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

Dampak Keterlibatan BAPPEDA dalam Rangka Pengembangan Kapasitas SKPD Lintas Sektor bagi Perencanaan dan Penganggaran Program Kesehatan Ibu dan Anak di Provinsi Papua

ABSTRACTBackground: Maternal and child mortality rate in Indonesia is still high. Indonesia is also expected not to reach the target of MDG 4 and 5 in 2015. In an effort to improve the health status of mothers and children in the context of decentralization, planning and budgeting at the district health is an important element of the health system. Evidence-Based Budgeting Planning Approach (EBP/PPBB), is a planning approach models that use data and academic health evidence in the framework of program decision-making as a references. Objectives: Describe the impact results of the PPBB KIA implementation in order to analyze, the impact of BAPPEDA involvement in maternal and child health planning advocacy through coordination across sectors.Research Methods: This study is a descriptive-correlative study that analyze the impact of BAPPEDA involvement in cross- sectoral planning for MCH programs, that are carried out in accordance with bottleneck analysis of the existing health system, using 66 interventions based continuum of care.Results: Cross-sectoral involvement in the planning and budgeting for MNCH brings a positive impact on the district health work plan. Bappeda involvement is crucial to coordinate cross-sectoral program for MNCH.Conclusions: Capacity of district planning staff is limited and should be improved, lack of evidence in planning is due to lack of health data, and the cross sector advocacy for health budgeting is insufficient. PPBB approach can improve capacity on planning on evidence-based and integrated planning for MNCH across-sectoral. Key Word: Planning, Maternal and Child Health, Cross Sectoral ABSTRAKLatar Belakang: Angka kematian ibu dan anak di Indonesia masih tinggi. Indonesia juga diprediksi tidak dapat mencapai target MDG 4 dan 5 pada tahun 2015. Dalam upaya peningkatan status kesehatan ibu dan anak dalam konteks desentralisasi, perencanaan dan penganggaran kesehatan di kabupaten merupakan elemen sistem kesehatan yang penting. Pendekatan Perencanaan Penganggaran Berbasis Bukti (PPBB) KIA, merupakan bentuk model perencanaan yang menggunakan bukti data dan referensi akademis dalam rangka pengambilan keputusan program kesehatan.Tujuan: memaparkan hasil implementasi PPBB-KIA dalam rangka melihat hubungan keterlibatan Bappeda dalam advokasi perencanaan perencanaan kesehatan ibu dan anak melalui koordinasi lintas sektor.Metode Penelitian: Kajian ini secara deskriptif-korelatif keterlibatan Bappeda dalam perencanaan lintas sector untuk progam KIA yang dilakukan sesuai dengan sumbatan sistem kesehatan yang ada dan berdasarkan 66 intervensi berbasis continuum of care.Hasil: Keterlibatan lintas sektor dalam perencanaan dan penganggaran KIA membawa dampak positif terhadap rencana kerja. Peran Bappeda semakin kuat dan memberikan kontribusi positif dalam kegiatan ini. Keterlibatan Bappeda terlihat berpengaruh dalam koordinasi program KIA untuk lintas sektor. Kesimpulan: Peningkatan kapasitas staf perencanaan kabupaten yang masih terbatas, kurangnya data kesehatan, peran advokasi lintas sektor ke Pemda yang belum kuat untuk meningkatkan pembiayaan kesehatan. Pendekatan PPBB dapat meningkatkan kapasitas perencanaan KIA secara berbasis bukti nyata terpadu dan terintegrasi dan lintas sektor di daerah. Kata Kunci: Perencanaan, Kesehatan Ibu dan Anak, Lintas Sekto

Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries

Background The COVID-19 pandemic was a health emergency requiring rapid scal resource mobilisation to support national responses. The use of e ective health nancing mechanisms and policies, or lack thereof, a ected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health nancing policies adopted in 15 countries during the pandemic, develop a framework for resilient health nancing, and use this pandemic to argue a case to move towards universal health coverage (UHC). Methods In this case study, we examined the national health nancing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health nancing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health nancing. Findings Resilient health nancing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain scal space for health to move towards UHC while building on resilient health nancing structures that can better prepare health systems for future health emergencies. We observed that ve key nancing policies were implemented across the countries— namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, e cient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure e cient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement. Interpretation Our ndings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health nancing policies robust and need to politically commit to public nancing mechanisms that work to prepare for future emergencies and as a lever for UHC.We thank the management team of the Bill & Melinda Gates Foundation and the Saw Swee Hock School of Public Health (National University of Singapore, Singapore) for all the administrative support given. This research was funded by the Bill & Melinda Gates Foundation (Investment ID INV-005598)

Implementasi Program Pengelolaan Penyakit Kronis (Prolanis) di Puskesmas Poasia Kota Kendari

Background: The Chronic Disease Management Program (Prolanis) is a system of health services and proactive approach, implemented in an integrated manner involving participants, health facilities and BPJS Health in order to maintain health for BPJS Health participants who suffer from chronic diseases to achieve optimal quality of life With the cost of effective and efficient health services. Prolanis program is to improve the quality of life of BPJS participants who suffer from chronic diseases, especially diabetes mellitus (DM) type II and hypertension. This prolanis is implemented by a government-owned first-level health facility (FKTP). Aims: to describe the influence of external factors, internal and individual character to the scope of implementation of prolanis program in kendari city. Method: The research type is descriptive research with qualitative method by using single case study design. Informants in this study are stakeholders who play a role in the Implementation of Chronic Disease Management Program (Prolanis) at Poasia Health Center of Kendari City which consists of 12 informants. The way data collection is done is by observation, in-depth interviews, and document review. This research was conducted in April-May 2017. It was analyzed with qualitative abalisa. Result: From the result of the research, it is obtained from the external influences in this case the health service fully supports the prolanis activity. On the internal factors obtained puskesmas poasia is good enough to carry out prolanis. And on the character factor of the invidu still the lack of knowledge and understanding of the health personnel involved in the implementation of prolanis. Conclusion: improving the knowledge and understanding of health personnel involved in the prolanis program.

A critical review of definitions of rural areas in Indonesia and implications for health workforce policy and research

Background: Choosing the appropriate definition of rural area is critical to ensuring health resources are carefully targeted to support the communities needing them most. This study aimed at reviewing various definitions and demon-strating how the application of different rural area definitions implies geographic doctor distribution to inform the development of a more fit-for-purpose rural area definition for health workforce research and policies. Methods: We reviewed policy documents and literature to identify the rural area definitions in Indonesian health research and policies. First, we used the health policy triangle to critically summarize the contexts, contents, actors and process of developing the rural area definitions. Then, we compared each definition’s strengths and weaknesses according to the norms of appropriate rural area definitions (i.e. explicit, meaningful, replicable, quantifiable and objective, derived from high-quality data and not frequently changed; had on-the-ground validity and clear boundaries). Finally, we validated the application of each definition to describe geographic distribution of doctors by estimating doctor-to-population ratios and the Theil-L decomposition indices using each definition as the unit of analysis. Results: Three definitions were identified, all applied at different levels of geographic areas: “urban/rural” villages (Central Bureau of Statistics [CBS] definition), “remote/non-remote” health facilities (Ministry of Health [MoH] definition) and “less/more developed” districts (presidential/regulated definition). The CBS and presidential definitions are objective and derived from nationwide standardized calculations on high-quality data, whereas the MoH definition is more subjective, as it allows local government to self-nominate the facilities to be classified as remote. The CBS and presidential definition criteria considered key population determinants for doctor availability, such as population density and economic capacity, as well as geographic accessibility. Analysis of national doctor data showed that remote, less developed and rural areas (according to the respective definitions) had lower doctor-to-population ratios than their counterparts. In all definitions, the Theil-L-within ranged from 76 to 98%, indicating that inequality of doctor density between these districts was attributed mainly to within-group rather than between-group differences. Between 2011 and 2018, Theil-L-within decreased when calculated using the MoH and presidential definitions, but increased when the CBS definition was used. Conclusion: Comparing the content of off-the-shelf rural area definitions critically and how the distribution of health resource differs when analysed using different definitions is invaluable to inform the development of fit-for-purpose rural area definitions for future health policy

The effect of health insurance and socioeconomic status on women’s choice in birth attendant and place of delivery across regions in Indonesia: a multinomial logit analysis

Background Evidence suggests that women gave birth in diverse types of health facilities and were assisted by various types of health providers. This study examines how these choices are influenced by the Indonesia national health insurance programme (Jaminan Kesehatan Nasional (JKN)), which aimed to provide equitable access to health services, including maternal health.Methods Using multinomial logit regression models, we examined patterns and determinants of women’s choice for childbirth, focusing on health insurance coverage, geographical location and socioeconomic disparities. We used the 2018 nationally representative household survey dataset consisting of 41 460 women (15–49 years) with a recent live birth.Results JKN coverage was associated with increased use of higher-level health providers and facilities and reduced the likelihood of deliveries at primary health facilities and attendance by midwives/nurses. Women with JKN coverage were 13.1% and 17.0% (p<0.05) more likely to be attended by OBGYN/general practitioner (GP) and to deliver at hospitals, respectively, compared with uninsured women. We found notable synergistic effects of insurance status, place of residence and economic status on women’s choice of type of birth attendant and place of delivery. Insured women living in Java–Bali and in the richest wealth quintile were 6.4 times more likely to be attended by OBGYN/GP and 4.2 times more likely to deliver at a hospital compared with those without health insurance, living in Eastern Indonesia, and in the poorest income quantile.Conclusion There are large variations in the choice of birth attendant and place of delivery by population groups in Indonesia. Evaluation of health systems reform initiatives, including the JKN programme and the primary healthcare strengthening, is essential to determine their impact on disparities in maternal health services