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Wulandari LPL, Lubis DS, Kurniati DPY, Sumintang K, Ardrini DAM, Mariani P, Januraga PP, Camellia A, Laksmi NMDP, Mahmudah L, Ong JJ, Causer L, Liverani M, Guy R, Wiseman V. Challenges to integrating programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B into antenatal care: Experiences from Indonesia. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002977. [PMID: 38446812 PMCID: PMC10917262 DOI: 10.1371/journal.pgph.0002977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/25/2024] [Indexed: 03/08/2024]
Abstract
The WHO's Asia-Pacific framework for triple elimination recommends that countries evaluate their programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B (EMTCT), including identifying gaps to improve program planning and the implementation of elimination strategies in antenatal care (ANC) services. In 2022, the Indonesian Ministry of Health reported that only 39% of pregnant women were tested for HIV, 14% for syphilis, and 28% for hepatitis B, respectively. We conducted a qualitative study involving a focus group discussion (FGD) and in-depth interviews with 25 key stakeholders in Bali and West Nusa Tenggara Provinces to identify specific challenges to testing for HIV, syphilis, and hepatitis B in ANC settings. Thematic analysis was used to identify the themes generated from the data. Health system bottlenecks experienced by stakeholders included supply chain management issues involving stock forecasting and stock monitoring, stock-outs of rapid test reagents which were particularly most frequent and for longer durations for syphilis and hepatitis B, high staff turnover, lack of staff training on how to perform the test, the complexity and time needed to record the data on women's characteristics, risk behaviours, and testing in both paper format and into the computer-based surveillance systems, discrepancies in program coverage data from different divisions of the district health office involved in the reporting system, high levels of stigma that prevented women from being followed up, challenges in notifying partners, and inadequate reporting and referral of women from private providers to public ones for testing. Interventions addressing the above challenges are worthy of consideration to improve the health system function and integrate EMTCT into the ANC settings.
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Affiliation(s)
- Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Dinar Saurmauli Lubis
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Desak Putu Yuli Kurniati
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Karjono Sumintang
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Dewa Ayu Mirah Ardrini
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | | | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Indonesia
| | | | | | | | - Jason J. Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Louise Causer
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Wahdi AE, Sutanto E, Setyawan A, Astrini YP, Adani N, Mardani H, Maulana N, Pattnaik A, Trihono T, Wilopo SA. National health insurance contribution to family planning program funding in Indonesia: A fund flow analysis. Gates Open Res 2024; 7:105. [PMID: 38605912 PMCID: PMC11006955 DOI: 10.12688/gatesopenres.14642.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 04/13/2024] Open
Abstract
Background Launched in 2014, Indonesia's national health insurance system (JKN) aimed to provide universal health coverage, including contraceptive services, to its population. We aim to evaluate the contribution of JKN to the overall spending for the family planning program in Indonesia. Methods Data from the Indonesian Demographic Health Survey, Survey on Financial Flows for Family Planning, Indonesia Motion Tracker Matrix, World Population Prospect, and Indonesian ministries' budget accountability reports were entered into the CastCost Contraceptive Projection Tool to define budgetary allocation and spending for the family planning program at the national level in 2019. Results Indonesia's family planning program in 2019 was financed mostly by the national budget (64.0%) and out-of-pocket payments (34.6%). There were three main ministries responsible for family planning financing: the National Population and Family Planning Board (BKKBN) (35.8%), the Ministry of Finance (26.2%), and the Ministry of Health (2.0%). Overall, JKN contributed less than 0.4% of the funding for family planning services in Indonesia in 2019. The majority of family planning spending was by public facilities (57.3%) as opposed to private facilities (28.6%). Conclusion JKN's contribution to funding Indonesia's family planning programs in 2019 was low and highlights a huge opportunity to expand these contributions. A coordinated effort should be conducted to identify possible opportunities to realign BKKBN and JKN roles in the family planning programs and lift barriers to accessing family planning services in public and private facilities. This includes a concerted effort to improve integration of private family planning providers into the JKN program.
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Affiliation(s)
- Amirah Ellyza Wahdi
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
| | - Edward Sutanto
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Althaf Setyawan
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
| | - Yufan Putri Astrini
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
| | - Nadhila Adani
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Halimah Mardani
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Nirwan Maulana
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Anooj Pattnaik
- ThinkWell, 1519 York Road, Lutherville, Maryland, 21093, USA
| | - Trihono Trihono
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Siswanto Agus Wilopo
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
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Sapkota S, Dhakal A, Rushton S, van Teijlingen E, Marahatta SB, Balen J, Lee AC. The impact of decentralisation on health systems: a systematic review of reviews. BMJ Glob Health 2023; 8:e013317. [PMID: 38135299 DOI: 10.1136/bmjgh-2023-013317] [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: 07/04/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Decentralisation is a common mechanism for health system reform; yet, evidence of how it impacts health systems remains fragmented. Despite published findings from primary and secondary research illustrating range of impacts, a comprehensive and clear understanding is currently lacking. This review synthesised the existing evidence to assess how decentralisation (by devolution) impacts each of the six WHO building blocks, and the health system. METHOD We systematically searched five electronic databases for reviews exploring impact of decentralisation on health systems, globally. Reviews, both systematic and non-systematic, published in the English language from January 1990 to February 2022 were included. Data were synthesised across each of six building blocks. Quality assessment of the reviews was conducted using Critical Appraisal Skills Program for systematic and Scale for Assessment of Narrative Review Articles for non-systematic reviews. RESULTS Nine reviews, each addressing somewhat different questions, contexts and issues, were included. A range of positive and negative impacts of decentralisation on health system building blocks were identified; yet, overall, the impacts were more negative. Although inconclusive, evidence suggested that the impacts on leadership and governance and financing components in particular shape the impact on overall health system. Assessment of how the impact on building blocks translates to the broader impact on health systems is challenged by the dynamic complexities related to contexts, process and the health system itself. CONCLUSIONS Decentralisation, even if well intentioned, can have unintended consequences. Despite the difficulty of reaching universally applicable conclusions about the pros and cons of decentralisation, this review highlights some of the common potential issues to consider in advance. PROSPERO REGISTRATION NUMBER CRD42022302013.
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Affiliation(s)
- Sujata Sapkota
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Amshu Dhakal
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Simon Rushton
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
- The University of Sheffield, Sheffield, UK
| | - Edwin van Teijlingen
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
- Bournemouth University, Poole, UK
| | - Sujan B Marahatta
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
- Nepal Open University, Lalitpur, Nepal
| | - Julie Balen
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
- The University of Sheffield, Sheffield, UK
- Canterbury Christ Church University, Canterbury, UK
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Hidayat MT, Oster C, Muir-Cochrane E, Lawn S. Indonesia free from pasung: a policy analysis. Int J Ment Health Syst 2023; 17:12. [PMID: 37138360 PMCID: PMC10155453 DOI: 10.1186/s13033-023-00579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Many people with mental illnesses remain isolated, chained, and inside cages, called Pasung in Indonesia. Despite numerous policies introduced to eradicate Pasung, Indonesia has made slow progress in decreasing this practice. This policy analysis examined existing policies, plans and initiatives in Indonesia targeted at eradicating Pasung. Policy gaps and contextual constraints are identified in order to propose stronger policy solutions. METHODS Eighteen policy documents were examined, including government news releases and organisational archives. A content analysis was undertaken of national-level policies that address Pasung within the context of the health system, social system and human rights since the establishment of Indonesia. This was followed by a case study analysis of policy and program responses particularly in West Java Province. FINDINGS While policy to address Pasung exists at a national level, implementation at national and local levels is complicated. Pasung policy has generated a sense of awareness but the different directions and ambiguous messaging across all stakeholders, including policy actors, has created a lack of clarity about institutions' roles and responsibilities in the implementation process, as well as accountability for outcomes. This situation is exacerbated by an incomplete decentralisation of healthcare policymaking and service delivery, particularly at the primary level. It is possible that policymakers have overlooked international obligations and lessons learned from successful policymaking in comparable regional countries, resulting in disparities in target-setting, implementation mechanisms, and evaluation. CONCLUSION While the public has become more informed of the need to eradicate Pasung, ongoing communication with the various clusters of policy actors on the aforementioned issues will be critical. Addressing the various segments of the policy actors and their challenges in response to policy will be critical as part of building the evidence base to establish a feasible and effective policy to combat Pasung in Indonesia.
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Affiliation(s)
- Muhamad Taufik Hidayat
- College of Medicine and Public Health, Flinders University, PO Box 2100, 5001, South Australia, Adelaide, South Australia, Australia
- West Java Psychiatric Hospital, Bandung, Indonesia
| | - Candice Oster
- College of Medicine and Public Health, Flinders University, PO Box 2100, 5001, South Australia, Adelaide, South Australia, Australia
| | - Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, PO Box 2100, 5001, Adelaide, South Australia, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, PO Box 2100, 5001, South Australia, Adelaide, South Australia, Australia.
- Lived Experience Australia Ltd, Adelaide, Australia.
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Setiawan KE, Kurniawan A, Chowanda A, Suhartono D. Clustering models for hospitals in Jakarta using fuzzy c-means and k-means. PROCEDIA COMPUTER SCIENCE 2023; 216:356-363. [PMID: 36643178 PMCID: PMC9829428 DOI: 10.1016/j.procs.2022.12.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
After facing the COVID-19 pandemic, national and local governments in Indonesia realized a gap in the distribution of health care and human health practitioners. This research proposes two unsupervised learning methods, K-Means and Fuzzy C-Means (FCM), for clustering a list of hospital data in Jakarta, Indonesia, which contains information about the number of its human health resources. The datasets used in this study were obtained from the website the Ministry of the Health Republic of Indonesia provided through the content scraping method. The result shows that implementing K-Means and FCM clustering results in the same number of clusters. Nevertheless, both results have different areas and proportions that can be observed by three distance metrics, such as Hamming, Euclidean, and Manhattan distance. By using the clustering result using the K-Means algorithm, the hospital list was separated into three clusters with a proportion of 84.82%, 14.66%, and 0.52% for clusters 0, 1, and 2, respectively. Meanwhile, using the FCM algorithm, the hospital list was separated into three clusters with a proportion of 17.80%, 73.82%, and 8.38% for clusters 0, 1, and 2, respectively. To the best of our knowledge, this is the first discussion of clustering healthcare facilities in Indonesia, especially hospitals, based on their health professionals.
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Affiliation(s)
- Karli Eka Setiawan
- Computer Science Department, School of Computer Science, Bina Nusantara University, Jakarta, Indonesia 11480
| | - Afdhal Kurniawan
- Computer Science Department, School of Computer Science, Bina Nusantara University, Jakarta, Indonesia 11480
| | - Andry Chowanda
- Computer Science Department, School of Computer Science, Bina Nusantara University, Jakarta, Indonesia 11480
| | - Derwin Suhartono
- Computer Science Department, School of Computer Science, Bina Nusantara University, Jakarta, Indonesia 11480
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Borghi J, Brown GW. Taking Systems Thinking to the Global Level: Using the WHO Building Blocks to Describe and Appraise the Global Health System in Relation to COVID-19. GLOBAL POLICY 2022; 13:193-207. [PMID: 35601655 PMCID: PMC9111126 DOI: 10.1111/1758-5899.13081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 06/15/2023]
Abstract
Adequately preparing for and containing global shocks, such as COVID-19, is a key challenge facing health systems globally. COVID-19 highlights that health systems are multilevel systems, a continuum from local to global. Goals and monitoring indicators have been key to strengthening national health systems but are missing at the supranational level. A framework to strengthen the global system-the global health actors and the governance, finance, and delivery arrangements within which they operate-is urgently needed. In this article, we illustrate how the World Health Organization Building Blocks framework, which has been used to monitor the performance of national health systems, can be applied to describe and appraise the global health system and its response to COVID-19, and identify potential reforms. Key weaknesses in the global response included: fragmented and voluntary financing; non-transparent pricing of medicines and supplies, poor quality standards, and inequities in procurement and distribution; and weak leadership and governance. We also identify positive achievements and identify potential reforms of the global health system for greater resilience to future shocks. We discuss the limitations of the Building Blocks framework and future research directions and reflect on political economy challenges to reform.
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Factors affecting optimal antenatal care utilization in Indonesia: implications for policies and practices. J Public Health Policy 2021; 42:559-573. [PMID: 34728813 DOI: 10.1057/s41271-021-00307-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/21/2022]
Abstract
Most maternal deaths are preventable with good antenatal care. The study aimed to examine factors relevant to optimal frequency of Antenatal Care (ANC) visits in Indonesia using the Indonesian Demographic and Health Survey 2017 data. Our study outcome was optimal numbers of ANC visits (≥ 8 visits). Predictors include age, had pregnancy termination, number of children, education level, employment status, awareness of pregnancy problems, wealth index, residence, region, health insurance coverage, and barriers to reach healthcare facilities. Of 3738 participants, about 60.2% had optimal number of ANC visits. There was an association between optimal ANC utilization and: experiencing pregnancy complications, distance to the healthcare facility, health insurance coverage, residence, region, awareness of pregnancy problems, and the number of children. Policymakers should improve healthcare facilities' availability, expand health insurance coverage, and educate women about the importance of ANC. This finding might be relevant in developing countries with similar health infrastructure situation.
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Azizatunnisa' L, Cintyamena U, Mahendradhata Y, Ahmad RA. Ensuring sustainability of polio immunization in health system transition: lessons from the polio eradication initiative in Indonesia. BMC Public Health 2021; 21:1624. [PMID: 34488698 PMCID: PMC8419659 DOI: 10.1186/s12889-021-11642-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sustaining an effective evidence-based health intervention will maximize its impact on public health. Political and governmental reforms impacted on immunization program sustainability both positively and negatively. This study aims to explore the sustainability of polio immunization in a decentralized health system taking lessons learned from a polio eradication initiative in Indonesia. METHODS We collected qualitative data through in-depth interviews with 27 key informants from various backgrounds at district, provincial, and national levels, consisting of frontline workers, managers, and Non-government Organizations (NGOs). We conducted thematic analysis and triangulated using document reviews. We also conducted member checking and peer debriefing to ensure trustworthiness. RESULTS Competing priority was identified as the significant challenge to sustain government commitment for polio immunization and AFP surveillance during the transition toward a decentralized health system. Variation of local government capacities has also affected immunization delivery and commitment at the sub-national level government. The government reform has led to a more democratic society, facilitating vaccine rejection and hesitancy. The multi-sector partnership played a significant role in maintaining polio immunization coverage. Strong and continuous advocacy and campaign were essential to raising awareness of the community and policymakers to keep polio in the agenda and to maintain the high polio immunization coverage. CONCLUSION Competing priority was the major factor affecting high polio immunization coverage during the decentralization transition. Strong advocacy is needed at every level, from district to national level, to keep polio immunization prioritized.
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Affiliation(s)
- Luthfi Azizatunnisa'
- Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Utsamani Cintyamena
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yodi Mahendradhata
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Riris Andono Ahmad
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Putri LP, Russell DJ, O'Sullivan BG, Kippen R. Factors Associated With Working in Remote Indonesia: A National Cross-Sectional Study of Early-Career Doctors. Front Med (Lausanne) 2021; 8:594695. [PMID: 34055819 PMCID: PMC8155628 DOI: 10.3389/fmed.2021.594695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Doctor shortages in remote areas of Indonesia are amongst challenges to provide equitable healthcare access. Understanding factors associated with doctors' work location is essential to overcome geographic maldistribution. Focused analyses of doctors' early-career years can provide evidence to strengthen home-grown remote workforce development. Method: This is a cross-sectional study of early-career (post-internship years 1–5) Indonesian doctors, involving an online self-administered survey on demographic characteristics, and; locations of upbringing, medical clerkship (placement during medical school), internship, and current work. Multivariate logistic regression was used to test factors associated with current work in remote districts. Results: Of 3,176 doctors actively working as clinicians, 8.9% were practicing in remote districts. Compared with their non-remote counterparts, doctors working in remote districts were more likely to be male (OR 1.5,CI 1.1–2.1) or unmarried (OR 1.9,CI 1.3–3.0), have spent more than half of their childhood in a remote district (OR 19.9,CI 12.3–32.3), have completed a remote clerkship (OR 2.2,CI 1.1–4.4) or internship (OR 2.0,CI 1.3–3.0), currently participate in rural incentive programs (OR 18.6,CI 12.8–26.8) or have previously participated in these (OR 2.0,CI 1.3–3.0), be a government employee (OR 3.2,CI 2.1–4.9), or have worked rurally or remotely post-internship but prior to current position (OR 1.9,CI 1.2–3.0). Conclusion: Our results indicate that building the Indonesian medical workforce in remote regions could be facilitated by investing in strategies to select medical students with a remote background, delivering more remote clerkships during the medical course, deploying more doctors in remote internships and providing financial incentives. Additional considerations include expanding government employment opportunities in rural areas to achieve a more equitable geographic distribution of doctors in Indonesia.
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Affiliation(s)
- Likke Prawidya Putri
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia
| | - Deborah Jane Russell
- School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia.,Menzies School of Health Research, Alice Springs, NT, Australia
| | - Belinda Gabrielle O'Sullivan
- School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia.,Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Rebecca Kippen
- School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia
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Ahmad RA, Ferdiana A, Surendra H, Sy TR, Herbianto D, Rahayujati TB, Rejeki DSS, Murhandarwati EEH. A participatory approach to address within-country cross-border malaria: the case of Menoreh Hills in Java, Indonesia. Malar J 2021; 20:137. [PMID: 33676491 PMCID: PMC7937247 DOI: 10.1186/s12936-021-03673-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria remains a significant public health issue in Indonesia. Most of the endemic areas are in the eastern parts of Indonesia, but there are a few remaining foci of persistent endemic malaria in Java, particularly in Menoreh Hills, a region bordering three districts of two provinces on this island. Despite a commitment to build a partnership to eliminate cross-border malaria, there is a lack of understanding of how this partnership might be translated into an implementable strategic plan. The study aims to provide evidence of how a participatory approach was used to strengthen the cross-border collaboration and stakeholders' capacity to develop a joint strategic, operational, and costing plan for cross-border malaria elimination. METHODS A participatory action research was conducted from January to August 2017, involving participants from the village, district, provincial, and national levels. This study was conducted in seven phases, including document review, focus group discussions (FGDs), planning and costing workshops, and a dissemination meeting. A total of 44 participants from primary health centres (PHC) and 27 representatives of affected villages in three districts, 16 participants from the district and provincial malaria programmes and planning bureaus, and 11 participants from the national level were involved in the processes. Data on priority issues, costing, programme coverage, and administration were collected. Thematic coding and feedback were used for analysis. RESULTS Problems identified by stakeholders included low community awareness and participation in malaria prevention, high mobility across three districts, lack of financial and human resources, lack of inter-district coordination, and poor implementation of migration surveillance. Cross-border strategies identified to address malaria were improving cross-border migration surveillance, strengthening the network, governance, and advocacy of malaria control implementation across borders, and developing the malaria information system. A working group composed of the three districts' representatives authorized to decide on cross-border issues will be created. CONCLUSIONS The participatory approach was applicable in cross-border malaria planning for within-country settings and useful in enhancing stakeholders' capacities as implementers. While done in a participatory way, the joint plan crafted was a non-binding agreement; stakeholders should advocate to ensure adequate funds are poured into mobilizing the programme.
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Affiliation(s)
- Riris Andono Ahmad
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. .,Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Astri Ferdiana
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Public Health, Faculty of Medicine, University of Mataram, Mataram, Indonesia
| | - Henry Surendra
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Tyrone Reden Sy
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Deni Herbianto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Theodola Baning Rahayujati
- Disease Prevention and Control, District Health Office of Kulon Progo, Kulon Progo, Yogyakarta, Indonesia
| | - Dwi Sarwani Sri Rejeki
- Department of Public Health, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Central Java, Indonesia
| | - E Elsa Herdiana Murhandarwati
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Parasitology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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He AJ, Tang VFY. Integration of health services for the elderly in Asia: A scoping review of Hong Kong, Singapore, Malaysia, Indonesia. Health Policy 2021; 125:351-362. [PMID: 33422336 DOI: 10.1016/j.healthpol.2020.12.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022]
Abstract
Against the backdrop of rapid ageing populations, there is an increasing recognition of the need to integrate various health services for the elderly, not only to provide more coordinated care, but also to contain the rapid cost inflation driven primarily by the curative sector. Funded by the Asia-Pacific Observatory on Health Systems and Policies, this scoping review seeks to synthesize the received knowledge on care integration for the elderly in four Asian societies representing varying socioeconomic and health-system characteristics: Singapore, Hong Kong, Malaysia, and Indonesia. The search for English-language literature published between 2009 and 2019 yielded 67 publications in the final sample. The review finds that both research and practice regarding health service integration are at a preliminary stage of development. It notes a marked trend in seeking to integrate long-term elderly care with curative and preventive care, especially in community settings. Many distinctive models proliferated. Integration is demonstrated not only horizontally but also vertically, transcending public-private boundaries. The central role of primary care is highly prominent in almost all the integration models. However, these models are associated with a variety of drawbacks in relation to capacity, perception, and operation that necessitate further scholarly and policy scrutiny, indicating the robustness and persistence of siloed healthcare practices.
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Affiliation(s)
- Alex Jingwei He
- Department of Asian and Policy Studies, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong Special Administrative Region.
| | - Vivien F Y Tang
- Department of Asian and Policy Studies, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong Special Administrative Region
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Sulistyawati S, Nilsson M, Ekasari MP, Mulasari SA, Sukesi TW, Padmawati RS, Holmner Å. Untapped Potential: A Qualitative Study of a Hospital-Based Dengue Surveillance System. Am J Trop Med Hyg 2020; 103:120-131. [PMID: 32394883 PMCID: PMC7356460 DOI: 10.4269/ajtmh.19-0719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence and geographical distribution of dengue fever has increased in recent decades. The actual disease burden is unknown owing to frequent underreporting and misclassification of cases. A well-functioning system for diagnosing, treating, and reporting cases is of prime importance as disease statistics is the foundation for decisions aiming to control the disease. This study aimed to explore the hospital-based disease surveillance system in Yogyakarta, a dengue-endemic region on Java, Indonesia. Semi-structured interviews were performed with 16 informants from four hospitals, including five general practitioners, three internists, four pediatricians, and four administrative staff working with administration relating to dengue diagnostics and reporting. Data were analyzed using content analysis. A theme arose from the analysis “Dengue surveillance stands and falls by the rigor of the health system.” The theme, and underlying categories and subcategories, describes a surveillance system that in the best-case scenario works well and is likely to produce reliable dengue case data. However, there is a lack of synchronization between regulations and guidelines in different hospitals and some friction between regulatory bodies and the care provider. Knowledge among the staff appears to vary, and many clinical and financial decisions are made rather arbitrarily, which ultimately might lead to unequal health service delivery. In conclusion, the dengue surveillance system under study could improve further, particularly by ensuring that all regulations and recommended procedures are standardized and that all staff are given the best opportunity to stay updated on dengue-related matters, clinical as well as regulatory, on a regular basis.
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Affiliation(s)
- Sulistyawati Sulistyawati
- Department of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Maria Nilsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Marlita Putri Ekasari
- Laboratory of Pharmacy Management and Community Pharmacy, Department of Pharmaceutics, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Tri Wahyuni Sukesi
- Department of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Retna Siwi Padmawati
- Department of Health Behaviour, Environmental, and Social Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Center of Health Behavior and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Åsa Holmner
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Radiation Sciences, Umeå University, Umeå, Sweden
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