COMMUNITY EMPOWERMENT THROUGH INTER-SECTORAL ACTION, A CASE STUDY OF GERBANGMAS IN LUMAJANG DISTRICT

The objective of this case study was to learn the policyprocess of the Gerbangmas movement in Lumajang districtas an innovation within decentralized system. Using qualitativeapproach, data was collected by in-depth interview of keyinformants and review of documents, then analyzedthematically. The study has revealed that the policy change ofGerbangmas initiative is not a radical but incremental processwhich takes around five years period. It started from“conventional Posyandus” to be “Balai Posyandu Mandiri”,then revived by the Bupati into Gerbangmas movement. Healthsector has successfully advocated the Bupati to create acommon vehicle for all sectors. The study has identified thatthe essences of Gerbangmas movement were (i) neutralvehicle, (ii) shared goals, (iii) all sectors could be passengers,(iv) strong power of the referee, (v) government financialstimulants, (vi) self management by community, and (vii) neutralcadres as the implementer (PKK). Gerbangmas movementhas encouraged multi sectors to set programs for communityempowerment. The study recommended that in conductingcommunity empowerment for addressing social determinantsof health, it is of importance to set a neutral vehicle that canaccommodate multi sectors’ interests.Keywords: community empowerment, Posyandu,Gerbangmas, inter-sectoral action, social determinants ofhealt

IMPROVING ACCESS TO NARCOTIC ANALGESICS: THE INTERNATIONAL CONTROL SYSTEM AND OPTIONS FOR QUANTIFICATION METHOD

Narkotika lebih dikenal masyarakat karena masalahpenyalahgunaannya, padahal salah satu kelompok narkotikayang digunakan dalam bidang medis adalah analgetika narkotika,utamanya tablet morfin, yang merupakan obat esensial.Penghitungan kebutuhan yang akurat untuk analgetika narkotikasangat penting untuk memastikan ketersediaannya bagipelayanan kesehatan pasien. Saat ini data global menunjukkanbahwa penggunaan morfin lebih terkonsentrasi di beberapanegara di Eropa dan Amerika Utara saja, sedangkan di negaranegaralain termasuk Indonesia, konsumsinya sangat minim.Morfin bahkan tak tersedia di 70 negara dan teritori.Penyebabnya bisa karena kurang akuratnya penghitungankebutuhan, kurang digunakan atau karena kebocoran distribusi.Di lain pihak, ketidakakuratan penghitungan juga bisamenyebabkan surplus persediaan yang bisa menyebabkankebocoran distribusi dan dapat mengarah ke penyalahgunaan.Oleh karena itu, sangatlah penting untuk memilih metodepenghitungan kebutuhan morfin yang paling tepat, agarkebutuhan medis terpenuhi secara optimal. Makalah inimenyajikan sistem pengawasan internasional untuk penyediaannarkotika bagi kebutuhan medis, dan langkah-langkah untukmeningkatkan keakuratan penghitungan kebutuhan analgetikanarkotika, dengan tetap memperhatikan langkah-langkahpengamanan distribusinya.Kata Kunci: sistem pengawasan internasional, analgetikanarcotika, morfin, estimasi, metode kuantifikas

CEMA-COMMUNITY TO IMPROVE KNOWLEDGE AND SKILLS IN EVALUATING MEDICINE ADVERTISEMENTS

Backgrounds: Since objective information on medicineadvertisements are often scarce, medicine advertisementsmay affect community’s perception and health. The CriticalEvaluation Medicine Advertisement by the community (CEMAcommunity)was a strategy that may empower community inevaluating medicine advertisements. It was developed basedon the previous study targeted to medical students withmodifications on the content and the inclusion of local regulationon medicine promotion.Objectives: To evaluate effectiveness of the CEMAcommunitymethod in improving knowledge and skills ofparticipants.Methods: The study utilized pre and post in time series withcontrol group design. The CEMA-community intervention methodconsisted of two sessions; the first was a brief lecture andthe second was small group discussions using printed andaudiovisual medicine advertisements in problem-orientedapproach. Activity materials and methods were developed andprovided to the activity. Data on knowledge was obtained byquestionnaires. Data on skills was assessed by the number ofinappropriate claims they could identify the advertisements.Effectiveness of approach was shown by the significance ofincreasing level of knowledge and skills after intervention.Results: Participants’ knowledge and skills in the CEMAcommunitygroup improved significantly (Wilcoxon test, p< 0.05).Score of knowledge in the CEMA-community group before-,right-, and 2, 4 weeks-after intervention (means: 13.9±2.52;18.0±2.72; 19.0±3.10; 18.3±3.74, respectively) improvedsignificantly (Mann-Whitney, p<0.05) as compared to controlgroup (means: 14.1± 2.84; 14.8±2.94; 14.8±2.85; 15.6±2.45,respectively). At the same time points, scores of skills in theCEMA-community group (means: 7.8±6.05; 16.5±10.01;32.6±12.89; 32.2±13.06, respectively) also improvedsignificantly (Mann-Whitney, p<0.05) as compared to controlgroup (5.5±6.60; 4.7±4.91; 8.7±10.07; 9.5±10.15, respectively).Conclusion: CEMA-community was effective in increasingknowledge and skills to critically evaluate medicineadvertisements.Keywords: community empowerment, medicineadvertisements, knowledge, skills, CEMA-community, problemorientedapproac

MEASURING TRANSPARENCY TO IMPROVE GOOD GOVERNANCE OF PHARMACEUTICALS IN INDONESIA

A national survey has been conducted to assess thetransparency in public pharmaceutical sector in Indonesia. Thesurvey was conducted during 2007, and writer was appointedby the government as independent assessor. The assessmentcovered five functions of government in pharmaceutical sector,i.e., registration, control of promotion, inspection of production,selection of essential medicines, and central procurement ofnational buffer stock. Key informants were selected based onfirst-hand knowledge on each function, representinggovernment, pharmaceutical company, academe/professionals,and NGOs, i.e. 10 informants for each registration, control ofpromotion, inspection of production, selection of essentialmedicines, and 20 informants for central procurement. Datawere collected by means of in-depth interviews, using sets ofquestionnaires provided by the WHO. Findings were analyzedfollowing a scoring system that ranging from zero to ten. Thesmaller the score indicates in-transparency, and thereforeindicates the more vulnerability for corruption.The results showed that the registration process scored 7.2,control of promotion scored 7.6, inspection of production scored8.7, selection of essential medicines scored only 5.5, and thecentral procurement scored 7.0. In general, it is appreciatedthat the functions of registration, control of promotion,inspection, and procurement were well governed, but theselection of essential medicines obtained a low score. Therehas been remarkable lacking of written procedures that publiclyavailable. In regard to the selection function, there is no writtenprocedure in every process of selection, i.e., selection criteriaof the revision committee member, written criteria for application,written criteria for addition, substitution and deletion, and writtenprocedures of decision making. Declaration of interest is tosome extents, lacking from most functions. It wasrecommended that the Government should establish writtenprocedures of each function and make them publicly available,establish mechanism to minimize conflict of interest in eachfunction i.e., by means of declaration of interest, and establishmeasures to fill up regulatory gaps. By the time of publication,corrective actions in all five functions have been made and atthe time being the Government is ready for re-assessment.Key words: transparency, pharmaceuticals, good governance,public sector, vulnerability for corruptio

A PILOT PROJECT ON INACTIVATED POLIO VACCINE IN YOGYAKARTA PROVINCE: THE COVERAGE AND TIMELINESS PILOT PROJECT VAKSIN POLIO INAKTIF DI PROPINSI YOGYAKARTA:

Background: Yogyakarta Province is the only province inIndonesia that piloted IPV immunization since September 2007.Therefore, it is essential to evaluate the implementation of thisnew program. This study was aimed to determine the coverageand timeliness of the IPV immunization after 2.5 years ofits introduction.Method: A cross sectional study was carried out using theWHO standard cluster sampling to estimate the immunizationcoverage in urban Yogyakarta City and the remaining ruraldistricts in Yogyakarta Province. The subjects consisted ofchildren aged 12-23 months old and their parents. A questionnairewas used to acquire information from parents/caregiverson demographic, socioeconomic, and IPV immunization status,dates, location, and access of immunization. Epi InfoTM 2003software was used for data entry and analysis.Result: Overall, 426 children were involved in the study (215in urban and 211 in rural areas). The coverage for IPV1 throughIPV4 was 100%, 99.8%, 99.3%, and 96.7%, respectively. Therewas no difference in coverage by urban/rural location, parents’education level, number of siblings, and distance to healthservice. The coverage is very similar to that of survey in 2004when this province still used oral polio vaccine. The meanages of IPV administration were 2.3, 3.5, 4.8, and 9.4 and nosignificant difference among urban and rural areas was found.More than 95% children received IPV immunization at appropriateage.Conclusion: The IPV pilot project in Yogyakarta Province hasbeen implemented well with high coverage and appropriatetimeliness.Keywords: immunization, polio eradication, IPV, coverage, timelines

INTEGRATING MULTIVARIATE METHOD AND QUALITY FUNCTION DEPLOYMENT TO ANALYZE IN-PATIENT SATISFACTION

Background : The increasing competition in healthcareindustry has caused the delivery of service quality to patientsbecome essential. Every hospital competes to deliver the bestservice to its patients. As a result, it is necessary to analyzehospitalized patient satisfaction. This study discusses servicequality improvement in healthcare industry by analyzing inpatientsatisfaction using Multivariate Analysis and QualityFunction Deployment (QFD).Objectives: The objectives of this study are to identify patients’characteristics which are significantly affect their satisfactionlevel, to identify service attributes and dimensions which arecritical to patients, and subsequently improve those attributes.Method: The identification of characteristics and servicedimensions which are significantly affect patients’ satisfactionlevel is accomplished using Multivariate Analysis. While thecritical service attributes identification is completed usingImportance-Performance Analysis. Afterward, using Houseof Quality (HOQ), as the basis of QFD, those critical serviceattributes are developed into service elements.Result: Using Discriminant Analysis, the result of this studyshows that patients’ characteristics which significantly affecttheir satisfaction level are sex and occupation. The male andunemployed patients are more satisfied than the female andemployed patients. Afterward, Factor Analysis brings aboutfive new factors (service dimensions), which are the linearcombinations of the original 42 service attributes. Based onthe Importance-Performance Analysis, there are four serviceattributes which are critical to be improved which have highimportance level, but low performance level. Then, using theQuality Function Deployment (QFD), the four critical serviceattributes are developed into service elements. The serviceelements with high priorities are training program, recruitmentof experts, standard of information flow, online administrationsystem, and computer as provider of information.Conclusion: Service quality improvement in healthcareindustry can be analyzed more comprehensive by integratingMultivariate Method and Quality Function Deployment (QFD).The result of this study may provide contributions to hospitalsin general in enhancing its service performance to achieve itspatients’ satisfaction.Keywords: customer satisfaction, healthcare industry,multivariate analysis, quality function deploymen

NURSE-PHYSICIAN COLLABORATIVE PRACTICE IN INTERDISCIPLINARY MODEL OF PATIENT CARE

Latar belakang: Penelitian tentang kolaborasi antara dokterdan perawat dalam asuhan pasien pada model pelayananrawat inap terpadu (MPRIT) merupakan bagian dari actionresearch yang bertujuan untuk mengembangkan model asuhanpasien sebagai basis integrasi antar profesi dalam pelayanankesehatan di rumah sakit pendidikan Hasan Sadikin. Modelpelayanan rawat inap terpadu (MPRIT) dikembangkan untukmeningkatkan tata kelola pelayanan pasien di tatanan rawatinap guna mengatasi fragmentasi pelayanan karena tumpangtindihnya peran dan fungsi care provider dengan latar belakangprofesi yang berbeda. Diharapkan potensi kerawanan terhadapberbagai kesalahan dapat diantisipasi dan diminimalisasi, sertakeutuhan dan kesinambungan pelayanan pasien dapatdiwujudkan. Tujuan penelitian ini adalah untuk mengidentifikasikerjasama dokter dan perawat secara kohesif dalam empatkomponen model yaitu alur proses pengelolaan pasien,pengelolaan pasien secara tim, dokumentasi asuhan pasiensecara terpadu dan pemecahan masalah secara interdisiplin.Metode: Penelitian ini menggunakan studi deskriptif untukmengidentifikasi perilaku afiliasi dan perilaku individu padakelompok dokter dan perawat yang menjalani proses kolaborasidalam pelayanan pasien di unit dengan MPRIT. Sejumlah 39dokter dan 32 perawat berpartisipasi dalam penelitian ini.Instrumen untuk mengukur perilaku afiliatif dan perilaku individudikembangkan berdasarkan konsep pelayanan interdisiplin dariSullivan. Kohesivitas dokter dan perawat dalam kolaborasiasuhan diukur dengan uji beda rerata skor perilaku afiliasi danperilaku individu pada keempat komponen model.Hasil: Rerata skor perilaku afiliatif secara signifikan lebih besardari perilaku individu pada tiga komponen model yaitu alur prosespengelolaan pasien, pengelolaan pasien secara tim, danpenyelesaian masalah secara interdisiplin. Temuan inimengindikasikan bahwa dalam proses kolaborasi, dokter danperawat cenderung menggunakan pendekatan share expertisedaripada personal autonomy. Hal ini merupakan ciri kohesivitaskelompok. Baik pada kelompok dokter maupun perawat, rerataskor perilaku afiliasi lebih besar dari perilaku individu. Pada ujibeda rerata skor perilaku individu antara dokter dan perawat,tidak ada perbedaan yang bermakna pada alur prosespengelolaan pasien dan dokumentasi asuhan terpadu. Adapunpada pengelolaan pasien secara tim dan penyelesaian masalahsecara interdisiplin, rerata skor perilaku individu dokter secarabermakna lebih besar dari perawat. Pada uji beda rerata skorperilaku afiliasi antara kelompok dokter dan perawat, tidak adaperbedaan yang signifikan di alur proses pengelolaan pasiendan pengelolaan pasien secara tim. Adapun untuk dokumentasiasuhan terpadu dan penyelesaian masalah secara interdisiplin,secara signifikan rerata skor perilaku afiliasi dokter lebih besardari perawat.Kesimpulan: Share expertise merupakan ciri penting perilakuafiliasi yang diperlukan untuk mewujudkan kerja sama yangkohesif antar pelaku pelayanan kesehatan. Penelitian inimenyimpulkan bahwa dokter dan perawat bekerjasama secarakohesif pada alur proses pengelolaan pasien dan pengelolaanpasien secara tim.Kata kunci: kolaborasi, dokter-perawat, interdisiplin, perilakuafiliasi, perilaku individ

DEVELOPING A FRAMEWORK FOR CIVIL AVIATION OCCUPATIONAL HEALTH AND SAFETY SYSTEM IN INDONESIA

A series of aircraft accidents in the past three years exposedserious safety problems in Indonesian civil aviation. Latestaviation accident investigations reported that flight crews weremainly responsible for two major accidents happened in 2007.This indicates that occupational health and safety (OHS) is anintegral part of civil aviation. Improvement in OHS system wouldthen contribute to the development in Indonesian civil aviationsafety in general. This paper seeks to present applicable OHSdesigns in Indonesian civil aviation by carefully consideringlocal situations, current problems and their determinants.Furthermore, ideal designs based on literature reviews andgood practices in some developed countries were examinedto show the main principles and components needed indesigning a civil aviation OHS system.Keywords: OHS system, civil aviation, IndonesiaABSTRAKSerangkaian kecelakaan pesawat udara dalam tiga tahunterakhir telah menunjukkan masalah keselamatan yang seriusdi dunia penerbangan sipil Indonesia. Dari hasil investigasiterbaru, kru penerbang dilaporkan bertanggung jawab terhadapdua kecelakaan maut yang terjadi tahun 2007. Hal inimengindikasikan bahwa kesehatan dan keselamatan kerja (K3)merupakan bagian yang sangat penting dalam penerbangansipil. Perbaikan dalam sistem K3 akan memberikan kontribusidalam peningkatan keselamatan penerbangan sipil di Indonesiasecara umum. Tulisan ini menunjukkan desain K3 yang bisaditerapkan di penerbangan sipil Indonesia denganmempertimbangkan situasi lokal, permasalahan saat ini danfaktor-faktor penentunya. Lebih jauh, desain yang idealberdasarkan studi kepustakaan dan praktik-praktik yang baikdi beberapa negara maju dianalisis untuk menunjukkan prinsipprinsipdan komponen-komponen utama yang diperlukan dalammerancang sebuah sistem K3 penerbangan sipil.Kata Kunci: sistem K3, penerbangan sipil, Indonesi

ROLES OF THE STAKE HOLDER AND PROVIDER OF BATAM CITY IN AN ATTEMPT TO ENHANCE CLINICAL GOVERNANCE OF HEALTH SERVICES IN CONNECTION WITH DOCTOR PRACTICE LAWS

Background: Deming (1984), Crosby (1979, 1985), and Juran(1988), all found that more than 85% of errors are related to asystem; whereas, only 15% of them constitute human error,or an employee’s. According to NGO coordinator, IskandarSitorus, 2000 victims of malpractice have been recordedthroughout Kepulauan Riau. This malpractice occurs when asystem does not have a proper policy, standard procedure,and equipment needed.Objective: The purpose of this research is to find out themanagement, obstacles, and expectations with regards toclinical governance management from the point of view of thestakeholder and provider of Batam City.Method: The method used in this research was a qualitativemethod with a grounded theory. The primary data are derivedfrom in-depth interview. The respondents involved are thecommission IV chairperson of Batam City local Parliament,Kepulauan Riau, chairperson of Medical Committee of Batu AjiLocal Public Hospital Kepulauan Riau using a purposivesampling with an extreme case sampling approach.Result and conclusion: The research shows that clinicalgovernance by the stakeholder and provider still needs furtherimprovement. There are still obstacles in terms of regulationsand implementation of clinical governance. Based on theMinimum Service Standard, some indicators of Batam City in2008 did not meet the performance target and national standard.Therefore, the clinical governance system has not beenimplemented throughout health services in Batam City.Suggestions: For IV Legislative Commission for People’sWelfare and Human Resources Batam Riau Islands areexpected to lack of regulation and appropriate systems inimproving health services. And then for Hospital MedicalCommittee Batu Aji, Batam Riau Islands is expected to implementClinical Governance.It is expected that the recording and reporting systems as wellas obtaining accurate data in making the next Batam healthprofile based on the quality of evidence-based.Keywords: Clinical Governance, stakeholder, provide

MODELLING THE DEMAND FOR HEALTH CARE GIVEN INSURANCE: NOTES FOR RESEARCHERS

Understanding on health care demand given insurance givesprecious information to anticipate health care costs in the future,which in turn provides valuable information for policy makers,among other, to estimate claim rate, set up premium, designcost-sharing policy, etc. Unfortunately, estimating the effectsof health insurance on health care demand is not straightforward. This paper identifies crucial factors (e.g., adverseselection and provider behaviour) that need to be consideredin estimating the effects of health insurance on health caredemand. These considerations persuade researchers to usea rigorous econometric model in estimating health care demandgiven insurance with a view to isolate the true effects ofhealth insurance program. Such considerations can be furtherclassified into two-main factors. First is the features of thedependent variables used to measure the demand, and secondis the source of the data (or study design) used in the analysis.Keywords: modelling, health insurance, demand healthcareservices, applied econometric