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How did primary health care centers in a remote district integrate national malaria protocol-based care?: A qualitative study in Buru district, Indonesia
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
2018 (engelsk)Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
Abstract [en]

Background: Malaria is still a health problem in Indonesia, particularly in remote area in eastern part of Indonesia. In 2006, Ministry of Health introduced the new National Malaria protocol-based care. One of its main objectives was to address drug resistance that might contributed to high malaria death and continuous transmission. However, this guideline integration process to the primary health centres at remote settings, to ensure smooth implementation, has not been widely studied. This study objective is to explore the integration process of the national Malaria protocol-based care in remote district in Indonesia.

Methods: A total of eight health workers (one district health officer, one doctor, one malaria officer, two midwives, two head of primary health care centres, one laboratory technician) were interviewed in Buru district, located in rural eastern Indonesia, with a history of high Malaria incidence. Data collection was conducted through a qualitative approach using semi-structured interviews. Thematic analysis following an abductive process, inspired by Atun’s conceptual framework was used in the analysis.

Findings: Four themes were identified that reflected four out of the five components of Atun’s framework: 1) “Malaria outbreak killed almost all people in the village” (the problem); 2) Thorough process and positive outcomes facilitated adoption (the intervention); 3) Central roles of leaders in diffusing the knowledge (the adoption process); 4) Remoteness and (partial) financial autonomy facilitated re-invention and innovation (the health system characteristic). The participants extensively discussed all these themes, and their interconnection between each other’s, across the interviews.

Conclusion: The integration of national Malaria protocol-based care in primary health care in Buru district was facilitated by the felt urgency of the Malaria problem, comprehensive guideline dissemination, observability of positive outputs of its implementation, motivated, reflective, and action-oriented leaders, diffusion of knowledge by malaria officers, autonomy in budget allocation, and opportunity of re-invention and innovation because of the remoteness of the area.

sted, utgiver, år, opplag, sider
2018. , s. 40
Serie
Centre for Public Health Report Series, ISSN 1651-341X ; 2018:16
Emneord [en]
Malaria, Buru district, Indonesia, Malaria protocol
HSV kategori
Identifikatorer
URN: urn:nbn:se:umu:diva-152669OAI: oai:DiVA.org:umu-152669DiVA, id: diva2:1256576
Eksternt samarbeid
Buru District Health Office; Unicef Indonesia - Maria Endang Sumiwi
Utdanningsprogram
Master's Programme in Public Health
Presentation
2018-05-22, Caring Science building, Room A110, Umeå University, Umeå, 13:00 (engelsk)
Veileder
Examiner
Tilgjengelig fra: 2018-10-22 Laget: 2018-10-17 Sist oppdatert: 2018-10-22bibliografisk kontrollert

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