Evaluation of the Tinnitus Teleconsulting System's Back-Referral Program for National Health Insurance Patients with Diabetes Mellitus in Primary Care.

BACKGROUND: One of the techniques available through Social Security healthcare organizations to assist the government in the implementation of social distancing without restricting patients access to particular health treatments is primary healthcare Tinnitus Teleconsulting. The purpose of this research is to gather data on how well the City of South Jakarta's primary medical care Audiology Teleconsulting strategy was implemented during the COVID-19 pandemic. METHOD: This study uses a qualitative research method and was conducted during November 2022-Mei 2023 at the City of South Jakarta Primary Health Care, the social security agency of health's South Jakarta Branch, and the social security agency of health's Primary Health Care Guarantee Division at the Head Office. Data collection techniques were through Focus Group Discussions, in-depth interviews with key informants, and document review. RESULTS: The results showed that most of the informants already knew the process and output of FKTP Tinnitus Teleconsulting performance; only a few FKTPs did not understand the process and output of policy performance, so even though they acknowledged that they had implemented it, there were no documents recorded in the logbook or electronically recorded patient medical data through the social security agency's health care application. CONCLUSION: The findings of this study can be used by FKTP and other district or city social security agencies of health to improve the performance achievement of FKTP Tinnitus Teleconsulting implementation.

Level and determinants of incentives for village midwives in Indonesia.

Since the early 1990s Indonesia has attempted to increase the level of skilled attendance at birth by placing rural midwives in every village in an effort to reduce persistently high levels of maternal mortality. Yet evidence suggests that there remains insufficient incentive to ensure an equal distribution across areas while the poor in all areas continue to access skilled attendance much less than those in richer groups. We report on a survey that was conducted as part of a complex evaluation of the rural midwife programme in Banten Province, to better understand the effect of financial incentives on the distribution of midwives and use of services. Midwives obtain almost two-thirds of their income from private clinical practice. Private income is strongly associated with competence and experience. Multivariate analysis suggests that midwives are well able to earn a substantial private income even in remoter areas. Yet the study also found a high level of unwillingness to move posts to a more remote area for a variety of non-financial reasons. The results suggest that the access to skilled attendance of those unable to afford fees may be impaired by the dependence on fee income, a result supported by companion household studies. In addition, ensuring that staff live and work in remoter areas is only likely to be financially sustainable if midwives can be attracted to live in these areas early in their careers. Finally, the overall strategy of basing skilled attendance mainly on village services throughout the country may need to be re-visited, with alternative models offered in areas where it continues to be impractical even with a change in the incentive framework.

Public funding for community-based skilled delivery care in Indonesia: to what extent are the poor benefiting?

Since the early 1990s, the Government of Indonesia has addressed high maternal mortality by attempting to ensure skilled attendance at delivery through access to trained village midwifery services in every village. Yet access to skilled services at delivery continues to prove problematic, with low levels of skilled attendance and high mortality. Making use of a funding flow analysis and population-based survey in two districts, we investigate to what extent funding allocated for maternal services enables access to skilled services by rich and poor households. The results suggest that, although resources reach remote poor areas, the poor obtain unequal access to skilled delivery services. Because rural midwives must earn a significant fraction of their income from private fees this acts to deter women from seeking their help. A new system of targeting poor women utilising the existing state insurance company (ASKES) is an important step in helping to reduce these barriers, but may not be sufficiently generous to protect all those that are considered vulnerable.

An economic analysis of midwifery training programmes in South Kalimantan, Indonesia.

In order to improve the knowledge and skills of midwives at health facilities and those based in villages in South Kalimantan, Indonesia, three in-service training programmes were carried out during 1995-98. A scheme used for both facility and village midwives included training at training centres, peer review and continuing education. One restricted to village midwives involved an internship programme in district hospitals. The incremental cost-effectiveness of these programmes was assessed from the standpoint of the health care provider. It was estimated that the first scheme could be expanded to increase the number of competent midwives based in facilities and villages in South Kalimantan by 1% at incremental costs of US$ 764.6 and US$ 1175.7 respectively, and that replication beyond South Kalimantan could increase the number of competent midwives based in facilities and villages by 1% at incremental costs of US$ 1225.5 and US$ 1786.4 per midwife respectively. It was also estimated that the number of competent village midwives could be increased by 1% at an incremental cost of US$ 898.1 per intern if replicated elsewhere, and at a cost of US$ 146.2 per intern for expanding the scheme in South Kalimantan. It was not clear whether the training programmes were more or less cost-effective than other safe motherhood interventions because the nature of the outcome measures hindered comparison.