27 results on '"Tampubolon, Gindo"'
Search Results
2. Climate justice for persons with disability:Few harmed much, fewer still harmed too much
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Tampubolon, Gindo
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ResearchInstitutes_Networks_Beacons/global_development_institute ,ResearchInstitutes_Networks_Beacons/02/13 ,Amartya Sen ,ResearchInstitutes_Networks_Beacons/03/01 ,climate justice ,Global inequalities ,Sustainable Futures ,climate change ,Global Development Institute ,disability ,Indonesia ,John Rawls ,social justice ,water and sanitation - Abstract
Building on Rawls’ theory of justice and Sen’s theory of capabilities, I present an outline of social justice under climate shocks, illustrating it with the experiences of persons with disability. Social justice holds when inequality is responded to by rules that afford more primary goods, such as rights and incomes, to those who have less—the maximin principle of the Rawlsian social welfare function. Climate injustice consists in putting more climate bads, not primary goods, on those with slender shoulders—a maximin social ill-fare function. Cross-country climate injustice is a larger instance of this.The developed world has achieved much economic progress (including more primary goods) on the back of burning fossil fuels, which has put the planet on a heating curve that puts massive climate bads on lives and livelihoods today and in future. Most of these bads are put on the shoulders of developing countries.This work addresses within-country climate injustice, such as when persons with disability shoulder extra losses in capabilities, especially being without drinking water for 24 hours. The significant capability losses estimated to have been endured by persons with disability in Indonesia in 2018 and 2020 should inform a more enlightened and socially just response to climate injustice so that, along a just transition, few are harmed much, fewer still harmed too much.
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- 2023
3. Multidimensional Poverty in Indonesia: Trend Over the Last Decade (2003–2013)
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Hanandita, Wulung and Tampubolon, Gindo
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- 2016
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4. Does reporting behaviour bias the measurement of social inequalities in self-rated health in Indonesia? An anchoring vignette analysis
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Hanandita, Wulung and Tampubolon, Gindo
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- 2016
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5. Decentralisation and Citizen Happiness: A Multilevel Analysis of Self-rated Happiness in Indonesia
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Sujarwoto, Sujarwoto and Tampubolon, Gindo
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- 2015
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6. Effect of a multifaceted mobile technology enabled primary care intervention on cardiovascular disease risk management in rural Indonesia: a quasi-experimental study
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Patel, Anushka, Praveen, Devarsetty, Maharani, Asri, Oceandy, Delvac, Pilard, Quentin, Kohli, Mohan, Sujarwoto, S, and Tampubolon, Gindo
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Mobile Health ,ResearchInstitutes_Networks_Beacons/global_development_institute ,Cardiovascular risk prediction ,Global Development Institute ,mHealth ,Indonesia ,Blood Pressure ,Cardiovascular risk management ,CVD - Abstract
Importance: Cardiovascular diseases (CVD) are the leading cause of disease burden in Indonesia. Implementation of effective interventions for CVD prevention is limited. Objective: To evaluate whether a mobile technology-supported primary healthcare intervention would improve use of preventive drug treatment among people with high CVD risk, vs usual care. Design: Quasi-experimental study involving four intervention and four control villages conducted between September 2016 and March 2018. Median duration of follow-up was 12.2 months. Setting: Malang district, Indonesia Participants: Residents aged ≥40 years were invited to participate. Those with high predicted 10-year CVD risk (previous diagnosed CVD; systolic blood pressure (BP) >160 mmHg or diastolic BP >100 mmHg; 10-year predicted CVD risk ≥ 30%; or 10-year predicted CVD risk of 20-29% and a systolic BP>140 mmHg) were followed. Intervention: A multi-faceted mobile technology-supported intervention facilitating community-based CVD risk screening with referral, tailored clinical decision support for drug prescription and patient follow-up. Main outcomes and measures: The primary outcome was the proportion on appropriate preventive CVD medications, defined as at least one BP lowering drug and a statin for all high-risk individuals, and an antiplatelet drug for those with prior diagnosed CVD. Secondary outcomes included mean change in BP from baseline. Results: Among 22,635 adults, 3494 (29.9%) and 3085 (28.1%) had high predicted CVD risk in the intervention and control villages, respectively. Of these, follow-up was completed in 2632 (75.3%) from intervention villages and 2429 (78.7%) from control villages. At follow-up, 15.5% of high-risk individuals in intervention villages were taking appropriate preventive CVD medications, compared with 1.0% of in control villages (adjusted risk difference, 14.1%, [95% CI, 12.7% to 15.6%]). This difference was driven by higher BP lowering treatment use (56.8% vs. 15.7%; adjusted risk difference, 39.4% [95% CI, 37.0% to 41.7%). The adjusted mean difference in change in systolic BP from baseline was -8.3 mmHg, [95% CI, -6.6 to -10.1 mmHg]). Conclusions and relevance: A multi-faceted mobile technology supported primary healthcare intervention was associated with greater use of preventive CVD medication use and lower BP levels among high-risk individuals in a rural Indonesian population.
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- 2019
7. Cost-effectiveness of a mobile technology-enabled primary care intervention for cardiovascular disease risk management in rural Indonesia.
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Angell, Blake, Lung, Thomas, Praveen, Devarsetty, Maharani, Asri, Sujarwoto, Sujarwoto, Palagyi, Anna, Oceandy, Delvac, Tampubolon, Gindo, Patel, Anushka, and Jan, Stephen
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CARDIOVASCULAR diseases ,PRIMARY care ,DISEASE management ,COST effectiveness ,COMMUNITY health workers ,CARDIOVASCULAR disease prevention ,PRIMARY health care ,COST benefit analysis ,RESEARCH funding ,RISK management in business ,TECHNOLOGY - Abstract
Cardiovascular diseases (CVD) are the leading cause of death in Indonesia, and there are large disparities in access to recommended preventative treatments across the country, particularly in rural areas. Technology-enabled screening and management led by community health workers have been shown to be effective in better managing those at high risk of CVD in a rural Indonesian population; however, the economic impacts of implementing such an intervention are unknown. We conducted a modelled cost-effectiveness analysis of the SMARThealth intervention in rural villages of Malang district, Indonesia from the payer perspective over a 10-year period. A Markov model was designed and populated with epidemiological and cost data collected in a recent quasi-randomized trial, with nine health states representing a differing risk for experiencing a major CVD event. Disability-Adjusted Life Years (DALYs) were estimated for the intervention and usual care using disability weights from the literature for major CVD events. Annual treatment costs for CVD treatment and prevention were $US83 under current care and $US144 for those receiving the intervention. The intervention had an incremental cost-effectiveness ratio of $4288 per DALY averted and $3681 per major CVD event avoided relative to usual care. One-way and probabilistic sensitivity analyses demonstrated that the results were robust to plausible variations in model parameters and that the intervention is highly likely to be considered cost-effective by decision-makers across a range of potentially acceptable willingness to pay levels. Relative to current care, the intervention was a cost-effective means to improve the management of CVD in this rural Indonesian population. Further scale-up of the intervention offers the prospect of significant gains in population health and sustainable progress toward universal health coverage for the Indonesian population. [ABSTRACT FROM AUTHOR]
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- 2021
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8. Determinants of cancer screening awareness and participation among Indonesian women
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Anwar, Sumadi L., Tampubolon, Gindo, Van Hemelrijck, Mieke, Hutajulu, Susanna H., Watkins, Johnathan, and Wulaningsih, Wahyu
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Adult ,pap smear ,Health Knowledge, Attitudes, Practice ,ResearchInstitutes_Networks_Beacons/global_development_institute ,cervical cancer ,Uterine Cervical Neoplasms ,Breast Neoplasms ,breast self-examination ,Breast cancer ,breast cancer ,Pap smears ,Humans ,Early Detection of Cancer ,Vaginal Smears ,screening ,Breast Self-Examination ,Middle Aged ,Patient Acceptance of Health Care ,Prognosis ,Global Development Institute ,Indonesia ,Population Surveillance ,Screening ,Cervical cancer ,Female ,Research Article ,Follow-Up Studies - Abstract
Background Cancer screening awareness and participation may be lower in low- and middle-income countries that lack established national screening programmes compared with those that do. We evaluated potential determinants of awareness about and participation in breast and cervical cancer screening, and breast self-examination (BSE) in women using survey data from Indonesia. Methods From the fifth Indonesian Family Life Survey (2014–2015), a total of 5397 women aged 40 and older without any history of cancer who responded to questionnaires concerning Pap smears, mammography, and BSE were included. Multilevel modelling was used to assess potential determinants in relation to awareness about Pap smears and mammography, and participation in Pap smears and BSE practice. Multivariable analyses were performed to identify independent predictors of cancer screening. Results Of the 5397 respondents, 1058 (20%) women were aware of Pap smears, of which 297 had never had the procedure. Only 251 (5%) participants were aware of mammography. A total of 605 (12%) of women reported they performed BSE. Higher education and household expenditure were consistently associated with higher odds of awareness about Pap smears and mammography (e.g. odds ratio [OR] of being aware of Pap smear and mammography: 7.82 (95% CI: 6.30–9.70) and 7.70 (6.19–9.58), respectively, for high school graduates compared to women with less educational attainment in the multivariable models), and participation in Pap smears and BSE. We also identified enabling factors linked with greater cancer screening awareness and participation, including health insurance, shorter distance to health services, and social participation. Conclusion There are socioeconomic disparities in cancer screening awareness and participation among Indonesian women. Our findings may help inform targeted health promotion and screening for cancer in the presence of limited resources. Electronic supplementary material The online version of this article (10.1186/s12885-018-4125-z) contains supplementary material, which is available to authorized users.
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- 2018
9. Premature natural menopause and cognitive function among older women in Indonesia.
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Sujarwoto, Sujarwoto and Tampubolon, Gindo
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AGING , *COGNITION , *MENOPAUSE , *PREMATURE menopause , *SURVEYS , *MULTIPLE regression analysis , *SOCIOECONOMIC factors , *LIFESTYLES , *REPRODUCTIVE history - Abstract
We examine the association between premature natural menopause and cognitive function among older women in Indonesia. Data come from Indonesia Family Life Survey (IFLS) 2014 (N = 1,031 menopausal women). Multilevel ordered logistic regression was used to take into account unobserved factors in the women's communities, also considering a range of potential confounding factors including their reproductive histories, lifestyles, and sociodemographic characteristics. The findings show that premature natural menopause was significantly associated with lower cognitive function in later life (ß = −0.97, P<.01, CI −1.61-(−0.33)). The findings were robust against potential confounding factors including reproductive history, lifestyle, and sociodemographic characteristics. [ABSTRACT FROM AUTHOR]
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- 2020
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10. Innovations in non-communicable diseases management in ASEAN: a case series
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Van Minh, Hoang, Pocock, Nicola Suyin, Chaiyakunapruk, Nathorn, Chhorvann, Chhea, Duc, Ha Anh, Hanvoravongchai, Piya, Lim, Jeremy, Lucero-Prisno, Don Eliseo, Ng, Nawi, Phaholyothin, Natalie, Phonvisay, Alay, Soe, Kyaw Min, Sychareun, Vanphanom, Chan, Melissa M. H., Alsagoff, Fatimah Z., Ha, Duc, Guinto, Ramon Lorenzo Luis R., Curran, Ufara Zuwasti, Suphanchaimat, Rapeepong, Pocock, Nicola S., Kittrakulrat, Jathurong, Jongjatuporn, Witthawin, Jurjai, Ravipol, Jarupanich, Nicha, Pongpirul, Krit, Kien, Vu Duy, Giang, Kim Bao, Weinehall, Lars, Ha, Bui T. T., Frizen, Scott, Thi, Le M., Duong, Doan T. T., Duc, Duong M., Maharani, Asri, Tampubolon, Gindo, Ng, See H., Kelly, Bridget, Se, Chee H., Chinna, Karuthan, Sameeha, Mohd Jamil, Krishnasamy, Shanthi, MN, Ismail, Karupaiah, Tilakavati, Low, Sharon, Tun, Kyaw Thura, Mhote, Naw Pue Pue, Htoo, Saw Nay, Maung, Cynthia, Kyaw, Saw Win, Shwe Oo, Saw Eh Kalu, Ormond, Meghann, Mun, Wong Kee, Khoon, Chan Chee, Ismail, Pg Khalifah Pg, and Koh, David
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universal health insurance ,migrant workers ,health financing ,content analysis ,multiple imputation ,medical licensing examination ,healthcare commodification ,Universal Health Coverage ,horizontal equity ,integration ,statistical data ,sugar-sweetened drink ,destination countries ,food marketing ,innovations ,health workforce ,policy process ,AEC ,Fiscal decentralisation ,medical qualification ,migrant health ,urban Vietnam ,Asean Integration and Its Health Implications ,internally displaced people ,Burma/Myanmar ,decomposition ,Asean Integration ,public–private health care investment ,entrepreneurial state ,healthcare utilization ,developing countries ,immunisation status ,television ,task shifting ,non-communicable diseases ,health care ,Southeast Asia ,Asean Integration and Its Health Implications Commentary ,Special Issue: ASEAN Integration and its Health Implications ,multilevel model ,obesogenic environment ,medical practice ,Vietnam ,Indonesia ,health system strengthening ,occupational health ,medical education ,medical tourism industry ,ASEAN - Abstract
Background The Association of Southeast Asian Nations (ASEAN) is characterized by much diversity in terms of geography, society, economic development, and health outcomes. The health systems as well as healthcare structure and provisions vary considerably. Consequently, the progress toward Universal Health Coverage (UHC) in these countries also varies. This paper aims to describe the progress toward UHC in the ASEAN countries and discuss how regional integration could influence UHC. Design Data reported in this paper were obtained from published literature, reports, and gray literature available in the ASEAN countries. We used both online and manual search methods to gather the information and ‘snowball’ further data. Results We found that, in general, ASEAN countries have made good progress toward UHC, partly due to relatively sustained political commitments to endorse UHC in these countries. However, all the countries in ASEAN are facing several common barriers to achieving UHC, namely 1) financial constraints, including low levels of overall and government spending on health; 2) supply side constraints, including inadequate numbers and densities of health workers; and 3) the ongoing epidemiological transition at different stages characterized by increasing burdens of non-communicable diseases, persisting infectious diseases, and reemergence of potentially pandemic infectious diseases. The ASEAN Economic Community's (AEC) goal of regional economic integration and a single market by 2015 presents both opportunities and challenges for UHC. Healthcare services have become more available but health and healthcare inequities will likely worsen as better-off citizens of member states might receive more benefits from the liberalization of trade policy in health, either via regional outmigration of health workers or intra-country health worker movement toward private hospitals, which tend to be located in urban areas. For ASEAN countries, UHC should be explicitly considered to mitigate deleterious effects of economic integration. Political commitments to safeguard health budgets and increase health spending will be necessary given liberalization's risks to health equity as well as migration and population aging which will increase demand on health systems. There is potential to organize select health services regionally to improve further efficiency. Conclusions We believe that ASEAN has significant potential to become a force for better health in the region. We hope that all ASEAN citizens can enjoy higher health and safety standards, comprehensive social protection, and improved health status. We believe economic and other integration efforts can further these aspirations., Background Non-communicable diseases (NCDs) are reaching epidemic proportions worldwide and present an unprecedented challenge to economic and social development globally. In Southeast Asia, the challenges are exacerbated by vastly differing levels of health systems development and funding availability. In addressing the burden of NCDs, ASEAN nations need to fundamentally re-examine how health care services are structured and delivered and discover new models as undiscerning application of models from other geographies with different cultures and resources will be problematic. Objective We sought to examine cases of innovation and identify critical success factors in NCD management in ASEAN. Design A qualitative design, focusing on in-depth interviews and site visits to explore the meanings and perceptions of participants regarding innovations in NCD against the backdrop of the overall context of delivering health care within the country's context was adopted. Results In total 12 case studies in six ASEAN countries were analysed. Primary interventions accounted for five of the total cases, whereas secondary interventions comprised four, and tertiary interventions three. Five core themes contributing to successful innovation for NCD management were identified. They include: 1) encourage better outcomes through leadership and support, 2) strengthen inter-disciplinary partnership, 3) community ownership is key, 4) recognise the needs of the people and what appeals to them, and 5) raise awareness through capacity building and increasing health literacy. Conclusions Innovation is vital in enabling ASEAN nations to successfully address the growing crisis of NCDs. More of the same or wholesale transfers of developed world models will be ineffective and lead to financially unsustainable programmes or programmes lacking appropriate human capital. The case studies have demonstrated the transformative impact of innovation and identified key factors in successful implementation. Beyond pilot success, the bigger challenge is scaling up. Medical technologies are crucial but insufficient; passionate and engaged leaders and communities enabled by enlightened policy makers and funding agencies matter more., Background As the Association of South East Asian Nations (ASEAN) gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years. While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC) reforms in most ASEAN countries. This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development. Design A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted. Results In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents. Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems. In terms of predominantly sending countries, the Philippines's social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component. Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants. However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies. Furthermore, countries must engage in multilateral and bilateral dialogue as they redefine UHC beyond the basis of citizenship and reimagine UHC systems that transcend national borders. Conclusions By enhancing migrant coverage, ASEAN countries can make UHC systems truly ‘universal’. Migrant inclusion in UHC is a human rights imperative, and it is in ASEAN's best interest to protect the health of migrants as it pursues the path toward collective social progress and regional economic prosperity., Background In the regional movement toward ASEAN Economic Community (AEC), medical professions including physicians can be qualified to practice medicine in another country. Ensuring comparable, excellent medical qualification systems is crucial but the availability and analysis of relevant information has been lacking. Objective This study had the following aims: 1) to comparatively analyze information on Medical Licensing Examinations (MLE) across ASEAN countries and 2) to assess stakeholders’ view on potential consequences of AEC on the medical profession from a Thai perspective. Design To search for relevant information on MLE, we started with each country's national body as the primary data source. In case of lack of available data, secondary data sources including official websites of medical universities, colleagues in international and national medical student organizations, and some other appropriate Internet sources were used. Feasibility and concerns about validity and reliability of these sources were discussed among investigators. Experts in the region invited through HealthSpace.Asia conducted the final data validation. For the second objective, in-depth interviews were conducted with 13 Thai stakeholders, purposely selected based on a maximum variation sampling technique to represent the points of view of the medical licensing authority, the medical profession, ethicists and economists. Results MLE systems exist in all ASEAN countries except Brunei, but vary greatly. Although the majority has a national MLE system, Singapore, Indonesia, and Vietnam accept results of MLE conducted at universities. Thailand adopted the USA's 3-step approach that aims to check pre-clinical knowledge, clinical knowledge, and clinical skills. Most countries, however, require only one step. A multiple choice question (MCQ) is the most commonly used method of assessment; a modified essay question (MEQ) is the next most common. Although both tests assess candidate's knowledge, the Objective Structured Clinical Examination (OSCE) is used to verify clinical skills of the examinee. The validity of the medical license and that it reflects a consistent and high standard of medical knowledge is a sensitive issue because of potentially unfair movement of physicians and an embedded sense of domination, at least from a Thai perspective. Conclusions MLE systems differ across ASEAN countries in some important aspects that might be of concern from a fairness viewpoint and therefore should be addressed in the movement toward AEC., Background A health system that provides equitable health care is a principal goal in many countries. Measuring horizontal inequity (HI) in health care utilization is important to develop appropriate and equitable public policies, especially policies related to non-communicable diseases (NCDs). Design A cross-sectional survey of 1,211 randomly selected households in slum and non-slum areas was carried out in four urban districts of Hanoi city in 2013. This study utilized data from 3,736 individuals aged 15 years and older. Respondents were asked about health care use during the previous 12 months; information included sex, age, and self-reported NCDs. We assessed the extent of inequity in utilization of public health care services. Concentration indexes for health care utilization and health care needs were constructed via probit regression of individual utilization of public health care services, controlling for age, sex, and NCDs. In addition, concentration indexes were decomposed to identify factors contributing to inequalities in health care utilization. Results The proportion of healthcare utilization in the slum and non-slum areas was 21.4 and 26.9%, respectively. HI in health care utilization in favor of the rich was observed in the slum areas, whereas horizontal equity was achieved among the non-slum areas. In the slum areas, we identified some key factors that affect the utilization of public health care services. Conclusion Our results suggest that to achieve horizontal equity in utilization of public health care services, policy should target preventive interventions for NCDs, focusing more on the poor in slum areas., Background In almost 30 years since economic reforms or ‘renovation’ (Doimoi) were launched, Vietnam has achieved remarkably good health results, in many cases matching those in much higher income countries. This study explores the contribution made by Universal Health Insurance (UHI) policies, focusing on the past 15 years. We conducted a mixed method study to describe and assess the policy process relating to health insurance, from agenda setting through implementation and evaluation. Design The qualitative research methods implemented in this study were 30 in-depth interviews, 4 focus group discussions, expert consultancy, and 420 secondary data review. The data were analyzed by NVivo 7.0. Results Health insurance in Vietnam was introduced in 1992 and has been elaborated over a 20-year time frame. These processes relate to moving from a contingent to a gradually expanded target population, expanding the scope of the benefit package, and reducing the financial contribution from the insured. The target groups expanded to include 66.8% of the population by 2012. We characterized the policy process relating to UHI as incremental with a learning-by-doing approach, with an emphasis on increasing coverage rather than ensuring a basic service package and financial protection. There was limited involvement of civil society organizations and users in all policy processes. Intertwined political economy factors influenced the policy processes. Conclusions Incremental policy processes, characterized by a learning-by-doing approach, is appropriate for countries attempting to introduce new health institutions, such as health insurance in Vietnam. Vietnam should continue to mobilize resources in sustainable and viable ways to support the target groups. The country should also adopt a multi-pronged approach to achieving universal access to health services, beyond health insurance., Background The past two decades have seen many countries, including a number in Southeast Asia, decentralising their health system with the expectation that this reform will improve their citizens’ health. However, the consequences of this reform remain largely unknown. Objective This study analyses the effects of fiscal decentralisation on child immunisation status in Indonesia. Design We used multilevel logistic regression analysis to estimate these effects, and multilevel multiple imputation to manage missing data. The 2011 publication of Indonesia's national socio-economic survey (Susenas) is the source of household data, while the Podes village census survey from the same year provides village-level data. We supplement these with local government fiscal data from the Ministry of Finance. Results The findings show that decentralising the fiscal allocation of responsibilities to local governments has a lack of association with child immunisation status and the results are robust. The results also suggest that increasing the number of village health centres (posyandu) per 1,000 population improves probability of children to receive full immunisation significantly, while increasing that of hospitals and health centres (puskesmas) has no significant effect. Conclusion These findings suggest that merely decentralising the health system does not guarantee improvement in a country's immunisation coverage. Any successful decentralisation demands good capacity and capability of local governments., Background Food advertising on television (TV) is well known to influence children's purchasing requests and models negative food habits in Western countries. Advertising of unhealthy foods is a contributor to the obesogenic environment that is a key driver of rising rates of childhood obesity. Children in developing countries are more at risk of being targeted by such advertising, as there is a huge potential for market growth of unhealthy foods concomitant with poor regulatory infrastructure. Further, in developing countries with multi-ethnic societies, information is scarce on the nature of TV advertising targeting children. Objectives To measure exposure and power of TV food marketing to children on popular multi-ethnic TV stations in Malaysia. Design Ethnic-specific popular TV channels were identified using industry data. TV transmissions were recorded for each channel from November 2012 to August 2013 (16 hr/day) for randomly selected weekdays and weekend days during normal days and repeated during school holidays (n=88 days). Coded food/beverage advertisements were grouped into core (healthy), non-core (non-healthy), or miscellaneous (unclassified) food categories. Peak viewing time (PVT) and persuasive marketing techniques were identified. Results Non-core foods were predominant in TV food advertising, and rates were greater during school holidays compared to normal days (3.51 vs 1.93 food ads/hr/channel, p, Background Burma/Myanmar was controlled by a military regime for over 50 years. Many basic social and protection services have been neglected, specifically in the ethnic areas. Development in these areas was led by the ethnic non-state actors to ensure care and the availability of health services for the communities living in the border ethnic-controlled areas. Political changes in Burma/Myanmar have been ongoing since the end of 2010. Given the ethnic diversity of Burma/Myanmar, many challenges in ensuring health service coverage among all ethnic groups lie ahead. Methods A case study method was used to document how existing human resources for health (HRH) reach the vulnerable population in the ethnic health organizations’ (EHOs) and community-based organizations’ (CBHOs) service areas, and their related information on training and services delivered. Mixed methods were used. Survey data on HRH, service provision, and training were collected from clinic-in-charges in 110 clinics in 14 Karen/Kayin townships through a rapid-mapping exercise. We also reviewed 7 organizational and policy documents and conducted 10 interviews and discussions with clinic-in-charges. Findings Despite the lack of skilled medical professionals, the EHOs and CBHOs have been serving the population along the border through task shifting to less specialized health workers. Clinics and mobile teams work in partnership, focusing on primary care with some aspects of secondary care. The rapid-mapping exercise showed that the aggregate HRH density in Karen/Kayin state is 2.8 per 1,000 population. Every mobile team has 1.8 health workers per 1,000 population, whereas each clinic has between 2.5 and 3.9 health workers per 1,000 population. By reorganizing and training the workforce with a rigorous and up-to-date curriculum, EHOs and CBHOs present a viable solution for improving health service coverage to the underserved population. Conclusion Despite the chronic conflict in Burma/Myanmar, this report provides evidence of the substantive system of health care provision and access in the Karen/Kayin State over the past 20 years. It underscores the climate of vulnerability of the EHOs and CBHOs due to lack of regional and international understanding of the political complexities in Burma/Myanmar. As Association of Southeast Asian Nations (ASEAN) integration gathers pace, this case study highlights potential issues relating to migration and health access. The case also documents the challenge of integrating indigenous and/or cross-border health systems, with the ongoing risk of deepening ethnic conflicts in Burma/Myanmar as the peace process is negotiated., Following the identification of medical tourism as a growth sector by the Malaysian government in 1998, significant government sector and private-sector investments have been channeled into its development over the past 15 years. This is unfolding within the broader context of social services being devolved to for-profit enterprises and ‘market-capable’ segments of society becoming sites of intensive entrepreneurial investment by both the private sector and the state. Yet, the opacity and paucity of available medical tourism statistics severely limits the extent to which medical tourism's impacts can be reliably assessed, forcing us to consider the real effects that the resulting speculation itself has produced and to reevaluate how the real and potential impacts of medical tourism are – and should be – conceptualized, calculated, distributed, and compensated for. Contemporary debate over the current and potential benefits and adverse effects of medical tourism for destination societies is hamstrung by the scant empirical data currently publicly available. Steps are proposed for overcoming these challenges in order to allow for improved identification, planning, and development of resources appropriate to the needs, demands, and interests of not only medical tourists and big business but also local populations., Like most ASEAN countries, Brunei faces an epidemic of non-communicable diseases. To deal with the complexity of NCDs prevention, all perspectives - be it social, familial or occupational – need to be considered. In Brunei Darussalam, occupational health services (OHS) offered by its Ministry of Health, among others, provide screening and management of NCDs at various points of service. The OHS does not only issue fitness to work certificates, but is a significant partner in co-managing patients’ health conditions, with the advantage of further management at the workplace. Holistic approach of NCD management in the occupational setting is strengthened with both employer and employee education and participation, targeting several approaches including risk management and advocating healthy lifestyles as part of a healthy workplace programme.
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- 2015
11. Cardiovascular disease risk factor prevalence and estimated 10-year cardiovascular risk scores in Indonesia: The SMARThealth Extend study.
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Maharani, Asri, Sujarwoto, null, Praveen, Devarsetty, Oceandy, Delvac, Tampubolon, Gindo, and Patel, Anushka
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CARDIOVASCULAR diseases risk factors ,SYSTOLIC blood pressure ,BLOOD pressure - Abstract
Background: The brunt of cardiovascular disease (CVD) burden globally now resides within low- and middle-income countries, including Indonesia. However, little is known regarding cardiovascular health in Indonesia. This study aimed to estimate the prevalence of elevated CVD risk in a specific region of Indonesia. Methods: We conducted full household screening for cardiovascular risk factors among adults aged 40 years and older in 8 villages in Malang District, East Java Province, Indonesia, in 2016–2017. 10-year cardiovascular risk scores were calculated based on the World Health Organization/International Society of Hypertension’s region-specific charts that use age, sex, blood pressure, diabetes status and smoking behaviour. Results: Among 22,093 participants, 6,455 (29.2%) had high cardiovascular risk, defined as the presence of coronary heart disease, stroke or other atherosclerotic disease; estimated 10-year CVD risk of ≥ 30%; or estimated 10-year CVD risk between 10% to 29% combined with a systolic blood pressure of > 140 mmHg. The prevalence of high CVD risk was greater in urban (31.6%, CI 30.7–32.5%) than in semi-urban (28.7%, CI 27.3–30.1%) and rural areas (26.2%, CI 25.2–27.2%). Only 11% and 1% of all the respondents with high CVD risk were on blood pressure lowering and statins treatment, respectively. Conclusions: High cardiovascular risk is common among Indonesian adults aged ≥40 years, and rates of preventive treatment are low. Population-based and clinical approaches to preventing CVD should be a priority in both urban and rural areas. [ABSTRACT FROM AUTHOR]
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- 2019
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12. Does corporatisation improve organisational commitment? Evidence from public hospitals in Indonesia.
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Maharani, Asri and Tampubolon, Gindo
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PUBLIC hospitals ,WORK values ,JOB satisfaction ,ORGANIZATIONAL commitment ,HEALTH care industry ,STRUCTURAL equation modeling - Abstract
This study aims to investigate the consequences of corporatisation on organisational commitment and to explain the relationship between work values, job satisfaction and organisational commitment. The research was carried out in 54 public hospitals in East Java, Indonesia, applying a multilevel structural equation model to survey data on 1282 workers in those hospitals. Analysis suggests that the longer a hospital has been corporatised, the greater the organisational commitment of its employees. Incentives have positive and substantive association with organisational commitment, while training and resource availability do not. We found that employees in larger hospitals are more committed than those in smaller hospitals and that work values and job satisfaction have a positive and significant relationship with organisational commitment. Our findings shed light on the debate on corporatisation as a lever for improving organisational commitment in public hospitals in developing countries. [ABSTRACT FROM AUTHOR]
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- 2018
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13. Spatial inequality and the Internet divide in Indonesia 2010–2012.
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Sujarwoto, Sujarwoto and Tampubolon, Gindo
- Subjects
- *
INFORMATION & communication technologies , *INFORMATION technology , *INTERNET access ,DEVELOPING countries - Abstract
Spatial inequality has been one of the key development characteristics considered across developing countries. However, relatively few studies examine the mechanisms by which spatial inequality explains the existing digital divide in a developing country. Applying the normalisation and stratification thesis in diffusion theory, this study examines the ways in which spatial inequality is related to the Internet divide in Indonesia, a developing country that is currently growing in its use of Information and Communication Technology (ICT), but that has experienced unequal regional development in the last three decades. Data comes from the Indonesian national socio-economic survey (Susenas) 2010–2012, which comprises 3.3 million individuals, 750,000 households and 292 districts. Far from moving towards convergence, the Internet divide expanded during this period; the inequality of Internet access by age, gender, income, and education deepens and widens across urban–rural, city–countryside, and remote island–mainland island areas. The results of analyses using both stratified and multilevel models indicate that supply factors across districts – particularly district disparities in telecommunications infrastructures, human capital and education services – are associated with the Internet divide. The results are robust against individual, household and district socio-economic characteristics associated with the Internet divide. Enlarging the distribution of telecommunication infrastructures and education facilities, particularly across districts in rural, countryside and remote islands, may thus help to bridge the Internet divide in Indonesia. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
14. Geography and social distribution of malaria in Indonesian Papua: a cross-sectional study.
- Author
-
Hanandita, Wulung and Tampubolon, Gindo
- Subjects
- *
MALARIA diagnosis , *MEDICAL geography , *BAYESIAN analysis ,RISK of malaria - Abstract
Background: Despite being one of the world's most affected regions, only little is known about the social and spatial distributions of malaria in Indonesian Papua. Existing studies tend to be descriptive in nature; their inferences are prone to confounding and selection biases. At the same time, there remains limited malaria-cartographic activity in the region. Analysing a subset (N = 22,643) of the National Basic Health Research 2007 dataset (N = 987,205), this paper aims to quantify the district-specific risk of malaria in Papua and to understand how socio-demographic/economic factors measured at individual and district levels are associated with individual's probability of contracting the disease. Methods: We adopt a Bayesian hierarchical logistic regression model that accommodates not only the nesting of individuals within the island's 27 administrative units but also the spatial autocorrelation among these locations. Both individual and contextual characteristics are included as predictors in the model; a normal conditional autoregressive prior and an exchangeable one are assigned to the random effects. Robustness is then assessed through sensitivity analyses using alternative hyperpriors. Results: We find that rural Papuans as well as those who live in poor, densely forested, lowland districts are at a higher risk of infection than their counterparts. We also find age and gender differentials in malaria prevalence, if only to a small degree. Nine districts are estimated to have higher-than-expected malaria risks; the extent of spatial variation on the island remains notable even after accounting for socio-demographic/economic risk factors. Conclusions: Although we show that malaria is geography-dependent in Indonesian Papua, it is also a disease of poverty. This means that malaria eradication requires not only biological (proximal) interventions but also social (distal) ones. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
15. National Economic Development Status May Affect the Association between Central Adiposity and Cognition in Older Adults.
- Author
-
Maharani, Asri and Tampubolon, Gindo
- Subjects
- *
OVERWEIGHT persons , *ECONOMIC development , *COGNITION , *HEALTH of older people , *GERIATRIC psychology , *WAIST circumference - Abstract
Background: Obesity is becoming a global problem, rather than one found only in developed countries. Although recent studies have suggested a detrimental effect of obesity on cognition, studies of the relationship between obesity and cognition among older adults have been limited to developed countries. We aimed to examine the associations between central obesity, as measured by waist circumference, and cognition level in adults aged 50 years and older in England and Indonesia. Methods: We used linear regression models to analyse these associations and multiple imputation to manage missing data. The 2006 English Longitudinal Study of Ageing Wave 3 is the source of data from England, while data from Indonesia is sourced from the 2007 Indonesian Family Life Survey Wave 4. Findings: Centrally obese respondents had lower cognition levels than non-centrally obese respondents in England. In contrast, central adiposity had a statistically significant positive association with cognition in Indonesia. Higher levels of education and higher economic status were associated with higher cognitive ability, while age was associated with lower cognition in both countries. Elevated C-reactive protein (CRP) concentrations and smoking behaviour, both linked to higher risk of obesity, were negatively associated with cognitive ability among older adults in England, but they had no statistically significant association with cognition among Indonesians. Interpretation: The contradictory findings on obesity and cognition in England and Indonesia not only create a puzzle, but they may also have different policy implications in these countries. Reducing the prevalence of obesity may be the main focus in England and other developed countries to maintain older adults’ cognition. However, Indonesia and other developing countries should place more emphasis on education, in addition to continued efforts to tackle the double burden of malnutrition, in order to prevent cognitive impairment among older adults. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
16. Inflammatory markers and physical performance in middle-aged and older people in Indonesia.
- Author
-
SUJARWOTO SUJARWOTO and TAMPUBOLON, GINDO
- Subjects
- *
GERIATRIC assessment , *BIOMARKERS , *C-reactive protein , *ENZYME-linked immunosorbent assay , *INFLAMMATION , *LONGITUDINAL method , *STATISTICS , *DATA analysis , *ACTIVITIES of daily living , *DATA analysis software , *DESCRIPTIVE statistics - Abstract
Background: although recent studies have suggested that inflammation may play an important role in the process of ageing and in the development of disabilities, knowledge about the role of inflammation in physical performance decline among middle-aged and older people in the context of developing countries is limited. Objectives: to examine the association between C-reactive protein (CRP) and the activities of daily living (ADL) among middle-aged (40--54 years old) and older (55--96 years old) people in Indonesia. Data: data from a population-based sample, the Indonesia Family Life Survey (IFLS) 2007, were analysed. The data consist of 1,702 respondents of middle age (40--54 years old) and 2,017 older respondents who had completed information on ADL and CRP. Methods: CRP concentrations in Dried Blood Spot (DBS) specimens were measured, using the validated enzyme-linked im-munosorbent assay (ELISA) method. Thirteen items of ADL were used to measure physical performance. A three-level linear model was applied to take advantage of the nested structure of data at the individual level within the household and community levels. Results: high levels of CRP were significantly associated with lower ADL for middle-aged and older people (P < 0.001). The model was adjusted for co-morbid conditions, health risk factors, medications, depressive symptoms and sociodemographic characteristics. Conclusion: the significant association between the high level of CRP and lower ADL among older people in Indonesia is in line with earlier studies in the context of developed countries. This study provides an extension in which the significant association was also found in middle-aged people (40--54 years old). [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
17. Decentralization in Indonesia: lessons from cost recovery rate of district hospitals.
- Author
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Maharani, Asri, Femina, Devi, and Tampubolon, Gindo
- Subjects
DECENTRALIZATION in management ,PUBLIC health ,HOSPITALS ,MEDICAL care - Abstract
In 1991, Indonesia began a process of decentralization in the health sector which had implications for the country's public hospitals. The public hospitals were given greater authority to manage their own personnel, finance and procurement, with which they were allowed to operate commercial sections in addition to offering public services. These public services are subsidized by the government, although patients still pay certain proportion of fees. The main objectives of health sector decentralization are to increase the ability of public hospitals to cover their costs and to reduce government subsidies. This study investigates the consequences of decentralization on cost recovery rate of public hospitals at district level. We examine five service units (inpatient, outpatient, operating room, laboratory and radiology) in three public hospitals. We find that after 20 years of decentralization, district hospitals still depend on government subsidies, demonstrated by the fact that the cost recovery rate of most service units is less than one. The commercial sections fail to play their role as revenue generator as they are still subsidized by the government. We also find that the bulk of costs are made up of staff salaries and incentives in all units except radiology. As this study constitutes exploratory research, further investigation is needed to find out the reasons behind these results. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
18. Has decentralisation affected child immunisation status in Indonesia?
- Author
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Maharani, Asri and Tampubolon, Gindo
- Subjects
- *
SURVEYS , *DECENTRALIZATION in management , *IMMUNIZATION of children , *LOCAL government , *MULTIVARIATE analysis , *RURAL health services , *LOGISTIC regression analysis - Abstract
Background: The past two decades have seen many countries, including a number in Southeast Asia, decentralising their health system with the expectation that this reform will improve their citizens' health. However, the consequences of this reform remain largely unknown. Objective: This study analyses the effects of fiscal decentralisation on child immunisation status in Indonesia. Design: We used multilevel logistic regression analysis to estimate these effects, and multilevel multiple imputation to manage missing data. The 2011 publication of Indonesia's national socio-economic survey (Susenas) is the source of household data, while the Podes village census survey from the same year provides village-level data. We supplement these with local government fiscal data from the Ministry of Finance. Results: The findings show that decentralising the fiscal allocation of responsibilities to local governments has a lack of association with child immunisation status and the results are robust. The results also suggest that increasing the number of village health centres (posyandu) per 1,000 population improves probability of children to receive full immunisation significantly, while increasing that of hospitals and health centres (puskesmas) has no significant effect. Conclusion: These findings suggest that merely decentralising the health system does not guarantee improvement in a country's immunisation coverage. Any successful decentralisation demands good capacity and capability of local governments. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
19. Does poverty reduce mental health? An instrumental variable analysis.
- Author
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Hanandita, Wulung and Tampubolon, Gindo
- Subjects
- *
INCOME , *MENTAL health , *POVERTY , *WEATHER - Abstract
Abstract: That poverty and mental health are negatively associated in developing countries is well known among epidemiologists. Whether the relationship is causal or associational, however, remains an open question. This paper aims to estimate the causal effect of poverty on mental health by exploiting a natural experiment induced by weather variability across 440 districts in Indonesia (N = 577,548). Precipitation anomaly in two climatological seasons is used as an instrument for poverty status, which is measured using per capita household consumption expenditure. Results of an instrumental variable estimation suggest that poverty causes poor mental health: halving one's consumption expenditure raises the probability of suffering mental illness by 0.06 point; in terms of elasticity, a 1% decrease in consumption brings about 0.62% more symptoms of common mental disorders. This poverty effect is approximately five times stronger than that obtained prior to instrumenting and is robust to alternative distributional assumption, model specification, sample stratification and estimation technique. An individual's mental health is also negatively correlated with district income inequality, suggesting that income distribution may have a significant influence upon mental health over and above the effect of poverty. The findings imply that mental health can be improved not only by influencing individuals' health knowledge and behaviour but also by implementing a more equitable economic policy. [Copyright &y& Elsevier]
- Published
- 2014
- Full Text
- View/download PDF
20. Poverty and mental health in Indonesia.
- Author
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Tampubolon, Gindo and Hanandita, Wulung
- Subjects
- *
COMPETENCY assessment (Law) , *POVERTY , *PSYCHOLOGICAL tests , *SPIRITUALITY , *SOCIAL capital , *DESCRIPTIVE statistics - Abstract
Abstract: Community and facility studies in developing countries have generally demonstrated an inverse relationship between poverty and mental health. However, recent population-based studies contradict this. In India and Indonesia the poor and non-poor show no difference in mental health. We revisit the relationship between poverty and mental health using a validated measure of depressive symptoms (CES-D) and a new national sample from Indonesia – a country where widespread poverty and deep inequality meet with a neglected mental health service sector. Results from three-level overdispersed Poisson models show that a 1% decrease in per capita household expenditure was associated with a 0.05% increase in CES-D score (depressive symptoms), while using a different indicator (living on less than $2 a day) it was estimated that the poor had a 5% higher CES-D score than the better off. Individual social capital and religiosity were found to be positively associated with mental health while adverse events were negatively associated. These findings provide support for the established view regarding the deleterious association between poverty and mental health in developed and developing countries. [Copyright &y& Elsevier]
- Published
- 2014
- Full Text
- View/download PDF
21. Has decentralisation affected child immunisation status in Indonesia?
- Author
-
Maharani, Asri and Tampubolon, Gindo
- Abstract
Background: The past two decades have seen many countries, including a number in Southeast Asia, decentralising their health system with the expectation that this reform will improve their citizens’ health. However, the consequences of this reform remain largely unknown. Objective: This study analyses the effects of fiscal decentralisation on child immunisation status in Indonesia. Design: We used multilevel logistic regression analysis to estimate these effects, and multilevel multiple imputation to manage missing data. The 2011 publication of Indonesia’s national socio-economic survey (Susenas) is the source of household data, while the Podes village census survey from the same year provides village-level data. We supplement these with local government fiscal data from the Ministry of Finance. Results: The findings show that decentralising the fiscal allocation of responsibilities to local governments has a lack of association with child immunisation status and the results are robust. The results also suggest that increasing the number of village health centres (posyandu) per 1,000 population improves probability of children to receive full immunisation significantly, while increasing that of hospitals and health centres (puskesmas) has no significant effect. Conclusion: These findings suggest that merely decentralising the health system does not guarantee improvement in a country’s immunisation coverage. Any successful decentralisation demands good capacity and capability of local governments. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
22. Mother's social capital and child health in Indonesia.
- Author
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Sujarwoto, Sujarwoto and Tampubolon, Gindo
- Subjects
- *
CHILDREN'S health , *INTERVIEWING , *MOTHERS , *SURVEYS , *SOCIAL capital , *CROSS-sectional method , *DESCRIPTIVE statistics - Abstract
Abstract: Social capital has been shown to be positively associated with a range of health outcomes, yet few studies have explored the association between mother's social capital and children's health. This study examines the relation between mothers' access to social capital (via participation in community activities) and child health. Instrumental variable estimation was applied to cross sectional data of the Indonesian Family Life Survey (IFLS) 2007 which consist of face-to-face interviews among the adult population in Indonesia (N mothers = 3450, N children = 4612, N communities = 309, and participation rate at 92%). The findings show strong evidence for the causal flow running from a mother's social capital to her children's health. All instruments are highly correlated with mothers' social capital but uncorrelated with child health. The findings are also robust to individual and community characteristics associated with child health, and suggest that enlarging mothers' social capital through various community activities is a particularly relevant intervention for reducing child health disparities in Indonesia. [Copyright &y& Elsevier]
- Published
- 2013
- Full Text
- View/download PDF
23. Rejoinder to Lund: Plan and action in mental health research and policy in low and middle-income countries.
- Author
-
Tampubolon, Gindo and Hanandita, Wulung
- Subjects
- *
MENTAL health , *POVERTY , *SOCIAL justice ,DEVELOPING countries - Published
- 2014
- Full Text
- View/download PDF
24. Essays on poverty and health in Indonesia
- Author
-
Hanandita, Wulung Anggara, Tampubolon, Gindo, and Ramlogan, Ronald
- Subjects
362.1 ,poverty ,health inequality ,mental health ,self-rated health ,nutrition ,malaria ,Indonesia - Abstract
This thesis presents five standalone essays that demonstrate the feasibility and utility of employing advanced analytic techniques to cross-sectional data from Indonesia in order to deal with some technical challenges typically encountered either in the estimation of social gradient in health or in the monitoring and evaluation of well-being as a multidimensional construct. The first essay estimates the causal effect of poverty on mental health by exploiting a natural experiment induced by weather variability across 440 districts in the Indonesian archipelago. The second essay applies parametric anchoring vignette methodology to investigate the extent to which the estimates of demographic and socio-economic inequalities in self-rated health are biased by survey respondents' differential reporting behaviour. The third essay formally assesses the existence and identifies the social determinants of the double burden of malnutrition in Indonesia using a variant of a generalised linear mixed model. The fourth essay maps the social and spatial distributions of malaria in 27 districts in Indonesian Papua using a probabilistic disease mapping technique that is capable of accounting for the complex dependency structure of spatially-correlated multilevel data. The fifth essay examines the extent and patterns of multidimensional poverty in Indonesia over the last decade using a novel poverty measurement method that is sensitive to both the incidence and intensity of multiple deprivations in income, health and education domains. Together, these essays show that although health and social researchers in the developing world have little choice but to conduct cross-sectional studies, new insights can sometimes be gained if one is willing to look at existing data through a new lens. In all five cases presented here, this approach is proved to be useful in shaping practical policy-making.
- Published
- 2016
25. Essays on decentralisation, public services and well-being in Indonesia
- Author
-
Sujarwoto, Sujarwoto, Tampubolon, Gindo, and Ramlogan, Ronald
- Subjects
320.9598 ,Decentralisation ,public services ,well-being ,Indonesia - Abstract
Decentralisation has been viewed as one means for promoting citizen well-being by bringing public goods and services closer to local needs. Yet empirical evidence across developing countries shows mixed results. This study aims to examine the association between decentralisation, public services and well-being in decentralised Indonesia. It argues that decentralisation enhances citizen well-being through improved local government capacity better able to deliver public goods and services. With lack of local government capacity and accountability, decentralisation decreases well-being. This study contributes to existing research on decentralisation and well-being in three ways. First, while most studies discuss decentralisation and well-being in a cross-country context, this examines the relationship in a cross-local government context, and specifically within a developing country. Second, while most decentralisation studies focus on objective measures of well-being, this study uses both a subjective measure (i.e. happiness and citizen satisfaction with public services) and an objective measure (i.e. child health and healthcare demand). Third, while most studies use either aggregate or individual analyses to examine the effect of decentralisation on well-being, this study uses multilevel analysis to examine the effect of local government determinants on individual well-being.This study uses unique datasets which combine individual and household level data and local government data. Individual and household level data is taken from the Governance and Decentralisation Survey (GDS) 2006, the Indonesian Family Life Survey (IFLS) 2007, and the Indonesia socio-economic survey (Susenas) 2009. Local government level data comes from the national village census (Podes) 2006-2008, the national election database 2004-2007, the national health database 2009, local development budget and expenditure information 2004-2008, and the consumer prices indices 2004-2009. The main findings show that well-being among Indonesians varies across local governments, and that disparities in both public services and well-being appear between more developed and less developed regions. Well-being is not only associated with individual and household determinants, but also with local government determinants. The results are consistent, namely, that variation in well-being is associated with the capacity of local governments to deliver public goods and services. Citizens report being happier and more satisfied when local governments are able to provide better public goods and services for them (i.e. able to spend more of their budget on providing public services). In contrast, well-being decreases in the face of local corruption and of weak capacity to govern. These findings suggest that improving local government capacity to provide effective policies and good public services is vital to improve citizen well-being in decentralised Indonesia.
- Published
- 2013
26. Decentralisation, performance of health providers and health outcomes in Indonesia
- Author
-
Maharani, Asri, RAMLOGAN, RONALD R, Tampubolon, Gindo, and Ramlogan, Ronald
- Subjects
Indonesia ,decentralisation ,health outcomes ,public hospitals - Abstract
Health reformers, especially in developing countries, have applied decentralisation to enhance the performance of health systems which in turn improve health outcomes. Proponents of decentralisation argue that increasing the authority of local government promotes resource allocation according to local needs. Yet critics point out that decentralisation is harmful as resources are more likely to be redistributed in favour of poorer areas in countries with centralised governments. Shedding light on those endless debates, this study aims to examine the association between decentralisation, performance of health providers and health outcomes in Indonesia. In 2001 Indonesia embarked on decentralisation in the form of devolution and fiscal decentralisation. Devolution transfers the responsibilities of providing health services from central government to local government, while fiscal decentralisation allows local government to manage its local economies. Following those reforms, Indonesia raised the authority of public hospitals’ managers through corporatisation in 2004. Those reforms aim to provide better health services for the population. Evaluating whether all three forms of decentralisation in Indonesia have achieved their aim or not, this study uses both primary and secondary data. The primary data was collected in 54 public hospitals in East Java province during summer 2013. The secondary data combined individual and household level data and local government data. The Indonesia socio-economic survey (Susenas) 2004-2013 and Indonesian Family Life Survey (IFLS) 2007 are the sources of individual and household data, while the national village census (Podes) 2003-2010 provides district-level data. I supplement these with local government fiscal data from the Ministry of Finance and the consumer price index 2004-2013. The assembled data possesses a multilevel structure in which individuals or households are nested within districts. The main findings show that health outcomes among Indonesians continue to vary across districts after decentralisation. Passing authority down from central government to lower-level institutions does not automatically bring about better performance of health providers and health outcomes regardless of the type of authority devolved and the characteristics of the delegated institutions. However, further analysis on multiyear data suggests that there is an important learning curve throughout the process of decentralisation implementation. Both local governments and hospital managers need time to learn how to utilise the authority they are given after decentralisation. These findings suggest that improving capacity and accountability of local authorities and an understanding of why some local authorities are better than others at learning during the process of decentralisation are vital to improve performance of health providers and health outcomes in decentralised Indonesia.
- Published
- 2015
27. Essays on Poverty and Health in Indonesia
- Author
-
Wulung Anggara Hanandita, RAMLOGAN, RONALD R, Tampubolon, Gindo, and Ramlogan, Ronald
- Subjects
nutrition ,poverty ,Indonesia ,malaria ,health inequality ,mental health ,self-rated health - Abstract
This thesis presents five standalone essays that demonstrate the feasibility and utility of employing advanced analytic techniques to cross-sectional data from Indonesia in order to deal with some technical challenges typically encountered either in the estimation of social gradient in health or in the monitoring and evaluation of well-being as a multidimensional construct. The first essay estimates the causal effect of poverty on mental health by exploiting a natural experiment induced by weather variability across 440 districts in the Indonesian archipelago. The second essay applies parametric anchoring vignette methodology to investigate the extent to which the estimates of demographic and socio-economic inequalities in self-rated health are biased by survey respondents' differential reporting behaviour. The third essay formally assesses the existence and identifies the social determinants of the double burden of malnutrition in Indonesia using a variant of a generalised linear mixed model. The fourth essay maps the social and spatial distributions of malaria in 27 districts in Indonesian Papua using a probabilistic disease mapping technique that is capable of accounting for the complex dependency structure of spatially-correlated multilevel data. The fifth essay examines the extent and patterns of multidimensional poverty in Indonesia over the last decade using a novel poverty measurement method that is sensitive to both the incidence and intensity of multiple deprivations in income, health and education domains. Together, these essays show that although health and social researchers in the developing world have little choice but to conduct cross-sectional studies, new insights can sometimes be gained if one is willing to look at existing data through a new lens. In all five cases presented here, this approach is proved to be useful in shaping practical policy-making.
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