JANGAN MENYERAH!

In the name of Allah, the Most Gracious, Most Merciful

When a mass disaster happen, it is not only involve preparation before it happen and what to do during it happen. Nevertheless, the management post disaster is also important and if it is neglected, it can create another problem and chronic/long term traumatic disorder.

Last Saturday, on the 27th of December, my colleagues and I went to one of the evacuation camp. Currently , there are three camps for merapi victims. Stadium Maguwoharjo, which is where we went, Youth Centre and Gor Sleman. My first sight before entering the stadium area was clothes hanging everywhere and even on the grass field. Thats when I know there must be a big number of people there.

Not all evacuees are placed at a same time. From my interview from one of the evacuee, the villagers from Cangkringan previously is at another camp but then they are evacuated again at Maguwoharjo. The reason is more efficient surveillance. So, including those from Cangkringan, the total of evacuee, there is 6500! Sure enough to held a charade.

Logistic Management Support

Logistic can be defined as a system whose parts interact smoothly to help reach a

good promptly and effectively to optimized use of resources.

"In emergency, logistic are required to support the organization and implementation of response operation in order to ensure their timeliness and efficiency" (PAHO-WHO 2001)

PAHO-WHO classified logistic items as the following:

1. MEDICINES

2. HEALTH SUPPLIES / KITS

3. WATER and ENVIRONMENTAL HEALTH

4. FOOD

5. LOGISTIC / ADMINISTRATION

6. SHELTER-ELECTRICAL-CONSTRUCTION

7. PERSONAL NEEDS / EDUCATION

8. HUMAN RESOURCES

9. AGRICULTURE / LIVESTOCK

10. UNCLASSIFIED / OTHERS

No. 1 and No. 2 are included as medic logistic. At the camp, medicines and health supplies are manage by several PHC. If I am not mistaken, there were three PHC from different province. However, there were no specific distribution for each sub district. Everyone can go to any of the post. Same goes to the distribution of water,food, clothes. Some of the evacuee complained that they have to queue for a long time since the were only 1 post for food.

The logistic still lack of efficiency. Some resources are excessive and some are in deficits. There are lots of shirts but that is not their priority. Instead, they need mattresses and blanket which is not enough as the weather is cold at night because the sleep in open air. Some of the clothes are left like a pile of trash, making the evacuee uncomfortable and hard to search for what they want. More over, some of the evacuee who just arrived a few days, does not now where to get help.

In my personal opinion, there should be a coordination in who is in charge for each village of district. The provincial health office (DINKES) should place one organization or several officers for each village or district. So that whenever they need clothes,food or medicine, they can go straight to the organization in charge. It will be easier to get access and faster.

Lastly, my apology if what I saw is wrong. And since it is a disaster and not evacuee came at the same time, so it is possible that problems in management could happen. I hope that it will be better in the future. The intentions are good and resources is already there, we just need to deliver it. Hang on Indonesia! Help is on the way. Wassalam.

Reference :

Lecture dr. Sulanto Saleh-Danu R., SpFK on Logistic (medical) and disaster

The 8 E.L.E.M.E.N.T.S

In the name of Allah, the Most Gracious, Most Merciful

Prior to Declaration of Alma Ata in 1978 regarding Primary Health Care (PHC), Indonesia has developed various forms of primary health care (PHC) in some regions. Since its a primary care, the services provided is not only diagnostic and therapeutic but more to preventive measure involved.

There are eight essentials health services which can be remembered by the mnemonic ELEMENTS :

1. E – Education for Health

2. L – Locally endemic disease control

3. E – Expanded program for immunization

4. M – Maternal and Child Health including responsible parenthood

5. E – Essential drugs

6. N – Nutrition

7. T – Treatment of communicable and non-communicable diseases

8. S - Safe water and sanitation

Community Based Health Activities

Since the main strategies of PHC in health development in Indonesia are to improve the access of community toward quality health services, and to activate and empower community live a healthy life, many activities involving the community has been held. Based on research in 1976 it is noted that 200 community - based health activities (CBHA) have been implemented and carried out within the community. Usually the community chooses health volunteers and the HC provides training for the health volunteers.

The community based health activities are varied, and some of them are :

· Posyandu (integrated service post/ISP) which is managed by health volunteers and spread out in all villages. Posyandu specializes on specific target. For example for children under five years old, for elderly people and for non-communicable disease. The posyandu is categorized into four level of development by using indicators as follows :

a. Pratama or fist level posyandu. I the unstable posyandu, the activities depend on the presence of health personnel.

b. Madya or second level posyandu. It has regular activities, but the program coverage is still less than <>

c. Purnama or third level posyandu. The activities has run regularly, the programme coverage is high (> 50%), but not yet supported by community health fund.

d. Mandiri or self reliant posyandu. It has a regular activity, high programme coverage and supported by community health fund.

· Polindes (village maternity home/VMH) which is managed by midwife. It is expected that every village has one VMH but so far not all villages have it.

· Poskesdes (village health post/VHP) which is managed by midwife and health volunteers. It is a community institution beyond VMH, to cover other public health services. Each VMH will be improved to be VHP.

· Village medicine post which is managed by health volunteers and usually is situated in remote area which is far from health service institution.

· Village malaria post which is managed by health volunteers. Its main role is to help in detecting malaria disease and curing it.

· Islamic school health post, which is managed by Islamic school student, the main role is to improve the healthy behaviors for Islamic school students.

· Occupational health post, which is managed by health volunteers who are appointed from the informal workers.

· Saka Bhakti Husada (Health Scout), which is managed by health volunteers and is developed in the scout organization. This organization activity covers various aspects such as nutrition, environment health, maternal and child health, disease prevention and narcotics and drugs.

Task Shifting

Task shifting is the name now given to a process of delegation whereby tasks are moved, where appropriate, to less specialized health workers. By reorganizing the workforce in this way, task shifting can make more efficient use of the human resources currently available. It is also implemented in PHC in Indonesia. Nurses are able to do doctors' job when doctors are in short supply. Health volunteers can potentially deliver a wide range of health services to the community especially in educating them as it it is a part of an important prevention intervention. This will free the time of doctors and qualified nurses thus allowing them to focus on serious cases or those with special needs.

In conclusion, the function of PHC does not only plays role in curing people, but also preventing them. Those who involved are not only the medical workers but also non medical people which is from the community, thus,making the access to health services easier and the development of health is more efficient. Wassalam.

References:

http://www.searo.who.int/LinkFiles/Conference_INO-13-July.pdf

http://www.who.int/healthsystems/task_shifting_booklet.pdf

Four Functions...

In the name of Allah, the Most Gracious, Most Merciful

There are four main health system function:

1. Stewardship (overall system oversight) sets the context and policy framework for overall health system. This function is usually (but not always) a governmental responsibility. What are the health priorities to which public resources should be targeted? What is the institutional framework in which the system and its many actors should function? Which activities should be coordinated with other systems outside the realm of health care and hoe (e.g., highway safety, food quality control)? What are the trends in health priorities and resource generation and their implication for the next 10, 20, or 30 years? What information is needed and by whom to ensure effective decidsion making on health matters, including prevention and mitigation of epidemics? These questions are the core of stewardship function. An additional central function of stewardship is generating appropriate data for policy making. These range from public health surveillance data to health system performance and provide the basis for assessing health status, regulating sector, and tracking health system performance, effectiveness and impact.

2. Public and private health service provision is the most visible product of the health care system. The best systems also pro,ote health and try to head off illness through education and preventive measures such as well-child consultations. All these roles and activities mean that the system has to perform a wide range of activities. “Delivering health services is thus an essential part of what the system does—­­but is not what the system is” (WHO, 2000).

3. Health service inputs (managing resources) is the assembling of essential resources for delivering health services, but these inputs are usually produce at the borders of health system. These inputs include human resources (produced mostly by the education system with some input from the health system), medications, and medical equipment. Producing these resources often takes a long time (e.g., a trained medical doctor, a new vaccine or drug). This function is generally outside the immediate control of health system policy makers who, nevertheless, have to respond to short-term population needs with whatever resources are available.

4. Health system financing includes collecting revenues, pooling financial risk, and allocating revenue (strategic purchasing of services).

· Revenue collection entails collection of money to pay for health services. Revenue collection mechanism are general taxation, Development Assistance for Health (DAH, donor financing), mandatory payroll contributions, mandatory or voluntary risk-rated contributions savings. Traditionally, each method of revenue collection is associated with a specific way of organizing and pooling funds and buying services. For example, public health systems are typically financed through general taxation, and social security organizations are usually financed through mandatory contributions from workers and employers (payroll contributions).

In most countries, health financing is a mix of general taxation, mandatory social insurance contributions, and household out-of-pocket expenditure (OOP). The relative importance of each source of financing varies greatly across countries. While countries in the Organization for Economic Cooperation and Development (OECD) rely heavily on public financing (either fiscal or mandatory payroll tax), the impotance of OOP is larger in middle income countries (MICs), and it is the largest in low-income (LICs), where it often reaches 70 or 80 percent of total health expanditures. DAH is an important source of health financing in a numbers of LICs, mainly in Africa. However, DAH on average contributes only about 7 percent of all health expanditures in LICs, ranging from 3 percent in a few LICs to more than 40 percent in a few.

· Risk pooling refers to the collection and management of financial resources in a way that spreads financial risks from and individual to all pool members (WHO, 2000). Financial risk pooling is the core function of health insurance mechanisms. Participation in effective risk pooling is essential to ensure financial protection. It is also essential to avoid payment at the moment of utilizing the services, which can deter people, especially the poor, from seeking health care when sick or injured. Each society chooses a different way of pooling its people’s financial risk to finanace its health care system.

· Strategic purchasing. Strategic purchasing is the way most risk-pooling organizations (purchasers) use collected and pooled financial resources to finance or buy health care services for their members. In practical, day-to-day interaction between purchasers and providers, the purchaser, within a regulatory framework, plays a key role in defining a substantial part of external incentives for providers to develop appropriate provider-user interaction and health service delivery models.

Wassalam...

Reference:

Healthy Development The World Bank Strategy for HNP Results, Annex L, April 24, 2007

WHAT MAKES A GOOD HEALTH CARE DELIVERY?

In the name of Allah, the Most Gracious, Most Merciful

A good health system. Sounds easy right? But the truth is health system does not only involves patients and doctors, Ministries of Health, health providers, health services organizations, pharmaceutical companies, health financing bodies, communities, and other organizations also play important roles. A doctor is able to give prompt treatment to a patient is not due to his credibility alone, but also the the interconnections of the health system which can be viewed as the functions and roles played by these parts. These functions include policy making, regulation, clinical services, health promotion, financing, and managing resources such as pharmaceuticals, medical equipment, information.

Still thinks doctor is the only important person?

Well,let me illustrate to you one situation. Let say you are working in a primary healthcare where in that area malaria is endemic and there is suddenly an outbreak of malaria fever. The drugs supply is delayed because the pharmaceutical company had a miscommunication with the primary healthcare administration, even though the drugs are supplied, it is not enough due to financial problem as lack of support by the Ministry of Health and other financing bodies. There are no surveillance system to estimate the numbers of patient and which area is affected the most. On top of that, the village committee which has been thought on how to prevent malaria, does not want to implement it along with other villagers as they feel it is unnecessary. In the end, many died especially children when they can actually be saved due to a flaw system.

Now, have you change your mind? ^_^ . Thank you. Wassalam.

Pray for Indonesia

In the name of Allah, the Most Gracious, Most Merciful

Let us pray for the souls that has been taken by Mentawai Tsunami and Mount Merapi which has taken about more than 400 and 35 lives respectively. May their souls rest in peace and may Allah give strength to the survivors.

Coincidently, in this block, we are learning about health system and disaster management. The content may seems unrelated to medical theory literally, but it certainly is important during the practise in medical world especially when a disaster happen outside clinical settings (as what has happen in Indonesia). A solid health system will generate an efficient and effective management.

My next piece of mind about health system will be written in a new post. So, please lend your lens for a while and feel free to leave a comment. Thank you. Wassalam.