Indonesian Journal of Health Administration (Jurnal Administrasi Kesehatan Indonesia)

Front Matter

Redaksi — Sun, 30 Jun 2024 00:00:00 +0700

WHAT IS THE ROLE OF JOURNALISM IN THE POLITICAL ADVOCACY OF HEALTH POLICY IN INDONESIA?

Ilham Akhsanu Ridlo — Tue, 25 Jun 2024 00:00:00 +0700

In this short commentary article, the complex association between journalism, health policy, and political campaigning in Indonesia is explained, in need of more scholarly expansion. Within those limitations, the paper does alert to the necessary function journalism serves intrinsic to the public discourse that drives health policy recommendations, as well as noting how this has been perverted by misinformation and dwindling faith in the media. The article examines how journalism (including digital and social media) has shaped health policy advocacy and public opinion and highlights the role of the media in health communication campaigns and policy reform. Through scrutiny of its role in health policy advocacy, with a broader look at how journalism roles have shifted over time. In this article, the author demonstrated that journalism is a bridge between health policy experts and the public, enabling a more informed democratic engagement with health policy. These conclusions highlight the need to build a nexus between democratic journalism and health policy advocacy for public health priorities in Indonesia.

Keywords: health policy, journalism, political campaign

EDUCATION'S ROLE IN PRIMARY HEALTHCARE UTILIZATION AMONG OLDER PEOPLE IN INDONESIA

Agung Dwi Laksono, Ratna Dwi Wulandari, Zuardin Zuardin, Nikmatur Rohmah — Thu, 13 Jun 2024 00:00:00 +0700

Introduction: The current situation shows that life expectancy is increasing, so the population of older people is also growing. As a vulnerable group, more senior people desperately need primary health care, and barriers to accessing services will increase vulnerability.

Aim: The study aimed to investigate the impact of education on primary healthcare utilization among older people.

Methods: This cross-sectional study examined 52,893 older people. It employed primary healthcare utilization as an outcome variable and education level as an exposure variable. Furthermore, the study used eight control variables: residence type, age group, gender, marital status, wealth, time travel to primary healthcare, and health insurance. We employed binary logistic regression to examine the data.

Results: The study showed that older adults with primary education were 1.050 times more likely than those without to utilize primary healthcare (95% CI 1.046-1.054). Older people with secondary education were 0.643 times less likely to use primary healthcare than those without (95% CI 0.638-0.649). Older adults with secondary education were 0.378 times less likely than those without to use primary healthcare (95% CI 0.372-0.383). Furthermore, the study indicated that all control variables were significantly related to direct healthcare utilization.

Conclusion: The study concluded that education level influences primary healthcare utilization among older people in Indonesia.

Keywords: elderly people, education, primary healthcare, healthcare evaluation, healthcare access, public health

THE IMPLEMENTATION OF PATIENT SAFETY GOALS FOR PATIENTS' SATISFACTION IN THE HEMODIALYSIS UNIT

Dwi Ambarwati, Arlina Dewi — Sat, 15 Jun 2024 00:00:00 +0700

Background: Surveys on patient safety in dialysis units uncover a range of significant patient safety issues. Hemodialysis centers are particularly vulnerable to adverse events due to a number of risk factors, such as machine malfunctions, excessive blood loss, patient falls, prescription errors, and inadequate infection control procedures.

Aim: Analyze the problem of implementing patient safety goals and describe the patients' satisfaction with the implementation of patient safety goals.

Methods: This study employs a concurrent embedded methodology with a mixed-methods design, utilizing quantitative data to complement the qualitative data. Applying the focus group discussion (FGD) technique, questionnaires and observations of hemodialysis patients' satisfaction with implementing patient safety goals were utilized to complete the data collection.

Results: According to the patient satisfaction survey, two patients were worried that their dialyzer tubes had been mixed up, earning a negative score of 5.13%. 23.07% of patients had negative results on the infection prevention risk questionnaire; 3 patients (7.69%) only seldom cleaned their hands before starting dialysis, and 6 patients (15.38%) did not.

Conclusion: The implementation of patients' identification and the reduction of infection risk through hand hygiene have not been carried out consistently, concerning patient safety goals in the hemodialysis unit.

Keywords: hand hygiene, hemodialysis, patient safety goals, patients' satisfaction, patients' identification

ANALYSIS OF THE MARKET STRUCTURE OF HOSPITAL INDUSTRY IN INDONESIA

Fri, 14 Jun 2024 00:00:00 +0700

Background: Over the past decade, private investments in health care including hospital have grown significantly, more than doubling. As the number of hospitals in Indonesia increases, a competitive business environment develops. Identifying hospital market structure can help various stakeholders to optimize the hospital's performance.

Aims: This study analyzed the market structure and concentration of the hospital industry in Indonesia.

Methods: This study used hospital characteristics data from Ministry of Health of Indonesia that retrieved in October 2020. Market concentration is determined by the number of industry players operating in a market, the distribution of services, and the types of services offered. The hospital market concentration was identified by measuring the Concentration Ratio (CR) and the Herfindahl–Hirschman index (HHI).

Results: The results showed that the market share of hospitals in Indonesia was still dominated by government hospitals, which represent 51.4% of the market share. The concentration ratio of four companies (CR₄) remains <40, indicating that competition remains relatively open among private hospitals at the national level.

Conclusion: Several cities have established hospital markets that are characterized by robust competition, whereas in other cities, the hospital industry remains oligopolistic or monopolistic. It is important to note, however, that this does not imply that the market structure is ineffective on account of competition; rather, it is the result of a scarcity of hospitals in a number of Indonesian cities.

Keywords: Concentration ratio, Economic competition, Herfindahl–Hirschman Index, Hospital market

LEADERSHIP TRAITS OF NURSE MANAGERS AND NURSE STAFF COMMITMENT IN THE PHILIPPINES HOSPITALS

Paida P. Abdulmalik, Hamdoni Pangandaman — Tue, 25 Jun 2024 00:00:00 +0700

Background: Effective nurse leadership significantly influences healthcare service quality. Nurse managers' leadership impacts staff nurse commitment, patient outcomes, and organizational success.

Aims: To examine nurse manager leadership traits and their relationship with staff nurse commitment in a government hospital.

Methods: Descriptive-inferential correlation research with stratified and randomized nurse managers (n = 21) and staff nurses (n = 117) as participants from five selected hospitals at Lanao del Norte. Adopted questionnaires on leadership traits and commitment were used and data were analyzed using frequency, percentage, mean, and standard deviation in SPSS v.25.

Results: The result shows that nurse manager leadership qualities are usually valid for a leader who encourages others to do what is right, gives subordinates continuing education, and is an ethical and self-confident leader. Their staff nurses believed positive components of the leadership traits of nurse managers were sometimes true. Staff nurses were generally still deciding whether they were committed to their work effectively, continuously, or normatively. Nurse managers' leadership traits are significantly related to the staff nurses' affective, continuance, and normative commitment.

Conclusion: Fostering positive leadership through education and supportive environments enhances staff nurse commitment and job satisfaction, reducing nurse turnover and improving nursing care quality.

Keywords: commitment, leadership traits, leadership qualities, nurse manager, nurse staff

HEALTH FINANCING ANALYSIS OF MINIMUM SERVICE STANDARDS IN THE HEALTH SECTOR

Arie Risdiyanti, Hadi Paramu, Sunarto Sunarto — Thu, 20 Jun 2024 00:00:00 +0700

Background: This research focuses on health financing Minimum Service Standards (MSS) in the health sector in Lumajang Regency, Indonesia, spanning 2019 to 2022. Despite the government's emphasis on Health MSS, disparities in service access and health conditions persist across different regions.

Aims: The research aims to provide insights into the effectiveness of health financing, serving as a foundation for policy recommendations to enhance the efficiency and effectiveness of health fund allocation in Lumajang Regency.

Methods: The research employs a quantitative descriptive approach, utilizing DHA and CBA. The study also investigates the budget allocation for MSS Health services.

Results: The findings of the research reveal that the realization of Local Original Revenue (LOR) in the Health sector tends to fall below targets. Non-Physical DAK dominate the funding sources in Community Health Centers (Puskesmas). Maternal health services receive the highest MSS Health budget allocation, but the spending proportion relative to total health expenditure is decreasing.

Conclusion: The research underscores the importance of addressing disparities in health financing and service access in Lumajang Regency. Recommendations include the diversification of funding sources, optimization of financing at the Puskesmas level, and a reevaluation of the budget allocation for maternal health services.

Keywords: CBA, DHA, health financing analysis, minimum service standards

THE EFFECTS OF SOCIAL ASSISTANCE PROGRAMS ON STUNTING PREVALENCE RATES IN INDONESIA

Siti Munawaroh, Moh Najikhul Fajri, Shochrul Rohmatul Ajija — Wed, 26 Jun 2024 00:00:00 +0700

Background: Social assistance, such as Non-Cash Food Assistance (BPNT) and the Family Hope Program (PKH), is among the instruments used to eradicate stunting in the short and long term. Therefore, it is important to ensure that individuals effectively use it.

Aims: This study aimed to review the effect of social assistance on stunting prevalence rates in Indonesia.

Methods: This research employs a quantitative approach, utilizing numerical measurements and statistical analysis. The data is secondary and sourced from the Central Bureau of Statistics and the Ministry of Finance. The specific method applied is the generalized method of moments (GMM) dynamic panel regression. The research sample encompasses panel data from 34 provinces from 2015 to 2021. This study utilizes the indicator of very short height for children less than five years of age as a proxy for stunting. Furthermore, low height in children is adopted as a measure of stunting. Furthermore, this study adopted a measure of low height in children to indicate stunting.

Results: The results showed that social assistance negatively affected stunting, supported by various other indicators such as the proportion of proper sanitation, the average length of schooling, protein consumption, and drinking water sources. Meanwhile, excessive calorie consumption increases stunting in a certain period.

Conclusion: In this condition, government social assistance was urgently needed since access to the lowest decile households increased stunting rates. The practical implications for policy derived from these findings involve optimizing the efficiency of social assistance initiatives, emphasizing the significance of addressing environmental factors in programs aimed at preventing stunting, integrating health and nutrition initiatives, and implementing educational campaigns within communities to raise awareness about calorie consumption.

Keywords: child health, social assistance, stunting, toddlers

ANTI-SMOKING MESSAGES VERSUS PRO-SMOKING MESSAGES AMONG INDONESIAN ADOLESCENT SMOKERS

Sun, 23 Jun 2024 00:00:00 +0700

Background: Anti-smoking messages (ASM) is a program designed to educate the public about the dangers of tobacco use, aiming to prevent adolescents and young people from smoking cigarettes in any form and to assist smokers in giving up their smoking habit. On the contrary, pro-smoking messages (PSM) is a marketing technique to promote tobacco products.

Aims: This study was conducted to describe the exposure to ASM and PSM among Indonesian adolescent smokers (IAS).

Methods: This study analyzed secondary data from the 2019 Global Youth Tobacco Survey (GYTS) Indonesia. The outcome variable was the respondent's smoking intensity in the last 30 days. The independent variables were the exposure to ASM and PSM in the various below-the-line media.

Results: Most IAS were male (93.4%), mostly in secondary school (60.3%) and spent more than IDR 11,000 per week (71.1%). Adolescent smokers were exposed to ASM at a rate of 92.4%. Furthermore, ASM exposure happened to 60.5% of the low-intensity youth smoker group and 39.5% of the high-intensity youth smoker group. Meanwhile, 93% of adolescent smokers were exposed to PSM, with 40.8% in the high-intensity youth smoker group and 59.2% in the low-intensity youth smoker group.

Conclusion: The exposure to ASM and PSM in the adolescent smoker group was relatively the same.

Keywords: ASM, PSM, prevention, public health, tobacco control, youth

EFFECTIVENESS OF TELEMEDICINE HEALTHCARE SERVICES IN RURAL AREAS OF BANGLADESH: A STUDY ON SELECTED VILLAGES

Md. Mafizur Rahman, Md. Arifur Rahman — Wed, 26 Jun 2024 00:00:00 +0700

Background: Bangladesh's healthcare system faces challenges in providing equitable access and quality healthcare to rural and remote communities compared to urban areas. To address these issues, the country has incorporated telemedicine into its healthcare system.

Aims: This study aimed to assess the effectiveness of telemedicine services in rural Bangladesh.

Methods: The study employed a mixed-method approach, including survey questionnaires and in-depth interviews. 100 participants were selected for the questionnaire survey for quantitative data, and 20 in-depth interviews were conducted to collect qualitative data.

Results: The findings indicate that telemedicine has garnered a positive reception among rural residents. An overwhelming 86% regarded telemedicine as a cost-effective healthcare option. 44% reported accessing telemedicine services within 10 minutes, demonstrating their accessibility. Furthermore, a majority (54%) expressed satisfaction with telemedicine services. However, dissatisfaction was noted concerning the physical environment of the telemedicine centers.

Conclusion: Overall, telemedicine in Bangladesh has proven effective in cost savings and time efficiency and has gained significant acceptance among rural residents. To further improve healthcare accessibility, expanding telemedicine centers to reach every remote union in Bangladesh is imperative. Additionally, raising awareness, providing ICT and telemedicine education, and ensuring affordable and reliable internet connectivity will maximize the potential of telemedicine services, ultimately benefiting underprivileged rural populations.

Keywords: healthcare, rural Bangladesh, telehealth, telemedicine

LYMPHATIC FILARIASIS DRUG TREATMENT POLICIES IN EASTERN INDONESIA: WHAT TARGET CHARACTERISTICS MATTER?

Tue, 25 Jun 2024 00:00:00 +0700

Background: Lymphatic filariasis (LF) drug treatment compliance remains a challenge in Eastern Indonesia.

Aims: The study sought to determine which aspects of Eastern Indonesia's LF drug treatment compliance policies were most pertinent.

Methods: The 2018 Indonesian Basic Health Survey data was employed. The analysis units were adults (â‰¥ 15 years) who had received LF drug treatment. LF drug treatment compliance was analyzed based on respondent characteristics (age, gender, marital status, education, occupation, wealth and comorbidities) using binary logistic regression.

Results: The proportion of adherence to LF treatment in Eastern Indonesia was 73.1%. Respondent characteristics that influenced LF treatment compliance were age group > 24 (aOR = 1.374, 95% CI: 1.305-1.447), female (aOR = 1.307, 95% CI: 1.263-1.353), all educated respondent status (aOR = 2.152, 95% CI: 2.043-2.268), and all employed respondents (aOR = 1.437, 95% CI: 1.365 - 1.512). Married respondents and those with all levels of wealth status were less likely to take LF drug treatment.

Conclusion: Policy focus on improving LF treatment compliance among the younger male, the less educated, the unemployed, and those with lower social economic status.

Keywords: compliance, Eastern Indonesia, lymphatic filariasis, public health

INPATIENT CARE UTILIZATION AFTER JKN: A STUDY CASE IN EAST NUSA TENGGARA

Aisyah Putri Rahvy, Ascobat Gani — Wed, 26 Jun 2024 00:00:00 +0700

Background: Healthcare utilization is a predictor of health status among the population. The issues of its accessibility and equity have been raised, particularly after the government launched JKN (Jaminan Kesehatan Nasional)

Aim: This study aims to analyze the determinants of inpatient care utilization in East Nusa Tenggara.

Method: We used SUSENAS 2019 dataset and carried out descriptive and econometrics analysis to covariates including age, gender, educational level, type of health insurance, employment status, and type of residence.

Result: We found that all covariates analyzed were statistically significant in affecting the probability of inpatient care utilization (p-value<0.005). Different patterns of sociodemographic factors among people in East Nusa Tenggara will affect their rate of inpatient care utilization.

Conclusion: Inpatient care utilization rate is crucial to measure health accessibility and prevent any aggravated morbidity due to delayed treatment. Strategies to increase inpatient care utilization are needed to provide accessible treatment for all and increasing population health status.

Keywords: East Nusa Tenggara, health utilization, hospitalization, inpatient care

COST-ANALYSIS OF REDUCING MORTALITY RATE FOR LBW BABIES AT FATMAWATI HOSPITAL'S NICU

Prasetya Rahman Salim, Nadia Dwi Insani, Estro Dariatno Sihaloho — Thu, 27 Jun 2024 00:00:00 +0700

Background: As a developing country that still struggles with infant mortality, Indonesia needs high-quality and efficient neonatal care. However, due to the complexity of neonatal care, the neonatal intensive care unit (NICU) still has a high cost, approximately USD 950 - 31,000, as the last line of care.

Aims: This study analyzes the cost incurred due to service improvement at Fatmawati General Hospital. The cost analysis may serve as useful evidence for other hospitals with NICUs that seek to improve their service.

Methods: We used cost analysis to examine pre-intervention costs in 2015 and post-intervention costs in 2021. Our data were gathered primarily in the NICU of Fatmawati General Hospital for three months in 2023.

Results: The results showed an increase in total cost of IDR 1,898,040,489 (55%). The largest cost increase was personnel and supplies costs, which accounted for 83.8% of the cost increase. However, this cost increase was also followed by a significant decrease in mortality rates, from 128 deaths per 1,000 births to 17 deaths per 1,000 births.

Conclusion: This study found a correlation between investment in service improvements and decreased infant mortality rates in the NICU of Fatmawati General Hospital. Although the 55% increase in total cost was associated with a significant decrease in infant mortality rates in the NICU of Fatmawati General Hospital, further studies are needed to determine the effectiveness of improvements in the NICU's services.

Keywords: cost, Indonesia, LBW, NICU

PROVISION OF LACTATION CLINIC IN COMPANIES IN SEMARANG CITY: A REVIEW OF POLICY IMPLEMENTATION

Jihan Nurul Qamariah Khalishah, Ayun Sriatmi, Rani Tiyas Budiyanti — Thu, 27 Jun 2024 00:00:00 +0700

Background: As of 2022, Semarang City has 4,083 companies. However, according to the Labor Office of Semarang City, only 109 out of 529 companies provide lactation clinics. In addition, based on previous research in Pedurungan, Semarang City, most of the women (83,3%) who work do not practice exclusive breastfeeding (EBF), one reason being the lack of lactation clinics in companies.

Aims: This study examines the implementation of lactation clinic policies in companies in Semarang City.

Methods: This study used a qualitative method with a descriptive approach. The research variables included effectiveness, consistency, relevance, organizational structure, resources, sociocultural environment, economic environment, organizational culture, geographic environment, knowledge and skills, communication, and political support. Informants were selected based on purposive criteria, involving eight key informants and 18 supporting informants from eight companies in Semarang City.

Results: Lactation clinic policies were ineffective because companies were unaware of their contents and perceived them as recommendations only. On the contrary, working mothers who breastfed recognized the benefits of the policies and considered them relevant. Three out of eight companies provided lactation clinics. The people in charge had yet to be appointed due to the different capacities of the companies. Due to a lack of support from the sociocultural environment, working mothers needed more awareness of the importance of breastfeeding. However, the companies' economic and geographic environments and organizational culture were relatively favorable. Meanwhile, adequate dissemination could have helped communication. In addition, most companies do not provide lactation clinics or recommend formula milk.

Conclusion: The current policies have not adequately supported the provision of lactation clinics in companies in Semarang City. To address this issue, lactation clinics should be classified according to the companies' capacities. It is also necessary to develop a leading sector that is transparent and responsible for supervising the provision of lactation clinics.

Keywords: exclusive breastfeeding in workplace, lactation clinic, policy implementation

HEALTH ADVERTISING ON INSTAGRAM: IS IT EFFECTIVE WHILE FOLLOWING ETHICAL GUIDELINES?

Anky Angga Alhudha, Winny Setyonugroho, Firman Pribadi — Thu, 27 Jun 2024 00:00:00 +0700

Background: Given the popularity of digital marketing in business today, every hospital can start utilizing it by establishing a social media account. Instagram is a social media platform that focuses on photographs. The AISAS (Attention, Interest, Search, Action, and Share) model can be used to assess the efficacy of marketing communications. Regardless, there are issues regarding legal and ethical issues. Therefore, a question emerges: How can health advertisements be effective while following ethical guidelines?

Aims: The purpose of this research is to analyze the content of healthcare advertisements on Instagram

Methods: This study uses the quantitative descriptive content analysis method. The samples are Instagram advertisements for health services. Search them using the hashtags (#) #dokterjogja, #klinikjogja, #klinikyogyakarta, and #rumahsakitjogja. Using convenience sampling, the researcher randomly scrolls and stops on Instagram. The data were assessed by two coders using a checklist to ensure objectivity. The checklist contains three indicators, in this case, the AIA (Attention, Interest, Action) indicator, and the other indicators were obtained from the Regulation of the Minister of Health of the Republic of Indonesia (PERMENKES) number 1787 of 2010

Results: The highest score of the AIA (Attention, Interest, Action) indicator is 12, and there are a total of 34 advertisements (coder 1), and 84 advertisements (coder 2) violate The Regulation of the Minister of Health (PERMENKES) No.1787/2010

Conclusion: This study finds that effective advertising is almost certain to violate the regulation. An educational health information advertisement that introduces the services provided is a good way to promote healthcare providers while remaining ethical.

Keywords: advertising, AISAS, ethics, health, social media

NAVIGATING BARRIERS: THE NEED FOR INTEGRATED HEALTH INFORMATION SYSTEM FOR TUBERCULOSIS-DIABETES CO-SCREENING

Fri, 28 Jun 2024 00:00:00 +0700

Background: Tuberculosis-diabetes mellitus (TB-DM) is a co-epidemic condition representing a double burden for high TB burden countries like Indonesia. Private primary care (PPC) in Indonesia was newly reintroduced to the TB program.

Aims: This study explores the challenges PPC healthcare workers (HCWs) face in implementing TB-DM bi-directional screening and strategies to improve it.

Methods: An explorative qualitative method was used by conducting two-round focus group discussions (FGDs) with HCWs (n=15) from five private clinics in Yogyakarta Special Region Province Indonesia and triangulated with 10 DM patients and the TB program manager from the provincial health office. The data were audio recorded, transcribed verbatim, and subjected to thematic analysis.

Results: HCWs face complex barriers in TB-DM co-screening implementation from patients, HCWs, and health system aspects. An integrated system to remind, support decision-making, report, reduce documentation duplication, monitor, and evaluate co-screening implementation emerged as a potential strategy, although some challenges to deploy.

Conclusion: Albeit HIS is promising in enhancing integrated TB-DM screening and management, a comprehensive approach and multisector roles are still needed to overcome impediments to TB-DM bidirectional screening in PPCs.

Keywords: diabetes mellitus, health information system, screening, tuberculosis

Back Matter

Redaksi — Sun, 30 Jun 2024 00:00:00 +0700

POLICY ADVICE ON EQUAL ACCESS TO HEALTHCARE: WHAT'S NEW?

Abdu Nafan Aisul Muhlis — Sun, 30 Jun 2024 00:00:00 +0700

We have less than ten years to achieve the 2030 Sustainable Development Goals (SDGs). In the health sector, it is crucial to focus on Goal 3, which aims for the health and well-being of everyone. Despite progress, disparities in healthcare access continue to affect vulnerable populations. Some countries have implemented Universal Health Coverage (UHC) to ensure equal healthcare access. This editorial emphasized the need for targeted interventions, policy reforms, and increased public awareness to achieve equitable healthcare access and better health outcomes for diverse populations.

Keywords: disparities, policy reforms, SDGs, UHC