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This study observes social movement in digitalized world along with its role in public policy process. It is especially on how the social movement has access as well as spread and was formed the knowledge in the digitalized world. This study is essential to be further explored in order to enrich the theories of governance and public policies in the digital era. The case to be studied here is anti-vaccine movement in Facebook which has developed in the digitalized world in the context of socio-politics of the Indonesian people in 2018-2019 and using a Content Analysis as method. This study result is that the Anti-vaccine Movement in Indonesia rejected the vaccine program by attacking knowledge hegemony created by medical institutions and government. It has formed a new knowledge by issuing a counter discourse toward the medical discourse. The argument centered on moral anger and structural repression by government agencies, worldwide institutions, pharmacy industries and media and shows the strong logic based on the religious believe idea. This fact shows that the social media plays a role in spreading the ideas of anti-vaccine and gives a way for the movement to develop and to have a strong network which is dynamic and can survive for a long period of time. By mobilizing knowledge through a social movement in the digitalized world, the anti-vaccine movement in Indonesia has a wider network and has a potential to influence the successful of the government program.

Analysing trends and levels of the burden of disease at the national level can mask inequalities in health-related progress in lower administrative units such as provinces and districts. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to analyse health patterns in Indonesia at the provincial level between 1990 and 2019. Long-term analyses of disease burden provide insights on Indonesia's advance to universal health coverage and its ability to meet the United Nations Sustainable Development Goals by 2030.We analysed GBD 2019 estimated cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 286 causes of death, 369 causes of non-fatal health loss, and 87 risk factors by year, age, and sex for Indonesia and its 34 provinces from 1990 to 2019. To generate estimates for Indonesia at the national level, we used 138 location-years of data to estimate Indonesia-specific demographic indicators, 317 location-years of data for Indonesia-specific causes of death, 689 location-years of data for Indonesia-specific non-fatal outcomes, 250 location-years of data for Indonesia-specific risk factors, and 1641 location-years of data for Indonesia-specific covariates. For subnational estimates, we used the following source counts: 138 location-years of data to estimate Indonesia-specific demographic indicators; 5848 location-years of data for Indonesia-specific causes of death; 1534 location-years of data for Indonesia-specific non-fatal outcomes; 650 location-years of data for Indonesia-specific risk factors; and 16 016 location-years of data for Indonesia-specific covariates. We generated our GBD 2019 estimates for Indonesia by including 1 915 207 total source metadata rows, and we used 821 total citations.Life expectancy for males across Indonesia increased from 62·5 years (95% uncertainty interval 61·3-63·7) to 69·4 years (67·2-71·6) between 1990 and 2019, a positive change of 6·9 years. For females during the same period, life expectancy increased from 65·7 years (64·5-66·8) to 73·5 years (71·6-75·6), an increase of 7·8 years. There were large disparities in health outcomes among provinces. In 2019, Bali had the highest life expectancy at birth for males (74·4 years, 70·90-77·9) and North Kalimantan had the highest life expectancy at birth for females (77·7 years, 74·7-81·2), whereas Papua had the lowest life expectancy at birth for males (64·5 years, 60·9-68·2) and North Maluku had the lowest life expectancy at birth for females (64·0 years, 60·7-67·3). The difference in life expectancy for males between the highest-ranked and lowest-ranked provinces was 9·9 years and the difference in life expectacy for females between the highest-ranked and lowest-ranked provinces was 13·7 years. Age-standardised death, YLL, and YLD rates also varied widely among the provinces in 2019. High systolic blood pressure, tobacco, dietary risks, high fasting plasma glucose, and high BMI were the five leading risks contributing to health loss measured as DALYs in 2019.Our findings highlight that Indonesia faces a double burden of communicable and non-communicable diseases that varies across provinces. From 1990 to 2019, Indonesia witnessed a decline in the infectious disease burden, although communicable diseases such as tuberculosis, diarrhoeal diseases, and lower respiratory infections have remained a main source of DALYs in Indonesia. During that same period, however, all-ages death and disability rates from non-communicable diseases and exposure to their risk factors accounted for larger shares of health loss. The differences in health outcomes between the highest-performing and lowest-performing provinces have also widened since 1990. Our findings support a comprehensive process to revisit current health policies, examine the root causes of variation in the burden of disease among provinces, and strengthen programmes and policies aimed at reducing disparities across the country.The BillMelinda Gates Foundation and the Government of Indonesia.For the Bahasa Indonesia translation of the abstract see Supplementary Materials section.

BackgroundWe assessed the effect of Indonesia’s national health insurance programme (Jaminan Kesehatan Nasional(JKN)) on effective coverage for maternal and child health across geographical regions and population groups.MethodsWe used four waves of the Indonesia Demographic and Health Survey from 2000 to 2017, which included 38 880 women aged 15–49 years and 144 000 birth records. Key outcomes included antenatal and delivery care, caesarean section and neonatal and infant mortality. We used multilevel interrupted time-series regression to examine changes in outcomes after the introduction of the JKN in January 2014.FindingsJKN introduction was associated with significant level increases in (1) antenatal care (ANC) crude coverage (adjusted OR (aOR) 1.81, 95% CI 1.44 to 2.27); (2) ANC quality-adjusted coverage (aOR 1.66, 95% CI 1.38 to 1.98); (3) ANC user-adherence-adjusted coverage (aOR 1.80, 95% CI 1.45 to 2.25); (4) safe delivery service contact (aOR 1.83, 95% CI 1.42 to 2.36); and (5) safe delivery crude coverage (aOR 1.45, 95% CI 1.20 to 1.75). We did not find any significant level increase in ANC service contact or caesarean section. Interestingly, increases in ANC service contact and crude coverage, and safe delivery crude coverage were larger among the poorest compared with the most affluent. No statistically significant associations were found between JKN introduction and neonatal and infant mortality (p>0.05) in the first 3 years following implementation.InterpretationExpansion of social health insurance led to substantial improvements in quality of care for maternal health services but not in child mortality. Concerted efforts are required to equitably improve service quality and child mortality across the population in Indonesia.

Highlights: Managing human resources for surge capacity in three referral hospital at West Kalimantan was evaluated. Availability, mobilization and recruitment, duties division, and hospital staff welfare are the reasons for referral hospitals in West Kalimantan are not optimal to face surge capacity during the Covid-19 pandemic. Provincial Health Office role had not been optimal in the HR management at referral hospitals during the Covid-19 pandemic. Abstract: One of the components of effective disaster response management to deal with surge capacity in referral hospitals in West Kalimantan, Indonesia, was to ensure the adequacy of the number of human resources (health workers). This study was conducted to evaluate three referral hospitals and identify the role of the West Kalimantan Provincial Health Office in managing human resources for health workers facing surge capacity due to the Covid-19 pandemic. This study used Rapid Assessment Procedures with qualitative and quantitative methods. Data were collected through observation and interview by using instruments adopted from the Checklist of WHO Hospital Readiness for Covid-19. Based on the checklist, 51.1% of referral hospitals had implemented HR management regarding staff availability. However, the readiness of referral hospitals in West Kalimantan to face surge capacity had not been optimal in several key components, such as staff availability, staff mobilization and recruitment, division of staff duties, and hospital staff welfare during the Covid-19 pandemic. The role of the Provincial Health Office had not been optimal in managing HR at referral hospitals. The Provincial Health Office only played an active role at the beginning of the Covid-19 pandemic, especially for the provision of volunteers. Meanwhile, in the second year of the Covid-19 pandemic, the role of the Provincial Health Office had decreased, especially in the staff availability and training at the referral hospitals. Therefore, the role of the West Kalimantan Provincial Health Office in HR management at the referral hospitals was highly not dominant (17.78%). The central government should regulate the authority of the Provincial Health Office as the leading sector in all types of referral hospitals to integrate all potencies and human resources of local governments to maximize HR management in referral hospitals to face surge capacity due to the increased cases of Covid-19.

BACKGROUND: The Indonesian Social Health Security Agency has a key role in improving the community’s quality of life by providing financial access to all citizens to fulfill basic health needs. The society has received government funding for basic health needs through direct costs. On the other hand, there are also indirect costs for non-medical needs that may potentially become problems for some people. The concept of philanthropy was developed and became a significant and concrete utility in responding to Indonesian health problems. AIM: Our study aimed to explore challenges faced by the Indonesian philanthropic institutions in managing charitable giving to the health sector. METHODS: We conducted a qualitative study to explore challenges faced by the Indonesian philanthropic institutions in managing charitable giving to the health sector. RESULTS: As a result, we found that internal and external support and synchronous collaboration become a common theme of challenges in managing health philanthropy in Indonesia. CONCLUSION: Cross-sectorial partnerships in the health sector might improve national welfare as we work toward achieving the sustainable development goals.

Background: RSUP dr Sardjito, as the primary teaching hospital of FK UGM received many PPDS1. PPDS 1 makes a significant contributionto patient care. PPDS1 at work has not been considered a hospital worker. Meanwhile, PPDS1 has the right as a temporaryofficial hospital worker while taking specialization education.Objective: This study aims to determine differences in the workload.Methods: This is observational research with direct observation of the length of time for DPJP and PPDS1 service activities accordingto the type of activity. The research subjects were PPDS1 from KSM General, KSM Pediatric Surgery, KSM Urology, KSM Pediatrics atvarious levels. Data analysis was carried out by compiling and calculating the group average of invasive and non-invasive medicalprocedures and the average of all.Results: The extended workload of PPDS1 and DPJP student services in pediatric surgery services carried out by red pin residentsis approximately 35%, yellow pin residents and 25%, green pin residents 25, and DPJP about 15%. In general surgery services,about 28% red residents, 24% yellow pin residents, 25% green pin residents, and 23% DPJP. In urology services, about 28% red pin residents, 25% yellow pin residents, 28% green pin residents, and 19% DPJP. UPA residents with red pins are 8%, yellow pin residentsare 23%, green pin residents are 59%, and DPJP is 10%. During the pandemic, the proportion of service time, in general, was 82% held by residents.Conclusion: The workload for red pin residents is 24%, yellow pin residents 24%, green pin residents 34%, and DPJP 18%. Duringthe pandemic, the proportion of surgical service time, in general, was carried out by residents. Service responsibility remains with DPJP even though the length of direct service to patients is only 18% on average.

Background: The number of global COVIF-19 cases was 191,148,056 million confirmed cases, 4,109,303 cases died, 204countries were infected, and 151 countries experienced local transmission. The outbreak of CoronaVirus Disease-19 (COVIF-19) inIndonesia is increasing. To date, 3,033,339 confirmed cases and 79,032 cases died. This situation causes COVID-19 cases to be stillthe main agenda in handling health in Indonesia and even globally.Objective: This study aims to identify and explain the analysis of preparedness, response, and recovery activities in handling Covid-19 cases in the Bima Regency.Methods: This type of research is qualitative research using a descriptive analysis approach that will describe an event based on theresults that have been analyzed. The research subjects were eight stakeholders who handled Covid-19 in Bima Regency. Researchdata will be collected using a checklist sheet from 2020 WHO guidelines.Data analysis is carried out using the Miles and Huberman model, namely: data collection, data reduction, data descriptionpresentation, conclusions.Results: Based on the percentage of activities that only developed by 21.43%, the preparedness and readiness phase, it canbe concluded that the handling of Covid-19 by stakeholders is not optimal due to several internal factors as well as from the community.Stakeholders have not conducted training and education for health workers regarding the handling of Covid-19 because no budgetplanning has been carried out. This has resulted in many health workers being exposed to Covid-19 in referral hospitals. Meanwhile,recovery by vaccinating the community is facilitated by all the primary health care in all areas of Bima Regency.Conclusion: In general, the Covid-19 Task Force in Bima Regency has not optimally carried out handling based on preparedness, response, and recovery aspects. The condition of handling Covid-19 cases has obstacles, namely the lack of health infrastructure, for example, health logistics and lack of public awareness in handling Covid-19 cases.

Background: The Kampung KB program since 2016 has made families take the initiative to invite the surrounding environment to participate in fulfilling family planning needs independently. The village KB program builds cross-sectoral collaboration, one of which is fulfilling aspects of family planning with the achievement of longterm contraceptives (MKJP).Objective: This study aims to explore the extent which is the effectiveness of Kampung KB Program was implemented and has an impact on MKJP achievements in Desa Sumberjaya Kecamatan Gondanglegi, Kabupaten Malang.Methods: The approach is a case study using quantitative and qualitative data that will provide information about the context, input, process, and product of family planning targets. Quantitative data were collected from documented secondary data reports. Subjects totalling 22 people are stakeholders involved in implementing family planning policies and program activities. Data were analyzed using content analysis.Results: The implementation of Kampung KB Program in Desa Sumberjaya, Kecamatan Gondanglegi, has been going well in termsof the implementation of POKJA activities, the activity of field line officers, and the availability of contraceptives. In addition, the obstaclesthat need to be addressed are the insufficient distribution of PLKB/Sub PPKBD/cadres in the field, low financial support coupledwith the absence of a strong policy and other challenges that are difficult to penetrate public trust related to MKJP.Conclusion: Aspects that caused MKJP’s achievement have not reached the target in Desa Sumberjaya Kecamatan GondanglegiKabupaten Malang, including the lack of field line officers, minimal operational funding support, less operational policies, and theexistence of a pandemic that caused many activities to be limited and even stopped as well as factors such as the socio-cultural complaints that are complained of difficult for field line officers to penetrate.

Background: WHO has designated COVID-19 as a World Public Health Emergency. Success of the district level in handling COVID-19 is determined by the efforts made in these 3 phases: preparedness, response, and recovery. Sleman which has an urban character has its own vulnerabilitie and resources in the COVID-19 pandemic situation. Objective: This study aimed to obtain an overview of the preparedness, response, and recovery in controlling COVID-19. Methods: Qualitative research with a case study design in Sleman using the WHO Practical Actions in Cities to Strength Preparedness Checklist for the COVID-19 Pandemic and Beyond. The research subjects are informants who play a role in Task Force. Data were collected by means of documentation studies, observation, and in-depth interviews. Data validation was done by triangulation of sources and research data. Results: Expert academics and communities are less involved. At the beginning of the pandemic, risk communication was less than optimal to form stakeholder awareness in the government and the community, resulting in poor public compliance with health protocols and public health measures. Mobility restrictions follow national directives. However, compliance monitoring and enforcement of violations are weak. Testing and tracing capacity is still far below the standard. The strategy to increase the capacity of COVID-19 beds in hospitals does not anticipate a surge in cases, and the formation of village shelters has not been maximized. Conclusion: Planning and coordination require improvement by taking into account existing vulnerabilities and involving all resources in the community. Risk communication strategies need to be strengthened according to changing situations and tailored to specific targets using effective media. The government needs to make adjustments to public health measures carefully, taking into account the epidemiological situation, the capacity of the health system, and the socioeconomic conditions of the community.

Background: Changes in the Hospital (RS) business environment have occurred significantly since JKN was introduced by BPJS Kesehatan. In this era, hospital managers are confused about the following changes and hospital performance is declining. Objective: This study measures the service and financial performance before and after the JKN era. Methods: Descriptive research design with quantitative methods at RSKIA SADEWA. The data used are secondary data from medical record data, hospital service data and financial statements (2011-2019) Results: After the implementation of the JKN program, there was an increase in the number of patient visits by 35.23% for outpatients and 36.43% for inpatients. The percentage of inpatients who used health insurance before the JKN era was only around 3%, and after the JKN era the number increased sharply to 73%. BOR increased by 1.83%. The SC rate decreased by 0.83%. Of all general patients with Caesarean Sectio in RSKIA SADEWA, an average of 54.75% were BPJS participants, but aborted their BPJS rights. The average hospital revenue increased by 93.72%, operating costs decreased 5.78%, HR costs increased 1.52% and net profit increased 4.26%. The proportion of hospital revenue obtained from BPJS patients on average is 26.38% of the total hospital revenue. The average ROA after JKN era increased 5,96%. The average financial quick ratio increased by 443%. The average financial solvency decreased by 0.03. The average CRR increased by 7%. Conclusion: After the JKN era, there was an increase in the number of outpatient and inpatient visits. BOR increases, and SC rate decreases. Financial performance is measured by indicators of ROA, Quick Ratio, solvency and CRR. All indicators show an improvement, and there is no change in the environment after implementing the JKN program. Strict evaluation is needed to maintain and improve the achieved performance.

BACKGROUND: Pandemics can increase disease spread, as well as unpredictable and highly in patient demand, which can have a negative impact on hospital capacity and the overall functioning of the health-care system. The preparedness and capacity of intensive care services to respond to COVID-19 in Indonesia are remain unknown. AIM: This study aimed to investigate the preparedness and capacity of intensive care services in Indonesia to respond to the initial stage of the COVID-19 pandemic. METHODS: A mixed-method research design was used in this study using in-depth interviews and an online survey. An in-depth interview was conducted with the medical team (intensive care consultant and an anesthesiologist) who is actively involved in the provision of COVID-19 services in 15 national referral hospitals. The online survey was conducted to all medical teams that provide direct care to the COVID-19 patients. A total of 459 (response rate was 95.2%) agreed to join the survey. The content analysis technique was used to analyze qualitative data and a descriptive analysis was used to describe issues encountered in providing health services to COVID-19 patients. RESULTS: The analysis preparedness and capacity of intensive care service in Indonesia to respond to the initial stage of the COVID-19 pandemic resulting in 4 themes with 12 sub-themes. The four themes were limited quality and quantity of standardized intensive care unit (ICU) isolation room (inadequate zoning systems, adequacy of the standardized ICU isolation room, the readiness of the hospital infrastructure, and telemedicine facilities are not yet widely used, including in the COVID-19 isolation room), limited medical service support (lack of personal protective equipment (personal protective equipment [PPE], re-used PPE, lack of availability of medical devices), limitations in the medical team’s quality and quantity management (lack of number and distribution of expert doctors and medical team screening for ICU), and command systems (task shifting, effective communication, and leadership). CONCLUSION: Medical team encounters several difficulties, particularly related to the quality of facilities, staff preparedness, and systems for the provision of services to COVID-19 patients with critical conditions. There is a critical need for well-defined pathways, legal protection, and occupational health for medical teams providing services in the aftermath of a pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID)-19 pandemic is a challenge for the intensive care unit (ICU) medical team. It requires management of space, stuff (medical equipment including drugs), staff, and system readiness (4S) to deal with the surge in the number of patients. AIM: This survey aims to describe the current readiness efforts among ICU medical team at the COVID-19 referral hospitals in Indonesia; space, stuff readiness, staff, and systems readiness. METHODS: We conducted a cross-sectional national web-based survey of ICUs across referral hospitals during pandemic COVID-19 in Indonesia from June to October 2020. The medical teams survey included 53 questions in multiple parts addressing five dimensions. A linear regression model was applied to determine the factors related with readiness. RESULTS: A total of 459 participants (83.6%) agreed to join in this study. The participants’ average age was 40.43 years (SD = 5.78). About 62.53% were male, 51.20% had bachelor degree, and 55.77% lived outside of Java Island. The mean of total score of medical team readiness was 2.76 (SD = 0.320) and the highest (maximum score) mean score of medical team readiness domain was stuff (2.81, SD = 7.72). Education, working experience, training, perception of risk of contracting COVID-19, and residence had a substantial effect on the readiness, with R2 values of 0.378, p < 0.05. CONCLUSIONS: This study provides an initial view of current preparedness efforts among a group of ICUs in Indonesia’s leading hospital during the first wave of pandemic. Interventions must be developed and implemented quickly to increase the medical team’s readiness to care for a future pandemic.

This study aimed to explore the perspectives of care and protection of healthcare workers during the pandemic COVID-19 using a descriptive qualitative study in Indonesia. This study used a qualitative descriptive approach in COVID-19 National Referral Hospitals. Purposive sampling was used to collect the sample. There were 45 respondents, with 22 men and 23 women taking part in this study. The qualitative data were analyzed using the content analysis. Three themes that emerge from the data analysis: health protection, legal protection, and incentive schemes. Health protection including calculation of the medical team's workload and lack of a systematic procedure for medical team quarantine. There was a lack of legal basis for medical practice in long-term disaster services. Dimension of incentive scheme, including incentives shift from rewards to demands, changes in incentive regulations, and discrepancy in incentive calculation. By stressing protection and rewards for each level of the medical profession, it is hoped to boost motivation in actively participating and supporting the service of COVID-19 patients in critical conditions across Indonesia.

Peran ahli gizi sebagai tenaga keolahragaan pada dasarnya merupakan mandat hukum dari Undang-Undang No. 3 Tahun 2005 tentang Sistem Keolahragaan Nasional, khususnya Pasal 63 yang menyebutkan bahwa ahli gizi merupakan salah satu tenaga keolahragaan. Pada praktiknya, implementasi peran ahli gizi sebagai tenaga keolahragaan di pusat pembinaan atlet masih belum optimal. Keterbatasan sumber daya manusia dan anggaran, serta belum adanya kebijakan operasional yang mengatur tentang penempatan ahli gizi di pusat pembinaan atlet menjadi beberapa kendala yang perlu solusi. Pengkajian ini menggunakan pendekatan kualitatif dengan melakukan studi dokumen terhadap delapan peraturan yaitu 1 undang-undang, 1 perpres dan 6 permen. Seluruh dokumen kebijakan tersebut selanjutnya ditetapkan pasal-pasal kritis yang dianalisis lebih lanjut untuk diberikan diskripsi penjelas, analisis mendalam pasal demi pasal, perumusan rekomendasi dan output kebijakan. Pengkajian ini telah memperoleh Ethical Clearance dari Komisi Etik FKKMK UGM dengan nomor: KE/FK/0292/EC/2020 pada tanggal 10 Maret 2020. Kajian terhadap Undang – Undang Nomor 3 Tahun 2005 dan peraturan hukum pendukungnya menunjukkan bahwa peran ahli gizi memiliki urgensi tinggi dalam pembinaan atlet. Namun demikian masih perlu kebijakan operasional yang mengatur tentang penempatan ahli gizi sebagai tenaga keolahragaan, meliputi tugas dan wewenang, serta standar kompetensi dan sertifikasi ahli gizi sebagai tenaga keolahragaan.

Background: Based on Permenkes No. 65 the year 2017, the Banjarnegara Health Research and Development (R&D) Unit is one oft he units under the NIHRD Ministry of Health, which has the task of conducting research and development of health with the advantage of leptospirosis control. The working area includes four provinces: DI Yogyakarta, DKI Jakarta, West Kalimantan, and South Sulawesi. In addition to conducting excellent research, Banjarnegara Health R&D Unit also has to do health research based on program needs in the target area. The Banjarnegara Health R&D Unit needs to understand its strengths, weaknesses, opportunities, and challenges through the identification of internal and external environments that can be using as a basis for developing strategic planning for organizational development. Objective: Formulate alternative strategies for the development of The Banjarnegara Health R&D Unit. Methods: Research A descriptive case study by using a holistic single case design plan. Variable research is the internal and external factor of Banjarnegara Health R&D Unit, development issues, and the strategies of develepment. Data obtained through in-depth interviews with the related informants, observation, and study of documents. Results: Internal environmental analysis to see the strengths and weaknesses of the Banjarnegara Health R&D Unit. Based on the results of internal environmental analysis, the Banjarnegara Health R&D Unit has considerable strength in terms of organizational as pects, HR experience, a budget that continues to increase every year, and infrastructure. External environmental analysis opportunities that can be utilized by the Banjarnegara Health R&D Unit are excellent stakeholder support, opportunities to collaborate with various institutions, sources of research funding, availability of information technology, and regulations that support the research climate. While the threats identified, require large budgets to keep abreast of medical or laboratory equipment technology, the development of potential epidemic diseases, limited recruitment of human resources and the potential to reduce PNBP. Conclusion: Strategies that can be used Banjarnegara Health R&D Unit for development are the development of services and products according to the needs of the stakeholders, the development of cooperation with strategic stakeholders, and the development of organizations with public service agency financial management patterns.

Background: The management of the Regional Health Insurance was merged into BPJS Health after the implementation of the 2014 National Health Insurance program. Kayong Utara Regency and Ketapang Regency are part of the Regency that combines regional health insurance participation into BPJS Health. The implementation of regional PBI governance needs to be supported by adequate regulations, a strong stakeholder vision, communication between stakeholders that is in line with the policies of regional leaders. Objective: The general objective of this research was to explore the ability of stakeholders in implementing the governance of PBI participation in the National Health Insurance Region. Methods: This study used a realist evaluation approach with a descriptive case study design. The study used purposive sampling, the research subjects were 24 people. Data was collected by means of in-depth interviews and document review. Results: The implementation of the JKN Program is a strategic policy. North Kayong Regency insures the rich and the poor at BPJS Health, while Ketapang Regency only insures the poor or the poor. Based on the Context, Mechanism, and Outcome hypothesis, the management of PBI participants responded differently in the two districts. In the implementation of non-comprehensive regulatory influences, the Regional PBI Management had not been good in the two districts, a strategic vision that was not accompanied by a strategic plan and partial communication (mechanism) contributes to the results or in ensuring health insurance for the poor (outcomes). Conclusion: The government of Kayong Utara and Kabupaten Ketapang have a strong commitment to managing health insurance for the poor. The implementation of the Regional PBI in the two districts faces challenges in the form of regulations that are not yet comprehensive. Comprehensive regulations, clear targets, and cross-structure coordination are needed in the management of Regional PBI in North Kayong Regency and Ketapang Regency so that it can be carried out properly.

Introduction: Chronic diseases have become a major cause of death in the world, and a major source of morbidity and misery. Approximately 80% of related deaths occur in developing countries. Chronic Disease Management Program (CDMP) is an integrative program aimed to control the prevalence of chronic diseases. Therefore, this study aimed to evaluate the interaction between context and process in CDMP services, and to determine how CDMP was implemented in developed and underdeveloped regions.Methods: This qualitative study used the Consolidated Framework for Implementation Research (CFIR). Subjects were selected by purposive sampling from CDMP organizers in Primary Health Centers for a commitment-based capitation assessment. Transcript data were analyzed thematically by summarizing and identifying major themes based on the CFIR domains.Results: The main activities of the CDMP (medical consultations, monitoring of health status, health educational, reminders, home visit and group activities/gymnastics) in developed regions were conducted according to the technical manual. However, in underdeveloped regions, some modifications were needed, i.e. the medical consultations, medical checkups and health education undertaken by a nurse in charge and not always conducted by a doctor; and, the services were conducted at the village meeting halls. Also, the reminders were delivered through socialization by local governments and direct invitation by team members when they met the participants on the roadway or in the neighborhood around the participants’ homes.Conclusion: CDMP cannot fully be implemented in underdeveloped regions and some modifications were needed according to local conditions.

Dengue Hemorrhagic Fever (DHF) is still a public health problem that is difficult to deal with in Tasikmalaya City, West Java Province. In 2019, the region experienced very significant cases increase leading to an Outbreak. Various attempts have been made without optimal results. DHF control program managers expressed the urgent need for strong policies, but no empirical studies have been carried out. It is important to analyze evidence as justification for urgency and impetus in the policy agenda. This policy research with naturalistic qualitative research with Analysis for Policy approach aims to explore evidence on the urgency of DHF control regional regulations at policy stakeholders’ aspect. The results of this study revealed the evidence of DHF Control Regional Regulation’s establishment urgency. Those are increasing community endangering situation of DHF cases; the urgent need of policies for program managers; and the corroborating evidence, asthe results of stakeholder analysis, in the form of majority stakeholder are the main policy stakeholder who have the power and strong interest in supporting the policies’ urgency. The urgency level of DHF control Regional Regulation based on this research has reached an emergency level, so there should be efforts to establish DHF control Regional Regulation in Tasikmalaya City. Abstrak. Demam Berdarah Dengue (DBD) masih menjadi masalah kesehatan masyarakat yang sulit ditangani di Kota Tasikmalaya, Provinsi Jawa Barat. Pada tahun 2019, Kota Tasikmalaya mengalami peningkatan kasus yang sangat signifikan mengarah kepada Kejadian Luar Biasa. Berbagai upaya telah dilakukan namun belum mendapatkan hasil yang optimal. Kebutuhan mendesak akan kebijakan yang kuat diungkapkan oleh pengelola program, namun belum pernah dilakukan studi empiris. Penting untuk menganalisis bukti sebagai justifikasi urgensi dan pendorong dalam agenda kebijakan dalam bentuk Peraturan Daerah (Perda) tentang pengendalian DBD di Kota Tasikmalaya. Penelitian ini merupakan riset kebijakan dengan jenis penelitian kualitatif naturalistik yang bertujuan mengeksplorasi bukti urgensi Perda tentang Pengendalian DBD pada aspek stakeholder kebijakan. Proses analisis kebijakan menggunakan pendekatan Analysis for Policy. Hasil penelitian ini mengungkapkan bukti perlunya pembentukan Perda tentang Pengendalian DBD. Bukti pertama adalah situasi kasus DBD yang semakin membahayakan masyarakat. Bukti kedua adalah kebutuhan adanya kebijakan bagi pengelola program yang semakin mendesak. Bukti selanjutnya yang menguatkan adalah hasil analisis stakeholder menunjukkan bahwa mayoritas stakeholder merupakan stakeholder kebijakan utama yang memiliki kekuatan dan ketertarikan yang kuat untuk mendukung urgensi kebijakan. Tingkat urgensi berdasarkan penelitian ini menunjukkan bahwa kebutuhan Perda Pengendalian DBD telah berada pada tingkat darurat sehingga perlu segera dilakukan upaya-upaya untuk pembentukan Perda tentang Pengendalian DBD di Kota Tasikmalaya.

This study examined a social movement in the digitalized world along with its role in the public policy process. The research focused on how the social movement was accessed and spread, and how knowledge was formed on Facebook so that it could influence the success or failure of a certain policy. It is essential to further explore how knowledge is mobilized through social movements in the digitalized world so as to enrich the theories of governance and public policies. In this study, content analysis was ued. The results showed that the group of main actors who criticized the vaccine’s safety was heterogeneous. In terms of vaccine criticism, there were the anti-vaccine movements, the marginally anti-vaccine movements, and the occasionally vaccine-critical movements. This heterogeneity could be found in the type of arguments mobilized to question the vaccine’s safety and in these actors’ likelihood of being involved in any vaccine-related controversies. The religion and conspiracy theory discourses were the two most used discourses to reject the vaccine delivery program in Indonesia. By mobilizing knowledge through a social movement in the digitalized world, the anti-vaccine movement actors had a wider network and had the potential to influence the success of the government program. Keywords: social movement, anti-vaccine, health policy, social media

Background The Corona virus disease 2019 (COVID-19) pandemic poses a risk of inequality between the number of prepared service staff and patients. Emergency hospitals, that do not have full-time employees due to the voluntary employment system, need to supervise the competence and knowledge of their staff, as they came with diverse backgrounds of knowledge and skill. The National Emergency Hospital Wisma Atlet Kemayoran, which can provide services for nearly 6000 COVID-19 patients, is required to be able to provide education and training continuously to improve the knowledge of its volunteers aiming to improve the quality of the care services. Methodology The present study is descriptive observational research to explore the challenge of education and training in the COVID-19 National Emergency Hospital Wisma Atlet Kemayoran in Jakarta. Results The COVID-19 health workers need to be equipped with sufficient knowledge about personal protective equipment (PPE), COVID-19 management, triage, admission, emergency and critical care for the COVID-19 patients. Supervision is needed to ensure that volunteers with various knowledge and skill backgrounds can collaboratively provide good services for the COVID-19 patients at all fronts. With frequent personnel changes, education and training on the same topic are always given repeatedly. To overcome this inefficiency, the Education and Training Department can film every practical skill related to health care service, and then create tutorial videos followed by small groups onsite skill station, when necessary. The hospital received enormous support from the governmental and non- governmental organizations to conduct education and training sessions on regular basis. Conclusions Education and training are very critical in the Emergency COVID-19 Hospital. The process has become a major challenge due to regular changes of staff. Information and communication technologies remain a more recommended alternative to the traditional onsite face-to-face method of education and training delivery as to prevent the spread of this virus. The training and education program in the National COVID-19 Emergency Hospital Wisma Atlet have received major supports from several Government agencies, and national private/non-government organizations. However, supports from International NGOs, international aid agencies, or humanitarian organizations, apart from the local professional organizations, which generally extend generous support need also to be explored.

The Indonesian government has been implementing the National Health Insurance ( Jaminan Kesehatan Nasional [JKN]) policy since 2014. This study aimed to evaluate JKN based on equity indicators, especially in skilled birth attendants (SBAs) use. The data were obtained from National Socio-Economic Survey of Indonesia during 2012 to 2016. To analyze the data, χ2 and logistic regression tests were applied. The respondents were married mothers from 15 to 49 years who had delivered a baby. Deliveries by SBAs increased at the national level, but this achievement showed significant variation according to geographical location. The coverage of deliveries by SBAs in the eastern areas of Indonesia was still much lower than those in the western areas. All factors determining SBAs utilization (health insurance ownership, education, household economic status, and geography factor) indicated the positive correlation ( P < .05). The inequity of SBA use in differences in geographical location and socioeconomic status continues to occur after the implementation of JKN.

Background: Public health cadres can play an important role in improving disaster response and recovery. However, a multidimensional instrument is needed to assess the levels of disaster knowledge for community health cadres. This instrument is important to develop a complete and effective educational program for disaster preparation for health cadres. Therefore, this study aimed to test validity and reliability of the disaster preparedness knowledge instrument for health cadres in areas prone to volcanic disasters.Methods: A cross-sectional study was conducted by involving 300 respondents. The instrument was developed by conducting literature review followed by completing a qualitative study. We reduced the original instrument from 50 items to a final instrument comprising 41 items, classified into 6 categories: 1) early warning [16 items]; 2) disaster triage [4 items]; 3) basic life support [7 items]; 4) first aid [7 items]; 5) search and rescue [5 items]; and 6) logistic, communications and team organization [2 items]. Instrument validation was assessed by using Pearson Product moment and the reliability was estimated by using internal consistency reliability.Results: 300 respondents were involved in this study with all respondents were women aged between 40-49 years old. All of them were either health cadre or high school students. In instrumental testing, all 41 items of the instrument were confirmed through content validity (Pearson Product Moment). Using internal consistency reliability, the study found reasonable inter-item reliability for all items (Cronbach’s α: 0.785-0.807).Conclusion: Higher score on disaster triage aspect suggest that health cadres have pivotal role in emergency care during disaster. The finding revealed that disaster triage technique and skills for health cadres or lay man is very important.

Integration was strategy of PMTCT (Prevention of Mother to Child HIV Transmission) and MCHS (Mother and Child Health Services) since 2006. This systematic review explored integration level between PMTCT and MCHS. Literature searched from June 2015 to January 2016 through Google, Google Scholar, University Library Website, Portal Garuda, ProQuest, PubMed and 90 institutions in Jakarta. Keywords were PMTCT, HIV Mother, PPIA HIV Evaluation and HIV PMTCT Evaluation. We yielded 157 literatures from 1995-2015. Research should be done at Public Primary Health Care (PHC), discussed PMTCT implementation, and captured perspectives of staffs or decision makers. Thematic analysis was done using Atun’s Integration Analysis Framework and CFIR. We included 7 studies. No study explored overall dimensions of integration, especially planning function. Challenges were resources, execution, needs of patients, networks and communications, policies, leadership, and access to information. Only 4 studies showed PMTCT results. Coverage of first visit counseling was 9-100% and percentage of pregnant women tested was 3.9 -60%. PMTCT integration was partial. Integration was not a sole solution to results. Planning should be done together with regional and local level, involving stakeholders to disseminate PMTCT information, increasing ownership and leadership. We proposed Atun’s Framework and CFIR for further research.

BackgroundHeart diseases are increasingly identified as an important indirect cause of maternal mortality in several cities in Indonesia. The management of pregnancy with heart diseases requires a multidisciplinary approach, and interprofessional collaboration practice (IPCP) is critical to improving the quality of patient care. To enable the effective implementation of IPCP, integrated care pathways (ICPs) are needed to define the roles and responsibilities of the health professionals involved. This study aims to examine the obstacles and enabling factors of IPCP, to develop and use ICPs in the implementation of IPCP in health care services for pregnant women with heart diseases.MethodsA participatory action study consisting of four stages (diagnostic, planning, implementation, and evaluation) will take approximately 2 years after consensus of ICPs are made. The primary data collection process will employ consensus, observations, focus group discussions, and in-depth interviews throughout the four stages, while secondary data from referral documents and medical records will be collected mainly during the diagnostic and evaluation stages. The findings are being analysed and will then be used to develop an ICPs through consensus building at the planning stage to be applied in the implementation stage. Finally, the implementation outcome, including acceptability, adoption, appropriateness, and feasibility of IPCP, will be assessed in the evaluation stage. All qualitative data will be analysed thematically by two coders using NVIVO 12 software.DiscussionThis research aims to assess the needs of IPCP, develop and use the ICPs in the implementation of IPCP in health care services for pregnant women with heart diseases. Findings from this study will be used for health service planning and policy making to strengthen practice of IPCP during the referral process. As a result, pregnant women with heart disease will have better access to high-quality services at every health care facility to reduce maternal mortality.Trial registrationRetrospectively registered in the ISRCTN registry with study IDISRCTN82300061on Feb 6, 2019.

Objectives: The study aims to understand the acceptability of Prolanis, a program that shifts the diabetes mellitus type 2 (T2DM) patient management from secondary to primary care, among Indonesian primary health care providers. Method: We completed face-to-face semistructured interviews with 14 health professionals from 3 urban and 4 rural government-owned primary health care clinics ( Puskesmas) in 4 districts. We performed content analysis using the theoretical framework of acceptability (TFA) to understand which factors could facilitate or reduce acceptability. Results: Our study identifies that lack of health care providers’ acceptability to Prolanis was attributable to the negative affective attitude, low perceived effectiveness, poor self-efficacy, and work burden. The use of Prolanis output as one of the pay-for-performance indicators was deemed unsuitable because it could demotivate health providers to capture more undetected T2DM cases. This, compounded by lacking perceived benefit for the health care providers, leading to negative attitudes. Participants believed that the program improved patients’ adherence to visiting clinics routinely; however, the absence of a formal evaluation of reductions of key T2DM indicators—blood glucose level and HbA1c—causing the health providers to doubt the program effectiveness. Availability of or access to adequate blood glucose testing equipment is also of paramount importance to improve acceptability. Although the significant increase in patient load only occurred to Puskesmas with lacking doctors, an increased workload burden due to clerical works was experienced by the nonmedical workforce. The program appears to be more acceptable for health care providers in urban Puskesmas compared with their rural counterparts, attributable to better geographical accessibility and care-seeking behavior among people living in urban locations. Conclusions: This study highlights critical issues that should be addressed to improve the acceptability of Prolanis among health care professionals. Government or stakeholders play a critical role in improving program acceptability. More study is needed to capture wider variety of health care facilities’ characteristics.

Background: The national healthcare insurance (JKN) has been in deficit since 2014-2016; one of the causes is fraud inpatient hospital service. Objective: This study aimed to analyze the validity, reliability and effectiveness of detection system of national healthcare insurance fraud based on computer application in hospital.Methods: Cross-sectional method was used. Fraud data were collected at one episode in the inpatient JKN participant service.Results: Validity was assessed by Fischer exact test. The interpretation was done by hospital internal verification officer and BPJS Kesehatan verification officer. There were only 2 out of 1.106 services claims were different, resulted in p-value 0.01. Reliability was assessed using Human Organization Technology Benefit questionnaire filled by admission administrator officer, BPJS Kesehatan officer and hospital internal verification officer; and then analyzed using Stata® software resulting in Cronbach’s alpha value of 0.8. Effectiveness was assessed by reducing potential fraud, conducted by RSUP dr. Soeradji Tirtonegoro from May until July 2017, which on May 2018 there were 8 findings, June 1 finding, and on July 2018 had no finding.Conclusion: System for detection of national healthcare insurance fraud based on computer application is valid, reliable and effective to be implemented in inpatient service in hospital.

To implement an online system to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on maternal and child health and nutrition essential health services in Indonesia.We developed an electronic monitoring and evaluation system to assist district health offices in making rapid assessments of the impact of COVID-19 on maternal and child health and nutrition programmes in their area and in developing policy and programme responses. This implementation research was conducted from September to December 2020 in 304 districts. The strategies consisted of technical assistance for district offices by 21 partner universities and development of an online dashboard for rapid situation analyses and reporting. We collected qualitative data on feasibility and adherence to the intervention, as well as quantitative data from routine health databases to analyse the impact of COVID-19 on maternal and child health and nutrition indicators.In the majority of districts key maternal and child health and nutrition services were moderately or severely affected by the pandemic, particularly child growth monitoring and antenatal care services. Adherence to the protocol of the intervention varied across districts but the system is a feasible approach to be scaled up to other regions and health programmes. High uptake by the health ministry, district office and university partners provided the platform with collaborative efforts for health-systems strengthening.The electronic monitoring and evaluation system could be implemented and completed with several modifications to accommodate district offices and universities. There is a potential to scale up the intervention with better implementation planning and training.Instaurer un système en ligne pour évaluer l'impact de la pandémie de maladie à coronavirus 2019 (COVID-19) sur les services essentiels de nutrition et de santé maternelle et infantile en Indonésie.Nous avons mis au point un système électronique de surveillance et d'évaluation afin d'aider les bureaux de la santé des districts à identifier rapidement les effets de la COVID-19 sur les programmes de nutrition et de santé maternelle et infantile dans leur région, et à déployer des politiques et programmes capables de les contrer. Cette étude de mise en œuvre a été menée de septembre à décembre 2020 dans 304 districts. Les stratégies prévoyaient de fournir une assistance technique aux bureaux de district avec le concours de 21 universités partenaires, et de créer un tableau de bord en ligne servant à établir rapidement des analyses et rapports de situation. Nous avons récolté des données qualitatives sur la faisabilité et l'adhésion à l'intervention, ainsi que des données quantitatives issues des bases de données sur les soins de routine, en vue d'analyser l'impact de la COVID-19 sur les indicateurs de nutrition et de santé maternelle et infantile.Dans la majorité des districts, les principaux services de nutrition et de santé maternelle et infantile ont été modérément ou gravement touchés par la pandémie, en particulier le suivi de la croissance des enfants et les soins prénatals. Bien que le respect du protocole d'intervention ait varié d'un district à l'autre, le système constitue une approche envisageable pouvant être étendue à d'autres régions et programmes de santé. La participation active et les efforts conjoints du ministère de la Santé, des bureaux de district et des partenaires universitaires ont permis à la plateforme de renforcer les systèmes de santé.Le système électronique de surveillance et d'évaluation pourrait être appliqué et accompagné de plusieurs modifications pour s'adapter aux différents bureaux de district et universités. Cette intervention peut être amenée à se développer en améliorant la formation et la planification de la mise en œuvre.Aplicar un sistema en línea para evaluar los efectos de la pandemia de la coronavirosis de 2019 (COVID-19) en los servicios sanitarios esenciales de salud y nutrición maternoinfantil en Indonesia.Se desarrolló un sistema electrónico de supervisión y de evaluación para ayudar a las oficinas distritales de salud a realizar evaluaciones rápidas sobre los efectos de la COVID-19 en los programas de salud y nutrición maternoinfantil en su zona y a elaborar respuestas normativas y programáticas. Esta investigación de aplicación se llevó a cabo de septiembre a diciembre de 2020 en 304 distritos. Las estrategias consistieron en la asistencia técnica a las oficinas de distrito a cargo de 21 universidades asociadas y el desarrollo de un tablero de mando en línea para realizar análisis rápidos de la situación y presentar informes. Se recopilaron datos cualitativos sobre la viabilidad y la adhesión a la intervención, así como datos cuantitativos de las bases de datos de salud sistemáticas para analizar los efectos de la COVID-19 en los indicadores de salud y nutrición maternoinfantil.En la mayoría de los distritos, los servicios clave de salud y nutrición maternoinfantil se vieron moderada o gravemente afectados como consecuencia de la pandemia, en especial la supervisión del crecimiento infantil y los servicios de asistencia prenatal. La adhesión al protocolo de la intervención varió en los diferentes distritos, pero el sistema es un método viable que se puede ampliar a otras regiones y programas sanitarios. La participación activa del ministerio de sanidad, la oficina del distrito y los socios universitarios proporcionó una plataforma de colaboración para el fortalecimiento de los sistemas sanitarios.El sistema electrónico de supervisión y de evaluación podría aplicarse y completarse con varias modificaciones que se adapten a las oficinas de distrito y a las universidades. Existe la posibilidad de ampliar la intervención mediante la mejora de la formación y la planificación de la aplicación.تنفيذ نظام عبر الإنترنت لتقييم تأثير جائحة مرض فيروس كورونا 2019 (كوفيد 19) على صحة كل من الأم والطفل، وخدمات التغذية الصحية الأساسية في إندونيسيا.قمنا بتطوير نظام إلكتروني للمراقبة والتقييم، لمساعدة مكاتب الصحة في المقاطعات في إجراء تقييمات سريعة لتأثير كوفيد 19 على صحة كل من الأم والطفل، وبرامج التغذية في منطقتهم، وفي تطوير الاستجابات للسياسات والبرامج. تم إجراء بحث التنفيذ هذا من سبتمبر/أيلول إلى ديسمبر/كانون أول 2020 في 304 منطقة. تكونت الاستراتيجيات من المساعدة الفنية لمكاتب المقاطعات بواسطة 21 جامعة شريكة، وتطوير لوحة معلومات عبر الإنترنت لتحليل المواقف وإعداد التقارير على وجه السرعة. قمنا بجمع بيانات نوعية حول الجدوى من التدخل والالتزام به، بالإضافة إلى بيانات كمية من قواعد البيانات الصحية الروتينية لتحليل تأثير كوفيد 19 على صحة كل من الأم والطفل، وكذلك مؤشرات التغذية.في غالبية المناطق، تأثرت خدمات صحة الأم والطفل الرئيسية وخدمات التغذية بشكل معتدل أو شديد نتيجة الجائحة، ولا سيما متابعة نمو الطفل وخدمات الرعاية السابقة للولادة. تنوع التقيد ببروتوكول التدخل عبر المناطق، ولكن النظام يُعد أسلوبًا عمليًا لتوسيع نطاق التدخل ليشمل المناطق والبرامج الصحية الأخرى. إن الاستيعاب الكبير بواسطة وزارة الصحة، ومكتب المنطقة، والشركاء من الجامعات، أدى إلى توفير المنصة بجهود تعاونية لتعزيز النظم الصحية.يمكن تنفيذ النظام الإلكتروني للمراقبة والتقييم وإكماله مع العديد من التعديلات لاستيعاب مكاتب المقاطعات والجامعات. هناك إمكانية لتوسيع نطاق التدخل من خلال تنفيذ أفضل للتخطيط والتدريب.印度尼西亚实施电子系统来评估 2019 年冠状病毒病 (COVID-19) 疫情对母婴健康和营养基本卫生服务的影响。.我们开发了一个电子监测和评估系统，以协助地区卫生办公室快速评估新冠肺炎对其所在地区母婴健康和营养计划的影响，并制定相关政策和计划响应。该项研究于 2020 年 9 月至 12 月在 304 个地区实施。这些战略包括由 21 所合作大学为地区办公室提供技术援助，和开发用于快速分析和报告情况的在线仪表板。我们收集了有关干预措施的可行性和依从性的定性数据，以及来自常规健康数据库的定量数据，来分析新冠肺炎对母婴健康和营养指标的影响。.在大多数地区，重要的母婴健康和营养服务，特别是儿童生长监测和产前护理服务，受到疫情的中度或严重影响。各地区对干预方案的遵守情况各不相同，但该系统是一种可行的方法，可以推广到其他地区和卫生计划。卫生部、地区办公室和大学合作伙伴的高度接受，为该平台提供了加强卫生系统的合作努力。.电子监测和评估系统可以在进行修改后进行实施和完成，以便适应地区办公室和大学。可以通过更好的实施规划和培训，来扩大干预范围。.Внедрить онлайновую систему для оценки влияния пандемии коронавирусной инфекции 2019 года (COVID-19) на основные услуги в области охраны здоровья и обеспечения питания матери и ребенка в Индонезии.Авторы разработали электронную систему мониторинга и оценки, чтобы помочь районным отделениям здравоохранения быстро оценить влияние COVID-19 на программы в области охраны здоровья и обеспечения питания матери и ребенка в своем регионе, а также разработать политику и программные меры реагирования. Такое имплементационное исследование проводилось с сентября по декабрь 2020 года в 304 районах. Стратегии включали техническую помощь районным отделениям со стороны 21 университета-партнера и разработку онлайновой информационной панели для быстрого анализа ситуации и отчетности. Были собраны качественные данные о целесообразности и последовательном исполнении данного мероприятия, а также количественные данные из стандартных баз данных о здравоохранении для анализа влияния COVID-19 на показатели состояния здоровья и питания матери и ребенка.В большинстве районов основные услуги в области охраны здоровья и обеспечения питания матери и ребенка пострадали от пандемии в умеренной или серьезной степени, особенно услуги по мониторингу развития детей и дородовой помощи. Соблюдение протокола мероприятия разнилось в зависимости от района, но эта система представляет собой вполне реализуемый подход, который можно внедрять в других регионах и программах здравоохранения. Высокая популярность платформы на уровне Министерства здравоохранения, районного отделения и университетов-партнеров послужила основой для сотрудничества по укреплению систем здравоохранения.Электронную систему мониторинга и оценки можно внедрять, а также можно вносить в нее изменения с учетом районных отделений и университетов. Существуют возможности для расширения масштабов мероприятия за счет лучшего планирования его внедрения и подготовки кадров.

Background: The INDEPTH Training & Research Centres of Excellence (INTREC) collaboration developed a training programme to strengthen social determinants of health (SDH) research in low- and middle-income countries (LMICs). It was piloted among health- and demographic researchers from 9 countries in Africa and Asia. The programme followed a blended learning approach and was split into three consecutive teaching blocks over a 12-month period: 1) an online course of 7 video lectures and assignments on the theory of SDH research; 2) a 2-week qualitative and quantitative methods workshop; and 3) a 1-week data analysis workshop. This report aims to summarise the student evaluations of the pilot and to suggest key lessons for future approaches to strengthen SDH research capacity in LMICs. Methods: Semi-structured interviews and questionnaires with 24 students from 9 countries in Africa and Asia were used to evaluate each teaching block. Information was collected about the students’ motivation and interest in studying SDH, any challenges they faced during the consecutive teaching blocks, and suggestions they had for future courses on SDH. Results: Of the 24 students who began the programme, 13 (54%) completed all training activities. The students recognised the need for such a course and its potential to improve their skills as health researchers. The main challenges with the online course were time management, prior knowledge and skills required to participate in the course, and the need to get feedback from teaching staff throughout the learning process. All students found the face-to-face workshops to be of high quality and value for their work, because they offered an opportunity to clarify SDH concepts taught during the online course and to gain practical research skills. After the final teaching block, students felt they had improved their data analysis skills and were better able to develop research proposals, scientific manuscripts, and policy briefs. Conclusions: The INTREC programme has trained a promising cadre of health researchers who live and work in LMICs, which is an essential component of efforts to identify and reduce national and local level health inequities. Time management and technological issues were the greatest challenges, which can inform future attempts to strengthen research capacity on SDH.

Introduction. Terminal cancer patients was increasing in Indonesia, and need attention to approach palliative and end of life care. Terminal cancer management was burden the hospital, because it causes high costly and the length of stay This study aimed to get a general picture of service palliative at Cipto Mangunkusumo, then to evaluate the relationship hospitalization and rates of inpatient services people with terminal cancer adults who received the intervention palliative care and to evaluate the relationship variable rates for accommodation (room), doctor visit, procedure/surgery, medicines and consumables, laboratory and radiology to palliative interventions in patients with terminal cancer in inpatient Dr. Cipto Mangunkusumo Hospital. Methods. This research was descriptive study with case control design and performed in the inpatient unit, Dr Cipto Mangunkusumo Hospital, during the month of January to December 2015. The subjects were medical records and billing of terminal cancer patients were .hospitalized adults in class III in January - December 2015 with National Health Insurance (BPJS). Inclusion criteria are terminal cancer patients, beusia ≥ 18 years, received palliative care consultation team while exclusion criteria are patients receiving palliative consultation on treatment days ≥ 25 days. Results. It is known that there is a significant relationship between palliative interventions to patients with hospital rates (p= 0.041), whereas there was no significant relationship between palliative interventions by the length of stay (p = 0.873). There is a significant relationship between palliative interventions and expenditures room rates, visite, action and medicine and palliative interventions. Conclusions. There is a significant relationship between palliative interventions with hospital rates. There is a significant relationship between palliative interventions and expenditures room rates, visite, action and medicine and palliative interventions. These data showed that palliative care intervention was saving money for hospital.

Background For a decade, experts have suggested integrating mental health care into primary care to help bridge mental health Treatment Gap. General Practitioners (GPs) are the first port-of-call for many patients with mental ill-health. In Indonesia, the WHO mhGAP is being systematically introduced to its network of 10,000 primary care clinics as an add-on mental health training for pairs of GPs and Nurses, since the end of 2015. In one of 34 provinces, there exists an integrated care model: the co-location of clinical psychologists in primary care clinics. This trial evaluates patient outcomes among those provided mental health care by GPs with those treated by clinical psychologists in primary care. Methods In this partially-randomised, pragmatic, two-arm cluster non-inferiority trial, 14 primary care clinics were assigned to receive the WHO mhGAP training and 14 clinics with the co-location framework were assigned to the Specialist arm. Participants (patients) were blinded to the existence of the other pathway, and outcome assessors were blinded to group assignment. All adult primary care patients who screened positive for psychiatric morbidity were eligible. GPs offered psychosocial and/or pharmacological interventions and Clinical Psychologists offered psychosocial interventions. The primary outcome was health and social functioning as measured by the HoNOS and secondary outcomes include disability measured by WHODAS 2.0, health-related quality of life measured by EQ‐5D-3L, and resource use and costs evaluated from a health services perspective, at six months. Results 153 patients completed the outcome assessment following GP care alongside 141 patients following Clinical Psychologists care. Outcomes of GP care were proven to be statistically not inferior to Clinical Psychologists in reducing symptoms of social and physical impairment, reducing disability, and improving health-related quality of life at six months. Economic analyses indicate lower costs and better outcomes in the Specialist arm and suggest a 50% probability of WHO mhGAP framework being cost-effective at the Indonesian willingness to pay threshold per QALY. Conclusion General Practitioners supported by nurses in primary care clinics could effectively manage mild to moderate mental health issues commonly found among primary care patients. They provide non-stigmatising mental health care within community context, helping to reduce the mental health Treatment Gap. Trial registration ClinicalTrials.gov NCT02700490

Background: The Indonesian government has been implementing the National Health Insurance Policy (Jaminan Kesehatan Nasional-JKN) since 2014. The utilization of family planning service is one of the programs to increase maternal and child health status that is included in the benefit package in JKN. This study aimed to describe determinants and to evaluate JKN based on equity indicators, especially in family planning services. Methods: Data were obtained from the 2012-2016 National Socio-Economic Survey (SUSENAS) of Indonesia. Contraceptive Prevalence Rate (CPR) and Long-acting contraceptives (LACs) use were used as indicators to evaluate family planning utilization. Chi-square and logistic regression tests were used to analyze the data. Respondents were married women between 15 and 49 years of age. Results: There was no progress in CPR after the implementation of JKN. At the national level, CPR decreased within five years (2012-2016). Decreasing in urban areas and in the group that does not have health insurance were more than in rural areas and in the group that has health insurance. Utilization of non-LACs, especially injection (56%-57%) and pill (21%-24%), were still high within 2012-2016. At the national level, LACs use increased 3.18% between 2012-2016 (15.54%-18.72%). Increasing in urban areas and in the group that has subsidized health insurance were more than in rural areas and in the group that does not have subsidized. In 2016, the geography factor (rural-urban) and household economic status associated negatively with the use of overall contraceptive methods (ppConclusions: Up to 2016, the JKN program did not increase CPR. Conversely, the JKN program obtained only small increases in LACs use. LACs use in rural areas is less than in urban areas. JKN program can increase LACs use in the group that has subsidized health insurance. CPR and LACs coverage could increase through health system improvement, and the societal norms approach. Health system improvement is operationalized through improving supply-side and regulations, increasing coordination among multiple agencies in the family planning program.

The recently concluded World Conference on Disaster Risk Reduction (WCDRR) in Sendai, Japan and the Sendai Framework for Disaster Risk Reduction 2015–2030 (SFDRR) have set renewed priorities for disaster risk reduction (DRR) for the next 15 years. This framework is the main guiding instrument for Disaster Risk Management (DRM) within the scope of sustainable development and the eradication of poverty. Disaster management policies and practices should be based on an understanding of risks, not just on an ideological level. Gap and key challenges identified include Still weak coordination, cooperation and linkages among the sectors related to DRR, Lacks of skills in loss assessment and post disaster needs, lack of strategic research agenda, absence of consensus regarding terminology, and limited coordination between stakeholders. The aim of this study was to gain an understanding of why disaster risk reduction efforts undertaken by regional policy often fail to improve future disaster responses. These findings can be used to help guide to improve regional policy in disaster risk reduction processes. This research is a systematic review study by collecting articles that are relevant to International Journal of Disaster Risk Science. From the analysis, we found that all four priorities for action in the Sendai Framework are relevant to Disaster Risk Management (DRM) field as follows: 1). Understanding disaster risk; 2). Strengthening disaster risk governance to manage disaster risk; 3). Investing in disaster risk reduction for resilience and 4). Enhancing disaster preparedness for effective response and to “Build Back Better” in recovery, rehabilitation and reconstruction.

Background: Caregivers play a central role in post-stroke patients' care. However, the role of and problems managed by caregivers have not been widely studied, particularly in Indonesia. This study aims to explore the roles and problems of caregivers in post- stroke patients’ care. Method: This was a qualitative study. Seven caregivers of post-stroke patients from the homecare clinic of Dr Sardjito General Hospital were purposely selected during January 2017 to June 2018. Focus group discussions were conducted to explore the roles and problems of caregiving. Results: Themes related to caregivers’ roles were: connecting patients with medical personnel and other family members, maintaining patients’ health conditions by fulfilling basic needs and assisting rehabilitation, as well as maintaining patients’ psychological conditions by encouraging conversation, telling jokes, or recreation. On the other hand, themes related to caregivers’ problems were: lack of knowledge caused by education inadequacy, underappreciated and unconcerned family, suboptimal service including limited physiotherapy and pharmacy resource, unthorough administration, lack of communication, physical limitations, and burnout, as well as uncooperative patients. Conclusions: Caregivers play essential roles as communicators and help to maintain patient's health conditions. Common problems are related to a lack of knowledge about strokes and a lack of attention from family. Further research to study the effects of these findings on the quality of life of both patient and their caregiver, as well as how to handle the caregiver issues should be investigated.

Komposisi penyebaran tenaga dokter spesialis anak (SpA) di tingkat propinsi di Indonesiamasih belum merata. Distribusi penyebaran tenaga spesialis ini hampir 70% berpusat diJawa dan Bali, bahkan tercatat di beberapa propinsi lain yang tidak memiliki satupuntenaga SpA. Tulisan ini menyajikan distribusi penyebaran SpA di setiap di propinsi diIndonesia dan proporsi pertumbuhan SpA berdasarkan jenis kelamin. Dalam tulisan inijuga didiskusikan beberapa implikasi terhadap kebijakan yang mungkin dapat dijadikanpertimbangan dalam pengembangan model distribusi tenaga SpA.

Supplemental material, Supplemental_Material for Can a National Health Insurance Policy Increase Equity in the Utilization of Skilled Birth Attendants in Indonesia? A Secondary Analysis of the 2012 to 2016 National Socio-Economic Survey of Indonesia by Siti Khadijah Nasution, Yodi Mahendradhata and Laksono Trisnantoro in Asia Pacific Journal of Public Health

By 2016, Member States of the World Health Organization (WHO) had developed and implemented national action plans on noncommunicable diseases in line with theEn 2016, les États membres de l'Organisation mondiale de la Santé (OMS) avaient élaboré et mis en œuvre des plans d'action nationaux sur les maladies non transmissibles conformément au Plan d'action mondial pour la lutte contre les maladies non transmissibles (2013–2020). En 2018, nous avons évalué l'état de l'application des interventions les plus avantageuses recommandées en matière de maladies non transmissibles dans sept pays asiatiques: le Bhoutan, le Cambodge, l'Indonésie, les Philippines, le Sri Lanka, la Thaïlande et le Viet Nam. Nous avons recueilli des données à partir de toute une série de rapports publiés et directement auprès des ministères de la Santé. Nous avons inclus les interventions qui concernaient la consommation de tabac et d'alcool, une activité physique inadéquate et une consommation de sel élevée, ainsi que les réponses des systèmes de santé, et nous avons identifié les lacunes et proposé des solutions. En 2018, les progrès étaient variables selon les pays. Les lacunes étaient largement dues à un financement inadéquat; des capacités institutionnelles limitées (malgré des unités dédiées aux maladies non transmissibles); une action inadéquate dans les différents secteurs au sein et en dehors du système de santé; et l'absence de mécanismes de suivi et d'évaluation standardisés pour orienter les politiques. Afin de combler ces lacunes, les gouvernements doivent investir davantage dans des interventions efficaces telles que les interventions les plus avantageuses recommandées par l'OMS, améliorer l'action dans les différents secteurs, et renforcer les capacités en matière de suivi et d'évaluation, mais aussi de recherche. En s'inspirant de la Convention-cadre pour la lutte antitabac, l'OMS et ses partenaires internationaux devraient élaborer un outil de suivi complet et standardisé sur la consommation d'alcool, de sel et d'aliments malsains, l'activité physique et la réponse des systèmes de santé.Para 2016, los Estados miembros de la Organización Mundial de la Salud (OMS) habían elaborado y aplicado planes de acción nacionales sobre las enfermedades no contagiosas de acuerdo con el Plan de acción mundial para la prevención y el control de las enfermedades no transmisibles (2013-2020). En 2018, se evaluó el estado de implementación de las intervenciones recomendadas en siete países asiáticos en materia de enfermedades no contagiosas: Bhután, Camboya, Filipinas, Indonesia, Sri Lanka, Tailandia y Vietnam. Se recopilaron datos de una serie de informes publicados y directamente de los ministerios de salud. Se incluyeron intervenciones que abordaron el uso del tabaco y el alcohol, la actividad física inadecuada y la ingesta elevada de sal, así como las respuestas de los sistemas de salud, se identificaron las deficiencias y se propusieron soluciones. En 2018, el progreso fue desigual entre los países. Las deficiencias en la aplicación se debieron en gran medida a la falta de financiación, a la limitada capacidad institucional (a pesar de las dependencias designadas para las enfermedades no contagiosas), a la inadecuación de las medidas adoptadas en los diferentes sectores dentro y fuera del sistema de salud y a la falta de mecanismos normalizados de supervisión y evaluación que sirvieran de base a las políticas. Para subsanar las deficiencias en materia de aplicación, los gobiernos deben invertir más en intervenciones eficaces, como las recomendadas por la OMS, mejorar las medidas adoptadas en los distintos sectores y aumentar la capacidad de seguimiento y evaluación y de investigación. A partir de las enseñanzas del Convenio Marco para el Control del Tabaco, la OMS y los asociados internacionales deberían elaborar un instrumento de seguimiento normalizado y completo para el consumo de alcohol, sal y alimentos no saludables, la actividad física y la respuesta de los sistemas de salud.قامت الدول الأعضاء في منظمة الصحة العالمية (WHO) في عام 2016 بتطوير وتنفيذ خطط عمل وطنية بشأن الأمراض غير المعدية بما يتماشى مع خطة العمل العالمية للوقاية من الأمراض غير المعدية ومكافحتها (2013-2020). في عام 2018، قمنا بتقييم حالة تنفيذ أفضل التدخلات الموصى في الأمراض غير المعدية في سبعة بلدان آسيوية: إندونيسيا والفلبين وبوتان وتايلند وسري لانكا وفييت نام وكمبوديا. قمنا بجمع بيانات من مجموعة من التقارير المنشورة، كما جمعنا البيانات مباشرة من وزارات الصحة. وقمنا بتضمين التدخلات التي تناولت استخدام التبغ والكحول، والنشاط البدني غير الكافي والاستهلاك المرتفع من الملح، وكذلك استجابات الأنظمة الصحية، وحددنا الفجوات والحلول المقترحة. وفي عام 2018، كان التقدم متفاوتا بين البلدان. وكانت الفجوات في مستوى التنفيذ ترجع إلى حد كبير إلى عدم كفاية التمويل؛ والقدرات المؤسسية المحدودة (على الرغم من الوحدات المخصصة للأمراض غير السارية)؛ وعدم كفاية العمل عبر القطاعات المختلفة داخل وخارج النظام الصحي؛ وعدم وجود آليات موحدة للرصد والتقييم لتوجيه السياسات. ولمعالجة الفجوات على مستوى التنفيذ، تحتاج الحكومات إلى أن تستثمر أكثر في التدخلات الفعالة مثل أفضل التدخلات التي توصى بها منظمة الصحة العالمية، وتحسين العمل عبر مختلف القطاعات، وتعزيز القدرة على الرصد والتقييم في الأبحاث. بناء على الاستفادة المحققة من الاتفاقية الإطارية لمكافحة التبغ، فإنه يجب على كل من منظمة الصحة العالمية والشركاء الدوليين تطوير أداة رصد قياسية وشاملة لكل من الكحول والملح والاستهلاك الغذائي غير الصحي والنشاط البدني واستجابة النظم الصحية.截至 2016 年，世界卫生组织 (WHO) 成员国均已根据《预防和控制非传染性疾病全球行动计划 (2013-2020)》开展并实施了非传染性疾病国家行动计划。2018 年，我们评估了亚洲七国预防和控制非传染性疾病的“最合算措施”以及其它推荐干预措施的实施情况。这七个国家分别是：不丹、菲律宾、柬埔寨、斯里兰卡、泰国、印度尼西亚、和越南。我们从一系列已发表的报告和卫生部门直接收集数据。调查涵盖了减少烟草使用、减少有害使用酒精、减少身体不足活动、减少高盐摄入等干预措施，同时还有卫生系统反应，我们由此确定实施的差距，并提出解决方案。2018 年，各国在此方面的进展并不均衡。干预措施的实施存在差距的主要原因包括资金不足；机构能力有限（尽管指派了非传染性疾病部门）；卫生系统内外不同部门的行动不足；以及缺乏制定政策的标准化监测和评估机制。为了解决实施差距，政府应更多地采取有效的干预措施，例如世界卫生组织预防和控制非传染性疾病的“最合算措施”以及其它推荐干预措施，从而改善不同部门的行动力，提高监测、评估和研究的能力。根据《烟草控制框架公约》，世卫组织及其国际合作伙伴应制定关于酒精、盐和不健康饮食、身体活动不足和卫生系统反应的标准化综合监测工具。.К 2016 году страны-члены Всемирной организации здравоохранения (ВОЗ) разработали и осуществили национальные планы действий в отношении неинфекционных заболеваний в соответствии с Мировым планом действий по предотвращению и контролю распространения неинфекционных заболеваний (2013–2020 гг.). В 2018 году была проведена оценка состояния рекомендуемых и наиболее популярных мер борьбы с неинфекционными заболеваниями в семи странах Азии: в Бутане, Вьетнаме, Индонезии, Камбодже, Таиланде, на Филиппинах и в Шри-Ланке. Были собраны данные ряда опубликованных отчетов, а также получены сведения непосредственно из министерств здравоохранения. Авторы включили в обзор действия в отношении употребления табака и алкоголя, борьбы с недостаточной физической активностью и высоким потреблением соли, а также оценили реакцию систем здравоохранения, выявили недостатки системы действий и предложили способы их устранения. По состоянию на 2018 год страны демонстрировали неравномерный прогресс. Основные недостатки предпринятых действий были связаны с недостаточным финансированием, ограниченными институциональными возможностями (несмотря на наличие специально созданных отделов по борьбе с неинфекционными заболеваниями), недостаточностью действий в разных секторах внутри системы здравоохранения и вне ее, а также с нехваткой стандартизированных механизмов мониторинга и оценки для информирования лиц, принимающих стратегические решения. Для ликвидации отставания правительства должны больше инвестировать в эффективные меры борьбы, которые рекомендованы ВОЗ как наиболее популярные, улучшать взаимодействие секторов и расширять возможности исследований, мониторинга и оценки. Опираясь на опыт Рамочной конвенции по борьбе против табака, ВОЗ и ее международные партнеры должны разработать стандартизированный всеобъемлющий метод мониторинга потребления алкоголя, соли и вредных продуктов питания, а также оценки физической активности и реакции системы здравоохранения.

This study uses five waves of the Indonesian Demographic Health Surveys to analyse decentralisation and geographical inequality in health services delivery. Accounting for unobserved community-level heterogeneity with random effects and correlated random effects models, we link facility-based birth delivery to the period of decentralisation and Indonesia’s major island groups using a pooled sample of 71,815 children. We also generate direct estimates of neonatal mortality from 1990 to 2007. The results show that the implementation of decentralisation has accorded with a marked expansion in both health service and outcome inequalities in Indonesia, at least with respect to neonates. Systemic funding failures for health and decision-space issues resulting from decentralisation are likely to have greater impact in disadvantaged regions where local capacity is weakest. The need to address these fundamental issues to reduce inequalities and improve general health outcomes appears supportable.

Malnutrisi akut berat merupakan malnutrisi yang paling serius yang memengaruhi balita dan merupakan masalah kesehatan utama di negara-negara berkembang. Malnutrisi telah meluas baik di perkotaan maupun perdesaan. Akar permasalahan malnutrisi di negara berkembang salah satunya adalah faktor sosial demografi. Tujuan penelitian untuk melihat perbedaan kejadian malnutrisi dan determinannya di area perkotaan dan pedesaan di Yogyakarta. Penelitian menggunakan desain potong lintang dengan responden adalah semua balita malnutrisi akut berat di Kabupaten Sleman (23 balita) dan Kota Yogyakarta (33 balita). Analisis data menggunakan statistik deskriptif dan inferensial. Penelitian dilaksanakan pada Bulan Desember 2012 - Februari 2013. Prevalensi balita malnutrisi akut lebih banyak di perkotaan daripada di pedesaan (59% vs. 41%). Persentase faktor risiko kejadian malnutrisi pada kelompok urban dan rural adalah jumlah balita dalam keluarga satu orang (60,7%), jenis kelamin laki-laki (58,9%), riwayat pemberian ASI tidak eksklusif (60,7%), usia ibu kurang dari 35 tahun (62,5%), pekerjaan non-PNS (98,2%), penghasilan orang tua lebih dari UMR (58,9%), tingkat pendidikan ayah dan ibu tinggi (71,4% dan 64,3% ) dan pengasuh balita di rumah adalah ibu (82,1%). Perbedaan yang signifikan (p

As in many countries, the geographic distribution of the health workforce in Indonesia is unequal, with a concentration in urban and more developed areas, and a scarcity in rural and remote areas. There is less information on the distribution of specialist doctors, yet inequalities in their distribution could compromise efforts to achieve universal coverage by 2014. This paper uses data from 2007 and 2008 to describe the geographic distribution of specialist doctors in Indonesia, and to examine two key factors that influence the distribution and are targets of current policies: sources of income for specialist doctors, and specialist doctor engagement in private practice. The data demonstrates large differences in the ratio of specialist doctors to population among the provinces of Indonesia, with higher ratios on the provinces of the islands of Java, and much lower ratios on the more remote provinces in eastern Indonesia. Between 65% and 80% of specialist doctors' income derives from private practice in non-state hospitals or private clinics. Despite regulations limiting practice locations to three, most specialists studied in a provincial capital city were working in more than three locations, with some working in up to 7 locations, and spending only a few hours per week in their government hospital practice. Our study demonstrates that the current regulatory policies and financial incentives have not been effective in addressing the maldistribution of specialist doctors in a context of a growing private sector and predominance of doctors' income from private sources. A broader and more integrated policy approach, including more innovative service delivery strategies for rural and remote areas, is recommended.

We estimate the distributional incidence of health care financing in 13 Asian territories that account for 55% of the Asian population. In all territories, higher-income households contribute more to the financing of health care. The better-off contribute more as a proportion of ability to pay in most low- and lower-middle-income territories. Health care financing is slightly regressive in three high-income economies with universal social insurance. Direct taxation is the most progressive source of finance and is most so in poorer economies. In universal systems, social insurance is proportional to regressive. In high-income economies, the out-of-pocket (OOP) payments are proportional or regressive while in low-income economies the better-off spend relatively more OOP. But in most low-/middle-income countries, the better-off not only pay more, they also get more health care.

The article compares the incidence of public healthcare across 11 Asian countries and provinces, testing the dominance of healthcare concentration curves against an equal distribution and Lorenz curves and across countries. The analysis reveals that the distribution of public healthcare is prorich in most developing countries. That distribution is avoidable, but a propoor incidence is easier to realize at higher national incomes. The experiences of Malaysia, Sri Lanka, and Thailand suggest that increasing the incidence of propoor healthcare requires limiting the use of user fees, or protecting the poor effectively from them, and building a wide network of health facilities. Economic growth may not only relax the government budget constraint on propoor policies but also increase propoor incidence indirectly by raising richer individuals' demand for private sector alternatives.