Adoption of policies to improve respectful maternity care in Timor-Leste.

INTRODUCTION: There are now well-established global standards for supporting improvement in women's experience of maternity services, including frameworks for the prevention of mistreatment during childbirth. To support initiatives to improve the quality of care in maternal health services in Timor-Leste, we examine the adoption of global respectful maternity care standards in the national intrapartum care policy and in three urban birth facilities in Dili. METHODS: From May to July 2022, we conducted a desk review of the Timor-Leste National Intrapartum Care Standards and Clinical Protocols for Referral Facilities and Community Health Centres. This was followed by a health-facility audit of policies, guidelines and procedures in three main maternity facilities in the capital, Dili to examine the extent to which the WHO (2016) standards for women's experiences of care have been adopted. RESULTS: Despite the availability of global guidelines, key standards to improve women's experience of care have not been included in the National Intrapartum Care guidelines in Timor-Leste. There was no mention of avoiding mistreatment of women, needing informed consent for procedures, or strengthening women's own capability and confidence. In the policy wording, women tended to be distanced from the care 'procedures' and the protocols could be improved by taking a more woman-centred approach. The results of the health facility assessment showed extremely low use of standards that improve women's experiences of care. Health Facility 1 and 2 met two of the 21 quality measures, while Health Facility 3 met none of them. CONCLUSION: The discourse communicated through policy fundamentally affects how health care issues are framed and how policies are enacted. Given the findings of this study, combined with previously documented issues around quality of care and low satisfaction with maternal health services, there is a need for a fundamental shift in the culture of care for women. This will require an immediate focus on leadership, training and policy-frameworks to increase respectful care for women in health facilities. It will also require longer-term effort to address the power imbalances that drive mistreatment of women within and across social systems, and to support models of care that inherently foster understanding and compassion.

The influence of knowledge and perceptions of doctors on the quality of medical records.

BACKGROUND: Medical record reflects the quality of health services provided, which is influenced by existing resources, such as the doctors in charge. This study aims to determine whether doctors' knowledge and perceptions affect the quality of the medical record. DESIGN AND METHODS: This is a quantitative and cross-sectional study carried out at Dr. Soetomo's general and academic hospital Surabaya, Indonesia, in September and October 2020. Data were purposively obtained from a total of 45 doctors working at the hospital's inpatient service surgery ward using the questionnaire and checklist medical record quality. Furthermore, ethical clearance and doctors' informed consent were obtained, with the data statistically processed and analyzed by multiple linear regressions. RESULTS: The results and conclusion showed that doctors' knowledge and perceptions of the quality of medical records were influence to medical record quality (p<0.05). CONCLUSIONS: Hospital management needs to regularly increase doctors' knowledge and perceptions by socializing and monitoring medical records.

Brand equity analysis to increase health care utilization.

Background: Health care utilization is one of the key indicators in measuring performance of health care services. Strong brand equity suggests positive correlation with great attraction for consumers to use a product. Design and Methods: A cross-sectional study was conducted to identify the effects of brand equity to health care utilization. 381 students were selected by simple random sampling. Multiple logistic regression tests were used to analyze the influence between variables. Results: Findings showed that there was an influence between brand equity and health care utilization (P=0.001). In the three attributes, brand equity was known to have an influence to the utilization of health care. The highest influence of the three attributes was brand association (Exp (B) = 2.501). Conclusions: It can be concluded that brand equity affects patient visits to AHCC showing that the brand equity significantly influence patient visits. Promotion to create familiarity and good impression was required to enhance brand equity and increase health care utilization.

Understanding patient satisfaction and loyalty in public and private primary health care.

Background: The quality of health centers, patient satisfaction, and loyalty are three key factors that enable health care providers to improve their services and cost-effectiveness. This study, therefore, aims to determine patient satisfaction and loyalty in public and private primary health care centers. Design and Methods: Data were obtained from a cross-sectional design of 1470 self-administered questionnaires and analyzed based on mean, standard deviation, and correlation coefficients. Results: The results showed respectively a strong and moderate correlation between patient satisfaction and loyalty in private (r=0.767) and public (r=0.54) primary health care centers, respectively. In addition, in both centers patients received adequate medical services, with social aspects as the least important factors affecting patient satisfaction. Conclusions: In conclusion, primary health care practices need to recognize the needs that influence patients' satisfaction and loyalty, to improve the quality of their services.

Development of sweet potato (Ipomoea batatas Lamk.) as excipient in tablet formulation.

Background: Sweet potato has a potential to be used as a raw material for tablets. However, it needs chemical modifications to produce derivatives with excellent pharmaceutical characteristics. The primary purpose of this research was to use sweet potato starch (Ipomoea batatas Lamk.) as a tablet excipient modified through a chemical process. Design and Methods: This study is experimental and is divided into three stages. The first stage is the extraction process to obtain sweet potato starch. The second stage is the chemical modification of sweet potato starch using pentanol-1 and glacial acetic acid. The third step is the analysis of the pharmaceutical properties of the mutated lab model compared to the control sample and Amprotab. Results: The descriptive-comparative analysis showed sweet potato starch modified with panthenol-1 had a higher hardness value (=2.55±0.34) compared to native starch (1.00±0.08). The particle size distribution of the modified sample with acetate acid (=15.20±1.79) was higher than the others. Conclusions: In conclusion, modified sweet potato starch has better pharmaceutical properties than native starch. Further research needs to be conducted on the magnitude of the potential of sweet potato starch as an excipient, both as filler, a binder, and a crushing agent on tablet preparations.

Health promoting hospital: A practical strategy to improve patient loyalty in public sector.

Background: The Health-Promoting Hospital (HPH) aims to improve the overall quality of health services for patient, families, and the community as a whole, with assessment and intervention as the essential components. In hospitals, this activity needs to be vigorously developed through interdisciplinary teamwork, shared decision-making process, and by involving patients and families during treatment and through the delivery of an evidence-based health promotion process. Previous studies analyzed some steps to improve patient loyalty through the HPH. However, limited studies were carried out on its use in the public sector. This study, therefore, aims to analyze the impact of HPHs to improve patient loyalty in the public sector. Design and Methods: The simple random sampling method was used to obtain data from 101 respondents in a public hospital, with the cross-sectional design used to gain a better understanding of patient loyalty. Results: The result showed that HPHs influenced patient expectations (P=0.030), which in turn affected perceived value (P=0.014) and satisfaction (P=0.002). In addition, perceived value and satisfaction have effects on patients' loyalty (P=0.001). Conclusion: In conclusion, HPHs have a positive impact on patient loyalty. Therefore, the public sector needs to enhance its services in accordance with the standards and guidelines.

The superior service based on the highest number of visits and income of Hajj Hospital Surabaya in The National Health Insurance era.

Background: A hospitals' superior service is expected to be of higher value than other available provisions, which consequently differentiates the facility from others, as the branding easily attracts the community attention. The purpose of this study, therefore, is to identify the most needed and profitable health services from existing hospitals. Design and methods: This was a descriptive research performed with a cross sectional study approach. The variables studied include the number of visits, and revenue based on National Health Insurance (JKN). Results: Findings show that the polyclinics were the highest number of visits between 2016 and 2017 include Cardiac, Internal Medicine, Medical Rehabilitation, Nerve, General Surgery, and also Dental & Mouth. Conversely, those with the most significant income include Heart, Polyclinics, Dental & Mouth, as well as General Surgery Polyclinics. Moreover, the Medical Rehabilitation and Internal Medicine outpatient installations demonstrated negative INA income, while the already running featured Services in high demand were Heart, Nerve, Dental & Oral, and also General Surgery polyclinics. Conclusions: In can be concluded that not all polyclinics with high traffic generate positive income, hence it is necessary to monitor and analyze National Health Insurance (JKN) monthly income.

People equity model as an effort to increase employees' intention to stay.

Background: The high turnover rate in the healthcare industry needs serious attention since it influences hospital service quality. So, there is a need to develop a new framework known as people equity, that can be used to manage intangible assets and reduce employees' intention to leave. The purpose of this study therefore was to develop a model of people equity as a strategy for enhancing employees' intention to stay. Design and methods: An analytical cross-sectional design was used to measure the associations between variables. 154 respondents were selected from stratified random sampling technique. Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to analyze the measurement model. Results: The results indicated that people equity was influenced by organizational factors (P=0.210), individual factors (P=0.183), and occupational factors (P=0.141). In addition to this, predictors for employees' intention to stay were people equity (P=0.432), individual factors (P=0.308), and environmental factors (P=0.117). Conversely, working and marital status, environment, and workload have no significant effect on people equity and intention to stay. Conclusions: People equity was influenced by organizational, individual, and occupational factors through the implementation of the Human Resources System. People equity model increased employees' intention to stay by improving organizational factors.

Health insurance literacy: discussion and reaction of Facebook users' towards the National Health Insurance in Indonesia.

Universal Health Coverage always persevered as a pro poor policy in many countries, characterized by a major impact on higher out-of-pocket healthcare costs, with low-cost alternative prescription drugs and capitation payments made to physicians, in order to reduce inequity. These concerns have been discussed widely on social media, including Facebook, but social media are consistently neglected as a source of scientific information. The purpose of this study, therefore, is to analyze the thought process or feelings of individuals about the policies, also focusing on the possible reactions. Hence, a systematic review in the form of discussion forums on the Facebook page of the National Health Insurance Agency, Indonesia was conducted from 2015 to 2016, with regards to the implementation of National Health Insurance, within a year and half after the policy was launched. In addition, the contents of 148 discussions were deductively analyzed, and the findings showed the pragmatic disposition of most Facebook users towards health care utilization, the costs of Insurance, and the possible benefits of payment. Furthermore, the debate conducted in social media related with the policy and its practice issues ought to be countered through appropriate modification.

Developing a Holistic-Comprehensive Assessment Model: Factors Contributing to Personal Protective Equipment Compliance among Indonesian Cement Workers.

CONTEXT: Noncompliance with personal protective equipment (PPE) in industrial workers results in increased injury or illness and is commonly reported worldwide. Numerous guidelines and management policies are employed to prevent work-related health hazards, yet industrial workers still exhibit low rates of PPE compliance, especially in outsourced workers. AIMS: The aim of this study was to develop a holistic-comprehensive assessment framework model summarizing the key factors in achieving the stated goals of interventions targeting PPE compliance in Indonesian cement workers. SETTINGS AND DESIGN: An analytic observational study was conducted among 183 Indonesian cement workers from a simple random sampling technique. METHODS AND MATERIAL: A self-designed questionnaire was used to investigate factors influencing PPE compliance among cement workers as well as management policies in place. STATISTICAL ANALYSIS USED: Statistical analysis was conducted using SPSS version 24. Results were tabulated using frequency distribution and mean with a standard deviation. The logistic regression model was developed to identify the factors that affect PPE compliance. RESULTS: The highest rate of compliance was 43.7%, a still low figure. Using correlation coefficients and logistic regression, both the behavior of the workers and the existing management policies were found to be significant contributing factors (P < 0.05). Punitive management policies were also found to be a determining factor (OR 5.22; 95% CI 1.01-1.07). CONCLUSIONS: Management policy, specifical punishment for noncompliance, was shown to be the strongest influence on PPE compliance in Indonesian cement workers.