Beruflich Dokumente
Kultur Dokumente
Atik Triratnawati
Department Of Anthropology, Faculty Of Cultural Science Gadjah Mada University,Yogyakarta 55281, Indonesia Makara, Kesehatan, Vol. 10, No. 1, June 2006
Average number of consults per week is 6 in Barualte and 0-1 in Imelda Underutilization of health centers in Cluster 10 To identify factors that affect underutilization of health centers To develop plans that aim to maximize utilization of health care services in rural areas
Patients seek care from more readily accessible and supporting traditional practitioners or from local equivalent of drugstores
SAN JUAN 42 Barangays MHOs DFCM residents Pedia residents Medical Interns
1 physician/puskesmas
1 Midwife : 1 puskesmas 10 Health personnel/puskesmas 30, 000 people/puskesmas
To investigate the utilization of PHC units through health sociology approach, focusing on the bureaucratic, administrative aspect of health care management, health seeking behavior, medical pluralism and labeling of community health centers
Puskesmas in Purworejo District, Central Java Qualitative method using in-depth interview, observation and Focus Group Discussion
In-depth interview of 3 health personnel and 3 persons FGD among 8 types of groups: paramedic, non paramedic , laboratory staff, bureaucrats, mothers who have children < 5, adolescents, adults, and elderly 8-10 participants from different villages or different Puskesmas
METHODS
Data collection from FebruaryMarch 2000 Data classified into certain themes Data analysis was descriptive with health sociology perspectives
RESULTS
Some PHCs in remote (mountainous) areas had only few patients
Problems Identified: [1] Transportation [2] Physician not available [3] Limited facilities (including medical equipment) [4] Health personnel not available during working hours
RESULTS
Different characteristics of the population
The government not concerned with the basic needs of society; concerned only with reaching their planning target
Purworejo district is divided into 16 subdistricts, each with own health center Staff - full time physician - 10 or more health workers - nurse - midwife - sanitary inspector - laboratory personnel - communicable disease worker
Health personnel with difficulties in serving patients due to strong bureaucratic system and regulations Dilemma of health personnel
To treat emergency cases or wait for physician (who controls all decisions) However, in some districts, the physician is not available during working hours Thus, the strong bureaucratic system is not applicable to all districts (decentralization)
Hierarchical structure of authority - Top managers who make decisions without consulting others - Paternalistic culture among health personnel
Midwife or health personnel replace the role of physicians Patients resort to consulting private clinics
Community health centers have the responsibility to deliver health care to the community Collaboration with other divisions is needed Lack of coordination + overlapping health programs overloading health personnel Influences efficiency and productivity in providing adequate health services
Community health centers: open 8 am 11 am (others closed later) Long waiting hours before being seen by the physician or paramedic For severe cases, medical equipment not available so patients are referred to hospitals
FGDs : Perception that PHCs are only suitable in curing diseases such as common colds, cough, fever or diseases of children < 5 Most patients are children and women
Antenatal care or tetanus toxoid immunization
Elderly patients consult for achy joints or fatigue Teenagers and adult males rarely consult
PHCS LABELING
Belief: Health center can only address acute cases but not chronic ones Belief: Drugs available in the center are very limited Belief: Drugs from private physicians or hospital are better quality
TMS still dominant Ministry of Health with program for village midwives to help in deliveries and management of sick children Traditional birth attendants still popular
Most give birth at home
Community Participation plays a role in health and development process Government still has a strong role
Local government needs income derived from health centers Physician has a target income, thus patients are not getting attention
Medical systems and multiple alternative sources of care which the patients could choose influence under-utilization of health centers
CONCLUSION
Un-bureaucratic, less paternalistic - Health personnel would be more capable in
making their own decisions
Emphasis on continuing education programs to increase efficiency and effectiveness The availability of physician during working hours will motivate patients to go to health centers.
CONCLUSION
Integration and coordination between departments of government and nongovernment institutions should be improved in order to reduce the task of health care staff. Government should consider the improvement of community participation.
Average number of consults per week is 6 in Barualte and 0-1 in Imelda Underutilization of health centers in Cluster 10 To identify factors that affect underutilization of health centers To develop plans that aim to maximize utilization of health care services in rural areas
Interview with midwife and BHWs of Barualte and Imelda revealed the ff possible reasons for under-utilization
Smaller population Self-care employed for minor illnesses Consult private practitioners for chronic and/or severe illnesses Distance of health center from home (especially in Imelda) Some still prefer traditional healers (hilot)
No provision of interview and FGD questions in the study Replication will require construction of own guide questions Explore benefit of a community survey in clusters with under-utilized centers