Tobacco Consumption by Health Insurance Participants: BPJS Risk? [Riskesdas 2013 Data Sources]

Background:Tobacco consumption can lead to the diseases that can cause death. Calculation of the experts in the Global Burden of diseases Generating Evidence, Guiding Policy (IHME and the University of Washington), smoking is a second highest risk factor after high blood pressure (12% mortality) that results in loss of 8 years of age healthy living (8 DALY) for each individual. Tobacco atlas in 2007 referencing that Indonesia is the fourth largest tobacco-consuming country in the world after China, Russia and the United States. Indonesia has made the implementation of the National Social Security health policy in force since January 2014, an insurance that doesnt see the participants risk factors because having the principle of mandatory participation. This paper would like to analyze the pattern of tobacco consumption on the health insurance participants, askes, jamsostek and jamkesmas based on Riskesdas, 2013, as a risk factor on the incidence of disease that will be borne by BPJS. Method: Bivariate analysis on Riskesdas 2013 data.Result: Jamsostek has the highest proportion of participants who consume tobacco every day as many as 26.2% of them followed by Jamkesmas (25.9%) and Askes participants (16.3%). Askes participants consume 13.6 cigarette per day, Jamsostek participants consume 12.1 stems per day and participants Jamkesmas 11.9 stems per day. Thus, if the average price of 1 stem of cigaretteis Rp 750, then the participants of Jamkesmas, Jamsostek and Askes in a month to pay as much as Rp.267.255, Rp. 273 781, and Rp. 307 412, - for cigarettes. Costs incurred by Jamkesmas participants for tobacco consumption in a month is almost 14 times the value of dues paid by the government. Rupiahs that burned into smoke and create risk factor of self and others death in Indonesia in a month in 2013 of 5.4 Trillion Rupiah in which three-quarters of amount came from Jamkesmas participants. Conclusion:The cost of tobacco consumption among smokers per day can pay the class 1 dues to 4 peoples health care. Cross-subsidies from people who are at risk and not at risk needs to be re-evaluated. Suggestion: Dues paid by the government should be examined in order not to burden the government budget

Building capacity for mortality statistics programs: Perspectives from the Indonesian experience

Information on deaths by age, sex, and cause are primary inputs for health policy and epidemiological research. Currently, most developing countries lack efficient death registration systems that generate these data on a routine and timely basis. The global community is promoting initiatives to establish and strengthen national mortality statistics programs across the developing world. Building human, technical, and institutional capacity to operate these programs are essential elements for the program. In Indonesia, the government has established a national Sample Registration System (SRS) covering a population of 9 million and is looking toward further scaling up of operations of the mortality statistics program in conjunction with expansion of the national Civil Registration and Vital Statistics (CRVS) systems. This article reports the theoretical and practical perspectives gained from experiences in developing human capacity in the Indonesian context. These perspectives are described in terms of the institutional, personnel, and functional components of the program for collection, compilation, analysis, and utilisation of mortality and cause of death data. The article also describes the challenges and potential solutions for implementing capacity building activities at national and subnational level. In conclusion, the need for and availability of training resources are discussed, including the potential for involvement of public health academia and international collaborations within a research framework on program management, quality evaluation, and data utilisation. Adequate attention to capacity building is essential to ensure the success and sustainability of national mortality statistics programs.CR and MK are partially supported by a development partnership grant from the Department of Foreign Affairs and Trade, Australia, which also supports part of the capacity building activities described in this manuscript

Iodine Salt Consumption in Indonesian Households: Baseline Health Survey 2007

Background: Iodine Deficiency Disorder (100) reduction program has been implemented since 1976. According to the National Economic Survey 2002, the average consumption of iodized salt was 6. 26 grams. The results of Iodine Salt Survey (SGY) 2003 showed that the consumption of iodine salt at the household level was 73.2%, meanwhile, the baseline health survey (Riskesdas) 2007 showed there was reduction of iodine salt consumption towards 60.2%. Methods: Type of study was secondary data analysis with cross-sectional design utilizing the Riskesdas 2007's data. Sample was selected purposively according to the previous SGY's survey based on the endemically criteria namely highly endemic, mediocre and non endemic. Results: The results of the analysis were there was discrepancy of iodine salt consumption among urban and rural areas as well as mother's education level. The iodine salt consumption was higher in the urban area (65.5%) compare to the rural area (52.9%). The higher the education of mothers the better the iodine salt consumed. The USAge of iodine salt in the households based on salt quick test was 60.2%, meanwhile, according to the salt titration it was only 23.4%. The results of Excretion Iodine Urine showed that the iodine intake among the school children (age of 6-12 years old) was 12.8% and was still below the cut-off point prevalence, which is greater than 50%. The conclusion of this analysisis that there was evidence of iodine salt reduction consumed at the household level. Conversely, there was inclination of the percentage of iodine urine level among the school children in Indonesia in the year 2007. It is recommended that policy analysis need to be conducted due to the achievement of the Universal Salt iodization target, especially in the endemic areas to asses the existence of the IDO prevalence

Penerapan European Foundation For Quality Management (Efqm) di Dinas Kesehatan Kabupaten/kota untuk Meningkatkan Kinerja Dinas

Since 2001, Indonesia has entering its new era of democratization called decentralization in all sectors, including health. From now and then, the District Health Office has been forced to be able to implement its health policy and function such as 1) stewardship, 2) health resources management, 3) health financing, and 4) health services provision. Basic function of health system is needed to achieve the health purpose that shown the performance of the health offices and its structure. The performance is related to the quality of management. European Foundation for Quality Management (EFQM) is a tool to quantify and assess the quality of management in an institution, so that it will be understood what is the weakness and the strength of the institution. EFQM was developed in Europe that has been proved that it can formulate an excellent management and performance by then. This study implements the EFQM model towards performance improvement model development in district/municipality health office. The objective of the study is implement EFQM model in improving health system performance in district/municipality. Type of study is a health system research with a cross sectional design in three selected district health office based on Human Development Index criteria, that is high, medium and low. Analysis has been done implementing the EFQM method called RADAR. The study location were Tabanan district (Bali), Bandar Lampung Municipality (Lampung), and Belu District (East Nusa Tenggara). The qualitative analysis was quantified using the RADAR for the nine pillars in the method. The nine criteria were grouping into enables and results criteria, such as 1) enables criteria of leadership, policy and strategy, employment, partnership and resources as well as process; 2) results criteria were: clients satisfaction, staff satisfaction, social results of the community as well as the main key. Each criteria has some sub-criteria. Each sub-criteria then be valued using the RADAR, and quantified ranged from 0-10 as no prove and anecdote only; 15-35 as there are some prove; 40-60 as proved; 65-85 as strongly proved, and 90-100 as completely proved. The final evaluation of each pillars done by counting the average values of the sub-criteria multiplied by each weight of the pillars that already formatted. The formatted weight was 1.0 for the leadership; 0.8 for the policy and strategy, 0. 9 for the employment; 0. 9 for the resources and partnership; 1.4 for process; 2. 0 for clients satisfaction; 0. 9 for staffs satisfaction; 0.6 for community social satisfaction and the 1.5 for the key indicator, with a total weight of 10. Results showed that the final results of the health office performance were Tabanan has the highest of 250, Bandar Lampung Municipality 239, and Belu 217. This scoring seems directly reflects the management achievement level of District Health office that correlate to the HOI Index. The EFQM method can be used as a model to improve staff performance in the district health office by maintaining the weaknesses found in the field as constraints

MORTALITAS DAN MORBIDITAS CEDERA PADA ANAK DI KABUPATEN PROBOLINGGO DAN TULUNGAGUNG-JAWA TIMUR 2005

Background: In Indonesia, births and deaths are seldom recorded, making basic health indices such as causes and rates of death difficult to know with any real degree of certainty. However, basic data available from National Institute of Health Research and Development-Ministry of Health Indonesia that namely Health National Survey (SURKESNAS) shows thirty three percent of people 12-24 years and thirteen percent of people 5-14 years are death due to injury, probability peoples 5-24 year of injury in male is five times from injury female. From this survey the risk factor and hazard of injury did not know. Drowning survey conducted (2003) in 0--5 years (balita) shows 0. 7 per 1000 population in rural area and 2.6 per 1000 population in urban area. Knowmg the environmental hazard and risk factor is important thing to make the preventive and awareness of safety and risk avoidance. This survey is conducting on two district in East Java, Probolinggoand Tulung Agung. Research methodology: Two districts was selected according UNICEF project area, namely Tulung Agung District and Probolinggo District. Estimation of total sample was 10,000 HH in each District. Using cluster Proportional Probability to Size (PPS) sampling were randomly sub-district and village in rural and urban area. All house hold was in the selected village was selected for sample. A house hold member was defined as a member living in the same house, sharing meal and information, for six month, including domestic helpers, long-term guest etch. Results: In the survey a total number of 784 deaths were identified in the preceding three years, in Tulung Agung District were 411 deaths and 373 in Probolinggo District. In the survey a total number of 304 deaths were identified in the preceding one year. In TulungAgung District were 163 deaths and 139 in Probolinggo District. In this survey, injury accounted for 21% of all classifiable deaths in children aged 1-17 years. Injury caused 5% of infant deaths, 11% of children (0--17 years) deaths drowning was the major cause of fatal injury (16/100,000) in children. The fatal injury rate from falls was 5/100,000,  drowning was occur in 1-4 age groups (24/100,000) and in 10--14 age groups (40/100,000). The fatal injury from falls was occur in infant age group (104/100,000). RTA (Road Transportation Accident) was the most cause non-fatal injury in aged 5-17 years old. The Second rank for leading causes non-fatal injury was fall. The other causes were electrocution, poisoining, and injury by mach me. All the children in aged 10--14 years had severe injury. While non-fatal injury rate in aged 15-17 years was highest but all cases had moderate severity.Key words: fatal injury, pilot study, east jav

PENERAPAN EUROPEAN FOUNDATION FOR QUALITY MANAGEMENT (EFQM) DI DINAS KESEHATAN KABUPATEN/KOTA UNTUK MENINGKATKAN KINERJA DINAS

Since 2001, Indonesia has entering its new era of democratization called decentralization in all sectors, including health. From now and then, the District Health Office has been forced to be able to implement its health policy and function such as 1) stewardship, 2) health resources management, 3) health financing, and 4) health services provision. Basic function of health system is needed to achieve the health purpose that shown the performance of the health offices and its structure. The performance is related to the quality of management. European Foundation for Quality Management (EFQM) is a tool to quantify and assess the quality of management in an institution, so that it will be understood what is the weakness and the strength of the institution. EFQM was developed in Europe that has been proved that it can formulate an excellent management and performance by then. This study implements the EFQM model towards performance improvement model development in district/municipality health office. The objective of the study is implement EFQM model in improving health system performance in district/municipality. Type of study is a health system research with a cross sectional design in three selected district health office based on Human Development Index criteria, that is high, medium and low. Analysis has been done implementing the EFQM method called RADAR. The study location were Tabanan district (Bali), Bandar Lampung Municipality (Lampung), and Belu District (East Nusa Tenggara). The qualitative analysis was quantified using the RADAR for the nine pillars in the method. The nine criteria were grouping into enables and results criteria, such as 1) enables criteria of leadership, policy and strategy, employment, partnership and resources as well as process; 2) results criteria were: clients satisfaction, staff satisfaction, social results of the community as well as the main key. Each criteria has some sub-criteria. Each sub-criteria then be valued using the RADAR, and quantified ranged from 0-10 as no prove and anecdote only; 15-35 as there are some prove; 40-60 as proved; 65-85 as strongly proved, and 90-100 as completely proved. The final evaluation of each pillars done by counting the average values of the sub-criteria multiplied by each weight of the pillars that already formatted. The formatted weight was 1.0 for the leadership; 0.8 for the policy and strategy, 0. 9 for the employment; 0. 9 for the resources and partnership; 1.4 for process; 2. 0 for clients satisfaction; 0. 9 for staffs satisfaction; 0.6 for community social satisfaction and the 1.5 for the key indicator, with a total weight of 10. Results showed that the final results of the health office performance were Tabanan has the highest of 250, Bandar Lampung Municipality 239, and Belu 217. This scoring seems directly reflects the management achievement level of District Health office that correlate to the HOI Index. The EFQM method can be used as a model to improve staff performance in the district health office by maintaining the weaknesses found in the field as constraints. Key words: EFQM, district health offices, scores, performance

Mortalitas dan Morbiditas Cedera pada Anak di Kabupaten Probolinggo dan Tulungagung-Jawa Timur 2005

Background: In Indonesia, births and deaths are seldom recorded, making basic health indices such as causes and rates of death difficult to know with any real degree of certainty. However, basic data available from National Institute of Health Research and Development-Ministry of Health Indonesia that namely Health National Survey (SURKESNAS) shows thirty three percent of people 12-24 years and thirteen percent of people 5-14 years are death due to injury, probability peoples 5-24 year of injury in male is five times from injury female. From this survey the risk factor and hazard of injury did not know. Drowning survey conducted (2003) in 0--5 years (Balita) shows 0. 7 per 1000 population in rural area and 2.6 per 1000 population in urban area. Knowmg the environmental hazard and risk factor is important thing to make the preventive and awareness of safety and risk avoidance. This survey is conducting on two district in East Java, Probolinggoand Tulung Agung. Research methodology: Two districts was selected according UNICEF project area, namely Tulung Agung District and Probolinggo District. Estimation of total sample was 10,000 HH in each District. Using cluster Proportional Probability to Size (PPS) sampling were randomly sub-district and village in rural and urban area. All house hold was in the selected village was selected for sample. A house hold member was defined as a member living in the same house, sharing meal and information, for six month, including domestic helpers, long-term guest etch. Results: In the survey a total number of 784 deaths were identified in the preceding three years, in Tulung Agung District were 411 deaths and 373 in Probolinggo District. In the survey a total number of 304 deaths were identified in the preceding one year. In TulungAgung District were 163 deaths and 139 in Probolinggo District. In this survey, injury accounted for 21% of all classifiable deaths in children aged 1-17 years. Injury caused 5% of infant deaths, 11% of children (0--17 years) deaths drowning was the major cause of fatal injury (16/100,000) in children. The fatal injury rate from falls was 5/100,000, drowning was occur in 1-4 age groups (24/100,000) and in 10--14 age groups (40/100,000). The fatal injury from falls was occur in infant age group (104/100,000). RTA (Road Transportation Accident) was the most cause non-fatal injury in aged 5-17 years old. The Second rank for leading causes non-fatal injury was fall. The other causes were electrocution, poisoining, and injury by mach me. All the children in aged 10--14 years had severe injury. While non-fatal injury rate in aged 15-17 years was highest but all cases had moderate severity

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN PEMANFAATAN RAWAT JALAN DAN RAWAT INAP PELAYANAN KESEHATAN DI JAWA, SUMATERA, DAN KALIMANTAN

Background: Utilization of health service facility constitutes the important indicator in assessing successful of healthservice. Level of utilization indicates whether health service is affordable and distributed equally. There are many factors which affecting utilization of health service facility such as socio-economic status and geographical access. So far, Kalimantan's health development is remained near to the ground compared with Java and Sumatra. Meanwhile, decentralization era insist the local specific data in health program planning. Objective: To find factors of utilization of health service facility in terms of socio-economic status, location of residence, distance to health facilities, and its utilization in Java, Sumatra,and Kalimantan islands. Methods: This study was observational with cross sectional study design. It was parallelized with Baseline Health Research (RISKESDAS) which is focused only in Java, Sumatra, and Kalimantan. The unit analysis was household of RISKESDAS 2007 and National Socio-Economic Survey (SUSENAS) 2007. The instruments were individual and household structure questionnaires. Data analyses were used univariate, bivariate, and multivariate techniques. Results: Generally, utilization of health service facilities were below than national rate (2.5%) particularly in-patient services.Those facilities were made the most of high economic class rather than the poor. There was a difference in using of health facilities of the people in those islands. The government hospital was mainly chosen by the people to have medication in Kalimantan, while in Java and Sumatra, the people preferred to utilize private hospitals especially in-patient services. In terms of ability to pay to health care and health insurance coverage, they were affordable by 3% and 20% of people respectively. The utilization of health service was influenced by economic level, health accessibility, gender, urban and rural areas, and island. Those factors have p value < 0.001. Conclusions: The study implied that the health service not yet equally given. There was disparity of health service distribution between urban and rural areas. Likewise, inequality of the utilization of health service among socio-economic levels. Social health insurance should be improved for the equity of utilization of health care. Key words: utilization, health service facilities, socio-economic statu

Faktor-faktor yang Berhubungan dengan Pemanfaatan Rawat Jalan dan Rawat Inap Pelayanan Kesehatan di Jawa, Sumatera, dan Kalimantan

Background: Utilization of health service facility constitutes the important indicator in assessing successful of healthservice. Level of utilization indicates whether health service is affordable and distributed equally. There are many factors which affecting utilization of health service facility such as socio-economic status and geographical access. So far, Kalimantan's health development is remained near to the ground compared with Java and Sumatra. Meanwhile, decentralization era insist the local specific data in health program planning. Objective: To find factors of utilization of health service facility in terms of socio-economic status, location of residence, distance to health facilities, and its utilization in Java, Sumatra,and Kalimantan islands. Methods: This study was observational with cross sectional study design. It was parallelized with Baseline Health Research (RISKESDAS) which is focused only in Java, Sumatra, and Kalimantan. The unit analysis was household of RISKESDAS 2007 and National Socio-Economic Survey (SUSENAS) 2007. The instruments were individual and household structure questionnaires. Data analyses were used univariate, bivariate, and multivariate techniques. Results: Generally, utilization of health service facilities were below than national rate (2.5%) particularly in-patient services.Those facilities were made the most of high economic class rather than the poor. There was a difference in using of health facilities of the people in those islands. The government hospital was mainly chosen by the people to have medication in Kalimantan, while in Java and Sumatra, the people preferred to utilize private hospitals especially in-patient services. In terms of ability to pay to health care and health insurance coverage, they were affordable by 3% and 20% of people respectively. The utilization of health service was influenced by economic level, health accessibility, gender, urban and rural areas, and island. Those factors have p value < 0.001. Conclusions: The study implied that the health service not yet equally given. There was disparity of health service distribution between urban and rural areas. Likewise, inequality of the utilization of health service among socio-economic levels. Social health insurance should be improved for the equity of utilization of health care