Buletin Penelitian Sistem Kesehatan

327–336

Authors: Supriyantoro, Harimat Hendarwan, Youth Savithri

Background: The variation of benefit packages implemented by some local social health insurance schemes(Jamkesda) become an important issue in the effort to integrating them into National Health Insurance (JKN). This study aims to describe implementation of Jamkesda’s benefit packages as a basic consideration in integration to JKN. Methods: Design of this study is case study with qualitative and quantitative aproaches,conducted 2013–2014 in all of districts/cities which already have Jamkesda. Primary and secondary data was collected. Primary data has been collected by focus group discussion,interview, observation, and self administered questioner. Secondary data collected from many sources such as articles, journal, official document, statistics data, and others. Results:Of this study show there is no significant relationship between fiscal capacity group and benefit packages (continuity correction, p value = 0.065).But,districts/cities with high fiscal capacity (high and very high) seem likely to have probability 1,920 bigger than lower capacity districts/cities in giving equal or more benefit than existing national social health insurance (Jamkesmas) (Mantel-Haenszel, Common Odds Ratio Estimates = 1.920; Confidence Interval 95% =1.008–3.658; asymp. Sig 2 sided = 0.047). There is variation of benefit packages between each Jamkesda.Qualitative results show there are many obstacles faced in giving benefit health services, such as limited community accessibility to health facilities, the absence of health workforce, and lack of health infrastructure and equipment. Recomendation: This study recommends to set a national minimum benefit packages and equalizing percetion of local decission maker.

345–352

Authors: Ainun Sajidah, Wimpie I. Pangkahila, J. Alex Pangkahila

Background:Disharmonious sexual life often create many problems. When the sexual function of the wives is not optimum, the sexual satisfaction of the husbands, or both husband and wife, will be disturbed. These will lead husbands to do sexual intercourses with FSW without condoms. Such intercourse may cause of STIs. The aims of this study were to identify the frequency of sexual intercourse without condom with FSW related to the level of sexual satisfaction of the husband and the risk of STIs. Methods:The study applied observational analytic with cross sectional design. The accidental sampling technique, the 196 samples, comprise of husband with the following criteria: having non-menopause legal wives, regularly having sex with wives without condoms within 6 months, having sex with FSW without condom at least once in 6 months, in the family stage II standard, healthy and willing to be respondents. Data on the level of sexual satisfaction and frequency of sexual intercourse without condom was collected through interviews, data on the risk of STIs was collected with physical and laboratory check-up by medical staff. The laboratory check-up for gonorrhea was done with the Gram’s coloring, syphilis with T. Pallidum Hemagglutination Assay (TPHA) and Veneral Disease Research Laboratory (VDRL), genital herpes and acuminate condyloma with clinical symptoms. The result was analysed descriptively and data normality was tested with Kolmogorov-Smirnov test and the correlaton test was done with the Spearman’s rho and Chi-Square tests. Results:The result showed there was the frequency of sexual intercourse without condom with FSW the most 1 time/week 57 persons (29.10%), with STIs 10 persons (5,10%) the level of sexual satisfaction that was quite satisfied 97 persons(49.50%), and the STIs 41 persons (20,90%). The frequency of sexual intercourse without condom with FSW not related to the level of sexual satisfaction of the husbands p = 0.146 (p > 0.05). The frequency of sexual intercourse without condom with FSW related to the risk STIs p = 0.001 (p < 0.01). Conclusions:The frequency of sexual intercourse without condom with FSW was not related to the level sexual satisfaction of the husband, but related to the risk of STIs. The study was expected to be used as the base of further study to know other factors the frequency of sexual intercourse without condom with FSW.

363–370

Authors: Anggi Septia Irawan , Aryani Pujiyanti , Wiwik Trapsilowati

Background: Malaria was becoming a re-emerging disease in central java, especially for Kebumen Regency, it has been hit by malaria outbreak with the increasing case. A study was conducted in rural area of sub district Rowokele, Kebumen, Central java to identify local knowledge and practice of the community that has been becoming one of the important factors for vector borne disease control, including malaria control. Methods: This research was conducted between June 2011 and November 2011, applying qualitative method with ethnoscience approach. Data were retrieved from in-depth interviews and focus-group. Qualitative thematic content analysis was applied to understanding sharpening of the social and cultural aspect of malaria disease. Results:Qualitative method using in-depth interview able to explain several findings, such as the result of a local term of malaria, called “udug-udug” in rowokele sub-district. It shows the insufficient understanding of malaria signs and symptoms in the sub of villages, it leads to delay for illness recognition and its treatment. Conclution: Misperceptions on the preventive activities, as well as confusion of malaria with dengue fever, were identified. This study detected risk group of malaria infection in community practices such as a farmer who works in the forest and seasonal migration. Recommendation: Promotion intensification and health education on vector, prevention and therapy are important to be introduced.

379–384

Authors: Roy G.A. Massie , Indra Domili, Joy Rattu

Background:The maternal mortality rate (MMR) in Indonesia is still high with 90% occured during labor and after delivery. In 2007–2009 MMR in the District of North Gorontalo is higher than the national. Efforts in order to decrease maternal mortality, especially in the antenatal phase had been formally conducted by health professionals in the form of promotion. There is effort that can be done traditionally by local cultural approach particularly in Gorontalo Province known as the ceremomial Molontalo. Molontalo is a statement from the husband’s family that first pregnancy is fulfilled expectations will be a continuation derived from legal marriage. The purpose of the research was to increase the hulango (village shaman) and hatibi’s (village priest) knowledge of MCH as community and religious leaders through traditional ceremonies Molontalo so the pregnant women can visit the health care workers and facilities. Methods:Operational research, which begins with the intervention, data collection, analyzed the objects, the situation that described descriptively. Results:Pre-test of the hatibi and hulango knowledge on MCH programs were low, but there was improvement in post-test. Furthermore, the hulango and hatibi, in terms of delivery MCH messages to the pregnant women could be maintained by the health workers, so they could involved in the health sector, especially for MCH program. The performanced of the hulango for delivering MCH message was good and the hatibi as well. However, there were need to be regularly improved the MCH program related to any Molontalo ceremonial activities. Conclusion:This ceremony may facilitate the delivery of MCH program especially in promotion stage. This activity was expected to decrease the maternal mortality rate. Recommendation:Evaluation needs to be done for the communities’ understanding of Molontalo ceremony in order to recognize the level of understanding of the MCH program. Each ceremony is expected to be conducted continuously and consistently in order to deliver the MCH program messages.

395–405

Authors: Niniek Lely Pratiwi, Agus Suprapto, Agung D Laksono, Betty R , Rukmini, Gurendro , Ristrini , Wahyu D Astuti, Oktarina, Mugeni S

Background: Health Policy Regulation Number 494/Menkes/SK/IV/2010 on the distribution of BOK funds to local government is one of the government’s responsibility for the development of public health in improving health promotion and prevention efforts in order to accelerate the achievement of MDGs in Health. The purpose of the study is to provide policy recommendations regarding to BOK in achieving the goals of maternal and child health programs. Methods: Secondary data review of the district health profile in 2009-2011 and analysis on the primary data collected from focus group discussion (FGD) with invited technical implementor from district health office and health centers as well as some of the staffs of the local government that handle BOK. Results: The decline in maternal and infant mortality rates are still slow and cases of malnutrition increased from the three profile data review Sampang, Gresik and Sidoarjo. Local governments pay little commitment in developing priority strategies of maternal and child health programs in the form of a local action and innovation plan. BOK preventive promotive activities are lacking of monitoring and accountability controls, especially in health centers located far from the district center. Financial accountability is less precise to the programs and targetes, having seen the data of maternal and child health outcomes KN1-KN4 coverage which rose in 2010, but then fell back in 2011. Conclusion: Evaluation and monitoring are needed on the utilization of BOK funds,supervising the activities by the district/city health office, as well as by local community leaders. Prioritise monitoring the health centers in the area with high MMR and IMR. Suggestion: Needed routine and periodic mentoring and coaching in the form of technical assistance related to the utilization of BOK

415–424

Authors: Riswati , Ni Ketut Aryastami, Meda Permana , Ratna Widyasari , Qomariah Alwi

Background:Jampersal program was launched in Indonesia in January of 2011 by Permenkes No.631/Menkes/PER/III/2011. The aim was to improve the coverage of antenatal care, delivery, postpartum care, postnatal, and family planning by health professionals free of charge. After over a year Jampersal program runs, The ANC figures of Jampersal utilization were still very low. Methods:Quantitative and qualitative research on socio- cultural factors in relation to the selection of health personnel by utilizing Jampersal conducted in 2012 which was then followed by a round table discussion to review the policy options related to the Jampersal utilization of the 6 rural districts. Results:Policy options suggested in Jampersal socialization activities need Intersectoral Commitment:The Ministry of Home Affairs, Ministry of Religious Affairs, and BKKBN, followed by a clear and decisive political commitment. They need active partnerships of the midwives, TBAs and cadres in Jampersal socialization. Midwives in the health center level should be prohibited from private practice, but the total amount of compensation of midwife in helping delivery should be adjusted. Regulations are required and procedures should be set for Jamkesnas, Jamkesda, and Jampersal; They need regulation on cooperation between the health centers staffs and village chiefs to further reinforce ID requirement;The transportation cost to refferal unit; TBAs services (division of task and cost); Financial restrictions to cover by Jampersal on second or third delivery. Additionally need a regulation of reward and punishment for midwives,TBAs and cadres involvement in serving pregnancy and delivery. In village level, they need to establish regulation, that TbaS AND Cadres should write the pregnat women data at the board office of village chiefts. Lastly, MoU between head of district health center and midwife assosiation related to midwife understanding of cultural approaches and on the job training for midewife should be established. Conclusion:Culture-Based Approach has important role to improve Delivery By Health WorkersIn Rural Areas. Recommendation:Shorterm and longterm priority of policy should be set up.