Building health systems resilience: understanding the social, economic, and cultural impacts of climate change from stakeholders' perspectives in Indonesia.

OBJECTIVES: This study explores stakeholders' perspectives on the direct, social, economic, and cultural impacts of climate change on health in Indonesia and identifies possible strategies to enhance health system resilience. METHODS: This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines to ensure comprehensive and transparent reporting. Purposive sampling was used to select 22 stakeholders with relevant expertise, including government officials, representatives from international and professional health organizations, health workers, and community representatives. Semi-structured interviews were conducted, and data were analyzed using directed content analysis. Data saturation was reached when no new themes emerged. RESULTS: The findings reveal significant challenges to Indonesia's health system due to climate change. Community awareness varies widely, with higher levels in disaster-prone areas. Socially, climate change has fostered community cooperation through collective adaptation efforts but has also led to tensions due to inequitable resource distribution. Economically, rising healthcare costs and financial instability, particularly in rural and disaster-prone regions, place a strain on the system. Culturally, there is a growing emphasis on environmental conservation, promoting eco-friendly practices and the integration of traditional and modern health approaches. CONCLUSION: Building health system resilience in Indonesia requires addressing the social, economic, and cultural impacts of climate change. Possible strategies include enhancing public health education, strengthening healthcare infrastructure, improving inter-agency coordination, and leveraging technology to support effective responses to climate-related health threats, ultimately promoting national health, social stability, and economic growth.

Growing Up Unequal: Disparities of Childhood Overweight and Obesity in Indonesia's 514 Districts.

BACKGROUND: Childhood obesity is a major public health concern as it increases the risk of premature death and adult disability. Globally, the latest estimates showed that more than 340 million children and adolescents between the ages of 5 and 19 were overweight or obese in 2016. This study aimed to investigate the disparities in childhood overweight and obesity across 514 districts in Indonesia, based on geographic and socioeconomic factors. METHODS: Geospatial and quantitative analyses were performed using the latest Indonesian Basic Health Survey data from 2018. Dependent variables were rates of overweight and obesity among children aged 5-17 years including by gender. RESULTS: This study found that the rates of overweight were 17.2%, 17.6%, and 16.8% among all children, boys, and girls, while the rates of obesity were 7.0%, 7.9%, and 6.1%, respectively. Boys were 1.30 times more likely to be obese than girls, while overweight was similar between both sexes. Urban cities had significantly higher prevalence of childhood overweight and obesity compared with rural districts by up to 1.26 and 1.32 times, respectively. In addition, the most developed region had significantly higher prevalence of childhood overweight and obesity than the least developed region by up to 1.37 and 1.38 times, respectively. With regard to socioeconomic factors, our analysis demonstrated a notable disparity in the prevalence of childhood overweight and obesity across income quintiles. Specifically, the wealthiest districts exhibited a 1.18 times higher prevalence of overweight and obesity among all children compared with the poorest districts. This association was particularly pronounced among boys; in the richest quintile, the prevalence of overweight and obesity was 1.24 and 1.26 times higher, respectively, in comparison to the poorest income quintile. In contrast, district-level education appears to exhibit an inverse relationship with the prevalence of childhood overweight and obesity, although the findings were not statistically significant.

Health Personnel Improvement in the Implementation of Shariah's Ethical Code of Conduct in Tangerang Hospital, Indonesia.

Background: The Shariah hospital aims to provide health services inclusive of the appropriate code of ethics of Sharia, which exceeds the standard of service expected of conservative hospitals. Hospital care depends on the performance of health professionals. The study aimed to assess the relationship between the implementation of the ethical code of Shariah hospitals and the performance of health personnel. Methods: The study is a quantitative analysis that collects cross-sectional data from 119 health personnel respondents in one Shariah hospital in Indonesia. Data analysis was performed using structural equation modeling (SEM). Results: The implementation of the ethical code of Shariah hospitals, whether explicit or implicit, has a significantly positive influence on the performance and well-being of health personnel, which is evident from the t value of 4.31 (more substantial than the t value of 1.960). This implementation should run consistently and with the commitment of all parties. Conclusion: Such insight, in turn, can be counted as an input to an approach to health services, particularly in increasing the performance rates in hospital. This study is the first to provide new insight into discussion about Shariah hospital's code of conduct by presenting its beneficiary to not only improve health personnels' performance but also provide the inclusive health service for all religions and cultures which is essential in further study.

Usefulness of the CODE ST-Segment Elevation Myocardial Infarction Program to Improve Quality Assurance in Patients With ST-Segment Elevation Myocardial Infarction.

The highest mortality rate associated with acute coronary syndrome is observed in patients with ST-segment elevation myocardial infarction (STEMI). Quality care in STEMI management depends on timely reperfusion of the ischemic coronary artery. The CODE STEMI program has been developed to reduce delays and serves as a method to improve quality care in patients with STEMI. Our study aimed to investigate the effects of implementing the CODE STEMI program on quality care and hospital marketing strategy. Our research was a descriptive study with mixed evaluation methods. We enrolled 207 patients with STEMI who underwent primary percutaneous coronary intervention from 2015 to 2018. We used quantitative methods by tracking medical records and administrative documents, as well as qualitative methods by observation and in-depth interviews. Statistical analysis was done using Mann-Whitney and chi-square tests. Our study demonstrated reduced door-to-balloon time, total cost, and length of stay of patients with STEMI who were treated with the CODE STEMI program (p <0.001, p <0.001, and p = 0.009, respectively). In addition, there was a likely decrease in major adverse cardiac event incidence and mortality rate after the implementation of CODE STEMI. The hospital and patients expressed their satisfaction with the CODE STEMI program. The program proved to have good efficacy, effectiveness, optimality, acceptability, legitimation, and equity. It also met the marketing mix principles, which included increasing the total number of patients with cardiovascular diseases as well as increasing levels of public trust in STEMI management. In conclusion, the CODE STEMI program has a positive impact on quality care and hospital marketing strategy.