AMINO IMSTC 2019 by AMSA-Indonesia

Indonesian Medical Students' Training & Competition (IMSTC) 2017 The Impact of Mobile Health Services for Public Health Nadhila, Cici Enjelia Nata, Denok Maretta Haq Abstract One of the effects of technological progress is the community's dependence on internet use, including in the health sector. These health services can be in the form of websites, applications, frequently asked questions via e-mail, and so on. The online health service system has the goal of providing health services anytime, anywhere, and for anyone. Mobile health plays an important role in achieving the goal of the online health service system, namely by implementing technologies such as websites and applications that are able to support the health care system for accessers. This technology helps patients to know early prevention of disease, supervise patients in the home, and help doctors to diagnose diseases related to complaints submitted by patients. This mobile health can even help patients to immediately get responses based on their complaints, especially in emergency cases that require quick handling to be followed up immediately. However, the use of technology facilities based on health is still very rarely applied by the community, especially people living in developing countries, such as Indonesia. This is due to the lack of the ability of the community to master the use of technology, especially the elderly, then the low level of the economy so that they do not have technological facilities, lack of public trust in online information obtained, either because some online health applications are only free for a certain time limit , after the time period expires, a substantial fee will be charged. Thus,needed mobile health iswhich is supported by reliable information in finding disease data, very easy use, and inexpensive costs.

Indonesian Medical Students' Training & Competition (IMSTC) 2017 The Impact of Mobile Health Services for Public Health Nadhila, Cici Enjelia Nata, Denok Maretta Haq I.

Introduction In the 20th century, which was the era of digitalization, technological progress developed very rapidly. One of the effects of these technological advances is people's dependence on internet use. Where people access everything through the internet. Good information about education, sports, culinary, and others concerning all their activities, including health (Subhiyakto, et al., 2015). Technological advances are also growing rapidly in the health sector. This can be seen from how the development of health science since ancient times who still use the method of acupuncture, meditation, treatment with herbal medicine, and others until now have been using MRI, CT Scan, chemotherapy, and others. From what used to be people who want to seek treatment, they must meet directly with the paramedics, now they can consult online through health services. These health services can be in the form of websites, applications, frequently asked questions via e-mail, and so on. Through these health-based websites or applications, users can

read information about health, disease prevention, question and answer about the symptoms they are experiencing along with the possibility of a diagnosis, regular health checks, and even help to treat the community, such as online counseling with the psychiatrist directly (Supono, 2006). The online health service system has the goal of providing health services anytime, anywhere, and for anyone. Mobile health plays an important role in achieving the goal of the online health service system, namely by implementing technologies such as websites and applications that are able to support the health service system for accessors (Subhiyakto, et al, 2016). For example, disabled patients or elderly patients can do check-ups routine without the need to come to the hospital (Bayraktar et al., 2011). This technology helps patients to know early prevention of disease, supervise patients in the home, and help doctors to diagnose diseases related to complaints submitted by patients. This mobile health can even help patients to immediately get responses based on their complaints, especially in emergency cases that require quick handling to be followed up immediately. Everything can be done without the need to face directly between doctors and patients (Subhiyakto, et al., 2016). In fact, the use of technology facilities based on health is still very rarely applied by the community, especially people living in developing countries, such as Indonesia. This is due to the lack of the ability of the community to master the use of technology, especially the elderly, then the low level of the economy so that they do not have technology facilities, lack of public trust in online information obtained, either because few applications mobile health there are only a for a certain time limit , after the time has expired, it is subject to considerable costs (Supono, 2006). Thus, is mobile health currently having a maximum effect on public health while the use of health-based technology facilities in the community is still very minimal? This is what will be the subject of discussion in this paper. II.

Method We explored the impact of mobile health for medicine and public health by searching through Pubmed, Science Direct, Springer Link, restricting published studies in the years of no later than 2006. III.

Results and Discussion 1. Use of the Internet as learning Information Information utilization through technology, especially the internet, is growing rapidly, and people are easier to get knowledge and education through the internet. Indonesia's population currently reaches 262 million people. More than 50 percent or around 143 million people have been connected to the internet throughout 2017 according to the Association of Indonesian Internet Service Providers (APJII). In other words, actually the internet as one of the channels for finding disease and communication data is the hope of many people in various countries, especially in developing countries. very easy use and very broad and open health information is also a strong reason for people to use internet services.

Use of Health Information Through the Internet According to Kim Than Win, in the late 60s and early 70s, health services began online by looking for health data on the sites provided, although this was still limited in its

own scope or often called the Internet, and also cooperation with several specialist doctors. Through the Internet, we can look for health information both natural health, physical health, social health and psychological health. We can also communicate with other people and even join social networks about health. In the medical field, the rapid development of the internet plays a very important role as a means of exchanging information and unlimited communication in medical scientific discussion forums and also the birth of the medical informatics discipline. In the medical world, with the rapid development of knowledge (approximately 750,000 latest articles in medical journals are published each year), doctors will quickly fall behind if they do not use various tools toupdate the latest developments via the internet. 3.

Benefits and Advantages mobile health Mobile Health Mobile-Health itself can broadly mean new fields of knowledge which are crosses of medical, public health, and business information related to health services and information exchanged or enhanced through internet channels and technology related to him. By using health services based on information and communication technology (mobile health) can improve the quality of human life by reducing the level of error because when using manuals it will rely on paper documents and will eventually cause errors and require a lot of time. It can also help doctors, nurses and other medical personnel to exchange electronic information so as to provide efficiency.services Mobile health are also accompanied by pictures and sounds to ensure that information seekers understand as explained and mobile health also creates 24-hour service so that the questions are easier and faster to respond. Mobile Health is also very much needed when there is the latest information on the development of diseases throughout the world, the latest issues regarding disease management, the use of medical devices, and also benefits from cost savings such as paper documents and energy savings needed in administration.

Implementation of Mobile Health as a Health Service through the Internet use of a very complex information system will be able to improve performance and allow various activities to be carried out quickly, precisely and accurately, so that it will ultimately increase productivity. The development of information technology shows the emergence of various types of activities based on this technology, such as e-government, ecommerce, e-education, E-Medicine, e-elaboratory, and others, all of which are based on electronics. The use of these technologies can be through e-mail facilities, web-sites, filling out online forms and so on. Around the 80s, some data stored in computer systems began to be used in medical activities that were connected in an integrated manner with hospital information systems that had collaborated and were accessible via the internet. The system has been used since the early 1990s, namely Telemedicine or E-Medicine. According to Jiang Tian and Huglory Tianfield, E-Medicine also has a major impact on the traditional health system. The use of the Emedicine system is on the delivery of health data through integrated information, communication, andtechnology human machine interface. EMedicine was developed to make it easier for patients to send multimedia information such as using video and audio to doctors. The E-Medicine system can be generally classified as:

1. 2. 3. 4.

Lifelong health and treatment, Individual health information, Remote consultation, Regular health checks. New technologies and methods will always be developed and released to become potential E-Medicine models. The application of E-Medicine is very beneficial in informing distance health, social and culture, this is because it can save energy and time. E-Medicine is a very broad application, starting from diagnostic (such as teleradiology), treatment, through telesurgery or telementoring where a specialist doctor acts as a guide. A good E-Medicine system uses advanced technologies such as Video Conference, Audio Conference, Audio Graphics, Interactive Multimedia and the use of network technology 5. Challenges to Using Health Services through the Internet Although it brings many benefits in health promotion and services, social media can also have a negative impact if it is not used wisely. The widespread use of social media has made the application of the law more complex. Some constitutional rights that can be applied in the use of social media, including freedom of speech, freedom of search, and privacy, whose limitations are now often reaping controversy. Some problems related to the use of social media by doctors are generally caused by violations of patient confidentiality, unclear boundaries of the relationship between doctors and patients, pollution of professional reputation, and the insufficient quality and reliability of information. In addition, people who still respect the honor of the medical profession, so that if there are social media accounts that mix public medical education with the freedom of personal expression, the public has the potential to perceive personal freedom as a reflection of his professionalism and trust in what is written. 6. Suggestions for Use of Health Services Through the Internet In the use of the internet as an information source, it should be noted that resources are used such as a trusted health account, and the background of the author who made the information. With this, it can minimize the misinformation obtained. What's more, on an account that has been devoted to health education that represents the medical profession, it is also necessary to categorize information that is appropriate to be accessed by the general public, or more appropriately that information is consumed by doctors and / or limited medical personnel. For this reason, special regulations are needed for the use of social media by doctors. As the development of Information and Communication Technology requires people to experience changes in order to get a better life. However, all changes should be limited by the rules of state law and Indonesian culture. Not demanding that humans adjust to changes due to information technology but adjust information technology changes with humans. Users or users play an important role in maximizing the performance of information technology so that we must know how to use technology ethically. If the user finds out, there will be no violation of rights or privacy.

Regarding the innovation of mobile-Health services, socialization is needed regarding the uses, methods of use, and benefits for the community. the internet as one of the channels for finding disease data and communication is the hope of many people in various countries, especially in developing countries. The use of these technologies should be supported by inexpensive costs, very easy use and very broad and open health information. Some developed countries have implemented asystem mobile-health, for example, as stated by Penny Lunt Crosman, in the city of Ohio, which is used at Union Hospital of Dover, Ohio. The hospital always accesses 6000 electronic documents, 250,000 patient data and 38,000 emergency rooms which is used every year. More than 100 million consumers are always looking for health information every year, some of them always interact online with their doctors. Research obtained from Manhattan found 57% of doctors recommended a disease through the site and 19% answered all questions via email. Whereas according to the International Telecommunication Union, telemedicine has been accessed by 7000 hospitals and health centers. Therefore, for a long-term opportunity the service system like this will be very beneficial for the community and health services.

IV.

Conclusion Thus, mobile health plays an important role in supporting the health care system for the community, namely as a means of health information and 24-hour health services. However, due to lack of public knowledge, the role of mobile health for public health is still not optimal. Thus,needed mobile health is which is supported by reliable information in searching disease data, very easy use, and inexpensive costs.

M-Health Application for Child Growth and Development Monitoring Name of authors:

1. Karunia Widhi Agatin Putri 2. Herdifitrianne Saintissa Yanuaristi 3. Gabriella Eva Victoria Agustina Pangaribuan 4. Christina Wunardi

Introduction: Child growth and development monitoring become essential because children are very susceptible to malnutrition and infectious diseases which both can be effectively prevented and treated with early report. The monitoring in current condition faces barriers, including location and time barriers, which both leads to inequality of access by the society across the nation. Thus, tools that can minimize the barriers are highly needed. The rising use of mobile phone across the country makes it possible to minimize both barriers. This become a promising condition that may answer the problem, which is why in current condition, with the rise of mobile phone usage, rises also mHealthâ&#x20AC;&#x201D;exponential technologies, including wireless gateways and connectivity, biosensors and wearable personal technology to support health and medical prevention and treatment. Material and method: Literature searching was conducted in PubMed, ClinicalKey, Cochrane Library, and Scopus by using keywords: mobile health, digital health, telemedicine, eHealth, child health, child growth, child development, growth monitoring. The inclusion criteria are (1) study was published between 2014 until 2018, (2) was written in English, (3) was fully accessible, and (4) was correlated to the aim of this paper. Result and discussion: Results show various kind of mHealth, including biosensor device, measurement software, website, mobile application, and SMS or text messaging. Despite the promising result in studies related to biosensor device, biosensor device, and measurement software, those modalities have several limitations. Considering the circumstance in Indonesia, mobile

application

and

SMS

are

suitable

implemented

Indonesia

Conclusion: mHealth has shown to be a potential platform for monitoring childâ&#x20AC;&#x2122;s growth and development. Mobile application and SMS or text messaging are the most relevant modalities which can be implemented in Indonesia. In order to achieve a successful mHealth program, supports from the government, health facilities management, and mHealth providers would be necessary.

IMSTC 2019

M-Health Application for Child Growth and Development Monitoring

Authors:

Karunia Widhi Agatin Putri (19704) Herdifitrianne Saintissa Yanuaristi (20008) Gabriella Eva Victoria Agustina Pangaribuan (20005) Christina Wunardi (19992)

AMSA-UNIVERSITAS GADJAH MADA 2018

Introduction The core of pediatrics stands on two fundamental aspects, growth and development.

Growth refers to the changes in size of the child, whereas development refers to the changes in form, function, and behavior. Changes that happen in unexpected times or even failure of changes may become an early alarm of diseases. Thus, the evaluation of growth and development are necessary in the diagnostic evaluation of any patient[1]. The first five years are very significant for a child’s brain development and their lifelong well-being[2]. More importantly, understanding that child development is a continuous process, when the child health is impaired in their early years, it would usually last over their entire life[3-5]. This shows the importance of child growth and development monitoring during their early years of life. As what have been set by the government as priority program 2015-2019 towards “Indonesia Sehat” or Healthy Indonesia, nutritional-based diseases among children remains become main challenge we all need to combat. In order to achieve the aim, government focuses on doing “Pendekatan Keluarga” or Family Approach through programs such as counseling, Posyandu, and KIA Book, short for Buku Kesehatan Ibu dan Anak[6]. As improvements have been made during past few years, multiple loopholes still exist in the implementation due to location and time barriers. Location barrier makes it hard to evenly distribute resources to all islands of the nation, which leads to inequality of access. Time barrier makes it hard to synchronize time between government program and the activities of the society, which leads to fluctuating number of participation. Thus, in order to achieve the goal, tools that can minimize the barriers are highly needed. With the rising use of mobile phone across the country, it becomes possible to minimize the location barrier with phone in hand. The accessibility of mobile phone anytime may also minimize time barrier. This become a promising condition that may answer the problem, which is why in current condition, with the rise of mobile phone usage, rises also mHealth. Mobile health or mHealth is defined as the use of exponential technologies, including wireless gateways and connectivity, biosensors and wearable personal technology to support health and medical prevention and treatment[3]. mHealth technologies refers to the application for smartphones, tablets, and other devices, including sensors and short message service (SMS). These technologies have potential advantages for medical treatment and prevention as they have significant reach, real-time data collection and ability to deliver tailored, interactive,

and adaptive interventions to the people. Moreover, they can be carried during daily activities[3,5]. Regarding the importance of child growth and development monitoring and the advantages mHealth, we proposed an idea of implementing mHealth as potential platforms in child growth and development monitoring. II.

Materials and Methods Literature searching was conducted with databases in PubMed, ClinicalKey, Cochrane

Library, and Scopus for articles published between 2014 until 2018. We used the following keywords in the search field: (“mobile health” OR “digital health” OR telemedicine OR eHealth) AND (“child health” OR “child growth” OR “child development”) AND “growth monitoring”. The search results were downloaded into a personal database. The inclusion criteria used in this literature searching were following: (1) study was published between 2014 until 2018, (2) was written in English, (3) was fully accessible, and (4) was correlated to the aim of this paper. The articles which did not meet the criteria were excluded. The literature searching process is shown in table 1.

III.

Results and Discussion According to literature searching we conducted, there are some varieties of mHealth

platforms implemented in child health improvement including biosensor device, measurement software, website, mobile application, and SMS or text messaging. Each of the modality has its own characteristics, advantages, and disadvantages. Biosensor and wearable devices has been widely developed for monitoring child’s growth and development. A new system based on stereoscopic vision is introduced to measure infant’s length since length is known as one of essential indicators of infant growth. By using two digital still camera combined with software, infant’s body length can be measured in supine position without causing discomfort to the newborns. The accuracy of this technique has been assessed by comparing with length board measurement. Technical error of measurement (TEM) for this new technique was 2.57 mm and for the length board measurement was 2.65 mm. It shows the great accuracy and precision of the stereoscopic system[7]. Another device which is called sensorized pacifier has been also developed to evaluate non-nutritive sucking (NNS) in newborns. NNS can be a predictor of neural system development in neonates as it is a basic reflective oromotor behavior. The parameters used are

number of sucks/s (Hz), expression duration (s), and suction duration (s). This device comprises a commercial teat with two pressure sensors so that a comprehensive pressure profile of the sucking pattern can be obtained[8]. The promising result coming from the use of biosensors does not make them become the device of choice to monitor the child growth and development in this era due to the lack of mobility and the need of specialized practitioners in their operation. Calibration and validation should also be done before each measurement. Both of them are more suitable to be used in clinical setting rather than at home, considering the function of sensorized pacifier as a diagnostic tool and stereoscopic system for measuring infantsâ&#x20AC;&#x2122; length inside the incubators. With the wide use of mobile phone among Indonesian society that is spread around more than 13.000 islands, mobile phone-based technologies become a promising way for the government to minimize the physical gap in reaching even those communities in rural areas[14]. Mobile phone penetration in Indonesia reaches the number of 184 million people in 2018, nearly 70% the total population. Supporting the fact, it is said that about 32% of the population (nearly 92 million users) have downloaded mobile health applications in their phone[14]. This fact than leads to the flourishing utilization of mobile-based technologies to support health intervention and monitoring. Mobile-based intervention requires less physical attendance that positively increases adherence by reducing targetsâ&#x20AC;&#x2122; travel time, providing a flexible schedule, and minimizing the amount of time spent[9]. Currently, the most used mobilebased interventions are websites, mobile application, and text messages. Website or web-based application used a prescriptive online program through a website to make good improvement and/or enhance knowledge, awareness, and understanding. This method offers various features, such as social networking with real-time support, alarm reminders, body mass index (BMI) calculators, and food tracking. Despite its advantages including low cost, ubiquity, and anonymity, several barriers still exist in the implementation of web-based intervention. These include less effective communication between the intervention and the individuals as it is only one-way message[10] and restriction to a comprehensive coverage[2, 10]. Some users may also face difficulties navigating the website or get distracted by other online activities[10]. A mobile application, iCHRCloud, has been developed in India. It is used to monitoring childâ&#x20AC;&#x2122;s health and will help India to reduce their child mortality. iCHRCloud has three components: mobile interface, doctor module, and cloud component. iCHRCloud linked to 20

hospitals and has 16.490 registered babies all in the urban and rural area. Parents can register their child and fill in all the information (i.e. name, sex, gestation, born date, weight, length, head circumference). iCHRCloud has some sections, including visit details, growth charts, vaccination schedule, prescription, and settings. All data will be recorded into the cloud component, which is connected to the hospital. After two years of study, iCHRCloud helps the parents and the doctor to monitor if there is any change in the child’s growth, and remind the parents who forget the vaccination date. It helps the government to understand the selective needs of urban versus rural area (i.e. in urban region, 15% of infants got immunized once, while 28% of children in the rural area). Moreover, as it is a mobile phone based, the information can only be accessed by the parents and hospitals, so the data won’t be leaked. The challenge is only that some users usually resist the adoption of this digitized solution[2]. Meanwhile, in Kenya, they have Information for Action (IFA). IFA could collect data on child growth and also give information and education by sending SMS to parents / caregivers. They use WHO standard for monitoring children’s growth development and use Ages-Stages Questionnaire (ASQ-3) for monitoring psychosocial development. There are 10 Community Health Volunteers (CHVs), 16 caregivers, and 313 children (mean age 5 years and 2 months) in this study. Overall, CHVs and caregivers are very comfortable with IFA because it’s faster compared to using paper-based tools and reduced the need to carry heavy counseling material. IFA also increased the confidence of CHVs and make the dialog with the parents become more interactive during home visits by the question and answer format in IFA app. CHVs also received advice and helps from IFA (i.e. CHV started using nets rather mosquito coils). The limitation are they have to do the training to understand the mobile phone and IFA. They have to look for electricity to charge the phone and have to be online anytime in order to upload the data. And because it’s stored online, the data could be accessed or stolen[11].

Another form of mobile-based intervention is SMS-based mHealth, that are suggested to have supported disease management and treatment adherence, health information delivery and behavior change, patient-provider communication, and early detection and screening[12].

In the role of child growth and development monitoring, SMS-based intervention plays a beneficial part in early detection and screening. One proven example is Baby Steps Text, a tool that allow parents to track and review developmental data of their child and connect them to resources using only text messages. It is a communication system as part of a developmental screening ecosystem, providing a way to include resource-constrained populations who may not yet have constant internet access with the most basic phones. The tool works by sending age-based questions in a regular frequency between the age of 0-5 years, tracking the developmental milestones of the baby. One example from the questions is “does your baby turn her head towards a loud noise?”, and the result might indicate a sign of developmental delay, which makes this tool beneficial for parents assess their child’s development and early intervention[12]. Positive result of SMS-based intervention has also been proven through a research in Malawi where they compare SMS versus other method to deliver MNCH (Maternal, Neonatal, and Child Health) communication. The research shows that all the modalities of SMS lead to high satisfaction level, comprehension, and informations well perceived, making it easier for the recipient to learn new information. Due to lower cost, high delivery success, and actual behavior change, SMS become a preferred delivery modality[13]. The idea of implementing mHealth, especially mobile application and SMS, in child’s growth and development monitoring in Indonesia should consider the critical success factor, including easy access, sufficient and relevant information, ease of user service, accuracy of information, trusted system, and also support for continuous improvement. Therefore, this idea need to be fully supported by the regulator, health facilities management, and mHealth providers[14].

IV.

Conclusion mHealth has shown to be a potential platform for monitoring child’s growth and

development since most of the studies reviewed in this paper shows positive results. Mobile application and SMS or text messaging are the most relevant modalities which can be implemented in Indonesia. In order to achieve a successful mHealth program, supports from the government, health facilities management, and mHealth providers would be necessary.

References 1. The WHO Child Growth Standards [Internet]. World Health Organization. 2018 [cited 20 December 2018]. Available from: https://www.who.int/childgrowth/en/ 2.

Singh H, Mallaiah R, Yadav G, Verma N, Sawhney A, Brahmachari S. iCHRCloud: Web & Mobile based Child Health Imprints for Smart Healthcare. Journal of Medical Systems. 2017;42(1).

3. Tucker S. Welcome to the world of mHealth!. Mhealth [Internet]. 2015 [cited 20 December

2018]

;

1(1).

Available

from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344173/ 4. Turner T, Spruijt-Metz D, Wen C, Hingle M. Prevention and treatment of pediatric obesity using mobile and wireless technologies: a systematic review. Pediatric Obesity. 2015;10(6):403-409. 5. Darling K, Sato A. Systematic Review and Meta-Analysis Examining the Effectiveness of Mobile Health Technologies in Using Self-Monitoring for Pediatric Weight Management. Childhood Obesity. 2017;13(5):347-355. 6.

Pedoman Umum Program Indonesia Sehat dengan Pendekatan Keluarga. Jakarta: Kementerian Kesehatan RI; 2016.

7. Grassi A, Cecchi F, Sgherri G, Guzzetta A, Gagliardi L, Laschi C. Sensorized pacifier to evaluate non-nutritive sucking in newborns. Medical Engineering & Physics. 2016;38(4):398-402. 8. Sokolover N, Phillip M, Sirota L, Potruch A, Kiryati N, Klinger G et al. A novel technique for infant length measurement based on stereoscopic vision. Archives of Disease in Childhood. 2014;99(7):625-628. 9. Nezami B, Lytle L, Tate D. A randomized trial to reduce sugar-sweetened beverage and juice intake in preschool-aged children: description of the Smart Moms intervention trial. BMC Public Health. 2016;16(1). 10. Okorodudu D, Bosworth H, Corsino L. Innovative interventions to promote behavioral change in overweight or obese individuals: A review of the literature. Annals of Medicine. 2014;47(3):179-185. 11. van Heerden A, Sen D, Desmond C, Louw J, Richter L. App-Supported Promotion of Child Growth and Development by Community Health Workers in Kenya: Feasibility and Acceptability Study. JMIR mHealth and uHealth. 2017;5(12):e182.

12. Suh H, Porter J, Racadio R, Sung Y, Kientz J. Baby Steps Text: Feasibility Study of an SMS-Based Tool for Tracking Childrenâ&#x20AC;&#x2122;s Developmental Progress. AMIA Annual Symposium Proceedings Archieve. 2017;2016:1987-2006. 13. Crawford J, Larsen-Cooper E, Jezman Z, Cunningham S, Bancroft E. SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience. Global Health: Science and Practice. 2014;2(1):35-46. 14. Handayani P, Meigasari D, Pinem A, Hidayanto A, Ayuningtyas D. Critical success factors for mobile health implementation in Indonesia. Heliyon. 2018;4(11):e00981.

VI. Tables and Figures Table 1. Findings

MOBILE HEALTH IMPLEMENTATION “SMS gateaway” FOR PROMOTING ADHERENCE TO-ANTI TUBERCULOSIS TREATMENT: A SYSTEMATIC REVIEW

Author: Indah Nurul Khairunnisa Leony Octavia Nor Farzana binti Mahmood

Asian Medical Students’ Association Indonesia (AMSA-Indonesia) 2018

ABSTRACT Background: Tuberculosis (TB) is one of the major public health problems in developing countries. In order to their adherence to the full treatment of 6 months , The possibility of patients not adhering to taking medication is very large because of the long treatment time, the large number of drugs, side effects, lack of awareness of patients of the disease and patients not taking drugs because they forget. Use of information and communication technologies, such as sending reminders through short message services (SMS), can bring potential innovations to address barriers to treatment adherence. And the most cost -effective way to communicate with people residing in difficult to reach areas. Material and Methods: We searched electronic databases (PubMed, EMBASE, Science Citation Index), reference lists of relevant articles, conference proceedings, and selected websites for eligible studies available started by 2011; regardless of language or publication status. Two authors independently screened selected eligible studies, and assessed risk of bias in included studies; resolving discrepancies by discussion and consensus. Result and Conclusion: Search results in the database, 16 articles were found and only 5 articles that met the inclusion criteria. The results of the articles found were the effect of using SMS on monitoring anti-tuberculosis drugs 72.94% - 100% and the effect of using telephone reminders on relationships taking medication increased 66% - 100%.

MOBILE HEALTH IMPLEMENTATION “SMS gateaway” FOR PROMOTING ADHERENCE TO-ANTI TUBERCULOSIS TREATMENT: A SYSTEMATIC REVIEW

Author: Indah Nurul Khairunnisa Leony Octavia Nor Farzana binti Mahmood

Asian Medical Students’ Association Indonesia (AMSA-Indonesia) 2018

Introduction Tuberculosis is a direct infectious disease caused by Mycobacterium tuberculosis (Depkes RI, 2005). Tuberculosis is transmitted to other people through inhalation. (Liu et al., 2014) Tuberculosis (TB) is a public health problem in the world. In the WHO report in 2014 stated that people around the world who suffer from pulmonary TB as many as 6.1 million TB cases and there are 5.7 million new cases and cases of TB relapse. India and China accounted for 37% of 5.7 million and the rest were in several countries such as African countries, Europe, America and Southeast Asia (WHO, 2014). Indonesia as one of the countries in Southeast Asia reported in 2014 that its population numbered 25,124,458 people and from that number suffered pulmonary TB as many as 285,254 people and there were 176,677 new cases of Positive AFB Pulmonary TB 176,677. In 2014 the cure rate for patients with pulmonary TB was 74.2%. (RI Ministry of Health, 2015). TB treatment lasts six to eight months and can cause side effects such as nausea, dizziness, skin rashes, and flu-like symptoms. Compliance with treatment regimens is very important for TB control. Failure to adhere to treatment can result in patients continuing to transmit the disease and can lead to the development of multi-drug resistant TB (MDR-TB). MDR-TB is more difficult to cure and requires a longer treatment regimen of up to two years. The World Health Organization WHO recommends the treatment of directly monitored TB called (DOTS). As a strategy to monitor patient compliance with medication. (Nglazi, Bekker, Wood, Hussey, & Wiysonge, 2013). One key to the success of TB treatment is adherence to pharmacotherapy. Forms of intervention to improve adherence is the provision of information according to the needs of patients so that patients understand the conditions and risks of their health understand the risks if not adherence. The form of Reminder (a reminder) that can be used and recommended is: Calendar, clear instructions, with large and conspicuous letters, letters, telephone pamphlets etc. (RI Ministry of Health, 2005) Several strategies to promote TB treatment compliance have been conducted. Providing communication about compliance; develop or improve support for medication compliance services offered by teams (nurses, doctors, pharmacies, patients, etc.) directly observed therapies (involving a health care worker, community care, or family members directly monitoring patients when taking TB drugs) (Nglazi et al., 2013). The use of text messages (sms services) has been proposed as a means to

promote compliance with TB treatment. Text messages are sent every day or weekly to remind patients to take drugs. (Nglazi et al., 2013). The global cellular mobile market is currently around 1.8 billion customers and estimated at 3 billion at the end of 2010 (Reid and Reid in Liliweri Alo, 2015). Mobile phones have changed the way in which all interpersonal interactions can occur in a society, therefore the sociological view of the presence of mobile phones is very relevant (Liliweri Alo, 2015). Based on the phenomena above, clinical questions are formulated in the form of PICO (Patients / Problem, Intervention, Comparison, Outcome). From one of the journal we can say that , P: Pulmonary TB patients, I: DOTS with SMS and reminders, C: DOTS Standard without O reminders: Compliance with anti-tuberculosis drugs. Clinical questions can be formulated from PICO to "is there any influence on the use of SMS and telephone reminders on compliance with taking anti-tuberculosis drugs?". To get the best evidence about cellphone use in the form of sms and telephone as one of the interventions to promote TB treatment compliance researchers conducted research using a systematic review.

II.

Materials and Methods I.

Data Sources Literature is taken based on the keywords included "Mobile Health Technology" "Short Massage System" "tuberculosis adherence treatment" "Directly- Observed Treatment Short-course (DOTS)". The publication texts used ranged from 2013-2017. The type of research used is quantitative and qualitative research, both conducting direct research, systematic reviews, pilot studies and protocol studies. The search index used is Pubmed, Science Direct, Proquest and Google Scholar.

II. Selection Criteria Types of participants Adults (including pregnant women) or children receiving treatment for TB infection, in any setting. Types of interventions We included interventions in which mobile phone text messages were used to promote adherence to TB treatment. The text messaging had to be delivered to a patient

with TB or, in the case of an infant or child, to a

caregiver. We also included studies in which the intervention was compared to

no intervention or other interventions for promoting adherence. We excluded studies in which used mobile phone voice speaking, voice messaging, a beeper, a pager,

multimedia messaging

service as interventions. In addition,

excluded studies in which text messages are bundled with other interventions unless it was possible to separate the effects of text messaging alone. Type of outcome measures The primary outcome considered

TB cure,

for this review was treatment adherence.

suc-cessful completion

of TB treatment and

We drug

resistance development as proxies for adherence. The secondary outcomes were exposure to stigma associated with TB as a result of the SMS revealing the patientâ&#x20AC;&#x2122;s disease status, and patient satisfication with the SMS intervention III.

Results The articles found through searching data on the ESBCO and PubMed database were 5 articles consisting of 2 articles with systematic review and 1 article with evaluation study type and 2 articles with Random Control Trial (RCT). The results of the articles found were the effect of using SMS on adherence to taking anti-tuberculosis drugs around 72.94% - 100% and the effect of using telephone reminders on medication compliance ranges from 66% to 100%. Complete results from five articles can be seen in table. No. 1.

Title

Author

Result

Mobile phone text messaging Mweete D Nglazi

The results of this study were

for promoting adherence to Linda Gail Bekker, that

days

after

the

antituberculosis treatment:

Robin

Gregory D Hussey intervention group had a higher

systematic

review

protocol

Charles

Tahun: 2013

Wiysonge

Wood, intervention was obtained, the S level of adherence compared to the control group, but this difference was not statistically significant (RR 1.49, 95% CI 0.90- 2.42)

Reminder systems to improve Liu Q, Abba K, The results of this study were patient

adherence

to Alejandria

MM, groups (sufferers) who were

tuberculosis

clinic Sinclair

D, treated with active TB increased

appointments for diagnosis Balanag

VM, attendance to the clinic and

and treatment

Lansang MAD

treatment to completion was higher in the group that received

Tahun: 2014

phone

calls

before

the

appointment (attendance at the clinic was 66% versus 50%; RR 1.32, 95% CI 1.10-1.59, one trial (USA), 615 participants, low

quality

treatment

evidence,

completed:

TB 100%

versus 88%; RR 1.14, 95% CI 1.02-1.27, one trial (Thailand), 92 participants, proof of low quality). Clinical attendance and treatment of completed TB were also higher by using failure reminders

(letters

home

visits) (attendance clinic: 52% vs 10%; RR 5.04, 95% CI 1.6115.78, one trial (India ), 52 participants,

low

quality

evidence; completion treatment: RR 1.17, 95% CI 1.11-1.24, two trials (Iraq and India), 680 participants,

medium

quality

evidence). 3.

Tuberculosis treatment with Piyada mobile-phone

medication Kunawararak,

The results of this study are 1. In the MDR-TB group

reminders in northern thailand Sathirakorn

treated for 18 months with

Tahun : 2011

Pongpanich,

Model 2 (treatment with DOTS

Sakarin

plus reminder telephone use)

Chantawong,

and non MDR-TB treatment

Pattana

Pokaew,

groups for 6 months with

Patrinee Traisathit,

Model 2, a 100% success rate

Kriengkrai

was obtained.

Srithanaviboonchai

2. In the MDR-TB group

and Tanarak Plipat

treated using Model 1 (Use of DOTs

without

phone

reminders) the success rate was obtained 73.7% and in the Non-MDR

Non-TB

group

treated with Model 1 obtained a

success

rate

96.7%.

Significant differences for both MDR-TB groups (p = 0,0001) and non MDR-TB groups (p = 0.047)

between

the

two

models. 4.

TextTB:

Sarah Iribarren

Statistical analysis uses IBM

Susan Beck

SPSS,

Acceptance, Feasibility, and

Patricia F. Pearce,

Independent-sample

Exploring Initial Efficacy of a

Cristina

chi-square test for dichotomous

Text Messaging Intervention

Chirico,

Etchevarria

results of this study were that

Daniel

medication adherence in the

Cardinale, and

short

Fernando

group was 77% and in the

Rubinstein

calendar group as 53%.

Pilot

MixedMethod

Study

Support

Evaluating

Treatment

Adherence Tahun: 2013

Mirta

version

categorical

with

test

variables.

message

Effects of and satisfaction

HSiu-Ling

The results of the

with short message service

Huang,

research are:

reminders

for

Yu-Chuan

medication

adherence:

and The

intervention

Jack

In the control group decreased

Yueh-Ching

the incidence of delayed doses

randomized controlled study

Chou4, Yow-Wen

by 46.4% in the control group

Tahun: 2013

Hsieh, Frank Kuo,

and

Wen-Chen Tsai1,

intervention group, the missed

patient a

Li,

78.8%

the

Sinkuo

Daniel

dose decreased by 90.1% in

Chai1,

Blossom

the intervention group and

Yen-Ju Lin, Pei-

61.1% in the control group. In

Tseng Kung and

the logistic regression analysis

Chia-

the intervention group had a

Chuang

Jung

3.2-fold higher probability of having

decrease

compared

control

delayed

group.

dose to

the

Conclusion:

The use of SMS significantly affected the level of taking medication as scheduled.

IV.

Discussion DOTS Program in Management of Lung Tuberculosis. Directly-Observed Treatment Short-course (DOTS) is the implementation of Tuberculosis prevention strategies adopted in Indonesia through WHO recommendations (Kamelia, 2014). The DOTS program in Indonesia is also guided by the TB national strategy for 2011-2014 (Kamelia, 2014). The DOTS program aims to cure patients with tuberculosis with short -course drugs for 6 months. The implementation of the DOTS program was evaluated through several studies. Research conducted by Noveyani & Martini (2014) evaluated the implementation of the DOTS program in Tanah Kalikedinding health centers in 2014, the results of which were associated with the achievement of indicators of Tuberculosis. The results obtained from one component of the DOTS are that there are still patients who do not have a supervisor swallowing drugs and all (100%) patients have forgotten to take antituberculosis drugs. The DOTS program requires a supporting innovation to reach the target of successful treatment of tuberculosis. In addition, innovation must also consider technological progress so that health workers can continue to intervene remotely. SMS gateway is a one-way broadcast SMS. SMS gateway based on the scheduled time. The system will send an SMS automatically to several telephone numbers that have previously been entered in the database. The sending time of the SMS must be in accordance with the predetermined scheduling. A common feature developed in the SMS gateway application is autoreply, mass delivery / broadcast message and scheduled delivery

(Wicaksono & Triyono, 2015). SMS gateways are devices or services that offer SMS transit, change messages to cellular network traffic from other media or vice versa that allow the transmission of SMS messages with or without using a cellphone. The thing that is unique in SMS gateways is sending simple e-mails to message recipients quickly with mass delivery capacity (Katankar & Thakare, 2010) The first thing that SMS gateway users do is access web-based applications and compose SMS with basic headers, recipient's cellphone numbers and messages to be sent. Compiled messages are sent at the web server level that will modify the message, apply several headers and pass it to the SMS gateway. The SMS gateway will then send this message to the recipient's cellular telephone according to the telephone number input made in the first stage (Katankar & Thakare, 2010). Farooqi, Ashraf, & Zaman (2017) in their study also found that the rate of drug withdrawal in the group given daily mobile smsreminders was lower than the standard DOTS program. Liu et al. (2015) in his research also stated that reminders from health workers can increase patient compliance in consuming OAT.

Overall, the included studies suggest that patients receiving mobile phone text messaging interventions had rates of adherence to TB treatment comparable

to or

higher than those receiving no intervention. Therefore, the findings provide mixed evidence for the effectiveness of mobile phone text messaging interventions designed to

promote adherence to TB treatment. Though the evidence is mixed, we cannot ignore the potential

of mobile phone text messaging to transform the delivery

messages

patients.

Mobile

phones have spread

globally; 45% of the

health worldâ&#x20AC;&#x2122;s

population were estimated to have access to a mobile phone at the end of 2012 [1,3]. In addition, the use of SMS has become popular throughout the world. Globally, there

were an estimated 5.9 trillion SMS messages sent in 2011 and SMS traffic is

expected to reach 9.4 trillion messages by 2016 [4,5]. This increasingly popular mode of communication can be used to deliver short health messages to people anywhere and provide interactive feedback and support to people when they need it the most. Previous research

has shown that

SMS interventions are effective as a means

to promote

multiple healthy behaviors such as adherence to antiretroviral treatment [2], diabetes management and control [6], smoking cessation [7], and immunization compliance [8]. We have found that currently available research utilizing SMS interventions to promote adherence to TB treatment is inconclusive. V.

Conclusion The findings of this systematic review indicate that SMS interventions have a potential for use to improve patientsâ&#x20AC;&#x2122; adherence to TB treatment, though the evidence is inconclusive. To conclude

that

such an intervention is effective is difficult

because there is a paucit y of high-qualit y studies. The current evidence is of low quality implying that further research is very likely to have an important impact on our confidence in the effectiveness of this intervention and is likely to change the magnitude of the estimate of effect. The results of the systematic review also lay an important foundation on which future studies can build upon. In its development, this system has not been able to objectively ascertain whether the drug is being swallowed up by the patient but this can be developed for further research based on technology. .

References 1. GSMA Intelligence: Global mobile penetration — subscribers versus connections. 2013.

https://gsmaintelligence.com/analysis/2012/10/global-

mobile-penetration-

subscribers-versus-connections/354. 2. Horvath T, Azman H, Kennedy GE, Rutherford GW: Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. Cochrane Database Syst Rev 2012, 3, CD009756. 3. United Nations, Department of Economic and Social Affairs, Population (UN DESA): World

Population

Prospects,

2010

revision;

2010.

http://esa.un.org/unpd/wpp/Documentation/pdf/WPP2010_VolumeI_Comprehensive-Tables.pdf. 4. mobiThinking: Global mobile statistics 2012 Part C: Mobile marketing, advertising and messaging; 2012. http://mobithinking.com/mobile-marketing- tools/latest-mobilestats/c. 5. Informa Telecoms and Media. Press release: SMS will remain more popular than mobile messaging apps over next five years. United

Kingdom; 2012.

http://blogs.informatandm.com/4971/press-release-sms-will-remain-more-popularthan-mobile-messaging-apps-over-next-five-years/. 6. Liang X, Wang Q, Yang X, Cao J, Chen J, Mo X, Huang J, Wang L, Gu D: Effect of mobile phone intervention for diabetes on glycaemic control: a meta- analysis. Diabet Med 2011, 28:455–463. 7. Whittaker R, McRobbie H, Bullen C, Borland R, Rodgers A, Gu Y: Mobile phonebased interventions for smoking cessation. Cochrane Database Syst Rev 2009, 11, CD006611. 8. Stockwell MS, Kharbanda EO, Martinez RA, Lara M, Vawdrey D, Natarajan K, Rickert VI: Text4Health: impact of text message reminder-recalls for pediatric and adolescent immunizations. Am J Public Health 2012, 102:e15–21. 9. Subbaraman R, Mondesert L De, Musiimenta A, Pai M, Mayer KH, Thomas BE, et al. Digital adherence technologies for the management of tuberculosis therapy : mapping the landscape and research priorities. 2018;1–16. 10. Bediang G, Stoll B, Elia N, Abena J, Geissbuhler A. SMS reminders to improve adherence and cure of tuberculosis patients in Cameroon ( TB-SMS Cameroon ): a randomised controlled trial. 2018;1–14.

Inequality of Healthcare Services based on Patientâ&#x20AC;&#x2122;s Satisfaction in Indonesia: A Preliminary Study

ELIZABETH MARCELLA, Rr. ADELIA CHRISTINE ARIANTO SECADININGRAT, SYLVIA AURORA HARYANTO

AMSA Universitas Pelita Harapan Faculty of Medicine 2018

Inequality of Healthcare Services based on Patient’s Satisfaction in Indonesia: A Preliminary Study Abstract Indonesia is one of the country suffering from inequality. It is boldly apparent that the healthcare quality in rural, isolated areas pale in comparison to those in more developed, thriving urbanized cities. This research aims to raise awareness of just how much unequal and unfair the distribution of healthcare quality in Indonesia really is and highlights what we, as medical students and future doctors can do to make a difference. According to the Health Ministry of Indonesia (2008), patient’s satisfaction is one of the major indicators for healthcare quality. This research is a descriptive, observational study of patients’ satisfaction done through cross-sectional method and literature studies. Questionnaires were distributed at random to 14 different provinces in Indonesia. 480 samples were taken through inclusion-exclusion process and the data was processed and evaluated using the Likert’s scale scoring formula. The result shows that patient’s satisfaction is higher in urban, more-developed provinces, such as Jakarta, Yogyakarta, and Banten, indicating better healthcare quality. Meanwhile, rural, underdeveloped provinces such as West Kalimantan, Bangka Belitung, and Papua show lower patient’s satisfaction, indicating low healthcare quality. In conclusion, based on patient’s satisfaction alone, the healthcare quality in Indonesia is still far from being equal. Some of the things that we, as medical students and future doctors, can do is becoming active participants in promoting the development of healthcare quality by first, being aware of the inequality ourselves and raising awareness of the urgency of the situation which we are actually facing, not only as a nation, but as human beings. This research aims to raise awareness of the healthcare inequality in Indonesia as the first step in realizing change for a better, equal healthcare services in Indonesia.

Keywords: health care service inequality, patient’s satisfaction

Inequality of Healthcare Services based on Patientâ&#x20AC;&#x2122;s Satisfaction in Indonesia: A Preliminary Study

ELIZABETH MARCELLA, Rr. ADELIA CHRISTINE ARIANTO SECADININGRAT, SYLVIA AURORA HARYANTO

AMSA Universitas Pelita Harapan Faculty of Medicine 2018

Inequality of Healthcare Services based on Patient’s Satisfaction in Indonesia: A Preliminary Study Abstract Indonesia is one of the country suffering from inequality. It is boldly apparent that the healthcare quality in rural, isolated areas pale in comparison to those in more developed, thriving urbanized cities. This research aims to raise awareness of just how much unequal and unfair the distribution of healthcare quality in Indonesia really is and highlights what we, as medical students and future doctors can do to make a difference. According to the Health Ministry of Indonesia (2008), patient’s satisfaction is one of the major indicators for healthcare quality. This research is a descriptive, observational study of patients’ satisfaction done through cross-sectional method. Questionnaires were distributed at random to 14 different provinces in Indonesia. 480 samples were taken through inclusion-exclusion process and the data was processed and evaluated using formulas explained later. The result shows that patient’s satisfaction is higher in urban, more-developed provinces, such as Jakarta, Yogyakarta, and Banten, indicating better healthcare quality. Meanwhile, rural, underdeveloped provinces such as West Kalimantan, Bangka Belitung, and Papua show lower patient’s satisfaction, indicating low healthcare quality. In conclusion, based on patient’s satisfaction alone, the healthcare quality in Indonesia is still far from being equal. Some of the things that we, as medical students and future doctors, can do is becoming active participants in promoting the development of healthcare quality by first, being aware of the inequality ourselves and raising awareness of the urgency of the situation which we are actually facing, not only as a nation, but as human beings.

Keywords: health care service inequality, patient’s satisfaction

Introduction Indonesia is an archipelago country with thousands of islands, displaying a broad diversity of culture, ethnicity, along with an untapped amount of natural resources. With that very same wealth, comes detriments, one of them being the difficulty to promote and maintain equality, fair healthcare being one of the major issues. As stated in the 1945 Constitution of Indonesia number 36 on Public Health established on 2009, health is considered as one of the major rights we, not only as citizens, but as human beings possess, and it is part of the governmentâ&#x20AC;&#x2122;s responsibility to ensure that those rights are fulfilled. It is guaranteed that the nation will provide the best healthcare quality service indiscriminately and unprejudiced, for health quality is one of the determinants of a successful development of a country. Despite this, it is generally accepted that the dream that was promised is still beyond grasp. It is without a shadow of a doubt that some provinces are faring so much better in healthcare quality and some do not even have the privilege of healthcare access. A massive difference of healthcare quality is boldly apparent in urbanized populations in the capital cityâ&#x20AC;&#x2122;s sprawling metropolis to the isolated rural areas of Papua. Facilities, distances, prices, and the amount of trained medical workers being some of the many hindrances. Though one might think it is merely an idealistic dream to reach an impossible conviction of equality, it is nothing short but a pressing and highly urgent matter of life and death. In 2015, BBC has announced that infant mortality in Papua is three times higher than Jakarta. It is a never-ending goal with side-effects more than what long term cigarette consumption do to smokers. If we cannot brush off people putting toxins into their lungs and suffering on their own accord to the consequences of their choice, then we surely cannot stand idle and watch as people, children, and infants die from causes we, as a country, can overcome. This is no longer about equality, this is about providing the rights of the people. This should be a priority of our nation as it is our people and the future of our children. The objective of this research is to raise awareness of the healthcare inequality in Indonesia as the first step in realizing change for a better, equal healthcare services in Indonesia.

II.

Materials and Methods This is a descriptive, observational research conducted using the cross-sectional method and literature review. Patient’s satisfaction questionnaires from previous studies of Kurniana (2005) and Supriyanto (2012) were used in this research to measure the quality of healthcare services all over Indonesia. Questionnaires were distributed to citizens from 14 different provinces all over Indonesia at random and 502 responses were recorded. Through inclusion and exclusion, 480 responses were analyzed. Some inclusion specifications that were used are that respondents need to be above 17 years old and are Indonesian, while some exclusions specifications that were used are that respondents being younger than 17 years old and data from each province recorded cannot be fewer than 5. The 6 major variables measured in the questionnaires as determinants for a healthcare quality are tangibility, empathy, reliability, responsiveness, assurance, and price. The determinants are then divided into more specific sub-variables which answers are measured using the Likert’s Scale, with one being very unsatisfied, two being unsatisfied, three being okay, four being satisfied, and five being very satisfied, shown on table 1. The data obtained was then analyzed using the formula below in order to find one region’s healthcare’s satisfaction level and therefore its quality. The Likert’s scoring formula used was based on a previous research done by Ngodigha (2015): !=

((1 ∗ ) + (2 ∗ ) + (3 ∗ ) + (4 ∗ ) + (5 ∗ )) (- + + . + / + )

x = final Likert’s score of one sub-variable a = the sum of people who answered 1 b = the sum of people who answered 2 c = the sum of people who answered 3 d = the sum of people who answered 4 e = the sum of people who answered 5 Based on the result, the cut-off point used is 3. Results above 3 shows satisfaction and results below 3 shows dissatisfaction. Average of sub-variables were calculated to find the final result of the major variable.

III.

Results and Discussion Based on the data obtained, through inclusion and exclusion mentioned above, the characteristics of the 480 respondents are shown on table 2.

Table 2: Respondentâ&#x20AC;&#x2122;s Characteristics Respondentsâ&#x20AC;&#x2122; Characteristics Gender Age

Last education

Job

Province

Total

Male

167

34.8

Female

313

65.2

17-24 years old

179

37.3

25-34 years old

125

35-49 years old

20.4

50-64 years old

16.3

Elementary

0.9

Junior High School

0.4

Senior High School

342

68.1

Diploma

6.4

S-1

105

20.9

S-2

3.3

Student

193

40.2

Civil Employee

108

22.5

Private Employee

153

31.9

Housewife

3.7

Merchant

1.7

Sumatera Utara

3.1

Sumatera Selatan

Papua Barat

Papua

1.9

Kepulauan Riau

1.9

Kalimantan Barat

5.6

Jawa Timur

2.3

Jawa Tengah

6.7

Jawa Barat

7.5

10. DKI Jakarta

174

36.3

11. Daerah Istimewa Yogyakarta

3.2

12. Banten

120

13. Bali

14. Bangka Belitung

1.5

The results were calculated using the formula mentioned above. We divided the results by provinces and major variables, shown in table 3. Table 3: Results of Patient’s Satisfaction of SERVQUAL from 14 different provinces Variables No

Province

DKI Jakarta

Tangibles

Empathy

Reliability

Average

Responsiveness

Assurance

satisfaction from

Price

6 major variables

82%

18%

84%

16%

76%

24%

76%

24%

78%

22%

70%

30%

3,9

80%

20%

78%

22%

74%

26%

76%

24%

80%

20%

64%

36%

3,8

82%

18%

78%

22%

76%

24%

78$

22%

78%

22%

64%

36%

3,8

78%

22%

74%

26%

74%

26%

74%

26%

76%

24%

70%

30%

3,7

78%

22%

76%

24%

74%

26%

74%

26%

76%

24%

62%

28%

3,7

Daerah 2

Istimewa Yogyakarta

3 4 5

Banten Jawa Tengah Sumatera Selatan

Jawa Timur

74%

26%

74%

26%

72%

28%

72%

28%

74%

26%

60%

40%

3,6

Jawa Barat

74%

26%

72%

28%

72%

28%

70%

30%

74%

26%

62%

38%

3,5

Bali

70%

30%

70%

30%

66%

34%

70%

30%

70%

30%

70%

30%

3,5

72%

28%

72%

28%

68%

32%

64%

36%

66%

34%

62%

38%

3,4

68%

32%

70%

30%

66%

34%

64%

36%

68%

32%

64%

36%

3,3

68%

32%

66%

34%

66%

34%

64%

36%

68%

32%

54%

46%

3,2

56%

44%

52%

48%

58%

42%

54%

46%

52%

48%

56%

44%

2,7

58%

42%

54%

46%

52%

48%

54%

46%

52%

48%

56%

44%

2,7

50%

56%

44%

56%

44%

52%

48%

50%

52%

48%

2,6

9 10 11 12 13 14

Sumatera Utara Papua Barat Kepulauan Riau Papua Bangka Belitung Kalimantan Barat

Description: +: satisfied -: unsatisfied

According to Respati (2015), healthcare quality is shown through patient’s satisfaction. Higher satisfaction indicates higher service quality. Therefore, patient’s satisfaction can measure the quality of healthcare service. The concept of service quality which correlates with patient’s satisfaction is determined by five major variables “SERVQUAL” (responsiveness, assurance, tangible, empathy and reliability). From the table above, the quality of healthcare service is highest in DKI Jakarta, with an average satisfaction of 3.9, showing patient’s satisfaction of 82% in tangibles/ facilities, 84% in medical worker’s empathy, 76% in medical worker’s reliability and responsiveness, 78% in assurance, and 70% in price. Meanwhile, the quality of healthcare service is lowest in West Kalimantan, with average satisfaction of 2.6, showing patient’s satisfaction of 50% in tangibles/ facilities, 56% in medical worker’s empathy, 56% in medical worker’s reliability, 52% in medical worker’s responsiveness, 50% in assurance, and 52% in price. This shows that the quality of healthcare services

in Indonesia is still far from being equal, as a big gap of patientâ&#x20AC;&#x2122;s satisfaction is clearly seen. IV.

Conclusion The healthcare quality in Indonesia is not distributed equally and fairly, the highest quality shown in urbanized capital city of Jakarta and the lowest in West Kalimantan. Education is one of the major fundamental determinants in good healthcare quality and as medical students and future doctors, education is something we often take for granted without actually realizing the importance of it and the big role it has on the nation-wide scale. If we want to make a difference, we should start with ourselves. Knowledge is power. By keeping ourselves well educated, we can keep others well informed. We can become active participants in promoting the development of healthcare quality by first, being aware of the inequality ourselves and raising awareness of the urgency of the situation which we are actually facing, not only as a nation, but as human beings. This is a preliminary study. Data from this study can be used for future studies. For future references, bigger population scales and samples could be used to represent the entirety of Indonesia and to avoid selection and misclassification bias.

References 1. Respati S. HUBUNGAN MUTU PELAYANAN KESEHATAN DENGAN TINGKAT KEPUASAN PASIEN RAWAT INAP DI PUSKESMAS HALMAHERA KOTA SEMARANG TAHUN 2014 [Internet]. 2018 [cited 18 December 2018]. Available from: https://lib.unnes.ac.id/20257/1/6411411220S.pdf 2. UNDANG-UNDANG REPUBLIK INDONESIA NOMOR 36 TAHUN 2009 TENTANG KESEHATAN [Internet]. Jdih.kemenkeu.go.id. 2018 [cited 18 December 2018]. Available from: https://jdih.kemenkeu.go.id/fulltext/2009/36TAHUN2009UU.htm 3. Ngodigha. [Internet]. 2015 [cited 18 December 2018]. Available from: https://www.researchgate.net/post/How_to_score_a_likert_Scale 4. Kurniana. Kuesioner untuk penelitian kepuasan pasien di Rumah Sakit Swasta [Internet]. Lib.ui.ac.id. 2008 [cited 18 December 2018]. Available from: http://lib.ui.ac.id/file?file=digital/118995-T%2025119-Analisis%20kepuasanLampiran.pdf 5. Suryawati C, Shaluhiyah Z. PENYUSUNAN INDIKATOR KEPUASAN PASIEN RAWAT INAP RUMAH SAKIT DI PROVINSI JAWA TENGAH [Internet]. Journal.ugm.ac.id. 2006 [cited 18 December 2018]. Available from: https://journal.ugm.ac.id/jmpk/article/viewFile/2752/2474 6. Ulinuha F. KEPUASAN PASIEN BPJS (BADAN PENYELENGGARA JAMINAN SOSIAL) TERHADAP PELAYANAN DI UNIT RAWAT JALAN (URJ) RUMAH SAKIT PERMATA MEDIKA SEMARANG TAHUN 2014 [Internet]. Eprints.dinus.ac.id. 2015 [cited 18 December 2018]. Available from: http://eprints.dinus.ac.id/8005/1/jurnal_13951.pdf 7. Supriyanto. [Internet]. Eprints.undip.ac.id. 2012 [cited 18 December 2018]. Available from: http://eprints.undip.ac.id/37113/1/SUPRIYANTO.pdf 8. Angka kematian bayi di Papua tiga kali lipat dibanding Jakarta [Internet]. BBC News Indonesia. 2015 [cited 18 December 2018]. Available from: https://www.bbc.com/indonesia/majalah/2015/09/150909_indonesia_unicef

Table and Figures

Table 1: Questionnaires involving SERVQUAL

No.

Indicator

Tangible

Sub Indicator

Measurement

1. The hospital building looks nice and clean 2. Hospital has enough comfortable waiting room, toilets, and sufficient water supply. 3. Hospital’s room possess complete facilities. 4. Medical workers and staff dresses politely, neatly, and accordingly. 5. Hospital has clear direction signs.

Empathy

1. Doctors give sufficient service time to patients. 2. Nurses give services accordingly and understand the needs of patients. 3. Nurses give utmost care and attention the patients. 4. Doctors listen to patient’s problem

Reliability

2 = unsatisfied

patients find solution during

3 = okay

consultation.

4 = satisfied

1. Medical workers give thorough and careful services on time as scheduled. 2. Medical workers and staffs always help patients readily. 3. Nurses inform the disease and its management thoroughly to patients. 4. Medical workers give adequate information to patients before service is given. 5. Medical workers explain thoroughly the services that will be given.

Responsiveness

1 = very unsatisfied

about their disease patiently and helps

5. Nurses serves politely and friendly. 3.

Likert’s Scale

1. Medical workers are willing to take care of patients’ complaint. 2. Nurses readily serve patients. 3. Medical workers accept and serve well.

5 = very satisfied

4. Medical workers commence quick and accurate actions. 5. Medical workers commence actions according to procedure. 5.

Assurance

1. Doctors possess sufficient, skill, and knowledge in order to give good diagnosis, therefore are able to answer every one of patientsâ&#x20AC;&#x2122; questions reassuringly. 2. Medical workers provide complete medications and medical facilities. 3. Medical workers are deft and appreciate patients. 4. Doctors serve reassuringly to make patients feel safe. 5. Medical workers have complete medical records of patients.

Price

1. The price that is charged is suitable to the benefits received by patients. 2. The price that is offered is affordable.

Telemedicine to Overcome The Lack of Health Workforce in Pukesmas of West Papua Province for Improving The Effectiveness Equity of Primary Healthcare Muna Soraya1, Airenda Mutiara Puspa Nagari2, Ulya Zhafirah Wardah3, Nathanael Ibot4 1 2

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM, muna.sorayaa@gmail.com

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM, airendamutiarapn@gmail.com 3 4

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM.

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UB, nathanaelibot@gmail.com

Background: One of the problems that found in West Papua Province is the low health status, main cause is lack of health workforce, also disobedient outpatient who didn’t come back to the doctor to maintain their condition in a recovering phase from a disease. So one of many solutions we could use to resolve those problems is Telemedicine Objectives: As a referral to the government to build equal distribution of healthcare in remote area, also as a solution to resolve the lack of health workforce in remote area Method: The method used to compile a literature review is to search journal sources obtained through the “Google Scholar”, “Kemenkes”, “ResearchGate”, and “Sciencedirect” search engine. Results and Discussion: The limit of health workforce becomes one of the problems the low health status in West Papua According to a report from the Ministry of Health, there were 5,209 health workers in West Papua Province in 2017 and reports from the West Papua Provincial Health Office every 24 general practitioners and every 12 specialist doctors would handle 100,000 residents, so there were still many health problems found there. To overcome that problem, one of the solutions is the use of telemedicine. The advantage of telemedicine is fulfillment for the need of continuous health care services (maintenance) though consultation using online media along with competent health worker focused in a remote area which is difficult to get reached by health facility. But it needs technology, which not every health personnel could operate. Also, telemedicine needs internet connection, and in addition the low awareness and knowledge about technology of the citizen. But we can overcome that by educating the tribal chief first. Conclusion: Telemedicine has been proven to be successful and could be implemented in Indonesia by empower the citizen.

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM, muna.sorayaa@gmail.com

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM, airendamutiarapn@gmail.com 3 4

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM.

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UB, nathanaelibot@gmail.com

ABSTRACT Background: One of the problems that found in West Papua Province is the low health status, one of the causes is lack of health workforce, other cause is that disobedient outpatient who didn’t come back to the doctor to maintain their condition in a recovering phase from a disease. So one of many solutions we could use to resolve those problems is Telemedicine Objectives: As a referral to the government to build equal distribution of healthcare in remote area, also as a solution to resolve the lack of health workforce in remote area Method: The method used to compile a literature review is to search journal sources obtained through the “Google Scholar”, “Kemenkes”, “ResearchGate”, and “Sciencedirect” search engine. Results and Discussion: The limit of health workforce becomes one of the problems the low health status in West Papua. According to a report from the Ministry of Health, there were 5,209 health workers in West Papua Province in 2017 and reports from the West Papua Provincial Health Office every 24 general practitioners and every 12 specialist doctors would handle 100,000 residents, so there were still many health problems found there. To overcome that problem, one of the solutions is the use of telemedicine. The advantage of telemedicine is fulfillment for the need of continuous health care services (maintenance) though consultation using online media along with competent health worker focused in a remote area which is difficult to get reached by health facility. But it needs technology, which not every health personnel could operate. Also, telemedicine needs internet connection, and in addition the low awareness and knowledge about technology of the citizen. But we can overcome that by educating the tribal chief first.

Conclusion: Telemedicine has been proven to be successful and could be implemented in Indonesia by empower the citizen. Key Words: System Health Problem in DTPK, Health Profile in West Papua, Indonesia Health System Review, INTRODUCTION One development

the

priorities

Telemedicine, and Health Care in China Remote Area In order to improve the range and government’s for

now

improving access and quality of basic health care and referrals, mainly in remote areas at the east part of Indonesia.(6) In Rencana Pembangunan Jangka Panjang Nasional (RPJPN) 2005-2025, health development directed to improve the awareness, will, and the ability to live a healthy life for each person to improve the people’s health status. One of the government’s health development is equity of access and health care in remote areas (3)

equity of health care services that have certain standards in remote areas, so a plan of action and development has been made by The Indonesia Ministry of Health, there are 6 strategies: 1) motivate and empower the citizen in remote areas 2) improving the remote areas citizen’s access to quality health care services 3) improving the funding of health care services in remote areas 4) improving the empowerment of the health workforce in remote areas, 5) improving the availability of medicine and supplies also strategy, 6) improving the management of Pukesmas in remote areas,

One of the problems that found in

including surveillance system, monitoring

remote areas is the poor primary health

and evaluation, also health information

care service caused by the lack of health

system. (2)

workforce in those areas. According to a

In addition to the plans established

report from the Ministry of Health, there

by the Indonesian Republic Ministry of

were 5,209 health workers in West Papua

Health, we could use technology that is

Province in 2017 and reports from the

now rapidly developing, one of which is

West Papua Provincial Health Office every

telemedicine. Telemedicine is the delivery

24 general practitioners and every 12

of health care services, where distance is a

specialist doctors would handle 100,000

critical

residents, so there were still many health

professionals

problems found there

(1,8)

factor,

communication exchange

by using

all

health

care

information

and

technologies valid

for

the

information

for

diagnosis, treatment and prevention of

individuals and their communities. With

disease

and

telemedicine, it can help to overcome

the continuing

geographical barriers, but telemedicine

education of health care providers, all in

requires the involvement of various ICT

the interests of advancing the health of

types. (9)

and

injuries,

evaluation, and for

METHOD

research

Results and Discussion 1. The Relation Between The Lack of Health Workforce and Health care Service in West Papua Province The limited number of health

TB,

Toddler

HIV/AIDS/Syphilis,

Pneumonia,

Diarrhea,

Malaria,

Measles, Dengue Fever, Filariasis, and one non communicable disease, Hypertension. (Table 4) 8.

workforce impacts the health care services, then the health problem isnâ&#x20AC;&#x2122;t solved and

2. The Relation Between The Lack of

lowering the health status. Based on the

Health Workforce and The Usage of

report by Secretary of Development and

Telemedicine

Health People Empowerment Indonesia Republic Ministry of Health, there are 5.209 health workforce in 2017 in West 1

Papua Province (Table 1) and the report from Health Resources at West Papua Provincial

Health

Official

every

Physician and 12 Specialist will handle 8

100.000 citizen (Table 2) . It means that a single Physician handle around 4.1664.167 citizen. While for a single Specialist doctor will handle around 8.333-8.334 citizen. Based on WHO, the ideal ratio of doctors is 1 to 2.500 citizens.

Based on some experts quote, Telemedicine means a part of Biomedical that

use

information

technology and

communication to exchange data, then the improvement of health care services is happening. The interaction in telemedicine vary in kind of information like data, text, audio, photo, and direct video like video conference in real time or not (prerecorded) like email. Telemedicine could involve the relationship between health personnel to health personnel and health personnel with patient. 5

The health problems that is found are the sufficiency of labor that helped by health

personnel

(Table

and

complication treatment for the mother who giving

birth,

high

prevalence

malnourished toddler and BGM (Graph 2), the low life expectancy rate (Graph 1), and also a lot of communicable disease cases

One of the main problems in primary health care services in West Papua Province is the lack of equal distribution of health workforce especially the doctor. Physician and Specialist doctor mainly focused in certain areas, so the citizen have to go to that certain areas which

make them difficult to maintain their

certain things. This kind of a thing could

health condition. 8

be taken as an advantage to implement

A country that has successfully implemented

Telemedicine

China,

especially in Henan province. Where Henan itself has the same problem as West Papua, the lack of health workforce caused by the lack of equal distribution in remote areas.

telemedicine in West Papua. As the principal of citizen counseling about knowledge delivery, we could benefit this to educate the tribal chief, then the tribal chief will be given an understanding that telemedicine could improve the health of the tribe. So by having the understanding, the tribal chief will persuade the tribe to

The advantage of telemedicine is a

implement telemedicine.

solution for problems like the lack of health workforce and fulfilling the needs of health care provider in remote areas and

at the same time, health professionals in

Effectiveness

remote areas can also be supported

Maintaining The Patientâ&#x20AC;&#x2122;s Condition

through

telemedicine

Recovering From Disease at Healthcare

are

in Henan Province

the

technology.

use But

of there

some

disadvantages of Telemedicine itself, it

The

Relation of

Telemedicine

Between

Telemedicine

has

been

The and

proven

needs various kind of technology which is

successfully implemented based on the

not every health personnel could use. Also,

testimony of a patient diagnosed with

it needs an internet connection that could

coronary heart disease along with diabetes

reach the area and the limit of awareness and

and hypertension, who for 66 years has

knowledge by the citizen in remote areas.

spent a whole day using expensive-fare

bus just to go to the nearest country the

hospital from his home in Liuwa village,

government must works hard to build the

Henan province, to undergo a scheduled

infrastructure,

the

medical test. It is said that he made his

empowerment of people by doing training

electrocardiographs and blood test at the

about technology, and the cooperation of

clinic in his own village, a rural backwater

the tribal chief in West Papua. Which each

more than 110 kilometers (68 miles) away

tribal chief will hold the important role to

from the capital city of Henan, and then

the obedient of the rest of the tribe in

have them reviewed by doctors in big-city

overcome also

those, it

needed

hospitals. He also could easily have a

video-call consultation with the same

that it could solve the health problem of

doctor that he used to visit in the country

the citizen in remote areas.

hospital, and also right after the test done, he could

get

back

farming. So

telemedicine is effective in cost, time, and service.

West Papua for all this time had been lost from the governmentâ&#x20AC;&#x2122;s focus, especially in the health problems, but it has

Beginning from an internet health

big

potential

telemedicine.

Through

to the

implement citizen

care start-up called WeDoctor that made

counseling principal (predisposing factor

devices distributed in the rural health care

dan

program as a part of a cooperation between

knowledge using the method of usage and

the

Tencent-backed

company

and

government authorities. These devices can run

tests,

blood

pressure

measurement, electrical activity of the heart, and routine urine and blood analysis. Then

the

results

are

automatically

uploaded to a data system for further online consultation.

enabling

factor)

obtaining

benefit of telemedicine, of course it is so beneficial to the citizen especially in West Papua that is still obedient to the tribal chief. The biggest hope of the telemedicine use in West Papua is to make it easy for the government in educating them by having the citizen educated first by the tribal chief. And with the use of telemedicine

the

government will be so easy to equally Conclusion

distribute of quality health care services

The use of telemedicine has been proven to solve some problems like distance and time that have been a big problem for health care service. Through the prove and experience obtained from what China did to solve the health problem of the citizen in Henan province,, telemedicine could be used as an effective way especially for the health treatment by any means like maintenance

continuous

Through telemedicine, we hope

REFERENCE

treatment.

even in the most remote area. The use of telemedicine has been proven effective to be implemented in the remote area, but it is better for the government

also

improving

the

awareness about equity in health care services to the remote area. Elaborative cooperation between equal health care distribution and the use of telemedicine could take the health care services of Indonesia to something holistic.

1. Indonesia Ministry of Health. Data

[Internet]. 2015 [cited 19

dan Informasi Profil Kesehatan

December 2018]. Available from:

Indonesia 2017. Jakarta; 2018.

https://www.researchgate.net/pub

2. Indonesia Ministy of Health. Pedoman Pelayanan Kesehatan di Puskesmas Terpencil dan Sangat Terpencil di Daerah Tertinggal, Perbatasan dan Kepulauan. Jakarta; 2010. 3. Indonesia Ministry of Health. Rencana Pembangunan Jangka Menengah Nasional 2015-2019. Jakarta; 2015. 4. Mahendradhata Y, Trisnantoro L, Listyadewi S, Soewondo P, Harimurti P, Marthias T et al. The Republic of Indonesia Health System Review 2017. Health System in Transition. 2017;7(1 2017). 5. Santoso B, Rahmah M, Setiasari T, Puji S. PERKEMBANGAN DAN MASA DEPAN TELEMEDIKA DI INDONESIA. THE 7TH

lication/281497363_PERKEMB ANGAN_DAN_MASA_DEPAN _TELEMEDIKA_DI_INDONES IA 6. Suharmiati S, Laksono A, Astuti W. UP Review Kebijakan tentang Pelayanan Kesehatan Puskesmas di Daerah Terpencil Perbatasan. 2013;16(2):109â&#x20AC;&#x201C;116. 7. The South China Morning Post. A look at how China is using technology to improve rural access to quality health care [Internet]. 2018. Available from: https://www.scmp.com/tech/articl e/2135880/look-how-chinausing-technology-improve-ruralaccess-quality-health-care 8. West Papua Province Health Official. Profil Kesehatan Propinsi Papua Barat 2017. 2018. 9. World Health Organization.

NATIONAL CONFERENCE

Telemedicine Opportunities and

ON INFORMATION

developments in member states.

TECHNOLOGY AND

Global Observatory for eHealth

ELECTRICAL ENGINEERING

series. 2010;2.

TABLE & GRAPH Graph 1. Low Life Expectancy Rate

Graph 2. Prevalece Of Malnourished Toddler and BGM

Table 1. Health Workforce in 2017 in West Papua Province

Tabel 2. The Ratio of Doctors to 100.000 Citizen

Tabel 3. The Sufficency of Labor Helped by Health Personnel

Tabel 4. Communicable and Non Communicable Disease in West Papua Province

The Role and Challenges of Synchronous (Videoconferencing) Teleconsultation Among Physicians and Its Future Application in Indonesia Rexel Kuatama, Jessica Rosemary Wikanto, Agnes Margareta Tanoto Introduction Disparity in healthcare is a major issue in Indonesiaâ&#x20AC;&#x2122;s healthcare system. As specialist tend to stay in urban cities, lack of medical expertise can be seen in remote areas. To resolve this matter, use of technology has allowed various means of long distance medical consultation (teleconsultation). This review aim to illustrate use of real-time (synchronous) teleconsultation among physicians, its observed benefits and challenges, and its feasibility for application in Indonesia Method A systematic review was conducted through database such as Pubmed, ClinicalKey, WHO, government data and Google Scholar from the last 5 years. The keywords used are remote consultation OR teleconsultation AND videoconferencing OR videoconference and telehealth AND Indonesia. Several inclusion criterias were used. After final assessment, 24 literatures were concluded for present literature study. Results and Discussion A hub and spokes model of teleconsultation where specialists in health centers in health centers (hub) connects with physicians in rural health facilities (spokes) has result in numerous benefits. For patient, synchronous teleconsultation among physician allows significant reduction in cost and time as referral rates decreased. For physician, teleconsultation provides learning and increased expertise in more complex cases overtime. Changes in clinical decision is also observed. One study reported specialist change physiciansâ&#x20AC;&#x2122; decision in 844 of 927 cardiac teleconsultations. Implementation cost provides biggest challenge for developing countries. Other observed challenges include ethical issues and policy. In Indonesia, several legal regulation regarding teleconference has provided groundwork for further development. Although infrastructure was lacking, broadband service has shown fast progress.

Conclusion Synchronous teleconsultation among physician has significant benefits to a national healthcare system. However, several challenges need to be addressed beforehand. Based on current progress, Indonesia hold promise for future implementation. As Indonesia has began its telehealth project, focus should be made towards its development. Keywords : Teleconsultation, Synchronous, Telehealth, Indonesia

The Role and Challenges of Synchronous (Videoconferencing) Teleconsultation Among Physicians and Its Future Application in Indonesia

Created by: Rexel Kuatama Jessica Rosemary Wikanto Agnes Margareta Tanoto

The Role and Challenges of Synchronous (Videoconferencing) Teleconsultation Among Physicians and Its Future Application in Indonesia Rexel Kuatama, Jessica Rosemary Wikanto, Agnes Margareta Tanoto

Introduction Disparity in healthcare is a major issue in Indonesiaâ&#x20AC;&#x2122;s healthcare system. As specialist tend to stay in urban cities, lack of medical expertise can be seen in remote areas. To resolve this matter, use of technology has allowed various means of long distance medical consultation (teleconsultation). This review aim to illustrate use of real-time (synchronous) teleconsultation among physicians, its observed benefits and challenges, and its feasibility for application in Indonesia Method A systematic review was conducted through database such as Pubmed, ClinicalKey, WHO, government data and Google Scholar from the last 5 years. The keywords used are remote consultation OR teleconsultation AND videoconferencing OR videoconference and telehealth AND Indonesia. Several inclusion criterias were used. After final assessment, 24 literatures were concluded for present literature study. Results and Discussion A hub and spokes model of teleconsultation where specialists in health centers in health centers (hub) connects with physicians in rural health facilities (spokes) has result in numerous benefits. For patient, synchronous teleconsultation among physician allows significant reduction in cost and time as referral rates decreased. For physician, teleconsultation provides learning and increased expertise in more complex cases overtime. Changes in clinical decision is also observed. One study reported specialist change physiciansâ&#x20AC;&#x2122; decision in 844 of 927 cardiac teleconsultations. Implementation cost provides biggest challenge for developing countries. Other observed challenges include ethical issues and policy. In Indonesia, several legal regulation regarding teleconference has provided groundwork for further development. Although infrastructure was lacking, broadband service has shown fast progress.

Introduction Indonesia has a population of 265 million expanding across the vast archipelago, with nearly half of it citizens living in rural areas.1 However, the distribution of physicians remains a major problem in Indonesia. The Ministry of Health data reported huge disparity among provinces in Indonesia. In 2015, the lowest specialist-population ratio in Indonesia is located in Papua with the ratio 3:10,000, while the highest is in Jakarta with the ratio 52.2:10,000. As consequence, lack of speciality care can be found across hospitals in remote areas.

Developments in Information and Communications Technology (ICT) has allowed ways to provide medical services despite geographical boundaries, a term known as telemedicine.3 The

use of telemedicine dates back decades ago when the first

telegraphically ECG data was sent in 1906. Since then, it continues to evolve as telehealth programs emerges worldwide.

This review focuses on one form of telemedicine which is teleconsultation, in particular synchronous teleconsultation among physicians. Teleconsultation is termed as the provision of consultation between physicians or physician to patient for diagnostic and/or treatment of a patient.3,5 . Teleconsultation has been found to be a feasible system to provide access of specialist healthcare to remote areas, increase productivity of healthcare.3,5,6 and instill education towards physicians. 4,7 This review serves to illustrate the benefits of synchronous teleconsultation among physicians, its challenges and future plausibility in Indonesia.

II.

Materials and Methods Literature Search A systematic review is conducted through database such as Pubmed, ClinicalKey, WHO, government data and Google scholar ranging from the last 5 years. The keywords used are

remote

consultation

teleconsultation

AND

videoconferencing

videoconference and telehealth AND Indonesia. Inclusion criteria The inclusion criteria used in this review are (1) studies that evaluate the implementation of synchronous (videoconferencing) teleconsultation among physicians, (2) illustrate the implementation of a telehealth program which include synchronous teleconsultation among physicians and (3) studies that analyze challenges in synchronous teleconsultation or (4) studies which illustrates current telehealth situation in Indonesia. Data Extraction Results from literature search were further assessed for relevance until consensus was finally achieved. From final assessment, we concluded 24 literatures which met the criteria for present literature study. III.

Results and Discussion Proposed model of teleconsultation among physicians Teleconsultation allows remote physicians to connect with specialists in urban hospitals to seek medical expertise.5,7 These can be done in two types of interactions: ‘Store and Forward’ (asynchronous) and ‘Real-Time’ (synchronous). A typical example of real-time telemedicine would be a real time videoconferencing while asynchronous can be in form of email or texting.4,8,9

Asynchronous offers lower cost and more

flexibility in schedule while synchronous allows face to face consultations with immediate response.10 However, study shows synchronous teleconsultation was more effective on leading to correct clinical decisions. A 2012 telestroke program in china shows that the decisions on using tPA was made more correctly via means of real-time videoconference (98%) compared to telephone based consult (82%).11,12 Therefore, teleconsultation should not omit synchronous means in its system. Instead, combination with asynchronous means (hybrid) allows better efficacy

The proposed teleconsultation network is a ‘hub and spoke’ model, where health science center act as a hub for rural health facilities (spokes).5,11 The teleconsultation protocol vary, yet the common concept is illustrated as follow: when a patient with unclear clinical problem present, remote physicians could request a teleconsultation session. An independent regulator will schedule sessions with available specialists on hub. Requesting physician will then supply hospital specialist with patient conditions in return for medical guidance. If necessary, patient may be present during consultation with prior consent.13 The flow of request can be seen on (Figure 1). In terms of infrastructure, a 2013 WHO report of

telemedicine regional consultation stated

important standard-setting for application of telemedicine.

(Figure 2)

Observed benefits of synchronous teleconsultation among physicians As the number of telehealth programs increases, various studies have been conducted to evaluate their benefits. One obvious benefit is bringing various specialized expertise to rural areas. Furthermore, synchronous teleconsultation allow a three way consultation (patient-physician-specialist). In this way, remote community can then access specialist through their physician. In patients’ perspective, teleconsultation can be cost effective as it eliminate the necessities to travel far to meet specialists.10,11,15 A 2016 study was conducted to evaluate a 12 year (2002-2013) government-telemedicine programme in West China Hospital of Sichuan University. The programme, which connect 249 rural hospital in 112 cities, estimated a net saving of $2,364,525 from travel cost to the hub.11 A 2012 study in Alentejo, which compared teleconsultation to direct consultation patients, shows a 63% reduction of average cost (€25.32 to €9.31) for patients.15 Reduced referrals are also observed in various projects.3,5-7,14 Specialists were found to filter overdiagnosis, resulting to those cases treated earlier in primary care. 6 In requesting physician’s perspective, improvements in clinical decision were observed. Use of synchronous videoconference changes diagnosis/treatment plan and minimize errors.3,6,9,16 A 2006-2008 teleconsultation service in Spain shows that specialists modified general physicians’ decision in 91% (844) of 927 cardiac teleconsultation. 17 In burn medicine and oncology,

use of videoconference result in

significant different courses of burn care, fluid resuscitation rate, deferring intubation and change in tumor treatment modalities.9,18 Synchronous videoconferencing among physicians also provide continuous learning process which increase expertise of remote physicians. This is proven by

reduced number of teleconsultation due to physicians becoming more accustomed in handling complex cases.3,5,7,16, A 2016 qualitative case study conducted to analyze fourteen teleconsultation project confirms this. In one project, physician was able to treat complex tuberculosis cases at lower costs. The increased expertise is also shown by reduced requested teleconsultation sessions.7 However, emergent learning experience can only be achieved when specialists embrace the role of teacher. When specialist explain motives behind a course of action, teleconsultation become more appealing to requesting physician and sustainability increase.5,7 Challenges towards a sustainable synchronous teleconsultation among physician The first major challenge is implementation cost. Real time videoconferencing requires more extensive equipments, higher maintenance, and staff training. In addition, adequate connection must be established which impose bigger challenge for rural areas.9,13,14,19,20 Ethical issues such as patient confidentiality is another major issue to be upholded. Therefore, there is a need for a secure network and national telemedicine policies to ensure regulatory framework and prevent misuse. 1,11,13,14,19,20 Several challenges comes from physicianâ&#x20AC;&#x2122;s perspective. Ineffective placement of teleconsultation facility has shown to reduce willingness and consultation activity. 5,7 Teleconsultation

activity especially in large scale implementation

depends on

reimbursement policy.7,8,10,21,22 Studies has shown that lack of reimbursement contributes to decline of activity in Netherlands and Norway. 8,10,22 Although synchronous teleconsultation among physician brings significant benefits, these challenges need to be addressed before incorporating it into healthcare system. Current situation and future application in Indonesia Development of telemedicine in Indonesia starts in 1980s and accelerates in 2000s along with ICT improvements. It was until 2012 when the government initiate the first pilot project in teleradiology with Dr. Cipto Mangunkusumo Hospital and tele-ECG in Harapan Kita Hospital. In 2013, the project expands aiming to reach more referral sites nationwide.14,15,23 According

to 2013 COIA assessment

on eHealth

technology,

Indonesiaâ&#x20AC;&#x2122;s

infrastructure, policy, protection, standards, services and governance preparedness needs major strengthening.14,15,23 (Figure 3). In terms of policy, in 2004, government has created

the

first

guidelines

the

implementation

telematics

including

teleconference.

Various legal regulations around medical records and electronically

patient confidentiality already exist. However, there is a need to strengthen and increase thoroughness of these policies. In addition, a

national centre for excellence in

telemedicine should also be included in upcoming plan. 14,23 From infrastructure point of view, data from 2017 annual report of Ministry of Communications and Informatics reported that 4G connection has reached 12,002 out of a total of 83,218 villages, 481 out of 514 municipalities/cities and all of the provinces in Indonesia. (Figure 4) Projects like fiber optic ‘palapa ring’ was also on progress to cover lagging

internet

regions. 24

municipality/cities.

2019,

broadband

connection

will

reach

all

These progress show promises in future establishment of an

integrated synchronous teleconsultation among physician. 7,13 IV.

Conclusion The huge disparity of healthcare coverage remains a big challenge in Indonesia’s healthcare system. Synchronous teleconsultation among physicians has proven to be effective to bring medical expertise to rural areas, reduce cost for patients, improve quality of primary care and provide continuous learning experience for physicians. However, to achieve a sustainable system, challenges such as implementation cost, adequate infrastructure and legal policy should be addressed. Indonesia’s first telemedicine pilot projects in 2012, advances in infrastructure and pre-existing policies hold promise for the future of a synchronous teleconsultation among physicians to provide equal access remote areas.

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6. Hoseini F, Ayatollahi H, Salehi SH. A systematized review of telemedicine applications in treating burn patients. Med J Islam Repub Iran. 2016 Dec;30:459. 7. Paul DL, McDaniel RR. Influences on teleconsultation project utilization rates: the role of dominant logic. BMC Med Inform Decis Mak [Internet]. 2016 Dec [cited 2018 Dec 19];16(1). Available from: http://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-0160392-2 8. Zanaboni P, Knarvik U, Wootton R. Adoption of routine telemedicine in Norway: the current picture. Glob Health Action. 2014 Dec;7(1):22801. 9. Atiyeh B, Dibo SA, Janom HH. Telemedicine and Burns: an Overview. American University of Beirut Medical Center. 2014 Jun;27(2):87-93 10. Tensen E, van der Heijden JP, Jaspers MWM, Witkamp L. Two Decades of Teledermatology: Current Status and Integration in National Healthcare Systems. Curr Dermatol Rep. 2016 Jun;5(2):96â&#x20AC;&#x201C;104.

11. Zhao G, Huang H, Yang F. The progress of telestroke in China. Stroke Vasc Neurol. 2017 Sep;2(3):168–71. 12. Vermeir P, Vandijck D, Degroote S, Peleman R, Verhaeghe R, Mortier E, et al. Communication in healthcare: a narrative review of the literature and practical recommendations. Int J Clin Pract. 2015 Nov;69(11):1257–67. 13. Harzheim E, Gonçalves MR, Umpierre RN, da Silva Siqueira AC, Katz N, Agostinho MR, et al. Telehealth in Rio Grande do Sul, Brazil: Bridging the Gaps. Telemed EHealth. 2016 Nov;22(11):938–44. 14. World Health Organization, Regional Office for South-East Asia. Telemedicine: sharing experiences and a way forward, Report of a regional consultation, Pyongyang, Democratic People's Republic of Korea, 30 July-1 August 2013. WHO Regional Office for South-East Asia. 2014. 15. Oliveira TC, Bayer S, Gonçalves L, Barlow J. Telemedicine in Alentejo. Telemed EHealth. 2014 Jan;20(1):90–3. 16. Díaz-Chao Á, Torrent-Sellens J, Lacasta-Tintorer D, Saigí-Rubió F. Improving Integrated Care: Modelling the performance of an online community of practice. Int J Integr Care [Internet]. 2014 Mar 10 [cited 2018 Dec 19];14(1). Available from: http://www.ijic.org/article/10.5334/ijic.1200/ 17. Zanaboni P, Scalvini S, Bernocchi P, Borghi G, Tridico C, Masella C. Teleconsultation service to improve healthcare in rural areas: acceptance, organizational impact and appropriateness. BMC Health Serv Res [Internet]. 2009 Dec [cited 2018 Dec 19];9(1). Available from: http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-9-238 18. Seeber A, Mitterer M, Gunsilius E, Mazzoleni G, Giovannetti R, Farsad M, et al. Feasibility of a Multdisciplinary Lung Cancer Videoconference between a Peripheral Hospital and a Comprehensive Cancer Centre. Oncology. 2013;84(3):186–90. 19. Mohamed KG, Hunskaar S, Abdelrahman SH, Malik EM. Telemedicine and ELearning in a Primary Care Setting in Sudan: The Experience of the Gezira Family Medicine Project. Int J Fam Med. 2015;2015:1–7. 20. Kiberu VM, Mars M, Scott RE. Barriers and opportunities to implementation of sustainable e-Health programmes in Uganda: A literature review. Afr J Prim Health Care Fam Med [Internet]. 2017 May 29 [cited 2018 Dec 19];9(1). Available from: https://phcfm.org/index.php/phcfm/article/view/1277

21. Shea CM, Haynes-Maslow L, McIntyre M, Weiner BJ, Wheeler SB, Jacobs SR, et al. Assessing the Feasibility of a Virtual Tumor Board Program: A Case Study: J Healthc Manag. 2014 May;59(3):177–93. 22. Zanaboni P, Wootton R. Adoption of routine telemedicine in Norwegian hospitals: progress over 5 years. BMC Health Serv Res [Internet]. 2016 Dec [cited 2018 Dec 19];16(1). Available from: http://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1743-5 23. World Health Organization, Regional Office for South-East Asia. Telemedicine in Indonesia “Country Experiences”. WHO Regional Office for South-East Asia. 2013. 24. Ministry of Communication and Information. Annual Report 2017. KOMINFO. 2018. Tables and Figures Figure 1. Flow of request in synchronous teleconsultation

Figure 2. Important infrastructure standard-setting for telemedicine application reported in 2013 WHO report of telemedicine regional consultation

Figure 3. 2013 COIA assessment on Indonesia eHealth technology

Figure 4. 4G Broadband of Covered Administrative Regions in Indonesia (2017 Annual report of Indonesia Ministry of Communications and Informatics)

The Effectiveness of Millennial Technology in Preventing Health Problem in Indonesia Rusti Nurgya Oktaviani Edwina Darmadji

Introduction According to the Indonesian Dictionary, Technology means 1) The scientific method for achieving practical goals; applied science, 2) the overall means for providing goods needed for the survival and comfort of human life. In this modern era, almost all aspects of society have handphone as a communication tool. Along with the advancements of the times, community diseases are increasingly diverse. Therefore, handphone is very reliable as a disease prevention tool. Material and Methods The method used is Literature Review by collecting journal sources Result and Discussion The first study of research related to YouTube was research conducted by Shabbir SyedAbdul. Et al. (2013) about anorexia on YouTube. The results of his research showed that videos with pro-anorexia information were identified as 29.3% of the related videos. Next is health-related research that uses Facebook as its media. Research conducted by Bender et al. (2011) aimed to determine the characteristics, goals, uses, and creators of Facebook groups related to breast cancer. Technology as a new media for health promotion is inevitably a necessity. The advantages of technology in terms of its effectiveness as a media can act as a double-edged knife. Conclusion From several facts of research results and empirical facts in the field it can be concluded that technology is very effective as a media for preventing disease problems in Indonesia. In addition, technology is also very effective in conveying contra information.

THE EFFECTIVENESS OF MILLENIAL TECHNOLOGY IN PREVENTING HEALTH PROBLEM IN INDONESIA

Rusti Nurgya Oktaviani Edwina Darmadji

FACULTY OF MEDICINE HANG TUAH UNIVERSITY SURABAYA 2018

Introduction Using health information technology (HIT) to improve care and outcomes for older adults in the Health Information Technology for Economic and Clinical Health (HITECH) Act (Blumenthal, 2010; Institute of Medicine, 2011). According to Indonesian Dictionary, Technology means 1) The scientific method for achieving practical goals; applied science, 2) the overall means for providing goods needed for survival and comfort of human life. In this modern era, almost all the mobile devices have a communication tool. Along with the advancements of the times, community diseases are increasingly diverse. Therefore, mobile phones are very reliable as a disease prevention tool (Ministry of education and culture, 1997). While according to Kaplan & Haenlein (2010), the definition of social media is a group of internet-based applications that build on the ideology based on Web 2.0 technology, which allows the creation and exchange of content that can be used by everyone. Materials and methods Research conducted by Chadwick Martin Bailey and iModerate Research Technologies (2010) in 1,504 respondents aged 18 years and over found that 60% of Facebook fans and 79% of Twitter followers tended to recommend brands since they were fans or follower (follower). This more market research study found that consumers were 67% more likely to buy from the brands they followed (follow) on Twitter, and 51% more likely to buy from brands they like (like / thumb) on Facebook. This shows clearly that society is strongly influenced by the phenomenon of social media. Have we ever imagined that there are posts of 50 million tweets per day? Or, on average, 600 tweets per second? Or, another amazing fact is that the official statistics of Facebook companies describe there are already 400 million active users worldwide and continue to grow by 20 million every day. Analyzing the impact of social media in our environment, gives us a complete picture that something is happening when we use communication with social media (Bailey, 2010; Garcia, 2011). The effectiveness of social media as an information media or promotion is mapped clearly by Israel Garcia (2011) in "Social Media Integration Theory Model". According to Garcia, the one-to-many integration model can work well when we carefully examine communication channels or implement online marketing. However, interactive social media platforms (Facebook, LinkedIn, Del.ici.ous, Twitter, YouTube, Foursquare, Digg in, etc.) have radically changed the communication paradigm. Because of the rapid adoption of social media marketing as a primary communication integration media, it is important to consider how social interaction has influenced the communication process.

Research conducted by Chadwick Martin Bailey and iModerate Research Technologies (2010) in 1,504 respondents aged 18 years and over found that 60% of Facebook fans and 79% of Twitter followers tended to recommend brands since they were fans or follower (follower). This more market research study found that consumers were 67% more likely to buy from the brands they followed (follow) on Twitter, and 51% more likely to buy from brands they like (like / thumb) on Facebook. This shows clearly that society is strongly influenced by the phenomenon of social media. Have we ever imagined that there are posts of 50 million tweets per day? Or, on average, 600 tweets per second? Or, another amazing fact is that the official statistics of Facebook companies describe there are already 400 million active users worldwide and continue to grow by 20 million every day. Analyzing the impact of social media in our environment, gives us a complete picture that something is happening when we use communication with social media (Bailey, 2010; Garcia, 2011). The effectiveness of social media as an information media or promotion is mapped clearly by Israel Garcia (2011) in "Social Media Integration Theory Model". According to Garcia, the one-to-many integration model can work well when we carefully examine communication channels or implement online marketing. However, interactive social media platforms (Facebook, LinkedIn, Del.ici.ous, Twitter, YouTube, Foursquare, Digg in, etc.) have radically changed the communication paradigm. Because of the rapid adoption of social media marketing as a primary communication integration media, it is important to consider how social interaction has influenced the communication process. Result and discusion The first study of research related to YouTube was conducted by Shabbir Syed-Abdul. Et al. (2013) about anorexia on YouTube. The results of his research showed that videos with prohistory information were identified as 29.3% of the related videos. Next is health-related research that uses Facebook as its media. Research conducted by Bender et al. (2011) aims to determine the characteristics, goals, uses, and creators of Facebook groups related to breast cancer. Technology as a new media for health promotion is inevitably a necessity. The technology in terms of its effectiveness as a media can act as a double-edged knife. As many as 50 adults participated in this study. There have been 773 tweets, including 2,862 hashtags or "hashtags": 1,756 hashtags about food and 1,106 hashtags about reasons to eat. Food group hashtags that are often reported are # granules (n = 365 tweets), #susu (n = 221), and #protein (n = 307). The most frequently cited reasons for eating were # social (activity) (n = 122), # taste (n = 146), and # comfort (n = 173). Study participants used the hashtag

combination provided and their own hashtag to describe behavior. Twitter is considered the easiest to use for the purpose of reporting behavior related to diet. The hashtag event map was developed according to the timing of suggested diet variations and behavior patterns (Hingle, et al, 2013). Researchers found there were 620 breast cancer groups on Facebook with a total of 1,090,397 members. The group was created for various purposes: fundraising (44.7%), awareness (38.1%), products or services related to fundraising promotions (61.9%), and patient support (46.7%). The overall awareness group dominates this group (n = 957,289). The majority of groups (85.8%) have 25 wall posts or less. Supporting oriented groups, 47% are formed by high schools or students (Bender, et al, 2011). Conculusion From several facts of research results and empirical facts in the field it can be concluded that technology is very effective as a media for preventing disease problems in Indonesia. In addition, technology is also very effective in conveying contra information.

Reference Bailey, Chadwick Martin. Consumers Engaged Via Social Media Are More Likely To Buy, Recommend. iModerate, Boston, Massachusetts. 2010 Bender, Jacqueline L., Maria-Carolina Jimenez-Marroquin, Alejandro R. Jadad. Seeking Support on Facebook: A Content Analysis of Breast Cancer Groups. Journal of Medical Internet Research, 13(1):e16. 2011 Departemen Pendidikan dan Kebudayaan (1997) Kamus Besar Bahasa Indonesia. Jakarta: Balai Pustaka Garcia, Israel. Social Media Integration Theory Model. Human Media, Spanish. 2011 Institute of Medicine. Digital infrastructure for the learning health system: The foundation for continuous improvement in health and health care: Workshop series summary. Washington, DC: The National Academies Press; 2011 Kaplan Andreas M.& Haenlein Michael. Users of the world, unite! The challenges and opportunities of social media, Business Horizons, Vol. 53, Issue 1. page 61. 2010 Shabbir, SA., Luis Fernandez-Luque, Wen-Shan Jian, Yu- Chuan Li; Steven Crain, Min-Huei Hsu, Yao-Chin Wang, Dorjsuren Khandregzen, Enkhzaya Chuluunbaatar, Phung Anh Nguyen, Der-Ming Liou. Misleading Health-Related Information Promoted Through Video-Based. Social Media: Anorexia on YouTube. Journal of Medical Internet Research. Volume 15 (2): e30: 2013

Using SIMPUSTRONIK and Puskesmas Integrated Healthcare Information System for Equity of Healthcare Access to Puskesmas Rohimatul Alya Dewi Alfina1, Gede Subhaga2, Afiv Dian Risnanda3 1

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM, rohimatul.alya8@gmail.com 2

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM.

ABSTRACT Introduction: One of the problems that faced by puskesmas in their duty to maintain and improve the health of surrounding area is the problem of access to health services both due to social and geographical factors. This is also supported by the rapid development of the global situation so that the old ways to overcome the problem of access to health services cannot be used anymore. For that reason, It is necessary for improvement of the system by making electronicbased health care system that include the use of SIMPUSTRONIK and Puskesmas Integrated Healthcare Information System. Objective: Providing solutions to the government to overcome the problem of equity access to health services at Puskesmas in Indonesia. Metode: The method used is a literature review which is to compile based on journal sources obtained through search engine such as“Google Scholar” and “ResearchGate”. Result and Discussion: Based on previous research and the benefits of SIMPUSTRONIK, SIMPUSTRONIK is feasible to be used as an application for the Puskesmas Management System in overcoming social access problem to health services. In addition, based on research by , Integrated Puskesmas Facility Service Information System is said to be able to overcome the problems of variable time and distance that cannot be estimated, the queue data variable that cannot be determined the amount and time of waiting. Conclusion: SIMPUSTRONIK and Puskesmas Integrated Healthcare Information System are effective and efficient to solve the problem of Healthcare Access to Puskesmas in Indonesia. Key Words: Puskesmas Facilities, Primary Healthcare, Puskesmas Information System, Equity of Healthcare and SIMPUSTRONIK

Using SIMPUSTRONIK and Puskesmas Integrated Healthcare Information System for Equity of Healthcare Access to Puskesmas Rohimatul Alya Dewi Alfina1, Gede Subhaga2, Afiv Dian Risnanda3 1

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM, rohimatul.alya8@gmail.com 2

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM.

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM. satisfying to the patient(5). Besides that, it

INTRODUCTION Equity in providing health services (1)

was also added by many people who did not

is a necessity in health development ,

want to go to the puskesmas for various

because health itself is the right of every

reasons either from social or geographical

human being and at the same time as an

factors(6).

investment in nation building, the same goes

Health services in this era are

for health development which is regulated

changing according to the influence of the

to implement health service equity(2). The

global situation, rapid progress in the field

purpose of health development according to

of information and technology. The global

UU article 3 No. 36/2009 is to increase

and national situation makes health care

awareness, willingness and ability to live

providers unable to use the old approach to

healthy for everyone in order to realize the

fulfill community needs(7). This makes

highest degree of public health. One form of

health services to make an innovation in

government efforts in organizing health

providing services so that health services in

development

Puskesmas become more efficient(8). One of

the

establishment

Puskesmas in each sub-district(3). Puskesmas

the

is a first-level health implementing unit that

infrastructure to access information about

and

health facilities is Integrated Puskesmas

improving the health of individuals, families

Service Information System. The integrated

and surrounding communities (4). But in its

system needs to be implemented to optimize

implementation, puskesmas services are

the health information facilities available to

currently not

with the

be received by the surrounding community

functions that should be performed so that

and expected to help the society in

the services obtained can be said to be less

estimating the distance and time from the

responsible

for

maintaining

accordance

inovation

developing

the

nearest Puskesmas, directions of the nearest

as“Google Scholar” and “ResearchGate”,

Puskesmas,

with

information

queue

keywords

“Puskesmas

registration, profile of Puskesmas, e-medical

“Primary

records, and patient’s referral information(9).

Information

Based on the Decree of the Minister of

Healthcare” and “SIMPUSTRONIK” with

Health No. 128/Menkes/SK/II/2004 stated

publication year range about 2014-2018 and

that

Management

from the search results, obtained 59,817

Information System (SIMPUS) is an order

journals. Then the journal is selected and the

that provides information to assist the

result is 15 journals that meet the criteria

management process of the puskesmas. The

and considered as valid and reliable to our

development of information and technology

discussion.

the

Puskesmas

Healthcare”,

Facilities”,

System”,

“Puskesmas “Equity

also affects the development of SIMPUS, that is by developing SIMPUSTRONIK.

RESULT AND DISCUSSION

The Electronic Health Center Management

Equity of Health Services in Puskesmas

Information System (SIMPUSTRONIK) is

Equity in access to health services is

the name of the SIMPUS application

a challenge faced by various countries,

provided by the local District Health Office

especially in Southeast Asia. As for equityof

with

Nations

health services in Indonesia have not been

Children's Fund) Facilitator(10). In order to

evenly distributed in each region. A review

enter the era of globalization which is

conducted by Idris found that based on a

absolutely needed accurate and up to date

study conducted by Nadjib, 13 provinces

information regarding the data of sick

showed that the probability of accessing

people, availability of drugs, immunization

health services proved to be different due to

problems and others, the practice of

geographical

SIMPUSTRONIK can be useful to improve

Geographical access in question includes the

data collection in puskesmas for reports to

distance

the District Health Office(11).

Puskesmas, transportation equipment and

METHOD

the time to reach Puskesmas. While the

UNICEF

(The

United

and

between

social the

house

factors(6). and

the

The method used is a literature

social access itself includes the attitude of

review which is to compile based on journal

the administrative officer, the attitude of the

sources obtained through search engine such

health care provider, and the inspection

data

and

queue(1).

mechanism

information makes

quickly.

health

The

services

This was supported by a study

Puskesmas more efficient because of the rapid

conducted by Masita, et al who found that

sharing of information so that patients do not

access to locations that were less close to the

need to feel tired due to complicated

Puskesmas, made the utilization of health

administration and waiting too long and

services also reduced by around 50.7% (12)

patients who end up on that day are

and a study conducted by Listyowati, et al

immediately recorded on the computer (11).

found the problem of health services

Based on research conducted by

complained

about

low

administrative

Farlinda, the mechanism can increase the effectiveness of health services, especially in

services as much as 14.3%(2).

terms

time

and

increase

patient

SIMPUSTRONIK As a Solution to Social

satisfaction. SIMPUSTRONIK application

Access Problem

is easy to understand and the quality of

The quality of health services in

information systems that work well become

Puskesmas can be improved through the use

the factor that makes SIMPUSTRONIK

Informasi

effective in Puskesmas health services. With

Manajemen Puskesmas Elektronik) which is

the research by Farlinda and the benefits,

the name of the SIMPUS application that

SIMPUSTRONIK is recommended to use as

has

Puskesmas

SIMPUSTRONIK

information

(Sistem

control

system

Puskesmas and addressed to the public so the public

Management

application . But according to Wibowo, et al the

has insight into health services

and increases the effectiveness of health

success

administration services in the Puskemas(11).

implementation

SIMPUSTRONIK simultaneously

the

is service

SIMPUSTRONIK is

applied

experience

SIMPUSTRONIK

the

System

(13)

influenced the

the

implementor,

supporting

facilities,

Puskemas starting from the registration

frequency

SIMPUSTRONIK

counter, poly room to the administration of

implementation

drugs at the pharmacy so that each room

coordination among implementors(10). So if a

must have one computer that is connected to

Puskesmas

a computer in another room in order to share

SIMPUSTRONIK, then it is necessary to

socialization wants

and

the apply

make a training by the SIMPUSTRONIK coordinator at the Puskesmas, working with the local health office in monitoring the implementor's Puskesmas

performance

and

periodically

the

reviewing

computer software(11). Puskesmasâ&#x20AC;&#x2122;

Integrated

Healthcare

Information System As A Solution To Fig. 1.1 Home Page Preview

Geographical Access Problem Healthcare

At the home page there are three choices,

Information System is a service application

that are puskesmas, queues, and referrals.

system in the health sector that is useful in

Puskesmas options contain list of the nearest

providing information about health facilities

puskesmas. Queue choice if the society

in an integrated health center(14).

wants to take the queue number without

Puskesmasâ&#x20AC;&#x2122;

Integrated

According to research by Yufrizal, et

long queues like in general. The choice of

al integrated information systems as a

referral is intended for people who have

solution to the problem of location or

been treated and received referrals for

distance in Puskesmas can be through a

treatment

mobile

application.

The

innovation

applied using an application that can be downloaded on mobile phones. Patients can log in any time and can see the data of the nearest Puskesmas, get a queue number online, and get a referral letter that has been made by a doctor(9).

advanced

level(9).

Fig. 1.2 Login Page Preview

has an impact on reducing paper use in

On the login page, the society can enter

carrying out daily operational activities,

username and password that was created

minimizing work that is often carried out

previously. In this integrated system, logins

repeatedly

are divided into three, that are as patients,

numbers

doctors, and admins (head of the puskesmas,

generated by the system, and decisions taken

administration department, and Puskesmas

are not too late because information can be

IT team)(9).

generated more quickly(15).

such and

some

dates, other

transaction input

data

CONCLUSION Equity in providing health services is fairness in the delivery of health services. But in its implementation, access to health services is hampered by either social or geographical access. To overcome the problem of social access, SIMPUSTRONIK Fig. 1.3 Admin Page Preview

can be implemented which is an application

After log in as an admin, admin can add

that has an information control system of

information data about Puskesmas data and

puskesmas

queue numbers for puskesmas visitors. Beside

effectiveness

that, the admin can update the system(9).

services

that

can

health

Puskemas.

improve

the

administration Meanwhile,

With the Integrated Health Center

overcome the problem of geographical

Facility Service Information System, it can

access, Puskesmas Integrated Healthcare

overcome the variable time and distance

Information System can be implemented by

problems that cannot be estimated, the

the, which is a application service system in

queue

the health sector that is useful in providing

determined the amount and time of waiting,

information about health facilities in an

does not know the previous medical record

integrated Puskesmas.

data

variable

that

cannot

data variable in the referral based on the patient's disease history(9). This system also

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1.1

Home

.....................4

Page

Preview

Fig.

1.2

.....................4

Page

Preview

Fig. 1.3 Admin Page Preview .....................5

The Implementation of Indonesian Mobile Health Clinics (IMHC) Associated With Nanobiosensors As An Effective System to Improve an Equal and Potent Patient-Centered Healthcare Management in the Fast Growing of Digital Era Peksi Saphira Miradalita Faculty of Medicine, Universitas Sriwijaya

ABSTRACT Introduction. Indonesia is the third most populous country in Asia and the fourth largest in the world with around 255 million people. In the current state, Indonesia is still facing hard challenges in the health sector, especially in relation to equal Healthcare access to all regions in Indonesia. Underpinning these problems are significant disparities in access to quality health services across geographic regions and socioeconomic groups, this is caused by 2 major barriers that contribute to the implementation of the Healthcare system, the Over-populated country and Financial Crisis of the country. Materials and Methods. Writer conducted a literature review from Indonesian Health Profiles, NCBI, Pubmed, ELSEVIER, WHO and Government documents. Only studies conducted from 2008-2018 are included in this review.

Results and Discussions. Mobile clinics integrated with Nanobiosensor as an effective diagnostic device, represent an integral component of the healthcare system that delivers care to populations that are hard to reach by the traditional system, improving access and supporting prevention and chronic disease management. Mobile clinics are able to leverage their ability to overcome barriers to access and build trusting relationships to reduce disparities, improve health, and reduce costs. The Implementation of Mobile Health Clinics was shown by a data in the United States. St. Joseph Health, that succeeded to provide Healthcare to more than 30.000 citizens, increasing their Health and promoting prevention programs.

Conclusion. In summary, this review contains data relating to the Integration between the IMHC (Indonesian Mobile Health Clinics) and nanotechnologies, which the nanobiosensor tool will be provided along with the Mobile Health Clinics, as the answer to help Indonesiaâ&#x20AC;&#x2122;s healthcare system in order to bring Equal Access to every citizen in the country.

Keywords: Healthcare Access, Mobile Health Clinics, Nanobiosensors

Name: Peksi Saphira Miradalita AMSA-Universitas Sriwijaya

Faculty of Medicine, Universitas Sriwijaya Palembang 2018

Abstract. Indonesia is the third most populous country in Asia and the fourth largest in the world with around 255 million people. In the current state, Indonesia is still facing hard challenges in the health sector, especially in relation to equal Healthcare access to all regions in Indonesia. Underpinning these problems are significant disparities in access to quality health services across geographic regions and socioeconomic groups, this is caused by 2 major barriers that contribute to the implementation of the Healthcare system, the Over-populated country and Financial Crisis of the country. Therefore, an effective system is needed in order to overcome this Healthcare barriers. The effect of the Healthcare access barrier is very possible to be reduced if a system that is able to prevent, diagnose, and monitor the Health of the citizens, both in Urban and Rural areas, is implemented. It is to be considered also that this system has to be cost-friendly, so that the system is feasible. This healthcare system discussed in this review evaluated the Implementation of Mobile Health Clinics, which is an application-based vehicle that delivers access of Healthcare in front of citizensâ&#x20AC;&#x2122; door, especially those in rural areas, and a Nanobiosensor that acts as a nano -specified diagnostic device as an integrated system that will be able to suppress the number of diseases by expanding healthcare access to rural areas as well as curating, detecting, and preventing a disease from a very early stage, thus the curative costs of the diseases could also be reduced.

Keywords: Healthcare Access, Mobile Health Clinics, Nanobiosensors

INTRODUCTION The Over-Population and Financial Crisis are the current barriers of the Equity to Healthcare Access in Indonesia Indonesia is a lower middle-income country with a Gross National Income (GNI) per capita of US$3630 with high Gross Domestic Product (GDP) growth, averaging 5.6% between 2007 and 2016. Indonesia is the third most populous country in Asia and the fourth largest in the world with around 255 million people. In the current state, Indonesia is still facing hard challenges in the health sector, especially in relation to equal Healthcare access to all regions in Indonesia. 1 The big challenges in Indonesiaâ&#x20AC;&#x2122;s Healthcare System are the rising number of Non-Communicable diseases, which actually could be easily prevented. Until date, Indonesia is facing a double burden of disease characterized by the rising number of non-communicable diseases, and chronic diseases, including Cancer as one of the major contributors. 1,2 Underpinning these problems are significant disparities in access to quality health services across geographic regions and socioeconomic groups. High government funding allocations to hospitals (less frequently utilized by poor and disadvantaged communities) and elevated government spending on pharmaceuticals has also reduced investment in primary and promotive health services. Indonesia spends only slightly more than 2% of its GDP on health, approximately half the level of other comparable income countries. Therefore, it is concluded that one of the major contributors of the inequity of healthcare access are the overpopulated country the inadequate funding allocations for the Improvement of Healthcare and also the Financial Crisis of Indonesian citizens. 2 It is reported also that Indonesia is facing a triple burden of health care problems due to the rise of chronic diseases. World Bankâ&#x20AC;&#x2122;s report also highlighted that the Indonesian healthcare system remains inefficient, unequal, and with low supervision rates where most people continue selftreatment, thereby creating decline of health services utilization. Thus, an effective system is needed in order to overcome this Healthcare barriers. The number of these diseases is very possible to be reduced if a system that is able to prevent, diagnose, and monitor the Health of the citizens, both in Urban and Rural areas, is implemented. It is to be considered also that this system has to be cost-friendly, so that the system is feasible. Therefore, the integration system between Mobile

Health Clinics and Nanobiosensor that will be discussed later in this review will be able to suppress the number of this disease by expanding healthcare access to rural areas as well as detecting and preventing a disease from an early stage, thus the curative costs of the disease could also be reduced.2,3 MATERIALS AND METHODS Search Strategy The data used in this article sourced from experiments, trials, and all published studies that are relevant to the topic of orientation discussed. Validity and relevance of the references can be accounted. The types of data obtained are secondary data which are qualitative and quantitative. Study Selection The studies included in this review were selected based on the following inclusion and exclusion criteria. Studies were included if 1. the study discussed the barriers of Indonesiaâ&#x20AC;&#x2122;s Healthcare System; 2. the study evaluated the potency of Mobile Health Clinics to be contributed to Indonesian Healthcare system; 3. the study evaluated the potency of Nanobiosensor as an effective diagnostic device to be integrated with the Mobile Health Clinics. Studies were excluded if 1.

the study was not available in English;

the study was published before 2008.

Searched terms in this review included Mobile Health Clinics, Nanobiosensor, Healthcare Access. Data Collection The writing of this review uses a literature study method that produces results for various literatures that have been tested for validity, relevance to writing studies, and ones that support the

analysis of this review. Data collection is conducted from 5th November 2018 to 20th December 2018. Data Analysis After the data is collected, data processing is done systematically and logically using argumentative analysis techniques, with descriptive writing, and potential information on The Implementation of Indonesian Mobile Health Clinics (IMHC) Associated With Nanobiosensor As An Effective System to Improve an Equal and Potent Patient-Centered Healthcare Management in the Fast Growing of Digital Era. After the process is carried out, a synthesis is processed by connecting the problem, the objectives and the discussion. RESULTS AND DISCUSSION App-Based Mobile Health Clinics provide a strong concept to expand access for vulnerable populations in Indonesia Mobile health clinics are customized vehicles that travel to the heart of communities, both urban and rural, and provide prevention and healthcare services where people work and live. They overcome barriers of time, money, and trust, and provide community-tailored care to vulnerable populations. By traveling to these communities and offering affordable, or, oftentimes, free services, mobile clinics remove logistical constraints such as transportation issues, difficulties making appointments, long wait times, complex administrative processes, and financial barriers such as health insurance requirements and copayments. This mobile health clinics could be ordered by Patients who needed treatment via application, and also this Mobile Health Clinics will be monitoring the areas constantly, which will be controlled and connected with the Government. 3,4 Promoting Prevention: Healthcare in front of the Citizensâ&#x20AC;&#x2122; door The Implementation of Mobile Health Clinics, despite its benefit in curating basic diseases, it is meant majorly to promote disease prevention. There has been considerable national focus on the need for safety-net programs to provide community-based prevention, screening, and chronic disease management, particularly for low-income, minority, and rural communities. Several studies have found that mobile clinics are successful at improving screening and identifying high

rates of chronic and infectious disease among underserved populations. Improved screening allows mobile clinics to deploy interventions that improve treatment and prognosis. This Mobile Health Clinics should be able to be sent to rural areas, by an application-based system provided by the Government.5,6 Indonesian Mobile Health Clinics (IMHC) is Potential in reducing significant Healthcare costs Mobile clinics can produce significant cost savings as a result of their ability to provide community-tailored care in high-risk areas. It is concluded that Mobile Health Clinics have a critical role to play in providing high-quality, low-cost care to vulnerable populations.6,7,8 Mobile clinics represent an integral component of the healthcare system that delivers care to populations that are hard to reach by the traditional system, improving access and supporting prevention and chronic disease management. The Implementation of Mobile Health Clinics was shown by a data in the United States. St. Joseph Health, a $4.4-billion nonprofit Catholic health system with 14 hospitals serving California, Texas, and New Mexico, is a prime example. St Joseph Health invests $5 million annually in mobile health clinics, 11% of which is offset by reimbursements. These mobile clinics provide care through their more than 32,000 patient encounters annually, and offer services such as primary care to people in need. 7,8

Table 1. Common Barriers to Health Services in Low-Income, Minority Communities and Methods Mobile Clinics Use to Overcome These Barriers. 5

Nanobiosensor: A Nano-Specific Prevention Promoting Device A biosensor is an analytical device that incorporates a biological sensing element with a transducer, to produce a signal used for the analyte concentration.

Figure 1. A schematic diagram shows basic biosensor assembly with a biological recognition element, transducer and processor. 7 A basic Concept of Nanobiosensor: Detecting a Disease from a Very Early Stage A nanobiosensor is a means of detecting biological agents such as antibodies, nucleic acids, pathogens, and metabolites. The working principle consists of binding bioanalytes of interest onto bioreceptors, which in turn modulate the physiochemical signal associated with the binding. Later, a transducer captures and converts the physiochemical signal into an electrical signal. The variation in signal such as electric potential, current, conductance, impedance, intensity and phase of electromagnetic radiation, mass, temperature, and viscosity is monitored. Analysis of the variation in one or more of these parameters quantifies the presence or absence of bioagents. The nanostructures in nanobiosensors act as an intermediate layer between biological agents and physicochemical detector components or biological agents, and the transducer is combined with nanomaterials to construct a biosensor.9,10 The ability of nanobiosensor to detect a disease at a very early stage is one of the answers of a standard biosensor that mostly could only detect a disease when it had developed to a much higher

stage. If this nano-specified diagnostic tool could be implemented, then it is most likely that the Government could save a lot of cost regarding to the high curative costs. 10,11,12 CONCLUSION In summary, this review contains data relating to the Integration between the IMHC (Indonesian Mobile Health Clinics) and nanotechnologies, which the nanobiosensor tool will be provided along with the Mobile Health Clinics, as the answer to help Indonesiaâ&#x20AC;&#x2122;s healthcare system in order to bring Equal Access to every citizen in the country. This system is very potential, proved by its implementation of Mobile Health Clinics in the United States, this review also evaluated the potency of Nanobiosensor as a diagnostic device that would sense the emerge of a disease from a very early stage, thus able to provide Prevention most leading cause of death in Indonesia that are very variative, for example Non-communicable diseases and Infectious diseases. Nanobiosensor also promise to extend the limits of current molecular diagnostics and enable point -of care diagnosis, integration of diagnostics with therapeutics, and development of personalized medicine. The most important clinical applications of the currently available nanotechnology are in the areas of biomarker discovery, cancer diagnosis, and detection of infectious micro-organisms. Nanomedicine promises to play an important role in the future development of diagnostics and therapeutics. ACKNOWLEDGMENT Declared none. CONFLICT OF INTEREST The author confirm that this article content has no conflicts of interest.

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Suryanto, Plummer V, Boyle M. Healthcare System in Indonesia. Hospital Topics. 2017;95(4):82-89.

Wiseman V, Thabrany H, Asante A, Haemmerli M, Kosen S, Gilson L et al. An evaluation of health systems equity in Indonesia: study protocol. International Journal for Equ ity in Health. 2018;17(1).

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Sohrabi N, Valizadeh A, Farkhani S, Akbarzadeh A. Basics of DNA biosensors and cancer diagnosis. Artificial Cells, Nanomedicine, and Biotechnology. 2014;44(2):654-663.

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Optimization Community Health Worker Uses mHealth to Achieve Sustainable Universal Health Coverage In Indonesia Silvia Husodo1, Donni Santoso2, Putu Ijiya Danta Awatara3 There are still 25.95 million poor people in Indonesia28 who need Universal Health Coverage (UHC) for fair, equitable, and integrated health service. Universal Health Coverage is a system that make people easier to access health services such as promotive, preventive, curative, rehabilitative, and palliative without any suffering1. Community health worker (CHW) are members of a community that chosen to become the front-line in primary health care. CHW who speak the local language and identify with the local community convey health message more effectively. CHW is very potential to make sustainable UHC real in Indonesia because they are people who are close to the community in terms of language, culture, environment, and habits. mHealth is needed by CHW to collecting data, reporting, decision-support tools, provider training, emergency referrals, alerts and reminders, also supervision and interaction of health systems actors. This scientific paper was based on the literature review through analytic study conducted through two approaches are method of exposition and analytic methods. Keyword: Universal Health Coverage, Community Health Worker, mHealth

OPTIMIZATION COMMUNITY HEALTH WORKER USES MOBILE HEALTH TO ACHIEVE SUSTAINABLE UNIVERSAL HEALTH COVERAGE IN INDONESIA

by:

Silvia Husodo

batch 2017

Donni Santoso

batch 2015

Putu Ijiya Danta Awatara

batch 2014

FACULTY OF MEDICINE 2018

Abstract There are still 25.95 million poor people in Indonesia28 who need Universal Health Coverage (UHC) for fair, equitable, and integrated health service. Universal Health Coverage is a system that make people easier to access health services such as promotive, preventive, curative, rehabilitative, and palliative without any suffering1. Community health worker (CHW) are members of a community that chosen to become the front-line in primary health care. CHW who speak the local language and identify with the local community convey health message more effectively. CHW is very potential to make sustainable UHC real in Indonesia because they are people who are close to the community in terms of language, culture, environment, and habits. mHealth is needed by CHW to collecting data, reporting, decision-support tools, provider training, emergency referrals, alerts and reminders, also supervision and interaction of health systems actors. This scientific paper was based on the literature review through analytic study conducted through two approaches are method of exposition and analytic methods. Keyword: Universal Health Coverage, Community Health Worker, mHealth

1. INTRODUCTION Universal health coverage (UHC) is a system that make people easier to access health services such as promotive, preventive, curative, rehabilitative, and palliative without any suffering1. Many countries applied the universal health coverage to make better health services and reach the target of SDGs. One of successful country that applied universal health coverage is Thailand. In 2000, Thailand was in healthcare crisis with more than 17,000 children younger than 5 years old died. But in 2002 Thailand was implemented Universal Coverage Scheme (UCS) and was successful in 2011 the program covered 98% population 2. There are still 25.95 million poor people in Indonesia28 who need UHC for equitable and integrated health services. Community health worker (CHW) are members of a community that chosen to become the front-line in primary health care. CHW who speak the local language and identify with the local community convey health message more effectively. They contributed to expand capacity of leadership in the local area and homebound patients can be more facilitated. There are several barriers like neglected in workforce planning that make program in each local community different because there is no principles and guidance, multiple actors involved without coordination, fragmented disease specific focus caused by different interventions, uncleared link health status because unclear coordination, and competing with nongovernmental organization3. But there are many successful CHW like Kentucky Homeplace, have family care advisors and provide more than 403,000 services4. CHW is very potential to make sustainable UHC real in Indonesia because they close to the community in terms of language, culture, environment, and habits. mHealth is needed by CHW to enable real-time quality review and analysis for decision-making, capable collectors of complete, high quality, and fewer errors5. 2. MATERIAL AND METHODS This scientific paper was based on literature review through analytic study on the effort of optimizing the CHW in order to achieve sustainable UHC. Some methods and program were carefully examined in order to find the right method. Socioeconomic and characteristic of mentioned region were considered to meet the right methods for the system proposed. Data collection methods in this study conducted by the method of literature review based on

issues, both through digital and non-digital literature such as journals and reports. The method of data analysis literature conducted through two approaches, namely: 1. Method of exposition, that the presented data and facts that may ultimately sought correlations between these data. 2. Analytic methods, namely through the analysis of data or information by giving the argument through logical thinking and were then taken to a conclusion. 3. RESULTS AND DISCUSSION a) Community Health Worker as a Frontline in Achieveing Health Access in Indonesia Indonesiaâ&#x20AC;&#x2122;s public health system largely managed through a decentralized system. Referral hospitals are located in the larger cities and provincial centers. District hospitals and community health centers (puskesmas) each cover a catchment of approximately 30,000 people. Below the puskesmas, there is a network of low-level facilities, including pustus (sub-healthcenters), polindes (village midwife clinics), and posyandus (health posts)6,7. CHW is a members and selected by the communities where they work, answerable to the communities for their activities, supported by the health system but not necessarily a part of its organization, and have shorter training than professional workers. Community health activities are carried out at the posyandu and staffed by various community health kaders. The posyandu links

people

the

village

level

with

the

formal

health

center8. Each posyandu serves approximately 700 childrens6. By 2009 there were more than 250,000 posyandus, and an average of 3.6 posyandus per village. (see Figure 2)

Figure 1. The health care system in Indonesia, including the posyandu (health post) at the community level. b) Community Health Worker Effectiveness and Challenges in Health System Strategy CHW improved the health outcomes across different populations through changing form health behaviour and conditions. Studies have investigated the challenge CHW’s facing from the perspective of both the servants and the community, we found out that CHW found themselves as the core in Health System Strategy. They are collecting data, interpreters and being the social determinant of health in the community that maybe different from professional health workers, because CHWs can see through the community in context of everyday life and have the time to provide social control to the community. In this study, the biggest challenge to CHW are: •

Community members do not value the work of CHWs

CHW can feel ‘invisible’ both in the healthcare and the community, community don’t value their advice as they value professional health workers, and they also not included as a team member in clinical decisions. •

Poor understanding of preventive medicine

CHWs tend to encourage the community to sign up for health screenings, but in fact, community in general still don’t understand the value of disease. •

Lack of communication between CHWs and Health System

When the community members arrive at the health center, they faced problems instead, such as false information about schedules, lack of healthcare personnel, and a long waiting list. •

Limited healthcare resources

They often can’t provide the service to the community just because the services are not always accessible to the community members. c) Sustainable Universal Health Coverage To make a sustainable UHC, the role of CHWs should be more prominent, this study has concluded a few area that can be improved: •

Inclusion of CHWs clinical access

This also tend to increase communication between CHW and professional health workers, and able to provide up-to-date information about the community. •

Community education

Community members tend to have misperception about preventive health that CHW served so they need education. â&#x20AC;˘

Expanding training and professional support for CHW

CHW will felt more effective in their role as a connector to health services if the role was professionalized through certified programs27. d) Optimizing Mobile Health for Community Health Worker in Achieving Sustainable Universal Health Coverage

Figure 2 Overview of role of Community Health Workers in delivering care using mobile health strategies. Data collection and Reporting. Data collection as one of the primary mHealth functions being performed by CHWs. Several studies suggested that mobile phones are an effective way to collect and report data 2426

transfer patient-relevant information to a centralised communication between CHWs and

members of the health delivery team12,14. It is necessary to integrate community data towards the authorized body that was established to provide medical coverage program, in Indonesia, called Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS-Kesehatan) so that it facilitates monitoring and evaluation of the sustainable UHC.

Once the client data have been entered into the system, it can be used to send health need specific messages

and reminders to the clientâ&#x20AC;&#x2122;s mobile phone to facilitate health

education and behaviour change communication11. Mobile-based system are less time to compile reports, cost effective, and reduce errors rates than paper-based systems. Decision-support tools and provider training. A mobile based patient assessment tool that incorporates treatment guidelines for specific health problems can provide patient-side decision support to CHWs. Five studies included in this review assessed the feasibility and effectiveness of decision-support tools used by CHWs in improving patient health outcomes20-23. The increasing cost of hospital services caused by the unsuccessful role of Primary Healthcare in optimizing preventive promotion. The implementation of preventive promotive efforts at the first level became the sector of Primary Healthcare (Puskesmas) supported by CHW. Preventive promotive efforts carried out by Puskesmas and CHW lead to a Program Keluarga Sehat (12 Indicator of Healthy Family) from the Indonesian The Ministry of Health 10. So through M-Health, CHW will gets information related to guidelines and media in achieving Program Keluarga Sehat so that they can be implemented to the community.

Emergency Referrals Four studies included in this review suggested that timely collection of patient data and reporting to the health facility facilitated the process of developing an alert system for emergency referrals of patients12,14,16. A study in Gambia connected CHWs to a hospital by providing them with mobile phones. In case of an emergency involving a pregnant woman or a young child, the CHW can contact the ambulance driver and the maternity ward 17. Alerts and Reminders. Mobile-based work planning through customised patient-specific alerts and reminders about follow-up visits sent to a CHWâ&#x20AC;&#x2122;s and patientâ&#x20AC;&#x2122;s mobile phones. Nine reported on the utility of sending appointment and care reminders to CHWs11,14,15. Supervision and interaction of health systems actors. A few studies suggest that mHealth tools can improve quality of supervision available to CHWs by facilitating regular and prompt communication across different levels of

providers11-12 as well as enabling assessment of the CHWâ&#x20AC;&#x2122;s performance through the webinterface dashboard13-14. DeRenzi et al. emphasise the importance of connecting CHW activities to regular supervision by higher level of providers or managers to reinforce the continuity of care15. 4. CONCLUSION CHW is the core in Health System Strategy, they are the first line in primary health care. mHealth is needed by CHW to resolve their barriers like neglected in workforce planning, miss coordination, different interventions, uncleared link health status, and lack of training. Sustainable UHC will be achieved because of the integrated CHW by mHealth. 5. REFERENCES 1. Kieny MP, Evans DB. Universal health coverage. Eastern Mediterranean Health Journal. 2013 Apr 1;19(4):305. 2. Limwattananon S, Tangcharoensathien V, Tisayaticom K, Boonyapaisarncharoen T, Prakongsai P. Why has the Universal Coverage Scheme in Thailand achieved a pro-poor public subsidy for health care?. InBMC Public Health 2012 Jun (Vol. 12, No. 1, p. S6). BioMed Central. 3. Tulenko K, Mgedal S, Afzal MM, Frymus D, Oshin A, Pate M, Quain E, Pinel A, Wynd S, Zodpey S. Community health workers for universal health-care coverage: from fragmentation to synergy. Bulletin of the World Health Organization. 2013;91:847-52. 4. Goodwin K, Tobler L. Community health workers: expanding the scope of the health care delivery system. National Conference of State Legislatures. 2008: 1-10 5. Braun R, Catalani C, Wimbush J, Israelski D. Community health workers and mobile technology: a systematic review of the literature. PloS one. 2013 Jun 12;8(6):e65772. 6. Zulkifli. Posyandu dan kader kesehatan. 2003. Available at: http://library.usu.ac.id/download/fkm/fkm-zulkifli1.pdf. 7. Ministry of Health Indonesia. Pedoman Umum Pengelolaan Posyandu (Posyandu General Guide). Jakarta, Indonesia; 2011.

8. Berman P. Community-based health programmes in Indonesia: the challenge of supporting national expansion. In: Frankel S, ed. The Community Health Worker: Effective Programmes for Developing Countries. England: Oxford University Press; 1992:62-87. 9. Abdullah A, Hort K, Abidin AZ, Amin FM. How much does it cost to achieve coverage targets for primary healthcare services? A costing model from Aceh, Indonesia. Int J Health Plann Manage. 2012; 27(3): 226-45. doi:10.1002/hpm.2099. 10. WHO. Indonesia Country Profile. 2003. Available at: http://www.who.int/disasters/repo/9062.pdf. 11. Macleod B, Phillips J, Stone AE, Walji A, Awoonor-Williams JK. The Architecture of a Software System for Supporting Community-based Primary Health Care with Mobile Technology: The Mobile Technology for Community Health (MoTeCH) Initiative in Ghana. Online J Public Health Inform [Internet] 2012: 4: 1–17. 12. Manda TD & Herstad J. “Implementing Mobile Phone Solutions for Health in Resource Constrained Areas: Understanding the Opportunities and Challenges.” E-Infrastructures and E-Services on Developing Countries. Springer: Berlin, Heidelberg, 2010: 95–104. 13. Tomlinson M, Solomon W, Singh Y et al. The use of mobile phones as a data collection tool: a report from a household survey in South Africa. BMC Med Inform Decis Mak 2009: 9: 51. 14. Ngabo F, Nguimfack J, Nwaigwe F et al. Designing and Implementing an Innovative SMS-based alert system (Rapid- SMS-MCH) to monitor pregnancy and reduce maternal and child deaths in Rwanda. Pan Afr Med J 2012: 13: 31 15. DeRenzi B, Findlater L, Payne J et al., editors. Improving community health worker performance through automated SMS. Proceedings of the Fifth International Conference on Information and Communication Technologies and Development, ACM, 2012: 25–34. 16. Chaiyachati KH, Loveday M, Lorenz S et al. A pilot study of an mHealth application for healthcare workers: poor uptake despite high reported acceptability at a rural south african community-based MDR-TB treatment program. PLoS ONE 2013: 8: e64662. 17. Cole-Ceesay R, Cherian M, Sonko A et al. Strengthening the emergency healthcare system for mothers and children in The Gambia. Reprod Health 2010: 7: 21.

18. Mitchell M, Hedt-Gauthier BL, Msellemu D, Nkaka M, Lesh N. Using electronic technology to improve clinical care–results from a before-after cluster trial to evaluate assessment and classification of sick children according to Integrated Management of Childhood Illness (IMCI) protocol in Tanzania. BMC Med Inform Decis Mak 2013: 13: 1– 8. 19. Zurovac D, Sudoi RK, Akhwale WS et al. The effect of mobile phone text-message reminders on Kenyan health workers’ adherence to malaria treatment guidelines: a cluster randomised trial. The Lancet 2011; 378: 795–803. 20. Blank A, Prytherch H, Kaltschmidt J et al. “Quality of prenatal and maternal care: bridging the know-do gap”(QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa. BMC Med Inform Decis Mak 2013: 13: 44. 21. Florez-Arango JF, Iyengar MS, Dunn K, Zhang J. Performance factors of mobile rich media job aids for community health workers. J Am Med Inform Assoc 2011: 18: 131– 137. 22. Svoronos T, Mjungu P, Dhadialla R et al. CommCare: Automated Quality Improvement to Strengthen Communitybased Health. D-Tree International: Weston, 2010. 23. Mitchell M, Getchell M, Nkaka M, Msellemu D, Van Esch J, Hedt-Gauthier B. Perceived improvement in integrated management of childhood illness implementation through use of mobile technology: qualitative evidence from a pilot study in Tanzania. J Health Commun 2012: 17: 118–127. 24. Bogan M, vanEsch J, Mhila G et al. Improving standards of care with mobile applications in Tanzania: W3C, 2009. 25. AlamM, Khanam T, Khan R, editors. Assessing the scope for use of mobile based solution to improve maternal and child health in Bangladesh: A case study. Proceedings of the 4th ACM/IEEE International Conference on Information and Communication Technologies and Development, 2010: ACM. 26. Rotheram-Borus M-J, Richter L, Van Rooyen H, van Heerden A, Tomlinson M, Stein A et al. Project Masihambisane: a cluster randomised controlled trial with peer mentors to improve outcomes for pregnant mothers living with HIV. Trials 2011: 12: 1–10. 27. Grossman‐Kahn R, Schoen J, Mallett JW, Brentani A, Kaselitz E, Heisler M. Challenges facing community health workers in Brazil's Family Health Strategy: A qualitative study. The International journal of health planning and management. 2018 Apr;33(2):309-20.

28. Badan Pusat Statistik. Presentase penduduk miskin maret 2018 turun menjadi 9,82 persen. 2018. Available at: www.bps.go.id/pressrelease/2018/07/161483/persentase-pendudukmiskin-maret-2018-turun-menjadi-9-82-persen.html 6. TABLE AND FIGURES Figure 1. The health care system in Indonesia, including the posyandu (health post) at the community level.

Figure 2 Overview of role of Community Health Workers in delivering care using mobile health strategies.

Optimise The Universal Health Coverage To Improving The Global Impact Of BPJS For Citizens Indonesia In 2019 Arlinna Rahmanda Yuliana Putri Citra Kembangsari Reynaldo Arysta Oki Prastica ABSTRACT National Health Insurance (JKN) The program held by BPJS Health implements a system of quality control and cost control. That service given is expected to provide health insurance for all people Indonesia but People are still reluctant to register as independent BPJS participants reasons for economic factors, lack of information and indeed still not interested to register to become a BPJS participant independently. This research is a study case with a qualitative descriptive study design. Results research shows that people are interested in registering to become participants. Factors that influence people's perceptions so they haven't registering as an independent participant is an economic, social influence of the community around that insurance is usury, indicated service for participants there is discrimination and unsatisfactory service and management complicated requirements. A universal health coverage (UHC) scheme that was adaptable and could accommodate these diverse needs and conditions, assure financial risk protection, and assure access to safe, affordable, and effective health care for all as mandated by the sustainable development goals (SDGs) was needed. Optimising the Universal Health Coverage (UHC) to be a better health services is one of the clue to improving the global impact of BPJS in Indonesia.

Introduction Indonesia is a middle-income country with 262 million inhabitants spread over 17.744 islands. Over the past decade, its gross domestic product (GDP) grew 5Âˇ6% per year. However, socioeconomic conditions vary widely across the country, and internal migration and urbanisation are high. Health indicators reveal a high burden with high maternal mortality (359 deaths per 100000 livebirths), childhood stunting (31% in children younger than 5 years), tuberculosis (1 million new cases per year), a steep rise in obesity from 10% in 2007 to 21% in 2016, and a rise in noncommunicable diseases, including a 63% increase in the number of diabetes cases since 2005. Moreover, because of substantial variations in disease burden by wealth quintile and in rural versus urban residence, and because of a fragmented health

financing and insurance system, by 2013, 121 million people (47% of the population) did not have access to adequate health care. To overcome this issues, The Government of Indonesia (GOI) issued Law No. 40 of 2004 regarding the implementation of the National Social Security System based on the humanity principle, the benefit principle, and social justice principle for all citizens. Furthermore, GOI has established the Social Security Provider (BPJS) (now changes as JKNKIS) to ensure the basic needs for living of participant and/ or their families. BPJS participants are Indonesian citizens and foreigners who lived in Indonesia for at least 6 months and above. This BPJS program covers health insurance, employment injury, old-age insurance, pensions, and death benefits to fulfill minimum standard of ILO convention. The implementation of those programs carried gradually. The Social Security Organizing Agency (BPJS) is a public legal entity established to organize social security programs. The community as a National Health Insurance organized by BPJS health and related stakeholders certainly needs to know service procedures and policies in obtaining health services in accordance with their rights. Health facilities submit claims every month on a regular basis up to the 10th of the following month, except capacity, no claim is required by Health facility. BPJS Health must pay Health Facilities for services provided to participants a maximum of 15 working days since the claim document is received in full at the branch office / Operational office of the Regency / City BPJS Health. When the BPJS participant patient registers at the place of registration whether outpatient or inpatient, the referral letter will always be asked and requested by the officer. Because the referral letter will be used to find out what type of services will be given to patients according to complaints and those referred to by the puskesmas. Where health services provided to patients are health services guaranteed by the government health. The loss obtained by the patient if at the time of treatment does not carry a referral letter, the patient is considered a general patient, and the patient must pay for it himself. While the losses obtained by the Hospital, especially officers are hampered the process of filing claims, and adds to the workload of the officers themselves. So in this Review, we explore the achievements, gaps, and opportunities for BPJS or JKN-KIS (now) to expand population coverage and equity, ensure qual ity of care, and enhance its impact on population health by optimising the Universal Health Coverage to improving BPJS to be a better health services in Indonesia.

Methods This scientific paper is based on literature review through analytic study on the efford of the progress to enhance health services in Indonesia. Some methods and program were carefully evaluated in order to find the right method to create innovative pathway for health warranty of the people in the area of Indonesia. Socioeconomic and characteristic of mentioned region were considered in order to meet the right methods for the system proposed. Data collection methods in this study are conducted by the method of literature (literature review) based on the issues, both through digital and non digital information from literature such as journals and reports. The method of data analysis literature conducted through two approaches, namely : 1. Method of Exposition, that the presented data and facts that may ultimately sought correlations between these datas. 2. Analytic methods, namely through the analysis of data or information by giving the argument through logical thinking and were then taken to a conclusion. Results The Health Insurance Organizing Agency (BPJS) is still controversy, there are still people who have not registered themselves as BPJS participants, especially those in the middle to lower class. This is obtained from data from the Ministry of Social Affairs No.5 Decree of 2018 concerning the Determination of Recipients of Health Insurance Contribution in 2018 which contains "Health Insurance Fee Contribution Recipient is poor data and poor people based on an integrated database of 92,400,000 (ninety two million four hundred thousand). While the target of the 2015-2019 National Medium-Term Development Plan (RPJMN) regarding the registration of BPJS health insurance must ensure 107.2 million residents become PBI participants through the Healthy Indonesia National Health Insurance (JKN-KIS). This means that there is still a potential quota for around 15 million more Indonesians who can be borne by the central government as JK PBI participants. For example, the number of staff was lower in the eastern provinces than in other provinces, creating a large gap between western and eastern regions, with Papua and West Papua having the lowest health personnel coverage, at 40% less than the national average. The geographic spread, isolated islands, and undeveloped facilities decrease willingness to work beyond Java and more developed areas. Despite improved policies and incentives for

placement, less than 10% of physicians practice in rural communities, which comprise 45% of Indonesiaâ&#x20AC;&#x2122;s population. Overall, these factors have caused inequalities in service delivery and decreased quality of care, and require policies for investments in health infrastructure to optimise Universal Health Covarage. Besides that, Community health centres (or puskesmas) are the primary frontline healthcare facilities and are supported by tertiary-care hospitals and other facilities through referral. Service delivery and supply-side readiness have improved over the past two decades, with the number of community health centres increasing from 7669 in 2005 to 9754 in 2015, and with placement of these centres in 92% of subdistricts, along with the number of hospitals nearly doubling from 1268 to 2488 (appendix). Still, as of 2015, subdistricts in the eastern regions did not have a community health centre, with the lowest coverage being in Papua, at 64%. Beyond these numbers is quality, wherein only 74% of community health centres met preparedness requirements, although this was somewhat better in urban areas than rural areas. The UHC system would therefore need to offer a variety of care options in specific locations to incentivise coverage and use of services. Discussions According to the data based on the text above, it is very necessary to optimising the Universal Health Coverage in Indonesia to improving BPJS for the healthy citizens. We can optimise the UHC in Indonesia first by supporting the Health Sector Governance Programs like Academic and research institutions within health systems research work programs sometimes have a thematic area related to governance and health, loosely defined. Examples include : The Institute of Tropial Disease of Airlangga University. Second, we can do like the WHO programs. That is HANSHEP (Harnessing Non-State Actors for Better Health for the Poor) consortium of development agencies has a mission of focusing on interventions that might be loosely described as stewardship interventions to improve health outcomes achieved by the private health sector, including private medicines sales. Or we can contribute like dr. Lie Agustinus Dharmawan, Ph.D, Sp.B, Sp.BTKV does. He is the founder of DoctorSHARE Foundation, Floating Hospital (RSA) Dr. Lie Dharmawan provides free health services to communities in poor and remote areas in Indonesia that are not covered by health services on a regular basis. So, by supporting all of this step, it can help to create the vission of BPJS which is The realization of a quality and sustainable Health

Insurance (JKN-KIS) for all Indonesians in 2019 based on fair cooperation through a reliable, superior and trusted Health BPJS. References Agustina, Rina. dkk. 2018. Universal health coverage in Indonesia: concept, progress, and challenges. Jakarta. The Lancet Journals. BPJS. 2018. Visi dan Misi BPJS. Jakarta. BPJS website Rolindrawan, Djoni. 2015. The Impact of BPJS Health Implementation for the Poor and Near Poor on the Use of Health Facility. Malang. Elsevier.

mHealth benefits, risk and barriers, to be taken into consideration as a potential breakthrough to access of Healthcare Yulianto Argo Nugroho1, Genoveva Adjeng2, Timothy Verellino P3, Alanis Maryjane M4

Abstract Introduction The use of cellular health applications is increasing along with the increasing use of mobile devices in various countries. MHealth is defined as the use of mobile devices and a wireless network to conduct a public health practice. Materials and Method In this study, a literature review method is conducted. The literacy are taken from the database Such as : Pubmed, Google Scholar, Cochrane library. With the main source of idea coming from WHO ehealth survey. We choose the literacy published from 2010, emphasizing the selection of literacy from 2013-2018. The keywords that we used on our study are: mHealth , Mobile Health Application, Health apps Results and Discussion The result that we have is that mHealth have benefits such as online consultation, health monitoring, helping a Healthcare Provider in making a clinical diagnosis, overcoming the distance between patients. And the risk and bariers of using mhealth is that in some developing countries, the cost of owning a mobile device is so high that it becomes a barrier for people that have a limited financial asset. And the risk of security is in consideration, since the security of a mobile device is not proven to be highly secure that may lead to an information leakage. Conclusion To summarize our study, we want to give the benefits, risk and barriers into consideration on further application of mHeatlh on Indonesia, while the risk and barriers remain, the benefits oh mHealth can become a potential breakthrough to helping people in rural areas getting an access to Healthcare.

Introduction The use of cellular health applications is increasing along with the increasing use of mobile devices in various countries. According to the Global Observatory of eHealth, the definition of a mHealth is a public health practice that is supported by mobile devices. Based on a survey conducted by WHO, as many as 83% of 112 countries participating in the survey have mHealth services figure 1.1 The benefit of using mobile health technology is that it can provide information and save time, health record and maintenance access, reference and information gathering, handle and monitor patients, clinical decision-making, and can provide education and medical training.2 In general, it is difficult to assess or find the risks posed by a medical application. But the users, especially the patients will certainly think of any risks that can be raised by a medical application. There are examples of scenarios where this can pose a risk; poor safety level for storing patient data, risk of poor communication, poor medication advice.3 Because currently there are many countries with an increase in the number of users of this application. From this study, we want to provide the potential, and also show the risks from the use of cellular health applications to increase insight and awareness of the social community, medical personnel, and also the government. Method and Materials In this study, a literature review method is conducted. The literacy are taken from the database Such as : Pubmed, Google Scholar, Cochrane library. With the main source of idea coming from WHO ehealth survey. We choose the literacy published from 2010, emphasizing the selection of literacy from 2013-2018. The keywords that we used on our study are: mHealth , Mobile Health Application, Health apps

Result and Discussion What is mHealth? eHealth is the use of Information and Communication Technologies (ICT) for health, while mHealth is a branch of eHealth, there have been no standard definition on mHealth, we define it as the use of mobile devices with wireless networking to access healthcare.1 Example use of mobile health Online Consultation is a service available in mhealth where the health proffesionals is able to conduct a clinic appointments more convenient by using a mobile device that have a camera and a network signal to do an online appointment with the patients as a way to overcome the distance between the patient to the clinic.4,5 Wearable Sensors, as the development of mHealth goes, Engineers have made a devices with specific sensor that are capable of providing the data of

a person, for example: Use of smartphone to determine a person’s cardiac rhythm or by wearing an adhesive patch for a continuous rhythm tracking . Imaging, in these days, the quality of camera that a smartphone have, allowed for a host of medical applications, from photometric diagnostics to medical-grade imaging.6

Benefit of using mHealth The benefits of using mHealth from the view point of a patients : Patients using a specific health monitor app will be able to use the system to track and record data of interest, such as calories eaten and burned, vital sign and time spent exercising.7 Patient are able to save time and have more access towards healthcare.6 The benefits of using mHealth from the view point of a Health Care Provider(HCP) : HCPs are able to keep a track on the patient’s current health condition using devices that monitor the patient, making a clinical-diagnosis assisted by the access to medical information, having a better time management by using mobile devices since patients are able to make an appointment online, increased working efficiency and productivity.2,8 Risk and Barriers of using mHealth One study found a conclusion about the risk of mhealth use in the view point of a student, the risk of loss such as: trust regarding the security of personal data and health information, system errors such as data loss and misdiagnosis based on information obtained.10 Risk of using mHealth from the perspective of Health Care Providers such as: Unreliable and poor quality of health information, poor views given by patients can be received by health care providers through nonprofessional content posted on HCP social media accounts.11 The risk of using mHealth from a patient's perspective is: Loss of privacy caused by poor security systems, poor quality of the patient’s data, risk of poor communication with a medical personnel, and poor quality of healthy lifestyle advice from applications.12 Current situation of mHealth also have a barriers on a developing country. The first notable barrier is the cost from using the application or the cost of the mobile device, in some developing country, many people still didn’t have a smartphone, this is caused by the price that is vary on different countries.13,14 The second notable barrier is the security system of the apps, while mHealth uses a wireless network that’s able to access recorded data fast and accurate, it is also prone to information leakage from a hacker, as technology grow by day, more apps are available for hackers to break through the security a device such as smartphones have, they are able to access patient’s electronic Personal Health Information and electronic Medical Record.15 The third barrier are the difficulty on using the apps, mhealth app user that find a difficult in using mHealth tend to ask for help to other people, this could lead to troubles on patient’s data.2

Conclusion To summarize the result found on literacy, the continued development of mHealth application and devices give more Healthcare access to people, the benefits such as overcoming the distance for people in rural areas to have an online consultation and appointment with a HCPs

helped people that have a limited access of transportation to go to see a doctor. Even if the benefits are great, the risk and barriers still exist on developing countries, such as the cost of the device, the difficulty to use the app, and the security threat that can lead to personal data leakage. With all that benefits, risk and barriers, a further mHealth application to people living in Indonesia can be a breakthrough to a wider Healthcare accessibility in rural areas, as people in Indonesia tend to have a smartphones individually, and the people

References 1. WHO. mHealth New horizons for health through mobile technologies Global Observatory for eHealth series - Volume 3. 2011. [Cited in 2018 Dec 19]. Accessed from https://www.who.int/goe/publications/goe_mhealth_web.pdf 2. Ventola C. Mobile Devices and Apps for Health Care Professionals: Uses and Benefits. P.T. 2014. 39(5): 356–364. 3. Lewis TL, Wyatt JC. mHealth and Mobile Medical Apps: A Framework to Assess Risk and Promote Safer Use. J Med Internet Res. 2014 ; 16(9): e210. 4.Smitch CE, Spaulding R, Piamjariyakul U, et al. mHealth Clinic Appointment PC Tablet: Implementation, Challenges and Solutions. J Mob Technol Med. 2015; 4(2): 21–32. 5. Steinhubl SR, Muse ED, Topol EJ. The emerging field of mobile health. Sci Transl Med. 2015 ; 7(283): 283rv3. 6. Dicianno BE, Parmanto B, Fairman AD, et al. Perspectives on the Evolution of Mobile (mHealth) Technologies and Application to Rehabilitation. Phys Ther. 2015 ; 95(3): 397–405. 7. Isakovic M, Cijan J, Sedlar U, et al. The Role of mHealth Applications in Societal and Social Challenges of the Future. 12th International Conference on Information Technology - New Generations. 2015. 8. Aranda-jan CB, Mohutsiwa-Dibe N, Loukanova S. Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC Public Health. 2014; 14:188. 9. Bull TP, Dewar AR, Malvey DM, et al. Considerations for the Telehealth Systems of Tomorrow: An Analysis of Student Perceptions of Telehealth Technologies. JMIR Med Educ. 2016; 2(2): e11.

10. Ventola CL. Social Media and Health Care Professionals: Benefits, Risks, and Best Practices. P.T . 2014 ; 39(7): 491-499, 520. 11. Wyatt JC. How can clinicians, specialty societies and others evaluate and improve the quality of apps for patient use? BMC Med. 2018; 16: 225. 12. Khatun F, Hanifi S, Iqbal M, et al. Prospects of mHealth Services in Bangladesh: Recent Evidence from Chakaria. PLOS ONE. 2014; 9(11): e111413. 13. Asangansi I, Braa K. The Emergence of Mobile-Supported National Health Information Systems in Developing Countries. Studies in health technology and informatics. MED INFO.2010; v160: 540 - 544

Table and Figures

Benefits In Practicing Telemedicine And Challenges That Must Be Faced

Authors Ellen, Ichtiwa Aruni Putri, Sahda Alfreda Faculty of Medicine Trisakti University

Abstract Background : Industry 4.0 is the name for the current trend of automation and data exchange in manufacturing technologies. Tele-medicine in Indonesia have been developed since 1980s when people recognized the importance of equally distribution of health care. The government signed the Telecommunication Law of 1989 that allow private sectors in participating in development of telecommunication infrastructure. Objective : this literature review aim to identify the benefits and also limitations in the usage of tele-medicine for futher improvement. Methods : We use database form PubMed, Proquest, Google Scholar, and Science Direct to conduct this literature review. While screening the title, abstract and full text eligibility there are 5 journal that meet the full criteria. Results : Studies showed that mobile health applications provide advantages for the users. Such as reducing stressful environtment by creating a new non-hospitalized environment, increase patient compliance and helps cover remote area. But there are some limitations, such as lack of simple design workflow, ambigous and confusing term, language barrier and cultural differences. Conlusion : As stated above, mobile health applications have so much benefits to cover now days health service issues. But, there are several limitations in practicing this technology that need to pay attention to. Follow-up and operational observation is needed to enhance the effectiveness of this technology Keywords : Mobile Health, Application, mHealth, eHealth, Smarphone Apps

Benefits In Practicing Telemedicine and Challenges That Must Be Faced

Authors Ellen, Ichtiwa Aruni Putri, Sahda Alfreda

Introduction Industry 4.0 is the name for the current trend of automation and data exchange in manufacturing technologies. One major characteristic of industry 4.0 is the immediate flow of information in real-time and the potential to react to changes without delay. It is obvious, how these IT technologies and IoT infrastructures will influence individual health perspectives and will impact medicine and medical workflows in general.[1] Modern healthcare growing rapidly with “triple aim”, which consist of 1) improving individual patient care and outcomes, 2) improving the overall health of a community or population, and 3) reducing the overall cost of the health care system. Mobile Integrated Healthcare (MIH) is an innovation to perform patient’s monitoring, evaluation, and treatment. Mobile Integrated Healthcare consist at least three categories of concept: 1) Chronic Disease Management 2) destination diversion programs, 3) health education/risk reduction initiatives. [2]

Tele-medicine in Indonesia have been developed since 1980s when people recognized the importance of equally distribution of health care. The government signed the Telecommunication Law of 1989 that allow private sectors in participating in development of telecommunication infrastructure. Direct to patients website such as Halodokter.com, KlikDokter.com, and Konsula are several example of the application of telecommunication in Indonesia. In HaloDok, patient can contact medical doctors with their own phone. In Konsula, patients also can book doctors using dedicated online directory. However, there is a few aspects that need to be paid attention to such as ethnical problems and patients privacy. In need of correct diagnosis, treatments, and patient’s satisfaction, face-to-face communication between patient and doctor is important. Anamnesis, psychological support play an important rule in determine correct diagnosis which may not be found in telemedicine programs. Also, authorization for access data need to be paid attention, especialy sensitive

patient data. Based on The Assessment of e Health technology in Indonesia using COIA rubrics, almost all aspect of telehealth technology such as infrastructure, standards, protection, governance, and policy needs a lot of strengthening. [3] Improving health services, in the same time lowering the cost continues to be a keen focus for healt providers. Several factors contribute on the increasing of healthcare cost including: 1) fragmented system of care, 2) challenges to access, 3) variable quality and 4) dissatisfying experiences. Based on Journal of Health Economics and Outcomes Research in 2016, using mobile integrated health decrease 19% in emergency department per member per month cost, 21% in emergency department utilization, 37% in inpatient per member per month cost, 40% inpatient utilization, all measures reached statistical significance. [4] Developing countries facing challenges in providing medical services such as shortage of health care professionals, equity medical services, inadequate infrastructure and medicine. To overcome this challenges, developing country started to exploring the role of telehealth. The purpose of developing telehealth is rather humanitarian than financial.[5]

Screening

Identification

Materials and Methods

Initial search results from Pubmed and EBSCOhost (50) Irrelevant titles excluded (30) Title screening of authenticity and duplication (20)

Eligibility

Abstracts screened (20)

Full-text assessed for eligibility (10)

Included

Full-text article excluded: (5)

Full-text eligible case-control articles included in review (5)

We used some databases to conduct this literative review such as: PubMed, Proquest, Google Scholar, and Science Direct. The following search terms were used in all five databases: mobile health, application, mHealth, eHealth, smarphone apps. We identify 50 papers through the initial finding, after screening the title, abstract and full text eligibility there are 5 paper that meet the full criteria

Result Author and Study Year

Location

Design

Sample

Range/

Size

mean

Method of analysis Health of

Device/App

sample age Couture et al, 2018

B User-

Northeast

centered

United

cohort

States

286

Outcom

lication Nielsenâ&#x20AC;&#x2122;s

10 MySafeCare

Usability Heuristics

Benefi

(MSC) Apps environ

familie

study

hospita

Limita

workfl terms Kim HY et Cross-

Vietnam,

al, 2018

sectional

Cambodia

Fisherâ&#x20AC;&#x2122;s exact test

helps c

survey

Chi-square test

Limita

Raven MC Hope et al, 2018

429

>19 years

STATA 13

Benefi

Uzbekista

cultura

probab

Oakland

350

>50 years

Logistic Regression

Benefi

Home

techno

Cohort

commu

Study

for

employ

Limita

at enr

comple

Second

homele

those w

have ph Galappatthy Cross P

Sri Lanka

505

23 years

al, Sectiona

2017

l Study

Statistical Package -

Benefi

for Social Sciences

anytim

(SPSS)

retrieva

software

,version14

Limita

Chi-square test

relation

academ

and the

medica Handayani

Qualitati

PW et al, ve 2018

Indonesia

127

Entropy

Mobile JKN

Benefi

and

develo

Quantita

applica

tive

Limita

limited

remain Discussion Studies showed that mobile health applications provide advantages for the users. Such as reducing stressful environtment by creating a new non-hospitalized environment, increase patient compliance, helps cover remote area, enable student to learn anytime and anywhere. Also, participant used these technologies for health care communication and to identify factors that effect the development of mobile health application. But mobile health also has limitations, such as lack of simple design workflow, ambigous and confusing term, language barrier and cultural differences, miscommunication probabilities,paticipant without phone less likely to complete the follow-up interview, and limited resources in order to remain efficient and effective

Conclusion As stated above, mobile health applications have so much benefits to cover now days health service issues. But, there are several limitations in practicing this technology that need to pay attention to. Follow-up and operational observation is needed to enhance the effectiveness of this technology

Reference [1] Neumaier M. Diagnostics 4.0: the medical laboratory in digital. healthClin Chem Lab Med 2018. [2] Haynes SR, Barbone MG, Jermusyk MJ. Information Technology Challenges for Mobile Integrated Healthcare. In2015 International Conference on Healthcare Informatics (ICHI) 2015 Oct 1 (pp. 578-586). IEEE. [3] Wiweko B, Zesario A, Agung PG. Overview the development of tele health and mobile health application in indonesia. InAdvanced Computer Science and Information Systems (ICACSIS), 2016 International Conference on 2016 Oct 15 (pp. 9-14). IEEE. [4]Castillo DJ, Myers JB, Mocko J, Beck EH. Mobile integrated healthcare: Preliminary experience and impact analysis with a Medicare advantage population. JHEOR. 2016;4(2):172-87. [5] Varghese S, Scott RE. Categorizing the telehealth policy response of countries and their implications for complementarity of telehealth policy. Telemedicine Journal and e-Health. 2004 Mar 1;10(1):61-9. [6] Couture B, Lilley E, Chang F, Smith AD, Cleveland J, Ergai A, et al. Applying usercentered design methods to the development of an mHealth application for use in the hospital setting by patients and care partners. Appl Clin Inform. 2018;9:302-12 [7] Kim HY, Kim JY, Park HY, Jun JH, Koo HY, Cho IY, et al. Health service utilization, unmet healthcare needs, and the potential of telemedicine services among Korean expatriates. BMC Global Health. 2018;14(1):120

[8] Raven MC, Kaplan LM, Rosenberg M, Tieu L, Guzman D, Kushel M. Mobile Phone, Computer, and Internet Use Among Older Homeless Adults: Results from the HOPE HOME Cohort Study. JMIR Mhealth Uhealth 2018;6(12):e10049 [9] Galappatthy P, Wathurapatha WS, Ranasinghe P, Wijayabandara MDMS, Warapitiya DS, Weerasuriya K. The (e-Generation): The Technological Usage and Experiences of Medical Students from a Developing Country. International Journal of Telemedicine and Applications Volume 2017 [10] Handayani PW, Meigasari DA, Pinem AA, Hidayanto AN, Ayuningtyas D. Critical success factors for mobile health implementation in Indonesia. Heliyon 4 (2018) e00981

“IS MOBILE HEALTH (mHealth) INTERVENTION THE BEST SOLUTION TO OVERCOME MATERNAL PROBLEM IN INDONESIA? : A SYSTEMATIC REVIEW” 1

Alexander Fernando, 1Dennis Ievan Hakim, 1Aleyda Zahratunany I 1

Asian Medical Student Association, University of Brawijaya

ABSTRACT Introduction: Despite increasing effort and attention for achieving better health status holistically, the maternal health problem is still becoming the major problem that cannot be solved. Indonesian government actually has conducted some solutions for preventing and managing this health issues, but implementation of these solutions is constrained as overall access to quality care is lacking. Nowadays, the global proliferation of mobile technology has shift the paradigm of healthcare access, one of them is mHealth. The wide availability and relative simplicity of mobile phones make them a promising instrument for delivering a variety of health-related interventions. Material and Methods: Systematic review about interventions of mHealth in low-middle income countries to maternal health was carried out using PRISMA statement. Studies search were conducted using search engine ScienceDirect, ProQuest, and PUBMED database with keyword “maternal health”, “mobile phone”, “mHealth in maternal”, “low-income country maternal problem” with criterion papers published in english between 2013 to 2018 and related about interventions of mHealth in maternal health. Quality assesment of included papers was conducted using CONSORT statement checklist for clinical trials study and STROBE statement checklist for observational studies. Result and Discussion : From the search, 392 studies were identified and finally obtained 11 studies that fulfill the criterion of this systematic review. The studies are organized according to common functions of mHealth as the following data collection, emergency medical support, point-of-care support, and health promotion. Studies show that mHealth interventions give significant improvement in many aspect stated above. However, because many of the studies came from low- and moderate-quality, the need of higher research quality is a must in this systematic review. Conclusion : mHealth interventions gave good improvement in maternal health service and access either for the patients and care provider. Future research should explore new areas of application the mHealth interventions.

“IS MOBILE HEALTH (mHealth) INTERVENTION THE BEST SOLUTION TO OVERCOME MATERNAL PROBLEM? : A SYSTEMATIC REVIEW” Participate in IMSTC 2019 by AMSA-Indonesia

Arranged by: Alexander Fernando

165070107111002

Dennis Ievan Hakim

175070107111010

Aleyda Zahratunany I

175070101111056

FACULTY OF MEDICINE UNIVERSITAS BRAWIJAYA 2018

Introduction Maternal health defined as the health of women during pregnancy, childhbirth, and the postpartum period. It is one of the most important health issue because it encompasses the fundamental aspect of health and quality of life of the next generation. Despite increasing effort and attention for achieving better health status holistically, the maternal health problem is still becoming the major problem that cannot be solved. Every hour, more than 30 mothers in the world die because of complications related to pregnancy and childbirth[1].

Moreover, in

Indonesia, the mortality rate keeps increasing every year[2]. According to systematic analysis conducted by World Health Organization (WHO), most of maternal deaths between 2003 and 2009 were due to obstetric complications (73%). Ironically, almost all (99%) of maternal deaths that occur in developing countries are caused by inadequate access to health services[3]. This condition is worsened by the inequalities in health care service given by the care provider. Indonesian government actually has conducted some solutions for preventing and managing this health issues, one of them is Rencana Pembangunan Jangka Panjang Menengah Nasional (RPJMN). RPJMN has goals to improve the health and nutrition status of the society holisticaly, include the maternal[4]. This solution has been implemented since 2015, but in fact, the rate of maternal health issues is still elevated thus still become a problem nowadays. Implementation of these solutions is constrained as overall access to quality care is lacking. The United Nations set Sustainable Development Goals (SDGs) in order to achieve a better and more sustainable future for all[5]. SDG 9 states the need to create advantages of new technologies available, especially those related to information and communication. The global proliferation of mobile technology has shift the paradigm of healthcare access. According to International Telecommunications Union, mobile coverage has increased to reach 90% of the worldâ&#x20AC;&#x2122;s total population and 80% of the global population living in rural area. The growing ubiquity of mobile phones has the initiation of mobile health (mHealth)[6]. It is a mobile application-based system which has potential to reduce inequalities in care through facilitating communication between clients and providers, promoting maternal and womenâ&#x20AC;&#x2122;s behavioral change, assisting in data collection, and helping care provider to resolve maternal complication problems, especially in rural areas in Indonesia with comprehensive purpose in order to improve access for quality of maternal health[7]. A systematic review on the use of mHealth reported multiple implementations of these innovation, such as data collection, provider-toprovider communication, appointment reminders, health education/promotion, and clinical follow-up. Overall, this systematic review aims to assess the effectiveness of mHealth

implementation in low-middle income countries in order to improve access to and quality of maternal health. Material and Methods A Systematic review of large clinical trials concerning mHealth interventions in lowmiddle income countries to maternal health status was carried out using the PRISMA Statement rules. Studies search were conducted using search engine ScienceDirect, ProQuest, and PUBMED database with keyword “maternal health”, “mobile phone”, “mHealth in maternal”, “low-income country maternal problem”. The criterion of inclusion are 1) papers published in english between 2013 to 2018, 2) papers evaluating mobile phone interventions addressing maternal health outcomes and improving health provider’s skills related to maternal health care or data collection, 3) researchs that were conducted in low-middle income countries. Quality assesment of included papers was conducted using Consolidated Standards of Reporting Trials (CONSORT) statement checklist for clinical trials study and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist for observational studies. From the search, 392 studies were identified. 336 studies were then exluded because there were duplications (n=14) and topic nonconformities (n=322). Another 45 studies were later excluded because of conducted on non low-middle income countries (n=8), discussing other aspect besides interventional outcome of mHealth to maternal health and care provider (n=31), and studies not found (n=6). Finally, we obtained 11 total studies that fulfill the criterion of this systematic review.

Figure 1. Journal Selection Systematics. Result In total, 11 articles satisfied the inclusion criteria. The articles revealed specific evidence of the impact of mHealth on maternal health (Table 1) or highlighted the best practices and impediments for sustaining such mHealth activities. Accordingly, the findings of this review describe the outcomes of mHealth maternal programs implemented across the globe. The studies are organized according to common functions of mHealth as the following: Data collection Emergency medical support Point-of-care support Health promotion Table I. Impelmentation Overview of mHealth interventions focusing on maternal health Intervention

Ref.

mHeath

Loca

Target

Function

tion

Population

Data

Liber

Traditional

Collection

Birth

real-time

Attendant/

data collection on the y

TBA (before

total

and

pregnant women in help, make calls without

after)

Findings

TBAs trained to send SMS

number

Significant

for in following abilities on 1post-test

assessment:

of turn on the mobile without

without

the community; asked help,

group

to send an SMS to coverage,

control

local

server

improvement [8]

identify

mobile

identify

with mobile is charged, create

personal information messages

without

help,

and information of send SMS without help; identified

pregnant continued

have

woman using a 10- difficulty adding minutes to a phone

digit code TBAs provided with mobile phones, call credit, charger

and

solar

Emergenc

Miln

Rural health

y medical e Bay workers support

Provi

rural

nce

centres

Providing

free-call

Solved

the

phone number which

communication

health

is available 24 h a day

problems

faced

for

regarding

childbirth

rural

health

workers

Papu

advices

childbirth

New

emergencies.

The

workers and labour ward

Guin

phone

was

staff

answered by trained

get during

complications Strengthen between

call

labour wards staff

[9]

teamwork rural

health

Allow the rural health worker to feel more confident in handling life-threatening childbirth complications

Decision/

Amh

health

Point-of-

ara

workers in 5

sends reminders for

likely to have at least 4

care

regio

health

scheduled visits and

antenatal visits (27.0%

support

facilities

educational messages

versus 23.4%)

An application that

Ethio

on dangers sign and

pia

common

complaints the

health

worker in deciding who

Women

were

likely to deliver their baby in the health center

during pregnancy Assisted

Women

(43.1% versus 28.4%) A

significantly

higher

was

percentage of women in

receive

the intervention group

‘Routine ANC/Basic

had PNC in the health

care’

centers (41.2% versus

eligible

than

‘Specialized Care’ Reported

the

total

number, round, and type of visit for each pregnant woman for any given period

21.1%

[10]

Appointm

Zanzi

Intervention

ent

bar,

: 12 Health

(short

reminders

Tanz

Facilities

service) that contain

and health ania

(1311

information

about

intervention group

Promotion

women),

contact

health

received â&#x2030;Ľ4 ANC

with control

provider,

health

visits vs. 31% in the

education,

Health

An automated SMS

antenatal care attendance

message ourcomes

and

44% of women in the

control group (OR,

facilities

appointment

2.39; 95% CI, 1.03-

(1239

reminder

5.55)

women)

Frequencies

the

30% of women in the

message : 2x per

intervention group

month

called their health

before

week gestation and 2x per week from week 36 until deliver

providers 59% of the women in the intervention group said text message influenced their decision to attend the antenatal visit 71% felt that the educational messages helped them learn about danger signs in pregnancy and to feel that the health system cared for them Skilled birth attendance outcomes Increased skilled birth attendance in the intervention group (60%) compared with the control group (47%)

[1113]

Significant increase in skilled delivery attendance in urban areas (OR, 5.73; 95% CI, 1.51-21.81); did not affect women from rural areas Higher levels of skilled delivery attendance among women who attended secondary school vs. those who had not (OR, 1.33; 95% CI, 1.01-1.77) and who were primigravida vs. those who had multiple pregnancies (OR, 1.86; 95% CI, 1.41-2.46) Perinatal outcomes 2482 children were born alive, 54 were stillborn, and 36 died within first 42 d of life Overall perinatal mortality rate was 27/1000 total births; 19/1000 births in intervention clusters vs. 36/1000 births in control clusters Intervention associated with a reduction in perinatal mortality

(OR, 0.50; 95% CI, 0.27-0.93) Insignificant changes in stillbirths and deaths within the first 42 d of life Appointm

Keny

HIV-

ent

Positive

pregnant

women

SMS sent every 2

clinic vs. 11.8%

(intervention

wk starting on week

women in control

group (n =

group (RR, 1.66; 95%

195)

(max 8 depending

CI, 1.02-2.70)

92% of intervention

Reminder

Up to 14 SMS sent

and

control group

(n=

193) )

19.6% of intervention

HIV-positive women;

pregnancy gestation);

women attended a maternal postpartum

additional messages

group infants received

sent weekly during

HIV testing compared

first

with 85% of control

group (RR, 1.0.8; 95%

postpartum Control

group

received

[14]

CI, 1.00-1.16)

standard

care Study was conducted using

Randomized

Control Trial (RCT) Follow-up

Vietn

1433 women

seeking

early

medical

differences in rate of

early

abortion

ongoing pregnancies

medical

hospitals in Vietnam

(clinic: 2.7%; phone,

abortion at 4

were randomized to

2.5%, RR, 0.9; 95%

hospitals

clinic

CI, 0.99-1.02)

433 women seeking

No significant

phone

follow-up Clinic returned hospital

85% of women in the follow-up: to

phone group did not

the

need an additional

for

clinic visit

[15]

confirmation

Phone follow-up and

abortion outcome 2

home pregnancy test

were effective in

after

mifepristone

screening for ongoing

administration

pregnancy; sensitivity

Phone

follow-up:

completed

92.8% and specificity a

90.6%

semiquantitative pregnancy test at initial

visit

determine baseline HCG and again at home 2 wk later. On the initial visit they received drugs to perform a medical abortion Clinic staff called

women

review

the

pregnancy

test

results and symptom checklist Decision

Guat

Traditional

support

emal

Birth

randomized

Attendants

controlled

(TBAs)

assesing

Pragmatic,

The rate of monthly emergency referrals is

effectiveness mHealth

trial

increasing either in

the

early-access group

decision

(median 31 referrals per 100 births) or late-

support to improve

access group (median

maternal

34 referrals per 100

health

status and referral

births)

rates

The early detection of

TBAs individually

were

complications is significantly

[16]

randomized in an

increasing, specially

unblinded

for hypertension

and

fashion

grouped

into

(because of platform

early-access (n=23)

feature) after

and

intervention with

later-access

(n=21) group to he mHealth system The

TBAs

were

introduced

with

mHealth

platform

that

allowed

collection of simple demographics, maternal

and

perinatal symptomps

and

clinical

signs,

maternal vital signs, and fetal health rate which

can

illustrated pictograph

in list

common

maternal

and

perinatal

complications. The platform

also

provided integrated use

peripheral

sensor devies such as pulse oximeter. Complications vital

or sign

abnormalities checking by TBAs also trigerred alert

platform (P=0.03)

text messages to the on-call team. Data

Liber

Traditional

Collection

Birth

study are to train

phone knowledge

Attendants

non-or-low

score was 3.67

(TBAs)

TBAs and mobile

between pre- and post-

phone

test

The aims of the literate data

Mean increase in cell

[17]

collection (n=99) TBAs

trained

send real-time SMS for data collection on the total number of pregnant women in the community; asked to send an SMS to local server with

personal

information

and

information

identified

pregnant

woman using a 10digit â&#x20AC;˘

code

TBAs

provided

with mobile phones, call credit, and solar charger Health

Kam

Mothers

Promotion

pong

newborns

An interactive voice response

system

Quantitative and qualitative results of

Chhn

send

ang,

messages to mothers

included for analysis

Cam

About 71%

bodia

promoting

pre-recorded newborns

infant health

about

126 respondents were

respondents reported that the interventions are useful to promote

[18]

Voices

messages

knowledge about

with duration 60 to

newborns health

90 s were delivered

About 83% of

in seven periodic to

respondents reported

the mobile phones

that they would be

of 1029

willing to pay for the

newborn

mother and after the

services indicating that

interventions,

the services are useful

registered

455

mothers

were

interviewed

using

quantitative

questionnare

Discussion Based on this systematic review, we found that intervention of mHealth in context of maternal health has been evaluated over a range of service applications, such as emergency medical support, data collection, point-of-care support (decision support, follow up), health promotion (education and appointment reminders). Studies show that mHealth interventions give significant improvement, specially in health education, appointment reminder, and lower the complication and infant mortality because the care provider become more educated an aware about the danger sign that need to be referred to higher health facility[10-14.16]. The satisfy rate of the mother also increased due to implementation of the interventions[18]. However, because many of the studies came from low- and moderate-quality, the need of higher research quality is a must in this systematic review. Two reports described data collections interventions with low study quality because of the sample size were small (some unknown) and the information effect of the interventions were not stritchly quantified[8,17]. Three other studies evaluate the use of mHealth to as a decision support for the health care provider and emergency medical support; the quality of most studies are low (2 low and 1 moderate) with small sample sizes[9,10,16]. Only studies that evaluating interventions of mHealth in appointment reminders, health promotion/education, and follow up that meets â&#x20AC;&#x153;high qualityâ&#x20AC;? criterion [11-15]. These findings suggest that implementation of mHealth is useful for increasing the attendance rate and promoting behavioral change for the maternal and care provider in term follow up. Another issues related to implementation of mHealth is the cost. Some of intervention studies were to provide mobile phones to health providers found the additional challenge of

mobile phone costs, maintenance, and lack of electricity[8,16-17]. Another problem is limited information whether the information given by SMS and voice were delivered to the subject of research or the behavioral changes were caused by the interventions. Our findings are in agreement and consistent with previous literature about mHealth in maternal health. A 2016 systematic review about mHealth interventions on maternal health in low-income countries[19]. This systematic review suggest that mHealth interventions offer probably best solutions in order to overcome maternal health problems by improving access to quality of prenatal and obstetric care, both from provider and patients. These improvement include reducing maternal mortality, emphasizing the technologies to enhance provider performance and skills and other aspects of quality, provider motivation, and patients satisfaction. By implementing mHealth interventions, we are one step closer to achieve holistic approach in equality of health service, in line with Sustainable Development Goals (SDGs). By using mHealth, we create advantages of new technologies available to improve access to and quality of health, specially in maternal health. Based on this systematic review, the effectiveness of previous implementations could bridge the access to quality care thus giving maternal health care and service holistically and actualize better Indonesia health. Conclusion In general, this review conclude that mHealth interventions gave good improvement in maternal health service and access either for the patients and care provider and thus again underlined the needs and importance for further studies with higher quality evidence to reinforce better mHealth design and its application to health the health care delivery setting for maternal health. Future research should explore new areas of application the mHealth interventions.

References 1. World Health Organization. Global Health Observatory (GHO) Data [Internet]. Geneva: World Health Organization; 2013 [cited 20 December 2018]. Available from: https://www.who.int/gho/maternal_health/mortality/maternal/en/ 2. KEMENKES RI. Mothers Day: Situasi Kesehatan Ibu Data [Internet]. Jakarta: KEMENKES

RI;

2014

[cited

December

2018].

Available

from:

http://www.depkes.go.id/resources/download/pusdatin/infodatin/infodatin-ibu.pdf

3. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2014;2(6):e323-33. 4. Pardede PM. Manajemen Strategik dan Kebijakan Perusahaan (Pedoman Utama Pembuatan Rencana Strategik (RENSTRA)/Rencana Pembangunan Jangka Menengah (RPJM), dan Rencana Pembangunan Jangka Panjang (RPJP)). Jakarta: Mitra Wacana Media. 2011. 5. Griggs D, Stafford-Smith M, Gaffney O, Rockström J, Öhman MC, Shyamsundar P, Steffen W, Glaser G, Kanie N, Noble I. Policy: Sustainable development goals for people and planet. Nature. 2013;495(7441):305. 6. International Telecommunications Union. ICT facts and ﬁgures: The world in 2010. Geneva: International Telecommunications Union. 2010. 7. Lee SH, Nurmatov UB, Nwaru BI, Mukherjee M, Grant L, Pagliari C. Effectiveness of mHealth interventions for maternal, newborn and child health in low–and middle– income countries: Systematic review and meta–analysis. Journal of global health. 2016; 6(1). 8. Munro ML, Lori JR, Boyd CJ, Andreatta P. Knowledge and skill retention of a mobile phone data collection protocol in rural Liberia. Journal of midwifery & women's health. 2014 Mar;59(2):176-83. 9. Watson AH, Sabumei G, Mola G, Iedema R. Maternal health phone line: saving women in Papua New Guinea. Journal of personalized medicine. 2015 Apr 27;5(2):120-39. 10. Shiferaw S, Spigt M, Tekie M, Abdullah M, Fantahun M, Dinant GJ. The effects of a locally developed mHealth intervention on delivery and postnatal care utilization; a prospective controlled evaluation among health centres in Ethiopia. PloS one. 2016 Jul 6;11(7):e0158600. 11. S. Lund, B.B. Nielsen, M. Hemed, et al.Mobile phones improve antenatal care attendance in Zanzibar: a cluster randomized controlled trial BMC Pregnancy Childbirth, 14 (2014), p. 29 12. S. Lund, M. Hemed, B.B. Nielsen, et al.Mobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: a cluster-randomised controlled trial Bjog, 119 (2012), pp. 1256-1264

13. S. Lund, V. Rasch, M. Hemed, et al.Mobile phone intervention reduces perinatal mortality in zanzibar: secondary outcomes of a cluster randomized controlled trial JMIR Mhealth Uhealth, 2 (2014), p. e15 14. Odeny TA, Bukusi EA, Cohen CR, Yuhas K, Camlin CS, McClelland RS. Texting improves testing: a randomized trial of two-way SMS to increase postpartum prevention of mother-to-child transmission retention and infant HIV testing. AIDS (London, England). 2014 Sep 24;28(15):2307. 15. Ngoc NT, Bracken H, Blum J, Nga NT, Minh NH, Van Nhang N, Lynd K, Winikoff B, Blumenthal PD. Acceptability and feasibility of phone follow-up after early medical abortion in Vietnam: a randomized controlled trial. Obstetrics & Gynecology. 2014 Jan 1;123(1):88-95. 16. Martinez B, Ixen EC, Hall-Clifford R, Juarez M, Miller AC, Francis A, Valderrama CE, Stroux L, Clifford GD, Rohloff P. mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial. Reproductive health. 2018 Dec;15(1):120. 17. Lori JR, Munro ML, Boyd CJ, Andreatta P. Cell phones to collect pregnancy data from remote areas in Liberia. Journal of Nursing Scholarship. 2012 Sep;44(3):294301. 18. Huang S, Li M. Piloting a mHealth intervention to improve newborn care awareness among rural Cambodian mothers: a feasibility study. BMC pregnancy and childbirth. 2017 Dec;17(1):356. 19. Colaci D, Chaudhri S, Vasan A. mHealth interventions in low-income countries to address maternal health: a systematic review. Annals of global health. 2016 Sep 1;82(5):922-35.

The Effectiveness of Health Care Mobile Application on Influencing Healthy Maternal Behavior in Developing Countries Clarissa Agatha Debora, Ananda Kukuh Adishabri Faculty of Medicine, Universitas Indonesia Abstract Mobile health as defined by World Health Organization is a practice of medical and public health by using mobile devices, monitoring devices and other wireless devices that provides information about health care. For example, mobile application has been used for optimizing maternal health behavior in several countries including developing countries. As we know, perinatal morbidity remains significant health issues globally, with impact on the health of women and their families especially in low and middle in income countries. This review has a primary goal to show the effectiveness of health care mobile application on influencing healthy maternal behavior in developing countries. We choose the literatures from Clinical Key, PubMed, Research Gate, and BMC. There are 3 literatures that are reviewed to evaluate the effectiveness of maternal health mobile application. Out of these three studies, the three of them show positive results such as reducing maternal death, reducing neonatal death, improve the awareness of pregnancy risk and improve the knowledge of birth preparedness and balanced diet for pregnancy. If Indonesian government can make policies about this implementation, it will show promising results in Indonesia. Indonesia government can replicate this intervention model of mobile application to improve the maternal health behavior and limit the barriers that have been the problem for years. Keywords: maternal health, effectiveness, mobile application

The Effectiveness of Health Care Mobile Application on Influencing Healthy Maternal Behavior in Developing Countries

Created by : Clarissa Agatha Debora Ananda Kukuh Adishabri

Universitas Indonesia 2018

Introduction Mobile health as defined by World Health Organization is a practice of medical and public health by using mobile devices, monitoring devices and other wireless devices that provides information about health care.1 For example, mobile application has been used for optimizing maternal health behavior in several countries including developing countries. As we know, perinatal morbidity remain significant health issues globally, with impact on the health of women and their families.2 In low and middle income countries (LMIC), women face a risk of maternal death of one in 160, compared with one in 3700 in high income countries.3 Further, due to preventable causes related to poor maternal health, it is estimated that 2,65 million stillbirth occur worldwide.4 Pregnant women who practice and maintain healthy behaviour can improve the health of themselves and their babies.2 Health communication methods such as mass media and audio-visual clips have been developed for decades to encourage healthy behaviours of pregnant women. Nowadays, women prefer these modalities over traditional, paper-based formats, in finding information during pregnancy. The appearance of mobile health modalities expands the opportunity to reach, connect, and empower individuals to address specific concern in health field. Broadly, mobile health technology has the potential to increase perinatal outcomes by increasing health information access and modifying demand for services.2 Aim This review aims to assess the effectiveness of health care mobile application interventions during pregnancy on influencing healthy maternal behaviour in developing countries. Material and Methods The literatures were collected from databases such as PubMed, Science Direct, BMC, and Research Gate. The key word that used for this study are “health care”, “mobile application”, “effectiveness”, “developing countries” and “maternal”. This search of studies

results of twelve references and three studies are reviewed to evaluate the effectiveness of health care mobile application on influencing maternal health behavior. The suitable studies include meta-analysis, systematic review or clinical trials. This diagram below shows our method to search the studies.

20 literatures were selected

12 literatures were selected for review

3 literatures were reviewed to evaluate the effectiveness of maternal health mobile application

8 studies was excluded because of the intervention model

9 literatures were reviewed for others application

Figure 1. Diagram showing methods of searching literatures Results and Discussions The characteristic of health care mobile application for maternal woman All of the mobile applications have a primary outcome to improve the quality of maternal health behavior. Maternal health data is needed to identify the problem, inform the decision maker, and take action to change the condition. We reviewed three mobile application such that influence healthy maternal behaviour in developing countries. The first mobile application is ReMind Program. ReMiND (reducing maternal and newborn deaths) program was started in Uttar Pradesh specifically in district Kaushambi. This program use

health workers named Accredited Social Health Activist (ASHA) as a link between health care service and the community. The pregnant woman registered in the application, updated the data, tracked the progress from pregnancy until the baby is born. The main goals from this program is reducing maternal and newborn mortality The ASHA workers could easily give counselling to the pregnant woman. The participant of this program are 300.000 individuals served by 259 ASHAs.5 The second mobile application is Mobile Midwife. Mobile Midwife is a reminder application that sends messages to the pregnant woman for giving information about health and notifying about appointment. This application was first implemented in Upper East Region in Ghana. Awutu Senya District has 1776 pregnant woman that use this Mobile Midwife. The participants of the study are 29 pregnant and nursing woman and already used Mobile Midwife one until three years.6 The third mobile application is MomConnect. MomConnect is a programme of South African National Department of Health that connect to 1,5 million pregnant women. MomConnect provides postpartum and pregnant women with twice-weekly information and access to a helpdesk for patient feedback and queries. The helpdesk has received 300.000 queries with average of 250 queries per day. The rapid growth of smartphone user presents big opportunities to reduce costs, increase real-time data collection, and improve the reach of MomConnect to serve.7 Effectiveness of health care mobile application for maternal woman To see the effectiveness of health care mobile application for maternal woman, we can observe the costs and benefits.8

ReMind Program has a primary outcome to enhance

preventive care such as complications during pregnancy. The result shows that thereâ&#x20AC;&#x2122;s a positive change because of the intervention from the mobile application.

For example, maternal

illness number decrease from 34,598,786 to 31,444,322. Besides that, maternal deaths number decrease from 96,921 to 96,609. ReMIND implementation is also cost effective. Intervention of ReMIND results cost saving of USD 105 per maternal and neonatal illness and USD 2567 per death averted from societyâ&#x20AC;&#x2122;s viewpoint. Reduction of the maternal illness is the reason why the cost of maternal health care decreased. Based on the data, ReMiND intervention has surpass the goal because there is a improvement in identifying and recognizing complication and illness. The care seeking was about 71.9 % in the intervention area as compared to the control area about 46.2%.5 This percentage shows that pregnant woman become more aware of the complication or illness that can happened in pregnancy.

The second mobile application, Mobile Midwife has a primary outcomes such as give advice related to pregnancy, recognize the need for pregnancy care, and gain the self confidence of pregnant woman to raise children. Mobile Midwife provided many information such as birth preparedness, breastfeeding, and balanced diet. This intervention has such success such as the pregnant woman able to save their money because of the free health maternal services. The participant also become more aware of the risk to pregnancy and newborn also know the solution for that problem. However, this study doesn’t include exactly how much money is saved by this implementation.6 This program could be replicated in others country because it can helped to improve the maternal health behavior. The third mobile application, MomConnect, grew fastly to national scale. In the first month, 50.000 pregnant women were registered. By 2016, MomConnect celebrated its 1.000.000 users and by August 2017, this programme has reached over 1,7 million pregnant women. This programme users report high satisfaction about the messaging services and its function in supporting pregnancy and their health. Overall, this programme has been well received by both pregnant women and health workers. This programme can be seen as the catalyst to transform South Africa’s public health care system through the use of technologies.7

Further implementation of health care mobile application for maternal woman in Indonesia Even though there is lack of studies about effectiveness of mobile application implementation for maternal woman in Indonesia, Hana Yuanita, et al. proposed an idea to improve maternal woman behaviour by targeting the husband of pregnant woman. The husband will download an app called Suami Siaga Plus. The participants of this study are about 38 couples which randomly selected. There are four main features that included in this application such as characteristic of woman, pregnancy, childbirth and postpartum. Husband will be the one who notice the danger signs of his wife’s pregnancy. Because of this intervention, it shows positive results. The husband’s knowledge about key danger signs and birth preparedness and complication readiness has increased, the same goes with the pregnant wife.9 To achieve the Millenium Development Goals Number 4(reduce child mortality) and number

5(improve maternal health), barriers have to be removed such as geographical,

financial and psychosocial. These barriers can be removed by mHealth intervention such as

mobile application for maternal woman.10 Based on the data, we can see that 220 women per 100,000 died because of complications of pregnancy and childbirth. One of the solution for this problem is mobile phone technology. Indonesian government has already collaborated with FrontlineSMS firm, for mapping the health data in rural areas, but there is still no mobile application that focuses on pregnant woman.11 This will be a challenge to Indonesia government to make policy how to improve maternal health behaviour using mobile application. This intervention has been tested in several countries and shows a positive results. The development of m-Health especially mobile application for maternal woman will show a promising benefits for the future.12 Indonesia government can learn from another developing countries to enhance the maternal health behavior by reviewing the recommendations from the previous studies about this.

Conclusion This study reviews the effectiveness of health care mobile application for maternal woman on influencing maternal health behavior in developing countries. There are three mobile applications that reviewed to evaluate the effectiveness of this intervention. The first mobile application is the ReMiND Program that was established in India. This program has a primary goal to enhance the preventive care for maternal woman. This application shows a success reducing maternal deaths, neonatal deaths and also a cost saving program. The pregnant woman become more aware about the risk in pregnancy. The second mobile application is Mobile Midwife. This application was first started in Ghana. This intervention has a goal to recognize the need of pregnancy care especially about balanced diet and birth preparedness. Mobile Midwife shows positive results because the pregnant woman get a free maternal health services even though there isnâ&#x20AC;&#x2122;t any exact number how much the money is saved. The third mobile application is MomConnnect. This programme was launched in august 2014 by South African National Department of Health. The primary goal of MomConnect is to strengthen the quality of infant and maternal health services by providing vital health information and helpdesk for queries and feedback. Overall, this programme has been well received by both pregnant women and health workers. In Indonesia, this intervention is still not established in an large scale group. One of the example is an app called Suami Siaga Plus which the participants are about 38 couples. This implementation also give a great results for improving maternal health behaviour.

Indonesian government has to make policies about m-Health especially mobile application to reach the Millennium Development Goals number four and five. With this kind of intervention, the barriers will be removed. This will improve the quality of maternal health behaviour and will reduce the maternal and neonatal death in Indonesia. Indonesian government can review the implementation in several developing countries that already successful.

References 1. WHO (2011). New horizons for health through mobile technologies. 2. Daly LM, Horey D, Middleton PF, Boyle FM, Flenady V. The effect of mobile application interventions on influencing healthy maternal behaviour and improving perinatal health outcomes : a systematic review protocol. 2017;1–8. 3. Feroz A, Perveen S, Aftab W. Role of mHealth applications for improving antenatal and postnatal care in low and middle income countries : a systematic review. 2017;1– 11. 4. Lund S, Nielsen BB, Hemed M, Boas IM, Said A, Said K, et al. Mobile phones improve antenatal care attendance in zanzibar : a cluster randomized controlled trial. 2014;1–10. 5. Prinja S, Bahuguna P, Gupta A, Nimesh R, Gupta M, Thakur JS. Cost effectiveness of mHealth intervention by community health workers for reducing maternal and newborn mortality in rural Uttar. Cost Eff Resour Alloc [Internet]. 2018;1–19. Available from: https://doi.org/10.1186/s12962-018-0110-2 6. Entsieh AA, Emmelin M, Pettersson KO. Learning the ABCs of pregnancy and newborn care through mobile technology. 2015;1:1–10. 7. Barron P, Peter J, Lefevre AE, Sebidi J, Bekker M, Allen R, et al. Mobile health messaging service and helpdesk for South African mothers ( MomConnect ): history , successes and challenges. 2018;1–6. 8. Boulos MNK, Brewer AC, Karimkhani C, Buller DB, Robert P. Mobile medical and health apps : state of the art , concerns , regulatory control and certification. 2014 9. Yuanita H, Santoso D, Sc M, Supriyana S, Ph D, Bahiyatun B, et al. Android Application Model of “ Suami Siaga Plus ” as an Innovation in Birth Preparedness and Complication Readiness ( BP / CR ) Intervention. 2017;11(1):30–6. 10. Fotso JC, Tsui A. Leveraging mobile technology to reduce barriers to maternal , newborn and child health care : a contribution to the evidence base. 2015 11. Daga G. Reducing maternal mortality in indonesia post modern era. 2014 12. Cahya D, Nugraha A. An overview of e-health in Indonesia : Past and Present Applications. 2018

The Role of Medical Students and Medical School in Fostering Health Equity in Indonesia: Perspective from Pre-Clinical Students Kevin Luke, Andro Pramana Witarto, David Nugraha Background: Medical school is obligated to be social accountable and directs their activities towards health priority of the areas they serve. There are several actions medical school can contribute in health equity which can involve its student during the implementation. Objective: To describe perspective from pre-clinical student about medical student and medical school’s role in fostering health equity in Indonesia Materials and Methods: This survey is single-centered cross-sectional study with pre-clinical students as participant. We constructed self-administered online questionnaire using Google Forms which can be accessed through http://bit.ly/kuisionerHE. The questionnaire consisted of participant identity (id, age, sex, batch 2015-2018) and twelve questions about participant’s perspective. The questionnaire then distributed through LINE app from December 16 th to 19th, 2018. The data then checked and processed with Microsoft Excel 2013. Results: Total of 143 students were included in this study which consisted of 32, 34, 37, and 40 student from batch 2015, 2016, 2017, 2018 respectively. The mean age was 19,46 years old and male percentage was 33,57%. Most of participants agreed that medical student and medical school are responsible for health equity in Indonesia (88,81% and 95,10%). Participants also agreed that medical students have role in fostering health equity in Indonesia (95,80%). Education (93,71% and 86,71%) and social service (91,61% and 84,61%) were perceived as the most possible actions by medical students and medical school. Active learning (96,50%), experiences (93,71%), and community welfare (86,71%) were perceived as benefits from medical students’ involvement. However, participants stated that they do not have adequate information about health equity and disparities in Indonesia (83,21%) and lectures given by medical schools is not enough to foster health equity in Indonesia (51,75%). Conclusion: Medical schools and medical students can be involved in fostering health equity, specifically in educating community. Further, monitoring and evaluation of social accountability implementation in medical school are also needed to boost its role in fostering health equity in Indonesia. Keywords: Health Equity, Medical Education, Medical School, Medical Student, Social Accountability

The Role of Medical Students and Medical School In Fostering Health Equity in Indonesia: Perspective from Pre-Clinical Students Kevin Luke - Andro Pramana Witarto - David Nugraha

Introduction Current major challenge in medical education in 21 st century is not only relied on educational responsibility, but also contribution on both health system and community health status improvement, making paradigm shift in medical school. 1 Medical school is obligated to be social accountable and directs their activities towards health priority of the areas they serve. 2 There are three actions medical school can contribute in health equity: (1) Augmentation of the medical curriculum; (2) Direct action through community engagement; and (3) Political advocacy. All of these actions can involve its student during the implementation. To our knowledge there is no study about student perspective of medical student and medical school’s role in fostering health equity in Indonesia.

Objective This study will describe perspective from pre-clinical student about medical student and medical school’s role in fostering health equity in Indonesia.

Materials and Methods This survey is single-centered cross-sectional study with pre-clinical students as participant. We constructed selfadministered online questionnaire using Google Forms which can be accessed through http://bit.ly/kuisionerHE. The link then shared to pre-clinical student (batch 2015-2018) through LINE application from December 16 th–19 th 2018 (Fig. 1). The answers then collected, checked, and processed using Microsoft Excel 2013.

Results and Discussion Yes

DO YOU HAVE ADEQUATE INFORMATION ABOUT HEALTH EQUITY AND DISPARITIES IN INDONESIA?

DO MED-SCHOOLS RESPONSIBLE FOR HEALTH EQUITY IN INDONESIA?

DO MED-STUD RESPONSIBLE FOR HEALTH EQUITY IN INDONESIA?

Yes

11%

17% 83%

95%

89%

Fig. 1 Participants answering online questionnaire DO ORGANIZATION AIDS MEDSTUD FOSTERING HEALTH EQUITY IN INDONESIA?

DO MED-STUD HAVE ROLE IN FOSTERING HEALTH EQUITY IN INDONESIA? Yes

Yes

DO CURRENT LECTURES GIVEN BY MED-SCHOOL IS ENOUGH TO FOSTER HEALTH EQUITY IN INDONESIA? Yes

52%

WHAT IS THE MOST POSSIBLE ACTION(S) BY MED-STUD/SCHOOLS IN FOSTERING HEALTH EQUITY IN INDONESIA? Med-Stud 100% 80% 60% 40% 20% 0%

92%

85% 90%

94%

Med-School

48%

93%

96%

Table 1. Baseline characteristics

WHAT IS THE BENEFIT(S) OF MED-STUD INVOLVEMENT IN FOSTERING HEALTH EQUITY IN INDONESIA? 120%

Actions by Participants

100%

87% 90%

97%

94%

87%

80% 55%

53% 51%

48% 27%

37% 36%

27%

60% 33%

40% 0%

20%

Not Beneficial

Other

Social Service

Health Education

Health Organization

Direct Treatment Political Advocacy

Nothing

Other

Active Learning

Experience

Community Welfare

Baseline characteristics are shown on Table 1. This result highlights medical students’ desire and medical school involvement in fostering health equity specifically in health education and social service. This means that most participants concern on direct community engagement, which is one of three actions medical schools can contribute in bringing health equity.2 Moreover, education is one of barriers to health access in low-income Asian countries and involving medical student to educate community had shown promising results.3-4 However, participants perceived that they do not have adequate information about health equity and disparities in Indonesia. Further, half of participants perceived lectures given by medical schools is not enough to foster health equity in Indonesia. One third of the participants (34,97%) complain about current medical school’s curriculum and 40,56% of participants agreed that changing current curriculum can foster health equity in Indonesia. Embedding social accountability in medical education has great impacts for students, local health workforce, and local communities.5

Conclusion Medical schools and medical students can be involved in fostering health equity, specifically in educating community and social service. Further, monitoring and evaluation of social accountability implementation in medical school are also needed to boost its role in fostering health equity in Indonesia. Reference: 1. Global Accountability Consesus for Social Accountability of Medical Schools. Global consensus for social accountability of medical schools. 2010;(December):16. Available from: www.healthsocialaccountability.org 2. Rudolf MCJ, Reis S, Gibbs TJ, Murdoch Eaton D, Stone D, Grady M, et al. How can medical schools contribute to bringing about health equity? Isr J Health Policy Res. 2014;3(1):1–6.

3. Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W. Addressing access barriers to health services: An analytical framework for selectingappropriate interventions in low-income Asian countries. Health Policy Plan. 2011;27(4):288–300. 4. Vijn TW, Fluit CRMG, Kremer JAM, Beune T, Faber MJ, Wollersheim H. Involving Medical Students in Providing Patient Education for Real Patients : A Scoping Review. 2017;(January 1990):1031–43. 5. Reeve C, Woolley T, Ross SJ, Mohammadi L, Halili S “Ben,” Cristobal F, et al. The impact of socially-accountable health professional education: A systematic review of the literature. Med Teach [Internet]. 2017;39(1):67– 73. Available from: http://dx.doi.org/10.1080/0142159X.2016.1231914

Indonesian Medical Students’ Training & Competition (IMSTC) 2019 ABSTRACT Carbon Emission-Based Vehicle Taxation: An Alternative Funding Source in Covering BPJS Financial Deficits Andrea Laurentius1 1Third

Year Medical Student, Universitas Indonesia, (085372724042, laurentiusandrea@gmail.com)

Introduction Indonesia has been implementing single-payer model of universal health coverage system, named as Badan Penyelenggara Jaminan Sosial (BPJS), to support equal health care protection. Recently, BPJS is facing its Rp16.5 trillion health fund deficits that further deteriorates both state budget reserve and quality of medical services, for obligatory monthly fee paid by member could not sufficiently cover the facilities’ claim on health expenses. Another source of funding is urgently important to maintain BPJS’ functional capacity in reaching 95% national coverage target in 2019. Therefore, establishment of carbon emission-based vehicle tax would be a solution to cover potential BPJS future deficits. Materials and Methods Materials were obtained predominantly through online databases accessed via remote library. Search terms might include ‘BPJS’, ‘Deficit’, ‘Carbon Tax’, and ‘Universal Health Coverage’ for obtained journal selection. Additionally, constructing mind map is done to aid assessment of qualitative studies in literature searching and analyses. Results and Discussion Most of BPJS income credits are obtained via obligatory premium fee paid per person that up to a total of Rp234.06 trillion budget reserves. Expanding its target to reach 95% population from would be a challenge for government to accomplish. Carbon emission-based vehicle tax could be beneficially granted in such developing countries, especially Indonesia. Proposed taxation is based on machine proportion, region of operation, or fuel type, for it will add value on private property taxation up to percentage defined by governments.

Conclusion Governments action in relieving such devastating costs of maintaining universal health coverage system could not be sufficiently executed. Carbon emission-based vehicle taxation would be the solution to cover the additional BPJS financial deficits. Mixed model of premium fee and taxation is an optimal revenue system for BPJS funding in Indonesia. Therefore, utilization of this proposed taxation would enable BPJS in reaching its 95% coverage and achieve the main SDG goal no. 3.

The Role and Challenges of Synchronous (Videoconferencing) Teleconsultation Among Physicians and Its Future Application in Indonesia Agnes Margareta Tanoto, Jessica Rosemary Wikanto, Rexel Kuatama Introduction Disparity in healthcare is a major issue in Indonesiaâ&#x20AC;&#x2122;s healthcare system. As specialist tend to stay in urban cities, lack of medical expertise can be seen in remote areas. To resolve this matter, use of technology has allowed various means of long distance medical consultation (teleconsultation). This review aim to illustrate use of real-time (synchronous) teleconsultation among physicians, its observed benefits and challenges, and its feasibility for application in Indonesia Method A systematic review was conducted through database such as Pubmed, ClinicalKey, WHO, government data and Google Scholar from the last 5 years. The keywords used are remote consultation OR teleconsultation AND videoconferencing OR videoconference and telehealth AND Indonesia. Several inclusion criterias were used. After final assessment, 24 literatures were concluded for present literature study. Results and Discussion A hub and spokes model of teleconsultation where specialists in health centers in health centers (hub) connects with physicians in rural health facilities (spokes) has result in numerous benefits. For patient, synchronous teleconsultation among physician allows significant reduction in cost and time as referral rates decreased. For physician, teleconsultation provides learning and increased expertise in more complex cases overtime. Changes in clinical decision is also observed. One study reported specialist change physiciansâ&#x20AC;&#x2122; decision in 844 of 927 cardiac teleconsultations. Implementation cost provides biggest challenge for developing countries. Other observed challenges include ethical issues and policy. In Indonesia, several legal regulation regarding teleconference has provided groundwork for further development. Although infrastructure was lacking, broadband service has shown fast progress.

One Click for Better Health La Ode MZ. Wali Amrullah L. Hasmar, Fitrah Hidayaturrahmat H.M, Nadya Septiannisa Nasrul Halu Oleo University Background Use of information technology is very important because it is proven that by using information technology, effectiveness and efficiency in carrying out a process faster can be achieved. With the availability of fast and quality information it is hoped that health services can be improved. One of the health fields that is currently developing in adopting information technology is e-health. In Indonesia the use of information technology for the health sector has been regulated in Law No. 36 of 2009 concerning health, where to carry out effective and efficient health efforts, health information is needed through information systems and across sectors. For that one click for better health takes a role in achieving optimal health status.[5] Method Method we use is to collect data through articles and journals. Results and Discussion One click for better health makes an application to allow all people either from government, students, and even the public to easily access information about health. The marketing communication process can be seen in the following figure: (1) Communication actors; (2) Communication Materials; (3) Communication Process E-health will become a future application in order to optimize the public health system. The prefix "e" is described as follows: ●

Efficiency

●

Education

●

Ethics

●

Equity [1][2][3][4][5][6]

Conclusion Indonesia has a great potential to implement e-health because electronic media can reach islands in Indonesia more quickly than non-electronic media even though there are still areas that do not have electricity and internet. Cooperation between government departments related to health services, telecommunications and informatics, and education needs to be coordinated well.[5] References [1] Eysenbach, G., "What is e-health ?," Journal of Medical Internet Research, J Med Internet, available from http://www.jmir.org/2001/2/e20, accessed December 10, 2018. [2] Kerin, Roger A., Peterson, Robert A. 1993. Strategic Marketing Problems, Cases and Coments. Sixth Edition. Massachusetts: Ally and Bacon A Division of Simon & Schuster, Inc. [3] Kotler, Philip, Gary Armstrong. 2001. Principles of Marekting. Ninth Edition. New Jersey: Pretince Hall, Inc. [4]Kotler, Philip. 2003. Marketing Management: Analysis, Planning, Implementation, and Control. Millennium Edition. USA: Pretince Hall, Inc. [5] Kristianto, E. 2013. E-Health in Indonesia. Journal of Engineering and Computer Science. 2 (06): 167-171 [6] Tresnati, R. 2007. Call Center as a Marketing Communication Tool in the 21st Century. 8 (01): 183-197

Telemedicine to Overcome The Lack of Health Workforce in Pukesmas of West Papua Province for Improving The Effectiveness Equity of Primary Healthcare Firyanadhira Imtiyasmi Syarifah1, Muna Soraya2, Prima Sultan H.3 1

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM, firyanadhirais@yahoo.co.id 2

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM,

Jurusan Pendidikan Dokter, Fakultas Kedokteran, UMM.

through

the

“Google

Scholar”,

“Kemenkes”,

“ResearchGate”,

and

“Sciencedirect” search engine. Results and Discussion: The limit of health workforce becomes one of the problems the low health status in West Papua According to a report from the Ministry of Health, there were 5,209 health workers in West Papua Province in 2017 and reports from the West Papua Provincial Health Office every 24 general practitioners and every 12 specialist doctors would handle 100,000 residents, so there were still many health problems found there. To overcome that problem, one of the solutions is the use of telemedicine. The advantage of telemedicine is fulfillment for the need of continuous health care services (maintenance) though consultation using online media along with competent health worker focused in a remote area which is difficult to get reached by health facility. But it needs technology, which not every health personnel could operate. Also, telemedicine needs internet connection, and in addition the low awareness and knowledge about technology of the citizen. But we can overcome that by educating the tribal chief first. Conclusion: Telemedicine has been proven to be successful and could be implemented in Indonesia by empower the citizen.

Application of Telemedicine in Improving Healthcare Access Among Asian Rural Communities: A Systematic Review Ugiadam Farhan Firmansyah*, Aruni Cahya Irfannadhira, Yehezkiel Alexander Eduard George *ugiadamfarhan@yahoo.co.id

Introduction: Telemedicine has been developed and applied in the last two decades. In rural Indonesia, traditional medicine is vital facility in healthcare, but it can not be used for further medical management. In 2005, prevalence of newborn baby mortality in rural Indonesia is about 32% because it still has lack of modern medical facilities. The new big challenge is implementation of telemedicine in Indonesia. Previous studies stated that Bangladesh, Jordan, and India has already implemented telemedicine and got many benefits from it. Objectives: (1) To recognize telemedicine and its form; (2) To evaluate effect and impact of telemedicine in rural areas; (3) To formulate the best decision about developing telemedicine in Asia rural areas Methods: Our systematic review consists of experimental studies about application of telemedicine in Asia rural areas. We conducted literature searching through PubMed and Scopus journal database (n = 41). We decided five full-text eligible articles which meet inclusion and exclusion criteria. We include only last 5 years experimental studies and exclude studies about telemedicine as war technology. For further review, those literatures were assessed with Cochrane Collaboration Tools for assessing risk of bias. Results and Discussion: This systematic review discusses several forms of telemedicine which are teleconsultation, teletesting, and mHealth. Telemedicine could be time efficient and cost-effective model since the application could be performed locally in rural area. Not only for patient, telemedicine also help village doctor in financial and social aspects. Conclusion and Recommendation: Many countries in Asia sustainably develop their network for improving internet quality. Therefore, telemedicine is a promising approach to improve healthcare access in Asia rural areas. We recommend the application of telemedicine in Asian countries, especially Indonesia since it has a great impact to reach highest health degree for the population. Keywords: Asia, rural, telemedicine, healthcare, access

PINTU PSIKI (Pilihan Jitu Pertolongan Psikis): An Approach in Reducing the Countryâ&#x20AC;&#x2122;s Burden and DALY Caused by Mental Health Problem Through Online-Based Platform as A Novel Innovative Strategy Alya Rahma Trishna, Nando Reza Pratama, Olga Putri Atsira Introduction: Mental disorders affect approximately over 1,1 billion people worldwide. Globally, more than 70% of people with mental illness receive no treatment from health care staff. This condition reduces the patientsâ&#x20AC;&#x2122; productivities and eventually bring more financial burden. WHO has estimated neuropsychiatric condition to rise to 15% from total of DALYs by 2020. Online-based mental disorder help services are proven to possess a huge opportunity to improve the access of mental health services. Materials and Methods: The data presented are secondary data, acquired through online exploration from Google Scholar, NCBI, and scientific sources. Results and Discussion: Factors increase the likelihood of treatment avoidance or delay before presenting for care. Evidence that online services had showed to have a good performance in screening or diagnosing. An online-based mental health application that provides screening, estimation of diagnoses, and option to certain budget and region features with two easy steps to follow by the users. Depiction of the application implementation and benefit intended to help people with mental disorder or their care taker. SWOT analysis regarding application capability to cover the factors that increase the treatment avoidance. Conclusion: PINTU PSIKI is a user-friendly platform that is useful for caretaker or those who need assistance on treating their own mental health condition. PINTU PSIKI, which has been analyzed by SWOT, facilitates the users to meet the psychiatrists through an interconnectedonline based system in a chatroom, audio, or video call. In the future, it has an immense potency to be developed to have more features such as a premium member in which the users can get much more services from us. Further study is needed so that PINTU PSIKI can be recommended and soon to be acknowledged as a strategic program in providing the mental health services by considering technological aspect, regulation, and social-economic cost.

Implementation of Early Warning System and Optimization of Referral System in Primary Healthcare System in Decreasing High Incidence of Postpartum Hemorrhage in Indonesia Muhammad Alifian Remifta Putra, Jason Phowira, Raya Makarim Penantian Faculty of Medicine, Universitas Indonesia, Indonesia Background: Postpartum hemorrhage (PPH) is a condition of losing more than 500 mL of blood within 24 hours post-delivery. Based on World Health Organization, PPH contributes to about 35% of maternal death, and in Indonesia, the number remains very high with 305 deaths in every 100.000 delivery in 2015. Cases of PPH are preventable if the early signs are detected and there is effective referral system established. Therefore, the authors propose application of early warning system and optimization of referral system to be implemented in Indonesia’s primary health care system, serving as keys to reduce maternal mortality rate in Indonesia. Material and methods: This scientific poster is based on literature searching done by three people through Google Scholar, PubMed, and NCBI, Ministry of Health Republic of Indonesia, and International Federation of Gynecology and Obstetrics (FIGO) data. Journals, systematic reviews, and non-governmental and governmental guidelines published from 2008-2018 are selected for eligibility. The search term covers “postpartum hemorrhage”, “early obstetric warning system”, “referral system”, and “Indonesia”. Results: Early Warning System and referral system play an important role in constructing a comprehensive healthcare system. Based on our findings, there are numerous types of EWS, however, Modified Early Obstetric Warning System, as one of the earliest and most advanced EWS, has been established across national hospitals in United Kingdom since 2007 and proven to successfully reduce maternal mortality rate in United Kingdom. Referral system is defined as a coordinated process of directing and redirecting patient to higher quality healthcare facilities. A suitable referral system, comprehensive cooperation between health subsystems, and adequate transports to the facilities are required to refer patients effectively, thus, improving patients’ survival rates.

Conclusion: Implementation of a well-established and effectively proven EWS, and comprehensive referral system are potential solutions in decreasing high maternal mortality rate in Indonesia.

BPJS in 2017 Author : Al Asâ&#x20AC;&#x2122;ari, Adpriyanti Candra S, Amelia Rachel Introduction In Indonesia, the philosophy and foundation of the state of Pancasila, especially the 5th principle, also recognizes the human rights of citizens to health. This right is regulated in UU 36/2009 about Health. In the law, it is affirmed that everyone has equal rights in gaining access to resources in the health sector and obtaining safe, quality, and affordable health services. On the contrary, everyone also has the obligation to participate in the social health insurance program. To realize this global commitment and constitution, the government is responsible for implementing public health insurance through the National Health Insurance (Jaminan Kesehatan Nasional / JKN) for the health of individuals.

Material And Methods BPJS will be supervised internally by the Board of Commissioners and an internal audit department and will be supervised externally by the National Social Security Council (Dewan Jaminan Sosial Nasional, DJSN), the new Financial Services Authority (Otoritas Jasa Keuangan, OJK) and the State Financial Audit Board (Badan Pemeriksa Keuangan, BPK) instead of the Ministry of Manpower and Transmigration (MOMT). Different reporting formats may need to be developed to meet the needs of each supervisory body. Result and Discussion BPJS need

Ketenagakerjaan have

will

appropriate

organizational structure and employees with relevant education, experience and competencies to be able to carry out the duties

required

support

the

implementation and operation of the SJSN employment programs. Since the programs,

coverage,

legal,

and

governance structure, and required

functions have changed, it will be necessary to re-evaluate the organizational structure of Jamsostek and its human capital to see what extent these meet the requirements for successful BPJS Ketenagakerjaan operations and SJSN employment programs implementation. Conclusion To ensure the smooth and successful transformation of Jamsostek to BPJS Ketenagakerjaan, the implementation working group must approve and take immediate action on some of the issues that occur.

Background

Picture

Indonesia a tropical country and

between

Visitation

2017

until

foreign 2018

tourist

(October)

largest archipelago country in the world

(source: Badan Pusat Statistik)

has 17,504 islands with an area of

While ministry of tourism report that

1,913,578 km2 [1]. Comprising thousands of

visitation of domestic tourists on 2017 are

islands

equator,

270.82 million. Compared with visitation

Indonesia has 257.5 million inhabitants

of domestic tourist on 2016, the number of

spread

across

the

(World Bank Indonesia Data, 2016)

[2]

domestic visitation increase from 264.34

natural

million to 270.82 million [6]. In other hand,

resources and potency to be a first option

many problems like limited access, bad

destination for tourists both domestic and

infrastructure, and heightened incident of

foreign tourist. Bali, Raja Ampat in Papua

travel disease inhibit development tourism

Island,

in Indonesia.

Indonesia

also

has

Mandalika

various

Lombok,

Ijen

Mountain with blue fire in Bayuwangi are

In health sector that can inhibit

example of top destinations in Indonesia

development of tourism industry is high

[3]

prevalence travel disease in Indonesia. In

. The number of traveler going to

Indonesia

increasing

(World

addition, Indonesia yields a large and

. Based report

growing population of notorious reservoirs

from Badan Pusat Statistik (BPS) exhibit

of zoonotic infections like poultry, rodent,

that increasing number of foreign tourist

wild birds, dog, pigs, and monkey

until 15.21% when compared between

Travel disease is disease that acquired

June 2017 and June 2018, or 1.14 million

when a person going to other country or

to be 1.32 million visitation from foreign

endemic area, previously the person not

tourist [5].

infected a disease or carry pathogen in

Economic Forum, 2015)

yearly [4]

incubation phase

[7]

[8]

. Infectious disease

remain one of leading cause of morbidity and mortality worldwide, especially in countries with a tropical or subtropical climate (WHO, 2014) [9]. Limited

information

and

data

related travel disease and endemic disease in Indonesia become inhibition factor for government to expand tourism market

[6]

In addition, when tourists infected they do

not know to access primary health care to

integrated with Wonderful Indonesia and

treat their symptoms. In other hand,

Ministry of Health, so through Traveler

different immunity between individual

Health Support Application can reduce

especially foreign tourists that come to

traveler disease incident and attract more

Indonesia have a higher risk to infected

tourist to come in Indonesia because this

travel disease or endemic disease cause

application can facilitate the tourist to be

different climate between their origin

more secure when they travel in Indonesia.

country and Indonesia then many different

Method

factor that caused heightened risk to

Literature

Review

arranged

infected. Limited information indeed every

based on journal sources obtained from

tourist both domestic or foreign has high

risk to infect some travel disease or

“Sciencedirect”, and “Proquest”. Besides

endemic disease, beside that they cannot

that we find the data from Badan Pusat

prepare before like specific vaccination for

Statistik, Ministry of Tourism Website, and

specific disease in specific area, specific

WHO. The Keywords that we use are

medication for prophylaxis and other

“Traveler Disease”, “Tourist”, “Tourism”,

preparation to prevent infection when they

and “Primary Health Care”. We use

travel are caused by limited information.

journals are publicized between 2008-

Then they are infected in certain area, they

2018. From finding result, obtained 31,200

do not know how to access nearest primary

journals. Then the journals are selected

health to get intensive primary medication

and the result are found three Journals

to prevent exacerbation.

corresponding with the criteria.

Based

problems

above,

“Traveler Health Support Application” an application-based

“Google

Scholar”,

Result and Discussion The

result

existing

data

provide

collaboration are: (1) This apps can

complete and systematic information about

facilitate travelers to understand the risk of

various travel disease problems. So every

travel disease and tropical disease, (2) Get

tourist that will come to certain area in

vaccines, prophylaxis, and special stuff

Indonesia can prepare to prevent a traveler

recommendations to keep the body healthy

disease or endemic disease, then in this

and safe on the trip, (3) Record the

application also provide how to access

vaccines that the traveler have received in

nearest primary health care when they

the application, (4) Use the packing list to

infected

pack for healthy and safe trip that

get

android

engines

intensive

primary

medication. This application will be

connected to the nearest primary health

Available

from:

care in the destination.

http://reports.weforum.org/travel-

Conclusion

and-tourism-competitiveness-

The result of the collaboration of

report2015/economies/#economy¼

existing data can increase awareness of the

IDN 5. Badan Pusat Statistik. Jumlah

risk of traveler disease and maximize primary health care efforts in the field of tourism so that the morbidity due to the

Juni 2018 Mencapai 1,32 Juta Kunjungan. Badan Pusat Statistik.

traveler disease can be resolved.

2018 [Cited 20 December 2018].

References 1. Badan

Kunjungan Wisman ke Indonesia

Pusat

Statistik.

Daerah

dan

Jumlah

Menurut

Provinsi,

Luas Pulau

2002-2016.

Badan Pusat Statistik. 2017 [Cited 20 December 2018]. Available

from:

https://www.bps.go.id/pressrelease/ 2018/08/01/1474/jumlahkunjungan-wisman-ke-indonesiajuni-2018-mencapai-1-32-jutakunjungan.html 6. Yunita R, Esthy RA. Kajian Data

from: https://www.bps.go.id/statictable/2 014/09/05/1366/luas-daerah-danjumlah-pulau-menurut-provinsi2002-2016.html 2. Worldbank Indonesia Data. 2016

Pasar

Wisatawan

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l.asp?c=145&id=4512 7. de Jong W, Rusli M, Bhoelan S,

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from:

mKADER: COMMUNITY HEALTH WORKER-BASED mHEALTH TO ACHIEVE SUSTAINABLE UNIVERSAL HEALTH COVERAGE IN INDONESIA Vanessa Carolina Gunawan1, Silvia Husodo2, Alexander Fernando3

Community health worker is the core in Health System Strategy because they are the first line in primary health care. Community health worker are members of communities where they work, selected by the communities, answerable to the communities for their activities, and supported by the health system but not necessarily a part of its organization. In this era, Community health worker need improvement in technology, mKader based mHealth is the answer. mHealth help in collecting data, reporting data, decision-support tools, provider training, emergency referrals, alerts and reminders, also supervision and interaction of health systems actors. Sustainable Universal Health Coverage can be achieved with this integrated system of health care. This scientific paper was based on the literature review through analytic study conducted through two approaches are method of exposition and analytic methods.

Keyword: mKader, Community Health Worker, mHealth, Universal Health Coverage

ABSTRACT Improving the First 1000 Days of Life to Support Childrenhood of Development and More Prosperous Futures by Focus on High-Impact Interventions by Cindy Refina Maharani S., Selvia, Milani Indah Kusumaningsih, Adilla Afra Introduction : Maternal mortality is unacceptably high. About 830 women die from pregnancyor childbirth-related complications around the world every day. And in 2015, Indonesia has a high maternal mortality rate of around 305 per 100,000 population, 99% of all maternal deaths occur in developing countries, rural areas and among poorer communities. The “first 1000 days” has been an area of focus, as a period shown to have a greatest potential for positive impact on long-term health outcomes, for both mother and child. . Interventions based on the knowledge of these critical windows have the potential to exert a profound global impact, as correction of nutritional deficits alone has been estimated to have the power to increase the world’s intelligence. The purpose of this review is to improve the quality of life of its people by significantly increasing public health in Indonesia. Methods : The literature search was carried out independently by four authors using Google Scholar and library database. Result and Discussions : The results were divided and presented as the background information of the respondents of how important first 1000 days of life has improved. And there has been data that indicates that with adequate mother’s knowledge can reduce mortality rates with raising infant life. Conclusion : Nutrition-specific and nutrition-sensitive interventions will have the most impact when working in collaboration to focus on this critical window of opportunity. Therefore, by applying some of the ways in high-impact interventions well in society, so, public health will also increase.

JCCI (Jayapura Cacao Clinical Insurance): A commodity-payment System to Provide a Comprehensive Healthcare Access in the City of Jayapura Junoretta Haviva Ernanto, Peksi Saphira Miradalita, Abdullah Farooqi Faculty of Medicine, Universitas Sriwijaya ABSTRACT Introduction. Based on the Poverty Assessment conducted by Indonesian BPS-Statistics in 2013, Papua Island was found to have the highest percentage of the poverty, reaching 31,53% of the population. The low Public Income made citizens incapable to pay for their health treatments. By using Jayapuraâ&#x20AC;&#x2122;s superior commodity, thereby targeting its most profession, the Cacao Farmers, we propose a concept of a Commodity-paymentsystem, making it possible for the citizensto pay for their Health treatments throughthe clinical insurance every month by using their harvest, Raw Cacao, potential of reaching the equality of Healthcare access in Jayapura.

Materials and Methods. We conducted a literature review from Indonesian Health Profile 2013, BPS-Statistic Indonesia data 2013, NCBI, Pubmed, WHO and Government documents. Only studies conducted from 2008-2018 are included in this review. Results. Table 1. Overview of the Representative Results among Clinical Insurance Members Number

Member

Cacao

Financial

Dues (IDR)

Conversion (IDR) 1

Mrs. J

1 kg

30.000

Mrs. S

1 kg

30.000

Mr. A

1 kg

30.000

Total

90.000

Table 2. Overview of the Jayapura Cacao Clinical Insurance Revenues Month

Insurance Revenue

Insurance Expenses

Balance (IDR)

Savings (IDR)

(IDR)

30.000.000

12.000.000

18.000.000

45.000.000

18.000.000

27.000.000

42.000.000

25.200.000

16.800.000

18.800.000

Total

63.800.000

The average insurance revenue per month

25.000.000

Discussion. The system is carried out by providing Clinics around Jayapura with the Cacao-payment system, from the citizensâ&#x20AC;&#x2122; cacao harvest worth 30.000 IDR every month (approximately 15 pieces of Cacao is equal to 1 kg) to be invested as an insurance for their future curative treatments. If we assume that in 1 Village consists of 1000 people who join this insurance system, the clinic will get revenue Rp30.000.000 IDR/month. The clinical insurance will only use approximately 40% of the balance, since in about 1000 citizens, it is only about 15% of the population (150 people) would be sick, and needed healthcare treatment. So, the balance in 1 clinic is Rp18.000.000 IDR/month (60% of the balance), which could be used to improve the public health holistically. The raw cacao will to be further integrated with Cacao stakeholders to be processed to worthselling goods. Conclusion. The Commodity-payment system is an Interprofessional System that provides answer to one of the major healthcare access barriers in Jayapura, which is the Financial Crisis of the citizens. This system will be able to provide healthcare by taking advantage of Jayapuraâ&#x20AC;&#x2122;s superior commodity and its most numerous professions in the region, which are Cacao Farmers.

DEVELOPING PRIMARY HEALTH CARE SYSTEMS “Do it now and get a better health future” Hairon Dhiyaulhaq, Marisa Prafita, Jesi Pebriani

Introduction: Primary Health Care (PHC) was introduced by the World Health Organization (WHO) in around 70 's, with the aim to increase the access of the community towards a quality health service. In Indonesia, the Organization of the PHC is implemented in puskesmas. Materials and methods: PHC research aims to determine the state of primary health care in Indonesia, especially human resources which are currently good or not in accordance with the indicators of the primary health care system. Using case study from Indonesia with data of PHC key indicators 2016. The sampling in this research use a total sampling techniques, with the number of total population of Indonesia is 255,461 million. Results and discussion: The density of health care personnel in Indonesia is much lower than the global average. There are only 2.9 physicians per 10 000 population, compared to a global average of 16 per 10 000. In addition, there is a discrepancy between the number of doctors in urban and in rural areas. By December 2014 based on clinical pathways, key performance indicators and rates of contact with patients,there were 9731 puskesmas, staffed by one or two general practitioners (GPs) on average, while 38.53% of puskesmas had more GPs than the average. However, 25.57% of puskesmas had a shortage of GPs. As a result, midwives and nurses have to take over GPs’ work, as a consequence of which patients fail to get proper PHC services. Conclusion: PHC Systems need to change like Governance who needs optimum comprehensive care. Moreover, the government needs to recognize private PHC facilities as a part of its PHC system and treat them equally with puskesmas in terms of support, control and involvement, thus removing the inequity related to the perception that “puskesmas is for the poor and private practice is for the rich.” for better primary health care in the future.

FIGHT BPJS WITH PRIDE! Nadhifah1, Junjungan Nimasratu Rahmatsani1, Kevin Yuwono1 1

Faculty of Medicine, Universitas Airlangga, Indonesia

AMSA Universitas Airlangga, AMSA-Indonesia Abstract Background: Universal Health Coverage (UHC) has forever been every country’s primary goals in achieving better health services. A truly equal access to first-rate quality services without being constantly worried about how much money they should spend seemed very unlikely at-first, but it is possible. Many countries have been successful in achieving UHC and Indonesia – a currently developing country – should be able to do the same. Many attempts had been done to achieve this. Since 1968, a single health insurance implementing agency for civil servants had been created and presently, ‘BPJS Kesehatan’ took its role since 2014 intending on reaching every person in Indonesia. They had been particularly successful; as only in 3 years, 72.9% of our population have already participated in ‘JKN-KIS’ program. Numerous awards were received, though by 2018 their financial deficit is estimated to reach 19.8 trillion rupiah. Various causes emerged, like low comprehension of the program leading to lack of compliance on paying the premium needed to ensure equal access to everybody. Objectives: Similar to the human needing gut microbiota to ensure its well-being, ‘JKN-KIS’ also needed ‘the people’ to support the program itself. This support can be done by taking ‘PRIDE’ on what we have. We should pay the Premium regularly, Recruit others who haven’t yet participated, Inform our concern regarding any misconduct, Demand our rights, and lastly Expand our knowledge of the program. Thus, we can increase this awareness in everybody that we are the axis of this program. We can make the change and that change will start now! Conclusion: Our ignorance can restrain people – especially those who truly needs this equality – from receiving suitable medical treatments. We should take ‘PRIDE’ on what we have and also aware of our responsibility. Whoever saves one life, saves the world entire. References World Health Organization. 2017. ‘Together on the Road to Universal Health Coverage’. Geneva: World Health Organization.

Mahendradhata, Y., et al. 2017. â&#x20AC;&#x2DC;The Republic of Indonesia Health System Reviewâ&#x20AC;&#x2122;. Health Systems in Transition, Vol. 7 No. 1 2017. BPJS Kesehatan. 2017. Laporan Pengelolaan Program dan Laporan Keuangan Jaminan Sosial Kesehatan Tahun 2017.

ABSTRACT a. Title : E-Posyandu for Healthier Future b. Authors : Ahmad Ramadhan, Nurul Muftiadliah A and Ni Made Ayu Sri Lestari c. Background : According to data from riskesdas 50% of indonesiaâ&#x20AC;&#x2122;s childern in 2010 rarely or have an irreguler schedule to go to maternal and child health services and most of them leave the maternal and child health services by the age of 3, we hope this poster would decrease those numbers because we believe by this poster, through E-posyandu App whould help the mother to gain many types of knowledge. d. Objective : The pourpose of this poster is to encourage mothers to bring their babys to the maternal and child health services. E-posyandu contain the information that mothers need for their baby, such as, the importance of immunization, help them to schedule it, and help them to provide the type of food and nutrition that their babys currenly need. And we believe babys as future generation deserve the best in every aspect including health care. e. Conclusion : We made this poster to provide information to mothers and their families that in the digital era everything is possible, including creating a healthy and smart generation of Indonesia

mHealth for A Better Care Naomi Juwita Tansil According to WHO, Indonesia ranks 92 in worldâ&#x20AC;&#x2122;s health systems. Also, based on Pusat Data dan Informasi Kementrian Kesehatan Republik Indonesia on 2017, Indonesia lacks 39,16% doctors and can only reach an area of 35,70%. This is the main reason why Indonesia should apply mobile health to promote the practice of medicine & public health in this digital era. Mobile health is one of the solution to provide health care because according to Athena Health, 70% of the worldâ&#x20AC;&#x2122;s five billion mobile wireless subscribers were in low- or middleincome countries, including Indonesia. By providing mobile health, the patient, medical practitioner and the government itself can give a better medical care. Through mobile health, people can easily access the health care they need. Such as, consultation with the medical practitioner, direct diagnose, and else. Also, mobile health can be easily access anywhere and anytime. This proves how mobile health is very useful and an easy application. Beside easy access, mobile health also provides the patient with their own medical data tracker especially useful for addictions to support recovery from oneâ&#x20AC;&#x2122;s addiction. Mobile health also provides a real-time patient monitoring to help the medical practitioner and the patient himself so they can easily monitor themselves without having to be in the same time and condition. Last, because mobile health can be easily access, thus make the government reach rural areas easily. So, through all this information, it is essential for the government to provide mobile health to make health care better and more efficient.

Medivel: Your Medical Assistant for Travelling Yohana Hartya, Theresa Puspanadi, Novelina Gracea Brawijaya University Indonesia is a tropical country which has some of the most exquisite places on earth. Unfortunately, some of these areas are home to various endemic diseases. Travelers coming to new place unequipped with medical knowledge are at risk of catching travel borne disease. In addition, health care facilities can be hard to find especially for travelers who are unfamiliar with the region. On the other hand, technology has developed vastly. According to the 2018 Global Digital suite of reports from We Are Social and Hootsuite, more than two-thirds of the worldâ&#x20AC;&#x2122;s 7.6 billion inhabitants now own a mobile phone, with more than half of the gadgets being smartphones. This means more people are able to enjoy the full benefit of the internet. Survey done by Asosiasi Penyelenggara Jasa Internet Indonesia in 2017 revealed that internet penetration rate in Indonesia reached 72.41 % in urban areas, 49.49% in rural-urban areas, and 48.25% in rural areas. Therefore, we use the opportunity to develop Medvel, a medical application that can help people to plan their travel better in a medical perspective. Medvel key features allow users to search their travel destination and the app will give information about the endemic disease in the area, suggest vaccines and preventive medication that needs to be taken before coming to the area to protect themselves from diseases in the area, as well as show health care facilities available in the area. In times of need, users can find the nearest hospital, private clinic or community health center and the app will show detailed information about the health care facility along with the contact and direction from user current location to there. Hopefully Medvel can assist travelers to plan safe and healthy travel, as well as raising awareness on the importance of health planning in travelling. References: Kemp, Simon. 2018. Digital in 2018: Essential Insights to Internet, Social Media, Mobile, and E-commerce Use Around the World. Retrieved from: https://wearesocial.com/blog/2018/01/global-digital-report-2018 Asosiasi Penyelenggara Jasa Internet Indonesia. 2017. Penetrasi dan Perilaku Pengguna Internet Indonesia 2017. Retrieved from: https://www.apjii.or.id/content/read/39/342/Hasil-Survei-Penetrasi-dan-PerilakuPengguna-Internet-Indonesia-2017

RADIO: Rural Area Deserves Information Of Health Care Adolf Gideon1, Andra Danika2, Hanna Melisa2 1

Fourth Year Medical Student, University of Brawijaya

Third Year Medical Student, University of Brawijaya

In this modern yet growing society, television and internet has become the most socially influencing media for most people in the urban society. Indonesia, a maritime country, has many rural areas with low quality of healthcare coverage although Indonesia has a universal health coverage system such as BPJS. Health promotion is one of the best choices we can do now. When we think about the most effective way to do health promotion, we tend to think about television and internet, or even the best way is to bring healthcare workers into the society to do some campaigns. But in the rural areas of Indonesian archipelago, it is hard to get access through with no adequate facilities, that’s why we need to find another solution. We found out from Nielsen survey (2016) that radio is still the top three favorite media which people use with 38% of usage. This is why we think that the country should make a radio station that focus on medical and health. Radio is considered as the most useful way to reach rural areas of Indonesia and help to maintain a healthy society. In order to make radio more interesting, we can make talk show and quiz with an interactive yet talkative speaker. As

for

2016,

the

government

launched

new

program

called

“Nusantara Sehat” which empowered the primary healthcare in rural area by sending adequate health workers from various departments (Kemenkes RI, 2016). This is a very good decision to ensure that everyone will get equity in health access. Last but not least, our team thinks we need to start with the basic such as health promotion using the radio because as people say it’s better to prevent than to cure. And still it should be balanced by an adequate healthcare service.

ARE YOU PROTECTED? Author: Ave Maria, Agnes Debora Sianturi, Shantidewi AMSA-Universitas Brawijaya

Background : Everyone has the same right to get health service with safety, quality, and affordable price. To protect that right, the government of Indonesia created national health protection insurance which is called Jaminan Kesehatan Nasional or JKN. To provide wider coverage of health insurance for all citizen of Indonesia, JKN is handled directly by Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Kesehatan). People that are already registered in JKN would get the membership card named Kartu Indonesia Sehat or KIS. Stated by the Director of BPJS Kesehatan, by the end of 2017 people of Indonesian that have registered in JKN-KIS reached 72.9% from the total number of Indonesian citizen. It means that there are still 27.1% of Indonesian citizen that need to register themselves to JKN-KIS in order to reach Universal Health Coverage (UHC). The goal set by the government is that 100% of Indonesian citizen registered in JKN-KIS, therefore there is some task that the government needs to do to reach the goal. The government needs to promote the benefits of being JKN-KIS participants, one of which is the easy access to health facility. Objectives : To support the Universal Health Coverage target set by the government, to engage the rest 27.1% of Indonesian people to join the â&#x20AC;&#x153;umbrellaâ&#x20AC;? of health coverage, and to support the right of all people to get equal health coverage and health service with safety, quality, and affordable price.

BPJS IS NOW AS EASY AND ACCESSIBLE AS IN YOUR HAND! Shantidewi â&#x20AC;&#x201C; Rininta Arifianingsih â&#x20AC;&#x201C; Ahmad Abdilla Adiwangsa AMSA-Universitas Brawijaya The development of information and telecommunication technology is growing rapidly. The number of smartphone users in Indonesia is estimated to reach over 150 million people. In fact, most of Indonesian people are following the development of technology, because of that, it is important to adapt the current trend. In improving health service for National Health Insurance or Jaminan Kesehatan Nasional (JKN), Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan launched JKN Mobile Application. JKN Mobile can be used by participants anywhere and anytime. This application is as a teamwork between Ministry of Health and Ministry of Communication and Informatics to make BPJS system is easier, and increasing the healthy level of Indonesian People. Participants have to download the application first in Google Play Store or Apple Store, and then register on the menu provided in the JKN Mobile Application. After that, participants can enter the application and utilize all its features. There are 4 useful features in the application, including Billing Feature, Service Feature, Registration Feature, and Screening Feature. Billing Feature can make easier for participants to make payments and find out information on fees and penalties. Service feature makes participant can find out the history of health service that have been obtained. Registration feature is created for participants to get the First Level Health Facilities (FKTP) easier that already connected to JKN Mobile. Screening feature is aimed at detecting chronic diseases such as hypertension, diabetes mellitus, chronic renal disease and coronary heart disease by answering the 47 questions. JKN Mobile application as new innovation to fulfill human rights for every people to get good health service by making easier access for health facilities in Indonesia.

Title of Poster

: WHAT DO YOU PREFER?

Authors

: 1. Afdina Melya Ganes Febiyanti 2. Aditya Kristiaji

Institution

: Universitas Gadjah Mada WHAT DO YOU PREFER? BPJS OR COMMERCIAL HEALTH INSURANCE

Background of the poster BPJS is a Public Legal Entity established to administer the Social Security Health Insurance Program (JKN) for Indonesian citizen. BPJS is aimed to make health coverage insurance universal and reduce the health disparity. According to Riset Kesehatan Dasar 2013, health care disparity in Indonesia reached 20,9%. Less awareness of the society is being one of the major cause of health disparity. We choose the fourth subtheme, that is “optimizing BPJS as the government’s healthcare program in improving Indonesian’s quality of life” cause we think that the health disparity could be reduced by increasing the awareness of society to join the BPJS program. Objectives of the poster The target of this poster is the society. This poster is aimed to raise awareness of the society in dealing with equality in healthcare access to improve community health. In this poster, we provide the advantages of joining BPJS program and the fact about BPJS. We also provide the fact about Commercial Health Insurance. We said that, by joining BPJS, the reader could be a part of reducing health disparity in Indonesia cause BPJS is aimed on it. BPJS covering over 115 diseases including Coronary Heart Attack and HIV/AIDS, while the Commercial Health Insurance have protection limit depend on the premi. So the reader could compare the benefit of joining BPJS or Commercial Health Insurance. And they could make their decision to take part to improve community health or not. Conclusion So the society could choose their own choices between joining the government program to help improve equal healthcare access for everyone, or joining the commercial health insurance.

Name

: Hana Dwi Setyarini (first author) Ifani Nurul Islamy

Institution

: AMSA-Universitas Gadjah Mada PUSKESMAS IS OUR “AVENGERS”

Health system in Indonesia is held by the government with national health assurance (JKN) in health assurance mechanism and it’s mandatory for all citizens. JKN service must be strengthen with Primary Health Care System (PHC) as the first level in health service Indonesia. PHC consists of public PHC and private PHC. Public PHC is held by Puskesmas that has two activities. Those are community health efforts (UKM) and individual h (RI, 2017)ealth efforts (UKP). Whereas private PHC is delivered by individual practies GPs, dentist, midwive, and nurse in private clinic that serve individual health efforts (UKP). So, Puskesmas as the public PHC have to be developed to build a better national health system. We make this public poster to educate citizens about Puskesmas and let them to come to Puskesmas. We want to educate that Puskesmas isn’t for certain community class. It’s for baby till elderly, for the poor till the rich people. The way to register as a patient is easy. We can use BPJS as assurance, so it will be cheaper. According to Indonesian Health Profile 2017, there are 9.825 Puskesmas in Indonesia and 1 subdistrict has 1 unit of Puskesmas or more. There are 3.225 Puskesmas have given standard service. The number of medical professional such as doctor, dentist, midwive, and nurse are also increase. So Puskesmas can make us satisfy. All of that reasons are make sense to let citizens come to Puskesmas. Then we can develop and support Puskesmas as a hero for Indonesia. So, we illustrate Puskesmas as “Avengers” for Indonesia. Through this poster, we hope that our intention will be reached, so we can give our contribution for this nations especially to build a better national health system in Indonesia. And with AMSA-Indonesia, we hope medical students can be a connecter for government and citizens. References Kemenkes RI, 2013. Ministry of Health Republic of Indonesia. [Online] Available at: http://www.depkes.go.id/development/site/jkn/index.php?cid=2244&id=jaminankesehatan-nasional-harus-diperkuat-dengan-dukungan-primary-health-care-yang--sedekat-

mungkin.html [Accessed 21 December 2018]. Kemenkes RI, 2017. Profil Kesehatan Indonesia Tahun 2016. Jakarta: Kementrian Kesehatan Republik Indonesia. Kemenkes RI, 2018. Profil Kesehatan Indonesia Tahun 2017. Jakarta: Kementrian Kesehatan Republik Indoneisa. WHO, 2017. Primary Health Care Systems (Primasys) Case Study from Indonesia. s.l.:World Health Organization. Licence: CC BY-NC-SA 3.0 IGO.

JKN is Not Just an Insurance! Abstract Ignatius Evan Santosa, Christina Wunardi AMSA-Universitas Gadjah Mada Achieving Universal Health Coverage (UHC) is one of the targets the nations of the world, including Indonesia, set when adopting the Sustainable Development Goals in 2015. UHC means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care. Jaminan Kesehatan Nasional (JKN) is a national health insurance scheme launched by Indonesia under the management of BPJS Kesehatan in 2014. It covers millions of people today and aims to provide universal health coverage to the whole population. JKN is a part of National Social Security System which is carried out using the mandatory social health insurance mechanism stipulated in Law of The Republic of Indonesia No. 40 Of 2004 with the aim of fulfilling the basic public health needs that are given to every person who has paid contributions or fees paid by the Government. The Government's target is about 95% of Indonesianâ&#x20AC;&#x2122;s population or 253.4 million people have become member of JKN program by January 2019. Meanwhile until 1 December 2018, JKN program member have only reached 207.8 million people. Being a member of JKN does not mean free coverage for all possible health problems, regardless of the cost, as no country can provide all services free of charge on a sustainable basis. All members of JKN program are required to pay for their contributions on time to help those who need it the most. Thus, this poster is expected to raise awareness of the society about Jaminan Kesehatan Nasional (JKN) and to remind their obligation to pay for their contribution on time. It is important to increase people's understanding of JKN as a step towards universal health coverage. Help each other, healthy together. Refferences 1.

BPJS Kesehatan. (2018). Peserta Program JKN. Retrieved from https://bpjskesehatan.go.id/bpjs/ [Accessed December 24,2018)

Government Regulation/PP No. 12/2013 on Health Security. Retrieved from http://www.jkn.kemkes.go.id/attachment/unduhan/Perpres%20No.%2012%20Th% 202013%20ttg%20Jaminan%20Kesehatan.pdf [Accessed December 23,2018)

Jaminan Kesehatan Nasional. Retrieved from http://www.jkn.kemkes.go.id/ [Accessed December 23,2018)

World Health Organization. (2018). Universal Health Coverage (UHC). Retrieved from https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage(uhc) [Accessed December 23,2018)

World Health Organization. (2018). Universal Health Coverage and Health Care Financing Indonesia. Retrieved from http://www.searo.who.int/indonesia/topics/hsuhc/en/ [Accessed December 24,2018)

Abstract Title

: Telemedicine: Road to Indonesia and Other Rural Areas of The World

Background

: Telemedicine is the distribution of health services in conditions where distance

is a critical factor, by health care providers using ICT to exchange at distance information useful for diagnosis. Telemedicine has improved the care of patients with difficult access to services, particularly those in rural areas for many countries. In the poster, it is written the fun facts and obstacles that bump the outgrowth of telemedicine, what has been made through years, and telemedicine condition in Indonesia as one of rural areas in the world. Objectives

: Through this poster, it is expected to raise knowledge about how telemedicine

has evolved, what should be done and what can people do to enhance telemedicine in Indonesia. Conclusion

: Indonesia America Society Academic (IASA) is collaborating with Papua

provincial government to accelerate the development of welfare in Papua, include telemedicine between hospitals within Papua, Universitas Cenderawasih and Universitas Gadjah Mada. As medical student, unconsciously we are obliged to either improve telemedicine in Indonesia, the system, implement the benefits or give suggestions to telemedicine. Within this public poster, people should start to acknowledge the existence of telemedicine and how far it can give benefits, especially to the ones who live in rural areas.

Prasista Ariadna Kusumadewi Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada

(E)arly (A)ccess (S)tart from (Y)ou Erik Veri Ramadani,R.A Lisya Anggraeni,Wa Ode Afifa Zain Universitas Halu Oleo Background Health is one of the utmostimportance in our lives. In the current era of techology advancement, rapid access to healthcare is a must. Collaboration between health and technology is one step forward to advance Indonesia. According to Manganello and Jennifer (2017), public health services are strongly influenced by the use of digital technology, the application of health interventions in the development of digital technology is very effective inhealthcare services. The advantage is that it can accelerate patients to be referred to the hospital by the examining doctor, efficient time in diagnosing when using health-based applications, the creation of insights for the community to recognize existing diseases, can facilitate doctors to assess which patients should be referred. Indonesia is still known to have not yet realized and are not familiar with the use of existing technology. Objective This poster aim to enticethe community to be aware and utilize the means of existing technologies for ease of health care services going forward. Conclusion Public healthshould be the number one concern. Globalization era requires doctors to be aware oftechnological utilization. Healthcare software andapplications will make it easier for doctors in to diagnose and make it easier for the public to maintain their health and wellbeing.

BPJS Cover your emergency cases Anastasia Elisabeth, Richard Holman Matanta, Valentina F. Tando Faculty of Medicine, Hasanuddin University â&#x20AC;&#x201C; Makassar, Indonesia Emergency cases runs in Indonesia as well as any other countries. Often times, ethical and financial problems may prevent patients from being treated properly. A universal and accessible insurance system may prevent this problem.

Indonesian government tries to

ensure that all citizen admitted to the Emergency Department to be treated properly through the establishment of Presidential Regulation Number 12 of 2013, which stated that all BPJS customers will be treated properly in the setting of emergency cases in every hospital, despite of their affiliation with BPJS Kesehatan. However, a lot of emergency cases are still not treated in the hospital setting because of financial problem, though these cases are not well documented. The main cause of this problem is due to peopleâ&#x20AC;&#x2122;s miscarriage to meet their responsibility, leading to their inactivation of BPJS services. This problem can be tackled by expanding peopleâ&#x20AC;&#x2122;s knowledge about the method of payments available. Through this publication, we aim to educate the citizens of Indonesia about better alternatives from cash payments, which may not be accessible due to geographical or personal problems. We also aim to emphasize the importance of insurance coverage for all individuals. Since 2014, BPJS Kesehatan have established agreement with local and national banks all over the country to help customers to fulfil their monthly fee, especially by the auto-debit system provided by these banks. This innovation was expected to increase people involvement with this system. BPJS Kesehatan also expanded its features in 2015, by opening access to citizen to pay the fee at more than 25.000 stores of Indonesian convenience store. However, most people in Indonesia are not aware of these features. We strongly recommend Indonesian citizen to maximize these features, to ensure their access to the services in emergency settings.

THINK OUT OF THE BOX Leony Octavia S., Anastasia Elisabeth Sarira, Frederick Wirawan Faculty of Medicine, Hasanuddin University â&#x20AC;&#x201C; Makassar, Indonesia The existence of BPJS Kesehatan since 2013 has been a great help for the society of Indonesia. Aiming to cover all layers of the society, BPJS Kesehatan also offers hundreds treatments for any kind of diseases and emergency conditions, only with paying from the range of Rp 25.500-80.000/month. Unfortunately, it has been documented that 115 millions people are not registered in BPJS Kesehatan, and this unfortunate condition is caused by the lack of knowledge and awareness about the benefits in joining the programme, even worse, many people have the mindset that paying the fee of BPJS Kesehatan is a waste of their money. We believe, joining BPJS Kesehatan is an investment, considering the fact that it covers almost every diseases, from hormonal diseases, congenital diseases, emergency conditions, even treatment for organ failure like hemodialysis and many more. It also covers your health needs for your whole life in a very affordable fee. Not to mention the cross-subsidee system that BPJS Kesehatan has, that allows us to work together in helping those in needs. These benefits are undeniable, that there should be no reason for our people not to join BPJS Kesehatan. Our poster aimed to emphasize those benefits in the form of comparison between the registered group and the non-registered group. The registered group will have things way easier rather than the non-registered one, because of the benefits they can gain from joining BPJS. Hopefully, those who are not registered are encouraged to register once they see our poster. Contact details Leony Octavia Sujono leonyoctavias@gmail.com +6282193087212

No Money, No Problem! Richard Holman Matanta, Valentina F. Tando, Anastasia Elisabeth

Background Indonesian is a large country consisting of more than 260 million people. This large number of people comes with also a large number of health problems. Majority of them lives in rural area, where transportation and internet communication are not available, because of the geographical landscape and also the socioeconomic status. Due to these problems, Indonesian are prone to miss to pay the premium for the current insurance system running in Indonesia, which is called BPJS Kesehatan. Because of this, a lot of citizens living in the rural area in Indonesia are having problem to receive primary healthcare services which are essential for their health and well-being. Meanwhile, the new Constitution for rural area are established. The regulation itself promises the authority of rural area government, and the establishment of their own financial corporation, which are later called BUMDes. Objectives We aim to give a solution for the payment of Indonesia citizenâ&#x20AC;&#x2122;s premium for BPJS Kesehatan. Our solution consisting a systematic organization between citizen, Badan Usaha Milik Desa (BUMDes) and also BPJS Kesehatan. Conclusion BUMDes can play a vital role in order to help citizens to pay their premium. As a legal institution, BUMDes can help to collect the premium for BPJS Kesehatan from all of its members, and collectively give the money to the BPJS Kesehatan, in order to cut the transportation cost and to ensure people do not forget their monthly fee. This solution aim to ensure a constant income for BPJS Kesehatan, and also universal health coverage to all citizens This idea are already implemented. In November 2017, BUMDes Manjungan signed a Memorandum of Understanding with BPJS Kesehatan to help all of its members to fulfil their premium. Unfortunately, only a few regions in Indonesia are aware for this solution.

PREION: SERVE BETTER, LESS REFERRAL Background Indonesia, a developing country with the 4th largest population in the world, has thrived in a matter of healthcare system. With the presence of Jaminan Kesehatan Nasional (JKN), non specialistic primary health care and secondary advanced referral health services becomes easier. But sadly, this does not significantly reduce the number of sick people in the community. It is stated that 95% of government’s budget in terms of health are used for treatment and care, whereas only 5% are for prevention issues and promotion. This issue means that most people would only focus on treating the sick that is right in front of them, and not really focusing on determining the long term needs of prevention to people who are susceptible to a disease in the future. Therefore we should raise our ambition and voice, prevent the preventable, promote health for all. Objectives Our objective is to portray the current situation of healthcare services in Indonesia which we consider still have more room for improvement. This is portrayed by the range of colours used as the background. The shift from pink colour to white colour signify the imperfection of healthcare services. With this poster, we hope to provide for a solution to the on going problem for the better healthcare services in Indonesia. PREION /prīˈôn/, is an abbreviation of Prevention and Promotion that we would like to advertise on. With this idea, overall healthcare services will tend to grow and the services would be efficient as less referral would be done. Most of the services could be done primarily with the indication of PREION. Our target audience are healthcare professionals as well as the government who have the largest saying on this matter. Preventing diseases and promoting health could both be done by establishing partnerships with given guidance to those prone to the disease risk factors and to build community development and advocacy in promoting public health.

Conclusion With this poster, we would like to advertise the idea of health prevention and promotion as the core of healthcare services in Indonesia. Community empowerment can be done through partnerships by building community development and advocacy in public health care to support promotion of health care. To decrease number of sick people, we can work together with community organization to guide people with risk factors of the disease. In conclusion, prevention and promotion in healthcare should be our priorities in primary health care and we must raise our ideas, prevent the preventable, and promote health for the community. References: 1. Ginting M, et al. Promosi kesehatan di daerah bermasalah kesehatan: Panduan bagi Petugas Kesehatan di Puskesmas. Jakarta: Kementrian Kesehatan Republik Indonesia; 2011 Oct. 2. The primary health care approach [Internet]. Ontario: Canadian Nurses Association; 2000

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aiic.ca/~/media/cna/page-content/pdfen/fs02_primary_health_care_approach_june_2000_e.pdf 3. Admin BPJS. Manfaat [Internet]. Jakarta: Badan Penyelenggaran Jaminan Sosial; 2017 [cited

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LET’S REGULARLY PAY OUR BPJS : OUR NATION’S HEALTH IS ON OUR HANDS University

: Universitas Indonesia

Author

: Mochammad Izzatullah, Sakinah Rahma Sari, Varalisa Rahmawati

Every people have the right to be healthy and the right to receive a proper healthcare. This statement has already stated in our nation’s constitution in Article 28H section 1. Through this constitution, the government must facilitated their citizens the best healthcare so the nation’s health is in optimum condition. One of the efforts that the government has done is by launching the BPJS Kesehatan. BPJS Kesehatan is a unit that is formed to establish a national health insurance. It is launched in January 2014 and have a target to cover all of Indonesian citizens health. As of December 1st 2018, there are more than 200 millions people have already become the member of the national health insurance which is the product of BPJS Kesehatan. However, the unit itself still suffers a deficit of 9,75 trillion. In 2017, BPJS Kesehatan has covered 84 trillions rupiah, but their income from the citizen who regularly pay the fee was only 74,25 trillions rupiah. One of the cause of the deficit is the low awareness to pay from the citizen who must pay it. This situation could lead to a serious problem as it can obstruct the healthcare services. As a result, we consider to promote more the importance of paying BPJS fee regularly with this public poster. We hope that this poster will encourage more people to pay their BPJS regularly even when they are not sick. Because by paying our BPJS fee regularly will help the poor people who needs the treatment could be treated well through the cross subsidization.

HEALTH PROMOTION THROUGH KNOWLEDGE Authors: Adpriyanti Candra S, Al Asâ&#x20AC;&#x2122;ari, Ayu Herlina Jambi University Introduction Health promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions. Objective To raise awareness of the society in dealing with equality in healthcare access to improve community health. To brainstorm for the solutions to the problems and achieve the amelioration of equality in healthcare access in Indonesia. Conclusion People need to acquire the knowledge, skills and information to make healthy choices. Example for medical students in health promotion starts from mastering their knowledge with the most underlying is how to find a good and correct journal

Primary Health Care System In Indonesia “Care To Cure” Amelia Rachel, Marisa Prafita Isman, Sania Zahira Rahman

Nowdays many places of health care with various units and levels. Of course, from each aspect it will be different. different in terms of service and price. Not everyone can fulfill the requirements to get the best health services. therefore primary health care systems are formed to create equality in public health services. Primary Health Care (PHC) was introduced by the World Health Organization (WHO) in around 70 's, with the aim to increase the access of the community towards a quality health service. In Indonesia, the PHC has three main strategies, namely the cooperation multisektoral, community participation, and the application of technology to suit your needs with the implementation in the community. But still the primary health care is still not optimal. Indonesia Primary Health Care (PHC) current overview still inequality, Demographic transition, Epidemiological transition, Triple burden of health problems, Lack of continuity of care, and Need for comprehensive coverage. There are framework for strengthening PHC system in Indonesia, that has need to change is Governance needs optimum comprehensive, Financing needs massive; specific; and coninuous information nationally, Human Resources needs collaborative care and high quality of care, Planning and Implementation needs governmental focus make PHC everyone’s business, Also Monitoring and Evaluation needs well organized online medical records towards coninuity and comperhensive care. Through this poster, we would like to inform the public to know about PHC. So, if we know about primary health care, we can optimize it well. And Indonesia can create primary health care that is equity and equality of health care access, continuity of care, optimum comprehensive care, and universal consumption.

Title of the Poster : The Synergy of the Government and the Society in Overcoming BPJS Health Deficit Name of Authors : Denok Marreta Haq, Halimatussadiah, Siti Shafira Alawiyah Nasution Background : BPJS health assurance program became the mainstay of the current Government to ensure the entire community are able to access healthcare. But problems over the years continue to occur. Deficit BPJS happens every year even started from its first year in 2014. Based on results of the audit of Finance and Development Supervisory Agency (BPKP), deficit Health BPJS per September 2018 reach Rp 10.98 trillion. According to the Director of health of BPJS Fachmi Idris, this happens because the quantities claim paid company is always greater than the contribution received from participants. It is caused because of BPJS applies to deal with a variety of ailments, but small contributions. Not only that, the compliance participants in paying dues also questionable. Claims do reach hundreds of millions but then once cured, they did not want to pay dues again. Per 31 May 2018 delinquent dues and corporate participants reached Rp 3.4 trillion. Related issues arise as a result of the deficit BPJS. In example the refusal BPJS patients by the hospital and late payment fees medical staff. Objectives : This poster aims to call upon the Government and the society to overcome the deficit BPJS as an effort to optimize the role of BPJS to increase the equal health access continuously to the entire community. Conclusion : According the BPJS Health deficit, we assess there should be a synergy of Governments and society in it. The Government can raise tuition gradually, as well as encourage more preventive health programs in order to increase the number of quality of life and reduce the burden of healthcare costs. We invite the community in order to pay dues on

time as a form of responsibility so that healthcare runs well, also do healthy living system to avoid the disease.

Mobile Health Through Digital Brian Luke Salim Ronald Wongkar

The advancement in technology in terms of computation and connectivity has emerged high potential not only promoting medical practices but also circulating health information through mobile health. Global Observatory of E-Health defined mobile health as the use of mobile devices such as mobile phones, patient monitoring devices and wireless devices for medical and public health practice. Applying this technology in the medical system theoretically enables institutes to overcome problems involving financial, geography and time, yet the infrastructure of e-Health in Indonesia has not been optimal, including m-health itself. In fact, e-Sistem Informasi Kesehatan Lamongan Elektronik recently came across internet difficulties the past month. Programs developed through mobile health are: communication between individuals and health services, consultation with health care professionals, health monitoring and surveillance, access to information and education for everyone. In Indonesia, communication between individual and health services have been done through health call centers, emergency toll-free telephone services, and SMS used as reminder or make an appointment with patients. Websites in Indonesian language containing medical resources and information such as medicine and disease is present, and provides consultation option with online doctors, although its qualification in Indonesia is still being questioned to operate reasonably. Besides that, health promotion campaign by SMS is rare and application providing health surveillance and m-learning is very few with Indonesian language. As previously stated, one of the largest factors to cause low reliability on mobile in Indonesia is its weakness in network capability. In compared to more developed country such as America or Japan, the price of internet and mobile access in Indonesia is still challenging, leading to poor application of mobile health. Despite the fact that Indonesia should fix the internet framework, our country should also explore the other possibility (health campaign, health application in Indonesian) that is seldom used.

Grab Your Health, Now! Irene Cicilia, Jessica Nathalia, Casey Christiany AMSA UKRIDA

Abstract BPJS stands for Badan Penyelenggara Jaminan Sosial (Social Insurance Administration Organization). BPJS is an authorized body that was established to provide medical coverage program for the Indonesian people. BPJS Kesehatan, which focuses on health insurance, started its operation in 2014. Every Indonesian citizen is required to have BPJS Kesehatan. There is no exception, despite the fact that they may be already have another medical insurance. However, BPJS noted that for the past four years BPJS Kesehatan had reached 187,982,949 people (72,9%) as of December 31, 2017. That means there are still many people (27,1%) in Indonesia who don't have national health insurance (BPJS Kesehatan). BPJS covers basic medical services include promotive and preventive services, medical treatment and consultation, medicines reimbursement, blood transfusion, first-degree hospitalization based on medical indications, and first-degree laboratorium check-up. On the other hand, advanced medical services cover medical consultation and treatment by a subspecialist and specialist, medicines reimbursement, advanced diagnostic treatment, medical rehabilitation, blood transfusion, services from forensic doctors and corpse service, non-intensive as well as intensive hospitalization. It can be concluded that having BPJS Kesehatan not only useful, it is also essential. Therefore everyone should working to create awareness for having BPJS Kesehatan. Because, indirectly they will be involved in optimizing the BPJS program.

Boosting Health by Telemedicine Magdalena and Juliana Susantio

Today, there are some existing health problems, especially in rural areas. The research was noted that two out of three children under two years of age are anaemic. Alex Wettstein, as a president of the Fair Future Foundation noted that Indonesia has failing to provide the health system. He shown that 90% of people donâ&#x20AC;&#x2122;t have health insurance, and many people can not afford doctorsâ&#x20AC;&#x2122; fees often receive no treatment at all.1 Not only him, there are also many studies that examined health care utilization. Focused on rural areas, the largest overarching reasons for avoidance of medical care is traditional barriers to medical care. It can also occur as factors that limit access to or ease of obtaining quality health care, like financial concerns, time constraints, distances, and so on.2 The way to increase medical care in managing health system is Telemedicine as well as has many benefits of the earth we live in. This tool is provide the health-care providers to connect with patients in the inpatient and ambulatory settings. It will occur more accessable, cost effective, time efficient, and absolutely be the preventive education. However, telemedicine is still lacking of 87% skilled staff, 83,2% training, 82,8% law and policies, 74,6% knowledge about telemedicine, and 66,6% computers.3 There are many reasons why telemedicine is still lacking, but the most impacting of them is lacking communication and collaboration among health-care providers, goverment, and society. This objectives then are aim to increase awereness the society and examine more deeply the Telemedicine, as the medical care utilization with the lackings. So, medical profesionals can have great collaboration with goverment in facilitate the lacking health system that should have existed, such as signal, laws, and other facilitations, that leads to a better access in rural community. References: 1. Wettstein A. Healthcare Access in Indonesia. 2015. Downloaded by: https://www.fairfuturefoundation.org/ on Desember 21th, 2018. 2. Taber JM, Leyva B, Persoskie A. Why do People Avoid Medical Care? A Qualitative Study Using National Data. J Gen Intern Med. 2015 Mar;30(3):p.290-7.

3. Mayoka KG, Rwashana AS, Mbarika VW, Isabalija S. A framework for designing sustainable telemedicine information systems in developing countries. Journal of Systems and Information Technology. 2012;14(3):p.200-19.

Road to Successful BPJS with AMSA Putu Dipa Septa Irawan, Dreimahlon Tumonggor, Richard Harris

BPJS is a public legal entity that we can briefly say they provide health services for all Indonesians. In its implementation, the BPJS encountered many problems. The most serious problem is about financial deficit. In the period January to August 2018, the BPJS got a financial problem in last two years about 16.5 trillion rupiahs. In addition to the financial deficit, an important problem is the lack of BPJS registrants from targets determined by the government. As of December 31, 2017, the number of JKN-KIS participants had only reached 187.98 million people, or 73 percent of the 2019 target of 257.5 million people. This is also the reason why our slogan says "Lots of people, Lots of health" means the more people joined to the program of BPJS, will raise up the awareness of Indonesians about BPJS leads to many positive things. To overcome the problems of BPJS, we can use AMSA as a forum to socialize BPJS. We also innovate AMSA as "Advance together, Maintain your health, Stay aware before getting worse, and Always pay on time." Advance together means move forward by participating to register for BPJS. That way, Indonesia's health statistics are increasing. Maintain your health means even BPJS makes a low treatment cost, doesn't mean we are being careless about our health. Stay aware before getting worse means when we feel early symptoms of an illness, we need to check it to prevent complications or chronic diseases. Always pay on time means that as BPJS participants, we have to pay on time so that the program can really work well. So by doing those things, we are supporting BPJS to be better and through BPJS we can reach people with any social economy level. We can say this is the easiest way to save our lives.

MaedRec. Asmarani Arieyanti Wibowo & Enrico Kuswahyuliawan, University of Muhammadiyah Malang Abstract As a developing country, Indonesia scores poorly on many healthcare parameters. Not only from the facilities, infrastructure, and system, but publics knowledge of health too. In most case, indonesian doesn't understand their disease because they tend to rely on myth and indigenous medical practitioners. Less communication between the doctors and their patients are the main cause of aforementioned issue. In conclusion, we need a system that allows the patientâ&#x20AC;&#x2122;s to check their medical history on their medical records. The systems include their history diseases, last therapies and treatments given, doctor who handles their diseases, and the methods to prevent the diseases.

Abstract LETâ&#x20AC;&#x2122;S MAKE BPJS IMPRESSIVE AS SOCIAL HEALTH CARE SYSTEM

Damas Tsaniyah Min Rohmatillah, Novelia Dhastika Sari, Maria Ulfah Agustina Jurusan Pendidikan Dokter, Fakultas Kedokteran,UMM, tsaniyahdamas@gmail.com Jurusan Pendidikan Dokter, Fakultas Kedokteran,UMM, novelia.dhastika@gmail.com Jurusan Pendidikan Dokter, Fakultas Kedokteran,UMM, mariaulfahagustina08@gmail.com

BPJS is the one of agency which engaged in health service to the society, to improve the health quality in Indonesia but in the reality the BPJS program has not been implemented properly. This problem make the society give public complaints just like Inadequate health facilities, may only choose one health facilitiy for reference, Service fees for health workers are minimal, medical expenses are not fully covered by BPJS. These problems are not only caused by internal parties from BPJS, but also external factors from the society, where the society doesn't obey the obligation from BPJS to pay according to the regulation of the BPJS. So the BPJS has a financial deficit that make decline the service quality of BPJS. To handle the deficit of BPJS, we suggest that you can do semething like the first settle the BPJS financial deficit from cigarette taxes, based on law no. 28 of 2009,the second is BPJS must implement a tiered referral service flow, the third is Increase the number of partnership with family doctor clinics that serve BPJS. The fourth is improve the system and quality of BPJS services, the fifth is increase payment standards for medical personnel services. We hope with this poster, there will be a change in health service of the BPJS and we hope that the society complay with the regulation of BPJS.

Easier In One Click Gede Subhaga, Firyanadhira Imtiyasmi Syarifah, Jeremi Setiawan Muhammadiyah Malang University In realizing the national health insurance program which mandated by UU No. 40/2004, the government formally formed BPJS on January 1, 2014. BPJS was formed to ensure that all Indonesians are protected by health insurance in fulfilling basic health needs given to everyone who has paid the contributions or contributions paid by the government. Payment of contributions depends on one's class 1) Contributions are paid by the government for PBI participants, employers of state administrators and pensioners 2) Contributions are paid independently for non-state employers and non-wage workers. However, in its implementation, contributions paid independently have several obstacles such as not knowing where they have to pay, busy working or lazy so that BPJS funds do not increase even though every day there are always claims by other participants. As a result, in 2018 BPJS experienced deficit of 16.5 T. To optimize BPJS again, we can take advantage of technological development through devices application in overcoming the problem of BPJS paying dues and we can use InsWallet. InsWallet is a free application based on top-up money that aims to help people pay insurance bills that they have, including the payment of BPJS contributions. Other than to pay, InsWallet also has a payment deadline reminder feature and an autopay feature so payment of insurance bills can be more on time each month. In conclusion, with the full feature of InsWallet that can overcome the root causes of why payment of insurance is often hampered, it is expected that BPJS bills payments can be paid regularly and on time so that the health services in healthcare provider such as puskesmas and hospital can be better. Just one click, InsWallet can save your time to save your life.

â&#x20AC;&#x153;GO DOCTORâ&#x20AC;? FOR YOUR HEALTHY INNOVATION

According to the data of the ministry of Health, the amount of doctors for the society in Indonesia is 1 doctor for 2538 people. That amount itself is really shocking, it will cause a really long line waitng only to get checked up in the hospital. In this situaton, people tend to be lazy to go to hospital, to make the situaton worst they will postpone their medical need untl their illnesses become worst or unbearable. From this situaton, we try to make an innovaton called "Go doc" that are expected to be an alternatve for this situaton

ABSTRACT Render Up: Reminder for Medical Check Up Authors: Raditya Widya Surianata, Salshabilah Azzahra Raswhita Universitas Muhammadiyah Malang Nowadays, the development of digital era makes technology play bigger role in improving the quality of life for people of Indonesia. The role of technology almost meets the entire scope of workspace, including health services. Sometimes it can makes our life easier but it can “destroy” our life too, one of the negative effects of current technological developments is increasing busyness of workers and students who are unconsciously always forgetting personal health conditions. To resolve this problem, we mix and match some of technology SMS Gateway, which is by making Render Up. Render Up is a reminder for medical check-up in the form of short messages received through mobile phones and can be replied by patients to determine the check-up date of the week, after determining the date, the patient will get a queue number to be shown to administration as evidence. Render Up automatically saves the patient's mobile number from the hospital database. The purpose of making Render Up is to increase awareness health of Indonesian people who are increasingly forgotten. With the existence of Render Up, it is expected that all communities, medical personnel, and government in Indonesia can improve the quality of life to be better. “Remember your health, before you can’t remember how to breath – Author’s.”’

Letâ&#x20AC;&#x2122;s Spread to Lead Others Salshabilah Azzahra Rashwita, Pravica Juti Arunasari Second Year Medical Student, University of Muhammadiyah Malang

The issue of healthcare in Indonesia is the number of doctors which is still lacking. The government prioritize health in Indonesia because this sector is very important for people. People usually go to doctor when they are sick. Doctors in Indonesia have exceeded the target quota, the disparities in distribution of doctors working area has made the issue widely recognized. Workforce equalization of medical staff, especially for doctors, are not evenly spread, some provinces still lack of doctor. It is not only one province but more than one. There are some medical students in Indonesia but after UKMPPD some of them prefer work in Java, there are some factors that influenced their decision. In Java, they will get more patient and high salary. Moreover, accommodation in Java is easier than other provinces. The example is West Sulawesi, West Sulawesi has least amount of doctor but there are only 10 doctors who handle 100.000 patients a day, it is so pathetic. To solve this problem, we have solution called SPREAD. First, save the patient without any different, it means that the doctor should give treatment without seeing religion, ethnic, and politic. Second, protect the patient with sincere, it means do not look for a big reward besides your salary. The next, Remember doctor's oath, dedicate life to save patient. The fourth, Equalize the distribution of doctor and adjust the distribution of the doctor by the government. It means, doctors in Indonesia should be spread evenly to the small area. The last but not least, donâ&#x20AC;&#x2122;t be afraid to work out of hometown, it means when become a doctor, doctor have to fulfill responsibility. In the end, we hope that distribution doctors in Indonesia are spread. Cause spread is lead to others.

JazMed Protect Apps (Authors : Yusfiana Zura Aniqah and R. M. Javier) The health problem facing Indonesia now is a low public health status. This can happen because health services in Indonesia are still not good and not evenly distributed due to cost problems. Restoring Hidayani Saragih, former Public Relation of IDI, stated that the cost of medical services in Indonesia is quite expensive when compared to other countries such as Malaysia and Singapore. Also there are several factors that influence the high price of medical services in Indonesia, among others: 1) The lack of government budget in the Health sector,itâ&#x20AC;&#x2122;s only 5 % of APBN. 2) The tax on health facilities in Indonesia it is equated with luxury goods tax, around 20 %. So, for increasing efforts towards health coverage to provide quality of health services for everyone, anytime, without financial difficulties, we make a great application named JazMed Protect Apps. This app is easy and efficient, it makes you always connected for consulting your health problem and the treatment. The benefit you can get from this application are 1) You can consult with your favourite doctor just with tapping your phone, no queue and you can start consult anytime, 2) Free consulting and you just pay for the medicine if your doctor give prescription, 3) There is an emergency button, if you are in an urgent situation and maximum 5 minutes our services will comes, 4) If you donâ&#x20AC;&#x2122;t need consultation, you can buy only the drug with prescription, not only free drug. You only need Rp5.000,- to download this application. The money that collected is used to pay the doctors. But don't worry, you can consult all your health problems here and of course can make people healthy without being burdened by expensive health costs.

Bridging the Gap, Through your Mobile App Satria Angga Widitama AMSA-Universitas Padjadjaran

Health care access in Indonesian rural community is relatively low compared to the urban area. There are several reason that can leads to this inequal access of health care. in has access to a health care even the nearest primary health. People in rural community do not know how health care system works, and think that it is complicated. The other reason is definitely the distance and the lack of instrastructure to go there, or it is simply because they do not know where is it located and how to contact them. Despite this condition there are a growing number of internet and smartphone users in rural area. Based on The Association for Internet Service Provider in Indonesia (APJII), 48,25 % of rural areas have access to internet and 42,06% of rural community population are smartphone users.

A development of healthcare app might be the solution to the inequal access of health care. The increase number of internet and smartphone users in rural community should be used as an advantage to tackle this problem. People in the rural community could easily find the answer of their question through their mobile phone, knowing where is the nearest primary health care, taking a queue in the waiting list, or finding out the schedule of their doctor. The gap between rural community and their access to an equal health care is both literal and figurative term. With the development of a single health care app, people in rural community could access it easier.

CHAT TO SAVE Elizabeth Marcella, Rr. Adelia Christine Arianto Secadiningrat, Anthony Yusuf

Background: As medical students and future doctors, we are concerned about the community around us, including the wellbeing of our family, friends, and the society. A wellbeing of a country is primarily determined by the quality of healthcare. As what is stated in the 1945 Constitution of Indonesia number 36 on Public Health, health is considered as a right and it is part if the governmentâ&#x20AC;&#x2122;s responsibility to fulfill it. Yet, a massive difference of healthcare quality is still boldly apparent throughout Indonesia due to limitations of resources and transportation. According to the Indonesiaâ&#x20AC;&#x2122;s Ministry of Health (2018), the ratio of health center per subdistrict in Jakarta reaches 7.73, while in Papua, it only reaches 0.70. With the advancement of technology, mobile health service can very well be the solution to those limitations. Therefore, with this poster, we aim to raise awareness of healthcare inequality and how mobile health can be the bridge to equal healthcare in Indonesia.

Objective: The primary objective of this poster is to portray concurrent problems and situations of primary health care in Indonesia and present solutions by using some applications of mobile health care system to promote the practice of medicine in the process of developing equal healthcare service in Indonesia. Mobile health can be utilized as a platform for healthcare practitioners to learn and consult with specialists in order to improve their performance and knowledge in their practice, hence improving the quality of their services. We also aim to raise awareness for members of society in Indonesia, including healthcare practitioners, medical student, citizens, and government in dealing with and solving problems of healthcare inequality in Indonesia.

Conclusion: The occurring problems of healthcare system and access in Indonesia is a major obstacle in ensuring the equal wellbeing and welfare throughout Indonesia. With this poster, we aim to raise awareness to the urgency we are facing as a nation and give solutions for these problems

through the application of mobile health care system in developing an equal healthcare service in Indonesia.

References: 1. Current status of integrated community based TB service delivery and the Global Fund work plan to find missing TB cases [Internet]. Who.int. 2018 [cited 19 December 2018]. Available from: https://www.who.int/tb/features_archive/indonesia_11apr18.pdf 2. Profil Kesehatan Indonesia 2017 [Internet]. depkes.go.id. 2018 [cited 19 December 2018]. Available from: http://www.depkes.go.id/resources/download/pusdatin/profilkesehatan-indonesia/Data-dan-Informasi_Profil-Kesehatan-Indonesia-2017.pdf 3. Yani A. Utilization of Technology in the Health of Community Health. Promotif: Jurnal Kesehatan Masyarakat. 2018;8(1):97. 4. Breen G, Matusitz J. An evolutionary examination of telemedicine: a health and computer-mediated communication. Perspective Soc Work Public Health. 2010;25:59â&#x20AC;&#x201C;71 5. International Telecommunication Union (ITU): Mobile eHealth for developing countries. ITU-telecommunication development bureau. 2010. 6. Undang-Undang Republik Indonesia Nomor 36 tahun 2009 tentang Kesehatan [Internet]. Jdih.kemenkeu.go.id. 2018 [cited 18 December 2018]. Available from: https://jdih.kemenkeu.go.id/fulltext/2009/36TAHUN2009UU.htm

TECHNOLOGY AND COMMUNICATION IMPROVEMENT TOWARD SOCIETY’S HEALTH The main theme in this poster is initiating an equal access for a better health care. Then we narrow the topic into the implementation of telecommunication and information technology to provide clinical healthcare and overcome distance barriers for a better access in distant rural communities. In our poster, we make the explanation of the topic simple with 3 columns which are problem, discussion, and solution. There are 3 objectives in the poster. Firstly, it is to raise awareness about the problem which is about the distance barrier that people need to overcome to get access in healthcare. Indonesia as developing country is still having trouble in managing its traffic due to large population. For instance, Jakarta as Indonesia’s capital city always troubled with congestion. Although their distance to nearest hospitals or other healthcare facilities are not far away, traffic jam makes a barrier that make people who looks for medical attention cannot pass the road easily. Secondly is to provide discussion, to let people think about this problem. With traffic jam in mind, how will people get to the nearest hospital quickly without having to drive too fast which can result in traffic accidents. Lastly is to inform about the solution we think of to confront this problem using the improvement of technology and communication. In this modern era, cellphones or smartphones are common communication device that everyone owned. We suggest a downloadable application to help people get access to healthcare more easily. They can consult to available doctor without having to meet face to face and can call ambulance while they do so if their current situation is labeled urgent. In conclusion, our poster is about the implementation of the improvement of technology and communication toward society’s healthcare access with congestion or traffic jam as the problem. Universitas Pelita Harapan, 1. Fred Rich Connery 2. Gelbert Reginald Thiotansen 3. Virya Prajnajaya

Healthcare does not care about your wealth Tharriel Jeremia, Christine Natalia AMSA-Universitas Pelita Harapan Background With a population of about 260 million people (based on 2018 World Population Review), Indonesia is known as the world’s largest archipelago. However not all these 260 million people can live at ease because of their surroundings, especially their health conditions they suffer. According to a review done by WHO, over 200 million of people in Indonesia do not have access to health facilities. There are many factors that lead to this problem happening. But at the same time, the government has already created policies to overcome this problem, namely BPJS and many others. Burdened with internal and external threats, these policies has yet reached it’s peak potential. One of this threat coincides with one of our nation, and most nations in that case, main problem, the social inequality. Social inequality is a discrimination based upon the social structure determined by wealth, race, gender, religion, and other social determinants. These determinants are used to deny or limit access to people in “lower” classes. An outdated idea, it severely impacts the goal of universal healthcare in Indonesia. Objective One of the determinants which we are a major obstacle is the problem of wealth; in Indonesia, those of “higher” wealth status have twice as many chance as those who are “lesser” to gain access to healthcare, sanitation and social services. Seeing that there are many people with stigmas and wrong ideas, this poster is meant to remind everyone that healthcare does not see wealth status as a criteria for access to healthcare. Conclusion We hope that with this poster we can help change an outdated mindset and, ideally, help to enhance the healthcare system in our country, so that we may see a society with better mindset and a better healthcare in the future as well as achieving universal health care coverage goal in Indonesia. Reference: STATE OF HEALTH INEQUALITY Indonesia.(2018). Apps.who.int.[online] Available at: http://apps.who.int/iris/bitstream/handle/10665/259685/9789241513340eng.pdf;jsessionid=2E3FBE3FE39DDC92E08B85AC99AFD5F1?sequence=1 [Accessed 24 Dec. 2018]

DARE TO IMPROVE PRIMARY HEALTH CARE Chyntia Aurellia, Melisa Sonia Foris

Abstract Primary Health Care (PHC) is the first contact of individuals, families, or communities with the health service system with the aim of increasing public access to quality health services. In Indonesia, PHC has 3 main strategies. First, multisectoral cooperation which in supporting this, the Indonesian Ministry of Health adpoted inclusive values, which is one of the 5 values that must be applied in implementing health development. Second, community participation which is carried out by increasing public health through community empowerment and also with the existence of health center. Third, the application of technology that fits the need of the community through a herbal medicine program aimed at increasing peopleâ&#x20AC;&#x2122;s access and affordability to medicines.[1] As already stated earlier that the health ministry adopts inclusive values where all health development programs must involve all parties. All components of society must actively participate,

which

includes

cross-sectors,

professional

organizations,

community

organizations of entrepreneurs, civil society and grassroots communities.[2] Unfortunately, these parties did not carry out their responsibilities to the fullest or did not cooperate well with

each other. For example in Indonesia itself, there is still problem of regional

autonomy[3], the government provides primary health care which is not accordance with the conditions of the people in the area, or even there is no awareness from the public to use the primary health care itself. Our poster depicts three buildings namely the government organization, citizen and nongovernmental organization, which describes the three elements that must participate in achieving equal access of primary health care. Through this poster, we hope that each party are able to carry out their duties to the maximum and can work well with each other, both from health care providers and healt care recipients. Therefore, primary health care can be developed better to improve an equal access for citizen.

References 1. Ministry of Health Republic of Indonesia. Implementasi Primary Health Care di Indonesia [internet]. Jakarta: Ministry of Health Republic of Indonesia; 2011 June 30 [cited

December

2018].

Available

from:

http://www.depkes.go.id/article/view/1558/implementasi-primary-health-care-diindonesia.html 2. Ministry of Health Republic of Indonesia. Visi dan Misi [internet]. Jakarta: Ministry of Health Republic of Indonesia; 2014 June 12 [cited December 2018]. Available from: http://www.depkes.go.id/article/view/13010100001/profil-visi-dan-misi.html 3. Ministry of Health Republic of Indonesia. Reformasi Primary Health Care [internet]. Jakarta: Ministry of Health Republic of Indonesia; 2011 January 21 [cited December 2018].

Available

from:

primary-health-care.html

http://www.depkes.go.id/article/view/1382/reformasi-

BETTER ACCESS BETTER HEALTHCARE Mobile health is a promising factor to increase efficiency in the healthcare industry. The World Health Organization declares that mobile health can be view as â&#x20AC;&#x153;medical practice supported by mobile deviceâ&#x20AC;?. With advanced technology, so many mobile devices can be used for this purpose, removing the boundaries that was once formed by distance. Healthcare workers can use mobile health to access clinical information, communicate with patients and fellow workers, monitor patients in real time, and many more. On the other hand, patients can also benefit from this technology. It enables them to track their own health data through applications, contact their physicians, and many more. Research has shown that in many countries, good quality mobile health has improved the health quality of the citizens. The ability to contact physicians and looking for information without being hinder by distance makes it easier for people to seek for answer and improve their health. The quality of mobile health will play a big role to reach better health for people. In conclusion, we believe that mobile health is the key to achieve equal medical access throughout Indonesia. By continuing to improve the quality of mobile health in Indonesia, people will have better access and therefore, better health quality.

ONE FOR ALL, ALL FOR ONE (KIS COVERS EVERYTHING) Adi Wijaya Syahputra Lumuhu, Jaka Kurniawan Alia, Widia Ramadhany Husain AMSA-Universitas Sam Ratulangi

BPJS (Badan Penyelenggara Jaminan Sosial) is a legal public entity formed by the Indonesiaâ&#x20AC;&#x2122;s government to organize national social insurance for Indonesian citizens in form of social protection so the public can afford their primary needs to fulfill their life. One of the programs that currently held in health sector is Kartu Indonesia Sehat (KIS) which is an identity card for JKN (Jaminan Kesehatan Nasional) participants that are managed by BPJS. It is undeniable that Indonesia is one of the developing countries that still have a lot of problems in economy sector because of the poverty rate. With KIS, middle to low income Indonesianâ&#x20AC;&#x2122;s health problems can be protected because the main purpose of KIS is to help them and the monthly fee is paid by the government. JKN-KIS program participants are now 207.834.315 (as of December 1 ,2018) where most of the funding is paid by the government (state). KIS is accepted in every health centers such as health clinics, primary healthcare center (Puskesmas) or any hospital in Indonesia. Not only for any health treatment, but KIS can also be used for any health prevention care services. With the existence of KIS, middle to low income Indonesians can still get a health insurance protection without having any payment issues. So Indonesia can be a healthy and prosperous country.

BPJS Kesehatan Procedure with 4G Badan Penyelenggara Jaminan Sosial (BPJS) is a legal entity established to implement the Jaminan Kesehatan Nasional (JKN) program, in the form of health protection so that participants receive health care benefits provided to everyone who pays contributions or the ones whose fees are paid by the government. BPJS participants are everyone who has paid contributions, including foreigners who have worked for a minimum of 6 (six) months in Indonesia. BPJS participants are divided into two groups, namely for disadvantaged groups or also called Penerima Bantuan Iuran (PBI) and capable community groups (non-PBI). Each BPJS health participant has the right to obtain health services that include promotive, preventive, curative, and rehabilative services including medical services and consumable medical materials according to the medical needs needed. To become a BPJS Kesehatan participant, you can conduct a series of registration processes that can be carried out either collectively or individually. Today, there are still many people who do not understand well about the procedures for implementing health insurance provided by BPJS, both those who have been registered as participants and those who have not. So we came with an idea to easily remember the BPJS Kesehatan procedure with 4G, which are; 1. Get yourself registered You can register yourself at the nearest BPJS Kesehatan office; 2. Go to primary healthcare service If you have any health problems you should go to a primary heaalthcare service first (puskesmas or dokterâ&#x20AC;&#x2122;s clinic); 3. Get a doctorâ&#x20AC;&#x2122;s referral The doctor may give you a referral if you need to have further treatment on a secondary healthcare service; 4. Go to hospital for secondary healthcare service Visit the nearest govermental, military or private hospital which has already collaborated with BPJS Kesehatan to get your treatment.

TRACKS FOR BPJS PROMPT TREATMENT Intan Chaharunia Mulya, Dera Senti Agchani, Rona Puspa Sari

ABSTRACT Indonesia has 9.825 units of Puskesmas (community health care), 7.641 general clinics and 2.776 hospitals spread all around Indonesia both in the rural and urban areas. These health care facilities are widely distributed throughout Indonesia to ensure health equality for every citizen. Indonesia also has a health referral system by BPJS (Badan Penyelenggara Jaminan Sosial/Social Insurance Administration Organization) which is a national health insurance authorized by the government to equalize prompt treatment for all members according to the stages of severity and urgency. BPJS health referral system is divided into primary health care (community health care/puskesmas, pratama clinic and type D hospital) and referral health care (general clinic, general hospital and special hospital). All insured patients are obliged to follow the procedure by consulting their complaints to the primary health care. In the need of specialty handling, general practitioner (GP) of primary health care is allowed to refer patient to the referral health care by making a referral indication. Meanwhile, in case of emergency, patient is allowed to visit any nearest health care facility including referral health care. This public poster represents Indonesiaâ&#x20AC;&#x2122;s BPJS health referral system in order to raise public awareness in getting a prompt treatment of their health complaint. Overall, the expected outcome of this public poster is an increase of public awareness related to the urgency of following proper procedure in getting prompt treatment for the sake of individual and public need.

Click Clinic: Your hcealth is one tap away! By: Chyntia’ (405180084), Theodorus Wijaya” (405180041), Timotius”’ (405180098) *First Year Medical Student, University of Tarumanagara, (chyntiak96@gmail.com) *First Year Medical Student, University of Tarumanagara, (wijayatheodorus21@gmail.com) *First Year Medical Student, University of Tarumanagara, (timotiusandrijun123@gmail.com) Background Healthcare is a universal right for every living person, yet in nowadays implementation we are still coming across an apparent social gap which hinder us to equalize healthcare services in whole Indonesia. Recorded until the year 2017, there are about 1056 health centers in West Java province. Yet, this number displays a significant comparison with North Borneo province with only 49 health centers, attaining the smallest number. (Riskesdes, 2018) The social gap also causes an insufficiency of facilities to be equally installed through out the nation. Objectives As we have aforementioned in the background, we are aiming to establish an equal yet integrated healthcare service in the whole archipelago. Hence, we require a proper medium to carry out that idea into reality which is a mobile health application. We propose an attempt to help Indonesia with the features we provided such as; informative healthcare magazines, a video guide to a healthy lifestyle and trustworthy online anamnesis that are supported by local clinics. Heed no worry of the facilities for we have financed every clinic with the standardized facilities, plus we also provide an emergency call button to regulate every cases’ level of priority with simple two taps away! CaRe, Click and Register. Conclusion This application simply requires patient’s registration in order to enjoy a variety of healthcare services that we offer. These features include: free and up to date healthcare magazines, tutorial videos to improve a healthy lifestyle, to even a credible online anamnesis. We also provide a booking section for every clinics in the province to save the patient’s time. Refrences: 1. Riskesdes. Data dan Informasi: Profil Kesehatan Indonesia 2017 2. Ditjen Pencegahan dan Pengendalian Penyakit, Kemenkes RI, 2018.

Register for Warranty Gisela Winata, Josephine Alicia Bierhuijs Abstract The first three years of life provide the foundation for every human’s social and emotional health. Thus, it is very important to pay attention to baby’s health to make healthy transitions into education and to sustain their positive health and wellbeing across developmental stages of childhood, adolescence and adult life. Indonesia has implemented universal health insurance program (BPJS) since 2014 with optimistic hope to cover the whole population by 2019. This is a progressive step taken by the Government to realize the right to health in Indonesia that cover the citizen from infant to elderly. One of the realization program is Jaminan Kesehatan Nasional (JKN) – Kartu Indonesia Sehat (KIS). Though it is a relatively new project, JKN has proven to be the suitable measures to realize the right to health due to its performing function as a bridge for the citizen to access quality health care. Based on the Annual Report of the Social Insurance Administration Organization, in 2017, JKN covers more than 70% of Indonesia population, approximately 181.210.694 persons. Recently, the Presidential Decree Number 82 of 2018 concerning the Regulation with regard to Health Insurance (Peraturan Presiden Republik Indonesia Nomor 82 Tahun 2018 tentang Jaminan Kesehatan) was established to emphasize every applicant to register KIS within the first 28 days of life. If parents don’t obey this new rule and register after 28 days of baby’s life, they have to pay the bills that counted from the birth day. In the other hand, if parents immediately register their baby KIS, the payment will be included with them. In our perspective, our Government has provided equal access to quality health care. With this poster, we want to encourage the society especially parents to register every baby’s JKN-KIS immediately from birth to achieve holistic protection and help improving the community health.

Act Like Millennials Astrid Cynthia Latief (1st), Ricko Eliafiana, Naziha Abdullah Zarkasih AMSA-Universitas Trisakti PUBLIC POSTER ABSTRACT According to social researchers, this Y generation or Millennials was born in the 1980s to 2000. In other words, this millennial generation is young people who are currently between 15-35 years old. One of the difference between the past generation and the millennial generation is the use of technology. In this modern era, there are 2.56 billion people worldwide are using smartphone, mobile health technology is a rapidly developing factor in health care today, promising to make health care better and more efficient. Mostly health application provide us as a patient or even a healthy person to check their personal health such as blood pressure or heart rate. Also, they can get free consultation with no limit time also without making an appointment with the doctors and waste time to go to the clinic/hospital. Health app help us to find more clinical information, access medical e-journal and e-book. Doctors can monitoring the progressivity of their patient significantly and the patients surely can check their clinical records easily. Seamless data flow, makes everything super organized and no need to worry about the misplaced papers, files, and folders. Enhances physician efficiency, make the medical job less stressful and helping doctors solve problems faster, physician can use mobile devices to record patient history with minimal errors. Med healthcare app has improved physician performance and ensured better patient care Objective of this poster is to spread information that smartphones are not just tools for entertainment, but the role of smartphones in the field of medical & health is also quite important. The conclusion is benefits of using a smartphone can be felt by doctors, medical students, and the community. Doctors can provide an e-consultation or using telemedicine in rural areas, medical students can use the smartphone for accessing medical e-journal or medical e-book, then community can use mobile health application for tracking their health or finding health article through their social medias.

Smart People, Smart Health, Smart Phone Gracia Natalia Theresia(1st), Ita Tazkia Izzati M, Ananda Rizki M AMSA-Universitas Trisakti Poster Abstact In this globalization era, the development of technology and internet has developed rapidly and has positive and negative impacts, one of which is in the health sector. The use of technology to channel information about health is one of the best solutions, especially for people who are living in rural so that it is more effective in serving the community. In addition, there are also many people who are triggered to change their lifestyle, for example by reading public health article, people awareness about health is rising. The use of information and communication technology is increasingly effective with the existence of the internet and social media where the presence of the internet and social media makes it easier for users to exchange information. The objectives of this public poster are we want the viewers especially Indonesian people to know how digital era has improve especially in health sector because from the data by the ministry of communication and information there are 52.96% internet users in global and 22% internet user in Indonesia, while for Mobile Health (M-Health) there are only 14.1% users in Indonesia. The conclusion from this abstract is Indonesian people awareness about health is still minimal, but through M-Health, we can access information about the latest health issues both through journals and applications available on smartphones, besides that we can directly consult with doctors online, and it helps to improve the quality of health services, especially for people who live in rural area. Our job as medical personnel is to urge people to use smartphones for health purposes, and in spreading health news must be valid and accountable. With so many Indonesians using the internet, Indonesia has a great opportunity to succeed in M-Health.

Healthy Self-Phone Muhammad Ilyas(1st), Melita, Moch. Fahmi Suratinoyo AMSA-Universitas Trisakti Poster Abstract In the current era of globalization, the development of various aspects ranging from health, education, technology, etc. are already very advanced, especially technology. According to the Ministry of communications and Informatics of the Republic Indonesia the number of smartphone users has reached 143.26 million or equivalent to 54.68 percent of the total population of Indonesia in 2017, and most of them are internet users. With the data from the Ministry of Communication and Information of the Republic of Indonesia, it cannot be denied that the Indonesian people are very dependent on the internet. Almost every day Indonesian people use the internet for their activities. The internet serves to get information and provide information about topics of life. The positive and negative impacts of the internet itself depends on the user. There are many positive impacts that we can look for or get from the internet, for example: in the health sector, we can provide / seek information about health how important health is for us, and we can provide information about the vigilance of an infectious disease to the community. But, today, people often use the internet for something negative. The objectives of this public poster to gain Indonesian people awareness about health and also open peopleâ&#x20AC;&#x2122;s eyes to see how developed our health sector in this technology era. The conclusion is, it is better if the community is wiser to use the internet, what is meant wisely here is that the community must choose and sort out the positive and negatives from internet. When people use the internet wisely we can advance Indonesia to be better. And we hope that the Indonesian people will be more aware of health issues that circulate on the internet and be more aware of themselves to maintain their own health.

Upgrade Your Health Assistance Yolanda Dwitania

Reni Anjarwati

Vanessa Christabel

In this digital era and with the rapid growth of the internet users, might be a great opportunity for the practice of medicine and for public health promotion to develop health information and disease prevention. But currently, as the users of the mobile internet gaining rapidly, the awareness of health in society is still underdeveloped. As for today, many people who are internet users, the active social media users, and other entertain purpose users are less aware of many things that can be obtained from the internet, one of which we can get is information on healthcare, development of the world of health, medical education, and much more about world of health so that there are no more barriers for seeking about health information, basic health checks, and it could become helpers to educate and improve health insight so we can achieve health equality in various parts of the region. As an example, we know that Indonesia’s health infrastructure doesn’t exists in all over area so that public couldn’t have health services optimality. Since developing healthy applications, people could know their health status easily. It’s very profitable. Because they could know their healthy condition until they consult to general practitioner. With the development of technology in this digital era, we can maximize to provide information and make a step forward to push public health growth and we can take advantages from that convenience to be able to reach healthier public. By bringing up this topic about the health sector in the development of technology in this digital era, we could maximize the application of the use of technology in the health sector to advance knowledge of health and promote public health.

Your Waste for Your Health By: Ardhy Ihza Mahindra / Universitas Brawijaya Through official laws and regulations owned by Indonesia, The 1945 Constitution of the Republic of Indonesia article 34 (1), the state has an obligation to care for the poor and neglected children. This includes education, residence, and especially health. However, until now, the state is still considered a failure to fulfill this promise. So many cases of patients are neglected by health care services because of the limited funds they have. Followed by the number of poverty reaching twenty six million people in Indonesia, this makes the problem more complicated. But here, we must also look at it from a different perspective. The issue of health insurance for the poor is not only the responsibility of the central government, but also the regional government, and so are we. A health service with waste as a means of payment is a small step but has a big impact on the health of the poor and neglected children. Waste like plastic bottle that is very easy to find around, can be collected and handed over to related health services. The waste will be sorted and processed to become a selling value item. The proceeds of this sale will later finance the health services of the poor. With this small step, starts with us, and for us, we can create new opportunities for equitable access to health services and also a clean environment to support better Indonesia in the future.

â&#x20AC;&#x153;Health Education is Our Passport of Tomorrowâ&#x20AC;? Desak Gede Yuliana Eka Pratiwi, Brawijaya University Background You want to be healthy person every day. When you want to be healthy, you always remember drugs or medication. However, did you know that the most important thing for your health is by prevent the sickness? How to prevent it? It can be prevent by learning health education. Health education can prepares your future to fight off the diseases. Objective This photo describe that it is very important to give a preventive approach and keeps healthcare costs down. When we talk about healthcare system, it is not always about the doctor, drugs, hospital or other facilities. Sometimes we forget the most basic and fundamental thing, it is knowledge. Do people know basic health information? Have we teach them since early on about basic health life style properly? I think we were lacking in these aspect, doing health promotion to the society. Based on WHO, health promotion itself is the process of enabling people to increase control over, and to improve their health. It moves beyond a focus on individual behavior towards a wide range of social and environment interventions. How nice it will be if we have enabling those behavior since early on. It might be not as helpful as sending doctors or drugs. But this can have a long-time advantage. Health and education should walk side by side to create a higher awareness and knowledge in our people. With proper knowledge and awareness it can reduced number of diseases and number of needed doctors and drugs. Conclusion To make a bright future, we must prepare and provide the best for our life; one of the thing is health. The knowledge and awareness must be teach from early on, to make a better and wiser people in the future. Let us learn, teach, and be aware for healthier world.

Health is Just a Click Away Name: Dhira Kumari Institution: Universitas Gadjah Mada In this modern era, most people in society prefer instant lifestyle. Everything has to be fast and easy to get, including access to health. These days, people can easily gain access to information about their sickness and what kind of medication that will heal them. There are several application where you can consult about your health with doctors, book a hospital visit or lab test, and also deliver your medicine to your home. You donâ&#x20AC;&#x2122;t have to leave your home to get what you want. But these easy and convenient access have their minus point. Many people can gains false information about their disease. Also they can easily buy prescription drugs and antibiotics. This can trigger new health problems like bacterial resistance or overdose. This photo is an example of easy access to medication. People can just open one of the health applications that they have on their smartphones (or people can just download them) and order what kind of medicine that they want. Then, enter the shipping address. Price estimation will be informed. Just click order and wait until the medicine is delivered to the address. Health is so easy to access, but we must be careful to the information on the internet and consult to the doctor first id you want to buy antibiotics or prescription drugs.

Safety Can Be Fun Kevin Eliezer Ferdinandus Universitas Gadjah Mada As a medical student, I’m lucky enough to live in Yogyakarta, where beaches, temples, and pine forests are just one-hour drive away from the city. They provide a shelter to hide away from the immense pressure of medical school. What I love about the places here, especially the beaches, is that they’re relatively untouched compared to the ones in Bali or Lombok; soothing, calming, and fun for the soul. With this privilege comes a tradeoff: lack of proper facilities. Paved roads are nonexistent, it’s just rocks and wood handles to lead your way. Food stall is hard to find, not to mention first aid kit. Lifeguard is a rare sight here, I’ve never seen one during my visit to the beach. All these are then juxtaposed with the wild waves of Pantai Selatan. Through this picture I’d like to invite you to imagine how things will roll if an accident happens. With the conditions I portrayed above accident seems inevitable. Most tourists will just panic and don’t know what to do, some will try to call for an ambulance, but by the time it arrives it is usually too late. Had only there been someone who can help, such as a doctor or even a lifeguard, things would’ve been different. With the advancement of telemedicine, a trained lifeguard can save the day. Data from Dinkes Papua Barat shows that out of 32 Puskesmas around the famous Raja Ampat there is no doctor assigned from Kemenkes in 2018 and there is only one nurse; a really disturbing fact on our healthcare disparity To conclude, I believe it is time for the government to rethink about the distribution of healthcare workers and implementation of telemedicine on rural tourist attractions.

The Corridor. Brigitta Setiawan Universitas Indonesia This picture was taken in Puskesmas Oinlasi, Amanatun Selatan, Timor Tengah Selatan, Nusa Tenggara Timur that recently appointed as one of the Basic Emergency Obstetry and Newborn Care or known as PONED. Owing to this title, this building have to allocate space for pregnant inpatient without any land/building expansion. Besides, the health services can not be optimal since there is only one internship doctor to cover up to 8 villages. As a result, the waiting time is getting longer and many patients have to wait in a narrow corridor with limited chairs and unfriendly heat. A young mom with her child is waiting to be checked as the Puskesmas routine program for maternal and child health. It was a busy day for her but she managed to keep her smile and joyful from her eyes as a reflection of her patience towards the doctor. We can see different emotions from the woman sitting next to her. This aims to bring out the rural primary healthcare services issue to become public awareness.

Air Su Dekat? Elvira Lesmana AMSA-Universitas Indonesia Healthcare is a universal right for everyone. Wherever they are, whoever they are, they all deserve the right to be treated, to be cared and most importantly to be healthy. This photo was taken in this childâ&#x20AC;&#x2122;s home-yard in Anin Village, South Amanatun Sub-District, South-Central Timor District, East Nusa Tenggara, Indonesia. Looking from where my feet stand usually, this area looks extremely unfamiliar. Everything around is dry and water is hardly to be accessed. With this area classified as malaria-endemic and occupy the third position as to the incidence of a positive malaria cases after the province of Papua and West Papua, Indonesia. Thus, the need for healthcare is surely high, especially in the prevention for malaria which can caused a deathly symptoms and effects. Unfortunately, his family told me a story, here in Anin, there is only one doctor, serving for more than six thousand population. In order to improve health level for everyone in the area, all the health-care providers need to work really hard to educate the people to keep their hygiene. Thus, I suggest, government needs to intervene directly. Not only this area needs more health-care providers, the health care system needs to be integrated with the open access for water. Since I believe, through granting everyone the access for clean water, hygiene would be maintained and health care would also improved.

Sharing Health Technology Information Ervin Widyantoro Pramono Universitas Kristen Krida Wacana A housewife who is being given information about a health application. In this modern era, information technologyis often used, yet in the field of health, information technology such as health applications are rarely used by people in the countryside, or most still unfamiliar with them. The difficulty of information technology in the field of health faced by the coutryside peoples, made them either consult directly with the doctor in the hospital which sometimes places far in the city or ignoring their condition because the lack of doctor in the countryside. The solution for this problem is, as in the current era everything use smartphones, health workers

need to educate the community about how to use

health services in the form of information technology such as applications so that they can help the community there. After the education provided, the community can use health applications easily so there is no need to queue for hours in the hospital and only need to consult a doctor through the mobile application. But what needs to be emphasized here is that health services in the field of technology such as this can only be used for the community as an initial diagnosis and as an indication of what drugs to buy so that people do not need to go to hospital if they are only mildly ill. The current situation of health services in Indonesia is available hospitals and health workers who cannot reach so people have to travel long distances to access health services. In other words the community also incurred extra costs and time to go to the hospital. With the availability of available health information technology, it will be very helpful for remote communities to help diagnose early diseases with drug indications or can be followed up if necessary.

A Phenomenon Of A Very Accessible Mobile Health Care Author : Clarissa Adinda Bella Puteri Universitas Muhammadiyah Malang Background : The Indonesia health care development concern in this years is emphasizing an effectiveness and bringing equal access towards the citizens to get a better level of health care. To actualize the health care development, Depkes RI( Health department of Indonesia ) launch a strategy to prioritize promotive and preventive action without ignoring curative and rehabilitee action towards the medical practitioners. In this digital era and in a country that has such a big spreaded population and a few primary health care , internet is a solution to connected each others and to share information about health promotive steps. Mobile health care that can easily access by people around the world by internet, will facilitate people to get a better health level by knowing the symptoms of disease, a first handling treatment, or a basic drugs that can be consume before they decide to go to hospital in every time, term, and condition. The accessible mobile health care has effectivity to reduce especially cost and time and to improve the health care development in Indonesia. Objective : the aim of the photo is to show the accessible and effectiveness of mobile healthcare to improve the awareness and to inform basic disease symptomps treatment that can be done by people to protect their healthy. Conclusion : mobile health care should be improve and be seriously considered to bring equal access towards the citizen to get a better health.

How to Get Your BPJS? Kartika Dyah Pertiwi Universitas Muhammadiyah Malang Nowadays, Indonesia government run a healthcare program that can help citizen to get healthcare service cheaper and easily and we called it BPJS Kesehatan. BPJS Kesehatan is a public agency that organize Indonesia citizen’s health guarantee program. BPJS helps people so much, especially who have no money to provide healthcare services. However, people keep complaining about the difficulty of BPJS administration. Beside, BPJS needs to even up its services to all Indonesia citizen, because this day, BPJS’s participants mostly gather in big city or capital city of provinces. To this day, the number is up until 520.000 participants. The reason behind this problem may not only government’s fault, but also the lack of enthusiasm from Indonesia citizen due to lack of knowledge to get the BPJS. The photo is addressed to both BPJS participants and government. Actually, the problem will be solved if BPJS participants understand the procedure. The government may make the administration procedure to be more easy and participants also should find information about BPJS so that they can know how to do the administration procedure easily. Briefly, Indonesia government should improve its program to be more good and easy to use for all citizen. So, citizen’s primary right to live healthy life will be fulfilled. Source: http://jkn.jamsosindonesia.com/home/cetak/1207/Ini%20Daftar%20FKTP%20Denga n%20Peserta%20BPJS%20Kesehatan%20Terpadat https://bpjs-kesehatan.go.id/bpjs/dmdocuments/eac4e7a830f58b4ade926754f74b6caf. pdf

Have Faith Sylvia Aurora Universitas Pelita Harapan A. Background Every human being wants to be healthy, that is something absolute. Humans are also very interested when they hear the word "Cheap" in good quality. This is what people demand, to stay fit in a cheap way with high quality products. Nowadays the problem is how to combine these two things without overloading one side of the community, health services, doctors, or the government. The government has already did something to overcome this particular problem by forming an authorize body that provide the medical coverage program for the Indonesian national health insurance system which is called BPJS. â&#x20AC;&#x153;Of all the forms of inequality, injustice in health care is the most shocking and inhumaneâ&#x20AC;? (Dr. Martin Luther King). This picture shows how valuable BPJS to that ordinary couple. There was a glance of relieved at the husbandâ&#x20AC;&#x2122;s face, because he knew his wife will be at his side for a longer time and he knew that although he used BPJS his wife got all the respect and proper treatment as patient in the hospital. B. Conclusion The inequality of medical services caused by people using BPJS is undeniable, people often complain about how inappropriate services that they get by using BPJS. This is something worthless for some people, but those people out there really need to be respected and provided an appropriate medical service despite using BPJS or not.

REASON Daisy Deriena Kristyo Perdana Felly Moelyadi According to the WHO in 2016, Indonesia was one of the other 57 countries that are facing a human resources crisis, not only by the inadequate number but also by the unequal distribution. A few challenges are being faced by Indonesiaâ&#x20AC;&#x2122;s long-term health development based on the Indonesian constitution (Undang-Undang) no. 17 year 2007 about RPJPN (Rencana Pembangunan Jangka Panjang Nasional). They include reducing the gap in public health status and access to health services between regions, socio-economic levels and gender, increasing the number and distribution of inadequate health workers and the increasing access to health facilities. Another issue that can be found is the lack of interpersonal communication skills of the medical professionals, for instance, in areas where the people can only use their traditional language, most doctors have difficulties in understanding the patients. These communication competencies are neglected in the medical practice although they actually determine the success in helping to resolve patientsâ&#x20AC;&#x2122; health problems. This issue is causing a social barrier which may result in a misunderstanding between doctors and patients. In making this video, we want to potray the current condition which is based on a certain experience about the difficulties in health access and the quality of communication skills that medical practitioners at the primary health cares in Indonesia have, so the viewers can realize the urgency to solve these problems. In these recent years, health services are more focused on the big cities, where there are already a lot of hospitals. Not many medical practitioners are also willing to be spread to the secluded areas. In terms of communication skills, many medical practitioners underestimate the importance to learn a certain language, mostly because they do not realize that language makes them able to communicate and empathize easily with patients from different backgrounds. Through the facts that can be found in our own country until now, these problems are still ignored by many subjects. Therefore, from this video we hope to change the medical professionals, society and the governmentâ&#x20AC;&#x2122;s point of view about the so the awareness can be raised.

ACCESSIMPLICITY Olga Putri Atsira, Sekar Afifah Priandhini, Finna Permata Putri

ABSTRACT Indonesia has several problems that need to be considered when it comes to its universal health-care system. The problems that we would like to address are Indonesia as a middleincome country with 262 million inhabitants spread over 17,744 islands and also its high burden with high maternal mortality, childhood stunting, tuberculosis, and a rise in noncommunicable diseases. Underpinning these problems are significant disparities in access to quality health services across geographic regions and socioeconomic groups. Therefore, the need to establish a Universal Health Coverage becomes one of the targets in Sustainable Development Goals. On January 1st 2014, Indonesia has finally established a national health coverage system called JKN. Indonesia has made progress with around 207.8 million people now members of the JKN. There is however mounting evidence of areas where the JKN is underperforming and without action, the JKN is unlikely to reach expected levels of population coverage, service coverage or financial protection by 2019. Factors behind the lack of membership of JKN has been studied and the result showed us that the main factor lies in the low understanding of JKN from the society. Starting from all the problems that arise just from the lack of understanding, we continue to seek the solution to tackle the core problem. We found out that there is an application offered by BPJS called mobile JKN that is easy to use and can answer the geographical barrier. We also learned from the study that 20% people who complaint about JKN had not yet utilized mobile JKN. Therefore through our video, we would like to introduce mobile JKN and what it is capable of. This video is the initial step toward optimizing JKN as the governmentâ&#x20AC;&#x2122;s healthcare program in improving Indonesianâ&#x20AC;&#x2122;s quality of life. Share the knowledge, the access is here. Access the access.

Smartphone Loves You So Much Ricko Eliafiana (1st), Ita Tazkiatul Izzati Mustopa, Vanessa Christabel AMSA-Universitas Trisakti VIDEO ABSTRACT In this modern era, there are 2.56 billion people worldwide are using smartphone and 52% of smartphone users gather health-related information on their phone. But, is everyone smart enough to use the smartphone? In this video, there are many scenes that indicates people in this age are mostly using smartphone for entertainment, such as gaming, social media, chatting, and watching un-educated video. The other function of smartphone especially in the field of health are quite beneficial. The video shows that smartphone can be used for redeem a prescription through mobile health application, gather many informations for medical students, using a lifestyle application to control diet, watching a medical educative video, and also control the blood pressure. Objective of this video is we want viewers to realize that smartphones are not just an entertainment facility, but the role of smartphones in the field of medical & health is also quite important. The conclusion of this video, the smartphone has many benefits, it can be felt by doctors, medical students, and the community. Doctors can provide an e-consultation through mobile health application, medical students can use the smartphone for accessing medical e-journal or medical e-book, then community can use mobile health application for tracking their health or finding health article through their social medias.

Change the Stigma Ananda Rizki M(1st), Gracia Natalia Theresia, Muhammad Ilyas AMSA-Universitas Trisakti VIDEO ABSTRACT Weâ&#x20AC;&#x2122;re now living in the era of technology, everyday technology developed rapidly. These days smartphone is one of the primary needs, most people detected to use smartphones. In Indonesia 98 from 100 people has smartphone, but only 14% use it for Mobile health. Smartphone gives us many things and it makes our lives much easier, there are many positive impacts from this technology era but, what happens is the negative impacts keep dominating every day. People choose to use their smartphone for social media, game online, watching un-educated videos, and some of them read or broadcasting hoax. Smartphone is a smart technology, if we take some time to understand the meaning of smartphone for our health, we can get many benefits by just on click. We can easily find medical pop quiz to gain more knowledge, find many digital health poster to promote health, watch educative videos to learn about disease, find health articles and journals to raise health awareness, and we donâ&#x20AC;&#x2122;t need to be worry about medical hoax because we can easily download medical application for online consultation with doctors. Objective of this video is we want people and viewers to start realizing how much positive things we can get from our smartphones, especially in medical sector our smartphones tends to have big impact as one of the solution to raise people awareness about health. We also hope after watching this video, the stigma about smartphones change. The conclusion of this video, there are many positive benefits from smartphones and everyone can feel it. Doctors, medical students, civilian, can feel the positive impacts especially in health sector from smartphones such as online consultation, educative health videos, digital health poster, and health articles.

Tell me: Telemedicine for Everyone Farrah Ziva1 Nisa aprilia2 and Candra Dewi3 1

Brawijaya University, Malang, Indonesia E-mail: astroglia3@gmail.com

Background Health is a human right and one of the elements of welfare that must be implemented according to Indonesiaâ&#x20AC;&#x2122;s goal of nation. But as a country with large area, facilities for health services are still limited, especially in remote areas. The main issues in remote areas are the access to health services, even distribution of health workers followed by the human resources equally, and referral systems at health installations. To overcome these problems, we use the advancement of information and technology, where Telemedicine is introduced. Telemedicine is a long-distance health services, using audio, visual, and data communications, using internet and satellite. Telemedicine is helpful because technology hold an important role in society and no exception for Indonesia. Taking advantage from this, we combine the idea of internet, technology, and health care to overcome the distance problem. Objectives This 3-minute-video is aimed at medical professionals, government, and society especially who lived in rural areas to acknowledge alternative way to access healthcare provider and improve their health and well being by using technology and Information. Conclusion By using Telemedicine we can provide an access to healthcare for people who lives in rural area where healthcare is limited.

References Lestari, Tri Rini Puji . 2013. Pelayanan Kesehatan Di Daerah Tertinggal, Perbatasan, Dan Kepulauan. Vol. V, No. 12/II/P3DI/Juni/2013 Asosiasi Penyedia Jasa Internet Indonesia. 2018. We are Social. https://www.apjii.or.id. 3 Desember 2018

a. Title : Sick? Click Me! b. Background We use “the mobile health application to promote the practice of medicine and public health in digital area" because nowadays everything gets easier with the existence of mobile technology. As college students, who are especially far away from home and do not have a lot of time, need something that can help everything practically. c. Objectives As college students who migrated, we are far from our parents who usually take care of us. When we fall sick, we only have friends who can help us. But we can't always depend on our friends because they have their own business too. Hence we will promoting a mobile health application that can help us. With this mobile health application, we will not need to worry about ourselves when we fall sick and there's nobody who can help. Just by tapping on the application, what you need will come. Using the mobile health, people who are ignorant about being ill, thinking that it’s not really bad, so they won’t go to doctor because it’s a waste of time. However, usage of the application can induce concern about theri illness because they are able to get their medicine easily by just clicking. With the video that we made, we hope every college student can maximalize the mobile health application, and that there will be more inovation for the mobile health application thet more practice, easy to use and cheaper. d. Conclusion Mobile health is the new inovation that helps a lot of people. By using the mobile health we can save our time and everything is easier. Mobile health can make new jobs and make a new system that is more eficient. Using the mobile health, we can minimize the pain on people whose in sick.

Title of Video BPJS, Key of Health Access

Author of Video Agung Rahmat Fauzi Febrianto Adi Husodo M Taufan WK

Background of the video Currently, half of the world’s population lacks access to essential health services, and universal health coverage remains a challenge for many countries worldwide. Indonesia’s health coverage program, the National Health Insurance (JKN) program, is administered by the Healthcare and Social

Security Agency (BPJS Kesehatan) - an authorized body that was established in 2014 to provide medical coverage program for the Indonesian people. With regards to participants of BPJS Kesehatan, they can be classified into two categories, namely

recipients of contribution assistance (PBI Jaminan Kesehatan) and Non-PBI Jaminan Kesehatan. The first category is entitled for those who are less fortunate (from low social class) and those with total disabilities.

The government has targeted that all Indonesians will have BPJS membership by 2019. One target of the Medium Term Development Plan (RPJM) 2015-2019 is to make sure 107.2 millions of society become the PBI participants. However, as of April 2018, the PBI participants reached 92.2 millions. Accordingly, there are many less fortunate people who are at risk of not getting their rights. Objectives of the video The aim of this video is to raise awareness on the rights of the less fortunate people to become PBI participants. Conclusion We believe this short video, entitled "BPJS, Key of Health Access” is an effective and interesting media to increase awareness and utilization of BPJS health insurance, especially for the potential PBI participants. References 14 kriteria miskin menurut standar BPS

BPJS Kesehatan Syarat dan prosedur pendaftaran peserta PBI

AUTHORS : DANIEL RAWIS ELISA WULUR NATHANAEL TARORE ONE CALL AWAY BACKGROUND We tend to ignore what is in front of us and think we do not have enough. Everything is on the internet—the shortcut to almost everything, with no exception in the matter of health access. BPJS Kesehatan is a good example. It is really only “one call away”, yet most people still think it is that hard to get the access. BPJS Kesehatan is the entity of universal health coverage under Indonesia’s Ministry of Health. It aims to reach all layers of society in need of medical help in Indonesia, with a mechanism of serving patients in primary care institutions such as community health centers (puskesmas) or general practitioners. BPJS Kesehatan is available throughout Indonesia, open for service to BPJS-registered citizens; this ranges from private general practitioners in big cities to sole community health centers of remote island areas with hard access to big cities, like the one in the video. Since BPJS works by paying a constant premium each month and not by visit, a patient would no longer need to pay at their visit, requiring only their BPJS card and ID to be given medical care. This is an upside to patients who may be at a condition where they are the only ones able to bring themselves to a healthcare institution, where they would not need to worry about the hassle of paperwork amidst their unwell body. OBJECTIVES The video we made is aimed at the society to be more active on knowing how the universal health coverage system actually works, especially in this era where communication is made easier. CONCLUSION

Learning about how the system runs actually saves livesâ&#x20AC;&#x201D;and money. People really need to understand that it is important to have a grip on how the universal health coverage system worksâ&#x20AC;&#x201D;in this case, BPJS Kesehatan.

Mutual Cooperation Samsul Rahmat Miftah Nurindah S M. Fadly Abdullah A. Title Mutual Cooperation B. Background The Indonesian government is improving to meet the needs of the society,one of which is meeting the needs in the field of health by presenting BPJS. With the concept of mutual cooperation BPJS is expected to meet the health care needs of the lower classes to the uppermost circles. But, what happens in society is not like the concept that has been thought about this BPJS. Starting from people who are lazy to pay premiums until people who just made BPJS when they will get action that requires a large fee. The culprit came from various circles. So is this still considered mutual cooperation? C. Objectivies The society itself becomes a discussion in this video D. Conclusion In this video we hope to make the society aware of itself so that program programs implemented by the government can run according to the initial design or concept and become more effective and increase health services in society, such as Mutual Cooperation concept in BPJS Program.

Tech: Solves inequalities Jenderal Achmad Yani Universities Siti Zakiaturrahmah, I Komang Prastika, Arsyad Parama Santosa

Background : The world is full of inequality. Thereâ&#x20AC;&#x2122;s racial, gender, education, political, economic, and of course health inequality. Some people are rich while some are poor and it may seem pretty impossible to fix, or maybe it isnâ&#x20AC;&#x2122;t?

When talking about health care in Indonesia we should think about 2 perspectives, just like two sides of a coin, each with a different meaning but still containing the same purpose. It is undeniably true that there are citizens who do not have the opportunity to receive healthcare (based on Survei Indikator Kesehatan Nasional Rancangan Sirkesnas 2016). The data was taken in 34 provinces, 264 cities, 400 districts, 400 primary healthcare centers, 1200 censuses, 22.795 households and 97.986 individuals.

Objectives : As a citizen, we want to get the best health care we could get, but on the other side, as a medical professional we want to get our rights. The important thing is how the health care system will provide or how the professionals will serve the citizens adequately. Lately, topics about health care provides have become one of the trending topics in Indonesia. Most citizens often speak negatively about healthcare in Indonesia. The reason might be because there are so many citizens that felt disappointed with the service, some may not even receive any service at all.

In rural areas, lack of necessary transportation to reach certain areas makes it difficult or even impossible for health professionals to accomplish their goals. Roads, modes of transportation and other supporting facilities are equally important to ensure that they could reach those areas safely.

Conclusion: Times change. So are we. Technology will speak for all the problem that we have. Technology can only progress because there are problems, problems that we have to solve. We are currently enjoying the benefits of technology advancements. Technology could help eliminate distances and easing our everyday work.