Elsa Pudji Setiawati

Distribution trends of Indonesia's health care resources in the decentralization era

Indonesia has been decentralized since 2001, and we evaluated the distribution trends of physicians, puskesmas (community health centers), hospitals, and hospital beds in 34 provinces in Indonesia for 2000 to 2014. Inequality index of Gini showed improvement of the distribution of physicians and decreased from 0.38 to 0.29. The indices in distributions of hospitals and hospital beds also decreased from 0.26 to 0.17 and from 0.25 to 0.18, respectively. However, the index in the distribution of puskesmas increased from 0.19 to 0.28. We also investigated the legislative transitions of the laws concerning health resources and found the strong affects of compulsory work laws for physicians and the increment of health budget. In the decentralization era, the local governments have some political autonomy for the development of health resources; however, the national government should monitor the nationwide distribution of health resources and advice necessary recommendations to the local governments.

Forensic Experts' Opinion Regarding Clinical Forensic Medicine Practice in Indonesia and Malaysia

Clinical forensic medicine is a progressing branch. In Indonesia and Malaysia, there is inadequate information regarding this practice. It is always unclear about the job scopes and practitioners involved in this field. The study outlined in this article is aimed to explore the current clinical forensic medicine practice compared to existing systematic practice globally and hence analyzing for presence of difference in this practice between these two countries. A qualitative study was conducted by forensic experts in Indonesia and Malaysia from September to November 2015. In-depth interview was carried out to obtain data which were then validated using literature and legal documents in Indonesia and Malaysia known as the triangulation validation method. Data were presented in narrative form. In Indonesia, forensic pathology and clinical forensic medicine were approached as one whereas in Malaysia separately. This practice was conducted by a general practitioner in collaboration with other specialists if needed in Indonesia; whereas, in Malaysia, this practice was conducted by forensic pathologists or medical officers in the absence of forensic pathologists. Both Indonesia and Malaysia followed the continental regimen in practicing clinical forensic medicine. There was still a lack of involvement of doctors in this field due to lack of understanding of clinical forensic medicine. The current clinical forensic medicine practice has not developed much and has no much difference in both countries. The gap between the current practice with systematic practice cannot be justified due to the absence of one standardized code of practice.

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

Sapodilla (Manilkara zapota) Broth as an Alternative Media for Candida albicans

Objective: To determine whether sapodilla can be used to grow Candida albicans . Among all the high galactose and arabinose content fruits, the sapodilla was chosen because it is available year round and can get easily in market. Other than that, it also contains vitamins, calcium and phosphorus which are very useful for fungi growth. Methods: This study used an experimental study as a method of research. The researcher culture Candida albicans on the experimental sapodilla media and identifies the morphology of the fungi by using Gram staining method. The experiment will be replicated two times to get accurate result. The procedure of this experiment constitute of sapodilla media preparation, sapodilla media observation, organism preparation, planting and incubation, observation of fungal colonies and identification of the fungi. Results: In 0%, there was no fungal growth at all. In 5%, there was mild density of fungal colonies. In 10%, there was moderate density of fungal colonies and in 15% the fungal grew with very dense colonies. Conclusions: Sapodilla ( Manilkara zapota ) broth can be used as an alternative media for Candida albicans . Keywords: Alternative media, Candida albicans, Sapodilla broth DOI: 10.15850/ijihs.v5n1.965

Role of Risk Factors in the Incidence of Multidrug-Resistant Tuberculosis

Objective: To determine the risk factors that played roles in the incidence of multidrug-resistant tuberculosis (MDR-TB) in such patients. Multidrug-Resistant Tuberculosis is a form of tuberculosis caused by Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampicin. Methods: This was a case control study to compare MDR-TB to non-MDR-TB pulmonary tuberculosis outpatients in Dr. Hasan Sadikin General Hospital, Bandung on August–September 2014. Fifty MDR-TB outpatients were included as the cases and 50 non-MDR-TB outpatients as controls. Data was collected by questionnaires and patient’s registration forms. Bivariate and multivariate analyses were performed using chi-square test and multiple logistic regression test, with p<0.05 considered significant. Results: From bivariate analysis, number of previous tuberculosis treatments, regularity of previous treatment, and burden of cost were significant risk factors for developing MDR-TB (p<0.05); while from multivariate analysis, number of previous TB treatments was the only risk factor that played a significant role in the incidence of MDR-TB (OR 24.128 95% CI 6.771-85,976). Conclusions: Patients and medication factors are risk factors that play roles in the incidence of MDR-TB. The significant risk factor is the number of previous TB treatment. Keywords: Multidrug-resistant tuberculosis, resistance, risk factors, tuberculosis DOI: 10.15850/ijihs.v5n2.991

Perspektif Mahasiswa: Evaluasi Program Pendidikan Profesi Dokter Rotasi Kedokteran Keluarga di Fakultas Kedokteran Universitas Padjadjaran, Bandung Indonesia

Berbagai inovasi dalam pendidikan kedokteran harus selalu dilakukan. Salah satu inovasi yang dilakukan adalah pengembangan Kurikulum PSPD Kedokteran Keluarga. Evaluasi program sangat diperlukan agar dapat diterapkan dengan baik. Evaluasi merupakan bagian integral pelaksanaan dan pengembangan kegiatan pendidikan, Tujuan penelitian ini adalah untuk mendapatkan gambaran evaluasi Program PSPD dari perspektif mahasiswa yang telah melakukan rotasi. Disain penelitian adalah deskriptif kuantitatif terhadap seluruh mahasiswa FK Unpad yang telah melakukan rotasi di PSPD Kedokteran Keluarga selama 6 bulan program diterapkan yaitu Januari – Agustus 2011. Tehnik pengambilan sampling secara total sampling terhadap 68 mahasiswa yang telah melakukan rotasi. Pengambilan data dengan kuesioner dan dianalisis dengan distribusi frekuensi. Hasil penelitian menggambarkan penilaian peserta didik terhadap tujuan, metode pembelajaran, modul, lembar kerja, metode asesmen, wahana pendidikan, pembimbing dan pendukung program. Gambaran tentang tujuan pendidikan didapatkan sebagian besar (96%) responden menyatakan program sudah sesuai kompetensi dan dapat dicapai melalui metode pembelajaran yang diberikan. Kompetensi juga dapat dicapai melalui alokasi waktu yang tersedia. Sebanyak 57% mahasiswa memberikan penilaian positif terhadap bahan ajar, terutama penilaian mengenai referensi dan tugas yang diberikan. Penilaian untuk lembar kerja mahasiswa, didapatkan ketidaksesuaian antara tugas pada lembar kerja dan pembekalan. Perlu evaluasi berkala untuk menilai pelaksanaan program dan beberapa hal perlu diperbaiki sesuai dengan umpan balik peserta didik. Kata kunci: evaluasi, profesi dokter, program pendidikan