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Widarna R, Afifah N, Djunaedy HAK, Sassi A, Vasquez NA, Oga-Omenka C, Salindri AD, Lestari BW, Pai M, Alisjahbana B. The shifting landscape of private healthcare providers before and during the COVID-19 pandemic: Lessons to strengthen the private sectors engagement for future pandemic and tuberculosis care. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003112. [PMID: 39361559 DOI: 10.1371/journal.pgph.0003112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/26/2024] [Indexed: 10/05/2024]
Abstract
INTRODUCTION COVID-19 pandemic changed many aspects of healthcare services and deliveries, including among private healthcare providers (i.e., private healthcare facilities [HCFs] and private practitioners [PPs]). We aimed to compare the spatial distribution of private providers and describe changes in characteristics and services offered during and before the COVID-19 pandemic, and explore the tuberculosis (TB) and COVID-19-related services offered by the private sector in Bandung, Indonesia. METHODS A cross-sectional study with historical comparison was conducted in 36 randomly selected community health centers areas (locally referred to as Puskesmas) in Bandung, Indonesia, during the COVID-19 pandemic from 5th April 2021 - 27th December 2021. Data pertaining to before the COVID-19 pandemic was abstracted from a similar survey conducted in 2017 (i.e., INSTEP study). We obtained latitude and longitude coordinates of private healthcare providers and then compared the geographical spread with data collected for INSTEP study. We also compared characteristics of, and services provided by private healthcare providers interviewed during the COVID-19 pandemic with those previously interviewed for INSTEP study. Differences were summarized using descriptive and bivariate analyses. RESULTS From April-December 2021, we surveyed 367 private HCFs and interviewed 637 PPs. Compared to INSTEP study data, the number of operating HCFs was reduced by 3% during the COVID-19 pandemic (401 vs. 412 before COVID-19), although we observed increases in laboratory service (37.8% increase), x-ray service (66.7% increase), and pharmacy (18.1% increase). Among a subset of private HCFs managing patients with respiratory tract infection symptoms, a quarter (60/235, 25.3%) indicated that they had to close their facilities in response to the emerging situation during the COVID-19 pandemic. For PPs, the number of practicing PPs was reduced by 7% during the COVID-19 pandemic (872 vs. 936 before COVID-19). Interestingly, the number of practicing PPs encountering patients with TB disease increased during the COVID-19 pandemic (42.9% vs. 35.7% before COVID-19, p = 0.008). CONCLUSION This study confirmed that the COVID-19 pandemic adversely impacted health care service deliveries in private sectors, largely marked by closures and shortened business hours. However, the increased service capacities (laboratory and pharmacy), as well as significant increase in the number of patients cared for TB disease by PPs during the COVID-19 pandemic, made a more compelling case to further the implementation of public-private mix model for TB care in Indonesia.
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Affiliation(s)
- Rodiah Widarna
- Tuberculosis Working Group, Research Center for Care and Control of Infectious Diseases Universitas Padjadjaran (RC3ID Unpad), Bandung, Indonesia
| | - Nur Afifah
- Tuberculosis Working Group, Research Center for Care and Control of Infectious Diseases Universitas Padjadjaran (RC3ID Unpad), Bandung, Indonesia
| | - Hanif Ahmad Kautsar Djunaedy
- Tuberculosis Working Group, Research Center for Care and Control of Infectious Diseases Universitas Padjadjaran (RC3ID Unpad), Bandung, Indonesia
| | - Angelina Sassi
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathaly Aguilera Vasquez
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Charity Oga-Omenka
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Argita Dyah Salindri
- Tuberculosis Working Group, Research Center for Care and Control of Infectious Diseases Universitas Padjadjaran (RC3ID Unpad), Bandung, Indonesia
| | - Bony Wiem Lestari
- Tuberculosis Working Group, Research Center for Care and Control of Infectious Diseases Universitas Padjadjaran (RC3ID Unpad), Bandung, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Madhukar Pai
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Bachti Alisjahbana
- Tuberculosis Working Group, Research Center for Care and Control of Infectious Diseases Universitas Padjadjaran (RC3ID Unpad), Bandung, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
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Wenang S, Emilia O, Wahyuni A, Afdal A, Haier J. Obstetrics care in Indonesia: Determinants of maternal mortality and stillbirth rates. PLoS One 2024; 19:e0303590. [PMID: 38968281 PMCID: PMC11226051 DOI: 10.1371/journal.pone.0303590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 04/04/2024] [Indexed: 07/07/2024] Open
Abstract
PROBLEM The Indonesian Healthcare Program starting in 2014 enabled access to healthcare delivery for large population groups. Guidance of usage, infrastructure and healthcare process development were the most challenging tasks during the implementation period. Due to the high social impact obstetric care and related quality assurance require evidence-based developmental strategies. This study aims for analysis of outcome and maternal health care utilization, as well as differences related to demographic and economic subgroups. METHODS For univariate group comparison ANOVA method was applied and combined with Scheffé procedure and Bonferoni correction for post-hoc tests. Meanwhile, multivariate approaches through regression analysis based on insurance reimbursement data antenatal, perinatal and postnatal care were performed at the province level. Maternal mortality (MMR) and stillbirth rates were used for outcome. Demographic characteristics, availability of obstetricians (SPOG), midwifes and healthcare infrastructure were included for their determinants. RESULTS Specialized hospital facilities (type A/B) for advanced care covered a large part of uncomplicated cases (~35%). Differences between insurance membership groups (poor, non-poor) were not seen. Availability of human resources (SPOG, midwifes) (R2 = 0.728; p<0.001) and rural setting (R2 = 0.288; p = 0.001) are correlated with reduced insufficient referral. Their presence within provinces was related to lower occurrence of complicated cases (R2 = 0.294; p = 0.001). However, higher SPOG rates within provinces were also related to high C-section rates (p<0.001). MMR and stillbirth rates can be predicted by availability of human resources and C-section rates explaining 49.0% of variance. CONCLUSIONS Improvement of perinatal outcome should focus on sufficient referral processes, availability of SPOG in provinces dominated by rural/remote demography and avoidance of overtreatment by high C-section rates. It is very important to regulate the education of obstetricians and gynecologists in Indonesia as well as distribution arrangements regarding to solve the problems with pregnancy complications in remote and rural areas.
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Affiliation(s)
- Supriyatiningsih Wenang
- Faculty of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Universitas Muhammadiyah Yogyakarta, Kasihan, Indonesia
| | - Ova Emilia
- Faculty of Medicine, Department of Obstetrics and Gynecology, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Alfaina Wahyuni
- Faculty of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Universitas Muhammadiyah Yogyakarta, Kasihan, Indonesia
| | - Andi Afdal
- BPJS (Social Insurance Administration Organization), Jacarta, Indonesia
| | - Joerg Haier
- Faculty of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Universitas Muhammadiyah Yogyakarta, Kasihan, Indonesia
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
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Harsono IW, Ariani Y, Benyamin B, Fadilah F, Pujianto DA, Hafifah CN. IDeRare: a lightweight and extensible open-source phenotype and exome analysis pipeline for germline rare disease diagnosis. JAMIA Open 2024; 7:ooae052. [PMID: 38883202 PMCID: PMC11179852 DOI: 10.1093/jamiaopen/ooae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/20/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Objectives Diagnosing rare diseases is an arduous and challenging process in clinical settings, resulting in the late discovery of novel variants and referral loops. To help clinicians, we built IDeRare pipelines to accelerate phenotype-genotype analysis for patients with suspected rare diseases. Materials and Methods IDeRare pipeline is separated into phenotype and genotype parts. The phenotype utilizes our handmade Python library, while the genotype part utilizes command line (bash) and Python script to combine bioinformatics executable and Docker image. Results We described various implementations of IDeRare phenotype and genotype parts with real-world clinical and exome data using IDeRare, accelerating the terminology conversion process and giving insight on the diagnostic pathway based on disease linkage analysis until exome analysis and HTML-based reporting for clinicians. Conclusion IDeRare is freely available under the BSD-3 license, obtainable via GitHub. The portability of IDeRare pipeline could be easily implemented for semi-technical users and extensible for advanced users.
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Affiliation(s)
- Ivan William Harsono
- Doctoral Program in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Yulia Ariani
- Department of Medical Biology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Beben Benyamin
- Australian Centre for Precision Health, University of South Australia, Adelaide 5000, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide 5000, Australia
- South Australian Health and Medical Research Institute (SAHMRI), University of South Australia, Adelaide 5000, Australia
| | - Fadilah Fadilah
- Department of Medical Chemistry, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
- Bioinformatics Core Facilities-IMERI, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Dwi Ari Pujianto
- Department of Medical Biology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Cut Nurul Hafifah
- Department of Child Health, Dr Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia
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Sudirham S, Sari TB. Equity in healthcare: lessons from Australia's vaccine campaign for Indonesia. J Public Health (Oxf) 2024; 46:e228-e229. [PMID: 38010622 DOI: 10.1093/pubmed/fdad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 09/18/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
- Sudirham Sudirham
- Department of Public Health, Manado State University, Tondano, North Sulawesi 95618, Indonesia
| | - Tika Bela Sari
- Department of Public Health, Manado State University, Tondano, North Sulawesi 95618, Indonesia
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Febriyanti RM, Saefullah K, Susanti RD, Lestari K. Knowledge, attitude, and utilization of traditional medicine within the plural medical system in West Java, Indonesia. BMC Complement Med Ther 2024; 24:64. [PMID: 38287364 PMCID: PMC10826289 DOI: 10.1186/s12906-024-04368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/20/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The concept of 'medical pluralism' has become more popular among scholars in applied health science and prevalent in societies where one medical system alone cannot adequately meet the health care needs of the entire population. METHODS The data collection is focused on the knowledge-belief-practice and the utilization of three medical systems in Kabupaten Bandung, West Java, Indonesia. Participants were purposively selected from households with at least one member experienced one of the listed diseases in the questionnaire. The extensive survey using a structured questionnaire has been undertaken to collect data on people's health care utilization behaviour. The dataset is further analyzed using multivariate analysis through non-canonical correlation, with the analytical data provided by Statistical Package for Social Sciences (SPSS). RESULTS With regards to the total utilization by patients, the traditional medical system presents as the dominant medical system in the research area, accounting for 59.3% (n = 419) of total utilization, followed by the modern medical system (33.0%, n = 233), and transitional medical system (7.7%, n = 54). This study identified that village category, illness, illness duration, occupation, belief in traditional medicine, knowledge of modern medicine, accessibility, cost, proximity to the medical service, and insurance have significant (χ2 = 0.000) relationship with the utilization of medical systems. The results of the multivariate analysis show that the block of the predisposing socio-demographic factors and the block of the predisposing psycho-social factors correlate strongly with the utilization of medical systems. CONCLUSIONS In general, people in Kabupaten Bandung, West Java, Indonesia seeks treatment from various sources, which in the context of the medical system, consists of the traditional, transitional, and modern medical system; therefore, it adopts the patterns of transcultural health care utilization. In terms of the knowledge, beliefs, and practices of traditional medicine in West Java, the inhabitants of the five research villages were commonly familiar with medicinal plants and speak profoundly about their knowledge of traditional medicine, which in the research area is perceived as accessible, efficacious, affordable and culturally appropriate with Sundanese community.
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Affiliation(s)
- Raden Maya Febriyanti
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang KM. 21, Jatinangor, Sumedang West Java, 45363, Indonesia.
- Herbal Study Center, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang KM. 21, Jatinangor, Sumedang West Java, 45363, Indonesia.
| | - Kurniawan Saefullah
- Faculty of Economy and Business, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang KM. 21, Jatinangor, Sumedang West Java, 45363, Indonesia
| | - Raini Diah Susanti
- Faculty of Nursing, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang KM. 21, Jatinangor, Sumedang West Java, 45363, Indonesia
| | - Keri Lestari
- Department of Pharmacology and Clinical Pharmacy, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang KM. 21, Jatinangor, Sumedang West Java, 45363, Indonesia
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Barcellona C, Mariñas YB, Tan SY, Lee G, Ko KC, Chham S, Chhorvann C, Leerapan B, Pham Tien N, Lim J. Measuring health equity in the ASEAN region: conceptual framework and assessment of data availability. Int J Equity Health 2023; 22:251. [PMID: 38053205 PMCID: PMC10696689 DOI: 10.1186/s12939-023-02059-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Existing research on health equity falls short of identifying a comprehensive set of indicators for measurement across health systems. Health systems in the ASEAN region, in particular, lack a standardised framework to assess health equity. This paper proposes a comprehensive framework to measure health equity in the ASEAN region and highlights current gaps in data availability according to its indicator components. METHODS A comprehensive literature review was undertaken to map out a core set of indicators to evaluate health equity at the health system level. Secondary data collection was subsequently conducted to assess current data availability for ASEAN states in key global health databases, national health accounts, and policy documents. RESULTS A robust framework to measure health equity was developed comprising 195 indicators across Health System Inputs and Processes, Outputs, Outcomes, and Contextual Factors. Total indicator data availability equated to 72.9% (1423/1950). Across the ASEAN region, the Inputs and Processes sub-component of Health Financing had complete data availability for all indicators (160/160, 100%), while Access to Essential Medicine had the least data available (6/30, 20%). Under Outputs and Outcomes, Coverage of Selected Interventions (161/270, 59.63%) and Population Health (350/350, 100%) respectively had the most data available, while other indicator sub-components had little to none (≤ 38%). 72.145% (384/530) of data is available for all Contextual Factors. Out of the 10 ASEAN countries, the Philippines had the highest data availability overall at 77.44% (151/195), while Brunei Darussalam and Vietnam had the lowest data availability at 67.18% (131/195). CONCLUSIONS The data availability gaps highlighted in this study underscore the need for a standardised framework to guide data collection and benchmarking of health equity in ASEAN. There is a need to prioritise regular data collection for overlooked indicator areas and in countries with low levels of data availability. The application of this indicator framework and resulting data availability analysis could be conducted beyond ASEAN to enable cross-regional benchmarking of health equity.
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Affiliation(s)
- Capucine Barcellona
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | | | - Si Ying Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Gabriel Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Savina Chham
- National Institute of Public Health Cambodia, Phnom Penh, Cambodia
| | - Chhea Chhorvann
- National Institute of Public Health Cambodia, Phnom Penh, Cambodia
| | - Borwornsom Leerapan
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Jeremy Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Harapan BN, Harapan T, Theodora L, Anantama NA. From Archipelago to Pandemic Battleground: Unveiling Indonesia's COVID-19 Crisis. J Epidemiol Glob Health 2023; 13:591-603. [PMID: 37707715 PMCID: PMC10686963 DOI: 10.1007/s44197-023-00148-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to countries worldwide, including Indonesia. With its unique archipelagic geography consisting of more than 17,000 thousand islands, Indonesia faces unique complexities in managing the spread of the virus. Based on existing literature, this review article elaborates on key issues that have shaped Indonesia's COVID-19 response. The article begins by examining the early stages of the COVID-19 pandemic in Indonesia, along with the implementation of various preventive measures and the impact of the virus on public health. This article examines how Indonesia's socio-economic factors have generally influenced its healthcare system and further delves into the COVID-19 response strategies implemented by the Indonesian government and public health authorities as well as overall crisis preparedness. It discusses the actions taken to control the spread of the virus, including testing strategies and vaccination efforts. The difficulties encountered in implementing these measures are presented. In conclusion, this review article provides a comprehensive understanding of the COVID-19 crisis in Indonesia, covering facts on multiple dimensions ranging from the timeline of the pandemic to vaccination efforts, epidemiology, socio-economic implications, testing strategies, mobility patterns, public holidays, the impact of working from home, and the utilization of complementary and alternative medicine in addition to the standard of care for COVID-19. The insights gained from this article can complement future strategies for pandemic management and response in Indonesia and other countries facing similar challenges.
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Affiliation(s)
| | - Triswan Harapan
- Complementary Cardiovascular Clinic (CCV Clinic), Tangerang Selatan, Indonesia
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Fattah RA, Cheng Q, Thabrany H, Susilo D, Satrya A, Haemmerli M, Kosen S, Novitasari D, Puteri GC, Adawiyah E, Hayen A, Gilson L, Mills A, Tangcharoensathien V, Jan S, Asante A, Wiseman V. Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018-2019. Int J Equity Health 2023; 22:185. [PMID: 37674199 PMCID: PMC10483778 DOI: 10.1186/s12939-023-01980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Indonesia implemented one of the world's largest single-payer national health insurance schemes (the Jaminan Kesehatan Nasional or JKN) in 2014. This study aims to assess the incidence of catastrophic health spending (CHS) and its determinants and trends between 2018 and 2019 by which time JKN enrolment coverage exceeded 80%. METHODS This study analysed data collected from a two-round cross-sectional household survey conducted in ten provinces of Indonesia in February-April 2018 and August-October 2019. The incidence of CHS was defined as the proportion of households with out-of-pocket (OOP) health spending exceeding 10% of household consumption expenditure. Chi-squared tests were used to compare the incidences of CHS across subgroups for each household characteristic. Logistic regression models were used to investigate factors associated with incurring CHS and the trend over time. Sensitivity analyses assessing the incidence of CHS based on a higher threshold of 25% of total household expenditure were conducted. RESULTS The overall incidence of CHS at the 10% threshold fell from 7.9% to 2018 to 4.4% in 2019. The logistic regression models showed that households with JKN membership experienced significantly lower incidence of CHS compared to households without insurance coverage in both years. The poorest households were more likely to incur CHS compared to households in other wealth quintiles. Other predictors of incurring CHS included living in rural areas and visiting private health facilities. CONCLUSIONS This study demonstrated that the overall incidence of CHS decreased in Indonesia between 2018 and 2019. OOP payments for health care and the risk of CHS still loom high among JKN members and among the lowest income households. More needs to be done to further contain OOP payments and further research is needed to investigate whether CHS pushes households below the poverty line.
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Affiliation(s)
- Rifqi Abdul Fattah
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Qinglu Cheng
- Kirby Institute, University of New South Wales, Sydney, Australia.
- Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, High Street, 2052, Kensington, NSW, Australia.
| | | | - Dwidjo Susilo
- Faculty of Medicine and Health, University of Muhammadiyah, Jakarta, Indonesia
| | - Aryana Satrya
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
- Department of Management, Faculty of Economics, University of Indonesia, Depok, Indonesia
| | - Manon Haemmerli
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Danty Novitasari
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Gemala Chairunnisa Puteri
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
- Centre for Health Economics and Policy Studies, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Eviati Adawiyah
- Biostatistics and Demography Department, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Lucy Gilson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Health Policy and Systems Division, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Anne Mills
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Augustine Asante
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Virginia Wiseman
- Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Asante A, Cheng Q, Susilo D, Satrya A, Haemmerli M, Fattah RA, Kosen S, Novitasari D, Puteri GC, Adawiyah E, Hayen A, Mills A, Tangcharoensathien V, Jan S, Thabrany H, Wiseman V. The benefits and burden of health financing in Indonesia: analyses of nationally representative cross-sectional data. Lancet Glob Health 2023; 11:e770-e780. [PMID: 37061314 DOI: 10.1016/s2214-109x(23)00064-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Indonesia has committed to deliver universal health coverage by 2024. Reforming the country's health-financing system is key to achieving this commitment. We aimed to evaluate how the benefits and burden of health financing are distributed across income groups and the extent to which Indonesia has achieved equity in the funding and delivery of health care after financing reforms. METHODS We conducted benefit incidence analyses (BIA) and financing incidence analyses (FIA) using cross-sectional nationally representative data from several datasets. Two waves (Feb 1 to April 30, 2018, and Aug 1 to Oct 31, 2019) of the Equity and Health Care Financing in Indonesia (ENHANCE) study household survey involving 7500 households from ten of the 34 provinces in Indonesia were used to obtain health and socioeconomic status data for the BIA. Two waves (2018 and 2019) of the National Socioeconomic Survey (SUSENAS), the most recent wave (2014) of the Indonesian Family Life Survey, and the 2017 and 2018 National Health Accounts were used to obtain data for the FIA. In the BIA, we calculated a concentration index to assess the distribution of health-care benefits (-1·0 [pro-poor] to 1·0 [pro-rich]), considering potential differences in health-care need. In the FIA, we evaluated the equity of health-financing contributions by socioeconomic quintiles by calculating the Kakwani index to assess the relative progressivity of each financing source. Both the BIA and FIA compared results from early 2018 (baseline) with results from late 2019. FINDINGS There were 31 864 participants in the ENHANCE survey in 2018 compared with 31 215 in 2019. Women constituted 50·5% and men constituted 49·5% of the total participants for each year. SUSENAS had 1 131 825 participants in 2018 compared with 1 204 466 in 2019. Women constituted 49·9% of the participants for each year, whereas men constituted 51·1%. The distribution of health-care benefits in the public sector was marginally pro-poor; people with low income received a greater proportion of benefits from health services than people with high income between 2018 (concentration index -0·008, 95% CI -0·075 to 0·059) and 2019 (-0·060, -0·139 to 0·019). The benefit incidence in the private health sector was significantly pro-rich in 2018 (0·134, 0·065 to 0·203, p=0·0010) and 2019 (0·190, -0·192 to 0·572, p=0·0070). Health-financing incidence changed from being moderately progressive in 2018 (Kakwani index 0·034, 95% CI 0·030 to 0·038) to mildly regressive in 2019 (-0·030, -0·034 to -0·025). INTERPRETATION Although Indonesia has made substantial progress in expanding health-care coverage, a lot remains to be done to improve equity in financing and spending. Improving comprehensiveness of benefits will reduce out-of-pocket spending and allocating more funding to primary care would improve access to health-care services for people with low income. FUNDING UK Health Systems Research Initiative, UK Department of International Development, UK Economic and Social Research Council, UK Medical Research Council, and Wellcome Trust.
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Affiliation(s)
- Augustine Asante
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.
| | - Qinglu Cheng
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Dwidjo Susilo
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Aryana Satrya
- Department of Management, Faculty of Economics, University of Indonesia, Jakarta, Indonesia; Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Manon Haemmerli
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Rifqi Abdul Fattah
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Soewarta Kosen
- National Immunization Technical Advisory Group, Ministry of Health, Jakarta, Indonesia
| | - Danty Novitasari
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Gemala Chairunnisa Puteri
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia; Centre for Health Economics and Policy Studies, University of Indonesia, Jakarta, Indonesia
| | - Eviati Adawiyah
- Biostatistics and Demography Department, University of Indonesia, Jakarta, Indonesia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Anne Mills
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Hasbullah Thabrany
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Virginia Wiseman
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Wijayanti SPM, Rejeki DSS, Rizqi YNK, Octaviana D, Nurlaela S. Assessing the user satisfaction on COVID-19 vaccination service in Indonesia. J Public Health Res 2023; 12:22799036231181852. [PMID: 37361237 PMCID: PMC10285437 DOI: 10.1177/22799036231181852] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Background The implementation of the COVID-19 vaccination is still being carried out in Indonesia to enhance immunity against SARS Cov-2 infection. However, the information about vaccination service satisfaction is still very limited. This study aims to assess how satisfied Covid-19 vaccination service users are in Indonesia. Design and methods This is an analytic study with a cross-sectional design was conducted through an online survey in the third week of June 2022. People with a minimum age of 17 years, having received at least one COVID-19 vaccination, and residing in Indonesia were allowed to participate in this study. We used the SERVQUAL model as an instrument, measuring five aspects covering tangibility, responsiveness, reliability, assurance, and empathy. The analysis carried out included univariate analysis and bivariate test using chi-square statistical test. Results A total of 509 respondents were included in this study. The findings of this study revealed that there was not much of a difference between the satisfied (50.1%) and dissatisfied categories (49.9%) of vaccination users. Of the five dimensions measured, the highest level of dissatisfaction is in tangibility particularly on facility (48.7%), while the highest level of satisfaction is in reliability (the vaccination service following applicable procedures; 59.7%). We find out that vaccination location (p = 0.038), provision of refreshment/reward/incentives (p = 0.001), providing emergency contact post-vaccination (p = 0.000), and observation time post-vaccination (p = 0.000) were associated with the satisfaction of users. Conclusion Many respondents in this study are still dissatisfied with the COVID-19 vaccination services, so it is necessary for taking continuous efforts to raise the quality of vaccination services to increase user satisfaction.
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Affiliation(s)
- Siwi Pramatama Mars Wijayanti
- Siwi Pramatama Mars Wijayanti, Public Health Department, Faculty of Health Sciences, Jenderal Soedirman University, B Building, Jl. Dr. Soeparno, Karangwangkal, Purwokerto 53123, Jawa Tengah, Indonesia.
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11
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Arafat R, Tahir T, Harisa A. Moral distress among nurses in caring COVID-19 patients. CLINICAL ETHICS 2023; 18:62-66. [PMID: 36875058 PMCID: PMC9904987 DOI: 10.1177/14777509211057251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
During the COVID-19 pandemic, nurses experienced tremendous dilemmas including the need to perform their duties in caring for patients while they have concerns about contracting the disease. This study described the moral distress of nurses in-charge of handling COVID-19 patients which can be used as baseline data for intervention programs in overcoming moral distress among nurses. This descriptive, cross-sectional study was conducted with nurses in-charge of handling COVID-19 treatment rooms. Before conducting the survey, ethical approval was obtained from the Medical Faculty of Universitas Hasanuddin. Questionnaires on moral distress for clinical nurses and the demographic data questionnaire were distributed to 128 respondents. These nurses experienced relatively low levels of moral distress despite the fact that they were generally exposed to morally stressful situations. Education background appeared as a factor influencing this condition, in which higher moral distress was mostly experienced by nurses with undergraduate education.
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Affiliation(s)
| | - Takdir Tahir
- Faculty of Nursing, Hasanuddin University, Indonesia
| | - Akbar Harisa
- Faculty of Nursing, Hasanuddin University, Indonesia
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12
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Wulandari RD, Laksono AD, Rohmah N, Ashar H. Regional differences in primary healthcare utilization in Java Region-Indonesia. PLoS One 2023; 18:e0283709. [PMID: 36972247 PMCID: PMC10042337 DOI: 10.1371/journal.pone.0283709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Policymakers must understand primary healthcare utilization disparity to minimize the gap because they must seek fair service for every citizen. The study analyzes regional differences in primary healthcare utilization in Java Region-Indonesia. METHODS The cross-sectional research analyzes secondary data from the 2018 Indonesian Basic Health Survey. The study setting represented Java Region-Indonesia, and the participants were adults 15 years or more. The survey explores 629,370 respondents. The study used primary healthcare utilization as an outcome variable and province as the exposure variable. Moreover, the study employed eight control variables (residence, age, gender, education, marital, employment, wealth, and insurance). The study evaluated data using binary logistic regression in the final step. RESULTS People in Jakarta are 1.472 times more likely to utilize primary healthcare than those in Banten (AOR 1.472; 95% CI 1.332-1.627). People in Yogyakarta are 1.267 times more likely to use primary healthcare than those in Banten (AOR 1.267; 95% CI 1.112-1.444). In addition, people in East Java are 15% less likely to utilize primary healthcare than those in Banten (AOR 0.851; 95% CI 0.783-0.924). Meanwhile, direct healthcare utilization was the same between West Java, Central Java, and Banten Province. They are sequentially starting from the minor primary healthcare utilization: East Java, Central Java, Banten, West Java, Yogyakarta, and Jakarta. CONCLUSION Disparities between regions exist in the Java Region-Indonesia. They are sequentially starting from the minor primary healthcare utilization: East Java, Central Java, Banten, West Java, Yogyakarta, and Jakarta.
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Affiliation(s)
- Ratna Dwi Wulandari
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- The Airlangga Centre for Health Policy (ACeHAP), Surabaya, Indonesia
| | - Agung Dwi Laksono
- The Airlangga Centre for Health Policy (ACeHAP), Surabaya, Indonesia
- National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
| | - Nikmatur Rohmah
- Faculty of Health Science, Muhammadiyah University of Jember, East Java, Indonesia
| | - Hadi Ashar
- National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
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13
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Jumu L, Hardy S, Riyadi S, Arief D, Afzal R, Sukatemin S. Ex-Migrant Nurses Empowerment after Recovery from Covid-19 Pandemic: An Analysis of Reflective Cycle Gibbs Model. JURNAL INFO KESEHATAN 2022. [DOI: 10.31965/infokes.vol20.iss2.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
During the Covid-19 outbreak, many ex-migrant nurses who had resigned and were living in Indonesia were unable to return to work. The objective of this study is to develop strategies for empowering ex-migrant nurses in the sustainable healthcare sector following the recovery from the Covid-19 pandemic. The Reflective Cycle Gibbs (RCB) model was employed during the research, which comprised six stages that began with a document review and PRISMA analysis. The PRISMA Analysis utilized Google search engines to filter documents from Google Scholar, Research Gate, and other sources. The RCB model examined 10 eligible journals and discovered records of nurses who returned to their home country due to inadequate pay, career development, workforce protection policy, and empowerment facilities. We concluded 4 problems encountered by returnee nurses i.e. lack of protection policy, poor wages, less career development, and lack of empowerment facilities.
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14
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Schaefers J, Wenang S, Afdal A, Mukti AG, Sundari S, Haier J. Population-based study on coverage and healthcare processes for cancer during implementation of national healthcare insurance in Indonesia. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 6:100045. [PMID: 37383343 PMCID: PMC10306014 DOI: 10.1016/j.lansea.2022.100045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background A national healthcare insurance has been implemented in Indonesia since 2014. Although cancer care currently represents a smaller part of the healthcare support, the demographic development will lead to a rapid growth of the population within age groups at cancer risk. This requires strategic and developmental planning of cancer care resources. Based on data of the national healthcare insurance, current cancer care processes and their determinants were evaluated. Methods Nationwide reimbursement data as well as demographic, economic and healthcare infrastructure data were used for the study. Poor and underserved population was stratified according to the national classification system. Availability of healthcare resources was evaluated at provincial level. Cancer care usage was analysed applying descriptive and multivariate statistical approaches (regression, cluster analysis, tree classification). Findings Cancer care was provided in primary care (PHC) for 2.6/1000 and advanced care (AHC) for 4.8/1000 participants within the family-based membership structure. Regression analysis revealed human resource availability in rural/remote areas a determinant for cancer PHC. Cancer care in AHC was determined by PHC provided by general practitioners (GP), availability of AHC infrastructure (Class A & B hospital beds) and treatment migration between provinces. Tree classification confirmed predominant roles of GP, AHC infrastructure and referral between cancer care provider levels. Interpretation Cancer care will gain much higher importance for the Indonesian healthcare system within the next decade. Infrastructure, human resources, and process development should avoid rising overload of cancer care delivery by targeting reduction of treatment migration (availability of GPs in rural/remote provinces), improvement of referral systems (effective clinical selection processes and back-referral) and AHC cancer care structures (regional distribution of Class A & B hospitals). Funding This project was supported by grants from Centre for Research, Publication, and Community Development Muhammadiyah University of Yogyakarta (SW, ID), and data provision by BPJS Indonesia.
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Affiliation(s)
- Juergen Schaefers
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
- IGP Institute for Health Sciences and Public Health, Muenster, Germany
| | - Supriyatiningsih Wenang
- Dept. of Pediatric Oncology, University Hospital Muenster, Muenster, Germany
- Faculty of Medicine and Health Sciences, University of Muhammadiyah Yogyakarta, Indonesia
| | - Andi Afdal
- BPJS Kesehatan (Social Insurance Administration Organization), Indonesia
| | - Ali Ghufron Mukti
- BPJS Kesehatan (Social Insurance Administration Organization), Indonesia
| | - Sri Sundari
- Faculty of Medicine and Health Sciences, University of Muhammadiyah Yogyakarta, Indonesia
| | - Joerg Haier
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
- IGP Institute for Health Sciences and Public Health, Muenster, Germany
- Faculty of Medicine and Health Sciences, University of Muhammadiyah Yogyakarta, Indonesia
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15
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Ihyauddin Z, Marthias T, Anindya K, Ng N, Dewi FST, Hulse ESG, Aji RP, Putri DAD, Lee JT. The relative impact of underweight, overweight, smoking, and physical inactivity on health and associated costs in Indonesia: propensity score matching of a national sample. BMC Health Serv Res 2022; 22:1170. [PMID: 36115979 PMCID: PMC9482737 DOI: 10.1186/s12913-022-08546-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Indonesia is in the middle of a rapid epidemiological transition with an ageing population and increasing exposure to risk factors for chronic conditions. This study examines the relative impacts of obesity, tobacco consumption, and physical inactivity, on non-communicable diseases multimorbidity, health service use, catastrophic health expenditure (CHE), and loss in employment productivity in Indonesia. Methods Secondary analyses were conducted of cross-sectional data from adults aged ≥ 40 years (n = 12,081) in the Indonesian Family Life Survey 2014/2015. We used propensity score matching to assess the associations between behavioural risk factors and health service use, CHE, employment productivity, and multimorbidity. Results Being obese, overweight and a former tobacco user was associated with a higher number of chronic conditions and multimorbidity (p < 0.05). Being a former tobacco user contributed to a higher number of outpatient and inpatient visits as well as CHE incidences and work absenteeism. Physical inactivity relatively increased the number of outpatient visits (30% increase, p < 0.05) and work absenteeism (21% increase, P < 0.06). Although being underweight was associated with an increased outpatient care utilisation (23% increase, p < 0.05), being overweight was negatively associated with CHE incidences (50% decrease, p < 0.05). Conclusion Combined together, obesity, overweight, physical inactivity and tobacco use contributed to an increased number of NCDs as well as medical costs and productivity loss in Indonesia. Interventions addressing physical and behavioural risk factors are likely to have substantial benefits for individuals and the wider society in Indonesia. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08546-6.
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16
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Maulana N, Soewondo P, Adani N, Limasalle P, Pattnaik A. How Jaminan Kesehatan Nasional (JKN) coverage influences out-of-pocket (OOP) payments by vulnerable populations in Indonesia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000203. [PMID: 36962301 PMCID: PMC10021284 DOI: 10.1371/journal.pgph.0000203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/09/2022] [Indexed: 11/19/2022]
Abstract
While Indonesia introduced a national health insurance scheme (JKN) in 2014 and coverage has grown to over 80% of the population, Indonesians still spend significant sums out-of-pocket (OOP) for their healthcare-over 30% of current health expenditure (CHE). This study aims to better understand how JKN is influencing OOP payments, especially among the poor and rural, at the range of health facilities. This study uses data from the National Socio-Economic Survey (SUSENAS) in 2018 and 2019, as these surveys started including a question on how much OOP spending a household incurs on health. The results show that households with JKN membership are far less likely than the uninsured to pay OOP for healthcare, and that if they do incur a cost, the magnitude of this cost is much lower among JKN households than uninsured ones. The results also show that JKN households in the two poorest quintiles have a higher probability to not incur any OOP (37% and 35%, respectively) compared to those in the wealthier quintiles 4 (32%) and 5 (30%). Poorer JKN households living in the eastern part of Indonesia-the less urbanized and developed regions-experienced the most cost-savings, though largely due to supply-side constraints. In fact, JKN members save more at public primary health care facilities vs. private ones (who often do not contract with JKN) and also save significantly more (over 50%) than uninsured households at both public and private hospitals. The study demonstrates the positive influence JKN has on OOP payments, especially among the poor and rural, but also highlights how the scheme needs to better engage with the growing private sector and invest in infrastructure in rural areas to help secure financial protection for its entire population.
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Affiliation(s)
| | | | | | | | - Anooj Pattnaik
- ThinkWell Institute, Washington, D.C., United States of America
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17
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Khan M, Rahman-Shepherd A, Bory S, Chhorn S, Durrance-Bagale A, Hasan R, Heng S, Phou S, Prien C, Probandari A, Saphonn V, Suy S, Wiseman V, Wulandari LPL, Hanefeld J. How conflicts of interest hinder effective regulation of healthcare: an analysis of antimicrobial use regulation in Cambodia, Indonesia and Pakistan. BMJ Glob Health 2022; 7:bmjgh-2022-008596. [PMID: 35589155 PMCID: PMC9121421 DOI: 10.1136/bmjgh-2022-008596] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/20/2022] [Indexed: 11/09/2022] Open
Abstract
Background There has been insufficient attention to a fundamental force shaping healthcare policies—conflicts of interest (COI). We investigated COI, which results in the professional judgement of a policymaker or healthcare provider being compromised by a secondary interest, in relation to antimicrobial use, thereby illuminating challenges to the regulation of medicines use more broadly. Our objectives were to characterise connections between three groups—policymakers, healthcare providers and pharmaceutical companies—that can create COI, and elucidate the impacts of COI on stages of the policy process. Methods Using an interpretive approach, we systematically analysed qualitative data from 136 in-depth interviews and five focus group discussions in three Asian countries with dominant private healthcare sectors: Cambodia, Indonesia and Pakistan. Findings We characterised four types of connections that were pervasive between the three groups: financial, political, social and familial. These connections created strong COI that could impact all stages of the policy process by: preventing issues related to medicines sales from featuring prominently on the agenda; influencing policy formulation towards softer regulatory measures; determining resource availability for, and opposition to, policy implementation; and shaping how accurately the success of contested policies is reported. Interpretation Our multicountry study fills a gap in empirical evidence on how COI can impede effective policies to improve the quality of healthcare. It shows that COI can be pervasive, rather than sporadic, in influencing regulation of medicine use, and highlights that, in addition to financial connections, other types of connections should be examined as important drivers of COI.
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Affiliation(s)
- Mishal Khan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK .,Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan
| | - Afifah Rahman-Shepherd
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Anna Durrance-Bagale
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Rumina Hasan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan
| | | | | | - Chanra Prien
- University of Health Sciences, Phnom Penh, Cambodia
| | | | | | | | - Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,Center for International Health Protection, Robert Koch Institut, Berlin, Germany
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18
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Wahidiyat PA, Sari TT, Rahmartani LD, Iskandar SD, Pratanata AM, Yapiy I, Setianingsih I, Atmakusuma TD, Lubis AM. Thalassemia in Indonesia. Hemoglobin 2022; 46:39-44. [PMID: 35950580 DOI: 10.1080/03630269.2021.2023565] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Indonesia is located along the 'Thalassemia Belt' and a hotspot for hemoglobinopathies. Around 3.0-10.0% of the population carry β-thalassemia (β-thal) and 2.6-11.0% of the population carry α-thalassemia (α-thal). It is estimated that around 2500 babies are born with β-thal major (β-TM) each year. At present, the cornerstone of treatment for β-TM in Indonesia remains supportive, including blood transfusions and iron chelation therapy. Hemovigilance systems in some cities are poor and it increases the risk of transfusion-transmitted infections and transfusion reactions. The availability of iron chelators remains uncertain, even in some rural areas, iron chelators do not exist. The poor adherence to iron chelation therapy and maintaining pretransfusion hemoglobin (Hb) levels above 9.0 g/dL are still a major issue in Indonesia. The cost of blood transfusion and iron chelation are covered by national health insurance. In line with the rise of life expectancy, the financial burden of thalassemia in Indonesia is increasing sharply. Thus, optimizing preventive programs may be the most suitable option for the current thalassemia condition in Indonesia.
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Affiliation(s)
| | - Teny T Sari
- Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ludi D Rahmartani
- Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Stephen D Iskandar
- Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Ivana Yapiy
- Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Tubagus D Atmakusuma
- Department of Internal Medicine, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Anna M Lubis
- Department of Internal Medicine, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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19
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Siagian RC, Ayuningtyas D, Soewondo P, Thabrany H, Achadi A, Bachtiar NS. Assessment of country readiness for drug development: A qualitative study in Indonesia. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ria C. Siagian
- Biological Products Registration Badan Pengawas Obat dan Makanan Jakarta Indonesia
| | - Dumilah Ayuningtyas
- Department of Health Policy and Administration Faculty of Public Health Universitas Indonesia Depok Jawa Barat Indonesia
| | - Prastuti Soewondo
- Department of Health Policy and Administration Faculty of Public Health Universitas Indonesia Depok Jawa Barat Indonesia
| | - Hasbullah Thabrany
- Department of Health Policy and Administration Faculty of Public Health Universitas Indonesia Depok Jawa Barat Indonesia
| | - Anhari Achadi
- Department of Health Policy and Administration Faculty of Public Health Universitas Indonesia Depok Jawa Barat Indonesia
| | - Novilia S. Bachtiar
- Surveillance and Clinical Trial Division PT. Bio Farma Bandung West Java Indonesia
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20
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Francis-Oliviero F, Cambon L, Wittwer J, Marmot M, Alla F. [Theoretical and practical challenges of proportionate universalism: a reviewAnálise dos desafios teóricos e práticos de universalismo proporcional]. Rev Panam Salud Publica 2021; 45:e102. [PMID: 34703455 PMCID: PMC8529998 DOI: 10.26633/rpsp.2021.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it. The two specific objectives of this scoping review were: (1) to describe the theoretical context in which PU was established, (2) to describe how researchers apply PU and related methodological issues. METHODS We searched for all articles published until 6th of February 2020, mentioning "Proportionate Universalism" or its synonyms "Targeted universalism" OR "Progressive Universalism" as a topic in all Web of Science databases. RESULTS This review of 55 articles allowed us a global vision around the question of PU regarding its theoretical foundations and practical implementation. PU principle is rooted in the social theories of universalism and targeting. It proposes to link these two aspects in order to achieve an effective reduction of health inequalities. Regarding practical implementation, PU interventions were rare and led to different interpretations. There are still many methodological and ethical challenges regarding conception and evaluation of PU interventions, including how to apply proportionality, and identification of needs. CONCLUSION This review mapped available scientific literature on PU and its related concepts. PU principle originates from social theories. As highlighted by authors who implemented PU interventions, application raises many challenges from design to evaluation. Analysis of PU applications provided in this review answered to some of them but remaining methodological challenges could be addressed in further research.
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Affiliation(s)
| | - Linda Cambon
- University of BordeauxBordeauxFranciaUniversity of Bordeaux, Bordeaux, Francia.
| | - Jérôme Wittwer
- University of BordeauxBordeauxFranciaUniversity of Bordeaux, Bordeaux, Francia.
| | - Michael Marmot
- Institute of Health Equity at the University College LondonLondresReino UnidoInstitute of Health Equity at the University College London, Londres, Reino Unido.
| | - François Alla
- University of BordeauxBordeauxFranciaUniversity of Bordeaux, Bordeaux, Francia.
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21
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Wenang S, Schaefers J, Afdal A, Gufron A, Geyer S, Dewanto I, Haier J. Availability and Accessibility of Primary Care for the Remote, Rural, and Poor Population of Indonesia. Front Public Health 2021; 9:721886. [PMID: 34621720 PMCID: PMC8491579 DOI: 10.3389/fpubh.2021.721886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Adopting Universal Health Coverage for implementation of a national health insurance system [Jaminan Kesehatan Nasional (JKN)/Badan Penyelenggara Jaminan Sosial or the Indonesian National Social Health Insurance Scheme (BPJS)] targets the 255 million population of Indonesia. The availability, accessibility, and acceptance of healthcare services are the most important challenges during implementation. Referral behavior and the utilization of primary care structures for underserved (rural/remote regions) populations are key guiding elements. In this study, we provided the first assessment of BPJS implementation and its resulting implications for healthcare delivery based on the entire insurance dataset for the initial period of implementation, specifically focusing on poor and remote populations. Methods: Demographic, economic, and healthcare infrastructure information was obtained from public resources. Data about the JKN membership structure, performance information, and reimbursement were provided by the BPJS national head office. For analysis, an ANOVA was used to compare reimbursement indexes for primary healthcare (PHC) and advanced healthcare (AHC). The usage of primary care resources was analyzed by comparing clustered provinces and utilization indices differentiating poor [Penerima Bantuan Iur (PBI) membership] and non-poor populations (non-PBI). Factorial and canonical discrimination analyses were applied to identify the determinants of PHC structures. Results: Remote regions cover 27.8% of districts/municipalities. The distribution of the poor population and PBI members were highly correlated (r2 > 0.8; p < 0.001). Three clusters of provinces [remote high-poor (N = 13), remote low-poor (N = 15), non-remote (N = 5)] were identified. A discrimination analysis enabled the >82% correct cluster classification of infrastructure and human resources of health (HRH)-related factors. Standardized HRH (nurses and general practitioners [GP]) availability showed significant differences between clusters (p < 0.01), whereas the availability of hospital beds was weakly correlated. The usage of PHC was ~2-fold of AHC, while non-PBI members utilized AHC 4- to 5-fold more frequently than PBI members. Referral indices (r2 = 0.94; p < 0.001) for PBI, non-PBI, and AHC utilization rates (r2 = 0.53; p < 0.001) were highly correlated. Conclusion: Human resources of health availability were intensively related to the extent of the remote population but not the numbers of the poor population. The access points of PHC were mainly used by the poor population and in remote regions, whereas other population groups (non-PBI and non-Remote) preferred direct access to AHC. Guiding referral and the utilization of primary care will be key success factors for the effective and efficient usage of available healthcare infrastructures and the achievement of universal health coverage in Indonesia. The short-term development of JKN was recommended, with a focus on guiding referral behavior, especially in remote regions and for non-PBI members.
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Affiliation(s)
- Supriyatiningsih Wenang
- Department of Pediatric Oncology, University Hospital Muenster, Muenster, Germany
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, University of Muhammadiyah Yogyakarta, Bantul, Indonesia
| | - Juergen Schaefers
- IGP Institute for Health Sciences and Public Health, Muenster, Germany
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Andi Afdal
- Badan Penyelenggara Jaminan Sosial (Social Insurance Administration Organization), Jakarta, Indonesia
| | - Ali Gufron
- Badan Penyelenggara Jaminan Sosial (Social Insurance Administration Organization), Jakarta, Indonesia
| | - Siegfried Geyer
- Institute for Sociology, Hannover Medical School, Hannover, Germany
| | - Iwan Dewanto
- Faculty of Medicine and Health Sciences, School of Dentistry, University of Muhammadiyah Yogyakarta, Bantul, Indonesia
| | - Joerg Haier
- IGP Institute for Health Sciences and Public Health, Muenster, Germany
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
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22
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Nuraini T, Tumanggor RD, Hungerford C, Lees D, Cleary M. Caregiver Burden for People with Schizophrenia in Medan, Indonesia. Issues Ment Health Nurs 2021; 42:790-793. [PMID: 33275466 DOI: 10.1080/01612840.2020.1847223] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tengku Nuraini
- Faculty of Nursing, Community and Psychiatric Nursing Department, Universitas Sumatera Utara, Medan, Indonesia
| | - Roxsana Devi Tumanggor
- Faculty of Nursing, Community and Psychiatric Nursing Department, Universitas Sumatera Utara, Medan, Indonesia
| | | | - David Lees
- College of Health and Medicine, University of Tasmania, Australia
| | - Michelle Cleary
- College of Health and Medicine, University of Tasmania, Australia
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Anindya K, Lee JT, McPake B, Wilopo SA, Millett C, Carvalho N. Impact of Indonesia's national health insurance scheme on inequality in access to maternal health services: A propensity score matched analysis. J Glob Health 2021; 10:010429. [PMID: 32566167 PMCID: PMC7298736 DOI: 10.7189/jogh.10.010429] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Reducing inequality in maternal, neonatal and infant mortality are key targets in the Sustainable Development Goals. This study is the first to evaluate the impact of Indonesia’s national health insurance scheme, Jaminan Kesehatan Nasional (JKN), on access to maternal health services by sociodemographic status. Methods Using data from the 2017 Indonesia Demographic and Health Survey (IDHS) on women with live births in 2016-2017, we conducted propensity score matching (PSM) analysis to evaluate the association of JKN enrollment on the following maternal health care utilisation outcomes: (1) at least four antenatal care (ANC4+) visits; (2) ANC4+ visits and received essential components of ANC; (3) skilled birth attendance; (4) facility-based delivery; (5) post-natal care (PNC); and (6) PNC with skilled provider. Analyses were conducted at the national level and by economic subgroup and region of residence. Additionally, we investigated the potential negative impact of JKN on access to maternal health services among the uninsured population by looking at trends over time using data from the 2012 and 2017 IDHS. Results Of the 5429 women who had recently given birth, 61% were insured by JKN in 2017. After matching treated and untreated women on key sociodemographic characteristics, enrollment in JKN was associated with a higher prevalence of receiving ANC4+ visits (7.4%, 95% confidence interval (CI) = 4.8-9.39); ANC4+ visits and received essential components of ANC (5.6%, 95% CI = 3.3-7.9); skilled birth attendance (3.0%, 95% CI = 1.5-4.5; facility-based delivery (10.2%, 95% CI = 7.5-12.7); PNC (4.0%, 95% CI = 2.2-5.7); PNC with skilled provider (4.5%, 95% CI = 2.6-6.5). Effect sizes were larger among the poor and those living in less-developed areas, such as Eastern Indonesia and Sulawesi, except for at least ANC4+ and received clinical components. Conclusions Expansion of health insurance coverage was associated with reductions in sociodemographic inequalities in access to maternal health services in Indonesia. However, large differences in utilisation persist across regions and by economic subgroup. Accelerating progress toward universal health coverage may reduce health inequalities in other low and middle-income countries.
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Affiliation(s)
- Kanya Anindya
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Tayu Lee
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Siswanto Agus Wilopo
- Center for Reproductive Health and Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Natalie Carvalho
- Centre for Health Policy & Global Burden of Disease Group, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Mansour A, Sirichotiratana N, Viwatwongkasem C, Khan M, Srithamrongsawat S. District division administrative disaggregation data framework for monitoring leaving no one behind in the National Health Insurance Fund of Sudan: achieving sustainable development goals in 2030. Int J Equity Health 2021; 20:5. [PMID: 33407542 PMCID: PMC7789368 DOI: 10.1186/s12939-020-01338-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 11/30/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The aim of this study is to monitor the concept of 'leaving no one behind' in the Sustainable Development Goals (SDGs) to track the implications of the mobilization of health care resources by the National Health Insurance Fund (NHIF) of Sudan. METHODS A cross-sectional study was used to monitor 'leaving no one behind' in NHIF by analyzing the secondary data of the information system for the year 2016. The study categorized the catchment areas of health care centers (HCCS) according to district administrative divisions, which are neighborhood, subdistrict, district, and zero. The District Division Administrative Disaggregation Data (DDADD) framework was developed and investigated with the use of descriptive statistics, maps of Sudan, the Mann-Whitney test, the Kruskal-Wallis test and health equity catchment indicators. SPSS ver. 18 and EndNote X8 were also used. RESULTS The findings show that the NHIF has mobilized HCCs according to coverage of the insured population. This mobilization protected the insured poor in high-coverage insured population districts and left those living in very low-coverage districts behind. The Mann-Whitney test presented a significant median difference in the utilization rate between catchment areas (P value < 0.001). The results showed that the utilization rate of the insured poor who accessed health care centers by neighborhood was higher than that of the insured poor who accessed by more than neighborhood in each state. The Kruskal-Wallis test of the cost of health care services per capita in each catchment area showed a difference (P value < 0.001) in the median between neighborhoods. The cost of health care services in low-coverage insured population districts was higher than that in high-coverage insured population districts. CONCLUSION The DDADD framework identified the inequitable distribution of health care services in low-density population districts leaves insured poor behind. Policymakers should restructure the equation of health insurance schemes based on equity and probability of illness, to distribute health care services according to needs and equity, and to remobilize resources towards districts left behind.
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Affiliation(s)
- Ashraf Mansour
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, 10400 Thailand
| | - Nithat Sirichotiratana
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, 10400 Thailand
| | - Chukiat Viwatwongkasem
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Mahmud Khan
- Arnold School of Public Health, University of South Carolina, Columbia, USA
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Cashin C, Dossou JP. Can National Health Insurance Pave the Way to Universal Health Coverage in Sub-Saharan Africa? Health Syst Reform 2021; 7:e2006122. [PMID: 34965364 DOI: 10.1080/23288604.2021.2006122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Countries of sub-Saharan Africa are increasingly turning to public contributory health insurance as a mechanism to advance UHC goals. Eight countries in sub-Saharan Africa have introduced national health insurance (NHI) systems, and at least seven more have plans or have passed legislation to establish NHI. Examining the experience of countries that have taken this path, some lessons emerge about whether and how contributory national health insurance may or may not be a viable path toward UHC in sub-Saharan Africa. Only Gabon, Ghana and Rwanda have been able to extend NHI coverage to a significant share of the population. None of the countries with NHI have peformed better on other UHC indicators-resource mobilization, service coverage and financial protection-than higher performing countries of Africa that did not introduce NHI. The experience of Gabon, Ghana and Rwanda provide lessons for what may be required to make NHI a viable path to UHC-there need to be explicit objectives and an understanding of why NHI can meet those objectives in the country's particular context; it must include key pro-equity design elements; and NHI needs to be supported by widespread political commitment and ongoing learning and adaptation. For many governments, achieving this kind of enabling environment for NHI may be particularly challenging for various political, economic, or social reasons. In these contexts, health sector leaders may consider looking inward to their existing health financing systems for ways to improve and be more effective.
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Affiliation(s)
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
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Erniaty E, Harun H. Understanding the impacts of NPM and proposed solutions to the healthcare system reforms in Indonesia: the case of BPJS. Health Policy Plan 2020; 35:346-353. [PMID: 31965166 DOI: 10.1093/heapol/czz165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2019] [Indexed: 11/14/2022] Open
Abstract
This study critically evaluates the adoption of a universal healthcare system recently introduced by the Indonesian government in 2014. Our study is driven by the lack of critical analysis of social and political factors and unintended consequences of New Public Management, which is evident in the healthcare sector reforms in emerging economies. This study not only examines the impact of economic and political forces surrounding the introduction of a universal health insurance programme in the country but also offers insights into the critical challenges and undesirable outcomes of a fundamental reform of the healthcare sector in Indonesia. Through a systematic and detailed review of prior studies, legal sources and reports from government and media organizations about the implementation and progress of an UHC health insurance programme in Indonesia, the authors find that a more democratic political system that emerged in 1998 created the opportunity for politicians and international financial aid agencies to introduce a universal social security administration agency called Badan Penyelenggara Jaminan Sosial (BPJS). Despite the introduction of BPJS to expand the health services' coverage, this effort faces critical challenges and unintended outcomes including: (1) increased financial deficits, (2) resistance from medical professionals and (3) politicians' tendency to blame BPJS's management for failing to pay healthcare services costs. We argue that the adoption of the insurance system was primarily motivated by politicians' own interests and those of international agencies at the expense of a sustainable national healthcare system. This study contributes to the healthcare industry policy literature by showing that a poorly designed UHC system could and will undermine the core values of healthcare services. It will also threaten the sustainability of the medical profession in Indonesia. The authors offer several suggestions for devising better policies in this sector in the developing nations.
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Affiliation(s)
- Erniaty Erniaty
- Faculty of Health Science, University of Canberra, Kirinari Street, Bruce, ACT 2617, Australia
| | - Harun Harun
- Faculty of Business, Government & Law, University of Canberra, Kirinari Street, Bruce, ACT 2617, Australia
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Asante A, Man N, Wiseman V. Evaluating Equity in Health Financing Using Benefit Incidence Analysis: A Framework for Accounting for Quality of Care. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:759-766. [PMID: 32567036 PMCID: PMC7716894 DOI: 10.1007/s40258-020-00597-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Equity in health care financing has gained increased attention in low- and middle-income countries (LMICs) following the renewed global interest in universal health coverage (UHC), a key component of the sustainable development goals (SDGs). UHC requires that people have access to the health services they need without risking financial hardship. Health financing is central to UHC and many LMICs have initiated reforms to align their health financing systems with the goals of UHC. Evaluation of the equity impact of these reforms has become a growing area of research, especially in countries with large health inequalities where the pressure to move towards UHC is most intense and the need for evidence to inform policy most critical. However, current analytical tools for evaluating equity in health financing conspicuously exclude indicators of quality, an important dimension of UHC. The aim of this paper was to address this critical methodological gap by introducing quality scores into benefit incidence analysis (BIA), one of the key techniques for assessing equity in health financing. BIA measures the extent to which different socioeconomic groups benefit from public spending on health care through their use of health services. The benefit (public subsidy) is captured in monetary terms by multiplying the quantity of a particular health service consumed by the unit cost of that service and subtracting any out-of-pocket costs incurred while using the service. It does not account for variations in the quality of health services in the computation of the public subsidy.
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Affiliation(s)
- Augustine Asante
- School of Public Health and Community Medicine, University of New South Wales (UNSW) Sydney, Room 238, Level 2 Samuels Building, Sydney, NSW, 2052, Australia.
| | - Nicola Man
- National Drug and Alcohol Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Kirby Institute, University of New South Wales (UNSW), Sydney, NSW, Australia
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Harrison ME, Wijedasa LS, Cole LE, Cheyne SM, Choiruzzad SAB, Chua L, Dargie GC, Ewango CE, Honorio Coronado EN, Ifo SA, Imron MA, Kopansky D, Lestarisa T, O’Reilly PJ, Van Offelen J, Refisch J, Roucoux K, Sugardjito J, Thornton SA, Upton C, Page S. Tropical peatlands and their conservation are important in the context of COVID-19 and potential future (zoonotic) disease pandemics. PeerJ 2020; 8:e10283. [PMID: 33240628 PMCID: PMC7678489 DOI: 10.7717/peerj.10283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/09/2020] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has caused global disruption, with the emergence of this and other pandemics having been linked to habitat encroachment and/or wildlife exploitation. High impacts of COVID-19 are apparent in some countries with large tropical peatland areas, some of which are relatively poorly resourced to tackle disease pandemics. Despite this, no previous investigation has considered tropical peatlands in the context of emerging infectious diseases (EIDs). Here, we review: (i) the potential for future EIDs arising from tropical peatlands; (ii) potential threats to tropical peatland conservation and local communities from COVID-19; and (iii) potential steps to help mitigate these risks. We find that high biodiversity in tropical peat-swamp forests, including presence of many potential vertebrate and invertebrate vectors, combined, in places, with high levels of habitat disruption and wildlife harvesting represent suitable conditions for potential zoonotic EID (re-)emergence. Although impossible to predict precisely, we identify numerous potential threats to tropical peatland conservation and local communities from the COVID-19 pandemic. This includes impacts on public health, with the potential for haze pollution from peatland fires to increase COVID-19 susceptibility a noted concern; and on local economies, livelihoods and food security, where impacts will likely be greater in remote communities with limited/no medical facilities that depend heavily on external trade. Research, training, education, conservation and restoration activities are also being affected, particularly those involving physical groupings and international travel, some of which may result in increased habitat encroachment, wildlife harvesting or fire, and may therefore precipitate longer-term negative impacts, including those relating to disease pandemics. We conclude that sustainable management of tropical peatlands and their wildlife is important for mitigating impacts of the COVID-19 pandemic, and reducing the potential for future zoonotic EID emergence and severity, thus strengthening arguments for their conservation and restoration. To support this, we list seven specific recommendations relating to sustainable management of tropical peatlands in the context of COVID-19/disease pandemics, plus mitigating the current impacts of COVID-19 and reducing potential future zoonotic EID risk in these localities. Our discussion and many of the issues raised should also be relevant for non-tropical peatland areas and in relation to other (pandemic-related) sudden socio-economic shocks that may occur in future.
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Affiliation(s)
- Mark E. Harrison
- Centre for Ecology and Conservation, College of Life and Environmental Sciences, University of Exeter, Penryn, UK
- Borneo Nature Foundation International, Penryn, UK
- School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Lahiru S. Wijedasa
- Integrated Tropical Peatland Research Program (INTPREP), Environmental Research Institute, National University of Singapore, Singapore, Singapore
- ConservationLinks Pvt Ltd, Singapore, Singapore
| | - Lydia E.S. Cole
- School of Geography and Sustainable Development, University of St. Andrews, St. Andrews, UK
| | - Susan M. Cheyne
- Borneo Nature Foundation International, Penryn, UK
- Humanities and Social Sciences, Oxford Brookes University, Oxford, UK
- IUCN SSC PSG Section on Small Apes, Oxford, UK
| | - Shofwan Al Banna Choiruzzad
- Department of International Relations, Universitas Indonesia, Depok, Indonesia
- ASEAN Studies Center, Universitas Indonesia, Depok, Indonesia
| | - Liana Chua
- Department of Social and Political Sciences, Brunel University, London, UK
| | | | - Corneille E.N. Ewango
- Faculty of Renewable Natural Resources Management/Faculty of Sciences, University of Kisangani, Kisangani, DR Congo
| | | | - Suspense A. Ifo
- Laboratoire de Géomatique et d’Ecologie Tropicale Appliquée, Département des Sciences et Vie de la Terre, Ecole Normale Supérieure, Université Marien Ngouabi, Brazzaville, Republic of Congo
| | | | - Dianna Kopansky
- Global Peatlands Initiative, Ecosystems Division, United Nations Environment Programme, Nairobi, Kenya
| | - Trilianty Lestarisa
- Faculty of Medicine, Palangka Raya University, Palangka Raya, Kalteng, Indonesia
- Doctoral Program of Public Health, Airlangga University, Surabaya, Indonesia
| | - Patrick J. O’Reilly
- School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | | | - Johannes Refisch
- Great Apes Survival Partnership, United Nations Environment Programme, Nairobi, Kenya
| | - Katherine Roucoux
- School of Geography and Sustainable Development, University of St. Andrews, St. Andrews, UK
| | - Jito Sugardjito
- Centre for Sustainable Energy and Resources Management, Universitas Nasional, Jakarta, Indonesia
- Faculty of Biology, Universitas Nasional, Jakarta, Indonesia
| | - Sara A. Thornton
- Borneo Nature Foundation International, Penryn, UK
- School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Caroline Upton
- School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Susan Page
- Borneo Nature Foundation International, Penryn, UK
- School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
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Francis-Oliviero F, Cambon L, Wittwer J, Marmot M, Alla F. Theoretical and practical challenges of proportionate universalism: a review. Rev Panam Salud Publica 2020; 44:e110. [PMID: 33088291 PMCID: PMC7556407 DOI: 10.26633/rpsp.2020.110] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/23/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it.The two specific objectives of this scoping review were: (1) to describe the theoretical context in which PU was established, (2) to describe how researchers apply PU and related methodological issues. METHODS We searched for all articles published until 6th of February 2020, mentioning "Proportionate Universalism" or its synonyms "Targeted universalism" OR "Progressive Universalism" as a topic in all Web of Science databases. RESULTS This review of 55 articles allowed us a global vision around the question of PU regarding its theoretical foundations and practical implementation. PU principle is rooted in the social theories of universalism and targeting. It proposes to link these two aspects in order to achieve an effective reduction of health inequalities. Regarding practical implementation, PU interventions were rare and led to different interpretations. There are still many methodological and ethical challenges regarding conception and evaluation of PU interventions, including how to apply proportionality, and identification of needs. CONCLUSION This review mapped available scientific literature on PU and its related concepts. PU principle originates from social theories. As highlighted by authors who implemented PU interventions, application raises many challenges from design to evaluation. Analysis of PU applications provided in this review answered to some of them but remaining methodological challenges could be addressed in further research.
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Affiliation(s)
| | - Linda Cambon
- University of BordeauxBordeauxFranceUniversity of Bordeaux, Bordeaux, France
| | - Jérôme Wittwer
- University of BordeauxBordeauxFranceUniversity of Bordeaux, Bordeaux, France
| | - Michael Marmot
- Institute of Health Equity at the University College LondonLondonUnited KingdomInstitute of Health Equity at the University College London, London, United Kingdom
| | - François Alla
- University of BordeauxBordeauxFranceUniversity of Bordeaux, Bordeaux, France
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Indiraswari T, Supriyanto S, Ernawaty E, Putri NK. Health insurance literacy: discussion and reaction of Facebook users' towards the National Health Insurance in Indonesia. J Public Health Res 2020; 9:1844. [PMID: 32728583 PMCID: PMC7376471 DOI: 10.4081/jphr.2020.1844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/13/2020] [Indexed: 11/23/2022] Open
Abstract
Universal Health Coverage always persevered as a pro poor policy in many countries, characterized by a major impact on higher out-of-pocket healthcare costs, with low-cost alternative prescription drugs and capitation payments made to physicians, in order to reduce inequity. These concerns have been discussed widely on social media, including Facebook, but social media are consistently neglected as a source of scientific information. The purpose of this study, therefore, is to analyze the thought process or feelings of individuals about the policies, also focusing on the possible reactions. Hence, a systematic review in the form of discussion forums on the Facebook page of the National Health Insurance Agency, Indonesia was conducted from 2015 to 2016, with regards to the implementation of National Health Insurance, within a year and half after the policy was launched. In addition, the contents of 148 discussions were deductively analyzed, and the findings showed the pragmatic disposition of most Facebook users towards health care utilization, the costs of Insurance, and the possible benefits of payment. Furthermore, the debate conducted in social media related with the policy and its practice issues ought to be countered through appropriate modification. Significance for public health Social media has been incorporated for the communication of health strategies in Indonesia, through the discussions related to National Health Insurance policies. Social media can provide opportunities to better understand the concept of health insurance literacy and facilitate growth in social norms and skills, as participants of online forums. Until now, there is a deficiency in studies related to the use of social media as source of news where people pay attention to specific issues. This study analyzes the thought process and feelings of individuals, as well as the reaction towards the National Health Policies implemented.
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Affiliation(s)
- Tika Indiraswari
- Doctoral Program of Public Health, Universitas Airlangga, Surabaya.,Faculty of Public Health, Universitas Serambi Mekkah, Banda Aceh
| | - Stefanus Supriyanto
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Ernawaty Ernawaty
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Nuzulul Kusuma Putri
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Ramli N, Anita A. The Analysis of Health Index Development Factor in Aceh Province, Indonesia. Open Access Maced J Med Sci 2019; 7:3673-3678. [PMID: 32010397 PMCID: PMC6986517 DOI: 10.3889/oamjms.2019.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Development of Health Index becomes important in measuring development. The development of the Health Index in Aceh Province is influenced by several internal and external factors. AIM The purpose of this study was to analyse the factors that influence the health index as well as formulate a health index development strategy for Aceh Province. METHODS The method used is quantitative with a survey approach. This research was conducted from January to March 2019 in Aceh Province. Participants were determined as many as 50 stakeholders using the purposive sampling method. Data was collected in the form of primary and secondary data. Primary data were obtained through questionnaires and interviews with key stakeholders such as the Aceh Provincial Government, regional authorities within the Aceh Province (Agency, Bureau, Office, Hospital, etc. Secondary data was obtained from relevant research reports, government regulations, and others. The SWOT analysis was used to identify internal and external factors, strategies for developing the health index of the Aceh Province. RESULTS Sixteen factors influence the development of a health index in the province of Aceh. Analysis of internal and external factors has identified five strength factors, six weakness factors, five opportunity factors, and five threat factors. The internal factors (strength) that influence the development of the health index are the increasing role of the provincial government in improving health (0.437). Internal factors (weaknesses) that influence the development of health indices in the province of Aceh are the low quality of human resources in the health sector (0.336). External factors (opportunities) that influence the development of health indices in Aceh province are support from the central government with a value (0.399). External factors that pose a threat to the development of health indices in Aceh province are the ability of the community to finance health with a value (0.437). The results of the SWOT analysis of the condition of the development of the health index are currently in squared II (Strategy Diversification). This condition shows that the development of the health index faces a big threat. Alternative strategies for the development of health indices can be done by increasing the allocation of health spending, increasing partnerships with the private sector in implementing health programs, cooperation between the central, provincial and district governments in improving policies and improving service quality. CONCLUSION Some factors influence the development of the Health Index in Aceh Province. Internal factors are the role of the provincial government in improving health, and the low quality of human resources in the health sector. While external factors are the existence of support from the central government, and the ability of the community to finance health.
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Affiliation(s)
- Nurlaili Ramli
- Department of Midwifery, Polytechnic of Health-Ministry of Health, Aceh, Indonesia
| | - Anita Anita
- Department of Midwifery, Polytechnic of Health-Ministry of Health, Aceh, Indonesia
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Nsiah-Boateng E, Prah Ruger J, Nonvignon J. Is enrolment in the national health insurance scheme in Ghana pro-poor? Evidence from the Ghana Living Standards Survey. BMJ Open 2019; 9:e029419. [PMID: 31266841 PMCID: PMC6609063 DOI: 10.1136/bmjopen-2019-029419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This article examines equity in enrolment in the Ghana National Health Insurance Scheme (NHIS) to inform policy decisions on progress towards realisation of universal health coverage (UHC). DESIGN Secondary analysis of data from the sixth round of the Ghana Living Standards Survey (GLSS 6). SETTING Household based. PARTICIPANTS A total of 16 774 household heads participated in the GLSS 6 which was conducted between 18 October 2012 and 17 October 2013. ANALYSIS Equity in enrolment was assessed using concentration curves and bivariate and multivariate analyses to determine associated factors. MAIN OUTCOME MEASURE Equity in NHIS enrolment. RESULTS Survey participants had a mean age of 46 years and mean household size of four persons. About 71% of households interviewed had at least one person enrolled in the NHIS. Households in the poorest wealth quintile (73%) had enrolled significantly (p<0.001) more than those in the richest quintile (67%). The concentration curves further showed that enrolment was slightly disproportionally concentrated among poor households, particularly those headed by males. However, multivariate logistic analyses showed that the likelihood of NHIS enrolment increased from poorer to richest quintile, low to high level of education and young adults to older adults. Other factors including sex, household size, household setting and geographic region were significantly associated with enrolment. CONCLUSIONS From 2012 to 2013, enrolment in the NHIS was higher among poor households, particularly male-headed households, although multivariate analyses demonstrated that the likelihood of NHIS enrolment increased from poorer to richest quintile and from low to high level of education. Policy-makers need to ensure equity within and across gender as they strive to achieve UHC.
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Affiliation(s)
- Eric Nsiah-Boateng
- Health Policy, Planning and Management, University of Ghana School of Public Health, Accra, Ghana
| | - Jennifer Prah Ruger
- School of Social Policy & Practice and Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Justice Nonvignon
- Health Policy, Planning and Management, University of Ghana School of Public Health, Accra, Ghana
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