Alternatif Strategi Pelaksanaan Peran Regulasi Pascadesentralisasi Di Daerah = Alternative Strategies To Implement Regulatory Function Post Decentralization At The Provincial And District Level

Background: Several reports and observations have urged the need to strengthen regulatory function in decentralization era. This is not unexpected as regulation is not only a new role for the provincial and district health office, but also regulation is not perceived as an important role. Limited literature in this field motivates the author to compose this review paper, with the objective to define regulatory function and its activities, and to discuss strategies to strengthen this function. Subject and methods: This policy paper reviews regulatory concepts in the context of decen¬tralization in health. Empirical papers and on-going projects related to development of this regulatory function is presented to illustrate the concept. Results: Regulatory function differs from provision of services in terms of its objective, unit of analysis, consequence and requirement. The objective of regulation is to ensure quality of service provided by health care facilities. The unit of analysis is, therefore, not only government facilities but also those that are privately owned.The scope of regulation covers modern, comple¬mentary and alternative medicine. Consequently, this function should be implemented in a credible and objective way, either through licensing, certification and accreditation. Two strate¬gies were presented to develop this regulatory function, i.e. strengthening the capacity of pro¬vincial-district health offices or building alliance with an independent body. Conclusions: This paper has presented the definition and breadth of regulatory function in terms of its scope and activities. Taking into consideration the design, information, capacity, authority and context, an appropriate strategy should be explored and determined by the pro¬vincial or district health offices. Future development of the strategy should then be based on a multiyears planning. Keywords: decentralization, regulatory function, healthcare service delivery, development strateg

Penanganan diare di pusat pelayanan kesehatan masyarakar

Keywords: penyakit diare, tingkat kematian, layanan masyarakat, pengobatan-penangana

MEN'S INVOLVEMENT IN FAMILY PLANNING: A GENDER PERSPECTIVE

Akhir-akhir ini, keterlibatan pria dalam kesehatan reproduksi secara umum mulai banyak mendapat sorotan. Tulisan ini terutama membahas apakah keterlibatan tersebut berartimempersempit kesenjangan antara pria dan wanita secara umum. Dengan perspektif gender, keterlibatan pria dan wanita dianalisis dalam 3 tingkatan, yaitu pada tingkat kebijakan internasional, tingkat program dan tingkat individu. Hasil studi pustaka ini menunjukkan bahwa proses pembuatan keputusan yang berkaitan dengan keluarga berencana belum banyak dibahas, berbeda halnya dengan jenis keputusan dan pembuat keputusan. Untuk menyatakan bahwa keterlibatan pria berakibat positif terhadap kesetaraan gender (gender equality), diperlukan pemahaman yang lebih mendalam mengenai proses pembuatan keputusan sebagai titik kritis ke arah kesetaraan jender

Men\u27s Involvement In Family Planning: A Gender Perspective

ABSTRAK Akhir-akhir ini, keterlibatan pria dalam kesehatan reproduksi secara umum mulai banyak mendapat sorotan. Tulisan ini terutama membahas apakah keterlibatan tersebut berarti mempersempit kesenjangan antara pria dan wanita secara umum. Dengan perspektif gender, keterlibatan pria dan wanita dianalisis dalam 3 tingkatan, yaitu pada tingkat kebijakan internasional, tingkat program dan tingkat individu. Hasil studi pustaka ini menunjukkan bahwa proses pembuatan keputusan yang berkaitan dengan keluarga berencana belum banyak dibahas, berbeda halnya dengan jenis keputusan dan pembuat keputusan. Untuk menyatakan bahwa keterlibatan pria berakibat positif terhadap kesetaraan gender (gender equality), diperlukan pemahaman yang lebih mendalam mengenai proses pembuatan keputusan sebagai titik kritis ke arah kesetaraan jende

Analisis Self Reported Asuhan Persalinan Oleh Lulusan DIII Kebidanan Dan Medical Error an Analysis of Self Reported of Delivery Care by DIII Midwifery Graduates and Medical Error

Background: Increased coverage of deliveries by health personnel in Indonesia (82.3%) does not synergize with decreased MMR (228/100.000 live births). The low quality of care at the primary level becomes the main causal factor for the slow achievement of the MDGs. Midwives as providers in the primary care level become the front liners in delivery assistance. Public perception of the low quality of DIII midwifery graduates becomes a concern to the occurrence of medical errors by DIII midwifery graduates. Competence of delivery care is one of midwives' competences at risk of medical error. In Bantul District, the number of maternal deaths in 2010 was 18 cases with a majority of deaths occurring during childbirth.Objective: To describe compliance to normal delivery care and medical errors that occurred in the delivery care conducted by DIII midwifery graduates.Methods: A quantitative study with a cross-sectional design to the occurrence of medical errors in delivery care by DIII midwifery graduates in Bantul District. Data were collected by questionnaire (self reported) and analyzed by univariate, bivariate and multivariate.Results: The results of the analysis suggested that 41.51% medical error occurred in the delivery care and 24.53% of delivery care by D III midwifery graduates were categorized as not good (n = 53). Self reported about medical errors in the four aspects being studied showed that 14 respondents (26.42%) said that medical error ever occurred in the action aspect of delivery assistance, 10 respondents (18.87%) said that medical errors occurred in the prevention of infection, 8 respondents (15.09%) stated that medical error occurred during the administration of drugs and only 3 respondents (5.66%) said that medical errors occurred at the time of diagnosis establishment. Not good delivery care was significant to the occurrence of medical errors (p = 0.000), and 3.8 times causing a medical error after being controlled by extraneous variables (facilities & SOP) with R² value of 0.16.Conclusion: Delivery care by DIII midwifery graduates in Bantul District 75,5% was categorized good, and 41.51% medical error occurred in the delivery care. The prevalence of not good delivery care increased the incidence of medical errors than that of good delivery care. Medical errors in delivery care expressed through self-reported in this study showed that they were also influenced by the completeness of equipment and standard operating procedures in obstetric care facility

Implementasi Tata Kelola Klinis Oleh Komite Medik Di Rumah Sakit Umum Daerah Di Provinsi Jawa Tengah

Background: Clinical governance aims to deliver the bestclinical care for patient as stipulated in Law No. 44 of 2009about Hospital and the Minister of Health Decree No. 755/Menkes/Per/IV/2011 about Implementation of Medical Committee.Medical committee is in charge of implementing clinicalgovernance so that the medical staff at the hospital maintainedtheir professionalism.Objective:To measure implementation of clinical governanceby the medical committee at district general hospitals in CentralJava province.Methods: This was a cross-sectional survey study. The subjectswere 48 District General Hospitals in Central Java consistingof 1 class A,17 class B, 26 class Cand 4 class D. Dataobtained using questionnaire which measurestructure andprocess of clinical governance implementation. There are 8variables on structures and 13 variables on processes. Questionnaireswere sent to respondents through a courier serviceand answers were given by interviews or written responsesand analyzed descriptively.Results: Data obtained from 30 hospitals (1 class A, 12 classB,14 classC and 3 class D). The average level of clinical governanceimplementation is 67%.The average fulfillment level ofthe structure is 75 and 58% forthe processes. Implementationof the medical committee assignments is a medical audit 3.3%,credentialing 3.3%, sustainable professional development 50%and medical professional development 70%. There is severalconstraints in implementation the Minister of Health Decree No.755/Menkes/Per/IV/2011 because of the uneven spread ofspecialist and lack of support from hospital management.Conclusions: Implementation of clinical governance by themedical committee in district's hospitals in Central Java has notbeen in accordance with existing regulations. There is a needto strengthened the medical committee. It would need to manufactureclinical governance guidelines by the authorities andmonitoring its implementation

Clinical Outcomes of Geriatric Care in Cipto Mangunkusumo Hospital, Before and After the Implementation of National Health Insurance Program

Background: the National Health Insurance (NIH/JKN) has been enacted since January 2014. Various outcomes of geriatric patient care, such as improved functional status and quality of life have not been evaluated. Prolonged hospitalization and re-hospitalization are potentially affecting the efficiency care of this vulnarable group. This study aimed to identify the differences of functional status improvement, quality of life improvement, length of stay, and hospitalization of geriatric patients admitted to CMH between prior to and after NHI implementation.Methods: a cohort study with historical control was conducted among geriatric patients admitted to Acute Geriatric Ward CMH Hospital on two periods of time: January-December 2013 (pre-NHI implementation) and June 2014-May 2015 (after NHI implementation). Patients who died within 24 hours of hospital admission, those with APPACHE II score >24, advance stage cancer, transfer to other wards before they were discharged or have incomplete record were excluded from the study. Data on demographical and clinical characteristics, functional status, quality of life, length of stay, and re-hospitalization were taken from patient’s medical record. The differences of studied outcomes were analyzed using t-test or Mann-Whitney test.Results: there were 102 subjects in pre-NHI and 135 subjects in NHI groups included in the study. Median lengths of stay were not different between two groups (12.5 days in pre-NHI and 10 days in NHI groups, p=0.087), although the proportion of patients with in-hospital stay less than 14 days was higher in NHI group. The difference of functional status of discharged patients in pre-NHI and NHI groups were 3 and 3 (p=0.149) respectively, whereas for health-related quality of life, although NHI group in the beginning showed a lower quality of life compared to the pre-NHI (0.163 [0.480] vs. 0.243 [0.550]; p=0.012). However, after incorporating comprehensive geriatric assessment (CGA) the quality of life improved significantly by the end of in-hospital care in both groups. Re-hospitalization incidence in NHI group was lower compared to pre-NHI (7 [5.2%] vs. 13 [12.7%]; p=0.038).Conclusion: our study shows that there was  no  significant difference regarding length of stay, functional status, and health-related quality of life between prior to and after national health insurance implementation on admitted geriatric patients. Rehospitalization incidence showed better results in NHI group and hence NHI implementation is favored