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"Upaya mencapai Universal Health Coverage (UHC) dengan memprioritaskan layanan kesehatan primer (PHC) sudah disepakati melalui Deklarasi Astana Tahun 2018. Identifikasi tantangan dalam sistem pendanaan PHC secara global dilakukan agar menjadi lessons learned untuk perbaikan implementasi kedepan, khususnya bagi Indonesia, sebagai masukan bagi Transformasi Kesehatan. Penelitian ini menggunakan metode scoping review melalui tiga database, yaitu Pubmed, EBSCOhost MEDLINE, dan Scopus, dengan total 43 literatur terinklusi. Tantangan pendanaan PHC ditinjau melalui tiga fungsi, yaitu revenue collection, pooling, dan purchasing. Tantangan dalam revenue collection antara lain sumber pendanaan yang tidak berkelanjutan dan minimnya akuntabilitas proses pengumpulan dana. Tantangan fungsi pooling meliputi terbatasnya cakupan peserta dalam pooling, banyaknya pooling dan tidak tersedianya regulasi yang mengatur beragam pooling untuk pendanaan satu program yang sama, lebih diutamakannya pendanaan layanan rujukan dibandingkan PHC, dan belum dilakukannya pengalokasian anggaran yang disesuaikan dengan risiko dan kebutuhan. Sementara itu, tantangan fungsi purchasing meliputi paket manfaat yang belum sesuai dengan kebutuhan, beban administratif yang besar untuk purchasing, tata kelola provider dan purchaser yang tidak akuntabel, serta besarnya intervensi politik terhadap keputusan purchaser dalam penentuan paket manfaat. Tantangan pendanaan PHC merupakan suatu satu kesatuan sistem pendanaan, sehingga tantangan yang terjadi di fungsi yang satu akan memengaruhi atau memicu munculnya tantangan di fungsi lainnya. Lessons learned untuk Transformasi Kesehatan Indonesia bahwa penghapusan skema alokasi earmarking perlu diikuti implementasi RIBK yang akuntabel. Indonesia sudah memiliki komitmen politik berupa berbagai regulasi untuk mencapai UHC melalui PHC, tetapi masih perlu memperhatikan dukungan SDM dan infrastruktur lainnya agar regulasi bisa dijalankan di tingkat layanan primer. Selain itu, trade-off antara cakupan penduduk dan cakupan layanan paket manfaat perlu diputuskan dengan berbagai pendekatan yang menjunjung nilai value for money dan tetap mengutamakan investasi ke layanan kesehatan primer.

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Efforts to achieve Universal Health Coverage (UHC) by prioritizing primary health care (PHC) have been agreed upon through the 2018 Astana Declaration. Identification of challenges in the PHC financing system globally was carried out to become lessons learned for future implementation improvements, especially for Indonesia, as input for Health Transformation. This study used a scoping review method through three databases, namely Pubmed, EBSCOhost MEDLINE, and Scopus, with a total of 43 included literature. PHC financing challenges were reviewed through three functions, namely revenue collection, pooling, and purchasing. Challenges in revenue collection include unsustainable financing sources and lack of accountability in the fund collection process. Challenges in the pooling function include the limited coverage of participants in the pool, the large number of pools and the unavailability of regulations governing various pools for financing the same program, the financing prioritization for referral services over PHC, and the lack of budget allocation tailored to risk and needs. Meanwhile, the challenges of the purchasing function include benefit packages that are not in accordance with the needs, a large administrative burden for purchasing, unaccountable governance of providers and purchasers, and a large amount of political intervention in purchaser decisions in determining benefit packages. PHC financing challenges are a unified financing system, so challenges that occur in one function will affect or trigger challenges in other functions. Lessons learned for Indonesia's Health Transformation is that the elimination of the earmarking allocation scheme needs to be followed by the implementation of an accountable RIBK. Indonesia already has the political commitment in the form of various regulations to achieve UHC through PHC. Still, it needs to pay attention to HR support and other infrastructure so that regulations can be implemented at the primary care level. In addition, the trade-off between population coverage and benefit package service coverage needs to be decided with various approaches that uphold value for money and still prioritize investment in primary health services."

"Pelayanan kesehatan primer merupakan elemen utama dari proses pelayanan kesehatan berkelanjutan. Pelayanan kesehatan primer didaulat sebagai level pertama kontak pasien terhadap pelayanan kesehatan. Namun dalam pelaksanaanya apabila tidak dilakukan dengan komprehensif akan berdampak terhadap kesenjangan pelayanan kesehatan di tingkat primer. Hal ini menunjukan bahwa pelaksanaan pelayanan kesehatan di tingkat primer belum optimal. Oleh sebab itu sistem gatekeeping dirancang untuk mengatasi masalah kesehatan utama di masyarakat yang dikemas secara terjangkau, melalui pelayanan kesehatan promotive, preventif, kuratif, dan rehabilitative. Penelitian ini bertujuan untuk mengetahui gambaran pelaksanaan dan dampak dari implementasi sistem gatekeeping di berbagai negara. Informasi pada penelitian ini diperoleh berdasarkan hasil penelusuran website dan jurnal yang telah dipublikasikan dengan bantuan akses online database seperti ScienceDirect, PubMed, Proquest, dan WileyOnline.Terdapat 10 studi yang termasuk kedalam penelitian ini. Hasil penelitian menunjukah bahwa sistem gatekeeping telah dilakukan di berbagai negara dengan kebijakan yang berbeda-beda. Faktor dukungan dari unsur tenaga kesehatan, fasilitas pelayanan kesehatan yang memadai dan status pendidikan pasien berkontribusi dalam efektivitas pelaksanaan sistem gatekeeping. Sistem gatekeeping berdampak positif yang menyebabkan utilisasi spesialis di fasilitas pelayanan kesehatan tingkat lanjut menurun dan menyebabkan biaya pengeluaran rendah. Namun, ditemukan bahwa pelaksanaan sistem gatekeeping berdampak negatif terhadap kepuasan pasien yaitu berkurangnya tingkat kepuasan pasien akibat waktu tunggu yang lebih lama dalam meengakses pelayanan kesehatan.

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Primary health care is the main element of the sustainable health care process. Primary health services are asked to be the first level of patient contact with health services. However, if it is not carried out comprehensively, it will have an impact on health services at the primary level. This shows that the implementation of health services at the primary level has not been optimal. Therefore, the gatekeeping system is designed to address the main health problems in the community that are packaged in an affordable way, through promotive, preventive, curative and rehabilitative health services. This study aims to describe the implementation and impact of the implementation of the gatekeeping system in various countries. The information in this study was obtained based on the results of browsing websites and journals that have received assistance in accessing online databases such as ScienceDirect, PubMed, Proquest, and WileyOnline. There are 10 studies included in this study. The results of the study show that the gatekeeping system has been carried out in various countries with different policies. Support factors from elements of health workers, adequate health care facilities and patient education status contribute to the effectiveness of the implementation of the gatekeeping system. The gatekeeping system has a positive impact on reducing visits to specialists and plays a role in reducing utilization and costs. However, in patient satisfaction the implementation of the gatekeeping system was found to have a negative impact, namely reducing the level of patient satisfaction due to long waiting times in accessing health services."

"Transformasi pelayanan kesehatan primer merupakan Pilar Pertama dalam Transformasi Kesehatan. Pendampingan Integrasi Pelayanan Kesehatan Primer di Puskesmas (ILP) untuk mewujudkan fokus transformasi pelayanan kesehatan primer dilaksanakan pada bulan Juli sampai Oktober 2022. Penelitian bertujuan melakukan analisis kebijakan ILP di lokasi intervensi awal, mewakili karakteristik wilayah Puskesmas. Lokasi penelitian adalah Puskesmas Kebonsari, Kota Surabaya, Puskesmas Jereweh, Kabupaten Sumbawa Barat, Puskesmas Banjarwangi, Kabupaten Garut, dan Puskesmas Niki-Niki, Kabupaten Timor Tengah Selatan. Penelitian menggunakan metode penelitian kualitatif dengan desain studi kasus eksploratif. Dalam penelitian ini digunakan pendekatan realist evaluation dengan empat tahap yaitu pengembangan teori program, pengumpulan data, pengujian teori program serta interpretasi dan perbaikan. Data primer diperoleh dari wawancara mendalam, FGD, telaah dokumen dan observasi. Informan penelitian ini sejumlah 73 orang mulai dari tingkat Pusat dan daerah (Dinas Kesehatan Provinsi, Kabupaten/Kota, Puskesmas dan Desa). Di seluruh lokasi, durasi pelayanan bertambah akibat skrining antara lain disebabkan kurangnya dokter. Di perkotaan, terdapat sistem pendaftaran online dan batasan durasi pelayanan yang berpengaruh. Posyandu Prima dan Posyandu mewujudkan tersedianya akses di tingkat desa melalui pemenuhan sumber daya termasuk bidan, perawat dan kader. Belum semua lokasi melaksanakan Posyandu dusun terintegrasi satu waktu. Pelaksanaan Posyandu integrasi perlu memperhatikan jumlah sasaran dan SDMK yang bertugas. Sosialisasi dengan pendekatan sesuai karakter masyarakat dapat meningkatkan utilisasi layanan dalam ILP. Dashboard untuk mewujudkan Pemantauan Wilayah Setempat masih belum optimal. Koordinasi kasus antar Puskesmas sampai desa dilakukan manual via telepon maupun kartu kontrol. Tingginya komitmen ditunjukkan oleh para aktor tingkat Pusat, Daerah dan Desa dibuktikan secara verbal, regulasi pendukung maupun alokasi anggaran termasuk insentif kader. Daerah siap mereplikasi ILP namun menyampaikan kebutuhan kejelasan regulasi. Penelitian ini menghasilkan teori program pelaksanaan ILP mengacu pada tiga fokus transformasi pelayanan primer serta regulasi, integrasi kebijakan dan dukungan stakeholders. Dalam konteks berbeda, pendekatan ILP akan mengalami mekanisme berbeda dalam menghasilkan outcome peningkatan utilisasi layanan. Diperlukan percepatan kebijakan untuk mendukung pendekatan ILP serta harmonisasi kebijakan pendukung untuk konsistensi dukungan daerah dalam replikasi ILP.

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Transformation of primary health services is the first pillar of Health Transformation. Pilot of Integrated Primary Health Care in Puskesmas (ILP) to implement the focus of the transformation of primary health services carried out from July to October 2022. This research aims to conduct a policy analysis of ILP at the initial intervention location, representing the characteristics of the Puskesmas. Research locations were in Puskesmas Kebonsari in Surabaya, Puskesmas Jereweh in Sumbawa Barat, Puskesmas Banjarwangi in Garut, and Puskesmas Niki-Niki in Timor Tengah Selatan. This research used qualitative method with an exploratory case study design. The study was conducted using a realist evaluation approach in four stages: development of program theory; data collection; testing the program theory; interpretation and refinement. Primary data were obtained from in-depth interviews, FGDs, document reviews, and observations. The informants for this study were 73 people from the central and regional levels (Provincial, District/City Health Offices, Puskesmas, and Villages). In all locations, the duration of service increased as a result of screening, in part because of a lack of doctors. In urban areas, there is an online registration system, and service duration limits that matter. Posyandu Prima and Posyandu provide access at the village level through the fulfillment of resources including midwives, nurses, and cadres. Not all locations performed integrated Posyandu at one time. The implementation of integrated Posyandu needs to pay attention to the number of targets and the health staff involved. Socialization with an approach depending on community character can increase service utilization od ILP. The dashboard for accomplish Local Area Monitoring is still not optimal. Coordination of cases between Puskesmas and villages was done manually via telephone or control card. Actors at the Central, Regional, and Village levels showed a high level of commitment as evidenced verbally, supporting regulations and budget allocations including cadre incentives. Several regions are ready to replicate the ILP, but convey the need for regulatory clarification. This research create program theories of ILP referring to the three focuses of primary service transformation as well as regulation, policy integration, and stakeholders support. In different contexts, the ILP approach will experience different mechanisms in producing service utilization improvement outcomes. Policy acceleration is needed to support the ILP approach and harmonize supporting policies for consistent local government support in ILP replication."

"Tesis ini membahas kesiapan puskesmas untuk mengimplementasikan PeraturanMenteri Kesehatan Nomor 5 Tahun 2014 tentang Panduan Praktik Klinis BagiDokter di Fasilitas Pelayanan Kesehatan Primer. Dokter di fasilitas pelayanankesehatan primer merupakan kontak pertama pasien yang diharapkan dapatmenegakkan diagnosis dan memberikan penatalaksanaan penyakit sedini mungkinsesuai dengan kebutuhan medis pasien. Untuk dapat menerapkan kebijakantersebut di puskesmas, dokter memerlukan dukungan/peran dari SDM kesehatanlainnya, kelengkapan obat, peralatan, sarana dan prasarana puskesmas yang sesuaidengan panduan. Penelitian ini merupakan penelitian kualitatif dengan sampelpenelitian yaitu tiga puskesmas di Kabupaten Garut dan terdapat 11 oranginforman untuk menggali informasi secara mendalam. Hasil penelitianmenunjukkan bahwa ketiga puskesmas kurang siap untuk mengimplementasikankebijakan. Untuk itu, disarankan agar puskesmas menjadi Badan Layanan UmumDaerah (BLUD) dan meningkatkan upaya kesehatan masyarakat yang bersifatpromotif dan preventif, untuk Kementerian Kesehatan agar melengkapiFormularium Nasionaldengan obat-obat yang dibutuhkan di fasilitas pelayanankesehatan primer, dan untuk Dinas Kesehatan Kabupaten Garut agar membuatperencanaan untuk pembanguan kesehatan di daerahnya dengan mengintegrasikansemua aspek, begitu pula dalam melakukan renovasi atau membuat bangunan barupuskesmas hendaknya mengikuti pedoman teknis bangunan dan prasaranapuskesmas.

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This thesis discusses the puskesmas readiness to implement the Minister of Health Regulation No. 5 of 2014 about Clinical Practice Guidelines for Doctors in

Primary Health Care Facilities. Doctors in primary health care facilities is the first contact patients who are expected to uphold a diagnosis and give treatment of

diseases as early as possible in accordance with the medical needs of the patient.

In order toimplement this policy in puskesmas, doctors need support/the role of

other health human resources, equipment, medicines, facilities and infrastructure

of puskesmas that accordance with the guidelines. This research was qualitative

research with a sample of research are three puskesmas in Garut and there were 11

people toexplorein depthinformation. The results showed that all

threepuskesmasare lessreadytoimplementthe policy. It is recommended that

puskesmas be the Badan Layanan Umum Daerah (BLUD) and increase promotive

and preventive activities,for the Ministry of Health in order to complement

NationalFormulariumwith needed medicines in primary health care facilities,

GarutHealth Office makes the development of health planning in the region by

integratingallaspectsandin doingrenovationsorcreatea newbuildingpus kesmasshouldfollowtechnicalguidelines forbuildingsandinfrastructure of puskesmas."

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Integrasi pelayanan kesehatan primer (ILP) merupakan bagian dari transformasi layanan primer yang bertujuan untuk mendekatkan akses pelayanan kesehatan yang berkualitas. Penelitian ini bertujuan untuk menganalisis kesiapan puskesmas dan jejaringnya dalam penerapan ILP. Penelitian ini menggunakan pendekatan kualitatif dengan mengambil studi kasus pada puskesmas dengan karakteristik perkotaan, yaitu di wilayah kerja Puskesmas Pamulang Kota Tangerang Selatan. Pengumpulan data dilakukan melalui wawancara mendalam, observasi, dan telaah dokumen. Penelitian mengadopsi kerangka konseptual pemantauan PHC oleh WHO dan teori kesiapan perubahan organisasi oleh Weiner. Hasil penelitian menujukkan bahwa kesiapan ILP di Puskesmas Pamulang belum sepenuhnya siap untuk pelayanan berbasis klaster, pendekatan jejaring, dan penguatan digitalisasi. Ketersediaan sumber daya berupa SDM, infrastruktur, dan sarana prasarana belum memadai, khususnya pada level jejaring puskesmas. Kesiapan teknologi digital masih terkendala dan belum turunnya pembiayaan menjadi faktor yang menghambat persiapan ILP. Terdapat komitmen individu berupa pemahaman informasi dan penilaian positif terhadap ILP, serta komitmen organisasi melalui dukungan tata kelola berupa draft regulasi dan pembiayaan yang telah dialokasikan sebagai inisiasi penerapan ILP sehingga hambatan yang bersifat teknis diharapkan dapat diatasi. Penelitian ini merekomendasikan agar pembiayaan untuk kegiatan persiapan ILP segera diturunkan, dilakukan pemenuhan sumber daya di puskesmas dan posyandu, serta diperlukan dukungan kerja sama dan komitmen semua pihak dalam penerapan ILP. Keterbatasan penelitian ini belum dapat menganalisis lebih detail kecukupan jumlah anggaran yang dialokasikan dan kebutuhan sumber daya sesuai standar pelayanan untuk setiap klaster sehingga dibutuhkan penelitian lebih lanjut yang dapat memperkaya analisis terhadap faktor-faktor tersebut.

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Integrated primary healthcare (ILP) is part of the transformation of primary healthcare aimed at improving access to quality healthcare. This study aims to analyze the readiness of community health centers (puskesmas) and their networks in implementing ILP. This research used a qualitative approach, focusing on a case study of a puskesmas in an urban setting, specifically in the operational area of Puskesmas Pamulang in South Tangerang. Data collection methods include in-depth interviews, observations, and document reviews. This research adopts the conceptual framework of PHC monitoring by WHO and Weiner's theory of organizational change readiness. The findings indicate that the readiness of ILP at Puskesmas Pamulang is not fully prepared for cluster-based services, networking approaches, and digitalization strengthening. Resource availability in terms of human resources, infrastructure, and facilities is inadequate, especially at the puskesmas network level. The readiness for digital technology is still constrained, and the lack of funding hampers ILP preparation. Individual commitment, demonstrated through an understanding of information and positive assessments of ILP, as well as organizational commitment evidenced by governance support such as draft regulations and allocated funding, serve as initiatives for ILP implementation, which is expected to overcome technical barriers. The study recommends prompt allocation of funding for ILP preparation, resource fulfillment in puskesmas and posyandu, and the need for cooperation and commitment from all stakeholders in ILP implementation. The limitation of the study lies in its inability to analyze in detail the adequacy of the allocated budget and resource needs according to service standards for each cluster. Further research is needed to enrich the analysis of these factors.

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"[Penelitian ini merupakan studi kualitatif untuk mengetahui profil dan beban kerja petugas yayasan dan petugas kesehatan di layanan primer (puskesmas) di sekitar Yayasan Galuh, perilaku mencari pertolongan dari pengguna jasa layanan Yayasan Galuh, kebutuhan pelatihan bagi petugas Yayasan Galuh maupun petugas puskesmas di sekitar yayasan. Penelitian dilakukan dengan melakukan focus group discussion (FGD) dan wawancara mendalam yang dilakukan terhadap petugas Yayasan Galuh, petugas Puskesmas Pengasinan, petugas Dinas Sosial Kota Bekasi, konsumer, dan keluarganya. Hasil penelitian menunjukkan bahwa Petugas Yayasan Galuh dan Petugas Puskesmas memiliki pengetahuan dan pelatihan yang minim di bidang kesehatan jiwa dan beban kerja yang tinggi. Inisiatif pengobatan terbanyak atas keinginan keluarga. Beberapa hal yang menyebabkan keluarga memilih pengobatan jiwa tradisional di Yayasan Galuh antara lain: tidak memiliki pelaku rawat, biaya perawatan di Yayasan Galuh yang terjangkau, perbaikan gejala gangguan jiwa, dan kurangnya pengetahuan akan penyakit jiwa. Kebutuhan pelatihan petugas Yayasan Galuh yang paling banyak diungkapkan adalah pelatihan di bidang kesehatan fisik. Kebutuhan pelatihan petugas Yayasan Galuh di bidang kesehatan jiwa yaitu : gejala, diagnosis dan pengobatan gangguan jiwa, tehnik komunikasi dengan ODGJ, cara perawatan ODGJ dengan: perilaku kekerasan, isolasi diri, perawatan diri kurang, perilaku kacau. Petugas puskesmas merasa perlu mendapatkan pelatihan bagaimana dapat melakukan deteksi dini, dapat mengenali tanda dan gejala gangguan jiwa yang lazim pada orang yang datang berobat ke Puskesmas.;This study is a qualitative study to explore the profile and workload profiles of foundation staff and primary health care staff workers in the area surrounding Galuh Foundation, help seeking behavior of Galuh foundation service users, the training needs for Galuh foundation staff and Primary Health Care Staff in the Area Surrounding Galuh Foundation. Data collection was done through focus group discussion (FGD) and in-depth interviews with Galuh Foundation staff and primary health care staff, Bekasi social service officers, service users and their family. The results showed that the Galuh Foundation staff and primary health care staffs in the surrounding area have high workload, with minimal knowledge and training in mental health. Most treatment initiatives came from the family. Some of the reasons cited from family members for choosing traditional treatment in Galuh Foundation were lack of caregivers at home, affordable cost at Galuh Foundation, improvement of mental illness symptoms after receiving care at Galuh Foundation, and lack of knowledge related to mental illness. The most widely expressed training needs were of physical health related training. Mental health training needs identified from Galuh Foundation Staffs were: symptoms, diagnosis and treatment of mental disorders, communication techniques with mentally ill persons, how to care for person with: violent behavior , self-isolation , poor self care , bizzare behavior. Primary health care staffs expressed needs to get mental health training in: mental illness early detection, signs and symptoms recognition of common mental disorders in community members who present to the primary health care., This study is a qualitative study to explore the profile and workload profiles of foundation staff and primary health care staff workers in the area surrounding Galuh Foundation, help seeking behavior of Galuh foundation service users, the training needs for Galuh foundation staff and Primary Health Care Staff in the Area Surrounding Galuh Foundation. Data collection was done through focus group discussion (FGD) and in-depth interviews with Galuh Foundation staff and primary health care staff, Bekasi social service officers, service users and their family. The results showed that the Galuh Foundation staff and primary health care staffs in the surrounding area have high workload, with minimal knowledge and training in mental health. Most treatment initiatives came from the family. Some of the reasons cited from family members for choosing traditional treatment in Galuh Foundation were lack of caregivers at home, affordable cost at Galuh Foundation, improvement of mental illness symptoms after receiving care at Galuh Foundation, and lack of knowledge related to mental illness. The most widely expressed training needs were of physical health related training. Mental health training needs identified from Galuh Foundation Staffs were: symptoms, diagnosis and treatment of mental disorders, communication techniques with mentally ill persons, how to care for person with: violent behavior , self-isolation , poor self care , bizzare behavior. Primary health care staffs expressed needs to get mental health training in: mental illness early detection, signs and symptoms recognition of common mental disorders in community members who present to the primary health care.]"

"ABSTRAKPenelitian ini bertujuan untuk menilai hasil pengukuran kemampuan dokterIndonesia di Fasilitas Kesehatan Tingkat Pertama FKTP dengan menggunakankuesioner yang disusun oleh Kementerian Kesehatan. Kuesioner penilaiankemampuan diri sendiri tersebut berisi kompetensi/kemampuan dokter menatalaksana 155 penyakit. Secara spesifik, penelitian ini dilakukan untuk mengetahuihubungan antara jenis kelamin, jenis perguruan tinggi, program internsip, programPTT, lama praktek dan daerah praktek dengan kemampuan dokter. Penelitian inimenggunakan desain cross-sectional yang melibatkan 285 dokter di 28kabupaten/kota yang tersebar di 22 provinsi di seluruh Indonesia.Hasil penelitian ini menunjukkan bahwa jenis perguruan tinggi , program PTT danprogram internsip berhubungan secara signifikan p < 0,05 dengan kemampuandokter menata laksana 155 penyakit di Fasilitas Kesehatan Tingkat Primer.Saat ini dibutuhkan suatu Kebijakan Nasional yang kuat di bidang Kesehatanyang mengedepankan pentingnya peranan dokter di Fasilitas Kesehatan TingkatPertama untuk meningkatkan capaian kesehatan.Kata kunci: kemampuan dokter, jenis kelamin, jenis perguruan tinggi,program internsip, program PTT, lama praktik, daerahpraktik

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ABSTRACTThis study aimed to assess Indonesian physicians self perceived activities inprimary care setting using questionnaires, constructed by the MOH. Selfassessmentquestionnaires comprise of competencies abilities of treating 155diseases. In specific, this study is to explore the association between gender, typeof college, internship program, PTT program, years of practice, and region ofpractice towards physician activities in treating diseases in a primary health care.This study is a cross sectional that involved 285 physicians in 28 districts in 22provinces across Indonesia.Results indicated that type of college, internship and PTT program aresignificantly related p .05 to physician abilities to treat 155 diseases at theprimary health care. A strong national health policy that requires the essential roleof primary care physicians in health outcome is urgently needed.Keywords physician activities, gender, type of college, intership program,PTT program, years of practice, region of practice"

"Penelitian ini menggunakan desain Rapid Assesmenl Procedures (RAP) dengan menerapkan metoda pendekatan kualitatif yang bertujuan mcndapatkan infonnasi yang mendalam mcngcnai gambaran koniidensialitas yang ada di puskesmas PKPR “Y” dan “X” Jakarta Selatan. Penelitian melibatkan remaja sebagai klien PKPR dan provider serta para pcmbuat kebiiakan dari pusat hingga tingkat puskesmas. Terdapat kesenjangan pengetahuan mengenai sehat, kesehatan reprcduksi dan kesehatan reproduksi, akses informasi PKPR, hukum yang melindungi hak~hak klien, serta pemahaman kerahasiaan di antara remaja, provider dan pembuat kebiiakan selain itu ada perbedaan persepsi mengenai konfidcnsialitas di PKPR menurut remaja, pnovider, dan pembuat kebUakan. Terjadi kesenjangan antara standar peiayanan dengan implementasi di lapangan dalam peiaksanaan prinsiflprinsif kerahasiaan di PKPR.Disarankan kepada Kepada Departemen Kesehatan untuk: 1) membuat buku panduan pelayanan kesehatan remaja yang dapat menjamin kerahasiaan di PKPR. 2) Bekerja sama dan berkoordinasi dengan dcpartemen tcrkait seperti Depclagri, Dep, dan Depag dalam sosialisasi PKPR. 3) Menjadikan program peer educator dan peer counselor sebagai salah satu media dan stratcgi penyebaran infom1asi. Kepada Sudinkes dan Dinas Kesehatan terkait: 1) Menjadikan program peer educator dan peer counselor sebagai salah satu media dan strategi penyebaran informasi mengenai kesehatan reproduksi, 2) Mengevaluasi dan monitoring PKPR secara rutin, 3) Melakukan pelatihan mengenai konfidensialitas pada semua tim PKPR oleh ahli dan praktisi konseling. Bagi Puskcsmas PKPR: 1) Membuat standar pelayanan yang memasukkan sikap dan etika petugas selama pelayanan kesehatan remaja, 2) Membuat jadwal yang ramah remzja. Kepada LSM: Bekeria sama dengan puskesmas PKPR dalam sosialisasi kesehatan rcproduksi pada remaja dan maupun mcnjadi sarana mjukan PKPR. Organisasi Profesi: Menyusun dan memperbaharui standar pelaksanaan profesi yang terkait dengan pelayanan kesehatan yang konfidensial pada remaja. Bagi Peneliti lain: Perlu dilakukan lebih dalam lagi mengenai pengaruh dan dampak konfidensilitas dalam pelayanan remaja.

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The study used qualitative method which the objective is to gain infomation deeply on confidentiality at Adolescent Friendly Health Services (AFHS) in Primary Health Care “Y” and “X” South Jakarta. This study involved Adolescent who had treated in AFHS as an informant and providers and policy makers as key informants. There are still lacking knowledge on health, reproductive health, adolescent reproductive health, access of information on AFHS, client’s rights, policy of cIient’s rights and also definition of confidentiality among clients, providers, and decision makers. Beside there is a different perception on confidentiality among them. Still lacking between standard and implementation on confidentiality at AFHS. Suggestion for Ministry of Health: 1) Developing guideline confidentiality services at AFHS. 2) Collaboration with Ministry of Home Afairs, the Ministry of National Education of Indonesia, and Department of Religious AlTairs for socialization on AFI-IS and reproductive health. District Level Health Office: 1) Monitoring and evaluation periodically, 2) attempting training on confidentiality at adolescent services for AFHS workers by an expert. For Primary Health Care Services: I) Provide standard of services which include ethics and attitude on AFHS services, 2) provide friendly schedule for adolescents. NGOs: collaboration with primary health care which provides AFHS on socialization reproductive health and for referral services. Professional organization: developing and refresh guideline of professional services on confidentiality for adolescent services. Others researcher: needs for following up research on impact of confidentiality on adolescent services."