Deni Kurniadi Sunjaya

Priority setting in HIV/AIDS control in West Java Indonesia: an evaluation based on the accountability for reasonableness framework

BACKGROUND Indonesia has insufficient resources to adequately respond to the HIV/AIDS epidemic, and thus faces a great challenge in prioritizing interventions. In many countries, such priority setting processes are typically ad hoc and not transparent leading to unfair decisions. Here, we evaluated the priority setting process in HIV/AIDS control in West Java province against the four conditions of the accountability for reasonableness (A4R) framework: relevance, publicity, appeals and revision, and enforcement. METHODS We reviewed government documents and conducted semi-structured qualitative interviews based on the A4R framework with 22 participants of the 5-year HIV/AIDS strategy development for 2008-13 (West Java province) and 2007-11 (Bandung). RESULTS We found that criteria for priority setting were used implicitly and that the strategies included a wide range of programmes. Many stakeholders were involved in the process but their contribution could be improved and particularly the public and people living with HIV/AIDS could be better engaged. The use of appeal and publicity mechanisms could be more transparent and formally stated. Public regulations are not yet installed to ensure fair priority setting. CONCLUSIONS To increase fairness in HIV/AIDS priority setting, West Java should make improvements on all four conditions of the A4R framework.

IMPORTANCE of MULTIPLE CRITERIA for PRIORITY SETTING of HIV/AIDS INTERVENTIONS.

Objectives: This study describes the views of various stakeholders on the importance of different criteria for priority setting of HIV/AIDS interventions in Indonesia. Methods: Based on a general list of criteria and a focus group discussion with stakeholders (n = 6), a list was developed of thirty-two criteria that play a role in priority setting in HIV/AIDS control in West-Java province. Criteria were categorized according to the World Health Organizations health system goals and building block frameworks. People living with HIV/AIDS (n = 49), healthcare workers (HCW) (n = 41), the general population (n = 43), and policy makers (n = 22) rated the importance of thirty-two criteria on a 5-point Likert-scale. Thereafter, respondents ranked the highest rated criteria to express more detailed preferences. Results: Stakeholders valued the following criteria as most important for the priority setting of HIV/AIDS interventions: an interventions impact on the HIV/AIDS epidemic, reduction of stigma, quality of care, effectiveness on individual level, and feasibility in terms of current capacity of the health system (i.e., HCW, product, information, and service requirements), financial sustainability, and acceptance by donors. Overall, stakeholders’ preferences for the importance of criteria are similar. Conclusions: Our study design outlines an approach for other settings to identify which criteria are important for priority setting of health interventions. For Indonesia, these study results may be used in priority setting processes for HIV/AIDS control and may contribute to more transparent and systematic allocation of resources.

Development of forensic medicine in post reform Indonesia

Forensic medicine practice in Indonesia was introduced through the Dutch colonial criminal justice system in the early twentieth century. After more than 70 years of national independence, the development of forensic medicine still faces fundamental challenges, including confusion in the distribution of responsibility with law enforcement agencies, difficulties in managing conflicts of interest, and impediments in scientific practice and professional development. Despite of the golden opportunity from the Indonesian Reform movement in the late 1990s, the impact on forensic medicine development has been less than expected. It is thus important to identify the scope of the problems plaguing the development of forensic medicine, as well as its causes. We conducted a qualitative study to explain the problems and propose solutions. The results show that the standards of practice have developed more slowly than those in many other branches of medicine, despite its increasing popularity from its role in counterterrorism and disaster victim identification. A strong thriving spirit exists in forensic science, although growth in forensic research activities should be facilitated more. The 2009 Health Law has included forensic medicine practice in the health system to cover the role of forensic medicine for health and medical education purposes. It also potentially provides a way to support the justice system without exposing forensic practitioners to possible conflicts of interest, for instance, by utilizing a tiered referral system. To this aim, an alternative is proposed: to place forensic medicine practice within the context of the health system.

Water Sources Quality in Urban Slum Settlement along the Contaminated River Basin in Indonesia: Application of Quantitative Microbial Risk Assessment

Fecal contamination in water sources is still found globally, especially in urban slum areas of mid-low income countries. Fecal contamination as an indicator of low levels of hygiene and sanitation practices as well as poor management of drinking water supply might increase the risk of waterborne diseases in developing countries like Indonesia. This study aimed to assess quality of all water sources in one of the urban slum settlements along a contaminated river basin in Indonesia. A cross-sectional survey was conducted during the period of August to October 2015. Water samples were taken with simple random sampling from households in urban slum areas along the Cikapundung river basin in the center of Bandung city, Indonesia. Water samples (n=379) from 199 households and 15 common wells were tested for microbiological contamination, and 61 samples of ground water sources and river were tested for selected heavy metal contamination. Annual risk of infection from all water sources was calculated using the quantitative microbial risk assessment. Tap water distribution was poor in this slum area. Most of the dug wells and half of refill bottled water were contaminated. Estimated highest annual risks of infection due to fecal contamination would be caused by dug well and spring water since majority of the households did not use septic tank and disposed human waste directly to the river. Improvement in point-of-use water treatment and storage is essential to prevent risk of waterborne diseases, and tap water should be more accessible and affordable in urban slum areas. The integrated monitoring system to control the quality of refill bottled water production is one of the many essential issues to be prioritized.

Konsep Kualitas Pelayanan Kesehatan berdasar atas Ekspektasi Peserta Jaminan Kesehatan Nasional

Masyarakat memiliki hak untuk mendapatkan pelayanan kesehatan yang bermutu dan terjangkau. Sejak awal tahun 2014, pemerintah berupaya meningkatkan akses pelayanan kesehatan melalui program Jaminan Kesehatan Nasional. Pelayanan kesehatan tersebut tentunya harus tetap berkualitas. Peneliti bertujuan merumuskan konsep kualitas pelayanan kesehatan berdasar atas ekspektasi pasien. Desain penelitian ini adalah kualitatif dengan paradigma konstruktivisme. Partisipan terdiri atas 17 pasien rawat jalan peserta Jaminan Kesehatan Nasional dan 7 petugas kesehatan Rumah Sakit Umum Daerah Al-Ihsan dan Soreang Kabupaten Bandung, Pengumpulan data dilakukan dengan cara wawancara mendalam selama bulan Agustus–November 2016. Pelayanan kesehatan yang berkualitas terdiri atas 11 dimensi. Dimensi sarana prasarana mengutamakan kecukupan kapasitas fasilitas. Dimensi karyawan mengutamakan kesesuaian jumlah kapasitas tenaga kerja. Dimensi pelayanan medis mengutamakan komunikasi. Dimensi pelayanan administrasi mengutamakan sistem antrian yang tertib. Dimensi keamanan pelayanan mengutamakan minimalisasi risiko bahaya. Dimensi kepercayaan menunjukkan loyalitas. Dimensi akses mengutamakan kemudahan menjangkau rumah sakit. Dimensi kesetaraan merupakan perlakuan yang sama antara pasien peserta JKN dan non-JKN. Dimensi transparansi informasi merupakan penyajian informasi yang jelas. Dimensi iur biaya mengungkapkan tidak ada penambahan biaya dalam tindakan medis maupun pengobatan. Dimensi kualitas antar bagian merupakan pelayanan yang sama di setiap titik bagian pelayanan. Pelayanan kesehatan yang berkualitas berdasar atas harapan pasien meliputi dimensi sarana prasarana, karyawan, pelayanan medis, pelayanan administrasi, keamanan pelayanan, kepercayaan terhadap rumah sakit, akses, kesetaraan, transparansi informasi, iur bayar, dan kualitas antarbagian. [MKB. 2017;49(2):102–9] Kata kunci : Ekspektasi pasien, Jaminan Kesehatan Nasional, kualitas pelayanan kesehatan Health Service Quality Concept based on Expectation of the National Health Insurance Participants Community has the right to receive affordable and qualified health care. Since the early 2014, the government has attempted to increase health care access through the implementation of the National Health Insurance (Jaminan Kesehatan Nasional, JKN) scheme that still requires quality health care. The aim of this study was to formulate the concept of health care quality based on patients’ expection. This was a qualitative study using constructivism paradigm on 17 JKN-member outpatients and 7 health care workers of Al-Ihsan General Public Hospital and Soreang Public District Hospital, Bandung District. Data were collected through in-depth interviews during the period of August–November 2016. Quality health care consists of 11 dimensions: facility and infrastructure dimension that prioritizes on adequacy of facility capacity; employee dimension that prioritizes on the number and capacity of human resource; medical service dimension that prioritizes on communication; administrative service dimension that prioritizes on orderly queuing system; service safety dimension that prioritizes on minimizing hazard risk; trust dimension that shows loyalty; access dimension that prioritizes on easy access to hospital; equality dimension that emphasizes same treatment for JKN and non-JKN patients; information transparency that prioritizes on clear information provision; cost sharing dimension that underlines no additioanl fee for medical actions and treatments; and inter-department quality dimension that includes same services in each service point. It is revealed that quality health care based on patients’ expectation includes facility and infrastrucutre, employee, medical service, administrative service, service security, trust towards hospital, access, equality, information transparency, cost-sharing, and inter-department quality. [MKB. 2017;49(2):102–9] Key words: Health Service Quality, National Health Insurance, Patient Expectation