RINGKASAN EKSEKUTIF
The project title of “Guided by the NAPHS, this consortium led by CHPM will focus on addressing specific gaps and building specific capacities of the MoH to detect, prevent & respond to public health threats in Indonesia”, demonstrated progress in detecting and responding to public health threats in collaboration with Indonesian Ministry of Health (MoH). This is a long-term project funded by the Centers for Disease Control and Prevention (CDC) to support Indonesia in achieving the Global Health Security Agenda (GHSA). We use terms of INSPIRASI (Improving Quality of Disease Preparedness, Surveillance & Response In Indonesia) as the program's name to create an easily pronounceable acronym. As a result, individuals or entities are easy to remember and willing to participate in this initiative.
TUJUAN
- to strengthen real-time surveillance by improving SKDR (EWARS) Data Recording and Reporting Quality Using ICD-10 and the utilization
- to further increase the capacity of PHEOC and surveillance activity piloting in South Sulawesi through functional-scale exercise and build an online training platform to ensure sustainability of education and information regarding the usage of EWARS application, PHEOC, and surveillance training.
TIM
Internal:
- Dr. dr. Hanevi Djasri, MARS, FISQua.
- Muhammad Hardhantyo P., MPH, Ph.D
- Anantasia Noviana, S.E.
- dr. Aldilas Achmad Nursetyo., MPH.
- Bernadeta Rachela
- Andriani Yulianti. S.E., MPH
- Eva Tirtabayu Hasri, S.Kep., MPH
- Rita Agita Saraswati
- Rizky Adinda, S.Kom
WAKTU
29 September 2022 – 30 September 2023
RINGKASAN EKSEKUTIF
Zoonotic diseases are an important global public health risk as a result of human-animal interactions, notably in Indonesia, in which 75% of Emerging Infectious Diseases are caused by zoonotic disease. Control of infectious diseases, including zoonoses, needs a one-health approach involving multisector from human, animal, wildlife, and other relevant sectors. The biggest challenge in implementing one health in Indonesia is maintaining resources from different ministries/departments. Improving coordination, collaboration, and building networks under one health approach is essential.
To improve the capacity of one health approach, we need to conduct 'Training of Trainers' Training on Zoonosis Prevention and Control using Ministry of Health (MoH) standard curricula with a participant from Provincial Health Offices (PHO), Animal Health Offices and Conservation of Natural Resources (BKSDA) in 30 Provinces of Indonesia. The participant will eventually become the "Master trainer" in their region, capable of implementing and disseminating information about the One Health approach.
Reaching the knowledge to 30 Provinces with multiple sectors involved is challenging; therefore, we used a hybrid teaching methodology through blended learning. Blended learning provides innovative solutions through a mix of classical onsite teaching combined with online synchronous and asynchronous programs. Training will be standardized through accreditation from BPPSDMK. Therefore facilitators, instructors, and an online Learning Management System (LMS) will be provided by BBPK Ciloto. These methods will able the participants to access learning materials from any location and at any time.
By the end of the program, we will have 120 master trainers in zoonotic diseases from 30 provinces throughout Indonesia. Furthermore, since the training is accredited by the Ministry of Health, it can be implemented by other organizations, increasing the number of individuals who understand on the zoonosis prevention and control using a one health approach.
TUJUAN
- Process training accreditation and training certification of Training of Trainers’ Trainings on One-Health Zoonosis Prevention and Control.
- Conduct four batch of Training of Trainers (ToT) trainings for 30 provinces for Training of Trainers’ Trainings on One-Health Zoonosis Prevention and Control for Provincial Health Offices (PHO), Animal Health Offices and Conservation of Natural Resources (BKSDA).
HASIL DAN REKOMENDASI
- Documents of ToTTrainings Plan on One-Health Zoonosis Prevention and Control consist of: TOR, participant, trainer and program implementation evaluation form, schedule, list of trainers, list of training facilities and infrastructure and field work guideline.
- Training accreditation on ‘Training of Trainers’ Trainings on One-Health Zoonosis Prevention and Control
- Organize four batches of ‘Training of Trainers’ Trainings on One-Health Zoonosis Prevention and Control covering 30 provinces with total 120 participant
- Evaluation report on every batch of training
- List of certified Trainers
- Comprehensive report of the activities, including technical and financial report presented to the World Health Organization.
TIM
Internal:
- Dr. dr. Hanevi Djasri, MARS, FISQua.
- Muhammad Hardhantyo P., MPH, Ph.D
- Anantasia Noviana, S.E.
- Eva Tirtabayu Hasri, S.Kep., MPH
- Indra Komala, MPH
WAKTU
9 Juni 2022 – 30 September 2022
RINGKASAN EKSEKUTIF
Program pendampingan peningkatan perencanaan dan penganggaran program kesehatan di Kabupaten merupakan upaya untuk mengatasi permasalahan yang biasa muncul dalam implementasi program kesehatan di daerah.
Program-program menjadi kurang efektif untuk mengatasi masalah-masalah kesehatan di lapangan. Salah satu penyebabnya adalah karena proses perencanaan yang kurang baik. Perencanaan yang tidak kuat dapat membuat program tidak efektif.
Berikut beberapa penyebab permasalahan dalam proses perencanaan:
- Dokumen rencana kerja (renja) tidak sesuai dengan nomenklatur anggaran
- Anggaran tidak dimonitor setelah disetujui
- Program dilaksanakan bukan berdasarkan kebutuhan
- Program tidak tepat sasaran
- Pemotongan dan keterbatasan anggaran
- Program kurang rinci
TUJUAN
Secara umum kegiatan ini bertujuan untuk mendampingi Kabupaten Kutai Barat Provinsi
Kalimantan Timur agar mempunyai kompetensi yang baik dan meningkatnya mutu pengelolaan pembangunan kesehatan di daerah dimana dalam menyusun Rencana Kerja Perangkat Daerah (Renja PD) dengan komprehensif, terintegrasi, dan evidence based
LOKASI
- Kab. Melawi, Kalimantan Barat
- Kab. Sintang, Kalimantan Barat
- Kab. Kutai Barat, Kalimantan Timur
- Kab. Mahakam Ulu, Kalimantan Timur
HASIL DAN REKOMENDASI
Hasil pendampingan :
- Tersusunnya Renja Kabupaten Melawi tahun 2021 dan 2022
- Proses perencanaan dan penganggaran di daerah sudah mengikuti aturan - aturan dari Pemerintah Pusat
Sektor selain kesehatan memegang peranan penting perencanaan dan penganggaran
Kesehatan sehingga diperlukan tahapan lebih lanjut untuk memperkuat hubungan lintas sektor seperti:
- Seminar penguatan perencana dan pelaksanaan program kesehatan dalam upaya meningkatkan status kesehatan dan kesejahteraan masyarakat.
- Audiensi atau diskusi kecil dengan berbagai sektor baik di tingkat kecamatanmaupun kabupaten.
- Melakukan pengukuran penilaian (assesment) untuk mendapatkan gambaran kekuatan dan kelemahan lintas sektor dalam kolaborasi untuk perencanaan dan pelaksanaan program kesehatan.
TIM
Internal:
- dr. Mubasysyir H.B., MA
- Ahmad Watsiq Maula, MPH
- Faozi Kurniawan, SE, Akt, MPH
- Faisal, SKM, MPH
- Citra Widya Kusuma, S.Gz, MPH
- Candra, SKM, MPH
- Agus Salim, SKM, MPH
- Maria Wigati, S.Gz, MPH
- Annisa Luthfia S., S.Gz, MPH
- Anantasia Noviana, SE
WAKTU
1 Maret – 30 Oktober 2022
RINGKASAN EKSEKUTIF
As a respond to the situation, the Government of Indonesia (GoI) introduced a promising National Strategy to Accelerate Stunting Prevention/StraNas Stunting (2018-2024) with ambitious target of reducing stunting to 14% in 2024. In order to get a picture of the implementation of stunting reduction and acceleration program Japan International Cooperation Agency (JICA) work together with Center for Health Policy and Management (CHPM) conducted a data collection survey for nutrition improvement to the stunting reduction. This survey aims to understand the situation of nutrition intervention to accelerate the stunting reduction as well as the progress toward the target. The findings from this case study is important for all parties including Government of Indonesia, development partners, academicians, and local government to get the overview of the national strategies to accelerate stunting reduction which can be used to enrich the existing monitoring and evaluation in order to design and plan for the improvement of the program.
TUJUAN
The focus of this case study is to investigate the implementation of nutrition specific program that related to first 1.000 days of life which consist of:
- Local policy and regulation that support acceleration of stunting reduction.
- Organizational and governance of stunting reduction team/partners in the provincial and district/city level including their role and interest.
- Nutrition services delivery and its challenges including management and operational challenges, cultural challenges, program challenges, etc.;
- Health information system including monitoring and evaluation mechanism; and Financing the stunting reduction program and its challenges
LOKASI
Jawa Barat, Bali, dan Nusa Tenggara Timur
HASIL DAN REKOMENDASI
Findings from this study suggest that some improvement has been identified in the stunting reduction and acceleration program in Indonesia, yet many works still needed to ensure the sustainability of the program in the future. Some notable findings that can be concluded from this study are:
- Although the prevalence of stunting in Indonesia has declined for these past years, the declining rate need further examination and analysis given the weak of data and information system and possible pandemic effect to the utilization of the services.
- Some key indicators in the maternal health have shown progress like delivery in health facilities, ANC, food supplementation for pregnant women, and IFA supplementation. However, key preventive interventions still need to be improved including IFA supplementation for adolescence girls, exclusive breastfeeding, infant and young child feeding, basic immunization, and growth monitoring. Achievement in the district level vary with low prevalence districts performed better compared to high prevalence districts.
- The implementation of new President Law No. 72/2021 with risk mitigation approach, TPPS, and family assistance team features still unable to solve the challenges in the field due to various factors including low capacity of human resources, unclear technical guidelines of operational, inadequate capacity building, lack of equipment support, and limited innovation to improve quality services.
- Convergence action as the key approach of StraNas Stunting in the district level still unable to improve the synchronization and promote efficiency of various nutrition-related services. Disconnection in planning, budgeting, and execution due to limited local staff capacity and unreliable data led to duplication and misallocation of resources.
- Improvement in health information system is not followed by improvement in infrastructure and human resources to manage the data collection process. Also, the usability of existing data for program improvement appear to be weak with multiple platform/application, unintegrated data management, and wide knowledge gap in evidence generation;
- Financing of stunting reduction and acceleration program is heavily depended on national provision including anthropometric tools, vaccines, vitamin A, food supplementation, etc. District government has limited contribution to the program with lack of innovation.
Recommendation
In these past 3 years of implementation, StraNas Stunting has brought a quite significant change to the nutrition program and intervention both in national and sub-national level. While majority of the program components in stunting reduction already covered by government and partners, there are some concerns and issues that still need attention, such as:
- Improvement of health information system that allow seamless exchange of information across levels of government and among stakeholders with quality and performance indicators in place. The existing information system still have weaknesses that need to be improve where multiple data sources exist with iterative task that need to perform. Besides, the indicators selected still not represent the quality aspect of the program. An advance data integration mechanism needs to be put in place to consolidate all these different data management system into one integrated and accessible system that can provide meaningful information for program improvement.
- Provision of clear strategic planning and budgeting process with focus on incentivize better reporting and accountability process including performance-based measured. Majority of the stunting program depends on the ability of district staff to analyze, plan, execute, monitor, and evaluate the implementation process in the district level yet they do not have enough capacities to do all those tasks due to various reasons. Thus, the national government need to provide adequate supports for them to promote strategic planning for effectivity and efficiency in program planning and execution. Simplification of bureaucracy, improvement of staff capacity, quality control of the program selection, and synchronization in cross-sector coordination and programs are examples of concerns that can be done strategically.
- Improvement of the quality of nutrition related services by provision of necessary inputs with focus on preventive actions. Most of the nutrition related services rely heavily on voluntary workers (cadre) who inadequately support with low incentives and little training. Besides, geographical inequality makes it difficult to reach all the targeted population in the district level. Program selection need to be directed to long-term cost-effective actions like adolescence girl supplementation, exclusive breastfeeding, growth monitoring, behavior change and communication, and infant and young child feeding compared to short-term solution like food supplementation. Strengthening of Posyandu and Puskesmas as the closest health care facilities need to be prioritized.
- Strengthen the organizational and governance of stunting reduction team with clear role distribution and incentives. The TPPS and BKKBN need to be supported by all stakeholder to be able to run their function as the leading sector in the stunting reduction and acceleration program. All parties in the TPPS need to understand their role and incentivized to ensure the convergence action implemented properly in all levels of government. Effective mechanism for coordination and communication must be set in place to accommodate all parties interest and close the knowledge gap.
Based on JICA portfolio and interest as well as a long history of collaboration with developing countries, there are some initiatives that can be done with the GoI for strengthening the stunting reduction and acceleration program, including:
- Development of dietary guidance to support the implementation of IYCF integrated in the nutrition education program. Japan has known for their continuous education of healthy dietary practices though “Shokuiku” which include what to eat, when to eat, and eating with others. The guidance will add more insight to the existing IYCF programs that still weak in engaging parents/caregivers to comply with the nutritious practice when moving from exclusive breastfeeding to complimentary food. Continuous education and promotion will hopefully have an impact to the knowledge, attitude, and behavior of parents/caregivers to pay attention to the nutritious intake for their babies/children for their growth and development. JICA has done collaboration work with MoH in MNH Book for decades which can be improved to increase utilization and addition of behavior change and communication campaign related to the first 1,000 days of life interventions for stunting reduction.
- Supporting researches in key topics to close the knowledge gaps and strengthen the nutrition policies. Research in key topics need to be intensified especially in determining the underlying factor of stunting given the different geographical and socio-economic characteristics in Indonesia. The results from the research should become the basis for nutrition policy development which hopefully can answer the needs of community and promote better program synchronization among stakeholders. Japan has known for its evident-based policies development in nutrition since 1800s with annual nutrition survey, etc. Support from JICA can strengthen and fix the evident-based generation efforts though national and sub-national survey and provide better understanding of the nutrition situation to produce more effective policies in IndonIndonesia.ning of health worker and cadre in the community in behavior change and communication campaign to support the delivery of quality nutrition services. The competency of health worker and cadre in nutrition service delivery still become a significant problem that affect the quality of nutrition services. Learning from the “Shokuiku”, JICA can support the improvement of health worker and cadre to be able to deliver the essential nutrition service for stunting reductions including the behavior change and communication campaign for key nutritional activities like exclusive breastfeeding, IYCF, basic immunization, etc.
TIM
Internal:
- Dr. dr. Hanevi Djasri, MARS, FISQua
- Stevie Ardianto Nappoe, MPH
- Andriani Yulianti, SE, MPH
- Eva Tirta Bayu Hasri, S.Kep, MPH
- Anantasia Noviana, SE
WAKTU
30 Juni – 29 September 2022
RINGKASAN EKSEKUTIF
This case study will focus on evaluation of performance-based capitation payment system as the tools for purchasing arrangement especially in PROLANIS program and its impact to the quality of NCDs services in Indonesia. Specifically, to answer several question including: Program overview, provider participation, quality monitoring, reward structure, payments, evaluation of impact, and facilitating factors.
The case study will use exploratory approach which consist of “what” and “who” questions of how the purchasing arrangement and quality of NCDs management performed. The data will be collected using primary and secondary methods to explore how the purchasing arrangement for chronic illness work and how the impact of the purchasing arrangement to the quality of chronic illness management. The primary data will be collected from in-depth interview with key stakeholder representatives and program implementer in the field while secondary data will be collected from documents including policy and regulation documents, program reports, monitoring and evaluation reports, and available research article that discuss about the performance-based capitation payment system and PROLANIS program.
TUJUAN
This case study will focus on evaluation of performance-based capitation payment system as the tools for purchasing arrangement especially in PROLANIS program and its impact to the quality of NCDs services in Indonesia. Specifically, there are several key questions that hopefully will be answered from this case study
LOKASI
Medan, Makasar, Jakarta
HASIL DAN REKOMENDASI
Kegiatan masih berlangsung sampai dengan Maret 2023
TIM
Internal:
- Prof. dr. Laksono Trisnantoro, MSc, PhD
- Dr. dr. Hanevi Djasri, MARS, FISQua
- Stevie Ardianto Nappoe, SKM, MPH
- Muhammad Fauzi Kurniawan, SE, MPH
- Aghna Gayatri, MSc, SpKKLP, PhD
- Dr. Ahmad Muhammad Kasim, S.Kep., M.Kes
- Anantasia Noviana
WAKTU
30 Juni – 29 September 2022
RINGKASAN EKSEKUTIF
Strengthen the PHC as the entry point of health services hopefully can be the answer of those problems. Though the Law No. 40/2004 concerning the National Social Security System (Sistem Jaminan Sosial Nasional/SJSN), the Government of Indonesia (GoI) has considered the PHC as the vital component to provide quality of health care to all Indonesian people as mandate by the constitution. The important role of PHC also included in the strategy to achieve the 2030 SDGs as well as the Minimum Service Standards (Standar Pelayanan Minimum/SPM).
One way to strengthen the PHC is through health service integration. According to WHO health service integration is health services that respond to the need of individuals and population through delivery of comprehensive good-quality health programs (including health promotion, disease prevention, diagnosis, treatment, disease-management, rehabilitation, and palliative care) by multidisciplinary team who work together in different setting. The benefits of having integrated services in PHC are improve access, reduce hospitalization and readmission, increase adherence to treatment, enhance patient satisfaction, promote health literacy and health promotion for the community, increase job satisfaction for health care workers, improve efficiency, and reduce the cost. The health service integration can be done in 4 main areas including primary care and public health integration, primary-secondary and tertiary-care integration, dedicated health initiatives integration, and multisectoral integration (WHO, 2018b).
Despite the significant benefit that health service integration offer, Indonesia and other LMIC countries have not been able to implement the integrated care initiative effectively due to constraint in resources (infrastructure and human resources). Although, some form of integration exist, those integration is only partially done with focus on specific cluster of services (e.g HIV-TB, MNCH-family planning), communicable disease prevention program (e.g HIV) or services for specific group of population (e.g maternal and child health) (Mounier-Jack, Mayhew, & Mays, 2017). Thus, it is important for Indonesia to have a feasible model of integrated service delivery that can be implemented to strengthen the PHC in providing quality services and contribute to the journey to UHC.
MoH through the Directorate of Primary Health Care Service as the government official in this business need to be informed about the possible model to be able to design policies for both public and private PHC to uptake the health care integration seriously. A situational analysis of the current performance of PHC is needed before considering the right integration model. Also, piloting with rigorous monitoring and evaluation must be done to test the model in the real health care setting. Plus, a roadmap must be developed to ensure the pathway to health service integration is available and can be used by the MoH to oversee the process of integration in Indonesia.
TUJUAN
- Provide situational analysis on PHC performance and management in Indonesia;
- Develop a proposal of the concept and design of health service integration and collaboration in PHC facilities that can be applied in Indonesia;
- Develop piloting plan and the protocol for monitoring and evaluation for health service integration and collaboration;
- Conduct the piloting and evaluation of the proposed model of integration in 2 districts in Indonesia;
- Develop health service integration roadmap.
LOKASI
Uji Coba Konsep:
- Kota Bandung Jawa Barat
- Kota Padang Sumatera Barat
Uji Coba Pelaksanaan:
- Kab Solok Sumbar
- Kab Kendal Jateng
- Kota Madiun Jatim
- Kota Makassar Sulsel
- Kab Deli Serdang Sumut
- Kota Palembang Sumsel
HASIL DAN REKOMENDASI
Rekomendasi Kebijakan IQ-Care
Internal:
- Dr. dr. Hanevi Djasri, MARS, FISQua
- Eva Tirtabayu Hasri, SKep, MPH
- Andriyani Yulianti, SE, MPH
- Stevie Ardianto Nappoe, SKM, MPH
- Anantasia Noviana
WAKTU
2020-2022