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Marthias T, McPake B, Carvalho N, Millett C, Anindya K, Saputri NS, Trisnantoro L, Lee JT. Associations between Indonesia's national health insurance, effective coverage in maternal health and neonatal mortality: a multilevel interrupted time-series analysis 2000-2017. J Epidemiol Community Health 2022; 76:jech-2021-217213. [PMID: 36288996 DOI: 10.1136/jech-2021-217213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND We assessed the effect of Indonesia's national health insurance programme (Jaminan Kesehatan Nasional (JKN)) on effective coverage for maternal and child health across geographical regions and population groups. METHODS We used four waves of the Indonesia Demographic and Health Survey from 2000 to 2017, which included 38 880 women aged 15-49 years and 144 000 birth records. Key outcomes included antenatal and delivery care, caesarean section and neonatal and infant mortality. We used multilevel interrupted time-series regression to examine changes in outcomes after the introduction of the JKN in January 2014. FINDINGS JKN introduction was associated with significant level increases in (1) antenatal care (ANC) crude coverage (adjusted OR (aOR) 1.81, 95% CI 1.44 to 2.27); (2) ANC quality-adjusted coverage (aOR 1.66, 95% CI 1.38 to 1.98); (3) ANC user-adherence-adjusted coverage (aOR 1.80, 95% CI 1.45 to 2.25); (4) safe delivery service contact (aOR 1.83, 95% CI 1.42 to 2.36); and (5) safe delivery crude coverage (aOR 1.45, 95% CI 1.20 to 1.75). We did not find any significant level increase in ANC service contact or caesarean section. Interestingly, increases in ANC service contact and crude coverage, and safe delivery crude coverage were larger among the poorest compared with the most affluent. No statistically significant associations were found between JKN introduction and neonatal and infant mortality (p>0.05) in the first 3 years following implementation. INTERPRETATION Expansion of social health insurance led to substantial improvements in quality of care for maternal health services but not in child mortality. Concerted efforts are required to equitably improve service quality and child mortality across the population in Indonesia.
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Affiliation(s)
- Tiara Marthias
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Carvalho
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Millett
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Comprehensive Health Research Center and Public Health Research Centre, National School of Public Health, NOVA University Lisbon, Lisbon, Portugal
| | - Kanya Anindya
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Laksono Trisnantoro
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - John Tayu Lee
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Department of Health Service Research and Policy, Australia National University, Canberra, Canberra, Australia
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Helmi M, Sari D, Kurniawaty J, Wisudarti CFR, Meliala A, Trisnantoro L. Indonesian Anesthesiologists Preparedness for COVID-19 Surge Capacity in the Early Pandemic. Med J Islam Repub Iran 2022; 36:59. [PMID: 36128268 PMCID: PMC9448482 DOI: 10.47176/mjiri.36.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/06/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Anesthesiologists play a crucial role in every disaster event, including biological disasters by COVID-19. This medical specialty should be prepared for a surge in patients due to a pandemic. The present study aims to evaluate the preparedness of anesthesiologists in facing the surge in the number of COVID-19 patients at the beginning of the pandemic in Indonesia. Methods: This is a descriptive cross-sectional study using an online survey to Anesthesiologists in Indonesia, with snowballing sampling method. A distribution frequency was used to describe the univariate analysis results of the variables. Pearson correlation was used to test the correlation between perceived resource adequacy/availability and perceived preparedness to face the surge. Results: A total of 141 anesthesiologists participated in our online survey; 47% of responders said they do not have enough staff, while 53% said that their staff did not have sufficient knowledge of handling the critical COVID-19 patients. They also reported limited resources, especially the limited isolation space and N95 masks. The correlation analysis indicated a strong and significant relationship between limited resources and the preparedness of anesthesiologists. Conclusion: At the beginning of the pandemic, Indonesian Anesthesiologists felt that they still had very limited resources, leading to unpreparedness to deal with the surge in the number of COVID-19 patients with critical conditions.
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Affiliation(s)
- Mochamat Helmi
- Department of Anesthesiology, Faculty of Medicine Universitas Tarumanagara, Jakarta, Indonesia,Corresponding author: Dr Mochamat Helmi,
| | - Djayanti Sari
- Department of Anesthesiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Juni Kurniawaty
- Department of Anesthesiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Calcarina FR Wisudarti
- Department of Anesthesiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Andreasta Meliala
- Center of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Laksono Trisnantoro
- Center of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Dinia F, Trisnantoro L, Helmi M. Managing Human Resources for Surge Capacity in Referral Hospitals Based on WHO Hospital Readiness Checklist for Covid-19. FMI 2022. [DOI: 10.20473/fmi.v58i2.32579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Highlights:
Managing human resources for surge capacity in three referral hospital at West Kalimantan was evaluated.
Availability, mobilization and recruitment, duties division, and hospital staff welfare are the reasons for referral hospitals in West Kalimantan are not optimal to face surge capacity during the Covid-19 pandemic.
Provincial Health Office role had not been optimal in the HR management at referral hospitals during the Covid-19 pandemic.
Abstract:
One of the components of effective disaster response management to deal with surge capacity in referral hospitals in West Kalimantan, Indonesia, was to ensure the adequacy of the number of human resources (health workers). This study was conducted to evaluate three referral hospitals and identify the role of the West Kalimantan Provincial Health Office in managing human resources for health workers facing surge capacity due to the Covid-19 pandemic. This study used Rapid Assessment Procedures with qualitative and quantitative methods. Data were collected through observation and interview by using instruments adopted from the Checklist of WHO Hospital Readiness for Covid-19. Based on the checklist, 51.1% of referral hospitals had implemented HR management regarding staff availability. However, the readiness of referral hospitals in West Kalimantan to face surge capacity had not been optimal in several key components, such as staff availability, staff mobilization and recruitment, division of staff duties, and hospital staff welfare during the Covid-19 pandemic. The role of the Provincial Health Office had not been optimal in managing HR at referral hospitals. The Provincial Health Office only played an active role at the beginning of the Covid-19 pandemic, especially for the provision of volunteers. Meanwhile, in the second year of the Covid-19 pandemic, the role of the Provincial Health Office had decreased, especially in the staff availability and training at the referral hospitals. Therefore, the role of the West Kalimantan Provincial Health Office in HR management at the referral hospitals was highly not dominant (17.78%). The central government should regulate the authority of the Provincial Health Office as the leading sector in all types of referral hospitals to integrate all potencies and human resources of local governments to maximize HR management in referral hospitals to face surge capacity due to the increased cases of Covid-19.
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Visnu J, Effendy C, Laksono PM, Trisnantoro L. Philanthropic Institutions’ Perspectives Regarding Challenges in the Indonesian Health Sector: A Qualitative Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The Indonesian Social Health Security Agency has a key role in improving the community’s quality of life by providing financial access to all citizens to fulfill basic health needs. The society has received government funding for basic health needs through direct costs. On the other hand, there are also indirect costs for non-medical needs that may potentially become problems for some people. The concept of philanthropy was developed and became a significant and concrete utility in responding to Indonesian health problems.
AIM: Our study aimed to explore challenges faced by the Indonesian philanthropic institutions in managing charitable giving to the health sector.
METHODS: We conducted a qualitative study to explore challenges faced by the Indonesian philanthropic institutions in managing charitable giving to the health sector.
RESULTS: As a result, we found that internal and external support and synchronous collaboration become a common theme of challenges in managing health philanthropy in Indonesia.
CONCLUSION: Cross-sectorial partnerships in the health sector might improve national welfare as we work toward achieving the sustainable development goals.
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Helmyati S, Dipo DP, Adiwibowo IR, Wigati M, Safika EL, Hariawan MH, Destiwi M, Prajanta Y, Penggalih MH, Sudargo T, Herawati DM, Marthias T, Masrul M, Trisnantoro L. Monitoring continuity of maternal and child health services, Indonesia. Bull World Health Organ 2022; 100:144-154A. [PMID: 35125539 PMCID: PMC8795852 DOI: 10.2471/blt.21.286636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 11/27/2021] [Accepted: 12/02/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To implement an online system to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on maternal and child health and nutrition essential health services in Indonesia. Methods We developed an electronic monitoring and evaluation system to assist district health offices in making rapid assessments of the impact of COVID-19 on maternal and child health and nutrition programmes in their area and in developing policy and programme responses. This implementation research was conducted from September to December 2020 in 304 districts. The strategies consisted of technical assistance for district offices by 21 partner universities and development of an online dashboard for rapid situation analyses and reporting. We collected qualitative data on feasibility and adherence to the intervention, as well as quantitative data from routine health databases to analyse the impact of COVID-19 on maternal and child health and nutrition indicators. Findings In the majority of districts key maternal and child health and nutrition services were moderately or severely affected by the pandemic, particularly child growth monitoring and antenatal care services. Adherence to the protocol of the intervention varied across districts but the system is a feasible approach to be scaled up to other regions and health programmes. High uptake by the health ministry, district office and university partners provided the platform with collaborative efforts for health-systems strengthening. Conclusion The electronic monitoring and evaluation system could be implemented and completed with several modifications to accommodate district offices and universities. There is a potential to scale up the intervention with better implementation planning and training.
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Affiliation(s)
- Siti Helmyati
- Department of Nutrition and Health, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Dhian P Dipo
- Directorate of Public Health Nutrition, Ministry of Health, Jakarta, Indonesia
| | - Insan Rekso Adiwibowo
- Center for Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Maria Wigati
- Department of Nutrition and Health, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Erri Larene Safika
- Center for Health and Human Nutrition, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Monita Destiwi
- Center for Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yoga Prajanta
- Center for Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mirza Hst Penggalih
- Department of Nutrition and Health, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Toto Sudargo
- Department of Nutrition and Health, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Dewi Md Herawati
- Department of Public Health, Padjadjaran University, Bandung, Indonesia
| | - Tiara Marthias
- Department of Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Masrul Masrul
- Department of Nutrition, Andalas University, Padang, Indonesia
| | - Laksono Trisnantoro
- Department of Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Muhrodji P, Wicaksono HDA, Satiti S, Trisnantoro L, Setyopranoto I, Vidyanti AN. Roles and Problems of Stroke Caregivers: A Qualitative Study in Yogyakarta, Indonesia. F1000Res 2022; 10:380. [PMID: 35186263 PMCID: PMC8822138 DOI: 10.12688/f1000research.52135.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Caregivers play a central role in post-stroke patients' care. However, the role of and problems managed by caregivers have not been widely studied, particularly in Indonesia. This study aims to explore the roles and problems of caregivers in post- stroke patients’ care. Method: This was a qualitative study. Seven caregivers of post-stroke patients from the homecare clinic of Dr Sardjito General Hospital were purposely selected during January 2017 to June 2018. Focus group discussions were conducted to explore the roles and problems of caregiving. Results: Themes related to caregivers’ roles were: connecting patients with medical personnel and other family members, maintaining patients’ health conditions by fulfilling basic needs and assisting rehabilitation, as well as maintaining patients’ psychological conditions by encouraging conversation, telling jokes, or recreation. On the other hand, themes related to caregivers’ problems were: lack of knowledge caused by education inadequacy, underappreciated and unconcerned family, suboptimal service including limited physiotherapy and pharmacy resource, unthorough administration, lack of communication, physical limitations, and burnout, as well as uncooperative patients. Conclusions: Caregivers play essential roles as communicators and help to maintain patient's health conditions. Common problems are related to a lack of knowledge about strokes and a lack of attention from family. Further research to study the effects of these findings on the quality of life of both patient and their caregiver, as well as how to handle the caregiver issues should be investigated.
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Affiliation(s)
- Paryono Muhrodji
- Doctorate Program of Medical and Health Science, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia, 55281, Indonesia
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia, 55281, Indonesia
| | - Hendrawan Dian Agung Wicaksono
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia, 55281, Indonesia
| | - Sekar Satiti
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia, 55281, Indonesia
| | - Laksono Trisnantoro
- Center for Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia, 55281, Indonesia
| | - Ismail Setyopranoto
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia, 55281, Indonesia
| | - Amelia Nur Vidyanti
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia, 55281, Indonesia
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Paryono P, Ar Rochmah M, Setyopranoto I, Trisnantoro L. Postacute-Stroke Management Problems in Home Care Service: A Qualitative Single-Centered Study in Yogyakarta, Indonesia. J Neurosci Rural Pract 2022; 13:50-59. [PMID: 35110920 PMCID: PMC8803516 DOI: 10.1055/s-0041-1740613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
This study explores the postacute-stroke management problems, particularly for patients with total dependency (Barthel Index <20), in home care service of Dr. Sardjito Hospital (SH) from the hospital personnel's and caregiver's points of view.
Materials and Methods
In-depth interviews with a semi-structured interview guide were conducted with hospital personnel and patients' caregivers based on the purposeful sampling. There were 10 hospital personnel that were interviewed: the director of medical service, head of home care unit, neurologists, general practitioners, nurses, and physiotherapist. There were eight caregivers who participated in the study.
Statistical Analysis
Data from the interviews were analyzed using systematic text condensation using Nvivo 12 plus.
Results
Our findings showed that all health personnel in SH agreed that home care service is a part of an integrated health care service for continuation of care. However, the preparedness by the hospital management is still lacking in infrastructures, such as standardized operational procedure, quality control, and financial system, as well as in terms of competent human resources and their welfare. In addition, the patient's family and caregiver are lacking in knowledge and independency to take care of the patients with the need of home care services' monitoring to deliver the expected home care for postacute-stroke's patient regularly.
Conclusion
Home care service is an act of implementing hospital obligation to fulfill the patients' rights. An established hospital policy to ensure a comprehensive home care service delivery is necessary. The capability and welfare of the health care personnel should be put into account for the standardized human resources.
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Affiliation(s)
- Paryono Paryono
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mawaddah Ar Rochmah
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ismail Setyopranoto
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Laksono Trisnantoro
- Department of Public Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Helmi M, Sari D, Meliala A, Trisnantoro L. What Is Preparedness and Capacity of Intensive Care Service in Indonesia to Response to COVID-19? A Mixed-method Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND: Pandemics can increase disease spread, as well as unpredictable and highly in patient demand, which can have a negative impact on hospital capacity and the overall functioning of the health-care system. The preparedness and capacity of intensive care services to respond to COVID-19 in Indonesia are remain unknown.
AIM: This study aimed to investigate the preparedness and capacity of intensive care services in Indonesia to respond to the initial stage of the COVID-19 pandemic.
METHODS: A mixed-method research design was used in this study using in-depth interviews and an online survey. An in-depth interview was conducted with the medical team (intensive care consultant and an anesthesiologist) who is actively involved in the provision of COVID-19 services in 15 national referral hospitals. The online survey was conducted to all medical teams that provide direct care to the COVID-19 patients. A total of 459 (response rate was 95.2%) agreed to join the survey. The content analysis technique was used to analyze qualitative data and a descriptive analysis was used to describe issues encountered in providing health services to COVID-19 patients.
RESULTS: The analysis preparedness and capacity of intensive care service in Indonesia to respond to the initial stage of the COVID-19 pandemic resulting in 4 themes with 12 sub-themes. The four themes were limited quality and quantity of standardized intensive care unit (ICU) isolation room (inadequate zoning systems, adequacy of the standardized ICU isolation room, the readiness of the hospital infrastructure, and telemedicine facilities are not yet widely used, including in the COVID-19 isolation room), limited medical service support (lack of personal protective equipment (personal protective equipment [PPE], re-used PPE, lack of availability of medical devices), limitations in the medical team’s quality and quantity management (lack of number and distribution of expert doctors and medical team screening for ICU), and command systems (task shifting, effective communication, and leadership).
CONCLUSION: Medical team encounters several difficulties, particularly related to the quality of facilities, staff preparedness, and systems for the provision of services to COVID-19 patients with critical conditions. There is a critical need for well-defined pathways, legal protection, and occupational health for medical teams providing services in the aftermath of a pandemic.
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Helmi M, Sari D, Meliala A, Trisnantoro L. Readiness of Medical Teams Caring for COVID-19 in the Intensive Care Units: A National Web-Based Survey in Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The coronavirus disease 2019 (COVID)-19 pandemic is a challenge for the intensive care unit (ICU) medical team. It requires management of space, stuff (medical equipment including drugs), staff, and system readiness (4S) to deal with the surge in the number of patients.
AIM: This survey aims to describe the current readiness efforts among ICU medical team at the COVID-19 referral hospitals in Indonesia; space, stuff readiness, staff, and systems readiness.
METHODS: We conducted a cross-sectional national web-based survey of ICUs across referral hospitals during pandemic COVID-19 in Indonesia from June to October 2020. The medical teams survey included 53 questions in multiple parts addressing five dimensions. A linear regression model was applied to determine the factors related with readiness.
RESULTS: A total of 459 participants (83.6%) agreed to join in this study. The participants’ average age was 40.43 years (SD = 5.78). About 62.53% were male, 51.20% had bachelor degree, and 55.77% lived outside of Java Island. The mean of total score of medical team readiness was 2.76 (SD = 0.320) and the highest (maximum score) mean score of medical team readiness domain was stuff (2.81, SD = 7.72). Education, working experience, training, perception of risk of contracting COVID-19, and residence had a substantial effect on the readiness, with R2 values of 0.378, p < 0.05.
CONCLUSIONS: This study provides an initial view of current preparedness efforts among a group of ICUs in Indonesia’s leading hospital during the first wave of pandemic. Interventions must be developed and implemented quickly to increase the medical team’s readiness to care for a future pandemic.
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Helmi M, Sari D, Sulistyowati Y, Meliala A, Trisnantoro L, Nurrobi T, Ratmono T. The challenge of education and training in the COVID-19 National Emergency Hospital Wisma Atlet Kemayoran in Jakarta. Avicenna 2021. [DOI: 10.5339/avi.2021.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background The Corona virus disease 2019 (COVID-19) pandemic poses a risk of inequality between the number of prepared service staff and patients. Emergency hospitals, that do not have full-time employees due to the voluntary employment system, need to supervise the competence and knowledge of their staff, as they came with diverse backgrounds of knowledge and skill. The National Emergency Hospital Wisma Atlet Kemayoran, which can provide services for nearly 6000 COVID-19 patients, is required to be able to provide education and training continuously to improve the knowledge of its volunteers aiming to improve the quality of the care services.
Methodology The present study is descriptive observational research to explore the challenge of education and training in the COVID-19 National Emergency Hospital Wisma Atlet Kemayoran in Jakarta.
Results The COVID-19 health workers need to be equipped with sufficient knowledge about personal protective equipment (PPE), COVID-19 management, triage, admission, emergency and critical care for the COVID-19 patients. Supervision is needed to ensure that volunteers with various knowledge and skill backgrounds can collaboratively provide good services for the COVID-19 patients at all fronts. With frequent personnel changes, education and training on the same topic are always given repeatedly. To overcome this inefficiency, the Education and Training Department can film every practical skill related to health care service, and then create tutorial videos followed by small groups onsite skill station, when necessary. The hospital received enormous support from the governmental and non- governmental organizations to conduct education and training sessions on regular basis.
Conclusions Education and training are very critical in the Emergency COVID-19 Hospital. The process has become a major challenge due to regular changes of staff. Information and communication technologies remain a more recommended alternative to the traditional onsite face-to-face method of education and training delivery as to prevent the spread of this virus. The training and education program in the National COVID-19 Emergency Hospital Wisma Atlet have received major supports from several Government agencies, and national private/non-government organizations. However, supports from International NGOs, international aid agencies, or humanitarian organizations, apart from the local professional organizations, which generally extend generous support need also to be explored.
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Affiliation(s)
- Mochamat Helmi
- Department of Anesthesiology, Faculty of Medicine, Universitas Tarumanagara, Jakarta, Indonesia
- COVID-19 National Emergency Hospital Wisma Atlet Kemayoran, Jakarta, Indonesia
| | - Djayanti Sari
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jogjakarta, Indonesia
| | - Yenny Sulistyowati
- Board of Development and Empowerment Human Resources of Health, Ministry of Health, Jakarta, Indonesia
- COVID-19 National Emergency Hospital Wisma Atlet Kemayoran, Jakarta, Indonesia
| | - Andreasta Meliala
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jogjakarta, Indonesia
| | - Laksono Trisnantoro
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jogjakarta, Indonesia
| | - Tjahja Nurrobi
- Faculty of Medicine, Universitas Pertahanan, Bogor, Indonesia
- COVID-19 National Emergency Hospital Wisma Atlet Kemayoran, Jakarta, Indonesia
| | - Tugas Ratmono
- Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia
- COVID-19 National Emergency Hospital Wisma Atlet Kemayoran, Jakarta, Indonesia
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Putri LP, Mawarni D, Trisnantoro L. Challenges of Shifting Diabetes Mellitus Care From Secondary- to Primary-Level Care in Urban and Rural Districts: A Qualitative Inquiry Among Health Providers. J Prim Care Community Health 2021; 11:2150132720924214. [PMID: 32517534 PMCID: PMC7288842 DOI: 10.1177/2150132720924214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives: The study aims to understand the acceptability of
Prolanis, a program that shifts the diabetes mellitus type 2 (T2DM) patient
management from secondary to primary care, among Indonesian primary health care
providers. Method: We completed face-to-face semistructured
interviews with 14 health professionals from 3 urban and 4 rural
government-owned primary health care clinics (Puskesmas) in 4
districts. We performed content analysis using the theoretical framework of
acceptability (TFA) to understand which factors could facilitate or reduce
acceptability. Results: Our study identifies that lack of health
care providers’ acceptability to Prolanis was attributable to the negative
affective attitude, low perceived effectiveness, poor self-efficacy, and work
burden. The use of Prolanis output as one of the pay-for-performance indicators
was deemed unsuitable because it could demotivate health providers to capture
more undetected T2DM cases. This, compounded by lacking perceived benefit for
the health care providers, leading to negative attitudes. Participants believed
that the program improved patients’ adherence to visiting clinics routinely;
however, the absence of a formal evaluation of reductions of key T2DM
indicators—blood glucose level and HbA1c—causing the health providers to doubt
the program effectiveness. Availability of or access to adequate blood glucose
testing equipment is also of paramount importance to improve acceptability.
Although the significant increase in patient load only occurred to
Puskesmas with lacking doctors, an increased workload
burden due to clerical works was experienced by the nonmedical workforce. The
program appears to be more acceptable for health care providers in urban
Puskesmas compared with their rural counterparts,
attributable to better geographical accessibility and care-seeking behavior
among people living in urban locations. Conclusions: This study
highlights critical issues that should be addressed to improve the acceptability
of Prolanis among health care professionals. Government or stakeholders play a
critical role in improving program acceptability. More study is needed to
capture wider variety of health care facilities’ characteristics.
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Affiliation(s)
- Likke Prawidya Putri
- Universitas Gadjah Mada, Yogyakarta, Indonesia.,Monash University, Bendigo, Victoria, Australia
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Muhrodji P, Wicaksono HDA, Satiti S, Trisnantoro L, Setyopranoto I, Vidyanti AN. Roles and Problems of Stroke Caregivers: A Qualitative Study in Yogyakarta, Indonesia. F1000Res 2021; 10:380. [DOI: 10.12688/f1000research.52135.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Caregivers play a central role in post-stroke patients care. However, the role of and problems managed by caregivers have not been widely studied, particularly in Indonesia. This study aims to explore the roles and problems of caregivers in post- stroke patients’ care. Method: This was a qualitative study. Caregivers of post-stroke patients from the homecare clinic of Dr Sardjito General Hospital were purposely selected during January 2017 to June 2018. Focus group discussions were conducted to explore the roles and problems of caregiving. Results: Themes related to caregivers’ roles were: connecting patients with medical personnel and other family members, maintaining patients’ health conditions by fulfilling basic needs and assisting rehabilitation, as well as maintaining patients’ psychological conditions by encouraging conversation, telling jokes, or recreation. On the other hand, themes related to caregivers’ problems were: lack of knowledge caused by education inadequacy, underappreciated and unconcerned family, suboptimal service including limited physiotherapy and pharmacy resource, unthorough administration, lack of communication, physical limitations, and burnout, as well as uncooperative patients. Conclusions: Caregivers play essential roles as communicators and help to maintain patient's health conditions. Common problems are related to a lack of knowledge about strokes and a lack of attention from family. Understanding the roles and problems of caregivers may help facilitate better management and increase the quality of life for both patients and their caregivers.
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Kasim AM, Mahendradhata Y, Trisnantoro L. Evaluation of chronic disease management programs in developed and underdeveloped regions in Indonesia. Bali Med J 2021. [DOI: 10.15562/bmj.v10i1.2099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Yuliyanti S, Utarini A, Trisnantoro L. A protocol study of participatory action research: integrated care pathway for pregnant women with heart disease in Indonesia. BMC Health Serv Res 2020; 20:932. [PMID: 33036607 PMCID: PMC7547524 DOI: 10.1186/s12913-020-05769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Heart diseases are increasingly identified as an important indirect cause of maternal mortality in several cities in Indonesia. The management of pregnancy with heart diseases requires a multidisciplinary approach, and interprofessional collaboration practice (IPCP) is critical to improving the quality of patient care. To enable the effective implementation of IPCP, integrated care pathways (ICPs) are needed to define the roles and responsibilities of the health professionals involved. This study aims to examine the obstacles and enabling factors of IPCP, to develop and use ICPs in the implementation of IPCP in health care services for pregnant women with heart diseases. METHODS A participatory action study consisting of four stages (diagnostic, planning, implementation, and evaluation) will take approximately 2 years after consensus of ICPs are made. The primary data collection process will employ consensus, observations, focus group discussions, and in-depth interviews throughout the four stages, while secondary data from referral documents and medical records will be collected mainly during the diagnostic and evaluation stages. The findings are being analysed and will then be used to develop an ICPs through consensus building at the planning stage to be applied in the implementation stage. Finally, the implementation outcome, including acceptability, adoption, appropriateness, and feasibility of IPCP, will be assessed in the evaluation stage. All qualitative data will be analysed thematically by two coders using NVIVO 12 software. DISCUSSION This research aims to assess the needs of IPCP, develop and use the ICPs in the implementation of IPCP in health care services for pregnant women with heart diseases. Findings from this study will be used for health service planning and policy making to strengthen practice of IPCP during the referral process. As a result, pregnant women with heart disease will have better access to high-quality services at every health care facility to reduce maternal mortality. TRIAL REGISTRATION Retrospectively registered in the ISRCTN registry with study ID ISRCTN82300061 on Feb 6, 2019.
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Affiliation(s)
- Suryani Yuliyanti
- Public Health Department, Faculty of Medicine, Universitas Islam Sultan Agung, Jl. Kaligawe Raya km 4, Semarang, 50122 Indonesia
- Doctoral Study Programme, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta, Sinduadi, Mlati, Special Region of Yogyakarta 55281 Indonesia
| | - Adi Utarini
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta, Sinduadi, Mlati, Special Region of Yogyakarta 55281 Indonesia
| | - Laksono Trisnantoro
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta, Sinduadi, Mlati, Special Region of Yogyakarta 55281 Indonesia
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Nasution SK, Mahendradhata Y, Trisnantoro L. Can a National Health Insurance Policy Increase Equity in the Utilization of Skilled Birth Attendants in Indonesia? A Secondary Analysis of the 2012 to 2016 National Socio-Economic Survey of Indonesia. Asia Pac J Public Health 2019. [PMID: 31810376 DOI: 10.1177/1010539519892394.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Indonesian government has been implementing the National Health Insurance (Jaminan Kesehatan Nasional [JKN]) policy since 2014. This study aimed to evaluate JKN based on equity indicators, especially in skilled birth attendants (SBAs) use. The data were obtained from National Socio-Economic Survey of Indonesia during 2012 to 2016. To analyze the data, χ2 and logistic regression tests were applied. The respondents were married mothers from 15 to 49 years who had delivered a baby. Deliveries by SBAs increased at the national level, but this achievement showed significant variation according to geographical location. The coverage of deliveries by SBAs in the eastern areas of Indonesia was still much lower than those in the western areas. All factors determining SBAs utilization (health insurance ownership, education, household economic status, and geography factor) indicated the positive correlation (P < .05). The inequity of SBA use in differences in geographical location and socioeconomic status continues to occur after the implementation of JKN.
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Nasution SK, Mahendradhata Y, Trisnantoro L. Can a National Health Insurance Policy Increase Equity in the Utilization of Skilled Birth Attendants in Indonesia? A Secondary Analysis of the 2012 to 2016 National Socio-Economic Survey of Indonesia. Asia Pac J Public Health 2019; 32:19-26. [PMID: 31810376 PMCID: PMC7066478 DOI: 10.1177/1010539519892394] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The Indonesian government has been implementing the National Health Insurance
(Jaminan Kesehatan Nasional [JKN]) policy since 2014. This
study aimed to evaluate JKN based on equity indicators, especially in skilled
birth attendants (SBAs) use. The data were obtained from National Socio-Economic
Survey of Indonesia during 2012 to 2016. To analyze the data, χ2 and
logistic regression tests were applied. The respondents were married mothers
from 15 to 49 years who had delivered a baby. Deliveries by SBAs increased at
the national level, but this achievement showed significant variation according
to geographical location. The coverage of deliveries by SBAs in the eastern
areas of Indonesia was still much lower than those in the western areas. All
factors determining SBAs utilization (health insurance ownership, education,
household economic status, and geography factor) indicated the positive
correlation (P < .05). The inequity of SBA use in
differences in geographical location and socioeconomic status continues to occur
after the implementation of JKN.
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Kamaluddin R, Trisnantoro L, Alim S. Validity and Reliability of the Disaster Preparedness Knowledge Instrument for Health Cadres in Volcanic Disaster-Prone Areas. Bali Med J 2019. [DOI: 10.15562/bmj.v8i3.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Surianto S, Alim S, Nindrea RD, Trisnantoro L. Regional Policy for Disaster Risk Management in Developing Countries Within the Sendai Framework: A Systematic Review. Open Access Maced J Med Sci 2019; 7:2213-2219. [PMID: 31456854 PMCID: PMC6698101 DOI: 10.3889/oamjms.2019.614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/28/2022] Open
Abstract
The recently concluded World Conference on Disaster Risk Reduction (WCDRR) in Sendai, Japan and the Sendai Framework for Disaster Risk Reduction 2015–2030 (SFDRR) have set renewed priorities for disaster risk reduction (DRR) for the next 15 years. This framework is the main guiding instrument for Disaster Risk Management (DRM) within the scope of sustainable development and the eradication of poverty. Disaster management policies and practices should be based on an understanding of risks, not just on an ideological level. Gap and key challenges identified include Still weak coordination, cooperation and linkages among the sectors related to DRR, Lacks of skills in loss assessment and post disaster needs, lack of strategic research agenda, absence of consensus regarding terminology, and limited coordination between stakeholders. The aim of this study was to gain an understanding of why disaster risk reduction efforts undertaken by regional policy often fail to improve future disaster responses. These findings can be used to help guide to improve regional policy in disaster risk reduction processes. This research is a systematic review study by collecting articles that are relevant to International Journal of Disaster Risk Science. From the analysis, we found that all four priorities for action in the Sendai Framework are relevant to Disaster Risk Management (DRM) field as follows: 1). Understanding disaster risk; 2). Strengthening disaster risk governance to manage disaster risk; 3). Investing in disaster risk reduction for resilience and 4). Enhancing disaster preparedness for effective response and to “Build Back Better” in recovery, rehabilitation and reconstruction.
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Affiliation(s)
- Surianto Surianto
- Doctoral Program, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta City, Indonesia
| | - Syahirul Alim
- Department of Nursing Sains, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta City, Indonesia
| | - Ricvan Dana Nindrea
- Doctoral Program, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta City, Indonesia
| | - Laksono Trisnantoro
- Department of Health Policy Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta City, Indonesia
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Tuangratananon T, Wangmo S, Widanapathirana N, Pongutta S, Viriyathorn S, Patcharanarumol W, Thin K, Nagpal S, Nuevo CEL, Padmawati RS, Puyat-Murga ME, Trisnantoro L, Wangmo K, Wellappuli N, Thi PH, Anh TK, Zangmo T, Tangcharoensathien V. Implementation of national action plans on noncommunicable diseases, Bhutan, Cambodia, Indonesia, Philippines, Sri Lanka, Thailand and Viet Nam. Bull World Health Organ 2018; 97:129-141. [PMID: 30728619 PMCID: PMC6357573 DOI: 10.2471/blt.18.220483] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/06/2018] [Accepted: 11/13/2018] [Indexed: 11/27/2022] Open
Abstract
By 2016, Member States of the World Health Organization (WHO) had developed and implemented national action plans on noncommunicable diseases in line with the Global action plan for the prevention and control of noncommunicable diseases (2013–2020). In 2018, we assessed the implementation status of the recommended best-buy noncommunicable diseases interventions in seven Asian countries: Bhutan, Cambodia, Indonesia, Philippines, Sri Lanka, Thailand and Viet Nam. We gathered data from a range of published reports and directly from health ministries. We included interventions that addressed the use of tobacco and alcohol, inadequate physical activity and high salt intake, as well as health-systems responses, and we identified gaps and proposed solutions. In 2018, progress was uneven across countries. Implementation gaps were largely due to inadequate funding; limited institutional capacity (despite designated noncommunicable diseases units); inadequate action across different sectors within and outside the health system; and a lack of standardized monitoring and evaluation mechanisms to inform policies. To address implementation gaps, governments need to invest more in effective interventions such as the WHO-recommended best-buy interventions, improve action across different sectors, and enhance capacity in monitoring and evaluation and in research. Learning from the Framework Convention on Tobacco Control, the WHO and international partners should develop a standardized, comprehensive monitoring tool on alcohol, salt and unhealthy food consumption, physical activity and health-systems response.
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Affiliation(s)
- Titiporn Tuangratananon
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Muang District, Nonthaburi 11000, Thailand
| | - Sangay Wangmo
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Muang District, Nonthaburi 11000, Thailand
| | | | - Suladda Pongutta
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Muang District, Nonthaburi 11000, Thailand
| | - Shaheda Viriyathorn
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Muang District, Nonthaburi 11000, Thailand
| | - Walaiporn Patcharanarumol
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Muang District, Nonthaburi 11000, Thailand
| | - Kouland Thin
- Swiss Agency for Development and Cooperation, Phnom Penh, Cambodia
| | - Somil Nagpal
- Global Practice on Health, Nutrition and Population, World Bank, Phnom Penh, Cambodia
| | | | - Retna Siwi Padmawati
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | | | - Kinzang Wangmo
- Policy and Planning Division, Ministry of Health, Thimphu, Bhutan
| | - Nalinda Wellappuli
- Management Development and Planning Unit, Ministry of Health, Colombo, Sri Lanka
| | - Phuong Hoang Thi
- Health Strategy and Policy Institute, Ministry of Health, Hanoi, Vietnam
| | - Tuan Khuong Anh
- Health Strategy and Policy Institute, Ministry of Health, Hanoi, Vietnam
| | - Thinley Zangmo
- Health Promotion Division, Ministry of Health, Thimpu, Bhutan
| | - Viroj Tangcharoensathien
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Muang District, Nonthaburi 11000, Thailand
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Henschke N, Mirny A, Haafkens JA, Ramroth H, Padmawati S, Bangha M, Berkman L, Trisnantoro L, Blomstedt Y, Becher H, Sankoh O, Byass P, Kinsman J. Strengthening capacity to research the social determinants of health in low- and middle-income countries: lessons from the INTREC programme. BMC Public Health 2017; 17:514. [PMID: 28545500 PMCID: PMC5445299 DOI: 10.1186/s12889-017-4399-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 05/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The INDEPTH Training & Research Centres of Excellence (INTREC) collaboration developed a training programme to strengthen social determinants of health (SDH) research in low- and middle-income countries (LMICs). It was piloted among health- and demographic researchers from 9 countries in Africa and Asia. The programme followed a blended learning approach and was split into three consecutive teaching blocks over a 12-month period: 1) an online course of 7 video lectures and assignments on the theory of SDH research; 2) a 2-week qualitative and quantitative methods workshop; and 3) a 1-week data analysis workshop. This report aims to summarise the student evaluations of the pilot and to suggest key lessons for future approaches to strengthen SDH research capacity in LMICs. METHODS Semi-structured interviews and questionnaires with 24 students from 9 countries in Africa and Asia were used to evaluate each teaching block. Information was collected about the students' motivation and interest in studying SDH, any challenges they faced during the consecutive teaching blocks, and suggestions they had for future courses on SDH. RESULTS Of the 24 students who began the programme, 13 (54%) completed all training activities. The students recognised the need for such a course and its potential to improve their skills as health researchers. The main challenges with the online course were time management, prior knowledge and skills required to participate in the course, and the need to get feedback from teaching staff throughout the learning process. All students found the face-to-face workshops to be of high quality and value for their work, because they offered an opportunity to clarify SDH concepts taught during the online course and to gain practical research skills. After the final teaching block, students felt they had improved their data analysis skills and were better able to develop research proposals, scientific manuscripts, and policy briefs. CONCLUSIONS The INTREC programme has trained a promising cadre of health researchers who live and work in LMICs, which is an essential component of efforts to identify and reduce national and local level health inequities. Time management and technological issues were the greatest challenges, which can inform future attempts to strengthen research capacity on SDH.
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Affiliation(s)
- Nicholas Henschke
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Anna Mirny
- Harvard Center for Population and Development Studies, Harvard University, Harvard, USA
| | - Joke A Haafkens
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute of Advanced Labour Studies, University of Amsterdam, Amsterdam, the Netherlands
| | - Heribert Ramroth
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | | | | | - Lisa Berkman
- Harvard Center for Population and Development Studies, Harvard University, Harvard, USA
| | | | - Yulia Blomstedt
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Heiko Becher
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Osman Sankoh
- INDEPTH Network, Accra, Ghana
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Public Health, Hanoi Medical School, Hanoi, Vietnam
| | - Peter Byass
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - John Kinsman
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Idris H, Satriawan E, Trisnantoro L. Determinant of Health Insurance Ownership in the Informal Sector: A Panel Study from Indonesia Family Life Survey. ACTA ACUST UNITED AC 2017. [DOI: 10.1166/asl.2017.9186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Elan Satriawan
- Faculty of Economics and Business, Gadjah Mada University, Indonesia
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Soenarto Y, Trisnantoro L, Fuad A. Penyebaran Spesialis Anak di Indonesia Tahun 2004: Implikasinya Terhadap Kebijakan Kesehatan dan Pendidikan. SP 2016. [DOI: 10.14238/sp8.2.2006.94-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Komposisi penyebaran tenaga dokter spesialis anak (SpA) di tingkat propinsi di Indonesiamasih belum merata. Distribusi penyebaran tenaga spesialis ini hampir 70% berpusat diJawa dan Bali, bahkan tercatat di beberapa propinsi lain yang tidak memiliki satupuntenaga SpA. Tulisan ini menyajikan distribusi penyebaran SpA di setiap di propinsi diIndonesia dan proporsi pertumbuhan SpA berdasarkan jenis kelamin. Dalam tulisan inijuga didiskusikan beberapa implikasi terhadap kebijakan yang mungkin dapat dijadikanpertimbangan dalam pengembangan model distribusi tenaga SpA.
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Mizumoto K, Murakami G, Oshidari K, Trisnantoro L, Yoshiike N. Health Economics of Nutrition Intervention in Asia: Cost of Malnutrition. J Nutr Sci Vitaminol (Tokyo) 2016; 61 Suppl:S47-9. [PMID: 26598883 DOI: 10.3177/jnsv.61.s47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Asia has recorded the fastest economic growth in the world. However, some countries are still struggling with economic stagnation and poverty. Even in the emerging countries, there are economic disparities between urban and rural areas within a country. Reflecting the situations, nutritional issues in Asia came to be the antithetical situation of excess and insufficiency. The rate of overweight and obesity keeps increasing, especially in emerging countries. Meanwhile, underweight is still a critical problem in the region. Although the importance of nutrition is well recognized for social and economic development, it is difficult to identify the immediate outcome of nutrition interventions. Evidence-based decision-making is an important element of quality health care and efficiency and effectiveness are always key words. Along with enhanced attention to accountability and transparency of budget use in health services, attention to the economic evaluation of nutrition interventions has increased in recent years. In this symposium, we will review the current situation of nutritional issues and economic evaluation of nutrition interventions in Asia through experience of an international organization, the basis and trends for health care economics, and also efforts have been made in an Asian country. Discussion will be made about efficient and effective ways to evaluate projects/programmes for nutrition improvement.
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Nahar N, Blomstedt Y, Wu B, Kandarina I, Trisnantoro L, Kinsman J. Increasing the provision of mental health care for vulnerable, disaster-affected people in Bangladesh. BMC Public Health 2014; 14:708. [PMID: 25011931 PMCID: PMC4099388 DOI: 10.1186/1471-2458-14-708] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/03/2014] [Indexed: 11/28/2022] Open
Abstract
Background Bangladesh has the highest natural disaster mortality rate in the world, with over half a million people lost to disaster events since 1970. Most of these people have died during floods or cyclones, both of which are likely to become more frequent due to global climate change. To date, the government’s post-disaster response strategy has focused, increasingly effectively, on the physical needs of survivors, through the provision of shelter, food and medical care. However, the serious and widespread mental health consequences of natural disasters in Bangladesh have not yet received the attention that they deserve. This Debate article proposes a practical model that will facilitate the provision of comprehensive and effective post-disaster mental health services for vulnerable Bangladeshis on a sustainable basis. Discussion A series of socially determined factors render the women and the poor of Bangladesh particularly vulnerable to dying in natural disasters; and, for those who survive, to suffering from some sort of disaster-related mental health illness. For women, this is largely due to the enforced gender separation, or purdah, that they endure; while for the poor, it is the fact that they are, by definition, only able to afford to live in the most climatically dangerous, and under-served parts of the country. Although the disasters themselves are brought by nature, therefore, social determinants increase the vulnerability of particular groups to mental illness as a result of them. While deeply entrenched, these determinants are at least partially amenable to change through policy and action. Summary In response to the 2004 Indian Ocean tsunami, the World Health Organisation developed a framework for providing mental health and psychosocial support after major disasters, which, we argue, could be adapted to Bangladeshi post-cyclone and post-flood contexts. The framework is community-based, it includes both medical and non-clinical components, and it could be adapted so that women and the poor are actively sought out and provided for. After training, these services could be run by Bangladesh’s pre-existing 50,000-strong Cyclone Preparedness Programme workforce, alongside the country’s extensive network of community-based health workers.
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Affiliation(s)
| | | | | | | | | | - John Kinsman
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, 91087 Umeå, Sweden.
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Susilo D, Eriksson M, Preet R, Padmawati S, Kandarina I, Trisnantoro L, Kinsman J. Reducing health inequity in Indonesia through a comprehensive training on social determinants of health among researchers and policy makers. BMC Public Health 2014. [PMCID: PMC4080113 DOI: 10.1186/1471-2458-14-s1-o2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Nugroho MN, Trisnantoro L, Purnomo E. The benefit of cooperation evaluation among hospitals in department of health and welfare of Muhammadiyah organization. BMC Public Health 2014. [PMCID: PMC4080454 DOI: 10.1186/1471-2458-14-s1-o6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Trisnantoro L. Universal health coverage and medical industry in 3 Southeast Asian countries. BMC Public Health 2014. [PMCID: PMC4080461 DOI: 10.1186/1471-2458-14-s1-i3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Seeberg J, Pannarunothai S, Padmawati RS, Trisnantoro L, Barua N, Pandav CS. Treatment seeking and health financing in selected poor urban neighbourhoods in India, Indonesia and Thailand. Soc Sci Med 2013; 102:49-57. [PMID: 24565141 DOI: 10.1016/j.socscimed.2013.11.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 11/13/2013] [Accepted: 11/18/2013] [Indexed: 11/19/2022]
Abstract
This article presents a comparative analysis of socio-economic disparities in relation to treatment-seeking strategies and healthcare expenditures in poor neighbourhoods within larger health systems in four cities in India, Indonesia and Thailand. About 200 households in New Delhi, Bhubaneswar, Jogjakarta and Phitsanulok were repeatedly interviewed over 12 months to relate health problems with health seeking and health financing at household level. Quantitative data were complemented with ethnographic studies involving the same neighbourhoods and a number of private practitioners at each site. Within each site, the higher and lower income groups among the poor were compared. The lower income group was more likely than the higher income group to seek care from less qualified health providers and incur catastrophic health spending. The study recommends linking quality control mechanisms with universal health coverage (UHC) policies; to monitor the impact of UHC among the poorest; intervention research to reach the poorest with UHC; and inclusion of private providers without formal medical qualification in basic healthcare.
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Affiliation(s)
- Jens Seeberg
- Department of Culture and Society, Aarhus University, Moesgaard, DK-8270 Hoejbjerg, Denmark.
| | - Supasit Pannarunothai
- Centre for Health Equity Monitoring, Faculty of Medicine, Naresuan University, Thailand
| | | | | | - Nupur Barua
- Department for International Development (DFID), British High Commission, India(1)
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Jimenez Soto E, La Vincente S, Clark A, Firth S, Morgan A, Dettrick Z, Dayal P, Aldaba BM, Kosen S, Kraft AD, Panicker R, Prasai Y, Trisnantoro L, Varghese B, Widiati Y. Investment case for improving maternal and child health: results from four countries. BMC Public Health 2013; 13:601. [PMID: 23800035 PMCID: PMC3701475 DOI: 10.1186/1471-2458-13-601] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 06/12/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Without addressing the constraints specific to disadvantaged populations, national health policies such as universal health coverage risk increasing equity gaps. Health system constraints often have the greatest impact on disadvantaged populations, resulting in poor access to quality health services among vulnerable groups. METHODS The Investment Cases in Indonesia, Nepal, Philippines, and the state of Orissa in India were implemented to support evidence-based sub-national planning and budgeting for equitable scale-up of quality MNCH services. The Investment Case framework combines the basic setup of strategic problem solving with a decision-support model. The analysis and identification of strategies to scale-up priority MNCH interventions is conducted by in-country planners and policymakers with facilitation from local and international research partners. RESULTS Significant variation in scaling-up constraints, strategies, and associated costs were identified between countries and across urban and rural typologies. Community-based strategies have been considered for rural populations served predominantly by public providers, but this analysis suggests that the scaling-up of maternal, newborn, and child health services requires health system interventions focused on 'getting the basics right'. These include upgrading or building facilities, training and redistribution of staff, better supervision, and strengthening the procurement of essential commodities. Some of these strategies involve substantial early capital expenditure in remote and sparsely populated districts. These supply-side strategies are not only the 'best buys', but also the 'required buys' to ensure the quality of health services as coverage increases. By contrast, such public supply strategies may not be the 'best buys' in densely populated urbanised settings, served by a mix of public and private providers. Instead, robust regulatory and supervisory mechanisms are required to improve the accessibility and quality of services delivered by the private sector. They can lead to important maternal mortality reductions at relatively low costs. CONCLUSIONS National strategies that do not take into consideration the special circumstances of disadvantaged areas risk disempowering local managers and may lead to a "business-as-usual" acceptance of unreachable goals. To effectively guide health service delivery at a local level, national plans should adopt typologies that reflect the different problems and strategies to scale up key MNCH interventions.
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Affiliation(s)
- Eliana Jimenez Soto
- School of Population Health, 4th Floor, Public Health Building, University of Queensland, Herston Road, Herston, QLD 4006, Australia.
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Meliala A, Hort K, Trisnantoro L. Addressing the unequal geographic distribution of specialist doctors in Indonesia: The role of the private sector and effectiveness of current regulations. Soc Sci Med 2013; 82:30-4. [DOI: 10.1016/j.socscimed.2013.01.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 12/19/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
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Setiawan E, Hasanbasri M, Trisnantoro L. How should the health system react to informal drug dispensaries? The case of self-medication in Yogyakarta Province. BMC Public Health 2012. [PMCID: PMC3507968 DOI: 10.1186/1471-2458-12-s2-a16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Marthias T, Trisnantoro L. Health system for maternal health – a case study from Papua, Indonesia. BMC Public Health 2012. [PMCID: PMC3507957 DOI: 10.1186/1471-2458-12-s2-a24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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34
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Sebayang SK, Rosemary R, Widiatmoko D, Mohamad K, Trisnantoro L. Better to die than to leave a friend behind: industry strategy to reach the young. Tob Control 2012; 21:370-2. [DOI: 10.1136/tobaccocontrol-2011-050223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sitorus FLP, Atthobari J, Kuncoro T, Trisnantoro L. SP6-27 The effect clinical pathways in length of stay, drug usage and charge per case in Indonesian hospitals: a quasi experimental. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976p.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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36
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Trisnantoro L, Soemantri S, Singgih B, Pritasari K, Mulati E, Agung FH, Weber MW. Reducing child mortality in Indonesia. Bull World Health Organ 2010; 88:642. [PMID: 20865063 DOI: 10.2471/blt.10.082073] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mahendradhata Y, Probandari A, Ahmad RA, Utarini A, Trisnantoro L, Lindholm L, van der Werf MJ, Kimerling M, Boelaert M, Johns B, Van der Stuyft P. The incremental cost-effectiveness of engaging private practitioners to refer tuberculosis suspects to DOTS services in Jogjakarta, Indonesia. Am J Trop Med Hyg 2010; 82:1131-9. [PMID: 20519613 DOI: 10.4269/ajtmh.2010.09-0447] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
We aimed to evaluate the incremental cost-effectiveness of engaging private practitioners (PPs) to refer tuberculosis (TB) suspects to public health centers in Jogjakarta, Indonesia. Effectiveness was assessed for TB suspects notified between May 2004 and April 2005. Private practitioners referred 1,064 TB suspects, of which 57.5% failed to reach a health center. The smear-positive rate among patients reaching a health center was 61.8%. Two hundred eighty (280) out of a total of 1,306 (21.4%) new smear-positive cases were enrolled through the PPs strategy. The incremental cost-effectiveness ratio per smear-positive case successfully treated for the PPs strategy was US$351.66 (95% CI 322.84-601.33). On the basis of an acceptability curve using the National TB control program's willingness-to-pay threshold (US$448.61), we estimate the probability that the PPs strategy is cost-effective at 66.8%. The strategy of engaging PPs was incrementally cost-effective, although under specific conditions, most importantly a well-functioning public directly observed treatment, short-course (DOTS) program.
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Affiliation(s)
- Yodi Mahendradhata
- Department of Public Health, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia.
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Riyarto S, Hidayat B, Johns B, Probandari A, Mahendradhata Y, Utarini A, Trisnantoro L, Flessenkaemper S. The financial burden of HIV care, including antiretroviral therapy, on patients in three sites in Indonesia. Health Policy Plan 2010; 25:272-82. [PMID: 20156918 DOI: 10.1093/heapol/czq004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This paper assesses the extent of the financial burden due to out-of-pocket payments for health care incurred by people living with HIV (PLHIV) and the effect of this burden on their financial capacity. Data were collected in a cross-sectional survey of 353 PLHIV from three cities in Indonesia (Jakarta, Jogjakarta and Merauke). Respondents in Jakarta were sampled from one hospital and one non-governmental organization working with PLHIV. In Jogjakarta and Merauke, all HIV patients on antiretroviral therapy (ART) who came to selected hospitals during the interview period were asked to participate in the survey. The survey collected data on the frequency and extent of payments for HIV-related care, with answers cross-checked against medical records. Results show that PLHIV had different burdens of payments in the different geographical areas. On average, respondents in Jogjakarta spent 68%, and PLHIV on ART in Jakarta spent 96%, of monthly expenditure for HIV-related care, indicating a substantial financial burden for many ART patients. These patients depended on several sources of finance to cover the costs of their care, with donations from their immediate family being the most common method, selling assets and payments from personal income being the second most common method in Jakarta and Jogjakarta, respectively. Most PLHIV in these two areas did not have insurance. In Merauke, there were little observed out-of-pocket payments because the government covers medical costs via the local budget and health insurance for the poor. The results of this study confirm previous findings that providing subsidized ART drugs alone does not ensure financial accessibility to HIV care. Thus, the government of Indonesia at central and local levels should consider covering HIV care additional to providing antiretroviral drugs free of charge. Social health insurance should also be encouraged.
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Affiliation(s)
- Sigit Riyarto
- Department of Public Health, Medical Faculty, University of Gajah Mada, Jl. Farmako Sekip Utara, Jogjakarta, Indonesia.
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O'Donnell O, van Doorslaer E, Rannan-Eliya RP, Somanathan A, Adhikari SR, Akkazieva B, Harbianto D, Garg CC, Hanvoravongchai P, Herrin AN, Huq MN, Ibragimova S, Karan A, Kwon SM, Leung GM, Lu JFR, Ohkusa Y, Pande BR, Racelis R, Tin K, Tisayaticom K, Trisnantoro L, Wan Q, Yang BM, Zhao Y. Who pays for health care in Asia? J Health Econ 2008; 27:460-475. [PMID: 18179832 DOI: 10.1016/j.jhealeco.2007.08.005] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Revised: 05/17/2007] [Accepted: 08/01/2007] [Indexed: 05/25/2023]
Abstract
We estimate the distributional incidence of health care financing in 13 Asian territories that account for 55% of the Asian population. In all territories, higher-income households contribute more to the financing of health care. The better-off contribute more as a proportion of ability to pay in most low- and lower-middle-income territories. Health care financing is slightly regressive in three high-income economies with universal social insurance. Direct taxation is the most progressive source of finance and is most so in poorer economies. In universal systems, social insurance is proportional to regressive. In high-income economies, the out-of-pocket (OOP) payments are proportional or regressive while in low-income economies the better-off spend relatively more OOP. But in most low-/middle-income countries, the better-off not only pay more, they also get more health care.
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Affiliation(s)
- Owen O'Donnell
- Department of Balkan, Slavic and Oriental Studies, University of Macedonia, 156 Egnatia Street, Thessaloniki 54006, Greece.
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van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, Harbianto D, Herrin AN, Huq MN, Ibragimova S, Karan A, Lee TJ, Leung GM, Lu JFR, Ng CW, Pande BR, Racelis R, Tao S, Tin K, Tisayaticom K, Trisnantoro L, Vasavid C, Zhao Y. Catastrophic payments for health care in Asia. Health Econ 2007; 16:1159-84. [PMID: 17311356 DOI: 10.1002/hec.1209] [Citation(s) in RCA: 282] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Out-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that are catastrophic, in the sense of severely disrupting household living standards, and approximate such payments by those absorbing a large fraction of household resources. Bangladesh, China, India, Nepal and Vietnam rely most heavily on OOP financing and have the highest incidence of catastrophic payments. Sri Lanka, Thailand and Malaysia stand out as low to middle income countries that have constrained both the OOP share of health financing and the catastrophic impact of direct payments. In most low/middle-income countries, the better-off are more likely to spend a large fraction of total household resources on health care. This may reflect the inability of the poorest of the poor to divert resources from other basic needs and possibly the protection of the poor from user charges offered in some countries. But in China, Kyrgyz and Vietnam, where there are no exemptions of the poor from charges, they are as, or even more, likely to incur catastrophic payments.
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Affiliation(s)
- Eddy van Doorslaer
- Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
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O'Donnell O, van Doorslaer E, Rannan-Eliya RP, Somanathan A, Adhikari SR, Harbianto D, Garg CC, Hanvoravongchai P, Huq MN, Karan A, Leung GM, Ng CW, Pande BR, Tin K, Tisayaticom K, Trisnantoro L, Zhang Y, Zhao Y. The Incidence of Public Spending on Healthcare: Comparative Evidence from Asia. ACTA ACUST UNITED AC 2007. [DOI: 10.1093/wber/lhl009] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, Harbianto D, Herrin AN, Huq MN, Ibragimova S, Karan A, Ng CW, Pande BR, Racelis R, Tao S, Tin K, Tisayaticom K, Trisnantoro L, Vasavid C, Zhao Y. Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. Lancet 2006; 368:1357-64. [PMID: 17046468 DOI: 10.1016/s0140-6736(06)69560-3] [Citation(s) in RCA: 360] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Conventional estimates of poverty do not take account of out-of-pocket payments to finance health care. We aimed to reassess measures of poverty in 11 low-to-middle income countries in Asia by calculating total household resources both with and without out-of-pocket payments for health care. METHODS We obtained data on payments for health care from nationally representative surveys, and subtracted these payments from total household resources. We then calculated the number of individuals with less than the internationally accepted threshold of absolute poverty (US1 dollar per head per day) after making health payments. We also assessed the effect of health-care payments on the poverty gap--the amount by which household resources fell short of the 1 dollar poverty line in these countries. FINDINGS Our estimate of the overall prevalence of absolute poverty in these countries was 14% higher than conventional estimates that do not take account of out-of-pocket payments for health care. We calculated that an additional 2.7% of the population under study (78 million people) ended up with less than 1 dollar per day after they had paid for health care. In Bangladesh, China, India, Nepal, and Vietnam, where more than 60% of health-care costs are paid out-of-pocket by households, our estimates of poverty were much higher than conventional figures, ranging from an additional 1.2% of the population in Vietnam to 3.8% in Bangladesh. INTERPRETATION Out-of-pocket health payments exacerbate poverty. Policies to reduce the number of Asians living on less than 1 dollar per day need to include measures to reduce such payments.
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Affiliation(s)
- Eddy van Doorslaer
- Department of Health Policy and Management, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Kusnanto H, Trisnantoro L. An input and process evaluation of Internet-based distance learning education for hospital managers in Indonesia. World Hosp Health Serv 1997; 34:27-30. [PMID: 10179644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
An evaluation study was carried out to describe the input and process of internet-based distance learning graduate education program for hospital managers in indonesia. The main research question addressed in the study was whether the program supported quality learning among students who were working full time and could not leave their jobs for the whole study period. The results of the study indicated that the program benefited those who lived in remote areas and women who could not leave their family for long period of time. The study suggests that interactions between students and their peers or tutors motivated better learning processes. Variability of performances were observed among students who were not equally supported by technological helps and with different learning motivations. It needs another year to evaluate whether the internet-based program is no less effective and efficient or even better than the in-class programs.
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Affiliation(s)
- H Kusnanto
- Graduate Program in Hospital Management, Gadjah Mada University, Indonesia
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