An Analysis of Transition Scheme From Regional Health Insurance To National Health Insurance System Packet

herry farjam lembaga penelitian dan pengabdian masyarakat universitas widyagama mahakam
samatinda
An Analysis of Transition Scheme from Regional Health

Insurance to National Health Insurance System
DIPI 2016 Research Call
lembaga penelitian dan pengabdian masyarakat universitas

widyagama mahakam samatinda
mr herry farjam lppm@uwgm.ac.id
Jl bung tomo gg swadayah 1 O: 0541737222
jl kh wahid hasim no 05 RT 07 Samarinda M: 085240114311
Samarinda, kalimantan timur 75124
mr herry farjam
Jl bung tomo gg swadayah 1 herryfarjam86@gmail.com
jl kh wahid hasim no 05 RT 07 Samarinda O: 0541737222
Samarinda, kalimantan timur 75119 M: 085240114311
Printed On: 31 July 2016 DIPI 2016 Research Call 1

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Application Form
General Application Data

Project Name*
An Analysis of Transition Scheme from Regional Health Insurance to National Health Insurance System
Total Budget*
DIPI is awarding competitive research grants for up to three years and IDR 1.5b/year. Your total
budget for the entire duration of the project may not exceed IDR 4.5 billion.
4500000000
Duration of Your Project (in months)*

Awards are expected to be made in December, 2016 at the latest. Project can last for up to three
months and must be completed by December 31, 2019.
December 31,2016- December 31,2019
Full Name of Principal Investigator*

Syarifah Masitah
Highest Degree Obtained*

Please select the highest academic degree received by the applicant (check one box only).
Masters (S2)
Name of the Applicant's Institution*

Institute for Research and Community Service (LPPM) University of Widya Gama Mahakam (UWGM)
Samarinda.
Work Mailing Address*

lppm@uwgm.ac.id
Other Current Professional Affiliation(s)

[Unanswered]
E-mail of the Principal Investigator*

masitah_sy@yahoo.com

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Phone Number*
089627976367
Nationality*
Indonesian
Nationality (others)
If you are not an Indonesian national, please specify your nationality:
Residency Status*
Are you are a resident of Indonesia?
Yes
Identification Number
KTP
Enter Your Identification Number

6472056901690001
Gender*
Please select the applicant's gender:
Female
Grant Focus Area*

Please select the grant focus area under which your proposal falls (please select ONE focus area
only)
Life, Health and Nutrition
Keywords
Please enter up to five keywords that best reflect your research proposal
Regional Health Insurance, National Health Insurance System, Public Health
Biographical Sketch of Applicant

Please include academic background, overall research scientific interests and goals
HEALTH SERVICES & ACTION RESEARCH As coordinator for training, human resource development and
health services development in the province, my role includes active participation in action research. My
current role as Coordinator for streamlining the health insurance programs in the province and prepare for
the launch of national health insurance involves working with large health information and services provision
data, and advice the department and the district health teams accordingly. This work and the participation in

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many research such as those listed below, helped me take the role of coordinator and facilitator of training
using these research for a large number of trainees in Indonesia and in Australia (assisted Dr Afzal Mahmood
and John Moss and other Adelaide University trainers)
2012: Maternal Health Services Provision in Bontang: Factors affecting continuity of care The study was
part of a larger health services development program in East Kalimantan. An honours research student was
involved for this component. In addition to help the team conceptualize the study, design of the interviews,
and help to plan data collection and analysis, I provided field supervision. The study contributed to better
quality maternal health care in Bontang as it provide information on factor that facilitate or hinder
coordinated care during pregnancy and labour and delivery.
2011: Access to hospital based intrapartum care by women in Kutai Barat District: I was involved from
the very early stage of planning a research about the use of hospital by women from across various areas of
this district. I was involved in the discussion about concepts development with the hospital administrators
and providing support to the team for questionnaire development. A student from the University of Adelaide
was involved and completed honours thesis on the basis of this research which informed that the hospital is
not accessible to women who live about 2 hours distance from hospital. As a senior staff in the provincial
government and in the department of health my participation helped and I disseminated the information to
various districts.
2010: Quality of ANC in government health centres in Samarinda and Balikpapan I participated in this
research with the local health care providers and managers and University of Adelaide and Trisakti
University faculty member s. An honours student from the University of Adelaide participated and took lead
in data collection and management. I was involved in design, questionnaire development and I also
supervised the student in the field during the data collection stage. The findings informed about the less than
optimum quality of ANC and helped define trainings and maternal health programs in the province. A paper
in a peer reviewed journal was also published. free public services available. These findings contributed to
the development of a larger maternal health care development program in the Province.
How Did You Hear About DIPI's Research Call?*

Institute for Research and Community Service (LPPM) University of Widya Gama Mahakam (UWGM)
Samarinda.
Project Summary
Project Summary*
The summary should be written for the comprehension of readers without technical expertise.
Briefly and clearly state the goals of the project, scientific merit and the associated proposed
activities; and describe the anticipated outcomes of the project.
This study will explore government policy in improving the health status of the people in a decentralized
environment. Then this activity will explore the extent to which the will and Traffic communities to pay the
stipulated iuaran Health Security Agency towards universal coverage (unversal cover rate). At the end of the
study will mengsilkan a strategic plan for local governments East Kalimantan and North Borneo.
Remember to save regularly using the "Save as Draft" button at the bottom of the page.

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Project Description
Prepare the project description with reference to the Section Review Process and Criteria in the
end of this application and the guidance provided in the Grant Manual. Please address the
following parts of the proposal concisely (within the character limits listed) and include citations
in the text with full references. List of references section must later be uploaded in the
Attachments section at the end of this application form. If needed, you may also upload up to a
total of five figures and/or tables for the entire proposal. Incomplete proposals and those not
submitted in the required format will not be considered.
Background*
Summarize the scope of the technical and/or development challenge your research will address
including issues relevant to both the local and international context.You can include in this
section a brief summary of past work done on the proposed topic as well as any evidence gaps
that your research will help fill.
The National Health Insurance (JKN) is a government program that aims to provide a comprehensive
guarantee of health insurance for all Indonesian people to be able to live healthy, productive and prosperous.
It has been mandated by Law No. 36 of 2009 Article 14 on Health.
Indonesia is an archipelagic country with a vast territory still found limited health care infrastructure,
especially in DTPK so that public access to health care facilities is very low. In addition, the lack of interest of
health workers who would be placed in the area DTPK contributed to the community health status is low. The
problem of inequality of health efforts has also caused social problems of poverty levels so that local
communities cannot reach health services. From the data obtained, the poor in East Kalimantan increased by
2,940 inhabitants of 209 980 212 920 soul into the soul period September 2015-March 2016.
Health is one of the basic needs and is also an important factor that has the productivity and quality of
human resources. Multi-causal health problems, the solution should be multidisciplinary. All activities either
directly or indirectly to prevent disease (prevention), improve health (promotion), treatment (curative) or,
restoration of health (rehabilitative) is a public health effort.
In public health efforts required collaboration between the public and health workers by preventing
disease and health recovery efforts. In addition, it is also necessary to support the factors in the improvement
of health such as socio-economic situation, environmental health, maternal and child health, clean water,
nutrition, health and occupational safety, health promotion and reproductive health.
Looking at the phenomenon of health problems, the government gives more protection to the public, with
the National Health Insurance program was launched, which is set by the Social Security Agency (BPJS).
However, the stepladders system issued BPJS, it seems rather difficult to be accessed by people who are in
DTPK. This benefit package becomes an important issue to remember when implementing integration of
Regional Health Insurance (Jamkesda) to JKN (Natioanl Health Insurance). In addition, the intended
beneficiaries of contributions and tiered system applied by BPJS.
The central government plays an important role in determining the best policy alternatives for the
implementation of the national health insurance system. Faced with the various issues mentioned above, then
to achieve the integration of Regional Health Insurance (Jamkesda) to JKN especially DTPK, we need a
formula policies that are able to integrate the implementation of Jamkesda in districts / cities and provinces
in the integration scheme JKN, both in terms of management, facilities, benefits package as well as the
amounts of fees.
Not only that, the question of quality of service BJPS, the contributions considered not maximized. It looks
from some of the news appearing in the media. Association of District Government of Indonesia (APKASI),
through Regent Gowa, garnering support for suing the Social Security Agency (BPJS) Health. It was addressed,
there is still dissatisfaction BPJS system formed in the community. Source Antara. com
Remember, every citizen withdrawn dues fund conformed their respective classes. There are three
classes, namely class 1, class 2 and class 3. That is, the Indonesian people still pay for the services, not free.
While Jamkesda services are health services provided by local governments free of charge to all residents

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who have not secured by other insurance. This paradigm was the one, which is still embedded in society,
especially DTPK areas.
Project Objectives*
Provide a clear statement of the research project objectives and/or research questions the project
will address. It is important that the project objectives are reasonable for the proposed timeline.
1. Obtain data related to the health of the environment includes the PAB (Water Supply), PAM, the
physical condition of the house, and the waste management disposal condition, MCK and SPAL.
2. Knowing the disease status of the community include the spread pattern 10 highest diseases by
person, place and time.
3. Knowing the nutritional state of society include diet, diet, the use of iodized salt, and the habit of
consuming the fruit.
4. Knowing the implementation of the MCH and family planning community includes examination of
Pregnancy, Childbirth Assistance, breastfeeding, as well as the use of contraceptives.
5. Knowing the state of occupational health and safety community includes workplace conditions, the
duration and type of work and the use of PPE (personal protective equipment).
6. Knowing the behavior patterns of living through the birth, exclusive breastfeeding, a child's weight,
hand washing, water supply, latrines family, house mosquito free, nutritious food consumption, exercise
habits and smoking habits.
7. Knowing the state of health care through knowledge of health policy, the latest education, the amount
of income, number of dependents in home, marital status and utilization of health facilities.
8. Reception community, social and culture about integration of Regional Health Insurance to National
Health Insurance in rural island of Borneo.
9. Readiness of health service facilities in rural area about the integration of Regional Health Insurance
to National Health Insurance.
10. Readiness of human Resources about the integration of Regional Health Insurance to National
Health Insurance.
11. Readiness of service information access about the integration of Regional Health Insurance to
National Health Insurance.
Research Plan*
Describe the project design, procedures, and analyses to be used to accomplish the specific
objectives of the project. If applicable,describe study populations and interventions. Discuss the
potential difficulties and limitations of the proposed procedures and present alternative approaches
to achieve the aims.
Field Observation : Recording the place and events of physical and non-physical environment.
Content Analysis Method: Examining secondary data including historical documents, and policy.
Focus Grup Discussion with PRA, Delbecq,and Consensus meeting approach : Compiling information
about the culural component of Kutai society through interviewing the stakeholders: such as local
organization, public figure, and related subjects.
In-depth Interview : Digging information from local goverment and society.
Audio and Visual Material : Recording and explanation data that researcher get from social activty.
Scientific Relevance*
Explain to what extent does the proposed research and experimental design address important
gaps in knowledge within the scientific field(s)/area(s) explored and DIPI Focus Areas.
National Health Insurance

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The National Health Insurance (JKN) developed in Indonesia is part of the National Social Security System
(SJSN). The National Social Security System is organize through the mechanism of the Social Health Insurance
Mandatory.
Principle Epidemiology
Definition of Epidemiology
Epidemiology is one part of the Public Health (Public Health), which emphasizes the attention to the
existence of a disease or other health problems in the community. Triangle epidemiology (triad
epidemiology) constitute the basic concepts of epidemiology that provides an overview of the relationship
between the three main factors that play a role in disease occurrence and other health problems. (Bustan,
2006).
Disease Prevention Efforts
Epidemiology is the basic science with the goal of prevention to prevent and reduce disease in the
community. Here is the level of disease prevention (Bustan, 2006):
1. Prevention of First Instance (Primary Prevention)
2. Second Level Prevention (Secondary Prevention)
3. Third Level Prevention (Tertiary Prevention)
Community Nutrition
Public health nutrition are related to community nutrition. Nutrition society more emphasis on
prevention (prevents) and increase (promotion). (Notoatmodjo, 2003)
Occupational Health and Safety
Occupational health is a specialty health science and its practice, which aims to enable the worker /
community workers obtain health standard as high, whether physical, mental, and social through the efforts
of preventive and curative against diseases / health problems caused by job / work environment and
common diseases (Sumanut, 1994).
Environmental Health
Environmental health sciences are the study of the interrelationships between health factors and
environmental factors.
Administration Health Policy
There are two types of health services, namely:
1. Medical Services (Medical Service)
2. Community Health Services (Public Health Service)
Healthy Lifestyle (PHBS)
Healthy Lifestyle is an attempt to provide a learning experience or creating a condition for individuals,
families, groups and communities.
Broader Impacts*
Explain to what extent will the proposedresearch enhance the infrastructure for research and
education, such asfacilities, instrumentation, networks, and partnerships? To what extent willthe
results be disseminated broadly to enhance scientific and technologicalunderstanding? To what
extent may the proposed activity benefit society?
Through this study, there was an increase in the health status in the community with Hendrik L Blum
theoretical approach which is environmental, behavioral, health services and ancestry. Where the four
components of the theory, the coverage in 2019 can be achieved. Through the study Transition Scheme
Analysis System to the Regional Health Insurance National Health Insurance System in East Kalimantan
province, Jamkesda still has a role as a companion of JKN. The results of this study will give employees the
scientific literature, to all interested parties through seminars, journals and strategic plan in order to achieve
universal coverage in 2019 in East Kalimantan.

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Sustainability*
Please list the merits of the scientific output of the research proposed in propelling future scientific
investigations. Describe the prospect and likelihood that the funding will enhance the investigator's
potential and commitment to productive independent scientific research in the future. Finally, please
show how the project will sustain itself past the award life-time.
Obtain data related to the health of the environment includes the PAB (Water Supply), PAM, the physical
condition of the house, and the waste management disposal condition, MCK and SPAL, Knowing the people
status diseases include 10 diseases spreading pattern highest on people, places and time, Knowing the
nutritional state of society include diet, diet, the use of iodized salt, and the habit to consuming fruit.
Knowing the implementation of the MCH and family planning community includes examination of
Pregnancy, Childbirth Assistance, breastfeeding, as well as the use of contraceptives, Knowing the state of
occupational health and safety workplace conditions, the duration and type of work and the use of PPE
(personal protective equipment), Knowing the behavior patterns of living through the birth, exclusive
breastfeeding, a child's weight, handwashing, water supply, latrines family, house mosquito free, nutritious
food consumption, exercise habits and smoking habits, Knowing the state of health care through knowledge
of health policy, the latest education, the amount of income, number of dependents in the home, marital
status and utilization of health facilities.
Social and cultural acceptance of the integration of the Regional Health Insurance to the National Health
Insurance in East Kalimantan, HCF preparedness in the border area of the integration of the Regional Health
Insurance to the National Health Insurance, Readiness Human Resources to the integration of the Regional
Health Insurance to the National Health Insurance, Readiness access the integration of information services to
the Regional Health Insurance National Health Insurance.
Innovative Approaches*
Explain how proposed concepts, approaches, methods, tools, or technologies used in your research
may represent an innovative or novel approach.
The concept of study
This study emphasizes the birth of a development concept of a concrete integration of Jamkesda to JKN, so
that the role of local government is still running so the universal coverage in 2019 can be realized to the
fullest. This study, combining SDGs with SKN in health, especially about the allocation of health funding, so
there synergism to be achieved regional, national government and also international.
Research methods
Type of this research is observational, namely data collection status of certain public health and the
incidence of disease for use in formulating hypotheses for further research. This research is survey study
which is directly observing the situation and health problems in the community and supported by the
secondary data collection.
Instruments
In this study will use support tools such as:
1. In some areas where the families reached by electricity and internet services, the research team will
use information technology-based equipment. Its also based on the absorption capability of local
communities.
2. In some areas where the families are not contained or limited electricity and internet services, the
research team will use the simple props equipment but still based on ICT.
The technology used
1. SMS gateway is used to facilitate the delivery of information to volunteer and enumerator team of
researchers around the distribution of families.
2. Online surveys are used to facilitate respondents in providing information to the research team
especially respondents residing in the territory served by the tribe and electricity and internet.
3. Social communication media used to disseminate the latest information on the progress report to
interested parties.

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4. Social Mapping applications use GIS (geography information system) or the like to perform mapping
the distribution of families communities in East Kalimantan.
5. Digital Photography used to capture the moment conditions in rural and urban communities
Personnel
Prior Experience and Relevant Capabilities of the Principal Investigator*
Briefly explain the qualifications of the applicant as they relate to the proposed project and
illustrate how the project will build upon existing expertise. Later, a Letter of Laboratory Group
Principal Investigator Agreement will be requested under the Attachments section to confirm the
role of the applicant as responsible for the research group, recognized as a legally binding
organizational entity.
Halliday D, Mahmood MA, Soerjoasmoro MA, Kusumaratna R, Masitah, Raheel H. Adequate visits,
inadequate service: comprehensive of ANC in Samarinda & Balikpapan, East Kalimantan. Pak J Public Health
Jan - Mar 2013; 3(1): 34-8.
HEALTH SERVICES & ACTION RESEARCH As coordinator for training, human resource development and
health services development in the province, my role includes active participation in action research. My
current role as Coordinator for streamlining the health insurance programs in the province and prepare for
the launch of national health insurance involves working with large health information and services provision
data, and advice the department and the district health teams accordingly. This work and the participation in
many research such as those listed below, helped me take the role of coordinator and facilitator of training
using these research for a large number of trainees in Indonesia and in Australia (assisted Dr Afzal Mahmood
and John Moss and other Adelaide University trainers)
2012: Maternal Health Services Provision in Bontang: Factors affecting continuity of care The study was
part of a larger health services development program in East Kalimantan. An honours research student was
involved for this component. In addition to help the team conceptualize the study, design of the interviews,
and help to plan data collection and analysis, I provided field supervision. The study contributed to better
quality maternal health care in Bontang as it provide information on factor that facilitate or hinder
coordinated care during pregnancy and labour and delivery.
2011: Access to hospital based intrapartum care by women in Kutai Barat District: I was involved from
the very early stage of planning a research about the use of hospital by women from across various areas of
this district. I was involved in the discussion about concepts development with the hospital administrators
and providing support to the team for questionnaire development. A student from the University of Adelaide
was involved and completed honours thesis on the basis of this research which informed that the hospital is
not accessible to women who live about 2 hours distance from hospital. As a senior staff in the provincial
government and in the department of health my participation helped and I disseminated the information to
various districts.
List of Personnel*
Please list all key personnel serving as Co-Principal Investigator(s), Researcher(s) and Technical
Staff. Keypersonnel are defined as all individuals who will contribute in a substantive,
meaningful way to the scientific development or execution of the project, whether or not salaries
are requested. Students and post-doctoral researchers should be included if they meet this
definition, as well as any other significant contributors. Include their names, last degree obtained
and technical/scientific role in proposed research project. Later, you willbe asked to upload CVs
of key personnel under the Attachments section of this application form. Members whereby

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salaries are requested will be required to include an additional Letter of Research Group
Membership Agreement as described in the Attachments section at end of this application form.
Co-Principal Investigator(s):
Arbain, M.Pd
Mazita, MPH
Researcher(s) :
Herry Farjam, SKM, M.Kes
Sulung Alfianto Akbar, S.Kom, M.Msi
Ferry Fadzul Rahman, SKM., M.Hkes
Godefridus Bali Geroda, SPd., M.Pd
Technical Staff :
Ilham Rahmatullah, SKM
Collaborations
Describe collaborations with domestic and international partners.This includes in-country partners such as
government ministries, non-governmental organizations, and research institutes/universities. Connections to
private companies, international networks or resources, and international organizations should also be
described if applicable. Explain the nature of these collaborations and describe what each partner will
specifically contribute to the Research Plan.If you do not have existing collaborations you may skip this
entry.
In the operationalization of this research will be in collaboration with Domestic Institute. The Institute of
Education, Research, Service and Protection of Peoples, (LP4M), with the number of notary deed 03 dated
June 22, 2010 by a notary and official land deed (PPAT) Arif Endang Dwi Wahjuni, SH., MK. N Health
Department,
Training
Training
Provide examples of any seminars, workshops, conferences,or other training activities planned as
part of the project, including estimates of the numbers and types of people to be trained
(undergraduate students, graduate students, postdoctoral researchers, laboratory
technicians,industry professionals, policymakers, and other stakeholders). For example: How many
PhD Students and publications will be expected to graduate from this research project?
During the process of this study for three years, will be held seminar delivery of results of studies and the
hiring with interested parties such as DPRD Kaltim, academics from universities, health professionals and
health authorities, the operator of the area and the Health Security Health Security Agency in the district
town.
Data Sharing and Dissemination Plan

Data Sharing and Dissemination Plan
Include a plan describing how the research findings will be disseminated to key stakeholders and the
broader scientific community, e.g.,via publication of results, submission of information to publicly

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accessible databases, informational meetings for stakeholders, or via other means appropriate to
your field.
The results of this study, will the team give to stakeholders for consideration of policy making issues of
health insurance in the region, such as the Regional Government of East Kalimantan, the House of
Representatives both in the center would also in the area of funds the Ministry of Health in the hope the
government can take decisions that do not burden the people
Timeline
Timeline
For the anticipated duration of the award, provide a list of major project activities and milestones
along with the estimated time required to complete each. You may type in your timeline in the
text area here or upload it later in the Attachments section of this application form under figures
and tables if it is in a separate file, such as spreadsheet or graphical format.
First year: Generate data for penyusanan hypothesis in the second year
Year Two: Generate Data to formulate hypotheses next dipenelitian
Year Three: Produce Plan Strategi universal era caver rate in 2019.
Human Subjects, Health, and Environmental Protection

Statutes, acts, laws, and regulations related to scientific research and development involving
activities resulting in a potential high-risk and negative impact on human health and safety, the
preservation of the environment and other living systems are governed by UU. No. 18 2002 on
the National System of Research Development and the Application of Science and Technology,
Article 30(2) and Article 22(2).
This is further defined by PP No. 48 2009, Article 22(3) UU No. 18/2002 on the requirements of
such permits and by PP No.8 2012 on what constitutes such activities considered to be a
potential high-risk of negative impact and the governmental organization authorized to give such
permits. the grantee will be responsible for obtaining the necessary permits prior to the start of
the proposed research activity.
A. Activities Related to Biomedical Research

Please check the appropriate box if the following is used in the proposed research (ONE OR
BOTH BOXES):
Human Subjects
If both or either of the above subjects are used, please state:
possible ethical consideration;

potential risk and/or negative impact on human health and safety;

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potential risk and/or negative impact on the preservation of the environment and
other living systems.
[Unanswered]
B. Use Of Human Subjects on Proposed Research

I. Previous Experiments
If the study involves the use of humans subjects, have experiments been conducted on animals
previously? If not, please explain why humans are used as initial subjects for the study.
humans are used as initial subjects for the study becasue the humen is the user in regional dan national
health care.
II. Negative Impacts

Please list potential direct or indirect negative impacts. This includes methods of intervention
where possible negative impacts are foreseen.
Misunderstanding between the community and researchers and citizens with BPJS as insurers in terms of
the perception of the referral scheme of primary care facilities to about advanced services were generally
good in the local regional and national level.
There may be a suspicion against the team of researchers in terms of their concern towards the
involvement of a political element behind the research field.
Chances are there politicians who will ride on the approach to the Community.
III. Duration
Please describe the length of time the human subjects will be involved in the study.
Desember 31, 2016 - Desember 31, 2017
IV. Consent
Explain your plan for obtaining consent.If the human subjects are informed verbally without
written consent, or if they are unable to give their consent, please provide a justification and
explain the tracking system to be implemented in order to protect the subjects.
If it does not obtain approval the steps to be taken are;
Team researchers will approach the Community Leaders especially those with a modern vision but
remains concerned about the health financing system, Before Thinking of our proposed research design in
this dipi paroject, Team Researchers have brainstormed and shared some steakholder hearing who have the
same interests of the health financing system multilevel, In this research project team also involves the
participation of the community who enjoy BPJS and regional health insurance
V. Damages
Can subjects sue for damages? If yes, what would be the amount of the compensation (in IDR)?

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Team Researcher sure there will be no damage or his kind but if it happens outside of our desire, the
Team will consolidate with Steakhooders which has been engage since the research design is done and hope
liberation then given a compensation of Rp 1.000.000,-per case.
VI. Will The Human Subject Be Insured?

(Check ONE BOX ONLY)
Yes
Material Transfer Agreement

For research activities involving collection, exchange and transfer of material between
collaborating non- Indonesian/foreign/overseas institution(s) and/or national(s), strict compliance
with the legislation in effect in both countries is expected.
Research activities involving non-Indonesian/foreign/overseas organization(s) and/or national(s)

is governed by PP. No. 41, 2006, Article 17(5) UU No. 18/2002 that regulates the procedures on
submission of permits, including requirements that include the need for an institutional
guarantor, the reporting of research activities conducted, and sanctions to those who violate such
requirements.
Article 20(2) prohibits the exchange of samples and/or specimens outside of the Republic of
Indonesia except by approval of the Minister of Research Technology as stipulated within UU
No. 4/2006 concerning International Treaty on Plant Genetic Resources for Food and Agriculture
relating to the procedures for Material Transfer Agreement.
The grantee will be responsible for furnishing required permit(s)/approval(s)/document(s)

relating to material transfer prior to the start of his/her research activities.
Collaboration with Non-Indonesian/Foreign/Overseas Institution(s) and/or
Nationals*
Will the proposed research involve collaborating non-Indonesian/foreign/overseas institution(s)
and/or national(s)?
No
Collection, Exchange and Transfer of Material*

Will the proposed research involve collection, exchange and transfer of material between
collaborating non- Indonesian/foreign/overseas institution(s) and/or national(s)?
No

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Budget
Applicants may request up to IDR 1.5B (or approximately US$100K) per year for up to 3 years.
This can include:
I. Equipment Maintenance, Materials, and Supplies
II. Salaries and Stipends of Principal Investigators, Co-Investigators research
assistants/technicians, Research Staff Wages
III. Travel Expenses related to sampling of material(s)/data, training and other skills and
education capacity-building
IV. Other Direct Costs includes Computing and Technical Data Infrastructure, Publication Costs,
Workshops and Conferences, Facilities and Other resources
V. Indirect Costs/Overhead?
Budget Form*
Provide an itemized budget for the project using the budget form provided. Projects may last
no more than three years, and proposals for multi-year projects must provide annual budgets
separately detailing the expected costs for each year. Value for the investment will be an
important consideration in proposal evaluation and selection, so all costs should be reasonable
and necessary. If your project involves more than one institution in Indonesia, please prepare a
separate budget table for each, so that it is clear what funds each institution needs, regardless of
whether you would ask for all the funds to be disbursed to the lead institution or whether you
would ask for separate awards to be made to each participating institution.
Note: Multi-Institutional teams may be eligible for a larger funding size, the amount of which
will be considered on a case by case basis. Requests for additional funding must be stated in the
budget form and the budget justification section.
budget form.xlsx
Budget Request Justification

I. Equipment and Supplies.
Provide an explanation and justification for the purchase of materials, supplies, consumables
required for the research is allowed. However, major equipment purchase will not be allowed
and only equipment rental fees/use fee will be allowed. Where possible, projects should leverage
existing durable equipment.
1. Equipment Rental/Use Fee : Rp120,000,000.00
2. Materials, Supplies & Consumables : Rp90,000,000.00
3. Computing and Technical Data Infrastructure Rental/Use Fee : Rp150,000,000.00
* for 3 Years
II. Salaries and Stipends

Provide an explanation and justification for any salary or stipend support requested, including a
list of the positions to be supported and the role each will play in the project and the percentage
of their time that would be devoted to the project.

samatinda
1. Principal Investigator : Rp.360,000,000.00

2. Co-Principal Investigator(s) : Rp288,000,000.00
3. Researcher(s) : Rp240,000,000.00
4. Technician(s) : Rp180,000,000.00
5. Research Staff Wages : Rp 432,000,000.00
* for 3 Years
III. Travel Costs

List travel costs related to sampling of material(s)/data, training and other skills and education
capacity-building related to research study. Provide the number, duration, location, and purpose
for any project-related trips for which funds are requested, along with the titles or positions of
the travelers.
1. Domestic Travel : Rp1,150,000,000.00
2. Daily Allowance/Per Diem, Domestic Travel : Rp920,000,000.00
3 International Travel : Rp120,000,000.00
4. Daily Allowance/Per Diem, International : Rp100,000,000.00
* for 3 Years
IV. Other Direct Costs

This includes computer services, publication costs, workshops and conferences, facilities and
other resources in support of research study.
1. Computer Services : Rp. 60,000,000.00
2. Publication Costs : Rp.30,000,000.00
3. Workshops and conferences : Rp160,000,000.00
4. Facilities and other resources : Rp.60,000,000.00
5. Intellectual Property Registration & Processing : Rp. 50,000,000.00
* for 3 Years
V. Overhead
List possible overhead costs as necessary in support of research activities. If requested, overhead
should be kept to a minimum. Examples include general purpose/office supplies, clerical and
administrative wages, electricity and other utilities.
1. General purpose/office supplies : Rp.90,000,000.00
2. Clerical & Administrative wages : Rp90,000,000.00
3. Electricity and other utilities : Rp. 30,000,000.00
* for 3 Years

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VI. Collaborating Institutions (If Any)

If your project involves other institutions besides your own, please list them, briefly describe the
roles they will play in the project, and indicate whether they will support their costs with their
own resources or with funds requested in your project budget (Note: Only Indonesian-based
collaborating institution will be eligible to receive DIPI funding).
No
VII. Other Funding Sources

List the source and amount of any other funds that you have received or applied for from other
sources to support your research.
No
Attachments
Please upload the following items in your proposal submission as instructed in this section.
Those marked by an asterix* are required in order to complete the proposal submission process.
References
Upload your references (literature citations) if they are included in your project description. It is
stronglyencouraged to include a list of references.
References.doc
Figures and Tables

Upload figures, and diagrams (if any) in a single document and refer to them in your project
description (for example, Figure 1, Table 2, etc.). Please do not exceed five figures/tables
combined and do not include additional project narrative in this document.
SKEMA PENELITIAN .rtf
Please also upload the following items in your proposal submission (your application will not be
complete and cannot be submitted without these attachments).
Curriculum Vitae*
Please upload curriculum vitae (CVs) for all key personnel as previously described. You may use
the template provided. Each CV should be no more than two pages in length and include
citations for no more than five to ten recent relevant publications or patents. If the project
includes more than one institution, please be sure to include a CV for the key project participant
at each institution. Please do not submit electronic copies of publications or other background
materials, as they will not be forwarded to reviewers. Please save all CVs in a single file and
upload them below.
CV.doc

samatinda
Letter of Research Group Membership Agreement*

All key personal requesting salary must submit a SURAT PERNYATAAN PENGIKATAN
SEBAGAI ORGANISASI PENELITIAN (Letter of Research Group Membership Agreement)
written in Bahasa Indonesia and signed as a statement that they are current members of the
laboratory group recognized as a legally binding organizational entity. Please use as a reference
the following letter template.
Pengikatan LPPM.jpg
Letter of Research Group Principal Investigator Agreement*

The PI must provide a SURAT PERNYATAAN PENANGGUNG JAWAB ORGANISASI
PENELITIAN (Letter of Research Group Principal Investigator Agreement) written in Bahasa
Indonesia and signed to confirm this or her role as responsible for the research group recognized
as a legally binding organizational entity. Please use as a reference the following letter template.
img090.pdf
List of Publications*
You should list at least one authored research paper published in national/international scientific
journals.
jurnal.doc
Institutional Letter of Support

An institution letter of support is not required for submission but strongly encouraged at the
application stage. However, it will eventually be required in order for you to receive funding at
the end of the review process should you be recommended for an award.
Please use this institutional letter of support template (also available in Appendix II of the grant
manual) and have it filled out and signed by an official at the PI's institution who is legally
authorized to make commitments on the institution's behalf. If you project involves more than
one institution, please submit a separate letter of support for each partnering institution and
upload them in a single document. The letter must be signed and written on official institutional
letterhead.
Rektor.pdf
Once you have filled out all the sections of the application and uploaded your attachments,
please scroll down to the section below to acknowledge that you have read and understood the
review process and criteria before submitting your application.

samatinda
Applicant Reviewer Recommendations (Optional)

A merit-based scientific evaluation and peer review process lies at the foundation of DIPI's
assessment procedure to ensure that the most promising scientific investigations of highest merit,
scientific impact and potential are given priority (more details can be found in the next section on
review process and criteria).
Applicants may include a list of suggested reviewers who they believe are especially well
qualified to review the proposal. Applicants also may designate persons they would prefer not
review the proposal. These suggestions are optional and will provide us with a means of ensuring
that proposals will be assessed and evaluated in an objective, transparent and fair manner,
avoiding possible personal bias and conflict of interest. Note that the information provided will
be held confidential and processed under strict observance of anonymity.
The decision whether or not to use the suggestions is at the final discretion of DIPI.
Sources of conflict of interest can include financial interests, professional and personal
relationships, employment, organizational membership and other interests and affiliations.
Recommended Reviewers
Please recommend the full name, including current professional affiliation and contact email
information, of both Indonesian and international experts within your proposed research area
who can provide professional and objective review about the scientific merit of your proposal.
dr. Osa Rapsodia, MPH
Emai: osa@toyusinku.com
Non-recommended Reviewers
Please list the full name, including current professional affiliation and contact email information
of whom DIPI should not assign to review your proposal due to potential conflict of interest(s).
Please state which conflict of interest applies to each reviewer based on these possible sources of
conflict of interest(s): "financial interests", "professional relationships", "personal relationships",
"employment", "organizational membership", "other interests."
No Body
Acknowledgment of Review Process and Criteria

DIPI will convene special review panels that will evaluate proposals using a scientific peer
review criteria.
As part of the scientific peer review, all proposals will:
Receive a written critique.

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Compete for available funds with funding decisions based on the following review
criteria.
Note: An application does not need to be strong in all categories to be considered for
funding. The proposals scientific merit and broader impact will be prioritized by
reviewers.
Review Criteria
1. Scientific Relevance: to what extent does the proposed research and experimental design
address important gaps in knowledge within the scientific field(s)/area(s) explored through the
questions asked/hypotheses tested?
2. Broader Impacts: to what extent will the proposed research enhance the infrastructure for
research and education, such as facilities, instrumentation, networks, and partnerships? To what
extent will the results be disseminated broadly to enhance scientific and technological
understanding? To what extent may the proposed activity benefit society?
3. Investigator Qualifications: do aspects of the investigator's background and experiences

suggest that his/her ability to conduct the proposed research will be successful?
4. Sustainability: to what extent do the merits of scientific output of the research proposed give
leverage in propelling future scientific investigations? What are the prospects and likelihood that
the funding will enhance the investigator's potential and commitment to productive independent
scientific research in the future?
5. Innovative approaches: does the proposed research provide novel approach to the questions
being asked, hypotheses tested and knowledge gap addressed? Explain how proposed concepts,
approaches, methods, tools, or technologies used in your research may represent an innovative or
novel approach to a specific development challenge.
Other measures during the review process include:
Relevance to DIPIs priority and focus areas

Availability of funds
Acknowledgement*
Please check the box below
I have read and understood DIPI's review process and criteria

samatinda
Once you have filled out all the sections of the application, uploaded all the required documents
and acknowledged that you have read and understood the review process and criteria, you can
then submit your application by clicking the "Submit Form" button at the bottom of the page.
Please consult the DIPI website for further information. If you have any additional questions
regarding the program, please contact us at 2016@dipi.id

samatinda
File Attachment Summary

Applicant File Uploads
budget form.xlsx
References.doc
SKEMA PENELITIAN .rtf
CV.doc
Pengikatan LPPM.jpg
img090.pdf
jurnal.doc
Rektor.pdf

Widyagama Mahakam University
Note: List all amounts in IDR only. Describe per categorical item, add Year 1
additional item lines if necessary.
1. Equipment Rental/Use Fee Rp 40,000,000.00

Equipment and Supplies 2. Materials, Supplies & Consumables Rp 30,000,000.00
3. Computing and Technical Data
Rp 50,000,000.00
Infrastructure Rental/Use Fee
Equipment Costs Total (I)
1. Principal Investigator Rp 120,000,000.00
Salaries and Stipends (list each 2. Co-Principal Investigator(s) Rp 96,000,000.00
position on separate line and indicate
3. Researcher(s) Rp 80,000,000.00
% of time to be spent add more
lines if needed) 4. Technician(s) Rp 60,000,000.00
5. Research Staff Wages Rp 144,000,000.00
Salaries and Stipends Costs Total (II) Rp 500,000,000.00
1. Domestic Travel Rp 350,000,000.00
2. Daily Allowance/Per Diem, Domestic
Rp 240,000,000.00
Travel Travel
3 International Travel Rp 60,000,000.00
4. Daily Allowance/Per Diem, International Rp 50,000,000.00
Travel Costs Total (III) Rp 700,000,000.00
1. Computer Services Rp 20,000,000.00
2. Publication Costs Rp 15,000,000.00
Other Direct Costs 3. Workshops and conferences Rp 40,000,000.00
4. Facilities and other resources Rp 20,000,000.00
5. Intellectual Property Registration &
Rp 20,000,000.00
Processing
Other Direct Costs Total (IV) Rp 115,000,000.00
1. General purpose/office supplies Rp 30,000,000.00
Overhead Costs 2. Clerical & Administrative wages Rp 30,000,000.00
3. Electricity and other utilities Rp 10,000,000.00
Overhead Costs Total (v) Rp 70,000,000.00
Grand Total Project Costs I+II+III+IV+V Rp 1,385,000,000.00

Year 2 Year 3
(if requested) (if requested) Project Total
Rp 40,000,000.00 Rp 40,000,000.00 Rp 120,000,000.00
Rp 30,000,000.00 Rp 30,000,000.00 Rp 90,000,000.00
Rp 50,000,000.00 Rp 50,000,000.00 Rp 150,000,000.00
Rp -
Rp 120,000,000.00 Rp 120,000,000.00 Rp 360,000,000.00
Rp 96,000,000.00 Rp 96,000,000.00 Rp 288,000,000.00
Rp 80,000,000.00 Rp 80,000,000.00 Rp 240,000,000.00
Rp 60,000,000.00 Rp 60,000,000.00 Rp 180,000,000.00
Rp 144,000,000.00 Rp 144,000,000.00 Rp 432,000,000.00
Rp 500,000,000.00 Rp 500,000,000.00 Rp 1,500,000,000.00

Rp 400,000,000.00 Rp 400,000,000.00 Rp 1,150,000,000.00
Rp 340,000,000.00 Rp 340,000,000.00 Rp 920,000,000.00
Rp - Rp 60,000,000.00 Rp 120,000,000.00
Rp - Rp 50,000,000.00 Rp 100,000,000.00
Rp 740,000,000.00 Rp 850,000,000.00 Rp 2,290,000,000.00
Rp 20,000,000.00 Rp 20,000,000.00 Rp 60,000,000.00
Rp - Rp 15,000,000.00 Rp 30,000,000.00
Rp 50,000,000.00 Rp 70,000,000.00 Rp 160,000,000.00
Rp 20,000,000.00 Rp 20,000,000.00 Rp 60,000,000.00
Rp 10,000,000.00 Rp 20,000,000.00 Rp 50,000,000.00
Rp 100,000,000.00 Rp 145,000,000.00 Rp 360,000,000.00

Rp 30,000,000.00 Rp 30,000,000.00 Rp 90,000,000.00
Rp 30,000,000.00 Rp 30,000,000.00 Rp 90,000,000.00
Rp 10,000,000.00 Rp 10,000,000.00 Rp 30,000,000.00
Rp 70,000,000.00 Rp 70,000,000.00 Rp 210,000,000.00
Rp 1,410,000,000.00 Rp 1,565,000,000.00 Rp 4,360,000,000.00

Daftar Pustaka
1. Kemenkes RI. Rencana strategis Kementerian Kesehatan 2010-2014. Jakarta: 2010.
2. Supriyantoro. Formulasi Kebijakan Integrasi Jaminan Kesehatan Daerah ke Sistem
Jaminan Kesehatan Nasional Menuju Universal Health Coverage. UGM: 2014.
3. Tahun 2004, (Undang-undang tentang Sistem Jaminan Sosial Nasional Nomor 40).
4. Gani A, Dkk. Laporan Kajian Sistem Pembiayaan Kesehatan di Beberapa Kabupaten dan
Kota, Pusat Kajian Ekonomi Kesehatan dan Analisis Kebijakan. Fakultas Kesehatan
Masyarakat Universitas Indonesia. 2008.
5. Chitra R, & Ermy, Ardhyanti,. Inisiatif Daerah Dalam Mengembangkan Program Jaminan
Kesehatan: Pola dan Pembelajaran
6. Direktorat Jenderal Bina Upaya Kesehatan Kemkes RI. Data dan Laporan Direktorat
Jenderal Bina Upaya Kesehatan Kemkes RI, . Jakarta: berbagai tahun.
7. Murti B. Strategi untuk Mencapai Cakupan Universal Pelayanan Kesehatan di Indonesia,
disampaikan pada Temu Ilmiah Reuni Akbar FKUNS, di Surakarta, 27 November. 2010.
8. Mukti AG. Reformasi Sistem Pembiayaan Kesehatan di Indonesia dan Prospek ke Depan.
Yogyakarta: PT. Karya Husada Mukti; 2007.
9. Dwicaksono A, Ari Nurman, & Panji 98 Aulia | Polemik Kebijakan Integrasi Jamkesda ke
Sistem JKN
Yudha Prasetya,. Jamkesmas and District Health Care Insurance Scheme. Bandung:
Perkumpulan Inisiatif. 2012.
10. BPS. Sensus Penduduk 2010. 2011.
Skema Peneliatian DIPI
Sistem Kesehatan Nasional Status Kesehatan Jaminan Kesehatan Nasional Pembiayaan

SDGs
Masyarakat Kesehatan
Kesejahteraan Sosial
Kesehatan
FCTC WHO Penelitian dan Pembiayaan dan Manajemen Resiko

Pengembangan Vaksin Pemerataan dan Kuwalitas
SDM
Orange : Diteliti
Biru : Tidak Diteliti

CURRICULUM VITAE
MASITAH
SKM/Bachelor of Public Health (Indonesia)
MQIH/Master of Quality Improvement in Health Care (Australia)
EDUCATION
- Master of Quality Improvement in Health Care, Centre for Clinical Epidemiology &
Biostatistics, Faculty of Medicine, University of Newcastle, New South Wales,
Australia, January 1998 July 1999
- Bachelor of Public Health, Faculty of Public Health, Hasanuddin University, South

Sulawesi, Indonesia 1987 1992
EMPLOYEMENT
1. Health & Development Sector, Government of East Kalimantan Province
Dec 2013 present Head of Provincial Health Insurance, East Kalimantan

May 2010 Dec 2013 Head of Health Section, Social Bureau, Governor Office of East
Kalimantan
Feb 2009 May 2010 Head of Family Planning Section, Women Empowerment
andFamily Planning Board East Kalimantan
2004 2008 Member of Technical Review Team, Health Work Force Project
supported by WHO and Ministry of Health Republic Indonesia
1993 2009 Staff, Medical Services Area, Provincial Department of Health
2. University Positions
2013 present Auditor, Public Health Faculty, Widyagama Mahakam University
2007 2013 Dean of Public Health Faculty, Widyagama Mahakam University
2003 2007 Vice Dean, Public Health Faculty, Widyagam Mahakam Uni
2003 - present Senior Lecturer, Public Health Faculty, Widyagam Mahakam Uni
2008-2010 Visiting Lecturer, at Midwifery Academy BungaHusada
2003-2006 Visiting lecturer at Medical Faculty Mulawarman University
COORDINATION- PUBLIC HEALTH& HEALTH SERVICES MANAGEMENT TRAINING

- Provincial Annual Health Coordination Meeting 2011 to 2015
- Attended & assisted in coordinating the training of Balikpapan Health Departement ,
Maternal Health Services Management October 2014, University of Adelaide
- Attended & assisted in coordinating the training of Provincial and Kutai Kertanegara
Health Departement, Maternal Health Services Management October 2013
- Attended & assisted in coordinating the training of Tarakan Health Departemant,
Role of Midwife for better health of mothers & babies, University of Adelaide (July
2012)
- Fellowship on Health Service Management Training, University of Adelaide
(December 2011)
- Fellowship of ALA-AUSAID on Maternal Health Technical Resource Team,
University of Adelaide (November 2011)
- Fellowship of ALA-AUSAID on Health Service Management Training, University of
Adelaide (November 2009)
MEMBERSHIP OF PROFESIONAL ASSOCIATION
2005- Present Indonesian Health Care Quality Network(Individual Member)
2015 to date Indonesian Red Cross, Samarinda branch (Deputy Head, Volunteers
&Human Resources)
2014 to date The Indonesian Association against Tuberculosis East Kalimantanbranch

(Counseling,TrainingandMedical ServicesDivision)
2012 2015 GuardianCouncilonAcademic, ProfessionalismDevelopmentand Health

Resources of Indonesian Public Health Association, East Kalimantan
Branch
2009 2012 Vice Chairman of Indonesian Public Health Association
East Kalimantan Branch
2009 2013 Indonesian Women Sport Association, member of SportsHealth Sector East
Kalimantan Branch
2011-2012 Food Security CouncilWorking Groupof Samarinda City
2015 to date Alumni Associationof students&familyof East Kalimantan (capacity building

division)
TRAINING & DEVELOPMENT SEMINARS (last 5 years)
1. Indonesia Health PolicyNetwork, Padang, West Sumatra, August 2015
2. Seminar: Measuring theimplementation ofthe NationalHealth

InsuranceImprovementon InputImplementation, Jogjakarta, Mach 2015
3. BPJSKalimantanregionalmeeting, INACBGsSeminar: Problemsand Solutions,

Balikpapan, December 2014
4. Evaluation of the Implementationof the NationalHealth Insurance, Denpasar, Bali,

December 2014
5. Coordination, MonitoringandEvaluationof Poverty ReductionAcceleration,

Balikpapan, October 2014
6. IndonesianHealth CareQuality Forum, Solo, Cetral Java, August 2014
7. 3rdAnnualHealth InsuranceSeminarMeeting: Achievements and

Challenges3monthsimplementationJKNinIndonesia: Inputtowardsimprovement,
Jogjakarta March 2014
8. International Workshop:"The adoptionof MSS
andAlternativeStrategiesPublicServiceinCanada, Balikpapan, March 2014
9. ForumNetworkHealth PolicyIndonesia, Kupang East Nusa Tenggara, September

2013
10. 3rd National Forum of IndonesianHealth PolicyNetworkStrengthening

ofIndonesiaHealth Policyfor theAchievement ofthe MDGsand Implementation
ofPoliciesandLegislation SJSN&BPJSSurabaya, East Java, September 2012
11. Mini University, Maternal and Child Health Integrated Program (MCHIP)USAID,
Samarinda East Kalimantan, May 2012
12. Annual Health Insurance Meeting 2012, Supported by Australian Aid & The Asia
Foundation. Medical Faculty Gajah Mada UniversityYogyakarta, March 2012
13. Faculty of Public Health Widyagama University. Facilitated National Seminar

Regional Health SystemSamarinda, East KalimantanMarch 2011
14. Social and PoliticalScienceFaculty Widyagama University. Seminar of

IndonesianForeign Policyand Implementation in theRepublic of
IndonesiabyRepresentatives offormerIndonesianAmbassadorin
ItalyandDiplomatsonMissioninIndonesiaremainUnionof NationsinNew York,
Samarinda, East Kalimantan, Dec 2010
15. Faculty of Public Health Widyagama University. Facilitated Health Seminar

Islamicsolutionsto overcome cervix cancer. Samarinda, East Kalimantan,
December 2010
16. 11th NationalCongress of Indonesian Public Health Association. Promotion &

Prevention as sustainable Investment for Health of Nations. Bandung, West Java
August 2010
17. Coordination ofPrivate UniversitiesKalimantanRegion

Attended FunctionalTrainingfor Improvement Lecturersof Private Universities.
Samarinda, East Kalimantan, January 2010
18. Attended Seminar on Health Economics 2010, Patients and Pharmaceutical use.
Faculty of Public Health University of Indonesia. Jakarta, January 2010
19. Attended 3rdNationalCouncil of Indonesian Association of public health institutions

Theme professional development andpublic healthresearchprioritiesMedan,
North Sumatera, August 2009
20. Faculty of Public Health Widyagama University. Facilited Seminarmanagement

systemsandoccupational health and safetycompetenciesto facethe challengesof
globalizationbynationaloccupational healthconsultant. Samarinda, East Kalimantan,
June 2009
21. Training of Mainstreaming Gender & Poverty Reduction, Sponsored by the Good
Local Governance Program (GLG) which is supported by the German Federal
Ministry for Economic Development & Cooperation (BMZ) in cooperation with the
Ministry of Home Affairs, Republic of Indonesia, Implemented by Deutsche
GesellschaftfuerTechnischeZusammenarbeit (GTZ). Yogyakarta, April 2009
22. Center for Education andTraining ofHealth Resources, Ministry of Health Training of
Trainer Health Centre Management. Jakarta, July 2008
23. Indonesian Healthcare Quality Network (IHQN) held Health Care Quality Forum
Challengesof HealthCareQuality Development: BetweenPatient Safety, Costand
Efficiency. Presented a paper Kaltim Quality&RegulatoryFrameworkSurabaya,
East Java, August 2007
STUDENTS RESEARCH SUPERVISED As public health faculty, at Widyagama University Samarinda
2015 Nita ViolenTamaela, the use of Puskesmas capitation funds towards patient's benefit (BPJS) in Lempake
Health Center Samarinda
JokoSaptoPramono, S.Kp, MPHM &Masitah SKM, MQIH
Floriana Doom, Factors affecting officer performance of 24 hours health center services in Lempake Health
Center Samarinda
Drs.I.PutuSukra, MPPM &Masitah, SKM, MQIH
LudinWijaya, The relationship between outpatient re-visit interest and quality service in Sempaja health
center Samarinda
DarnahAndiNohe, M.Si&Masitah, SKM, MQIH
2014 LimyeMayasari, Relationship Analysis between access and the utilization health services by district
insurance participants (jamkesda) at Loa Janan Health Center KutaiKertanegara
dr. Oswald Simatupang, MPPM &Masitah SKM, MQIH
HennyHerawati, Evaluation of the ISO implementation in MuaraJawaPuskesmasKutaiKertanegaraDistric
Masitah, SKM, MQIH &dr. Oswald Simatupang, MPPM
2013 Khairul. Overview of the performance services in Sidomulyo Health Centers Samarinda
dr. RahmatBachtiar, MPPM &Masitah, SKM, MQIH
WahyuNingsih. The effect of employee performance by giving operational funds in Mangkupalas Health
Center Samarinda
Dr. dr. EndangSawitri, M.Kes&Masitah SKM, MQIH

Alvia, Analysis of early detection of high risk pregnant mothers against efforts to reduce the risk of maternal
mortality in the Makroman Health Center area Samarinda
dr. EviFitriani, M.Kes&Masitah, SKM, MQIH
Sri Wiyanti, Overview of perception and implementation of delivery assurance program (Jampersal) by
midwife at North Malinau Health
dr. TumpakSinaga, MPH &Masitah, SKM, MQIH
KhairulImanuddin, The ISO mechanism in emergency unit at AbadiSamboja Hospital of

KutaiKertanegaraDistric
2012 Fatimah, Study of the ISO implementation for delivery services by midwife at South Bontang Health
Center
2011 PrioHadiSusatyo, Government employees health insurance participant s perception of the quality of
outpatient services in Balikpapan health centers
TaufikRahmatHidayat, Overview of time management by health professionals in the technical activities of

delivery service at Rose Ward Abdul WahabSyahranie Hospitals Samarinda
1. dr. Eva Rachmi, M.Kes&Masitah, SKM, MQIH
Eka Nanda Budi Pratiwi, The relationship poor patient satisfaction with health services in
PuskesmasJuandaSamarinda
dr. RahmatBachtiar, MPPM Masitah, SKM, MQIH

CURRICULUM VITAE
Herry Farjam
M.Kes/Master of Public Health (Indonesia)
EDUCATION
- Master of Public Health, , Faculty of Public Health, Study Program Public Health,
University Hasanuddin ,indonesia, July 2010 Mei 2012
- Bachelor of Public Health, Faculty of Public Health, Widyagama University, East

Borneo, Indonesia 2005-2010
EMPLOYEMENT
2013 - present Full Timer Lecturer, Public Health Faculty Public Health, University
Widyagama
2016- present anggota bidang riset dan penelitian kesehatan di ikatan ahli
kesehatan masyarakat cabang Kaltim
2014 present Anggota bidang pengembangan kebijakan kesehatan persatuan
sarjana kesehatan masyarakat
2016 Enumerator research survey indicators national health

2016 training ISO 9001
2015 seminar about health assurence cover
CURRICULUM VITAE
Ferry Fadzlul
MH.Kes/Master of Health Law (Indonesia)
EDUCATION
- Master of Health law, , Faculty of Law, Study Program Health Law, University
Gadjah mada,Yogyakarta,indonesia, July 2013 Mei 2015

EMPLOYEMENT
2003 - present Full Timer Lecturer, Public Health Faculty, Muhammadiah University
2015- present Visiting Lecturer, at Midwifery Academy Mutiara Mahakam
2015- present Visiting lecturer at Medical Faculty Mulawarman University
2015- present Visiting lecturer at Public Health Faculty Mulawarman University
2015- present Visiting lecturer at Public Health Faculty Widyagama University
2016- present Ketua 2 masyarakat hukum kesehatan Indonesia cabang Kaltim

2016- Present Ketua bidang hukum dan advokasi kesehatan di ikatan ahli kesehatan
masyarakat cabang Kaltim
2015- present Sekretaris umum Masyarakat Hukum kesehatan Indonesia
2015 Mediator penyelensaian sengketa medis Mahkamah Agung

2014 seminar sistem pembiyayaan kesehatan di indonesia
CURRICULUM VITAE
Godefridus Bali Geroda
SP.d/Bachelor of Education (Indonesia)
MPd/Master of Education (Indonesia)
EDUCATION
- Master of Education, Faculty of Education, Study Program English Education,
University Mulawarman,Samarinda,indonesia, July 2012 Mei 2016
- Bachelor of Education, Faculty of Education,University Mulawarman, East Borneo,

Indonesia 2007-2011
EMPLOYEMENT
University Positions
2003 - present Full Timer Lecturer, Public Health Faculty, University Widyagama
CURRICULUM VITAE
Ilham Rahmatullah
MH.Kes/Master of Health Law (Indonesia)
EDUCATION
- Master of environtment, , Faculty of Law, Study Program environtment,, University
Mulawarman,indonesia, July 2012 Mei 2016

EMPLOYEMENT
2003 - present Full Timer Lecturer, Public Health Faculty, Widyagama University
Curriculum Vitae
Personal Information
Full Name : SulungAlfianto Akbar

Place/Date of Birth : Samarinda, Indonesia/April 18th 1986
Nationality : Indonesia
Home Address : Jl.KSTubun, RT 08 NO 27,
Samarinda(75123),KalimantanTimur,Indonesia
Mobile Phone : +62-852-3254-3956
Email Address : pagihari42@gmail.com
Blog : www.sulung42.com
Sex : Male
Marital Status : Maried
Educational Background
2008 2010 Master Degree Management Information System (MMSI),

Faculty of Computer Sciences,
UniversitasBina Nusantara, IndonesiaGPA : 3.41
2003 2008 Bachelor DegreeComputer Science(S.Kom),
Faculty of Mathematics and Natural Science,
UniversitasMulawarman, IndonesiaGPA : 3.26
2000 2003 Senior High School, SMUN 3Samarinda
1997 2000 Junior High School, SLTPN 6 Samarinda
1991 1997 Elementary School, SD Muhammadiyah 1 Samarinda
1990 1991 Kindergarten, TK NuciferaSamarinda
Research Experience
Spesification Place Period Status
Expert System on The Unmul Laboratory 2007- 2008 Senior Member

Computers
Troubleshooting
Construction
Competitive Strategy SMK Muhammadiyah 1 2009-2010 Teacher

School Information Samarinda
Communication
Technology
Enterprise Resource PT DSN Temanggung 2010 Researcher

Planning Information
System
Information System WIDYAGAMA 2011 Researcher
Risk Management
MAHAKAM University
Services Oriented Republic Cinta 2009 Senior Member

Architecture In Management
Entertainer
Relevant Skills
Database System Microsoft SQL Server 2005, MySQL, and Microsoft Access
Language Programming PHP, VB Net, Pascal, C++, and Java
Operating System Windows NT, Windows 2000, Windows XP, Windows VISTA,
Windows 7, Windows 8and Linux Debian
Software Microsoft Office 2010 0r 2007, Macromedia(Dreamweaver, Flash,

Director MX 2004), Design Raster (Adobe Photoshop and CorelDraw),
Multimedia (Windows Movie Maker, Pinnacle Studio 9,Ulead 9, Adobe
Premiere pro, Adobe After Effect, Sonny Vegas Pro)
Work Experience
January 2004 October 2006 Project Manager in Moss Media Production
January 2009 - January 2011 Executive Manager in RestoeBoemi ProductionAnd Editor In

Republic Cinta Management
August 2010 Desember 2011 Lecture in Faculty ofMathematics and Natural Science,
UniversitasMulawarman
January 2011 Now Lecture in F-Kesehatan masyarakat, Economic and Pertanian,

UniversitasWidyagama Mahakam Samarinda
January 2011 Now Tutor UniversitasTerbuka
January 2014 Now Lecture in POLNES Broadcast
August 2006 Now Teacher in SMK Muhammadiyah 1 Samarinda
Lecture Experiences
Organization Experiences
Specification Place Period Status

Tehnik Komputer Jaringan And SMK Muhammadiyah 2006-now Teacher
Multimedia 1 Samarinda
Pengantar Sistem Operasi F-MIPA& FTIKOM 2010-2011 Lecture
Komputer UNMUL
Sistem Informasi F-MIPA& FTIKOM 2010-2013 Lecture
UNMUL
SistemKeamananKomputer F-MIPA& FTIKOM 2010-2011 Lecture
UNMUL
Etika Profesi F-MIPAUNMUL 2010-2011 Lecture
Sistem InformasiManajemen FTIKOM UNMUL 2011-2013 Lecture
Pengantar Komputer& Aplikasi F-KESMAS 2011- Now Lecture
Komputer (SPSS) UWIGAMA
Strategic Knowledge Information System, 2012-now Lecture
Management BINUS ONLINE
LEARNING SYSTEM
Editor Electronic POLNES BROADCAST 2014-Now Lecture
Komputer dan Media Universitas Terbuka, 2011-Now Tutor
Pembelajaran PAUD dan PGSD KALTIM
Specification Place Period Status

OSIS Senior High 2001-2003 Coordinator
School
BEM F-MIPA UNMUL, 2006-2007 Secretary Jendral
Samarinda
HIMAKOM (Himpunan UNMUL, 2006-2008 Counsellor
Mahasiswa Ilmu Komputer) Samarinda
Indonesia Berkebun DKI Jakarta 2010-now Coordinator
Pergerakan Mahasiswa Islam Kalimantan 2006-2008 Ketua Umum
Indonesia Metro Timur
No Nama Judul Penerbit Tahun
1 Ferry fadzlul Implementasi pasal Jurnal Kesmas 2016
31 PP 61 tahun 2014 Widyagma Vol 3
tentang Aborsi
2 Herry farjam Analisis manfaat Jurnal Kesehatan 2015
pelayanan kesehatan Masyarkat Vol 2
yang di terima pasien
BPJS kesehatan di
puskesmas LPKE
3 Masitah the use of Puskesmas Jurnal Kesehatan 2015
capitation funds masyarakat vol 2
towards patient's
benefit (BPJS) in
Lempake Health
Center Samarinda

An Analysis of Transition Scheme From Regional Health Insurance To National Health Insurance System Packet

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herry farjam lembaga penelitian dan pengabdian masyarakat universitas widyagama mahakam

An Analysis of Transition Scheme from Regional Health

lembaga penelitian dan pengabdian masyarakat universitas

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Desember 31, 2016 - Desember 31, 2017

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