Mubasysyir Hasanbasri

How should the health system react to informal drug dispensaries? The case of self-medication in Yogyakarta Province

Background The government seeks to build a healthy community through quality, generic drugs that are available, accessible and affordable. On the other hand, self-medication among different community segments has grown in popularity. In this paper, we want to argue that if the government fail to regulate and to supervise informal drug dispensaries, the community particularly the poor is more likely to gain harmful effects through the practice of self-medication and the use of unregulated informal drug stores. This study aims to: determine the pattern of self-medication in the province of Yogyakarta, identify the type of drug dispensaries that self-medication users seek in their communities, and to evaluate the effectiveness of ministry of health’s regulations and supervisions on drug dispensaries.

Analisis Determinan Ketersediaan Dokter Spesialis dan Gambaran Fasilitas Kesehatan di RSU Pemerintah Kabupaten/Kota Indonesia (Analisis Data Rifaskes 2011)

Determinants of specialist availability in public hospitals: analysis of 2011 Rifaskes ABSTRACT Background:Indonesia still faces theproblem of unequal distribution of specialist doctors. The ratio of health workers per 100.000 population has not met the target. In 2008, the ratio of health workers to medical specialist per 100.000 population amounted to 7,73 compared to the target which is 9. Some areas of development in underserved areas, such as low economic power, lack of hospital system capacity and hospital medical equipment, have been neglected by government. Engagement of stakeholder to improve hospital quality system is a critical element to contribute to the policy of specialist doctors dsitribution, typically to increase the number of specialist doctors practising in rural and remote areas. Objective: To assess the determinants ofavailability of specialist doctors in government/public hospitals and to find out the correlation of variable factors. Methods: A cross sectional design was adopted for this study, in which 7 factors were chosen to assess determinant of availability of specialist doctors using a Health Facilities Research (Rifaskes) conducted Bay the HealthMinistry in 2011 and to describe availibility of hospital facilities in the Indonesian public hospitals. Results: Bivariate analysis indicated that level of district, hospital accredited, BLU versus Non-BLU, remuneration, hospital facilities, dan GNP significantly affect to the number of specialist doctors (p <0,05). Logistic regression indicated that the strongest predictors of availibility specialist is accredited public hospital with 12 standard of care (odds ratio 9,32 ; 95% CI: 1,2-72,4) ; p < 0.03). Level of district have significantly associated to availibility specialist in public hospital (odds ratio 2,15 ; (95% CI: 1,36-3,39) ; p = 0,001). Conclusion: The current study makes an important contribution to the literature in finding the determinants of distribution of specialist doctors in public hospital in Indonesia to address maldistribution between urban and rural barriers. Additional research is needed to examine preference to choose rural location and the incorporation of other retention strategies, such as medical educationinitiatives, community and professional support, differential rural fees and alternate funding models. Keywords: Availability,specialist doctors, specialistic facilities

Clinical learning experiences and professional development: implementation of a district level undergraduate midwifery program in Indonesia

Purpose The aim is to examine the suitability of the educational process in place with the expected professional development. Method We conducted in-depth interviews with (a) 16 third-year student who recently completed 2-month clinical rotation in the hospital and (b) four teachers. Results Evidence from this study indicate weak learning environment. Clinical instructor only has a limited time to meet with students, so that students rarely get the guidance and direct supervision. Students more often obtain “lessons” of the young staff, which many of them indifferent in providing guidance. Students feel insecure and fear in communicating with senior staff from both the nursing and medical professions. Academic lecturers provide minimum learning support. Their supervision does not allow students to reflect on their experiences. Conclusion Professional development as reflected in clinical rotations in hospitals is still very limited. The government must monitor more strictly, especially for the medical school located in the district, where professional educators are very limited.

Pelatihan seperti apa yang dapat mendukung implementasi kebijakan: perspektif peserta - evaluasi training manajer mid-level untuk imunisasi di Kota Banda Aceh

Background: Training is an effort to develop knowledge and skills and change attitudes through learning experiences to achieve effective perfomance in an activity or range of activities. Tsunami disaster on December, 26th 2004 attacked Aceh Province, in 2007-2009, the Ministry of Health in collaboration with UNICEF/PATH conducted mid level management training on immunization in Aceh Province with the main objective to improve performance of health workers who served as manager in implementing the policy of national program on immunization service at the provincial level, district/ city and clinic. Research: This is a case study design using descriptive qualitative and quantitative analysis. The unit of analysis is the managers of the immunization in District Health Office and in the health centres that have been trained in Banda Aceh. The methods of data collection are brainstorming, in-depth interviews, focus group discussions, reports and documents, and assesment. Result: Immunization managers have a good knowledge of management and type of the vaccine, vaccine logistics, place and schedule of vaccinations. The number of cases of diseases preventable by immunization have decreased and results coverage of routine immunization has been increasing after mid-level management training. Conclusion: Trainees have a positive reaction to training, results of immunization coverage and knowledge were increased and behavioral change occured. Keywords: Evaluation, Training Mid Level Management, Immunization.

Obesity and the poor women living in urban slum areas: health system response

Background Obesity is one of the risk factors for non-communicable disease (NCD). The prevalence of overweight and obesity among the poor in Indonesia is increasing. Indonesia is also experiencing an epidemiological transition where the trend for causes of death is changing from infectious disease to NCD. Following previous studies on obesity among the poor, we study the risk factors for obesity in urban slum areas in order to seek for the appropriate health system solution to this matter.