Paper presented at 8th National Public Health Conference. Hotel Equatorial, Melaka. 2-4th August 2016

1. Machmud,R1 , Azkha,N2 , Masrul1, Symond,D2 , Semiarti,R1
1Faculty of Medicine, Andalas University, West Sumatera, Indonesia
2Faculty of Public Health, Andalas University, West Sumatera, Indonesia
Implementing Social determinant of
Health through Social capital and
Empowerment of the Jati Village to
Reduce Inequities in Health
Presented in the 8th National Public Health Conference 2016. 2-4 August 2016. Hotel Equatorial
Melaka

2. PROBLEMS
▪ The weakness of community level health service is a
major concern for health promotion in Indonesia.
▪ These services barely maintain current community
healthcare needs and struggle to generate long-term
changes.
▪ The development of sustainable local health programs
and services is critical.

3. GOALS
▪ To identify implementation processes in Jati Village,
Indonesia that strengthen community-based health
services and
▪ To evaluate the 5-year health impacts and
sustainability.

4. CONCEPT RELATED

5. WHAT IS SOCIAL CAPITAL ?
DEFINITION
Putnam, Leonardi & Nanenetti (1993:167)
define social capital as those “features of
social organization, such as trust, norms,
and networks that can improve the efficiency
of society by facilitating coordinated
actions”.
Social capital describes the pattern and
intensity of networks among people and the
shared values which arise from those
networks.

6. SOCIAL CAPITAL

7. Community
Social
Capital
Model
University
Minnesota 2009

8. METHOD
Applying the 4 pillars of
the action health model
empowerment, capacity
building, equipment &
attractive activity
Deliberating and
brainstorming with the
community about their
problems to co-
produce solutions
Mapping the
determinant of
health problem ; 400
respondents
including key
container-pupal
survey
Phase 1 Phase 2 Phase 3

9. Phase 1
Mapping the
determinant of health
problem

10. The Potential problem at Jati village
Observation & Interviews
The attitude of the community : Throwing away all garbage in the environment

11. THE GRAPH OF MALNOUSRISHED CHILDREN UNDER 5-YEARS OLD AT
EVERY DIVISION OF SUB DISTRICT AT JATI VILLAGE
0
5
10
15
20
25
RW 1 RW 2 RW 3 RW 4 RW 5 RW 7 RW 8 RW 9 RW 10
6 6
20
18
17
24
18
19
11
0
1
4
0
1
3
2
0
1
NORMAL MALNOURISHED
11

12. There are pregnant women
with high-risk bearing (25,9%)
Malnutrition in
Children under 5-years old
(8,5%)
High risk
26%
Low risk
74%
Pregnant women
High risk Low risk
Normal
91%
Malnourishe
d
9%
Malnourished
Normal Malnourished
12

13. PUPAL SURVEY

14. Deliberating and
brainstorming with the
community
Phase 2

15. VILLAGE SOCIETY MEETING
▪ The citizen are curious and enthusiastic to
discuss the solution of their problems
15

16. BRAINSTORMING
▪ The chief of Jati village, with the
citizens & society figures, is
committed to establish groups to
manage & coordinate the interfering
activities of the primary problem,
existing in Jati village
▪ The chief announced to establish
working groups to manage all social
activities in the environment as well as
society health in Jati village
16

17. Phase 3
Applying the 4 pillars of
the action health model

18. THE ACTION HEALTH MODELS
EMPOWERMENT
CAPACITY
BUILDING
EQUIPMENT
ATTRACTIVE
ACTIVITIESCOMPANY LOGO

19. No Plan of activities Time Target
Person in
charge
Goals
1. Jati village society meeting about
society empowerment
Date: 17-02-
2010 time:
20.00 WIB.
Society figure &
youth
Collage
student &
chief of the
village
To make commitment together how
important the organization is
2. Encouraging society through
cooperation from the youth centre
location to their own house
Date: 21-02-
2010
Time: 09.00 AM
Society & youth College
student
To increase the participation as well
as the solidity of the exsissting
project
3. Empowering the society through
the planting of the herbal plants in
their house yard
Date:21-02-
2010
Time: 09.00 AM
Society & youth College
student
To empower the appointed society
4. Running The green program by
partnership approach, with Padang
cleanliness & gardening office. As
impact, the community received
50 young palm trees then with the
youth do the planting
Date: 21-02-
2010
Time:09.00 AM
Society & youth College
student
To established partnership approach
with Padang cleanliness & gardening
office in ordered to increase the
participation of the youth
5. Guiding the young generation
through setting up a simple sport
court
Date: 21-02-
2010 time:
09.00 WIB
Society & youth College
student
To re-function the simple sport court
as a mean of society sport centre
6. Building a public toilet at youth
centre
Date: 21-02-
2010
Time: 10.00 AM
Society & youth College
student
To support society activities at youth
centre
7. Refreshing the cadre of Buah
Delima I & IV integrated health
service
Date:23-02-
2010
Time:02.00 PM
Cadre College
student &
public health
centre officer
To increase the cadre knowledge
abouth the five table system of the
integrated health centre
19

20. N
o
Plan of activities Time Target
Person in
charge
Goals
8. Counseling about
entepreneurship in suporting
health programs.
Date: 25-02-2010
Time: 7.00 PM
The 3rd Sub
Group of Jati
vilage
Enterpreneur
JCC
to motívate the citizen and the
youth to be enterpreuner.
9. Creating and setting the board
of integrated service post and
youth
Date: 28-02-2010
time: 09.00 AM
Youth centre College student There is a name board of the
youth center.
10 Creating and sticking health
poster.
Date:28-02-2010
time: 09.00 AM
Youth centre College student As health information in youth
centre
11 Creating and sticking society
organization chart.
Date:28-02-2010
time: 09.00 AM
The youth and
society
organization
College student Empowering to each existing
organization.
12 Counceling the behavior of
clean & healty life style in
supporting the increase of
the health of society
Date: 28-02-2010
time: 04.00 PM
The youth and
society
College student The improvement of the
knowledge of the society in
order that they are able to be
active in health field.
13 Activiating “the distributing
thousand for health” each
house hold
Date: 04-03-2010
time : 01.00 PM
society College student
& Public health
centre
Searching the potencial funds
in society.
14 Relocating integrated service
for health “ buah Delima 1” to
youth centre
Date:04-03-2010
Time :10.00 AM
cadre College
student, Public
health centre &
chief of sub
district
To optimallize the use of youth
centre
15 Counseling as well as
recycling about all garbage
Date:04-03-2010
time:11.00 AM
society College student To motivate citizen & youth to
enterpreune
20

21. ▪ Growing the family-herbal plants
(TOGA)
▪ Performing social working
cooperation with citizens and
college students

22. Guiding the young generation in restoring the sport youth centre “volley courtyard”

23. Counselling also included
information about
garbage recycling.
Counselling on the
behavior of clean & healty
life style.

24. Relocating integrated service for
health service center “ buah
Delima 1” to youth centre
Activating “the thousand rupiahs
charity for health” from each
house hold

25. 2010-2015
SUSTAINABILITY-
AFTER 5 YEARS

27. PRE SCHOOL EDUCATION
CALLED PAUD
THE CHILDREN AGED 2-5 YEARS
ARE IN SCHOOL 3 TIMES IN A
WEEK
2010

28. Start of the project 2009 – new building 2011 – fences 2012 – continue until 2016
28

29. ADDITIONAL BUILDING FOR
THE MULTIPURPOSE
ACTIVITY 2011
BUILDING BASED ON
COMMUNITY FUNDING AID
2011

30. The inauguration of the business
unit by The former ministry of
welfare in 2012
The community members donated
some money to the business unit,
and the agency manages the
turnover of the money. Some of the
profits will be used for community
development in 2012
2012

31. New building in 2013, the development continues
each year

32. Sustainability and development of public utility 2009 -2015
2009
2015

33. 33

34. This environment
after being
renovated
They separate
between organic and
inorganic rubbish
The environment
is clean, no
garbage in ditch

35. OUTPUTS
Succeed to initiate
and drive the
processes of
social changes
The Improvement
of living conditions
conducive to
health
Get Multiplier
Effects

36. OUTCOMES
Fostering the growth of some other community based
actions
The availability
of health care for
senior citizen
The availability
of pre school
education
The availability
of income
generating
activities

37. IMPACTS
Community
demonstrates
trust and
confidence in
each other
Community
helps each
other and
enables them
to be the
member of
social group
Community
becomes
successful in
social, cultural,
and health terms

38. RESULTS
▪ Result of the pupal survey in pre and post intervention within 6 month
showed that the number of positive containers decreased from 33.3% into
4%.
▪ The occurrence of dengue hemorrhagic fever in Jati village has
decreased within 5 years and become null.
0
5
10
15
20
25
30
35
40
45
Pre-Intervension Post-
Intervention
Negative 30 43
Positive 15 2
Negative
Positive

39. CONCLUSIONS
Creating community based health service programs with lasting effects requires a
deliberate, thoughtful approach to planning, leading &collaborating.
Building an effective, integrated & sustainable system from bottom-up is an important
step in improving the overall health & well-being of a community.
Activities as the foundations for a well-balanced social system, health literacy at the
individual and community levels, social capital which favors mutual collaboration between
social agencies, all generate sustainability of this system itself