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Serotipe Virus Dengue dan Populasi Aedes aegypti dan Aedes albopictus (Diptera: Culicidae) Di Kota Bengkulu
No full textDengue virus serotype and the population of Aedes aegypti and Aedes albopictus in Bengkulu City: its implications for dengue prevention programs Purpose: This study aimed to prevent the development of dengue virus by detecting dengue virus serotypes of Aedes aegypti (Ae. aegypti) and Aedes albopictus (Ae. albopictus) and to determine the population of Ae. aegypti and Ae. albopictus in dengue endemic area (Sidomulyo Village) and dengue sporadic area (Tanjung Jaya Village) in Bengkulu City, Indonesia. Methods: The design of study was observational-analytic. Aedes sp eggs were collected by ovitraps from Sidomulyo and Tanjung Jaya Villages. The eggs were reared to adult and identified to determine of Ae. aegypti and Ae. albopictus. Identification of species Ae. aegypti and Ae. albopictus uses the pictorial key for the identification of mosquitoes by Rueda. Detection of dengue virus serotypes were done by RT-PCR and nested PCR method using specific primers Lanciotti. Results: The Serotypes of dengue virus of Ae. aegypti in dengue endemic and sporadic areas were dengue-3 (DENV-3) and the serotypes of dengue virus of Ae. albopictus in dengue sporadic area was dengue-3 (DENV-3). The population ratio of Ae. aegypti and Ae. albopictus in dengue endemic area (61%:39%) and dengue sporadic areas (27%:73%), respectively. Conclusions: Aedes aegypti in dengue endemic and sporadic areas and Ae. albopictus in dengue sporadic area has potential as a dengue-3 vector. Health Agency of Bengkulu City could optimize the prevention program of dengue and activate the Jumantik cadres.AbstrakTujuan: Penelitian ini bertujuan untuk pencegahan perkembangan penyakit DBD dengan mendeteksi serotipe virus dengue pada nyamuk Ae. aegypti dan Ae. albopictus dan menentukan rasio populasi nyamuk Ae. aegypti dan Ae. albopictus di daerah endemis dan sporadis DBD di Kota Bengkulu. Metode: Desain penelitian ini adalah observasional-analitik. Telur nyamuk Aedes sp dikumpulkan menggunakan ovitrap dari daerah endemis DBD (Kelurahan Sidomulyo) dan daerah sporadis DBD (Kelurahan Tanjung Jaya). Identifikasi spesies Ae. aegypti dan Ae. albopictus menggunakan pictorial key for the identification of mosquitoes Rueda. Deteksi serotipe virus dengue dilakukan dengan metode RT-PCR dan Nested PCR menggunakan primer spesifik Lanciotti. Hasil: Serotipe virus dengue yang ditemukan pada Ae. aegypti adalah DENV-3 (daerah endemis dan sporadis DBD) dan DENV-3 pada Ae. albopictus (daerah sporadis DBD). Perbandingan populasi Ae. aegypti dan Ae. albopictus pada daerah endemis dan sporadis DBD berturut-turut adalah (60,51%:39,49%) dan (27,08%:72,92%). Simpulan: Aedes aegypti di daerah endemis dan sporadis DBD serta Ae. albopictus di daerah sporadis DBD berpotensi sebagai vektor dengue-3. Dinas Kesehatan Kota Bengkulu dapat mengoptimalkan program pencegahan DBD dan mengaktifkan kader Jumantik.AbstrakTujuan: Penelitian ini bertujuan untuk mendeteksi serotipe virus dengue pada nyamuk Ae. aegypti dan Ae. albopictus dan menentukan rasio populasi nyamuk Ae. aegypti dan Ae. albopictus di daerah endemis dan sporadis DBD di Kota Bengkulu. Metode: Desain penelitian ini adalah observasional-analitik. Telur nyamuk Aedes sp dikumpulkan menggunakan ovitrap dari daerah endemis DBD (Kelurahan Sidomulyo) dan daerah sporadis DBD (Kelurahan Tanjung Jaya). Identifikasi spesies Ae. aegypti dan Ae. albopictus menggunakan pictorial key for the identification of mosquitoes Rueda. Deteksi serotipe virus dengue dilakukan dengan metodi RT-PCR dan Nested PCR menggunakan primer spesifik Lanciotti. Hasil: Serotipe virus dengue yang ditemukan pada Ae. aegypti adalah DENV-3 (daerah endemis dan sporadis DBD) dan DENV-3 pada Ae. albopictus (daerah sporadis DBD). Perbandingan populasi Ae. aegypti dan Ae. albopictus pada daerah endemis dan sporadis DBD berturut-turut adalah (60.51%:39.49%) dan (27.08%:72.92%). Simpulan: Aedes aegypti di daerah endemis dan sporadis DBD serta Ae. albopictus di daerah sporadis DBD berpotensi sebagai vektor dengue-3
Hubungan pemanfaatan dana bantuan operasional kesehatan (BOK) dengan peningkatan cakupan kunjungan antenatal K4 di puskesmas kota Serang tahun 2014-2016
No full textRelation between health operational aid fund (BOK) with increase in K4 antenatal visiti scope at Serang city community health centers year 2014-2016Health Operational Aid Fund (BOK) realization at Serang City Community Health Centers (CHC) through 2014-2016 has always reached 100% mark which more than 30% of the fund was allocated for maternal and children health each year. However the achievement from maternal and children health scope especially on K4 antenatal visit was not proportional with the budget, instead each year a decreasing trend from proposed target (75%) was observed thus the need of evaluation. This study was conducted at regional health agency and four CHCs (Banten Girang, Curug, Sawah Luhur and Serang Kota) with retrospective study case design and considering fund variables and scopes. The result shows lack of human and other resources in managing maternal and children health program; the lack of operational fund for preventive and promotive activities from regional government budget (APBD) and only rely on health operational fund; the lack of supervision in midwife records and reports, also the contract ending of trained cadres as the result of village chief replacement.Relation between health operational aid fund (BOK) with increase in K4 antenatal visiti scope at Serang city community health centers year 2014-2016Health Operational Aid Fund (BOK) realization at Serang City Community Health Centers (CHC) through 2014-2016 has always reached 100% mark which more than 30% of the fund was allocated for maternal and children health each year. However the achievement from maternal and children health scope especially on K4 antenatal visit was not proportional with the budget, instead each year a decreasing trend from proposed target (75%) was observed thus the need of evaluation. This study was conducted at regional health agency and four CHCs (Banten Girang, Curug, Sawah Luhur and Serang Kota) with retrospective study case design and considering fund variables and scopes. The result shows lack of human and other resources in managing maternal and children health program; the lack of operational fund for preventive and promotive activities from regional government budget (APBD) and only rely on health operational fund; the lack of supervision in midwife records and reports, also the contract ending of trained cadres as the result of village chief replacement.Health Operational Aid Fund (BOK) realization at Serang City Community Health Centers (CHC) through 2014-2016 has always reached 100% mark which more than 30% of the fund was allocated for maternal and children health each year. However the achievement from maternal and children health scope especially on K4 antenatal visit was not proportional with the budget, instead each year a decreasing trend from proposed target (75%) was observed thus the need of evaluation. This study was conducted at regional health agency and four CHCs (Banten Girang, Curug, Sawah Luhur and Serang Kota) with retrospective study case design and considering fund variables and scopes. The result shows lack of human and other resources in managing maternal and children health program; the lack of operational fund for preventive and promotive activities from regional government budget (APBD) and only rely on health operational fund; the lack of supervision in midwife records and reports, also the contract ending of trained cadres as the result of village chief replacement
Analisis regresi linier perilaku dan pelayanan kesehatan dengan sub indeks penyakit tidak menular tahun 2014
No full textPHDI (Public Health Development Index) is a picture of progress in the health sector and a further elaboration of the health component of the Human Development Index (HDI) in Indonesia. PHDI 2014 consists of seven component sub-indices which are sub-index of Non Communicable Diseases (NCD). The analytical method used is multiple linear regression, while data from data Basic Health Research (Riskesdas) 2013 and the Potential of Village (PODES) 2011 which are consisted of 497 districts / cities throughout Indonesia. The purpose of analysis is to find the relationship of NCD sub index with behavioral and health services as well as making a prediction value of NCD index variable through independent variables which include the proportion of tobacco consumption, the proportion of properly brushing teeth, the proportion of adequately physical activity, the proportion of the number of doctors in sub-district and the proportion of Health Care Assurance ownership. The analysis showed that the variables such as brushing teeth, physical activity and smoking absence have a significant relationship with the sub-index of NCD (p-value = 0.000) with influence of 10.7%. Variables that have the most impact on the sub-index of NCD is adequately physical activity with a coefficient of 0.002
An increasing trend and impact of non communicable diseases in Vanuatu
Get PDFNon Communicable Diseases (NCDs) continue to elevate in the western pacific regions, including Vanuatu. Much efforts have been made in reducing the disease burden, however the challenges remains due to certain sociocultural behaviours, globalization, and urbanization which promotes unhealthy lifestyles such as eating lifestyles (unhealthy diet), physical inactivity, harmful use of alcohol and tobacco use. All these contributing factors tends to give rise to common risks for the intermediate factors such as raised in blood pressure, raised in the level of glucose in the blood, the unhealthy lipid profiles, and obesity.Comparing this disease in low-income countries and high-income countries it seem that the rate of NDC are higher in low-income countries, more specifically the countries in the western pacific regions. Even that there are few South East Asian countries such Vietnam, Malaysia, Philippines, and Cambodia which were also regarded as having high mortality rates of NCD (1). According to the profile in 2008 it was estimated that it's the western pacific region that has more of the effect, showing more than a quarter of the 36 million deaths were due to NCD alone.Furthermore it continue to states that the trend will continue to increase by 15% between 2010 and 2020, meaning an estimation (from baseline) from an elevation of up to 44 million deaths will be cause by NCD alone (1). And if we divide the figures up it will then show that the highest proportion will be from the Western Pacific regions, of 12.3 million of deaths, while South-East Asian regions on the other hand is estimated to reach 10.4 million. This is also supported by a report on economic-cost of NCD in the Pacific Island countries which states that NCD is already a challenge in the Pacific, leading to account for 70% or more of the deaths. And the most common cause is of cardiovascular disease, which accounts for between 29% and 38% of death from all other causes (2). In Vanuatu NCD is in the top 10 disease agenda due to fast escalating trend, and similarly are Cardiovascular diseases, including diabetes and hypertension. According to the reported it was estimated that 18% of deaths were due to circulatory heart diseases (7).Another study been conducted in 2008 showed a record of 0.5% and 0.3% deaths were respectively caused by NCD in male and female. The current daily tobacco smoking as a form of behavioural risk factor constitute of 12.3%, where 21.3% in male and 3.1% in female. Additionally from the study record it showed that males are more risks than female in having high blood pressure above normal. This is supported by showing 44.5% of males in the study have raised blood pressure, while female on contrary have 39.1% raised blood pressure. Other contributing factor in the metabolic risks factors are overweight and obesity. From the study it showed that 21% of both male and female are overweight, while 34.2% is of obesity (3).From the findings we have to know that there are unprecedented changes in our environment – cultural, economic, physical, political and social – pose new risks and threats to health. And from most reports and future focus it is predicted that NCD will continue to elevate globally, whether it is urbanization and the built environment, severe air pollution, climate change, unregulated marketing of tobacco and other harmful food products, or easy access to nutrient-poor and calorie dense food (4). In some countries, for instance Vanuatu still accepts more imported and processed food and is predicted to upscale further should the climate conditions such as the current El Nino continue to place threats on garden crops. There is additionally a weak monitoring on food regulations on imported food products and where most labelling are in languages. Lack of proper laboratory analysis of the content against the labelling is another contributing factor. Thus it is imperative that leaders in both Government and related Non-Government Organizations (NGOs) find innovative solutions to complex health challenges in ever-changing common practices and environments. Only then will the population be safe and healthy from the disease. On the other hand we have to understand that at each developmental stage of life, human beings exhibit different vulnerabilities and are exposed to different risks, placing them more vulnerable to contracting those diseases.According to WHO report in 2008 on prevention and control of non-communicable diseases (Annex 1-B) (5), in year 2000 the WHO's Member States adopted a global strategy for prevention and control of NCDs during the fifty-third World Health Assembly. The Global Strategy on Diet, Physical Activity and Health was endorsed in 2002. In 2003, the WHO launched the Framework Convention on Tobacco Control, and this treaty came into force in 2005. Even that in 2008 the Member States endorsed the Action Plan for the Global Strategy for the Prevention and Control of non-communicable Diseases at the Sixty-first World Health Assembly. And the Regional Committee for the Western Pacific called for action to combat non-communicable diseases and their related risk factors in specific resolutions. There are also various regional action plans related to NCD prevention and control (e.g. Regional Plan for Integrated Prevention and Control of Cardiovascular Diseases and Diabetes for the Western Pacific Region 1998–2003, Tobacco Free Initiative Regional Action Plans 2000–2004 and 2005–2009, Plan of Action 2006–2010 for the Western Pacific.Declaration on Diabetes, and the Regional Strategy to Reduce Alcohol-related Harm) were developed over the past decade, sharing a focus on policy and planning, surveillance, health promotion and clinical prevention. Furthermore WHO developed a Pacific Framework for the Prevention and Control of Non-communicable Diseases in 2007 to serve as a guide in addressing NCDs among Pacific island countries and areas, and this framework was adopted by the Secretariat of the Pacific Community (SPC). Augmenting these action plans and frameworks is a Region-wide interest and commitment to fostering health systems change, particularly in relation to the prevention and control of NCDs. In November 2007, the WHO-supported meeting on "Strengthening Health Systems to Improve Chronic Disease Prevention and Control" culminated in a set of recommendations for reducing the health burden from non-communicable diseases through health systems improvements. The Western Pacific Regional Action Plan for NCDs is a collaborative effort by the WHO Regional Office for the Western Pacific and Member States to establish a shared vision and strategic actions to reduce the NCD burden (5).However despite of all these developed global and regional framework, strategies, planning, and action plans it is still recognized that countries still have less capacities and some are still at different stages of progress in the fight against non-communicable diseases. Therein it is suggested that more plenary discussions, consultations, and a support networking collaborations be established between the Government and private sectors, including the partners and associated stakeholders, and the affected communities. Moreover the Regional Action Plan also aims to operationalize the objectives of the Global Action Plan within the Western Pacific context, thereby adding value through concrete and relevant guidance. In other words the member states need to reconsider and rectify these further to be able to absorb perfectly into the country settings and the environmental contexts. Vanuatu on the other hand has also the capacity to address and respond to NCDs as it has its funding available for Cardiovascular diseases, NCD treatment for control, prevention and health promotion messages, and NCD surveillance and M&E. Additionally the health reporting system also includes information on screening of patients at health peripheries, NCD cause specific –morbidity, and the risks factors. Further to that the country has an integrated or topic-specific policy, programme, and action plan which is currently operational for these mentioned NCD diseases, including Alcohol, unhealthy diet, overweight, and obesity. Physical inactivity and Tobacco were other areas that the policy and action plan covers (1).Furthermore the member states need to strictly consider and implement WHO global NCD action plan which is a road map from 2013 to 2025 (6). In the road map are six global objectives that clearly states to make prevention and control of NCDs a priority, strengthening national capacities and leaderships, reduce modifiable risks factors, promote high-quality research, and finally is to monitor the impact and the trend of the disease. Additionally are nine major and more specific targets along the road map towards 2025. These are to be able to establish 80% availability of affordable technology and medicine to treat NCDs, ensuring that at least 50% of the patients receive preventive therapy for heart attacks and stroke, be able to pause the rise in diabetes and obesity, at least a 30% drop in sodium chloride (salt) intake, a 10% reduction in the harmful in the use of alcohol, to at least also receive 25% drop in premature death of people age 30-70 from cardiovascular diseases, cancers, diabetes, or chronic respiratory diseases, be able to reduce 10% in the prevalence of insufficient physical activity, reduce by 30% in tobacco use, and finally is to drop by 20% in the prevalence of high blood pressure (6). All these can be adopted and implemented strategically and effectively only when adequate resources such as adequate human resource, access to appropriate technology at all levels of implementations, adequate financial support, good working collaborations with partners and NGOs, including the communities, other associate stakeholders such as community leaders, and a very motivated and action-oriented personals are in place. Moreover is the health systems, political commitment, good network with shop entrepreneurs, and private sector that can contribute in the prevention and promotion of these mentioned health lifestyles.It is therefore strongly believed that unless all these are identified and notified then will there be some changes expected, and thus meet most of the target indicators as stated in the 2013-2025 target objectives
Hubungan pola konsumsi natrium dan kalium dengan kejadian hipertensi di puskesmas Paccerakkang Makassar
No full textLatar belakang: Hipertensi menjadi masalah kesehatan yang risikonya linear dengan pertambahan usia. Kenaikan tekanan pada dinding arteri hingga nilai ekstrim berpotensi memicu berbagai komplikasi kardiovaskular. Tingkat konsumsi natrium dan kalium menunjukkan asosiasi yang cukup berarti dengan kejadian hipertensi. Keduanya menunjukkan efek antagonis dalam menentukan kekuatan dinding arteri menahan laju aliran darah. Tujuan: Penelitian ini dikembangkan untuk mengobservasi korelasi antara konsumsi natrium dan kalium dengan kejadian hipertensi di wilayah kerja Puskesmas Paccerakkang Kota Makassar. Metode: Jenis penelitian yang digunakan adalah observasional analitik dengan rancangan cross-sectional. Populasi dalam penelitian ini merupakan individu berusia ≥ 30 tahun yang melakukan kunjungan ke Puskesmas Paccerakkang. Sebanyak 78 responden diikutsertakan dalam penelitian ini dengan teknik penarikan secara accidental sampling. Tingkat konsumsi diobservasi menggunakan instrumen penelitian berupa food recall untuk menggambarkan asupan natrium dan Food Frequency Questionnaire (FFQ) untuk menggambarkan asupan kalium. Analisis bivariat dilakukan untuk memahami hubungan konsumsi garam mineral dengan kejadian hipertensi. Hasil: Hasil penelitian menunjukkan beban hipertensi pada populasi target mencapai 51,3%. Konversi hasil survei konsumsi mengindikasikan masih adanya responden sebanyak 39,7% yang mengonsumsi natrium melebihi batas aman yang direkomendasikan. Namun, tingkat konsumsi natrium yang tinggi masih dapat diimbangi dengan konsumsi kalium yang cukup dengan persentase mencapai 65,4%. Hasil analisis bivariat menunjukkan adanya korelasi yang berarti antara pola konsumsi natrium dengan kejadian hipertensi di wilayah kerja Puskesmas Paccerakkang Makassar (p-value=0,018), berbeda dengan konsumsi kalium yang tidak mencapai level signifikansi dengan kejadian hipertensi (p-value=0,133). Simpulan: Hanya konsumsi natrium yang berhubungan dengan kejadian hipertensi di wilayah kerja Puskesmas Paccerakkang Makassar. Sementara konsumsi kalium meskipun menunjukkan adanya perbedaan, namun tidak menemui kemaknaan yang berarti
Evaluasi Sistem Surveilans Faktor Risiko Penyakit Tidak Menular Berbasis Posbindu di Kabupaten Sleman Tahun 2017
No full textLatar belakangWHO mencatat 36 juta jiwa pertahun (63%) penyebab kematian didunia adalah penyakit tidak menular (PTM). Riset Kesehatan Dasar 2007 dan 2013 menunjukkan 61% dari total kematian karena PTM. Profil Kabupaten Sleman tahun 2017 tercatat penyakit hipertensi mencapai 83.000 kasus dan Diabetes Mellitus 33.987 kasus. Tujuan evaluasi untuk melihat pelaksanaan sistem surveilans faktor risiko penyakit tidak menular (FR-PTM) berbasis Pos Pembinaan Terpadu (Posbindu) di Kabupaten Sleman tahun 2017.MetodeDesain penelitian adalah observasional. Dilaksanakan Januari-Februari 2018. Responden adalah penanggungjawab surveilans PTM Posbindu di 17 puskesmas. Teknik pengambilan sampel menggunakan purposive sampling. Evaluasi sistem surveilans terkait struktur sistem, fungsi inti, fungsi pendukung dan kualitas surveilans berdasarkan pedoman WHO. Instrumen menggunakan kuesioner terstruktur. Analisis data dilakukan secara deskriptif.Hasil136 posbindu yang tersebar di 17 puskesmas dan yang aktif melapor 95 posbindu. Dari struktur sistem menunjukkan 82,38% belum mengetahui tentang legal aspek pelaksanaan sistem surveilan PTM. Pada segi fungsi inti diketahui 76,47% deteksi kasus masih dilakukan oleh kader dengan supervisi dokter karena keterbatasan tenaga. Sebanyak 82,35% tidak dapat melakukan analisis dan interpretasi data FRPTM. Dari fungsi dukungan sebanyak 23,53 responden belum mengikuti pelatihan portal Web PPTM, sedangkan pada kualitas surveilans diketahui 82,35% data tidak lengkap dan tidak tepat waktu.SimpulanPerlu penguatan pada penanggungjawab PTM Posbindu di puskesmas melalui sosialisasi legal aspek, pembuatan format sederhana, pelatihan analisis dan interpretasi data serta pelatihan portal Web PPTM untuk meningkatkan kualitas sistem pelaporan PTM.Latar Belakang: WHO mencatat 36 juta jiwa pertahun (63%) penyebab kematian didunia adalah penyakit tidak menular (PTM). Riset Kesehatan Dasar 2007 dan 2013 menunjukkan 61% dari total kematian karena PTM. Profil Kabupaten Sleman tahun 2017 tercatat penyakit hipertensi mencapai 83.000 kasus dan Diabetes Mellitus 33.987 kasus. Tujuan evaluasi untuk melihat pelaksanaan sistem surveilans faktor risiko penyakit tidak menular (FR-PTM) berbasis Pos Pembinaan Terpadu (Posbindu) di Kabupaten Sleman tahun 2017. Metode: Desain penelitian adalah observasional. Dilaksanakan Januari-Februari 2018. Responden adalah penanggungjawab surveilans PTM Posbindu di 17 puskesmas. Teknik pengambilan sampel menggunakan purposive sampling. Evaluasi sistem surveilans terkait struktur sistem, fungsi inti, fungsi pendukung dan kualitas surveilans berdasarkan pedoman WHO. Instrumen menggunakan kuesioner terstruktur. Analisis data dilakukan secara deskriptif. Hasil: 136 posbindu yang tersebar di 17 puskesmas dan yang aktif melapor 95 posbindu. Dari struktur sistem menunjukkan 82,38% belum mengetahui tentang legal aspek pelaksanaan sistem surveilan PTM. Pada segi fungsi inti diketahui 76,47% deteksi kasus masih dilakukan oleh kader dengan supervisi dokter karena keterbatasan tenaga. Sebanyak 82,35% tidak dapat melakukan analisis dan interpretasi data FR-PTM. Dari fungsi dukungan sebanyak 23,53 responden belum mengikuti pelatihan portal Web PPTM, sedangkan pada kualitas surveilans diketahui 82,35% data tidak lengkap dan tidak tepat waktu. Kesimpulan: Perlu penguatan pada penanggungjawab PTM Posbindu di puskesmas melalui sosialisasi legal aspek, pembuatan format sederhana, pelatihan analisis dan interpretasi data serta pelatihan portal Web PPTM untuk meningkatkan kualitas sistem pelaporan PTM.
Pengaruh jaminan kesehatan terhadap pemanfaatan pelayanan kesehatan primer di perkotaan Indonesia: adilkah bagi masyarakat miskin?
Get PDFTujuan: Studi ini memberikan gambaran pengaruh jaminan kesehatan terhadap pemanfaatan pelayanan kesehatan primer perkotaan di Indonesia. Metode: Penelitian ini menganalisis data (IFLS 5) dengan rancangan penelitian cross sectional menggunakan uji regresi logistik. Sampel penelitian adalah penduduk kota di 13 provinsi Indonesia yang berusia 15 tahun ke atas. Hasil: Total responden yang didapat sebesar 2.563 responden, 35% responden menggunakan pelayanan kesehatan pemerintah. 39,72% responden belum memiliki jaminan kesehatan. Jaminan kesehtatan mempunyai pengaruh terhadap pemanfaatan pelayanan kesehatan (p<0,05). Simpulan: Perlu adanya kebijakan untuk meningkatkan pemanfaatan pelayanan kesehatan milik pemerintah sebagai fasilitas kesehatan propoor dan meningkatkan cakupan jaminan kesehatan yang berkeadilan ke seluruh masyarakat khususnya masyarakat miskin
Strategic purchasing dalam menjaga sustainabilitas JKN
Get PDFMasalah yang dihadapi BPJSK saat ini adalah kepesertaan yang belum maksimal, kepuasan pasien terhadap pelayanan yang tidak sesuai harapan, dana kurang, dan potential fraud yang semakin meningkat. KPK menyebutkan 30% dari dana JKN (Rp 67 T) yaitu Rp 20 T berpotensi fraud yang mana dana tersebut dapat menutupi defisit dana JKN sebesar Rp 9 T. Oleh karena itu, peran BPJSK sebagai purchaser perlu didorong agar dapat berfungsi dengan baik untuk meningkatkan kualitas dan efisiensi. Dalam konsep strategic purchasing yang harus dipertimbangkan purchaser adalah pelayanan apa yang akan dibeli (benefit); terjadinya conflict of interest dikarenakan adanya regulasi yang menyatakan bahwa semua fasilitas kesehatan pemerintah harus bekerjasama dengan BPJSK sedangkan regulasi lain menyebutkan bahwa faskes yang bekerjasama dengan BPJSK harus memenuhi standar dan terakreditasi sementara hanya ±70% yang memenuhi credentialing dan sebagian besar berada di Pulau Jawa; serta penentuan bagaimana pelayanan akan dibeli baik benefit, provider, dan cara belinya. Evaluasi mengenai apakah benefit JKN yang unlimited sudah sesuai dengan kondisi Indonesia sangat diperlukan. Puskesmas harus setara dalam menjalankan fungsinya sebagai UKM dan UKP, jika puskesmas hanya memprioritaskan kuratif, maka akan mempengaruhi sustainabilitas JKN. Sekitar 80-83% dana JKN yang digunakan untuk kuratif di RS, sehingga perlu dilihat lagi fungsi gate-keeper. Perlu ada peraturan yang memberi kewenangan dinas kesehatan untuk melakukan monev misalnya 1% saja dari dana JKN yang digunakan untuk monev, oleh karena itu perlu ada kontrol dari pihak ketiga yang dapat menilai kinerja purchaser. Dalam pelaksanaan JKN penting adanya equity terhadap akses dan utility sehingga dibutuhkan kolaborasi antara pemerintah pusat dan daerah untuk membangun infrastruktur. Diperlukan juga peningkatan akuntabilitas dan transparansi purchaser dengan membuat data yang dapat diakses oleh masyarakat dan pemangku kepentingan, penguatan pengendalian mutu pelayanan kesehatan dan pencegahan kecurangan untuk sistem pemantauan JKN dan BPJS
Evaluation of the completeness and timeliness nutrition surveillance data reporting in Wonogiri district, Central Java province, 2017
Get PDFSome of the nutrition problems still found in Wonogiri district. To solve that problems, completeness, and timeliness of the nutrition surveillance data reporting are needed so the data can be used as the basis for making policy appropriately. Evaluation of nutrition surveillance system was conducted to find out completeness and timeliness of the nutrition surveillance data reporting. This was an evaluative study using quantitative descriptive analysis which conducted from December 2017 to January 2018. Subjects of this study were nutritionists in District Health Office and 25 Primary Health Care (PHC) which selected randomly using Slovin samples size. Data collected by interviews and observation on surveillance data reporting form. PHC that reported complete data were 6 PHC (24%). One PHC (4%) did not report malnutrition data due to poor of time management. Ten Puskesmas (40%) did not report Hemoglobin data because they assumed that it was the duty of the laboratory officer or midwife. Three PHC (12%) did not report exclusive breastfeeding data every month, because they consider that the data should be collected only once every six months. Nine PHC (36%) did not report goiter data because they considered that it was no need to report if no cases. Most PHC (52%), never report the data timely. Most nutritionists (84%) had another duty that inhibits them to finish the surveillance data timely. Only two PHC (8%) whom the nutritionists had another duty but always report the data timely. Completeness and timeliness of the nutrition surveillance data reporting were still unsatisfying. PHC should be encouraged to collect data completely and timely. The data collection procedure should be fixed on the indicator collected and the time period in the data collection
Sosial determinan kesehatan kasus HIV/AIDS pada pegawai negeri sipil di kabupaten Nunukan tahun 2017
Get PDFBerdasarkan laporan kasus HIV/AIDS Dinas Kesehatan Kab. Nunukan di Provinsi Kalimantan Utara mencatat bahwa ada penemuan kasus baru sebanyak 12 kasus di sepanjang tahun 2016. Angka ini meningkat dari tahun sebelumnya yang berjumlah 10 kasus pada tahun 2015. Dari seluruh penderita yang dimaksud, teridentifikasi ada yang berprofesi sebagai PNS (Pegawai Negeri Sipil), 12 persennya PNS. Mereka yang tertular penyakit tersebut rata-rata ibu rumah tangga dan kepala rumah tangga, yang berusia produktif. Peningkatan kasus HIV/AIDS justru dari kalangan masyarakat umum sedangkan dari tempat lokalisasi, Dinas Kesehatan Kab. Nunukan tak menjumpai adanya peningkatan. Bahkan kasusnya ditemukan di pedesaan jauh seperti di Krayan, Kab.Nunukan, Provinsi Kalimantan Utara. Tujuan penelitian ini adalah untuk mengeksplorasi sosial determinan kesehatan kasus HIV/AIDS pada pegawai negeri sipil di kabupaten Nunukan tahun 2017. Penelitian ini dilakukan dengan pendekatan kualitatif dengan melakukan wawancara mendalam. Informan yang diwawancarai diantaranya adalah peneliti HIV/AIDS, penanggung jawab program KPAI serta dosen bidang promosi kesehatan. Instrumen yang digunakan diantaranya panduan wawancara mendalam dan dilengkapi dengan alat perekam suara. Hasil yang didapat adalah adanya pengetahuan masyarakat yang minim akan HIV/AIDS memunculkan stigma yang terbentuk di masyarakat, adanya akses ke pelayanan “plus-plus” meskipun berada di daerah terisolir, adanya dominan penyebab kasus HIV/AIDS pada PNS adalah akibat gonta ganti pasangan. Hal ini tidak terlepas dari perilaku seksual. Rata-rata penderita HIV/AIDS berada di usia produktif. Dibutuhkan kerjasama dengan stakeholder terkait untuk melaksanakan program penanggulangan kasus HIV/AIDS. Fungsi pengawasan dan penindakan juga harus ditingkatkan dalam hal pelaksanaan kebijakan program HIV/AIDS