Indonesian Journal of Health Administration (Jurnal Administrasi Kesehatan Indonesia)

Back Matter

Redaksi — 2024-12-17

BUILDING RESILIENT HEALTH SYSTEMS: THE CRITICAL ROLE OF PRIMARY HEALTH CARE AND NATIONAL HEALTH INSURANCE

Ernawaty — 2024-12-17

This editorial article explores the critical role of primary health care (PHC) in building resilient health systems, particularly within the context of Indonesia's National Health Insurance (JKN) program. It emphasizes the importance of universal access to comprehensive health services as a fundamental aspect of effective PHC. The discussion highlights best practices for strengthening PHC, including enhancing collaboration between public and private sectors, improving information exchange, and establishing quality evaluation systems. The article also addresses significant challenges, such as workforce shortages and coordination issues between primary and secondary health services. Furthermore, it underscores the necessity of developing suitable assessment tools, such as the Primary Care Assessment Tool (PCAT), to evaluate and enhance PHC services tailored to local needs. The findings suggest that addressing poverty is essential for improving access to health care, requiring collaborative efforts across various societal sectors. Overall, the article advocates for sustained investment in PHC to achieve better health outcomes and resilience in health systems.

Keywords: Health Insurance, Health System, Primary Health Care

Front Matter

Redaksi — 2024-12-17

RECOMMENDATIONS TO IMPROVE EMPLOYEE PERSONAL ATTITUDE TOWARD REPORTING PATIENT SAFETY INCIDENTS

Purwo Andari — 2024-12-02

Background: Patient Safety Incidents (PSI) in hospitals are adverse events that need to be reported for effective identification and risk management, aiming to prevent reoccurrence of incidents. However, not all incidents are documented, as evidenced by the discrepancy in the number of phlebitis reported by employees as well as Infection IPCLN at three hospitals.

Aims: Provide recommendations to improve employee Personal Attitude towards reporting PSI at three hospitals owned by Company A.

Methods: The method adopted was a cross-sectional research design; data were collected from three hospitals owned by company A and tested using multiple logistic regression statistics tests. Data on Phlebitis reported from January to July 2018 at three hospitals owned by Company A was used. Furthermore,135 respondents were taken from the service installations of the three hospitals. The Lameshow formula and proportional random sampling are applied to determine the sample.

Results: The variables of error orientation (p = 0.001; β = 0.349), behavioral belief (p = 0.008; β = 0.234), and perceived behavioral control (p = 0.003; β = 0.222) had a positive and significant effect on the personal attitude of employees reporting PSI.

Conclusion: Two approaches were recommended to improve the personal attitude of employees in reporting PSI.

Keywords: Hospital, Patient safety incidents, Personal attitude, Underreporting

POVERTY LEVELS MUST BE REDUCED TO IMPROVE ACCESSIBILITY TO HEALTH SERVICES

Desri Yesi — 2024-12-03

Background: Access to health services is a fundamental right for every citizen, but its equitable distribution remains challenging due to the influence of several variables. Indonesia has achieved Universal Health Coverage (UHC), but access to health services for those with health problems is still low.

Aims: This study aims to determine the variables influencing access to health services in Indonesia.

Methods: Longitudinal analysis of panel data was used, and the dataset was taken from the 34 provinces of Indonesia from 2018 to 2022. The data obtained were then analyzed descriptively and analytically by linear regression using STATA software.

Results: Individual and family variables influencing access to health services for the population with health problems included variable need (health problem), ownership of health insurance, and ability to pay. Furthermore, the results showed that the number of areas with high poverty rates (socioeconomic) was a contextual factor with a higher level of influence.

Conclusion: Based on the results, policies to improve access to health services, a basic human right, could not be solely achieved by the health sector. Therefore, integrated comprehensive planning collaboration of Penta-Helical elements was needed to reduce poverty enclaves.

Keywords: ability to pay, access to health services, health insurance, poverty

RELATIONSHIP OF SERVICE RECOVERY TOWARDS PATIENT SATISFACTION IN HOSPITAL IN WEST SUMATERA

Rima Semiarty — 2024-12-03

Background: Patient satisfaction in the M. Djamil Hospital was recorded as 79.61% between January and March 2018. It signifies that patient satisfaction rate has not met the target set of 85%.

Aims: This study aims to determine the frequency distribution of service recovery patients, patient satisfaction, and the relationship between services and service recovery patient satisfaction to improve service recovery.

Methods: The authors used a cross-sectional research design. The sample was inpatients at RSUP M. Djamil in total of 424 people. The sampling technique was consecutive sampling. The data were collected using the Importance Performance Analysis questionnaire. Data were analyzed using unpaired t-tests and multiple linear regression.

Results: The results of the service recovery (distributive justice, procedure justice, interactive justice, reputation justice) has a significant relationship (p-value <0.05) with patient satisfaction. Interactive justice has the strongest relationship with appropriate patient satisfaction and has the greatest Beta value (0,254). Patient satisfaction has a significant relationship (p-value <0.05) with Word of Mouth.

Conclusion: RSUP M. Djamil needs to emphasize interactions and justice, especially in providing clear information about medical actions to the patient's family, serving patients politely and friendly, and providing solutions to patients if there are service complaints.

Keywords: Hospitalization, Satisfaction, Service Recovery

USER ACCEPTANCE OF MOBILE-JKN: INSIGHTS FROM THE TECHNOLOGY ACCEPTANCE MODEL

Ferina Septiani Damanik — 2024-12-05

Background: Technological advancements in healthcare have driven BPJS Kesehatan Indonesia to develop the Mobile JKN application to enhance accessibility, efficiency, and quality of services. Despite its potential benefits, the implementation of this application faces various challenges, such as application errors, differing levels of digital literacy, and data security issues, necessitating an evaluation of its adoption and acceptance.

Aims: To analyse the public acceptance of Mobile JKN based on the Technology Acceptance Model (TAM) variable while also exploring user experiences towards the application.

Methods: A descriptive-analytical approach with a cross-sectional design. Data were collected through a questionnaire developed based on the TAM model, involving 406 respondents across Indonesia. Data analysis was performed using a regression linear test with SPSS after all basic assumptions were met.

Results: Perceived Ease of Use, Perceived Usefulness, and Attitude Toward Use individually and simultaneously impact Actual System Use (Sig. 0.000; R-Square 0.827). Respondents generally answered “Agree” to all TAM indicators, with mean scores of 4.20 for Perceived Usefulness, 4.16 for Perceived Ease of Use, 4.25 for Attitude Toward Use, and 4.33 for Actual System Use. Most users accessed the app through self-access (48%), frequently used features were membership information (28%), and encountered issues such as application errors (25%).

Conclusion: The app was deemed relevant, accurate, easy to use, and beneficial. To enhance public acceptance, BPJS Kesehatan should focus on developing a user-friendly Mobile JKN app by incorporating key TAM factors, optimizing popular features, improving technical stability, and regularly addressing user feedback to ensure effective health administration and service delivery.

Keywords: Adoption, Application, BPJS Kesehatan, Mobile JKN, TAM

PERCEPTIONS AND THEIR CORRELATION WITH ENROLLMENT IN THE INDONESIAN NATIONAL HEALTH INSURANCE SCHEME

Asmaripa Ainy — 2024-12-09

Background: Health insurance serves as a key mechanism in facilitating wider and more equitable availability of healthcare services, ensuring that every individual can access the services they need.

Aims: This research aims to examine the correlation between community perceptions and enrollment in the National Health Insurance (JKN) in the Musi Rawas Utara District, Indonesia.

Methods: This research applied a cross-sectional study by collecting data from 384 respondents. Logistic regression analysis was used to assess the correlation between perceptions and JKN enrollment.

Results: The results showed that 68.49% of respondents were not enrolled in the JKN. Factors associated with JKN enrollment include perceptions regarding JKN, income, and the history of illness. People with favorable perceptions have a 1.90 times higher chance to join the JKN membership. People with income ≥ provincial minimum wage (UMR) have an opportunity of 0.50 times higher than people with income < UMR to join the JKN membership. The history of illness is likely to enhance JKN enrollment by 7.86 times.

Conclusion: In the Musi Rawas Utara District, the rate of enrollment in the JKN program remains low. Strategic policy reforms, accompanied by targeted advocacy and health education promotion, have the potential to significantly increase JKN enrollment and contribute to the realization and sustainability of universal health coverage (UHC) goals.

Keywords: Perception, Enrollment, National Health Insurance

DETERMINE THE POLICY TARGET TO INCREASE INSTITUTIONAL DELIVERY AMONG INDONESIAN FEMALE WORKERS

Isyatun Mardhiyah Syahri — 2024-12-10

Introduction: Indonesia continues to face a significant challenge in terms of maternal and infant mortality. The government is working to promote the use of health facilities for childbirth to mitigate maternal mortality.

Aim: The study aims to determine the policy target to increase the rate of institutional delivery among female workers in Indonesia.

Methods: The study analyzed secondary data from the 2023 Indonesian Health Survey. It conducted cross-sectional research on 30,173 female workers. In addition to institutional delivery as the dependent variable, we examined eight independent variables: residence, age, education, marital status, wealth, insurance, antenatal care (ANC), and parity. The analysis involved bivariate method followed by binary logistic regression in the last stage.

Results: Approximately 70.6% of female workers had institutional delivery. Female workers in urban areas were 1.157 times more likely than rural workers to perform institutional delivery (95%CI 1.153-1.161). Three worker characteristics (age, education, and marital status) were related to institutional delivery. Wealthier workers had a greater the possibility of executing institutional delivery. Insured workers were more likely than the uninsured ones to deliver in health facilities. Female workers with adequate ANC were 1.210 times more likely than those with inadequate ANC to execute institutional delivery (95%CI 1.166-1.256). Additionally, women with fewer childbirths had a higher probability of performing an institutional delivery.

Conclusion: The policy target to increase institutional delivery was women workers in rural areas who were older, had poor education, were divorced/widowed, were the poorest, had inadequate ANC, were uninsured, and were grand multiparous.

Keywords: institutional delivery, institutional birth, maternal health, female worker, public health.

THE COST OF SMS REMINDER TO IMPROVE ARV ADHERENCE AMONG KEY POPULATIONS

Mery Nurma Juwita — 2024-12-10

Background: HATI is an implementation trial aimed at improving HIV care and treatment, including through SMS reminders.

Aims: This study aimed to estimate the cost and analyze the outcomes of providing SMS Reminders within the HATI program in different settings.

Methods: Data were analyzed using a micro-costing approach from providers' and health systems' perspectives. Subjects were divided into intervention and control groups for outcome analysis, with adherence as the outcome indicator.

Results: From a provider's perspective, the highest cost was incurred in primary health care (PHC) clinics, while the lowest was in hospital clinics, most likely due to a much higher volume of SMS sent from hospitals. Costs from the health system perspective were more than two times higher than those from the provider perspective, as they included costs borne by HATI management and intervention setup. In one year, the number of patients with >95% adherent visits was higher in the intervention group than the control group, although visits decreased over time in both groups. The highest number of patients with >95% adherent visits was found in PHC clinics, while the lowest was in hospital clinics.

Conclusion: SMS reminders can be expensive initially due to setup and program costs. However, they become cheaper once they are embedded into the existing system. Further studies are necessary to determine better site options for scaling up SMS reminder intervention and to study the declining adherence rate in all clinics.

Keywords: Adherence, cost analysis, HIV, Indonesia, SMS reminder

BARRIER OF REFERRAL–BACK IN SECONDARY HEALTH FACILITIES: PROVIDER AND PATIENT PERSPECTIVES

Putu Cindy Elisya Intan Larasati — 2024-12-10

Background: The referral-back program (RBP) is a program for chronic outpatient patients at hospitals to return to access services at first-level health facilities (Primary Healthcare Centers/ PHC) once their condition has been declared stable by the doctor. However, data indicate that many hospitals and clinics in Denpasar City have not met the RBP target.

Aims: This study aimed to explore the implementation of RBP and the challenges faced by providers and patients.

Methods: Conducted in March 2023, this study used a qualitative approach with in-depth interviews. The sample was determined purposively, consisting of 13 informants. The data were analyzed using the thematic method.

Results: From the provider's perspective, issues included low commitment of medical staff, lack of coordination between the hospital and PHC, limited supply of RBP drugs at the PHC, absence of Standard Operating Procedures (SOPs), and ignorance of notifications regarding potential RBP patients. Moreover, from the patient's perspective, challenges included low patient knowledge about RBP, proximity of the patient's house to the hospital so that patients tend to visit the hospital, difficulty in obtaining RBP drugs at PHC, and ineffective procedures.

Conclusion: To overcome these obstacles, coordination, and improvement of RBP are needed through the preparation of SOPs and determination of RBP patient criteria.

Keywords: barrier, implementation, referral-back program

ANALYSIS OF PUBLIC SAFETY CENTER 119 AMBULANCE SERVICES USING LEAN SIX SIGMA

Thasya Sabilla Putri Rojak — 2024-12-12

Background: DKI Jakarta reports about 5,000 annual deaths from heart disease, disasters, accidents, and other causes. Ambulance demand has risen, especially for COVID-19 cases that require quick medical attention. In 2022, the average emergency response time was 21-30 minutes. Therefore, efforts are needed to improve the response time of PSC 119 ambulances to minimize impacts.

Aims: This study uses the Lean Six Sigma methodology to analyze the factors contributing to prolonged response times in emergency ambulance services.

Methods: This study used a mixed-method approach based on the DMAI (define, measure, analyze, and improve). The data were collected through observations, document reviews, and in-depth interviews.

Results: The results showed that the average duration of ambulance services was 4 hours and 30 minutes. The identified inefficiencies include software issues with the Nusantara app, staff fatigue, and license renewals, difficult access for ambulance and URC units, delays from call center staff awaiting family decisions, closely located posts leading to fewer cases per post, community-initiated patient movements, challenges in finding suitable referral hospitals for special cases, and slow response times from referral hospitals.

Conclusion: The recommended improvements include using a kaizen board, conducting expert training, promoting the Integrated Referral System or Sistem Informasi Rujukan Terintegrasi (SISRUTE), and revising standard operating procedures.

Keywords: ambulance services, Public Safety Center 119, Lean Six Sigma

POLICY IMPLEMENTATION TO ACCELERATE STUNTING REDUCTION: A QUALITATIVE STUDY

Demsa Simbolon — 2024-12-17

Background: The prevalence of stunting in Kepahyang Regency in Bengkulu Province is high (24.9%). Despite the policy of Accelerating Stunting Reduction or Percepatan Penurunan Stunting (PPS) outlined in Presidential Decree Number 72 of 2021, results have been suboptimal.

Aims: This study aims to analyze and evaluate the implementation of PPS policies and identify supporting and inhibiting factors.

Methods: Research using a qualitative approach, focusing on the evaluation of achievements of 11 specific nutrition intervention indicators with policy implementation analysis using the strengthening of Edward III policy analysis. Data collection used in-depth interview guidelines with six stakeholders, focus group discussions (FGD) in two groups, and document observation. Informants are selected by purposive sampling. Data analysis uses content analysis.

Results: The implementation of PPS in Kepahyang Regency faces communication problems, limited resources, complex bureaucratic structures, and inadequate supervision, which shows the need for increased coordination and support. Village government support and good social conditions are supporting factors, while lack of communication between the village government and the community and minimal budget support are the main obstacles.

Conclusion: Communication issues, resource limitations, bureaucratic complexity, and inadequate supervision are the inhibiting factors. Strong support from local government and health workers is the supporting factor.

Keywords: implementation, policy, specific nutrition interventions, stunting

MEMBERSHIP IN NATIONAL HEALTH INSURANCE AMONG WORKERS IN INDONESIA

Ratna Dwi Wulandari — 2024-12-17

Background: The government regulates National Health Insurance (NHI), making it mandatory for everyone. However, at this time, only some, including workers, are NHI members. Moreover, the government regulates who pays these workers' premiums.

Aims: The study aimed to analyze the disparities of occupation type in NHI membership among workers in Indonesia.

Methods: We involved 22,275 workers in the analysis. The analyzed variables included NHI's membership, occupation type, residence type, age group, gender, education level, marital status, and wealth status. The study employed binary logistic regression in the final step.

Results: The results showed that government employees were 11.864 times more likely to be a member of NHI than the informal sector (95%CI 11.811-11.917). The private sector was 1.646 times more likely than the informal sector to be an NHI member (95%CI 1.643-1.648). Meanwhile, entrepreneurs were 0.828 times less likely to be NHI members than the informal sector (95%CI 0.827-0.829). The study found six control variables related to NHI membership: residence, age, gender, education, marital, and wealth status.

Conclusion: The study concluded that NHI membership disparities existed based on occupation type. Accordingly, government employees, the private sector, the informal sector, and entrepreneurs are the most likely to become NHI members.

Keywords: health insurance, health policy, national health insurance, occupation type.

AN EXAMINATION OF THE IMPLEMENTATION OF INTERNET OF THINGS IN HEALTHCARE UTILIZING SMARTWATCHES

Fatemeh Sadeghi Boshrabadi — 2024-12-01

Background: Smartwatches can use sensors to collect and send data to medical teams and family members through the platform of the Internet of things (IoT). The data are first analysed on the platform and the final results are used by the medical team.

Aims: This paper reviews and categorises studies conducted in the field of the Internet of things based on smartwatches.

Methods: The covered papers have been published over 13 years from 2010 to 2022. The search yielded 227 papers out of which 43 papers were reviewed after screening. The search keywords were “wearables, internet of things, smartwatches, smart bracelet, healthcare, and disease”. The search covered databases including PubMed, ScienceDirect, and IEEE.

Results: Smartwatches are used in three fields of healthcare, including palliative care, speech therapy, diagnosis, disease prevention, rehabilitation, and health improvement.

Conclusion: Smartwatches are not free of drawbacks and have not received the attention they deserve in the healthcare field. Given the potential of smartwatches, they can be useful in the health sector.

Keywords: Disease, IOT, Smartwatch, Wearable

ENHANCEMENT OF PRIMARY CARE ASSESSMENT TOOL (PCAT): A SCOPING REVIEW

Dewi Surya Ningsih — 2024-12-04

Background: Strengthening the quality of primary health care is one way to improve public health. For this reason, an appropriate primary care assessment tool (PCAT) is necessary to evaluate and improve primary health care.

Objective: This study aims to provide an overview of the development of primary care assessment tools.

Methods: The study was conducted through a scoping review of articles written in English that were published in the PubMed, Scopus, Science Direct, and Semantic Scholar databases from 2010 to 2023.

Results: A total of 10 selected articles describe the development of primary care assessment tools, namely PCAT Malawi, Vietnam PCAT-PE, Vietnam PCAT-AE, CR-PCAT (China), PCAT-TI (Tibet), UG-PCAT (Uganda), PCAT-C (China), PCAT-Facility (Spain), KS-PCAT (Standard Korean), PCAT-10 (Spain), and Colombia PCAT. Each tool has a different development focus according to the context of each country.

Conclusion: This study provides an overview of the development of PCAT. In general, the development of PCAT in each country demonstrates different characteristics. The selection of a health service assessment tool must align with the needs of the element or aspect to develop.

Keywords: primary care assessment tool, PCAT development, primary health care assessment, PCAT modification.

IMPLEMENTATION OF PRIMARY HEALTH CARE SYSTEM IN COUNTRIES

Memo Lukito — 2024-12-04

Background: Primary Health Care (PHC) systems are essential for delivering comprehensive and accessible health services globally, focusing on individuals’ and communities’ fundamental health and well-being.

Aims: To assess PHC systems to ensure universal access, regardless of socio-economic status or location, by providing comprehensive services such as illness prevention, treatment, rehabilitation, support, and health promotion.

Methods: This study utilised the PICO framework, with methods and results of this systematic review based on PRISMA guidelines. Articles were identified through an initial generic search in PubMed, ScienceDirect, and Scopus databases.

Results: After the assessment, a total of 18 articles were selected. The following priorities for PHC policy implementation emerged: enhancing collaboration between public and private sectors, improving information sharing through technology and health literacy, establishing quality evaluation systems, and promoting community-based training programs. Identified challenges include workforce shortages, particularly in rural areas, and inadequate coordination between primary and secondary care. Addressing these challenges and focusing on these priorities can lead to better health outcomes and more effective PHC systems.

Conclusion: The Alma-Ata Declaration of 1978 was a transformative milestone in global health. It advocated for "Health for All" through Primary Health Care (PHC). Despite initial challenges, the principles of Alma-Ata have significantly influenced PHC systems worldwide.

Keywords: Country-specific health primary care, health care systems, primary healthcare

A SCOPING REVIEW OF MHEALTH TECHNOLOGIES FOR PATIENTS UNDERGOING HAEMODIALYSIS

Sarah Amalia — 2024-12-06

Background: The prevalence of patients requiring haemodialysis increases annually, highlighting the need for improved quality of care. Haemodialysis care involves several key aspects, including monitoring, education, and patient connectivity. The availability of mobile health (mHealth) technology enhances the effectiveness and efficiency of patient monitoring compared to conventional methods, ultimately improving patients’ quality of life.

Aims: To map the development, types, and impact of mHealth technologies on patients undergoing haemodialysis.

Methods: We conducted a scoping review following the Arksey and O’Malley methodological framework. We searched PubMed, Scopus, ScienceDirect, Google Scholar, CINAHL, and Sage Journals to identify relevant studies describing integrated mobile health applications for monitoring patients with CKD undergoing haemodialysis. Two independent reviewers screened and categorised findings based on predefined synthesis questions. Eleven studies representing various mHealth technologies were included. The PRISMA-ScR guidelines for scoping reviews were followed to ensure comprehensive reporting of results.

Results: Out of 1,200 papers, 11 studies representing mHealth technologies were included. Most respondents were patients, though several articles also involved healthcare providers. We map our findings into three themes: the functionality of the applications, the types and features of mHealth technologies, and their impact.

Conclusion: mHealth can be implemented as web-based or application-based platforms, offering innovative solutions for monitoring, education, and enhanced connectivity between patients and healthcare providers.

Keywords: mHealth, haemodialysis, quality of life, monitoring, CKD