under-utilization of community health centers
TRANSCRIPT
-
8/13/2019 Under-utilization of Community Health Centers
1/36
UNDER-UTILIZATION
OF COMMUNITYHEALTH CENTERS
IN PURWOREJO
REGENCY, CENTRAL
JAVA
Atik Triratnawati
Department Of Anthropology, Faculty Of Cultural Science
Gadjah Mada University,Yogyakarta 55281, Indonesia
Makara, Kesehatan, Vol. 10, No. 1, June 2006
-
8/13/2019 Under-utilization of Community Health Centers
2/36
Average number of consults per week is
6 in Barualte and 0-1 in Imelda
Underutilization of health centers in
Cluster 10
To identify factors that affect
underutilization of health centers
To develop plans that aim to maximizeutilization of health care services in
rural areas
-
8/13/2019 Under-utilization of Community Health Centers
3/36
-
8/13/2019 Under-utilization of Community Health Centers
4/36
-
8/13/2019 Under-utilization of Community Health Centers
5/36
Health systems of Kenya, Ghana,Zaire, Pakistan, Indonesia andBangladesh
Nation wide networks but with weaksupportive structures and underutilizedhealth services
Lack of implementation of plans
Declining share in the national budget Most hospitals and medical schools in
Indonesia are private
-
8/13/2019 Under-utilization of Community Health Centers
6/36
Indonesia Health Vision by 2010 Providing PHC by the government
Hospital-doctor oriented care tocommunity-based PHC
Health paradigm, decentralization,professionalism and manage care
215 million in more than 13,600 islands
Variety concerning race, ethnic, religion,social strata, education and language
Total health cost Rp. 5.1 billion 30% government (2.5% of total annual
government budget)
70% private sectors
-
8/13/2019 Under-utilization of Community Health Centers
7/36
Community health centers or
Puskesmas
Health status of the Indonesians
increased gradually
After the economic crisis in 1997,
many people could not afford to
fulfill basic needs Most Indonesian health care
centers are under-utilized
-
8/13/2019 Under-utilization of Community Health Centers
8/36
United Nations report (1979)
-
8/13/2019 Under-utilization of Community Health Centers
9/36
Purworejo Regency, Central Java
utility of PHCs seemed to bedecreasing
Purworejo has 25 PHCs, 63 sub-PHCs, 81 physicians, 26 dentists,and 233 paramedics
comprised of 16 sub-districts and
494 villages Infectious and nutritional
deficiencies of women and children
-
8/13/2019 Under-utilization of Community Health Centers
10/36
PURWOREJO SAN JUAN
25 PHCs 42 Barangays
81 physicians MHOs
DFCM residents
Pedia residents
Medical Interns
1 physician/puskesmas 2-3 medical interns
1 Midwife : 1 puskesmas 1 Midwife: 2-3 BHC
10 Healthpersonnel/puskesmas
5-6 BHW/health center(Cluster 10)
30, 000 people/puskesmas 1556 (Barualte)
905 (Imelda)
-
8/13/2019 Under-utilization of Community Health Centers
11/36
To investigate the utilization of
PHC units through health sociology
approach, focusing on the
bureaucratic, administrative aspect
of health care management,
health seeking behavior, medical
pluralism and labeling ofcommunity health centers
-
8/13/2019 Under-utilization of Community Health Centers
12/36
-
8/13/2019 Under-utilization of Community Health Centers
13/36
Puskesmasin Purworejo District, CentralJava
Qualitative method using in-depthinterview, observation and Focus Group
Discussion In-depth interviewof 3 health personnel
and 3 persons
FGDamong 8 types of groups: paramedic,non paramedic , laboratory staff,
bureaucrats, mothers who have children