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  • 1.
    Putilala Silalahi, Olivi Ondchintia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    How did primary health care centers in a remote district integrate national malaria protocol-based care?: A qualitative study in Buru district, Indonesia2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    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.

  • 2.
    Silalahi Putilala Ondchintia, Olivi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Indonesia Exclusive Breastfeeding Policy Analysis: Evaluation of the policy actions and its potential to address socioeconomic inequality2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Policy analysis focusing on reducing socioeconomic inequality in policy actions is still rarely performed. The study objective is to analyse if the Indonesian exclusive breastfeeding policy has potential to address socioeconomic inequality. As for the specific objectives are to utilize the Gradient Evaluation Framework as an assessment tool, and to compare exclusive breastfeeding rates before and after the policy established.

    Methods: The policy that will be evaluated is the Indonesia Government Regulation Number 33 Year 2012 concerning Exclusive Breastfeeding. The study method is policy analysis using the Gradient Evaluation Framework where literature review including grey literature, and personal communication with several organizations were applied, and also conducted a comparison of two waves cross-sectional study from secondary data using Indonesia Family Life Survey (IFLS 4 and IFLS 5). This study setting is Indonesia. Analysis of the policy will follow the Gradient Evaluation Framework steps, and the cross-sectional analysis will be performed using Chi-Square through Stata software.

    Results: Two of eight components covered in rapid assessment of the Gradient Evaluation Framework showed that the exclusive breastfeeding policy has potentials to address social gradient. Although another six components showed “in between” potentials, and one component was showed as unfulfilled. The overall policy description discussed in Dimension Two showed the complexity of policy making and actions to achieve its goal. Based on cross-sectional study comparison analysis, the exclusive breastfeeding rate was decreasing from 68.89 percent in 2007 to 44.44 percent in 2014.

    Conclusions: The combination of framework application and quantitative methods to policy analysis provided a complementary perspective on the outcome achievement. The Gradient Evaluation Framework can be utilized to evaluate Indonesia exclusive breastfeeding policy potentials to address socioeconomic inequality in breastfeeding practice, although several adjustments are required. Further quantitative and qualitative research are required.

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