The role of profession in preparing health promoters in covid-19 pandemic

1. THE ROLE OF PROFESSION IN
PREPARING HEALTH
PROMOTERS IN COVID-19
PANDEMIC
Rita Damayanti
Panel 1: 08.35-10.00
Community readiness for effective
Covid-19 prevention
INTERNATIONAL HEALTH SEMINARS
SILIWANGI UNIVERSITY,
Thursday 25 November 2021

2. OUTLINE
1. THE ROLE OF ISHPE
2. COVID 19 SITUATION IN
INDONESIA
3. BEHAVIOR CHANGE
STRATEGY
4. IMPROVING COMMUNITY
COMPLIANCE

3. 1. THE ROLE OF INDONESIAN SOCIETY
ON HEALTH PROMOTION AND
EDUCATION

4. Under law
number 36
year 2014
regarding
health
professional
article 11
• Medical doctor
• Nurse
• Pharmacist
• nutritionist
• Physical therapist
• Medical technician
• Public Health
Health Professional
• Epidemiologist
• Health Promotion
• Occupational Health & Safety
• Public Health Administration
• Biostatistician
• Reproductive Health
Public Health

5. Law Number
36/2014
regarding
Health
Professional
Chapter V
Professional
Organization
Article 50:
1) Every health professional should
have organization as a place to
improve and/or develop knowledge
and skills, dignity and professional
ethics of health
2) Every health professional should
have only one organization

6. PROFESSIONAL ORGANIZATION
FOR HEALTH PROMOTOR
Established: 22 Februari 1971
Established. : 14 February 1988,
# PROVINCIAL. : 23/34 (68%)
# DISTRICT/CITY : 134 /514 (26%)
# MEMBER : 8.889
# REGISTERED : 3.365 (update Ags 2021)

7. OTAWA
CHARTER
(1986)

8. IUHPE Core competencies and
professional standard

9. Health Promotion Domain of Core Competencies
(Galway Consensus 2009)
Advocacy Partnership
Catalyzing Change
Leadership
Implementation Evaluation
Assessment
Planning

10. PROFESIONAL STANDARD FOR HEALTH
PROMOTOR
KEPMEN
HK.01.07/MENKES/315/2020
Schematic Arrangement for
Standard Competency

11. AREA OF COMPETENCY
6. BASIC PH:
PROBLEM SOLVING CYCLE
5. TECHNICAL SKILL:
IEC, EMPOWERMENT,
PARTNERSHIP, ADVOCACY
4. APLICATION OF HP
1. PROFESIONALITY
2. SELF DEVELOPMENT
3. LEADERSHIP AND
EFFECTIVE
COMMUNICATION

12. INTERNATIONAL
QUALIFICATION
FRAMEWORK

13. COMPETENCY BASED ON IQF
Level 6
Primary Health Care
Level 7
Hospital setting, in
the worksite, school,
addiction clinic
Level 8
Consultant on
planning and
evaluation
Level 9
Consultant on in
health promotion
policy

14. 12
COMPETENCIES
COMPETENCY BASED ON LEVEL OF EDUCATION
Competency
D3
(level 5)
D4
(level 6)
S1 Kesmas
(level 6)
Profesi (level
7)
S2
(level 8)
S3
(level 9)
1 Problem solving cycle x x x x x x
2
Health promotion
knowledge
x x x x x x
3 Communication x x x x x x
4
Leadership and team
building
x x x x x x
5 Media Development x x x x x x
6 Community empowerment x x x x x
7 Partnership x x x x
8 Advocacy x x x x x
9
Financing in Health
Promotion
x x x x
10 Professional ethics x x x
11 Health behavior research x x
12 Healthy Public Policy x

15. 1. COVID 19
SITUATION IN
INDONESIA

16. PREDICTION OF COVID-19 NEW CASES IN
INDONESIA
Note: # of cases detected by
the testing capability
# of cases in reality 5-10
times higher
Source: Iwan Ariawan, Pandu Riono, Muhamad N Farid, hafizah Jusril, Wiji Wahyuningsih. Pemodelan Epidemi COVID-19 pada Masa Transisi di
Indonesia dan 7 Provinsi
24 Oct 2020: 4070 new cases

17. DAILY PROGRESS OF CONFIRMED CASES
OF COVID-19

18. DAILY DEATH CASES

19. ASSESSMENT OF COVID-19 SITUATION
IN INDONESIA (NOVEMBER 2021)

20. ASSESSMENT OF COVID-19 SITUATION
IN WEST JAVA (NOVEMBER 2021)

21. Reference for assessment for the level
of Community Activity Restrictions
(PPKM)
21
Tim Pandemi FKM UI
Indikator Laju
Penularan
Tidak
ada
kasus
Kasus
Impor /
Sporadis
Kluster
Kasus
Transmisi Komunitas
/ 100.000 penduduk / minggu
Level 1 Level 2 Level 3 Level 4
Kasus
Konfirmasi
Tidak ada
Kasus
diimpor
atau
sporadis.
Kasus
terbatas
pada
kluster.
<20 20-50 50-150 >150
Perawatan
RS 5 5-10 10-30 >30
Kematian 1 1-2 2-5 >5
Indikator Respon
Kesehatan
Memadai Sedang Terbatas
Testing
– Positivity
Rate
<5% 5–15% >15%
Tracing –
Kontak Erat
per Kasus
Konfirmasi
>14 5–14 <5
Treatment –
Bed
Occupancy
Rate
<60% 60–80% >80%
Level Laju
Penularan
Level Kapasitas Respon
Memadai Sedang Terbatas
Tidak ada
kasus
0 0 1
Kasus
impor/sporadi
s
0 1 1
Kluster kasus 1 1 2
Transmisi
komunitas
level 1
1 2 2
Transmisi
komunitas
level 2
2 2 3
Transmisi
komunitas
level 3
2 3 3
Transmisi
komunitas
level 4
3 3 4
Asesmen Situasi
Jika salah satu indikator masuk dalam level 4 di indikator laju penularan, maka daerah tersebut masuk
ke level 4 meskipun
di indikator lain masuk ke level 1-3. Hal ini juga berlaku untuk indikator respon Kesehatan.
Sumber: Kemenko Marves, 24 Juli 2021 (Adaptasi dari WHO, 14 June 2021)

22. 2. BEHAVIOR
CHANGE
STRATEGY

23. RISK OF NOT COMPLY WITH
SOCIAL DISTANCING

24. Behavior Protection Efect to reduce risk of
having Covid-19
1. Derek K Chu, Elie A Akl, Stephanie Duda, Karla Solo, Sally Yaacoub, Holger J Schünemann. Physical distancing, face masks, and eye protection to
prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. www.thelancet.com Published
online June 1, 2020 https://doi.org/10.1016/S0140-6736(20)31142-9
2. Andrew Hayward, Sarah Beale, Anne M Johnson, Maria Zambon, Ellen B Fragaszy. Hand and Respiratory Hygiene Practices and the Risk and
Transmission of Human Coronavirus Infections in a UK Community Cohort. The Lancet, pre-print, https://dx.doi.org/10.2139/ssrn.3551360
Risiko
tertular
Without any
prevention
Risk of
having
C-19
(5-20%)
Physical distancing
More than 1 meter 1
0,15R
Reduced
risk by
+85%
Washing hands
with soap/
handsanitizer
0,65R
Reduced
risk
+35%
Using cotton
mask 1
0,55R
Reduced
risk by
+45%
Using surgery mask 1
0,30R
Reduced
risk by
+70%

25. Note: If more than 75% of people using mask the
Covid-19 pandemic can be controlled.
Sumber: The multiplicative power of mask. https://aatishb.com/maskmath/

26. BEHAVIOR CHANGE STRATEGY
EDUCATION ENGINERING
ENFORCEMENT EMPOWERMENT

27. 1. EDUCATION
UNDERSTANDING
(KNOWLEDGE)
ACTION
(PRACTICE)
EVALUATING
(ATTITUDE)
(Taxonomy Bloom)

28. 2. INTERVENTION
Access
• Affordable
• Easy
Attractive
• Influencer
• Prestigious
Beneficial
• Profit and lost
consideration
• Long term vs
short term

29. (Bandura, Social Cognitive Theory)

30. 3. ENFORCEMENT
Behavior Change Theory (SR, Skinner)
ANTECEDENT  BEHAVIOUR  CONSEQUENCE
Positive C19  still go to the factory  Incentive
harian
Must WFO Not using mask fine Rp. 250.000

31. A Ladder of Citizen Participation
(Arnstein, Sherry R, 1969. Jurnal of the American Institute of Planners)
Participation is a medium of empowerment in community development
4. EMPOWERMENT

32. Robert D. Putnam (1993) social capital can facilitate supportive networking
in the community to solve communitity problem.

33. Source: Community Resilience as a Metaphor, Theory, Set of
Capacities, and Strategy for Disaster Readiness. Fran H. Norris,
Susan P. Stevens, Betty Pfefferbaum, Rose L PfefferbaumApril,
2008 American Journal of Community Psychology 41(1-2):127-50
• Community resilience
is a process linking a
network of adaptive
capacities (resources
with dynamic
attributes) to
adaptation after a
disturbance or
adversity.

34. • Community adaptation
is manifest in
population wellness,
defined as high and
non-disparate levels of
mental and behavioral
health, functioning,
and quality of life.
COMMUNITY RESILIENCE CAN MAKE THE
ADAPTION OF NEW BEHAVIOR

35. COMMUNITY RESILIENCE STRATEGY
• Strategy that can make
community readiness to
adapt with disturbance
situation such as Covid-
19 pandemic.
Economic
Development
Social Capital
Information
and
communication
Community
Competence
COMMUNITY RESILIENCE

36. HOW TO BUILD
COLLECTIVE RESILIENCE?
Steps to build Comm Resilience
• Reduce risk and resource
inequities
• Engage local people in
mitigation
• Create organizational linkages
• Boost and protect social
supports
• Plan for not having a plan,
which requires flexibility
• Decision-making skills
• Trusted sources of information
What have the Government
done?
• Special program for the
poor such as grocery
package from, financial
support for the unemployed
• Using local people to help
health promotion and
surveillance
• Building network with CBO
and NGOs
Source: Community Resilience as a Metaphor, Theory, Set of Capacities, and Strategy for Disaster Readiness.Fran H. Norris, Susan P.
Stevens, Betty Pfefferbaum, Rose L PfefferbaumApril, 2008 American Journal of Community Psychology 41(1-2):127-50

37. 3. IMPROVING
COMPLIANCE

38. MIXED UP THE TARGET BEHAVIOR
REDUCED RISK
• Social distancing
– Physical distancing
– Using mask properly
• Personal hygiene
– Washing hands with soap
frequently
– Take a bath and change
clothes after go outside
– Clean the surrounding using
disinfectant
INCREASE PROTECTION
• Eating proper fruits and
vegetables
• Exercising
• No smoking

39. TARGET COMMUNICATION
1
SAFE GROUP
2
PANIC GROUPk
3
UNCONCERN
GROUP
4
UNREACHABLE
GROUP
VERY CONCERN
NO CONCERN
HIGH
KNOLEDGE
LOW
KNOWLEDGE
THIS IS OUR FOCUS

40. GROUP WITH HIGH KNOWLEDGE
AND CONCERN
• Stay at home
• Stay clean
• Stay healthy
• Stay cool
AND NO CONCERN
• Belief in herd immunity
• Do not care about flattening
the curve
• Using mask only for sick
people
THEY HAVE ACCESS TO SOCIAL MEDIA

41. LOW KNOWLEDGE
AND CONCERN
• Belief in Hoax
• Stigmatize people with
Covid-19 by rejecting
NO CONCERN
• Socio-economic condition
• Living in a very small house
• Limited access to social
media
• Lack of nutritious food
WHAT IS THE EFFECTIVE STRATEGY TO REACH THIS
GROUP?

42. WHO COMPLY WITH
SOCIAL DISTANCING?
STAY AT HOME NORMAL ACTIVITY
(Source: Iwan Ariawan et.all, 2020)

43. DILEMA C-19
KESEHATAN
EKONOMI
HEALTH CONCERN
ECONOMIC CONCERN

44. GOVERNMENT STRATEGY
TO PREVENT COVID-19
TIGHT REGULATION TRANSITION
TIGHT
REGULATION
AND PROCEDURE
SANCTION
USING MASK
TESTING
WASH HANDS
TRACING
PHYSICAL
DISTANCING
TREATMENT

45. HOW TO MAKE PEOPLE COMPLY?
Knowledge Attitude Practice
C-19 very contagious I’m afraid of C-19 I’m staying at home
CLASSICAL THEORY
OF KAP

46. HEALTH BELIEF MODEL
Source:Irwin M. Rosenstock, Godfrey M. Hochbaum, S. Stephen Kegeles, and Howard Leventhal (1950), modified 1988

47. THEORY OF REASON ACTION
Ajzen dan Fishbein (1980)

48. Indonesian core-value
Tolerant and resigned
Compassionate
Mutual cooperation
Collectivistic, family values
Short term
Low responsibility for the interests
of many people
Short cut to jump into conclusion
Easy to be influenced
POSITIVE
NEGATIVE

49. HOW TO MAKE THE VUNERABLE GROUP ADAPT
THE NEW BEHAVIOR?
TO PROMOTE NEW MANNERS IN THE COMMUNITY

50. NEW MANNER TO PARENTS
PREVIOUS MANNER NEW MANNER

51. NEW MANNER TO GREET PEOPLE
PREVIOUS MANNER NEW MANNER

52. NEW MANNER FOR SOCIAL SMOKER
PREVIOUS MANNER NEW MANNER

53. NEW MANNER TO VISIT OTHER FAMILY
NEW MANNER
• Using mask
• Wash your hand before
came in to the houses
• Visit as necessary
• No need to give or received
snacks
NEW MANNER

54. NEW MANNER
Avoid visiting sick people
PREVIOUS MANNER NEW MANNER
SHOW YOUR ATTENTION THROUGH YOUR
TEXT, NO NEED TO VISIT

55. THANK YOU FOR YOUR ATTENTION
LET’S SPREAD OUR NEW MANNER….