An effective strategy for combatting AMR in Indonesia is to make the use of antibiotics in hospitals more rational with the help of an Antimicrobial Resistance Control Program (AMR-CP). This study aims to analyze the implementation of the AMR-CP in hospitals by conducting in-depth interviews with health professionals from ten hospitals and health officers of ten provincial health offices in ten different provinces and observation towards its documents. The sample location was selected by purposive sampling. Informants at the hospitals were hospital directors, chairmen of the AMR-CP team, chairmen of the medical committee, persons in charge of the microbiology laboratory, clinicians, nurses, clinical pharmacists, and those program managers at the provincial health offices who are responsible for administering antibiotics. Information is first collected and then a thematic analysis is applied along with triangulation to confirm the validity of information from multiple sources, including document observation results. The analysis is adapted to the framework of the system (i.e., input, process, and output). Results show that hospitals in Indonesia already have the resources to implement AMR-CP, including AMR-CP team and microbiology laboratories. Six hospitals examined also have clinicians trained in microbiology. Though hospital leadership and its commitment to implementing AMR-CP are favorable, there is room for improvement. AMR-CP teams organize routine activities for socialization and training, develop standard operating procedures (SOPs) for antibiotic use, antibiotic patterns surveillance, and bacterial mapping. Some obstacles to implementing AMR-CP policies are posed by the human resources, facilities, budget, antibiotics and reagent shortages, and clinician compliance with SOPs. The study concludes that there was an improvement in antibiotic sensitivity patterns, rational use of antibiotics, use of microbiological laboratories, and cost-efficiency. It recommends the government and healthcare providers continue to improve AMR-CP in hospitals and promote AMR-CP policy by making the regional health office of the hospital a representative of the regional government.
The elderly is vulnerable group because they suffer from many diseases (multimorbidity), functional disability and dependence on others. East Java Province has an old population structure so that it needs good handling, especially when related to health. This study aimed to analyze the implementation of the elderly health service program carried out by the East Java Provincial Health Office. This research was an observational study with a cross sectional design. Data collection employed in-depth interviews, focus group discussions, review of coverage data and related regulatory documents. Data were analized descriptively. The results showed that the East Java Provincial Health Office had a policy baseline for the Elderly health program, where the program included activities inside and outside the building. Program barriers include infrastructure, budget, human resources, and policies. Efforts to improve the elderly program are carried out with long-term care, advocacy, training and mentoring at the Puskesmas. The coverage of elderly health services in East Java Province are: 1) hospitals with Integrated Geriatric Team services (3.13%), 2) Elderly Posyandu integrated with Posbindu (7.3%) and 3) Community Health Centers for the Elderly (42.9%). As recommendation, it is necessary to increase the capacity building of human resources through training as well as to ensure the availability of facilities and infrastructure for elderly health services at Health Center. Abstrak Lansia merupakan kelompok rentan karena mengidap banyak penyakit (multimorbiditas), ketidakmampuan secara fungsional dan ketergantungan pada orang lain. Provinsi Jawa Timur memiliki struktur penduduk tua, sehingga perlu penanganan yang baik terutama terkait kesehatan. Penelitian ini bertujuan menganalisis implementasi program pelayanan kesehatan Lansia yang dilaksanakan oleh Dinas Kesehatan Provinsi Jawa Timur. Penelitian ini merupakan penelitian observasional dengan desain cross-sectional. Pengumpulan data dilakukan dengan wawancara mendalam, diskusi kelompok terarah, telaah data cakupan dan dokumen regulasi terkait. Analisis data secara deskriptif. Hasil penelitian menunjukkan Dinas Kesehatan Provinsi Jawa Timur telah memiliki landasan kebijakan program kesehatan Lansia, di mana kegiatan program meliputi kegiatan dalam gedung Puskesmas Santun Lansia dan kegiatan luar gedung. Hambatan program meliputi, sarana prasarana, anggaran, SDM dan kebijakan. Upaya perbaikan program Lansia dilakukan dengan perawatan jangka panjang, advokasi, pelatihan dan pendampingan Puskesmas. Cakupan pelayanan kesehatan Lansia di Provinsi Jawa Timur yaitu: 1) RS dengan pelayanan Tim Geriatri Terpadu (3,13%), 2) Posyandu Lansia yang terintegrasi dengan Posbindu (7,3%) dan 3) Puskesmas santun Lansia (42,9%). Direkomendasikan, perlunya peningkatan kapasitas SDM melalui pelatihan serta menjamin ketersediaan sarana dan prasarana untuk Yankes Lansia di Puskesmas.
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