Search

Background: The government makes various policies to improve the health of pregnant women, which in turn has an impact on reducing maternal mortality and infant mortality. Antenatal care (ANC) is the most important strategy to improve the health of pregnant women. Distric/city governments must ensure the availability of antenatal services for their communities in primary health facilities (PHF). Midwives are the primary provider of antenatal care at PHF. This study describes the time required for midwives to provide standardized antenatal care.Methods: This study was a time study method, which analyzes the average time of ANC Services by midwives in PHF. The study observed fifty-eight midwives who gave ANC services to five hundred fifty-two pregnant women in six districts in West Java. The data collection was carried out in January-February 2019.Results: In this study, it was found that the time to ANC varied widely; for ANC-I, the average is 30.34 minutes (Min 25 minutes- Max 50 minutes; lower mean 56,7%), ANC-II 23.12 minutes (Min 17 minutes - Max 36 minutes; Lower mean 63,5%), and ANC-T 26.9 minutes (Min 23 minutes - Max 35 minutes; lower mean 53,2%). The order of service time is as follows: ANC-I, ANC-T and ANC-II.Conclusions: The time used for ANC is still significantly less than that recommended by the WHO for pregnant women's visits (40 minutes per visit). The reason will undoubtedly affect the quality of ANC services. It is hoped that District/City Administrative and Health Authorities will pay more attention to the duration time of ANC visits by developing a standard time of visit per patient or increasing the number of midwives in carrying out ANC services at that location.

The COVID-19 vaccination program in Indonesia that started on January 13, 2021 is expected to accelerate the herd immunity that will impact on reducing the infected cases. The World Health Organization (WHO) explained that vaccine performance can be measured through vaccine efficacy, effectiveness, and impact. This community service activity aims to provide inputs for policy implementation on COVID-19 vaccination strategy to the government by conducting predictive analysis using a dynamic mathematical modeling to determine the effectiveness and impact of vaccination at the community level. Five types of vaccines were analyzed, namely AstraZeneca, Moderna, Pfizer, Sinopharm and Sinovac. Two basic model scenarios of with and without the vaccination policy implementation were simulated. The model demonstrated that the policy noticeably reduces the number of COVID-19 cases. The main finding demonstrated by the model is that the effectiveness of the vaccine after it is immunized into the community is affected by its efficacy, but the efficacy of various vaccines type does not influence significantly to the vaccine impact on community. Thus, it is recommended that the government ensures the availability of any type of vaccines to accelerate the vaccination program and encourage community participation to be vaccinated to achieve the target goal. Furthermore, since the impact of vaccine on the community is not only determined by its efficacy, the government have to do persistent health education and drive community engagement to adhere with the COVID-19 health protocol. Keywords: COVID-19, Dynamics Modeling, High Leverage Policy, Vaccine Effectiveness, Vaccine Impact Abstrak Program vaksinasi COVID-19 di Indonesia yang mulai dilaksanakan pada tanggal 13 Januari 2021 diharapkan dapat mempercepat terjadinya kekebalan kelompok (herd immunity) yang nantinya berdampak pada penurunan jumlah kasus yang terinfeksi. Organisasi Kesehatan Dunia (WHO) memaparkan bahwa kinerja vaksin dapat dilihat dari tiga pengukuran yaitu melalui efikasi, efektivitas, dan dampak vaksin. Kegiatan pengabdian kepada masyarakat ini bertujuan untuk memberikan masukan kepada pemerintah dalam mengimplementasikan strategi vaksinasi COVID-19 dengan menyediakan analisis prediksi menggunakan pemodelan matematika dinamis untuk mengetahui efektivitas dan dampak vaksinasi pada tingkat masyarakat. Lima jenis vaksin yang dianalisis adalah AstraZeneca, Moderna, Pfizer, Sinopharm dan Sinovac. Dua skenario dasar pemodelan yaitu dengan dan tanpa intervensi kebijakan vaksinasi disimulasikan. Hasil keluaran model menunjukkan kebijakan vaksinasi memberikan dampak dalam penurunan jumlah kasus COVID-19. Temuan utama yang didemonstrasikan oleh model adalah efektivitas vaksin setelah diimunisasikan ke masyarakat dipengaruhi oleh efikasinya, tetapi efikasi antar jenis vaksin tidak terlalu berpengaruh terhadap dampak vaksin di masyarakat. Oleh karena itu disarankan agar pemerintah menjamin ketersediaan vaksin apa pun jenisnya untuk mengakselerasi proses vaksinasi ke masyarakat dan mendorong partisipasi masyarakat untuk divaksin sehingga target yang sudah ditetapkan tercapai. Selanjutnya, mengingat bahwa dampak vaksin di masyarakat bukan hanya ditentukan oleh efikasinya, maka pemerintah harus terus melakukan upaya edukasi dan mendorong pelibatan masyarakat secara aktif untuk patuh menerapkan protokol kesehatan COVID-19. Kata kunci: COVID-19, Pemodelan Dinamis, Kebijakan Berpengaruh Tinggi, Efektivitas Vaksin, Dampak Vaksin