019. To generate estimates for Indonesia at the national level, we used 138 location-years of data to estimate Indonesia-specific demographic indicators, 317 location-years of data for Indonesia-specific causes of death, 689 location-years of data for Indonesia-specific non-fatal outcomes, 250 location-years of data for Indonesia-specific risk factors, and 1641 location-years of data for Indonesia-specific covariates. For subnational estimates, we used the following source counts: 138 location-years of data to estimate Indonesia-specific demographic indicators; 5848 location-years of data for Indonesia-specific causes of death; 1534 location-years of data for Indonesia-specific non-fatal outcomes; 650 location-years of data for Indonesia-specific risk factors; and 16 016 location-years of data for Indonesia-specific covariates. We generated our GBD 2019 estimates for Indonesia by including 1 915 207 total source metadata rows, and we used 821 total citations. Findings Life expectancy for males across Indonesia increased from 62·5 years (95% uncertainty interval 61·3–63·7) to 69·4 years (67·2–71·6) between 1990 and 2019, a positive change of 6·9 years. For females during the same period, life expectancy increased from 65·7 years (64·5–66·8) to 73·5 years (71·6–75·6), an increase of 7·8 years. There were large disparities in health outcomes among provinces. In 2019, Bali had the highest life expectancy at birth for males (74·4 years, 70·90–77·9) and North Kalimantan had the highest life expectancy at birth for females (77·7 years, 74·7–81·2), whereas Papua had the lowest life expectancy at birth for males (64·5 years, 60·9–68·2) and North Maluku had the lowest life expectancy at birth for females (64·0 years, 60·7–67·3). The difference in life expectancy for males between the highest-ranked and lowest-ranked provinces was 9·9 years and the difference in life expectacy for females between the highest-ranked and lowest-ranked provinces was 13·7 years. Age-standardised death, YLL, and YLD rates also varied widely among the provinces in 2019. High systolic blood pressure, tobacco, dietary risks, high fasting plasma glucose, and high BMI were the five leading risks contributing to health loss measured as DALYs in 2019. Interpretation Our findings highlight that Indonesia faces a double burden of communicable and non-communicable diseases that varies across provinces. From 1990 to 2019, Indonesia witnessed a decline in the infectious disease burden, although communicable diseases such as tuberculosis, diarrhoeal diseases, and lower respiratory infections have remained a main source of DALYs in Indonesia. During that same period, however, all-ages death and disability rates from non-communicable diseases and exposure to their risk factors accounted for larger shares of health loss. The differences in health outcomes between the highest-performing and lowest-performing provinces have also widened since 1990. Our findings support a comprehensive process to revisit current health policies, examine the root causes of variation in the burden of disease among provinces, and strengthen programmes and policies aimed at reducing disparities across the country. Funding The Bill & Melinda Gates Foundation and the Government of Indonesia. Translation For the Bahasa Indonesia translation of the abstract see Supplementary Materials section

Analisis Subsidi Silang Antar Unit Produksi di RSUD Wonogiri

Cost Recovery Rate (CRR) for production unit at District Hospital was influenced each income level to expect establishing cross-subsidy concept for equity of health care service. The case research performed at 1 (one) District Hospital in Central Java Province Wonogiri District Hospital). The data is collected by observing available research result of writer in 2000 and the financial data collection 2001 by applies adjustment with Consumption Price Index (CPI) of budget 2000. There are 2 methods of cost calculation namely full cost and direct cost. The research result shows tha the highest production unit income at Wonogiri Distric Hospital 2000 is from hospital wards and the lowest from electrical diagnostic, in 2001 the highest also from hospital wards and the lowest from operation room (OK). Full cost calculation defind that biggest total cost at production unit of year 2000 at Wonogiri Distric Hospital is hospital wards and the lowest electro diagnostic, in 2001 the biggest and the lowest are also from hospital ward and electro diagnostic. If calculation with direct cost the bigest and the lowest in 2000 are hospital wards and electro diagnostic, in 2001 the bigest and the lowest also from hospital wards and electro diagnostic. CRR at Wonogiri Distric Hospital full cost calculation difine that there are 2 production units having CRR > 100%, CRR percentage of retribution at Wonogiri District Hospital 35.27 and 29.95%, and direct cost calculation define also 2 production units having CRR > 100%, CRR percentage of distribution at Wonogiri District Hospital 56.98 and 47.09%. Full cost calculation business yield remaining (SHU) of production unit at Wonogiri District hospital in 2000 and 2001 almost never have positive SHU that there are some production units having positive SHU where such cross subsidy is establish among production units. However total SHU from total retribution show negative result