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The role of a nutritionist as a sportsman was a legal mandate listed on Law No. 3 of 2005 in Article 63 concerning the National Sports System, stated that nutritionists are one of the sports personnel. However, the implementation of the nutritionist's role in the athlete training center was still lacking. The importance of nutritionist existence ought to be assessed to explore the perception of athletes and coaches. Qualitative approach was used to analyze focus group discussions on 15 athletes and 10 coaches located in 3 cities in Indonesia (Jakarta, Yogyakarta, Malang). Results, the acceptance of the food in the training center are satisfactory even though some still eat out. More knowledge concerning nutrition, performance, and posture are obtained from in-class education, brochure, personal counselling, and small talk by the presence of nutritionists. Conclusion, athletes and coaches perceive that nutritionists are urgently necessary for optimum nutrition support to enhance sports performance.

Summary: Background: Indonesia is making significant strides toward achieving universal health coverage, which involves providing free access to essential medicines. This study examines the availability of essential medicine in primary health centres (PHCs) across Indonesia, the reasons why medicines are unavailable, and the extent to which communities have access to alternative dispensing points. Methods: Enumerators visited each of the 9831 PHCs in all 514 districts to assess the availability of 60 essential medicines and identify reasons for any absent medicines. We correlated the results with the national village census to assess the relationship between availability, poverty, and access to alternative dispensing points. Findings: Medicine availability varied greatly. The median availability for 17 priority medicines was 82%, while 58% of the broader selection of 60 essential medicines was present. The availability of maternal and childcare medicines was highest (73%) and lowest for mental health (42%). The main reasons for absence were that medicines were deemed unnecessary (46%) or not supplied (38%). The Java/Bali region had the highest medicines availability, and rural areas in Eastern Indonesia had the lowest. In these districts, the population is financially struggling, most dependent on free medicines from public providers, and had the least access to alternative dispensing points. Interpretation: The availability of priority medicines in PHCs is relatively high, while public-paid prices are low by international standards. To improve availability of all essential medicines, the government should prioritize areas with the highest need, increase funding for PHCs in remote areas, and implement transparent monitoring of medicines availability. Funding: Indonesian Government.

The impact of providing nutrition education on the nutritional knowledge of young athletes in Indonesia Background: A lack of nutritional knowledge can lead to poor eating habits and nutritional deficiencies in young athletes. One of the issues leading to athletes' need for more knowledge is the absence of professional assistance in educating them about nutrition. Objective: This research was analyzed to investigate the impact of nutrition education through counseling and group-based nutrition education on the nutritional knowledge of young athletes in Indonesia. Methods: This study is a pre-and post-experimental study without control. One hundred eighty-five young athletes who trained in PPLP and SKO received nutrition intervention for two months, including three nutrition education sessions using sports nutrition module media, nutritional counseling, and eating assistance based on eating etiquette. A modified Abridged Nutrition for Sport Knowledge Questionnaire (ANSKQ) questionnaire assessed athletes' nutritional knowledge before and after the intervention. Data was examined by comparing scores before and after the intervention. The Kolmogorov-Smirnov test was used in the normality test, and a paired t-test was used to compare nutritional knowledge before and after the intervention. Results: Before the intervention, 88.65% had a low level of knowledge about nutrition. The scores for sports nutrition and overall nutritional knowledge increased significantly (p0.05). Conclusions: There was a significant increase in sports nutrition knowledge but not general nutrition knowledge. The provision of nutritional education assisted by nutritionists impacts athletes' nutritional knowledge.

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.

Abstract Background Heart 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. Methods A 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. Discussion This 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 registration Retrospectively registered in the ISRCTN registry with study ID ISRCTN82300061 on Feb 6, 2019.

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.

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.

Abstract 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.

Komposisi penyebaran tenaga dokter spesialis anak (SpA) di tingkat propinsi di Indonesia masih belum merata. Distribusi penyebaran tenaga spesialis ini hampir 70% berpusat di Jawa dan Bali, bahkan tercatat di beberapa propinsi lain yang tidak memiliki satupun tenaga SpA. Tulisan ini menyajikan distribusi penyebaran SpA di setiap di propinsi di Indonesia dan proporsi pertumbuhan SpA berdasarkan jenis kelamin. Dalam tulisan ini juga didiskusikan beberapa implikasi terhadap kebijakan yang mungkin dapat dijadikan pertimbangan dalam pengembangan model distribusi tenaga SpA.

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.

Penggunaan open source software (OSS) merupakan sebuah pilihan yang diambil oleh rumah sakit untuk menghemat anggaran dan kemudahan dalam pengembangan sistem informasi rumah sakit (SIRS). Penggunaan OSS juga mendukung program pemerintah “Indonesia Goes Open Source”. Sayangnya masih sedikit bukti seberapa jauh OSS digunakan di fasilitas kesehatan. Penelitian ini bertujuan untuk mendeskripsikan bagaimana OSS di rumah sakit dan bagaimana OSS digunakan untuk pengembangan SIRS pada rumah sakit yang ada di Indonesia. Metode yang digunakan adalah kualitatif dengan rancangan studi kasus, mengunakan tipe multikasus holistik. Proses pengumpulan data menggunakan instrumen observasi dan wawancara. Subyek dalam penelitian ini adalah manajer, staff dan programmer pada unit teknologi informasi di 3(tiga sampel) rumah sakit dengan karakteristik yang berbeda. Hasil dalam penelitian ini menunjukan bahwa OSS telah digunakan rumah sakit baik untuk kegiatan umum maupun khusus, yaitu pengembangan SIRS. Faktor biaya secara umum bukan merupakan faktor utama ketika memutuskan untuk mengunakan OSS padapengembangan SIRS. Peran vendor yang memiliki komitmen dalam pengembangan SIRS berbasis OSS berpengaruh terhadap keberlangsungan SIRS di rumah saki. Selain itu transfer pengetahuan dan dukungan dari universitas juga merupakan faktor yang berpengaruh terhadap keputusan rumah sakit dalam penggunaan OSS untuk pengembangan SIRS.Kata Kunci: Open Source Software, Sistem Informasi Rumah Sakit.

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.

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. 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. Understanding the roles and problems of caregivers may help facilitate better management and increase the quality of life for both patients and their caregivers.