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Journal of Health Policy and Management
Journal of Health Policy and Management (JHPM) is an electronic, open-access, double-blind and peer-reviewed international multidisciplinary and integrative journal, focusing on health policy, health system, and healthcare management. It began its publication on October 21, 2015. The journal is published twice yearly. It aims to improve the design and implementation of health policies, health systems, and healthcare management, primarily in low- and middle-income countries. JHPM analyzes policy initiatives and healthcare systems and provides evidence-based research to guide policymaking and management decision-making.
Articles
45
Articles
Factors Associated with Health Personnel Performance in Tuberculosis Control Using “ACHIEVE” Model

Pangestuti, Reni Dwi, Hernawati, Sri, Ningtyias, Farida Wahyu

Journal of Health Policy and Management Vol 3, No 2 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Tuberculosis (TB) remains a major public health problem in the world that causes morbidity and mortality. The role of health personnel is important in the implementation of lung TB control program. Health personnel performance that is not optimal can cause the TB case to remain high. Little is known about the factors affecting the performance of health personnel in Indonesia. This study aimed to examinethe determinants of health personnel performance in TB control using “ACHIEVE” model.Subjects and Method: This was an analytic observational study with a cross-sectional design. The study was conducted in community health center in Jember, East Java. A sample of 45 health personnel of TB program implementation was selected for this study by simple random sampling. The dependent variable was health personnel performance, which included TB case finding, observation, and monitoring of TB patients. The independent variables were ability, clarity, help, incentive, evaluation, validity, and environment (ACHIEVE). The data were collected by questionnaire and analyzed by logistic regression in SPSS 16.Results: Of all health personnel under study, 43 (93.4%) had good ability, 75.6% received positive organizational support, and 84.5% received appropriate evaluation. Health personnel performance was determined by ability (OR= 2.98; p= 0.002), clarity (OR= 1.18; p= 0.013), help (OR= 2.98; p= 0.002), incentive (OR= 0.98; p= 0.054), evaluation (OR= 1.18; p= 0.013), and environment (OR= 0.80; p= 0.047).Conclusion: Health personnel performanceis determined by ACHIEVE model, except validity which was not examine in this study.Keywords: tuberculosis program, health personnel, performance, ACHIEVE modelCorrespondence: Reni Dwi Pangestuti. Masters Program in Public Health, Universitas Jember, Jl. Kalimantan I No.93, Krajan Timur, Sumbersari, Jember 68121, East Java. Email: renidwi730@gmail.com.Journal of Health Policy and Management (2018), 3(2): 71-75https://doi.org/10.26911/thejhpm.2018.03.02.02

Motivation, Competence, Workload, and Their Association with Nurse Performance in Dr. Arif Zaenudin Hospital, Surakarta

Pundati, Tia Martha, Tamtomo, Didik, Sulaeman, Endang Sutisna

Journal of Health Policy and Management Vol 3, No 2 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Nurses performance remains long standing determinates of quality service rendered for patients admitted to hospitals. Improvements in quality health service can be achieved by improving nurse performance. This study aimed to analyze the relationship of competence, motivation, and workload on the nurse performance in Surakarta.Subjects and Method: This was a cross sectional study conducted at Dr. Arif Zaenudin Mental Hospital, Surakarta, Central Java, from November 24 to December 24, 2017. A sample of 200 study subjects was selected by total sampling. The dependent variable is the nurses performance, while the independent variables are competence, motivation, workload, employment status, education and the distance between the nurses residence and the hospital. The dependent and independent variables were measured using a questionnaire. The data analysis was done using path analysis with the STATA 13 program.Results: The performance is influenced by competence (b= 1.08; 95% CI= 0.32 to 1.74; p= 0.005), motivation (b= 0.91; 95% CI= 0.15 to 1.68; p= 0.019), workload (b= 2.65; 95% CI= 1.91 to 3.40, p<0.001), there are 2 variables that have an indirect relationship with the nurses performance, namely education (b= 0.67; 95% CI= -1.24 to -0.11; p = 0.019) and the distance of residence (b= -0.61; 95% CI= -1.20 to -0.20; p= 0.043).Conclusion: There is a direct relationship between competence, motivation, workload and work period with nurse performance. There is an indirect relationship between education and home distance with performance.Keywords: pathway analysis, competence, motivation, workload, performanceCorrespondence: Tia Martha Pundati. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: tiamarthapundati@gmail.comJournal of Health Policy and Management (2018), 3(2): 63-70https://doi.org/10.26911/thejhpm.2018.03.02.01

Implementation of Community Mental Health Service in Malang, East Java

Ulya, Zuhrotun, Sulistyono, Adi, Novianto, Widodo T.

Journal of Health Policy and Management Vol 3, No 2 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: The culture of mental-health care in Indonesia relies heavily on backward pseudo-science rooted in dated spiritual traditions. In Indonesia, some people with mental disorder was shackled in sheds or backyards for years on end, which is known as pasung. Based on report, 1 in 7 mental disorder patients were at risk of pasung. The success of mental health service program need a collaboration from community as preventive and promotive besides curative component. This study aimed to analyze the legal system working based on legal, substance, and law’s culture in Wonorejo, Malang District, East Java.Subjects and Method: This was a qualitative study (descriptive non-doctrinal legal research) conducted in Wonorejo, Malang, East Java. Nine informants consisting of psychiatrist, general doctor, nurse, caregiver, social worker, public health officer, and village leader was selected for this study by purposive sampling. Data collected by interview, observation and documentary review. Data were analyzed by data reduction, presentation, and verification. Results: Integration of human resources is needed as a driver of the legal structure and there was urgency to add more resources (human, technology, fund). The constraint of this program is the limited number of workers (doctor, nurse, social worker) and limited distribution and kind of psychiatric drugs. Communication as a modality of legal substance has done well between social worker, caregiver, public health services, mental health hospital dan village). Community acceptance be legal culture was completely done by various educational programs, advocacy, and socialization. There was good coordination and acceptance between internal and external legal culture. The legal system has done well and leads to optimal community mental services.Conclusion: Analyzing of legal system working in community mental health services from structure, substance and legal culture in Wonorejo, Malang District, East Java has shown integration, effectiveness and acceptance from their community. Implication of this study that are needed policies to increase resources and fulfill of psychiatric drug distribution that was need by the patient.Keywords: community, mental health, legal systemCorrespondence: Zuhrotun Ulya. Masters Program in Law, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: psychiatry.law12@gmail.com. Mobile: 082232839048.Journal of Health Policy and Management (2018), 3(2): 108-113https://doi.org/10.26911/thejhpm.2018.03.02.07

Health System Strengthening: Adopting WHO Building Blocks- Comparison between India and Indonesia

Gill, Shikha

Journal of Health Policy and Management Vol 3, No 2 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: The objective of this review was to review and compare between Indian and Indonesian health systems. It attempted to understand the health system strengthening activities adopted by both the countries.Subjects and Method: This was a systematic review using qualitative method. The internet-based search strategy extended the traditional approach of using biblio­graphic data­bases, journals, citations to include grey literature, abstracts, web­sites, reports and documents from WHO, World Bank, Ministry of Health Indonesia, and Ministry of Health and Family Welfare India.Results: The concept of designating house­hold meeting requisite health standards as a healthy home is something which can be successfully implemented in India as social recognition plays a vital part in encouraging people to move towards healthier lifestyles. India is in the process of upgrading 150,000 Sub Centres into health and wellness centers. Compre­hensive health care will be provided in these centers, including for mother and child health and noninfectious diseases. Essential drugs and diagnostic services will be provided free of cost at these centers. Another notable feature from India is the concept of ASHA which is an acronym and stands for Accredited Social Health Activist. ASHAs are locally selected and trained women who performed the duties of health promoters and educators in communities. The ASHA is trained to work as an intermediary between the public health system and the community. Medical Insurance coverage for Primary Care and the concept of VVIP Rooms at differential pricing is some­thing which can be tried in Indian context while, the latest  Government funded medical insurance for Secondary and Tertiary care and Strategic purchase from Private sector is something Indonesia can emulate. For tackling the rural health care problems : schemes like National Rural Health Mission (NRHM) and mandatory service in rural areas by doctors if they want government job can be looked at by Indonesian Health care professionals. The concept of Posyandu (Maternity Hut) and the registered midwife clinics is a unique concept which can be tried in Indian Context.Conclusion: The Indian and Indonesian health care systems have been compared and contrasted.Keywords: health care system, India, IndonesiaCorrespondence: Shikha Gill. International Institute of Health Management Research, New Delhi, India Email: shikhaparttapgill@gmail.comJournal of Health Policy and Management (2018), 3(2): 101-108https://doi.org/10.26911/thejhpm.2018.03.02.06

BPJS Barrier to Strategic Purchasing of Primary Care Service at Public and Private Health Facilities in Subulussalam, Aceh

Darma, Satria, Juanita, Juanita, Rochadi, R. Kintoko

Journal of Health Policy and Management Vol 3, No 2 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Strategic purchasing plays an important role in the cost structure and competitiveness of small and large businesses. Managing Board of Social Insu-rance (BPJS) has implemented strategic purchasing of health services in the National Health Insurance (JKN) scheme. Strategic purchasing is important to provide quality products and services at low costs. Strategic purchasing of health service has five critical criteria: (1) what is to purchase; (2) to whom it is for; (3) whom it is from; (4) what is the price; (5) how to purchase it. This study aimed to assess BPJS barrier to strategic purchasing of primary care service at public and private health facilities in Subulussalam, Aceh.Subjects and Method: This was a qualitative study conducted in Subulussalam, Aceh, from February to July 2015. A total of 12 key informants for this study, including BPJS administrators and hospital managers. The theme was strategic purchasing of health service. The data were collected by in-depth interview, direct observation, and document review. The data was analyzed by thematic analysis.Results: BPJS administered the same standards of strategic purchasing health service from the public and private health providers. However, there were some unresolved problems: (1) BPJS faced difficulty to select primary care providers independently; (2) Illegal use of other member’s JKN card to get health service; (3) Redundant claims from the primary care providers; (4) Claim of inpatient days exceeding the maximum allowable limit; (5) Delay in non-capitations reimbur-sement payment to primary care provider; (6) Inequitable distribution of health manpower across health facilities.Conclusion: BPJS has implemented strategic purchasing of primary care services with the same standards applied to public and private primary care providers. However, there remain some problems of purchasing health services that call for immediate corrective actions, including routine monitoring, explanation of delay, advocacy, equitable distribution of health manpower.Keywords: strategic purchasing, primary care service, health facility, BPJS.Correspondence: Satria Darma. Department of Health Policy and Administration, Universitas Sumatera Utara, North Sumatera. Email: s4tria.darma@yahoo.com. Mobile: 085260077824.Journal of Health Polic and Management (2018), 3(2): 81-91https://doi.org/10.26911/thejhpm.2018.03.02.03

Legal Construction of Nursing Accountability in Circumcision Practice

Sediyo, Panggih, Isharyanto, Isharyanto, Suryono, Arief

Journal of Health Policy and Management Vol 3, No 2 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Circumcision is one of the surgical practices often performed by nurses in rural and urban areas. Minister of Health Decree No. 1239 of 2001 on the registration and practice of nurses has not provided clarity on the limits of authority and legal protection for certain nurses. Many nurses provide services in the community that are not in accordance with the rules and authority.Subjects and Method: This was a normative study with statute, case study, and conceptual approach. Legal materials were collected using document review. Legal materials were analyzed by describing the problem under study.Results: Article 65 of Law Number 36 the Year 2014 on Health Personnel provides delegation of authority from the doctor to the nurse if the doctor cannot perform a medical service, provided that the physician is obliged to provide clear written authority delegation to perform the medical service. Regulation of the Minister of Health of the Republic of Indonesia No. 17 of 2013 on Amendment to Regulation of the Minister of Health No. Hk.02.02/Menkes/148/I/2010 Concer­ning Permits and Implementation of Nurse Practices states that medical service can only be delivered based on written request from the doctor. Regulation of the Minister of Health of the Republic of Indonesia Number 17 the Year 2013 Concerning Amendment to Regulation of the Minister of Health No. Hk.02.02/Menkes/148/I/2010 Concerning Permission and Implemen­tation of Nurse Practice Article 3a authorize Nurses to undertake nursing practice in health-care facilities outside of the solo practice.Conclusion: Legal construction for nurses who practice circumcision provides legal certainty in the rules relating to solo practice so that there is a law protection. Ministerial Regulation does not have binding power. The researcher suggests that a more binding legal regulation of circumcision by nurses be developed, for example by adding to the provisions of Law No. 36 of 2014.Keywords: circumcision, health service, nursing accountability, legal protection, nurse authorityCorrespondence: Panggih Sediyo. Masters Program in Law, Universitas Sebelas Maret, Jl. Ir. Sutami No. 36 A, 57126, Surakarta, Central Java. Email: panggihsediyo@gmail.com. Mobile: +6285726509884.Journal of Health Policy and Management (2018), 3(2): 92-100https://doi.org/10.26911/thejhpm.2018.03.02.05

The Determinants of Health Consultation Utilization among HIV Patients at Budi Kemuliaan Hospital, Batam, Indonesia

Siregar, Dawiyah, Juanita, Juanita, Rochadi, R. Kintoko

Journal of Health Policy and Management Vol 3, No 2 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: HIV and AIDS is a global public health problem. Until the end of 2016, there were more than 36.7 million people living with HIV. HIV & AIDS counseling is a confidential communication between clients and counselors aimed at increasing the ability to deal with stress and make decisions regarding HIV & AIDS. The purpose of this study was to determine the effect of the ability to pay and the environmental factor on consultation health service utilization at Budi Kemuliaan hospital, Batam.Subjects and Method: This was a cross-sectional study was conducted at Budi Kemuliaan Hospital, Batam, from May 8 to June 18, 2018. A sample of 76 HIV patients was selected by systematic random sampling. The dependent variable was the use of consulting service. The independent variables were risk of illness and environment. The data were collected using questionnaires and analyzed by a multiple logistic regression.Results: The use of consultation health service was influenced by the risk of illness (OR = 6.82; p = 0.011) and supportive environment (OR= 4.59; p= 0.028).Conclusions: The use of consultation services is influenced by risk factors for illness and the environment.Keywords: consultation service, the risk of illness, environment, HIV/AIDS patientCorrespondence: Dawiyah Siregar. Department of Administration and Health Policy. Universitas Sumatera Utara, Jl. Universitas No.32, Padang Bulan, Medan Baru, Medan, North Sumatera 20222. Email: dawiyahsrg@gmail.com. Mobile: +6281267500608Journal of Health Policy and Management (2018), 3(2): 76-80https://doi.org/10.26911/thejhpm.2018.03.02.03 

Does Accreditation Status Affect Job Performance of the Electronic Medical Record Clerks at Community Health Center?

Seha, Harinto Nur, Tamtomo, Didik, Sulaeman, Endang Sutisna

Journal of Health Policy and Management Vol 3, No 1 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Primary care doctors and other staff working in primary care require comprehensive and accurate data on patients at the point-of-care if they are to provide high quality health services to their patients. Electronic patient records are an effective method of achieving this objective, by dispensing with the need to use difficult to access, and often illegible, paper-based records. This study aimed to analyze the effect of accreditation status on job performance of the electronic medical record clerks at community health center.Subjects and Method: This was an analytic observational study with a cross-sectional design. The study conducted for 25 puskesmas (community health centers), in Yogyakarta, from March to June 2018. A sample of 200 patient medical records was selected by simple random sampling. The dependent variables were completeness and accuracy of medical record. The independent variables were tenure and multi task as level 1 in the multilevel model (MLM). Accreditation status of puskesmas was taken as level 2 in the MLM. The data were collected by questionnaire and analyzed by MLM.Result: Longer tenure (b= 1.03; 95% CI= 0.30 to 1.77; p= 0.006) and single task occupation (b= 4.21; 95% CI= 6.23 to 2.20; p<0.001) were positively associated with completeness of electronic medical record. Likewise, longer tenure (b= 0.54; 95% CI= 0.079 to 1.01; p= 0.022) and single task occupation (b= 2.14; 95% CI= 3.42 to 0.87; p= 0.001) were positively associated with accuracy of medical record medical record. Accreditation status of puskesmas showed negligible contextual effect on completeness (ICC= 0.36%) and accuracy (ICC= 1.17%) of the electronic medical record.Conclusion: Longer tenure and single task occupation are positively associated with completeness and accuracy of medical record. Accreditation status of puskesmas shows negligible contextual effect on completeness and accuracy of the electronic medical record.Keywords: completeness, accuracy, tenure, occupation, accreditation status, community health center, electronic medical recordCorrespondence: Harinto Nur Seha. Medical Record and Health Information, School of Health Polytechnics Permata Indonesia, Yogyakarta. Email: harinto_ns@permataindonesia.ac.id. Mobile: +62 85749724513.Journal of Health Policy and Management (2018), 3(1): 56-62https://doi.org/10.26911/thejhpm.2018.03.01.08

Predictors of Work Performance among Nurses at PKU Muhammadiyah Hospital, Yogyakarta

Rusmitasari, Heni, Sulaeman, Endang Sutisna, Murti, Bhisma

Journal of Health Policy and Management Vol 3, No 1 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: A nurse has an important role as a caregiver for patients and helps to manage physical needs, prevent illness, and treat health conditions.This study aimed to determine predictors of work performance among nurses at PKU Muhammadiyah Hospital, Yogyakarta.Subjects and Method: This was an analytic observational study with a cross-sectional design. The study was conducted at PKU Muhammadiyah Hospital, Yogyakarta, from April to June 2018. A sample of 203 nurses was selected for this study by simple random sampling. The dependent variable was work performance. The independent variables were motivation, skill, tenure, and motivation. The data were collected by questionnaire and analyzed by path analysis.Results: Work performance was directly improved with better skill (b=1.74; 95%CI= 1.07 to 2.41; p<0.001), longer tenure (b=0.71; 95%CI= 0.07 to 1.35; p= 0.003), and stronger motivation (b=-0.62; 95%CI= -0.07 to 1.31; p= 0.079). Work performance was indirectly affected by satisfaction. Conclusion: Work performance is directly improved with skill, tenure, motivation, and is indirectly affected by satisfaction.Keywords: work performance, tenure, motivation, skill, satisfactionCorrespondence: Heni Rusmitasari. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: heni.rusmitasari@gmail.comJournal of Health Policy and Management (2018), 3(1): 41-46https://doi.org/10.26911/thejhpm.2018.03.01.06

Factors Affecting the Quality of Microscopic Tuberculosis Examination in Madiun, East Java: A Multilevel Analysis

Hartini, Sri, Sulaeman, Endang Sutisna, Murti, Bhisma

Journal of Health Policy and Management Vol 3, No 1 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Tuberculosis (TB) remains major cause of morbidity and mortality due to any one of infectious agent worldwide. In low income countries, Ziehl-Neelsen sputum smear microscopy is the only cost-effective tool for diagnosis and monitoring of patients on treatment. Refresher training for laboratory professionals involved in Acid Fast Bacilli (AFB) microscopy at peripheral health facilities is important. This study aimed to assess factors affecting the quality of microscopic tuberculosis examination in Madiun, East Java, using a multilevel analysis model.Subjects and Method: A cross-sectional study conducted at 23 puskesmas (community health centers) in Madiun, East Java, from March to April 2018. A sample of 230 preparations was selected by simple random sampling. The dependent variable was quality of microscopic TB examination. The independent variables were tenure, refresher training, and accreditation status of puskesmas. The data were collected by questionnaire and analyzed by a multilevel logistic regression.Results: Quality of microscopic TB examination was positively associated with tenure ≥3 years (b= 2.77; 95% CI= 0.81 to 4.73; p= 0.006) and accredited community health center (b= 3.06; 95% CI= 0.81 to 4.62; p<0.001). The association between refresher training and quality of microscopic TB examination was not statistically significant (b= -0.51; 95% CI= -2.33 to 1.32; p= 0.580). Puskesmas had a contextual effect on quality of microscopic TB examination with ICC= 22.01%.Conclusion: Quality of microscopic TB examination is positively associated with tenure and accredited puskesmas. Refresher training for laboratory technicians was not effective in improving the quality of microscopic TB examination Puskesmas has a considerable contextual effect on quality of microscopic TB examination.Keywords: microscopic TB examination, quality, tenure, community health center, accreditation, multilevel analysisCorrespondence: Sri Hartini, Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: hartinis191@gmail.comJournal of Health Policy and Management (2018), 3(1): 34-40https://doi.org/10.26911/thejhpm.2018.03.01.05