Sample Registration System (SRS) is a demographic survey for providing data on causes of death (COD) in Indonesia. The quality of COD will be taken into consideration for health policies development. This paper aims to assess the quality of data on the causes of death in Indonesia through the proportion and level of garbage codes on the impact when used in policy making. The 2014 National COD data set were assessed by applying the Analysis of National Causes of Death for Action (ANACONDA) software tool version 3.7.0. Distributions and levels of unusable and insufficiently specified “garbage” codes were analyzed. The Result shows, Diseases of the circulatory system (62.6%) contributed the most to garbage cause of death. The proportion of unusable COD was 31% of total data. 80% of garbage code were unspecified deaths group. Most of the garbage codes has low-level on severity of impact level for policy, while 11% of total codes has medium, high dan very high level of impact. In Conclusion, the 2014 SRS data was not at high quality, but the implications of garbage code in making inappropriate policies are mostly at low level. The use of low-level codes has less important impact on public health policy. The 2014 SRS data could be considered as a scientific basis evidence for public health policy. Quality improvement still needs to be done by conducting training and refreshing to determine the cause of death for doctors and data collection techniques for data collectors Keywords : Cause of Death, quality of data, Sample Registration System, ANACONDA Abstrak Sample Registration System (SRS) merupakan survei demografi untuk menyediakan data penyebab kematian (COD) di Indonesia. Kualitas COD akan menjadi bahan pertimbangan dalam membuat kebijakan kesehatan. Tulisan ini bertujuan untuk menilai kualitas data penyebab kematian di Indonesia melalui besar proporsi dan level kode sampah terhadap dampak yang ditimbulkan ketika digunakan dalam membuat kebijakan. Data penyebab kematian nasional tahun 2014 dinilai dengan menggunakan perangkat lunak Analisis Penyebab Kematian Nasional untuk Tindakan (ANACONDA) versi 3.7.0. Distribusi dan level kode "sampah" yang tidak dapat digunakan dianalisis dengan menggunakan ANACONDA. Hasil analisis menunjukkan, Diseases of the circulatory system (62.6%) berkontribusi terbanyak dalam hal kode sampah. Proporsi kode sampah yang tidak dapat digunakan adalah 31% dari total kode. Kode sampah yang paling umum digunakan adalah kelompok penyebab kematian tidak spesifik dan kelompok penyebab kematian antara. Berdasarkan tingkat keparahan dalam membuat kebijakan, sebagian besar kode sampah termasuk kategori level rendah, hanya 11% dari total kode memiliki tingkat dampak sedang, tinggi dan sangat tinggi. Kesimpulannya, kualitas data SRS 2014 masih kurang baik, namun implikasi yang ditimbulkan kode sampah dalam membuat kebijakan yang salah sebagian besar berada pada level rendah. Penggunaan kode-kode level rendah memiliki dampak yang kurang penting bagi kebijakan kesehatan masyarakat. Data penyebab kematian SRS 2014 layak dipertimbangkan untuk digunakan sebagai dasar kebijakan Kesehatan masyarakat. Pelatihan penentuan penyebab kematian untuk dokter dan juga petugas AV perlu dilakukan agar kualitas data COD selanjutnya dapat lebih baik Kata kunci: penyebab kematian, kualitas data, Sample Registration System, ANACONDA
Abstrak Merokok merupakan salah satu faktor risiko terhadap penyakit yang membahayakan, seperti jantung, stroke, kanker, dan lain sebagainya. Perilaku masyarakat khususnya perokok aktif yang merokok di sembarangan tempat masih cukup memprihatinkan. Perokok membebankan risiko merokok bukan hanya pada diri sendiri tetapi juga kepada orang lain yang ada di sekitarnya. Analisis dilakukan dengan menggunakan data GATS (Global Adult Tobacco Survey) 2011, dimana desain penelitian adalah cross sectional. Pemilihan sampel menggunakan teknik sampling proportional probabilitas to size (PPS). Hasil dari analisis antara lain: masyarakat yang terpapar rokok di dalam rumah lebih banyak pada kelompok laki-laki dibandingkan perempuan, yang terbanyak pada kelompok umur 45-64 tahun dengan pendidikan tidak tamat SD, tempat tinggal di pedesaan, dan pekerjaan wiraswasta. Kebijakan keluarga yang mengizinkan merokok dalam rumah sebesar 46,9%, dan seseorang yang merokok dalam rumah setiap hari mencapai 62,5%. Masyarakat yang terpapar rokok di ruang kerja sebesar 51,4%, dan kantor yang mengizinkan merokok dalam ruang kerja sebesar 38,4% dan yang tidak ada kebijakan sebesar 19,8%. Terpapar rokok di kantor pemerintahan 66,4%, di universitas 55,3%, di sekolah atau fasilitas pendidikan lainnya 40,3%, di fasilitas keagamaan 17,9%, di fasilitas kesehatan 18,4%, di bar atau klub 91,8%, dan transportasi umum 70,8%. Hasil ini dapat menjadi data dasar untuk mengembangkan intervensi program pengendalian tembakau yang efektif, termasuk menyediakan layanan berhenti merokok, terutama di fasilitas kesehatan. Pemerintah pusat dan daerah perlu meningkatkan sosialisasi tentang bahaya merokok di tempat-tempat umum dan dampaknya terhadap masyarakat khususnya yang bukan perokok; yaitu dengan membuat peraturan yang jelas dan tegas tentang pelarangan merokok di tempat-tempat umum dan memberikan sangsi yang tegas terhadap yang melanggar peraturan tersebut. Upaya layanan berhenti merokok dapat dilaksanakan dengan meningkatkan kegiatan promosi oleh tenaga kesehatan, sosialisasi ‘Quitline’ Kementerian Kesehatan, skrining CO2, bantuan konseling dan mengembangkan metode terapi berhenti merokok bagi para perokok aktif di berbagai fasilitas kesehatan yang tersedia. Kata kunci: rokok, perokok pasif, pengendalian tembakau Abstract Smoking is one of the risk factors for severe diseases, such as heart disease, stroke, cancer, and so on. The behavior of active smokers who smoke arbitrarily at many public places is still quite alarming. Smokers impose the risk of smoking not only on themselves but also to others around them. The analysis was performed using GATS (Global Adult Tobacco Survey) 2011 data, where the research design was cross-sectional. The sample selection uses a proportional probability to size (PPS) sampling technique. The results of the analysis show people who are exposed to cigarettes in the house are mostly males than females with the characteristics were at age groups 45-64 years old, educational level was not completed elementary school, living in rural areas, and self-employee. Family policies that allow smoking in the home were 46.9%, and someone who smokes in the house every day reaches 62.5%. People who are exposed to cigarettes in the workspace were 51.4% and offices that allow smoking in the workspace were 38.4% and those without any ‘free smoking area’ policy were 19.8%. Exposure to cigarettes was 66.4% in government offices, 55.3% in universities, 40.3% in schools or other educational facilities, 17.9% in religious facilities, 18.4% in health facilities, 91.8% in bars or clubs, and 70.8% in public transportation. These results could be a reference or base evidence in developing an effective tobacco control program, including providing smoking cessation services. Central and local governments need to increase awareness about the risk of smoking in public places and their impact on public health, especially for non-smokers, by issuing a strict regulation on free smoking areas in public places and enforce punishment to people who violate these regulations. The efforts to stop smoking services can be implemented by increasing promotion activities by health workers, socialization of the Ministry of Health 'Quitline', CO2 screening, counseling assistance and developing methods of smoking cessation therapy for active smokers in existing health facilities. Keywords: cigarette exposure, passive smokers, tobacco control
Introduction: The prevalence of stunting among under five years old children in Indonesia is still high, including those living in urban and non-remote areas that was taught to have better access of food and nutrition. The study aimed to determine the correlation between predisposing factors of stunting among toddlers in non-remote areas which thought to have good access to food and healthcare. Methods: This was a secondary data analysis using Indonesia’s Nationally Representative Survey known as the Basic Health Research 2018. The sample were children aged 0-59 months who were measured in selected households. Stunted children was determined based on the measuring height for age (HAZ) with a z-score less than -2 standard deviation. Multivariate analysis with a logistic regression test was performed to test predisposing factors associated with stunting. Results: The results showed that the prevalence of stunting among under-five years old children in non-remote areas of Indonesia was 29.7%. Adjusting for the multivariate analysis, the predisposing factors that significantly correlated with the incidence of stunting in a non-remote areas were families with a poor economic (AOR=1.49; 95%CI=1.39-1.59), household heads with low education levels (AOR= 1.50 (1.33-1.69) and health insurance ownership (AOR=1.16; 95%CI=1.09-1.24). Conclusions: In conclusion, families living in non-remote areas of Indonesia did not necessarily benefit from food availability or healthcare facilities, but it needs to be educated and wealthy enough to purchase food and also insurance. Trial Registration: Ethical approval research was issued by the Health Research Ethics Commission, Health Research and Development Agency of the Ministry of Health Number LB.02.01/2/KE.267/2017.
Analisis kinerja fungsi sistem penelitian kesehatan nasional (SPKN) diperlukan untuk identifikasi penguatan dan peningkatan sistem yang mendukung pencapaian pemerataan kesehatan. Penelitian ini bertujuan mengukur skor kinerja fungsi utama SPKN yang meliputi pengelola, pendanaan, mengumpulkan dan memelihara sumber, produksi dan penggunaan riset berdasarkan pendapat stakeholders (peneliti, pembuat kebijakan, dan pengguna). Sumber data yang digunakan adalah pilot study WHO di Jakarta dan Makassar WHO dengan ukuran sampel 278 responden. Analisis dilakukan terhadap skor rata-rata 6 dimensi pendapat meliputi lingkungan; pandangan sistem, pembuatan, penggunaan, akses literur ilmiah dan media. Metoda analsis meliputi analisis kuantitatif univariat dan cross tabulasi tanpa uji statistik dan analisis kualitatif terhadap pertanyaan terbuka. Hasil studi memperlihatkan distribusi responden meliputi peneliti (62.2%), pembuat kebijakan (21.6%) dan peng- guna (16.2%). Secara keseluruhan, kinerja fungsi sistem litkes dinilai belum baik oleh 54,7% responden. Kinerja baik ditemukan pada fungsi pengelola dan penghasil riset. Sebaliknya kinerja tidak baik pada fungsi pengumpul dan pemelihara sumber daya, menggunakan riset, akses literatur ilmiah dan akses media. Analisis kuali- tatif memperlihatkan lima area yang berkontribusi penting pada penguatan lingkungan penelitian di indonesia meliputi pendanaan, fasilitas, gaji, kerjasama, dan komunikasi. Komponen yang dinyatakan penting pada penguatan sistem litkes adalah visi, sumber data manusia, pendanaan, etik litkes dan alokasi. Prioritas utama SPKN adalah masalah kesehatan masa depan dan masalah kesehatan yang persisten (bertahan lama). Disimpulkan bahwa SPKN belum berfungsi optimal. Peningkatan dapat dilakukan dengan revisi dan reorientasi prioritas SPKN antar stakeholders, peningkatan alokasi dana, optimalisasi peran dan fungsi jaringan litbangkes, serta peningkatan fungsi stewardship badan litbangkes dalam kapasitas kepemimpinan ilmiah yang baik.Kata kunci : Penilaian kinerja, sistem riset kesehatan nasionalAbstractNational health research system (NHRS) performance assessment will be very important to strengthen the capability of NHRS in order to improve the advancement of knowledge and health equity. The objective of this study is to measure the three functions performance of stewardship, creating and sustaining resources and producing and utilizing of health research based on the perceptions of NHRS stakeholders (researchers, policy makers and users). This study used secondary data WHO pilot study which was carried out in Jakarta and Makassar, in 2003-2004. The study design used is cross sectional with quantitative and qualitative data analy- sis for 278 respondents of NHRS individual survey. The respondents consist of NHRS stakeholders such as researchers (62.2%), policy makers (21.6%) and research users (16.2%). Overall performance of NHRS functions has been perceived as not well performed by 50.4% respondents. Good performances only on stewardship and producing research have been perceived by respondents. In the other hand, the performance of creating and sustaining resources, research utilization, access to scientific literatures and to media have been perceived unsatisfactorily by the respondents. Important contribution areas in improvement and strengthening the NHRS in Indonesia are: networking, facility, budget, collaboration and communication. While important contribution components in Indonesia are vision, human resources, ethics, budget and allocation. The main research priorities were identified as future health problem and persistent health problem in all respondent’s groups. In sum- mary, NHRS were not yet in optimum well functions., to strengthen the system: pledged to increase budget allocation and improve budget accountability; activating the national and local net working of health research and development, improvement of stewardship function of NHRS in its capacity as ‘good scientific leadership’Key words : Health research system, performance assessment.
Abstrak Imunisasi adalah suatu intervensi kesehatan yang hemat biaya dan efektif untuk mencegah penderitaan akibat penyakit, kelumpuhan dan kematian. Dukungan pendanaan diharapkan mampu meningkatkan cakupan Imunisasi Dasar Lengkap (IDL).Tulisan ini merupakan hasil analisis data Riset Pembiayaan Kesehatan (RPK) di Era Jaminan Kesehatan Nasional (JKN) Tahun 2015. Metode District Health Account (DHA) digunakan untuk menghitung pendanaan program imunisasi dasar di kabupaten/kota pada tahun 2013-2014 menurut sumber dan alokasi anggaran. Hasil analisis menunjukkan anggaran imunisasi dasar di 71 kabupaten/kota berkisar 0,10%–2,3% dari APBD Kesehatan Tahun 2013, dengan disparitas yang cukup lebar. Sumber utama pendanaan program imunisasi di kabupaten/kota adalah PAD, DAU, dekonsentrasi (Dekon) dan BOK atau masih tergantung dari dana transfer pusat. Pendanaan imunisasi nasional pada tahun 2014 meningkat secara bermakna mencapai sekitar 2,6 kali lipat dari tahun 2013. Pendanaan program imunisasi sekitar 90% didanai dari APBN, sisanya dari donor (terbesar dari GAVI). Komponen terbesar alokasi secara nasional adalah untuk pengadaan vaksin, pengenalan vaksin baru dan investasi. Sementara alokasi di kabupaten/kota (dana pendamping) sebagian besar dimanfaatkan untuk kegiatan pelayanan dan kurang dari 8% untuk surveilans dan pelatihan. Daerah dengan kapasitas fiskal tinggi tidak berarti memiliki anggaran imunisasi yang besar atau cakupan IDL yang tinggi. Direkomendasikan untuk mempertahankan kebijakan pendanaan imunisasi yang berbiaya tinggi (vaksin, kulkas vaksin, cold room) bersifat sentralistik dari APBN, sedangkan provinsi dan kabupaten/kota menyediakan anggaran untuk pelatihan, distribusi, vaksin carier beserta bahan habis pakai dan injection kit. Perlu crash program khusus dengan tambahan dana pendamping (operasional) dari APBN bagi kabupaten/kota yang tidak pernah berhasil mencapai IDL 80%. Perlu dikembangkan alternatif sumber pembiayaan untuk pendanaan imunisasi di kabupaten/kota, misalnya melalui dana kapitasi dan sektor swasta. Puskesmas harus memperbaiki dan meningkatkan kemampuan perencanaan dan belanja anggaran imunisasi yang efektif. Kata kunci: imunisasi, pembiayaan, District Health Account Abstract Immunization is an effective and efficient health intervention to prevent severe illness, disability and child deaths. Funding support is important in order to achieve targeted universal child immunization (UCI) at high coverage. An Analysis of 2015’s National Survey on Health Financing in the Implementation of National Health Insurance (JKN) was conducted by using District Health Account method to figure out the sources and budget allocation on routine immunization programs in 71 districts / cities in 2013-2014. The results shows that the routine Immunization budget varies from 0.10% to 2.3% of the 2013 APBD (district budget), with a wide disparity. The main sources of funding for immunization programs in districts/cities are PAD, DAU, Dekon and BOK, which were still depend on central transfer funds (APBN). National immunization funding in 2014 increased significantly by 2.6x from 2013. Sources for the routine immunization program was around 90% funded by APBN (central budget), the rest from donors (GAVI, WHO, Unicef). At national level, funding allocation was mostly for vaccines procurement, introduction of new vaccines and investments. While, allocations in districts / cities was mostly used for service delivery and less than 8% for surveillance and training. District/city with high fiscal capacity doesn’t significantly having a large immunization budget or high coverage. It is recommended to maintain centralistic mechanism on immunization funding for high-cost components (vaccine, vaccine refrigerator, cold room) by APBN; while the Province and District / City provide a budget for training, distribution, vaccines carrier along with consumables gods and injection kits adjusted by fiscal capacity and service demands. Special crash programs need to carry out with additional accompaniment fund source from the provincial or district budget for targeted areas which never reached 80% coverage. Other funding resources should be widely explored to examine alternatives budget, such as capitation (JKN), private fund. Puskesmas competency also should be improved on budget planning and effective purchasing. Keywords: immunization, financing, District Health Account
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