Pemenuhan Fasilitas Kesehatan Ibu Melahirkan Era Jaminan Kesehatan Nasional

Menjelang berakhirnya Millennium Development Goals (MDGs) 2015, Indonesia masih menyisakan rapor merah terhadap penurunan target kelima MDGs, yaitu Angka Kematian Ibu (AKI). Pemerintah Indonesia berupaya menekan AKI melalui program Jaminan Kesehatan Nasional (JKN). Hal ini dimulai ketika Undang Undang Nomor 24 Tahun 2011 tentang Badan Penyelenggara Jaminan Sosial (BPJS) disahkan, maka secara bertahap semua bentuk perlindungan sosial beralih menjadi Jaminan Kesehatan Nasional (JKN). Termasuk Jaminan Persalinan (Jampersal) yang sebelumnya memberikan pelayanan kebidanan menjadi lebur dalam sistem Jaminan Kesehatan Nasional dan menjadi bagian pelayanan kesehatan ibu dan anak. Antusiasme masyarakat untuk menggunakan layanan kesehatan JKN yang ditanggung BPJS Kesehatan tercermin melalui jumlah peserta yang melebihi target. Data BPJS Kesehatan per 30 Juni 2014 memperlihatkan bahwa jumlah peserta BPJS Kesehatan yang terdaftar telah mencapai 124.553.040 jiwa. Dari total jumlah peserta tersebut sudah memenuhi target kepesertaan dalam setahun, yaitu minimal menjaring sekitar 121 juta jiwa. Namun dalam pelaksanaannya terdapat permasalahan yang dirasakan oleh masyarakat peserta JKN, terutama perempuan yang ingin menggunakan layanan kebidanan. Women Research Institute (WRI) mengidentifikasi beberapa tantangan yang dihadapi oleh perempuan peserta Jaminan Kesehatan Nasional yang ingin memanfaatkan layanan kebidanan

Layanan Kebidanan Era Jaminan Kesehatan Nasional: Memperkuat Posisi Bidan Praktik Mandiri

Survei Demografi Kesehatan Indonesia (SDKI) 2007 menunjukkan Angka Kematian Ibu (AKI) di Indonesia mencapai 228 kematian per 100.000 kelahiran hidup dan pada 2012 menunjukkan peningkatan menjadi 359 kematian per 100.000 kelahiran hidup. Angka ini sangat jauh dari target Millennium Development Goals (MDGs) yaitu sebesar 102 kematian per 100.000 kelahiran hidup. Menjelang berakhirnya Millennium Development Goals 2015, Indonesia masih menyisakan rapor merah terhadap penurunan target tujuan kelima MDGs, yaitu Angka Kematian Ibu. Sebagai upaya mencapai target tersebut, sejak 1 Januari 2014 pemerintah mengimplementasikan jaminan pelayanan kesehatan kepada perempuan hamil, melahirkan, dan dalam masa nifas melalui Jaminan Ke sehatan Nasional (JKN) yang seharusnya sudah disiapkan sejak Undang-Undang Nomor 24 Tahun 2011 tentang Badan Penyelenggara Jaminan Sosial (BPJS) disahkan. Dalam konteks penurunan angka kematian ibu, bidan merupakan tenaga kesehatan yang menjadi ujung tombak dalam pelayanan kesehatan nasional. Bidan tidak hanya diharapkan mampu menghadapi tantangan dalam implementasi JKN, tetapi juga diberikan tanggungjawab dalam menurunkan angka kematian ibu dan mencapai akses universal terhadap pelayanan kesehatan reproduksi. Melalui penelitian Women Research Institute (WRI) mengenai JKN terkait Pelayanan Kebidanan di Jakarta dan Bandung, didapat berbagai temuan terkait tantangan yang dihadapi oleh bidan dan perempuan peserta JKN dalam mengakses pelayanan kebidanan

Application of Social Marketing in Active Case Finding of Tuberculosis: Evidence from Indonesia

BACKGROUND: Tuberculosis remained a major public health issue in many developing nations. Case detection rate remained low in Indonesia. Social marketing induces behavior change by making it compatible with individual perception, values, and convenience. This study aimed to apply social marketing to increase active case detection 0f tuberculosis. SUBJECT AND METHOD: This was a qualitative-quantitative study conducted in two puskesmas (community health centers) in Sukoharjo district, Central Java, Indonesia. A sample of 30 health cadres was selected for this study. Another sample of health personnels from puskesmas and health programmers from the district health office, Sukoharjo, were selected for this study. The data were collected by interview, focus group discussion, and document review. Changes in knowledge and social marketing among health cadres before and after training was tested by t test. Case detection rates before and after training were compared and tested by chi square. RESULTS: Knowledge in tuberculosis before training (mean=67.37; SD=11.37) increased after training (mean=83.97; SD=9.22), and it was statistically significant (p<0.001). Knowledge in social marketing before training (mean=73.04; SD=12.25) increased after training (mean=85.12; SD=12.02), and it was statistically significant (p<0.001). Tuberculosis case detection rate before trainingvincreased twice as many after training (OR=2.10; 95%CI=0.48 to 10.99; p=0.168). CONCLUSION: Social marketing can be used to increase knowledge in tuberculosis among health cadres and case detection rate through active case finding

Globally invariant metabolism but density-diversity mismatch in springtails.

Soil life supports the functioning and biodiversity of terrestrial ecosystems. Springtails (Collembola) are among the most abundant soil arthropods regulating soil fertility and flow of energy through above- and belowground food webs. However, the global distribution of springtail diversity and density, and how these relate to energy fluxes remains unknown. Here, using a global dataset representing 2470 sites, we estimate the total soil springtail biomass at 27.5 megatons carbon, which is threefold higher than wild terrestrial vertebrates, and record peak densities up to 2 million individuals per square meter in the tundra. Despite a 20-fold biomass difference between the tundra and the tropics, springtail energy use (community metabolism) remains similar across the latitudinal gradient, owing to the changes in temperature with latitude. Neither springtail density nor community metabolism is predicted by local species richness, which is high in the tropics, but comparably high in some temperate forests and even tundra. Changes in springtail activity may emerge from latitudinal gradients in temperature, predation and resource limitation in soil communities. Contrasting relationships of biomass, diversity and activity of springtail communities with temperature suggest that climate warming will alter fundamental soil biodiversity metrics in different directions, potentially restructuring terrestrial food webs and affecting soil functioning

Globally invariant metabolism but density-diversity mismatch in springtails

Soil life supports the functioning and biodiversity of terrestrial ecosystems. Springtails (Collembola) are among the most abundant soil arthropods regulating soil fertility and flow of energy through above- and belowground food webs. However, the global distribution of springtail diversity and density, and how these relate to energy fluxes remains unknown. Here, using a global dataset representing 2470 sites, we estimate the total soil springtail biomass at 27.5 megatons carbon, which is threefold higher than wild terrestrial vertebrates, and record peak densities up to 2 million individuals per square meter in the tundra. Despite a 20-fold biomass difference between the tundra and the tropics, springtail energy use (community metabolism) remains similar across the latitudinal gradient, owing to the changes in temperature with latitude. Neither springtail density nor community metabolism is predicted by local species richness, which is high in the tropics, but comparably high in some temperate forests and even tundra. Changes in springtail activity may emerge from latitudinal gradients in temperature, predation and resource limitation in soil communities. Contrasting relationships of biomass, diversity and activity of springtail communities with temperature suggest that climate warming will alter fundamental soil biodiversity metrics in different directions, potentially restructuring terrestrial food webs and affecting soil functioning

Globally invariant metabolism but density-diversity mismatch in springtails

Soil life supports the functioning and biodiversity of terrestrial ecosystems. Springtails (Collembola) are among the most abundant soil arthropods regulating soil fertility and flow of energy through above- and belowground food webs. However, the global distribution of springtail diversity and density, and how these relate to energy fluxes remains unknown. Here, using a global dataset representing 2470 sites, we estimate the total soil springtail biomass at 27.5 megatons carbon, which is threefold higher than wild terrestrial vertebrates, and record peak densities up to 2 million individuals per square meter in the tundra. Despite a 20-fold biomass difference between the tundra and the tropics, springtail energy use (community metabolism) remains similar across the latitudinal gradient, owing to the changes in temperature with latitude. Neither springtail density nor community metabolism is predicted by local species richness, which is high in the tropics, but comparably high in some temperate forests and even tundra. Changes in springtail activity may emerge from latitudinal gradients in temperature, predation and resource limitation in soil communities. Contrasting relationships of biomass, diversity and activity of springtail communities with temperature suggest that climate warming will alter fundamental soil biodiversity metrics in different directions, potentially restructuring terrestrial food webs and affecting soil functioning.The article is an outcome of the #GlobalCollembola community initiative that is voluntarily supported by researchers around the world.</p

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally