This study aims to explore the general practitioner (GP)'s views and perspectives related to the formal postgraduate training in primary care that may influence their enrolment in PCP program. We conducted semi-structured interviews with a topic guide. The study took place in Yogyakarta from January to December 2016. The participants were GPs practicing in Yogyakarta primary care clinics who were recruited using purposive-maximum variation sample design. The interviews were audio-recorded and transcribed. The data were analysed using interpretative phenomenological analysis approach. Nineteen GPs participants were involved in this study. Three major themes were identified, namely unfamiliarity, resistance, and positivism. Almost all the GP participants were unfamiliar with the primary care training program. They were also pessimistic if the training could change the health service in the country while it lacked resources and infrastructures. However, exposure to the training brought positive insights that it could improve the doctors’ knowledge and skills in primary care practice. The government intention to establish PCP training is currently on the right tract. However, information dissemination and more supports in primary care are also essential.
Ayushman Bharat, also known as Pradhan Mantri Jan Arogya Yojana (PM-JAY), is India's flagship public health insurance scheme launched to provide universal health coverage. It aims to provide a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10 crore poor and vulnerable families. The scheme covers both public and private hospitals across India for various pre-existing diseases and medical conditions for beneficiaries.
The implementation of BPJS health program At public health center martapura i...IJRES Journal
Improving the quality of health services at the primary level is very important to reduce the burden of services which will be covered hospital when the BPJS program applied. The aimed of this study is to describe the implementation of the program of BPJS in Public Health Center (PHC) Martapura. This study was a qualitative research with case study design. The informants are the head of PHC and manager program were taken by purposive sampling. Data were collected through interviews using in-depth interview guide. Result of this study was since the enactment BPJS January 1, 2014, Banjar Regency Health Office only once to disseminate ie in March 2014. This makes the health center to get the barriers in the field of the sustainability of the information obtained from the health department with the information captured on the official website BPJS. Another barriers was the disbursement claims that have not been implemented which should have been right to health centers for services provided. Support from the health department and BPJS needed to inform about the national health insurance program regularly to health centers so that health centers do not confusion in implementing the program.
The document outlines a research grant application to study the effectiveness of an educational intervention program on strengthening leadership qualities among nursing managers in a hospital in Nepal. It includes sections on the title, investigators, duration, budget, and declaration by the investigators. It also provides details of the study aims, objectives, design, participants, intervention, and outcomes. A literature review covers topics on quality of healthcare, leadership, nursing education, and factors influencing nursing. The rationale is that continuous education is needed for healthcare workers to improve quality as fields advance and expectations rise. The study aims to assess and strengthen leadership skills of nursing managers through an educational program.
Evaluation Of The National Health Insurance Program In Tabalong District Sout...irjes
This document evaluates the implementation of the national health insurance program in Tabalong District, South Kalimantan, Indonesia in 2014. It finds that:
1) The regional health insurance program Jamkesda continued operating, though some residents enrolled in the national program JKN/Health BPJS. Barriers to JKN implementation included insufficient health workers and their lack of knowledge about the new program.
2) Efforts were made to improve health facilities and transition members from other insurance programs to JKN. Local regulations on health insurance standards and funds were also established.
3) While health worker numbers increased in some areas between 2013-2014, overall the district still lacked specialists, doctors, nurses and midwives compared to
Ayushman bharat comprehensive primary health care through healthRajeswari Muppidi
- The document discusses the establishment of Health and Wellness Centers (HWCs) in India as part of the Ayushman Bharat program to provide comprehensive primary healthcare through improved public health centers.
- The HWCs aim to expand services, increase access through population enumeration and empanelment, and improve health outcomes through a continuum of care across various levels of the healthcare system. They will work to reduce costs, mitigate disease risks, and ease overcrowding at higher-level facilities.
- Key goals for HWCs include delivering comprehensive preventive, promotive, curative, rehabilitative and palliative care through adequately staffed and equipped centers integrated with mobile units, health promotion, community
Standard treatment guideline bring everyone involved in medicines onto the same page. They are used by policy makers in the health ministries to set standards and regulate practices.
The document provides guidelines for treatment of patients under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) program. It outlines procedures for package selection, pre-authorization, hospitalization, and discharge of patients. Key points include:
- The empaneled hospital is to select applicable treatment packages based on diagnosis and block packages using the IT system.
- Required diagnostic reports must be uploaded for pre-authorization and claims.
- Pictures of the patient must be taken and uploaded at admission, during treatment, and discharge.
- Feedback is to be collected from patients and follow-up calls made to assess quality of care.
- Specific
The National Institute of Health and Family Welfare in New Delhi offers a 3-year MD degree in Community Health Administration and a 2-year Diploma in Health Administration affiliated with the University of Delhi. The NIHFW is an autonomous organization under the Ministry of Health and Family Welfare that acts as a technical institute and think tank for health programs in India. The MD program incorporates aspects of public health, community medicine, and hospital administration, and provides opportunities to work with health organizations and conduct research. Upon completion, graduates can pursue careers in public health, hospital administration, academia, and government.
Ayushman Bharat, also known as Pradhan Mantri Jan Arogya Yojana (PM-JAY), is India's flagship public health insurance scheme launched to provide universal health coverage. It aims to provide a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10 crore poor and vulnerable families. The scheme covers both public and private hospitals across India for various pre-existing diseases and medical conditions for beneficiaries.
The implementation of BPJS health program At public health center martapura i...IJRES Journal
Improving the quality of health services at the primary level is very important to reduce the burden of services which will be covered hospital when the BPJS program applied. The aimed of this study is to describe the implementation of the program of BPJS in Public Health Center (PHC) Martapura. This study was a qualitative research with case study design. The informants are the head of PHC and manager program were taken by purposive sampling. Data were collected through interviews using in-depth interview guide. Result of this study was since the enactment BPJS January 1, 2014, Banjar Regency Health Office only once to disseminate ie in March 2014. This makes the health center to get the barriers in the field of the sustainability of the information obtained from the health department with the information captured on the official website BPJS. Another barriers was the disbursement claims that have not been implemented which should have been right to health centers for services provided. Support from the health department and BPJS needed to inform about the national health insurance program regularly to health centers so that health centers do not confusion in implementing the program.
The document outlines a research grant application to study the effectiveness of an educational intervention program on strengthening leadership qualities among nursing managers in a hospital in Nepal. It includes sections on the title, investigators, duration, budget, and declaration by the investigators. It also provides details of the study aims, objectives, design, participants, intervention, and outcomes. A literature review covers topics on quality of healthcare, leadership, nursing education, and factors influencing nursing. The rationale is that continuous education is needed for healthcare workers to improve quality as fields advance and expectations rise. The study aims to assess and strengthen leadership skills of nursing managers through an educational program.
Evaluation Of The National Health Insurance Program In Tabalong District Sout...irjes
This document evaluates the implementation of the national health insurance program in Tabalong District, South Kalimantan, Indonesia in 2014. It finds that:
1) The regional health insurance program Jamkesda continued operating, though some residents enrolled in the national program JKN/Health BPJS. Barriers to JKN implementation included insufficient health workers and their lack of knowledge about the new program.
2) Efforts were made to improve health facilities and transition members from other insurance programs to JKN. Local regulations on health insurance standards and funds were also established.
3) While health worker numbers increased in some areas between 2013-2014, overall the district still lacked specialists, doctors, nurses and midwives compared to
Ayushman bharat comprehensive primary health care through healthRajeswari Muppidi
- The document discusses the establishment of Health and Wellness Centers (HWCs) in India as part of the Ayushman Bharat program to provide comprehensive primary healthcare through improved public health centers.
- The HWCs aim to expand services, increase access through population enumeration and empanelment, and improve health outcomes through a continuum of care across various levels of the healthcare system. They will work to reduce costs, mitigate disease risks, and ease overcrowding at higher-level facilities.
- Key goals for HWCs include delivering comprehensive preventive, promotive, curative, rehabilitative and palliative care through adequately staffed and equipped centers integrated with mobile units, health promotion, community
Standard treatment guideline bring everyone involved in medicines onto the same page. They are used by policy makers in the health ministries to set standards and regulate practices.
The document provides guidelines for treatment of patients under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) program. It outlines procedures for package selection, pre-authorization, hospitalization, and discharge of patients. Key points include:
- The empaneled hospital is to select applicable treatment packages based on diagnosis and block packages using the IT system.
- Required diagnostic reports must be uploaded for pre-authorization and claims.
- Pictures of the patient must be taken and uploaded at admission, during treatment, and discharge.
- Feedback is to be collected from patients and follow-up calls made to assess quality of care.
- Specific
The National Institute of Health and Family Welfare in New Delhi offers a 3-year MD degree in Community Health Administration and a 2-year Diploma in Health Administration affiliated with the University of Delhi. The NIHFW is an autonomous organization under the Ministry of Health and Family Welfare that acts as a technical institute and think tank for health programs in India. The MD program incorporates aspects of public health, community medicine, and hospital administration, and provides opportunities to work with health organizations and conduct research. Upon completion, graduates can pursue careers in public health, hospital administration, academia, and government.
The document provides an overview of various national health programs in India, including:
1) The National Health Mission which aims to provide universal access to equitable and quality healthcare. It oversees various disease control programs.
2) Key disease specific programs like the National AIDS Control Program, National Leprosy Eradication Program, and Pulse Polio Immunization Program.
3) Other initiatives like the Rashtriya Kishor Swasthya Karyakram for adolescents, Mission Indradhanush for immunization, and the Affordable Medicines program.
The document provides information about the PG Diploma in Management (PGDM-Executive) in Hospital Management course offered through distance learning by the National Institute of Health and Family Welfare (NIHFW) in India. The course is recognized by the All India Council of Technical Education (AICTE) and lasts 15 months. It includes study materials, assignments, a dissertation, and two mandatory contact programs. The document outlines the course structure, eligibility requirements, fees, evaluation process, and other administrative details.
The document discusses universalizing access to primary healthcare in India. It outlines the current healthcare structure and reasons for poor access, including insufficient funding, lack of availability and affordability. It proposes a roadmap to improve the system through measures like increasing infrastructure and availability of resources, improving human resource management, strengthening regulations, and public-private partnerships. The goal is to ensure equitable, affordable and quality healthcare access for all Indians.
The document summarizes the Ayushman Bharat Yojana (ABY) health insurance program in India. It has two main components: (1) creating 150,000 Health and Wellness Centers to provide comprehensive primary healthcare, and (2) the Pradhan Mantri Jan Arogya Yojana (PM-JAY) which provides health insurance coverage to over 100 million poor families for hospitalization costs up to $7,000 per year. The goals of ABY are to reduce out-of-pocket healthcare expenses, improve access to quality care nationwide, and mitigate the financial risks of illnesses for vulnerable populations.
Ayushman Bharat is India's flagship public health insurance scheme launched by the government. It has two major components - Health and Wellness Centers and Pradhan Mantri Jan Arogya Yojana (PM-JAY). PM-JAY provides health insurance coverage of Rs. 500,000 per family per year for secondary and tertiary care hospitalization to over 100 million poor and vulnerable families. It covers pre-existing diseases, hospitalization costs, and post-hospitalization expenses. States implement PM-JAY through either an assurance model run directly by the state or an insurance model where an insurer manages the scheme. Hospitals empanelled under PM-JAY provide cashless services to beneficiaries
This document summarizes health insurance options provided by different private insurance companies in Nepal. It discusses several major insurers such as Shikhar, Sagarmatha, Rastriya Bema, American Life, Surya Life, Nepal Insurance, The Oriental, and Prime Life. It provides details on the types of coverage offered such as medical, accidental death, travel, and more. Common products covered hospitalization, surgery, pre-and post-hospitalization. The document also reviews literature on health insurance awareness and use in Nepal and concludes more promotion is needed to increase coverage of insurance schemes.
1. Nepal transitioned to a federal system of government, which created opportunities and challenges for decentralizing the national health system.
2. Key challenges include ensuring uninterrupted medical supplies during the transition and developing local government capacity for tasks like procurement, emergency response, and data collection.
3. Local governments now face dilemmas in managing health services under the new structure, such as conducting vaccination programs without separate budgets and addressing epidemics without technical skills. Coordination between levels of government and clarity of roles and responsibilities remain issues.
Public health posting as a motivating factor for medical students to work in ...Alexander Decker
This document summarizes a study that assessed the impact of a public health posting on medical students' motivation to work in rural areas after graduation. The majority of students reported their motivation as good or very good after the posting. Students felt positively about their public health knowledge, ability to work with colleagues, and perceptions of rural communities. The study concludes that exposing medical students to rural field work through a public health posting can help motivate them to consider rural practice after graduation by improving their understanding and perceptions of rural areas.
Post Pregnancy Family Planning Webinar 2: Approaches to Working in the Privat...GetItTogetherNG
This webinar highlighted how the Government, Clinical and non-clinical NGOs have successfully worked with the private sector to increase the provision of post-pregnancy family planning services.
Speakers:
1. Dr. Victoria Egunjobi (Reproductive Health Coordinator, Lagos State Ministry of Health);
2. Bolaji Oladejo (State Program Manager, IntegratE Project);
3. Dr. Odanye Omotunde Busayo (Technical Officer-Service Delivery, Post Pregnancy Family Planning Project);
4. Dr. Kayode Akinkunmi (Medical Director, @Life Fount Medical Centre).
Moderator:
Iyadunni Olubode (Nigeria Director, MSD for Mothers)
The document discusses mid-level health providers, their roles, and training. It begins by outlining the objectives of the seminar, which are to introduce mid-level providers, define them, explain their need, discuss their training, and describe their roles and responsibilities. It then provides details on mid-level providers, including their scope of practice and role in bridging gaps between communities and healthcare. The document also discusses India's Community Health Officer program and the services mid-level providers offer, such as maternal, child, and chronic disease care. It concludes by listing the roles and responsibilities of community health officers.
This document analyzes Nepal's human resources for health, including production, distribution, and skill mix of health workers. It finds that Nepal faces critical shortages of health workers, especially in rural areas. While pre-service training output has increased, distribution remains uneven, with vacancies as high as 38% for doctors and 10% for nurses. The skill mix is also inadequate, with many primary health centers and rural hospitals lacking essential cadres like doctors, nurses, and technicians. Recommendations include better coordinating training with needs, strengthening workforce data and monitoring, incentivizing rural hiring, and revising staffing norms to address gaps.
This document provides an overview of the school health policy framework and programming in Cambodia as of 2013. It outlines the national school health policy, which focuses on health education, health services, hygiene, sanitation, and learning environments. While school health policy is integrated across relevant sectors, implementation remains a challenge, especially at local levels, due to capacity issues and reliance on individual school principals. Both international and national NGOs play an important role in building capacity and implementing programs locally. People in Need is well-positioned to contribute to school health given its community relationships, but should partner with experienced organizations already working in targeted provinces.
“The Hospital Skills Program (HSP) provides a life-long pathway for self-directed medical education across three levels of agreed expertise, utilising a variety of traditional and non-traditional resources and methods appropriate to the working environment of the participant, resulting in the acquisition of a skills portfolio useful to an employer, and appropriate to the local patient community.
The document discusses Ayushman Bharat, India's national health scheme. It aims to provide comprehensive primary health care through Health and Wellness Centers (HWCs), which will be established/upgraded to deliver preventive, promotive and curative services. The key components of HWCs include community outreach, primary care services at SHCs/PHCs, and referral linkages to higher levels. It outlines plans to scale up HWCs, train community health officers and frontline workers, expand diagnostics and medicines, implement a robust IT system, and ensure quality of care. Task forces will provide operational guidelines and support implementation. The goal is to achieve universal health coverage through a continuum of affordable primary to tert
Core competencies for Public Health Professional : Article Review Mohammad Aslam Shaiekh
The document summarizes the core competencies for public health professionals as outlined in an article. It describes the three tiers (entry-level, management, and senior leadership) and lists the competencies for each tier in several domains including analytical/assessment skills, policy development, communication, cultural competency, community dimensions of practice, and public health science. The competencies are designed to help public health organizations understand, assess, and meet education and training needs at different career levels.
Myanmar Strategic Purchasing 5: Continuous Learning and Problem SolvingHFG Project
This is the fifth in a series of briefs examining practical considerations in the design and implementation of a strategic purchasing pilot project among private general practitioners (GPs) in Myanmar. This pilot aims to start developing the important functions of, and provide valuable lessons around, contracting of health providers and purchasing that will contribute to the broader health financing agenda. More specifically, it is introducing a blended payment system that mixes capitation payments and performance-based incentives to reduce households’ out-of-pocket spending and incentivize providers to deliver an essential package of primary care services.
The document outlines the organizational structure and roles of Nepal's central health services. It describes three departments under the Ministry of Health: Department of Health Services, Department of Ayurveda, and Department of Drug Administration. The Department of Health Services has seven divisions that oversee areas like management, child health, and primary care. It also operates several centers for tuberculosis control, health training, public health laboratories, and AIDS/STD control. The organizational structure extends from the central level down to regional, district, and local health facilities. The central level determines resources and plans while lower levels provide services and refer patients within the network.
Medical Education: Reorientation of Medical Education program training and fi...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The lived experiences of pantawid pamilya beneficiaries pptAlma Sy-Patron
This document summarizes a phenomenological study on the lived experiences of beneficiaries of the Pantawid Pamilya program on the implementation of the PhilHealth Indigent Program (PIP) in the Philippines. Key findings included that beneficiaries appreciated the program's value in relieving hospital expenses but also experienced limitations and restrictions. Their coping strategies involved seeking assistance from PhilHealth and local officials. Beneficiaries' insights were that PIP membership provides benefits but the program and services could be enhanced to help more disadvantaged families. The study was limited to two urban areas and recommendations included expanding the research to rural areas and other regions.
The document provides an overview of various national health programs in India, including:
1) The National Health Mission which aims to provide universal access to equitable and quality healthcare. It oversees various disease control programs.
2) Key disease specific programs like the National AIDS Control Program, National Leprosy Eradication Program, and Pulse Polio Immunization Program.
3) Other initiatives like the Rashtriya Kishor Swasthya Karyakram for adolescents, Mission Indradhanush for immunization, and the Affordable Medicines program.
The document provides information about the PG Diploma in Management (PGDM-Executive) in Hospital Management course offered through distance learning by the National Institute of Health and Family Welfare (NIHFW) in India. The course is recognized by the All India Council of Technical Education (AICTE) and lasts 15 months. It includes study materials, assignments, a dissertation, and two mandatory contact programs. The document outlines the course structure, eligibility requirements, fees, evaluation process, and other administrative details.
The document discusses universalizing access to primary healthcare in India. It outlines the current healthcare structure and reasons for poor access, including insufficient funding, lack of availability and affordability. It proposes a roadmap to improve the system through measures like increasing infrastructure and availability of resources, improving human resource management, strengthening regulations, and public-private partnerships. The goal is to ensure equitable, affordable and quality healthcare access for all Indians.
The document summarizes the Ayushman Bharat Yojana (ABY) health insurance program in India. It has two main components: (1) creating 150,000 Health and Wellness Centers to provide comprehensive primary healthcare, and (2) the Pradhan Mantri Jan Arogya Yojana (PM-JAY) which provides health insurance coverage to over 100 million poor families for hospitalization costs up to $7,000 per year. The goals of ABY are to reduce out-of-pocket healthcare expenses, improve access to quality care nationwide, and mitigate the financial risks of illnesses for vulnerable populations.
Ayushman Bharat is India's flagship public health insurance scheme launched by the government. It has two major components - Health and Wellness Centers and Pradhan Mantri Jan Arogya Yojana (PM-JAY). PM-JAY provides health insurance coverage of Rs. 500,000 per family per year for secondary and tertiary care hospitalization to over 100 million poor and vulnerable families. It covers pre-existing diseases, hospitalization costs, and post-hospitalization expenses. States implement PM-JAY through either an assurance model run directly by the state or an insurance model where an insurer manages the scheme. Hospitals empanelled under PM-JAY provide cashless services to beneficiaries
This document summarizes health insurance options provided by different private insurance companies in Nepal. It discusses several major insurers such as Shikhar, Sagarmatha, Rastriya Bema, American Life, Surya Life, Nepal Insurance, The Oriental, and Prime Life. It provides details on the types of coverage offered such as medical, accidental death, travel, and more. Common products covered hospitalization, surgery, pre-and post-hospitalization. The document also reviews literature on health insurance awareness and use in Nepal and concludes more promotion is needed to increase coverage of insurance schemes.
1. Nepal transitioned to a federal system of government, which created opportunities and challenges for decentralizing the national health system.
2. Key challenges include ensuring uninterrupted medical supplies during the transition and developing local government capacity for tasks like procurement, emergency response, and data collection.
3. Local governments now face dilemmas in managing health services under the new structure, such as conducting vaccination programs without separate budgets and addressing epidemics without technical skills. Coordination between levels of government and clarity of roles and responsibilities remain issues.
Public health posting as a motivating factor for medical students to work in ...Alexander Decker
This document summarizes a study that assessed the impact of a public health posting on medical students' motivation to work in rural areas after graduation. The majority of students reported their motivation as good or very good after the posting. Students felt positively about their public health knowledge, ability to work with colleagues, and perceptions of rural communities. The study concludes that exposing medical students to rural field work through a public health posting can help motivate them to consider rural practice after graduation by improving their understanding and perceptions of rural areas.
Post Pregnancy Family Planning Webinar 2: Approaches to Working in the Privat...GetItTogetherNG
This webinar highlighted how the Government, Clinical and non-clinical NGOs have successfully worked with the private sector to increase the provision of post-pregnancy family planning services.
Speakers:
1. Dr. Victoria Egunjobi (Reproductive Health Coordinator, Lagos State Ministry of Health);
2. Bolaji Oladejo (State Program Manager, IntegratE Project);
3. Dr. Odanye Omotunde Busayo (Technical Officer-Service Delivery, Post Pregnancy Family Planning Project);
4. Dr. Kayode Akinkunmi (Medical Director, @Life Fount Medical Centre).
Moderator:
Iyadunni Olubode (Nigeria Director, MSD for Mothers)
The document discusses mid-level health providers, their roles, and training. It begins by outlining the objectives of the seminar, which are to introduce mid-level providers, define them, explain their need, discuss their training, and describe their roles and responsibilities. It then provides details on mid-level providers, including their scope of practice and role in bridging gaps between communities and healthcare. The document also discusses India's Community Health Officer program and the services mid-level providers offer, such as maternal, child, and chronic disease care. It concludes by listing the roles and responsibilities of community health officers.
This document analyzes Nepal's human resources for health, including production, distribution, and skill mix of health workers. It finds that Nepal faces critical shortages of health workers, especially in rural areas. While pre-service training output has increased, distribution remains uneven, with vacancies as high as 38% for doctors and 10% for nurses. The skill mix is also inadequate, with many primary health centers and rural hospitals lacking essential cadres like doctors, nurses, and technicians. Recommendations include better coordinating training with needs, strengthening workforce data and monitoring, incentivizing rural hiring, and revising staffing norms to address gaps.
This document provides an overview of the school health policy framework and programming in Cambodia as of 2013. It outlines the national school health policy, which focuses on health education, health services, hygiene, sanitation, and learning environments. While school health policy is integrated across relevant sectors, implementation remains a challenge, especially at local levels, due to capacity issues and reliance on individual school principals. Both international and national NGOs play an important role in building capacity and implementing programs locally. People in Need is well-positioned to contribute to school health given its community relationships, but should partner with experienced organizations already working in targeted provinces.
“The Hospital Skills Program (HSP) provides a life-long pathway for self-directed medical education across three levels of agreed expertise, utilising a variety of traditional and non-traditional resources and methods appropriate to the working environment of the participant, resulting in the acquisition of a skills portfolio useful to an employer, and appropriate to the local patient community.
The document discusses Ayushman Bharat, India's national health scheme. It aims to provide comprehensive primary health care through Health and Wellness Centers (HWCs), which will be established/upgraded to deliver preventive, promotive and curative services. The key components of HWCs include community outreach, primary care services at SHCs/PHCs, and referral linkages to higher levels. It outlines plans to scale up HWCs, train community health officers and frontline workers, expand diagnostics and medicines, implement a robust IT system, and ensure quality of care. Task forces will provide operational guidelines and support implementation. The goal is to achieve universal health coverage through a continuum of affordable primary to tert
Core competencies for Public Health Professional : Article Review Mohammad Aslam Shaiekh
The document summarizes the core competencies for public health professionals as outlined in an article. It describes the three tiers (entry-level, management, and senior leadership) and lists the competencies for each tier in several domains including analytical/assessment skills, policy development, communication, cultural competency, community dimensions of practice, and public health science. The competencies are designed to help public health organizations understand, assess, and meet education and training needs at different career levels.
Myanmar Strategic Purchasing 5: Continuous Learning and Problem SolvingHFG Project
This is the fifth in a series of briefs examining practical considerations in the design and implementation of a strategic purchasing pilot project among private general practitioners (GPs) in Myanmar. This pilot aims to start developing the important functions of, and provide valuable lessons around, contracting of health providers and purchasing that will contribute to the broader health financing agenda. More specifically, it is introducing a blended payment system that mixes capitation payments and performance-based incentives to reduce households’ out-of-pocket spending and incentivize providers to deliver an essential package of primary care services.
The document outlines the organizational structure and roles of Nepal's central health services. It describes three departments under the Ministry of Health: Department of Health Services, Department of Ayurveda, and Department of Drug Administration. The Department of Health Services has seven divisions that oversee areas like management, child health, and primary care. It also operates several centers for tuberculosis control, health training, public health laboratories, and AIDS/STD control. The organizational structure extends from the central level down to regional, district, and local health facilities. The central level determines resources and plans while lower levels provide services and refer patients within the network.
Medical Education: Reorientation of Medical Education program training and fi...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The lived experiences of pantawid pamilya beneficiaries pptAlma Sy-Patron
This document summarizes a phenomenological study on the lived experiences of beneficiaries of the Pantawid Pamilya program on the implementation of the PhilHealth Indigent Program (PIP) in the Philippines. Key findings included that beneficiaries appreciated the program's value in relieving hospital expenses but also experienced limitations and restrictions. Their coping strategies involved seeking assistance from PhilHealth and local officials. Beneficiaries' insights were that PIP membership provides benefits but the program and services could be enhanced to help more disadvantaged families. The study was limited to two urban areas and recommendations included expanding the research to rural areas and other regions.
This document provides an overview of the dissertation titled "Public Health and Patient Care Aspects in Pharmacy Education and Pharmacists’ Role in National Public Health Programs in India" by Siva Prasada Reddy Maddirala Venkata. The dissertation consists of four studies that compare pharmacy education curricula and assess pharmacy students' and physicians' perceptions of pharmacists' roles in public health programs in India. The studies find that Indian pharmacy curricula focus less on public health and patient care than programs in other countries. Students and physicians generally have positive views of pharmacists involvement in public health, though more exposure is needed. The dissertation concludes that expanding public health and patient care content in Indian pharmacy education could help
Continuous medical education (CME) originated in the US in the 1920s to address deficiencies in physician training. In India, CME was introduced in 1985 to utilize Indian physicians in the US for CME and patient care in India. A study found that 59% of Indian clinicians attend CMEs to meet experts. However, CME attendance in India is challenging due to heavy patient loads and lack of institutional support. Learning from the US model, India can adopt strategies like involving medical education companies and using e-learning to improve geographic access to CME opportunities.
Lack of a family medicine system in Kurdistan Region: Challenges and solutionsAI Publications
This document discusses the lack of a family medicine system in the Kurdistan Region of Iraq, including challenges and potential solutions. It begins by providing background on family medicine and its role in public health. The study aims to understand the challenges of developing family medicine in Erbil through interviews with 16 professionals. Three main themes emerged: 1) the past lacked family medicine and primary care centers provided limited services, 2) the present is in the early stages with one family medicine center, and 3) the future requires addressing challenges like shortages to develop objectives and strategies. The conclusion is that cooperation is needed between the Ministry of Health, universities, and parliament to further develop family medicine in the region.
Cme model of dmims (du) wardha the 10 point action program for learning and q...Alexander Decker
The article discusses the 10 point action program for continuing medical education (CME) at Datta Meghe Institute of Medical Sciences (DMIMS) in India. Key points of the program include:
1. Providing grants for CME activities to reduce influence from pharmaceutical companies and support preclinical departments.
2. Conducting needs assessments to identify gaps and design relevant CME activities.
3. Providing pre-CME counseling to set objectives and design effective activities.
4. Preparing an annual CME calendar and obtaining university approval and budget.
5. Ensuring accreditation standards are met and credit is allocated for activities.
The goal of the 10 point program is to make
Sri Lankan Undergraduate Healthcare Student’s Perceptions of Interprofessiona...pateldrona
Interprofessional learning primarily aims to reduce prejudice among professionals, improve awareness of the roles and duties of other professional groups, and advance teamwork and collaborative competencies. This study was conducted in order to assess the perception of undergraduate health care professional students on interprofessional education/learning in Sri Lanka.
Sri Lankan Undergraduate Healthcare Student’s Perceptions of Interprofessiona...pateldrona
Interprofessional learning primarily aims to reduce prejudice among professionals, improve awareness of the roles and duties of other professional groups, and advance teamwork and collaborative competencies. This study was conducted in order to assess the perception of undergraduate health care professional students on interprofessional education/learning in Sri Lanka.
Sri Lankan Undergraduate Healthcare Student’s Perceptions of Interprofessiona...pateldrona
: Interprofessional learning primarily aims to reduce prejudice among professionals, improve awareness of the roles and duties of other professional groups, and advance teamwork and collaborative competencies. This study was conducted in order to assess the perception of undergraduate health care professional students on interprofessional education/learning in Sri Lanka.
This document provides an overview of health systems research (HSR), including its definition, purpose, focus, features, and steps involved in conducting HSR projects. It discusses HSR in India, highlighting institutions conducting HSR and priority areas. It also addresses problems related to utilizing HSR results and future directions for HSR in India, such as improving dissemination of findings to health managers and identifying information needs to design targeted research.
This document discusses principles of curriculum development in medical education. It covers:
1) Goals of medical education which include meeting patient/society needs, balancing basic and clinical sciences, and developing knowledge, attitudes, and problem-solving skills.
2) Major changes in curricula over time from apprenticeship to discipline-based, organ-system based, and now outcome-based models.
3) Examples of outcome-based frameworks used internationally to define competencies in areas like patient care, medical knowledge, and professionalism.
This document discusses principles of curriculum development in medical education. It covers:
1) Goals of medical education which include meeting patient/society needs, balancing basic and clinical sciences, and developing knowledge, attitudes, and problem-solving skills.
2) Major changes in curricula over time from apprenticeship to discipline-based, organ-system based, and now outcome-based models.
3) Examples of outcome-based frameworks used internationally to define competencies in areas like patient care, medical knowledge, and professionalism.
This document provides background information on curriculum development in medical education. It discusses the goals of medical education including balancing basic sciences, clinical studies, and practice while focusing on problem-solving. It outlines the educational system and medical career path in Japan. It then describes the major changes in medical education curricula over time from apprenticeship to integrated, problem-based models. Finally, it discusses outcome-based education frameworks and examples, as well as quality assurance and accreditation systems in Japan.
The implementation of BPJS health program At public health center martapura i...irjes
Improving the quality of health services at the primary level is very important to reduce the burden of services which will be covered hospital when the BPJS program applied. The aimed of this study is to describe the implementation of the program of BPJS in Public Health Center (PHC) Martapura. This study was a qualitative research with case study design. The informants are the head of PHC and manager program were taken by purposive sampling. Data were collected through interviews using in-depth interview guide. Result of this study was since the enactment BPJS January 1, 2014, Banjar Regency Health Office only once to disseminate ie in March 2014. This makes the health center to get the barriers in the field of the sustainability of the information obtained from the health department with the information captured on the official website BPJS. Another barriers was the disbursement claims that have not been implemented which should have been right to health centers for services provided. Support from the health department and BPJS needed to inform about the national health insurance program regularly to health centers so that health centers do not confusion in implementing the program.
This document discusses trends in health professions education. It covers topics such as outcome-based education, professionalism, learning through simulation, interprofessional education, and community-based medical education. Specifically, it outlines the goals of outcome-based education including balancing knowledge, skills, and attitudes. It provides examples of competency frameworks from organizations like ACGME. The document also discusses the importance of professionalism in medicine given changing public expectations. Additional sections cover how simulation can enhance learning and the benefits of interprofessional education and community-based training to better meet community health needs.
Enhancing the quality of life for palliative care cancer patients in Indonesi...UniversitasGadjahMada
Palliative care in Indonesia is problematic because of cultural and socio-economic factors. Family in Indonesia is an integral part of caregiving process in inpatient and outpatient settings. However, most families are not adequately prepared to deliver basic care for their sick family member. This research is a pilot project aiming to evaluate how basic skills training (BST) given to family caregivers could enhance the quality of life (QoL) of palliative care cancer patients in Indonesia. The study is a prospective quantitative with pre and post-test design. Thirty family caregivers of cancer patients were trained in basic skills including showering, washing hair, assisting for fecal and urinary elimination and oral care, as well as feeding at bedside. Patients’ QoL were measured at baseline and 4 weeks after training using EORTC QLQ C30. Hypothesis testing was done using related samples Wilcoxon Signed Rank. A paired t-test and one-way ANOVA were used to check in which subgroups was the intervention more significant. The intervention showed a significant change in patients’ global health status/QoL, emotional and social functioning, pain, fatigue, dyspnea, insomnia, appetite loss, constipation and financial hardship of the patients. Male patient’s had a significant effect on global health status (qol) (p = 0.030); female patients had a significant effect on dyspnea (p = 0.050) and constipation (p = 0.038). Younger patients had a significant effect in global health status/ QoL (p = 0.002). Patients between 45 and 54 years old had significant effect on financial issue (p = 0.039). Caregivers between 45 and 54 years old had significant effect on patients’ dyspnea (p = 0.031). Thus, it is concluded that basic skills training for family caregivers provided some changes in some aspects of QoL of palliative cancer patients. The intervention showed promises in maintaining the QoL of cancer patients considering socioeconomic
and cultural challenges in the provision of palliative care in Indonesia.
Maternal mortality remains a major challenge to health system worldwide. This problem requires the attention of health practitioners and health professional educators including midwives. Effective clinical decision making is among the most important skills required by healthcare practitioners in the intra-profession and interprofessional context. This study aims to explore the midwifery student's clinical decision-making ability and attitude toward interprofessional learning. This studyused quantitative design with cross-sectional approach. Subjects of research were 50 midwifery students. The instruments were The Readiness for Interprofessional Learning Scale (RIPLS) questionnaire; and an assessment rubric of the obstetric case study. Most of the students are not ready to collaborate with other health professions (68%), and have low and moderate clinical decision-making abilities (98%). There is a significant positive correlation (p <0.05) between student readiness for inter-professional collaboration with clinical decisionmaking ability. This study emphasizes that the ability of a midwife in clinical decision making, especially in emergency cases, is related to their readiness or experience in collaborating with other health professionals.
The document summarizes the work of the USAID-funded Health Finance and Governance (HFG) project in Indonesia from 2012-2018. The project worked with the Government of Indonesia and other stakeholders to:
1) Build capacity for strategic health purchasing to improve the sustainability and efficiency of the national health insurance program, JKN.
2) Conduct implementation research to identify challenges affecting JKN at decentralized levels and inform policy adjustments.
3) Strengthen Indonesia's health financing tracking and analysis through health accounts.
The project facilitated strategic purchasing reforms, provided evidence on bottlenecks in JKN implementation, and improved Indonesia's ability to make resource allocation decisions based on data.
Admission Policies And Methods At Crossroads A Review Of Medical School Admi...James Heller
This document reviews the admission policies and methods of medical schools in seven Asian countries: Indonesia, Japan, Malaysia, the Philippines, Singapore, Sri Lanka, and Taiwan. Each country has its own governing bodies that set policies for medical school admissions. While academic criteria are universally important, countries also consider local needs and values in their policies. This includes widening access through quotas. Tensions exist between selecting the most qualified candidates and increasing access. Finding the right balance requires considering each country's resources and needs. The review identifies similarities and differences in the countries' policies and methods, and how they address common issues.
Similar to The Indonesian general practitioners’ perspectives on formal postgraduate training in primary care (20)
ON OPTIMALITY OF THE INDEX OF SUM, PRODUCT, MAXIMUM, AND MINIMUM OF FINITE BA...UniversitasGadjahMada
Chaatit, Mascioni, and Rosenthal de ned nite Baire index for a bounded real-valued function f on a separable metric space, denoted by i(f), and proved that for any bounded functions f and g of nite Baire index, i(h) i(f) + i(g), where h is any of the functions f + g, fg, f ˅g, f ^ g. In this paper, we prove that the result is optimal in the following sense : for each n; k < ω, there exist functions f; g such that i(f) = n, i(g) = k, and i(h) = i(f) + i(g).
Toward a framework for an undergraduate academic tourism curriculum in Indone...UniversitasGadjahMada
We analyse policy documents as well opinions of stakeholders contributing to the development of the undergraduate academic tourism curriculum, namely: The Government which develops the general framework for curriculum development in Indonesian universities; non-governmental tourism associations which assist universities with opinions and guidance; tourism academics who develop and implement the curriculum in the classroom; and tourism trade associations. Two issues characterize the development of the tourism curriculum namely: determining the appropriate balance between vocational and academic frameworks, and an aspiration to move from inter- to mono-disciplinary instruction.
Association of the HLA-B alleles with carbamazepine-induced Stevens–Johnson s...UniversitasGadjahMada
Carbamazepine (CBZ) is a common cause of life-threatening cutaneous adverse drug reactions such as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Previous studies have reported a strong association between the HLA genotype and CBZ-induced SJS/TEN.We investigated the association between the HLA genotype and CBZ-induced SJS/TEN in Javanese and Sundanese patients in Indonesia. Nine unrelated patients with CBZ-induced SJS/TEN and 236 healthy Javanese and Sundanese controls were genotyped for HLA-B and their allele frequencies were compared. The HLA-B*15:02 allele was found in 66.7% of the patients with CBZ-induced SJS/TEN, but only in 29.4% of tolerant control (p = 0.029; odds ratio [OR]: 6.5; 95% CI: 1.2–33.57) and 22.9% of healthy controls (p = 0.0021; OR: 6.78; 95% CI: 1.96– 23.38). These findings support the involvement of HLA-B*15:02 in CBZ-induced SJS/TEN reported in other Asian populations. Interestingly, we also observed the presence of the HLA-B*15:21 allele. HLA-B*15:02 and HLA-B*15:21 are members of the HLA-B75 serotype, for which a greater frequency was observed in CBZ-induced SJS/TEN (vs tolerant control [p = 0.0078; OR: 12; 95% CI: 1.90–75.72] and vs normal control [p = 0.0018; OR: 8.56; 95% CI: 1.83–40]). Our findings suggest that screening for the HLA-B75 serotype can predict the risk of CBZ-induced SJS/TEN more accurately than screening for a specific allele.
Characteristics of glucomannan isolated from fresh tuber of Porang (Amorphoph...UniversitasGadjahMada
Porang is a potential source of glucomannan. This research objective was to find a direct glucomannan isolation method from fresh porang corm to produce high purity glucomannan. Two isolation methods were performed. In first method, sample was water dissolved using Al2(SO4)3 as flocculant for 15 (AA15) or 30 (AA30) minutes with purification. In second method, sample was repeatedly milled using ethanol as solvent and filtered for 5 (EtOH5) or 7 (EtOH7) times without purification. The characteristics of obtained glucomannan were compared to those of commercial porang flour (CPF) and purified konjac glucomannan (PKG). High purity (90.98%), viscosity (27,940 cps) and transparency (57.74 %) of amorphous glucomannan were isolated by EtOH7. Ash and protein level significantly reduced to 0.57% and 0.31%, respectively, with no starch content. Water holding capacity (WHC) of EtOH7 glucomannan significantly enhanced, whereas its solubility was lower than those of PKG due to its ungrounded native granular form.
Phylogenetic Analysis of Newcastle Disease Virus from Indonesian Isolates Bas...UniversitasGadjahMada
This study was conducted to analyze phylogenetic of Indonesian newcastle disease virus(NDV) isolates based on fusion (F) protein-encoding gene, with aim to determine which genotype group of Indonesian NDV isolates, compared to vaccine strain that circulating in Indonesia.
Land Capability for Cattle-Farming in the Merapi Volcanic Slope of Sleman Reg...UniversitasGadjahMada
This research carried out to study the cattle farming development based on the land capability in rural areas of the Merapi Volcanic slope of Sleman Regency Yogyakarta after eruption 2010. Samples taken were Glagaharjo village (Cangkringan Sub-District) as impacted area and Wonokerto village (Turi Sub-District) as unimpacted area. Survey method used were to land evaluation analysis supported by Geographic Information System (GIS) software. Materials used were Indonesian topographical basemap (RBI) in 1:25000 scale, IKONOS image [2015], land use map, landform map, and slope map as supple- ments. Potential analysis of land capability for cattle forage using the production unit in kg of TDN per AU. The result showed that based on the land capability class map, both villages had potential of carrying capacity for forage feed that could still be increased as much as 1,661.32 AU in Glagaharjo and 1,948.13 AU in Wonokerto.
When anti-corruption norms lead to undesirable results: learning from the Ind...UniversitasGadjahMada
This paper analyzes how and why adverse side-effects have occurred in the implementation of two articles of Indonesia’s anti-corruption law. These articles prohibit unlawful acts which may be detrimental to the finances of the state. Indeed, the lawmakers had good intentions when they drafted the two articles. They wanted to make it easier to convict corrupt individuals by lowering the standard of evidence required to prove criminal liability. The implementation of these articles has raised legal uncertainty. The loose definition of the elements of the crime enables negligence and imperfection of (public) contracts to be considered as corruption. The Constitutional Court has issued two rulings to restrict and guide the interpretation of these articles. However, law enforcement agencies (Supreme Court and public prosecutors) have been unwilling to adhere to the rulings. There are two possible reasons for this. First, as has been argued by several commentators, the law enforcement agencies have misinterpreted the concept of Bunlawfulness^. Besides, the law enforcement agencies wish to be seen to be committed to prosecuting and delivering convictions in corruption cases. To do so, they need to maintain looser definitions of the elements of the offence. This paper endorses the Constitutional Court rulings and provides additional reasons in support of their stance. The paper can be considered as a case study for other countries that may be contemplating similar legislation.
Receptor binding and antigenic site analysis of hemagglutinin gene fragments ...UniversitasGadjahMada
We reported a retrospective study on hemagglutinin (HA) gene fragments of Avian Influenza (AI) viruses recovered between 2010 to 2012, using reverse transcriptase polymerase chain reaction (RT-PCR) followed by sequencing. The results provide information about the receptor binding sites (RBS) and antigenic sites character of HA gene of AI viruses in Indonesia. Viral RNA was extracted from allantoic fluid of specific pathogen free (SPF) of chicken embryonated eggs inoculated by AI suspected samples. Amplification was performed by using H5 specific primers to produce amplification target of 544 bp. The resulting sequences were analyzed with MEGA-5 consisting of multiple alignment, deductive amino acid prediction, and phylogenetic tree analysis. The results showed that out of the 12 samples amplified using RT-PCR technique, only 7 were detected to be avian influenza serotype H5 viruses. Sequence analysis of AIV H5 positive samples, showed a binding preference towards avian type receptors. Antigenic site analysis is consistent with the previous report, however, the antigenic site B at position 189 showed that the residue had undergone mutation from arginine to methionine. Phylogenetic tree analysis showed that these viruses were clustered into clade 2.1.3. Our report supports the importance of the previous study of RBS and antigenic properties of HPAI H5N1 in Indonesia.
Sustaining the unsustainable? Environmental impact assessment and overdevelop...UniversitasGadjahMada
Bali faces serious environmental crises arising from overdevelopment of the tourism and real estate industry, including water shortage, rapid conversion of agricultural land, pollution, and economic and cultural displacement. This article traces continuities and discontinuities in the role of Indonesian environmental impact assessment (EIA) during and since the authoritarian ‘New Order’ period. Following the fall of the Suharto regime in 1998, the ‘Reform Era’ brought dramatic changes, democratizing and decentralizing Indonesia’s governing institutions. Focusing on case studies of resort development projects in Bali from the 1990s to the present, this study examines the ongoing capture of legal processes by vested interests at the expense of prospects for sustainable development. Two particularly controversial projects in Benoa Bay, proposed in the different historical and structural settings of the two eras—the Bali Turtle Island Development (BTID) at Serangan Island in the Suharto era and the Tirta Wahana Bali Internasional (TWBI) proposal for the other side of Benoa in the ‘Reform Era’—enable instructive comparison. The study finds that despite significant changes in the environmental law regime, the EIA process still finds itself a tool of powerful interests in the efforts of political and economic elites to maintain control of decision-making and to displace popular opposition forces to the margins.
Magnetogama is an open schematic handassembled fluxgate magnetometer. Compared to another magnetometer, Magnetogama has more benefit concerning its price and its ease of use. Practically Magnetogama can be utilized either in land or attached to an unmanned aerial vehicle (UAV). Magnetogama was designed to give open access to a cheap and accurate alternative to magnetometer sensor. Therefore it can be used as a standard design which is directly applicable to the low-budget company or education purposes. Schematic, code and several verification tests were presented in this article ensuring its reproducibility. Magnetogama has been tested with two kind of tests: a comparison with two nearest observatories at Learmonth (LRM) and Kakadu (KDU) and the response of magnetic substance.
Limitations in the screening of potentially anti-cryptosporidial agents using...UniversitasGadjahMada
The emergence of cryptosporidiosis, a zoonotic disease of the gastrointestinal and respiratory tract caused by Cryptosporidium Tyzzer, 1907, triggered numerous screening studies of various compounds for potential anti-cryptosporidial activity, the majority of which proved ineffective. Extracts of Indonesian plants, Piper betle and Diospyros sumatrana, were tested for potential anticryptosporidial activity using Mastomys coucha (Smith), experimentally inoculated with Cryptosporidium proliferans Kváč, Havrdová, Hlásková, Daňková, Kanděra, Ježková, Vítovec, Sak, Ortega, Xiao, Modrý, Chelladurai, Prantlová et McEvoy, 2016. None of the plant extracts tested showed significant activity against cryptosporidia; however, the results indicate that the following issues should be addressed in similar experimental studies. The monitoring of oocyst shedding during the entire experimental trial, supplemented with histological examination of affected gastric tissue at the time of treatment termination, revealed that similar studies are generally unreliable if evaluations of drug efficacy are based exclusively on oocyst shedding. Moreover, the reduction of oocyst shedding did not guarantee the eradication of cryptosporidia in treated individuals. For treatment trials performed on experimentally inoculated laboratory rodents, only animals in the advanced phase of cryptosporidiosis should be used for the correct interpretation of pathological alterations observed in affected tissue. All the solvents used (methanol, methanol-tetrahydrofuran and dimethylsulfoxid) were shown to be suitable for these studies, i.e. they did not exhibit negative effects on the subjects. The halofuginone lactate, routinely administered in intestinal cryptosporidiosis in calves, was shown to be ineffective against gastric cryptosporidiosis in mice caused by C. proliferans. In contrast, the control application of extract Arabidopsis thaliana, from which we had expected a neutral effect, turned out to have some positive impact on affected gastric tissue.
Self-nanoemulsifying drug delivery system (SNEDDS) of Amomum compactum essent...UniversitasGadjahMada
This document summarizes research on the development of a self-nanoemulsifying drug delivery system (SNEDDS) for Amomum compactum essential oil. Key points:
- Virgin coconut oil was selected as the carrier oil due to its high solubility of the essential oil compared to other oils tested.
- A D-optimal mixture design was used to optimize the SNEDDS formulation, with emulsification time and transmittance as the response variables.
- The optimized formulation contained 10% Amomum compactum essential oil, 10% virgin coconut oil, 65.71% Tween 80 surfactant, and 14.29% PEG 400 co-surfactant.
Attenuation of Pseudomonas aeruginosa Virulence by Some Indonesian Medicinal ...UniversitasGadjahMada
This study aims to discover quorum sensing inhibitors (QSI) from some Indonesian medicinal plants ethanol extract to analyze their inhibitory activities against QS-mediated virulence factors in P. aeruginosa using in-vitro experimental study-laboratory setting. Indonesian medicinal plant ethanolic extracts were tested for their capability to inhibit P. aeruginosa motility, biofilm formation using microtiter plate method, pyocyanin and LasA production using LasA staphylolytic assay. Statistical significance of the data were determined using one way ANOVA, followed by Dunnett’s test. Differences were considered significant with P values of 0.05 or less. The findings obtained showed that Ethanolic extract of T. catappa leaves and A. alitilis flower capable to inhibit P. aeruginosa motility as well as pyocyanin production and biofilm formation. Both extracts also showed capability in reducing LasA protease production. It is concluded that T. catappa and A. alitilis are an interesting sources of innovative plant derived quorum quenching compound(s), thus can be used in the development of new antipathogenic drug.
Short-chain alcohols are a group of volatile organic compounds (VOCs) that are often found in workplaces and laboratories, as well as medical, pharmaceutical, and food industries. Realtime monitoring of alcohol vapors is essential because exposure to alcohol vapors with concentrations of 0.15–0.30 mg·L−1 may be harmful to human health. This study aims to improve the detection capabilities of quartz crystal microbalance (QCM)-based sensors for the analysis of alcohol vapors. The active layer of chitosan was immobilized onto the QCM substrate through a selfassembled monolayer of L-cysteine using glutaraldehyde as a cross-linking agent. Before alcohol analysis, the QCM sensing chip was exposed to humidity because water vapor significantly interferes with QCM gas sensing. The prepared QCM sensor chip was tested for the detection of four different alcohols: n-propanol, ethanol, isoamyl alcohol, and n-amyl alcohol. For comparison, a non-alcohol of acetone was also tested. The prepared QCM sensing chip is selective to alcohols because of hydrogen bond formation between the hydroxyl groups of chitosan and the analyte. The highest response was achieved when the QCM sensing chip was exposed to n-amyl alcohol vapor, with a sensitivity of about 4.4 Hz·mg−1·L. Generally, the sensitivity of the QCM sensing chip is dependent on the molecular weight of alcohol. Moreover, the developed QCM sensing chips are stable after 10 days of repeated measurements, with a rapid response time of only 26 s. The QCM sensing chip provides an alternative method to established analytical methods such as gas chromatography for the detection of short-chain alcohol vapors.
APPLICATION OF CLONAL SELECTION IMMUNE SYSTEM METHOD FOR OPTIMIZATION OF DIST...UniversitasGadjahMada
This paper proposes an application of clonal selection immune system method for optimization of distribution network. The distribution network with high-performance is a network that has a low power loss, better voltage profile, and loading balance among feeders. The task for improving the performance of the distribution network is optimization of network configuration. The optimization has become a necessary study with the presence of DG in entire networks. In this work, optimization of network configuration is based on an AIS algorithm. The methodology has been tested in a model of 33 bus IEEE radial distribution networks with and without DG integration. The results have been showed that the optimal configuration of the distribution network is able to reduce power loss and to improve the voltage profile of the distribution network significantly.
Screening of resistant Indonesian black rice cultivars against bacterial leaf...UniversitasGadjahMada
The document summarizes a study that screened Indonesian black rice cultivars for resistance to bacterial leaf blight caused by Xanthomonas oryzae pv. oryzae. Five black rice cultivars and four white rice cultivars were inoculated with the bacteria and their resistance was evaluated based on disease symptoms and gene expression. The cultivar showing the best resistance was Cempo Ireng, which had the lowest disease intensity and expressed resistance genes xa5, Xa10, Xa21, and RPP13-like after inoculation. Cempo Ireng was identified as the most resistant cultivar and potential source of resistance genes for breeding programs.
This article analyzes the life of young millennial Salafi-niqabi in Surakarta and their strategies in dealing with power relations in their everyday lives. Studies on Salafi in Indonesia have focused more on global Salafimovements, power politics, links with fundamentalist-radical movements, state security and criticism of Salafi religious doctrine. Although there are several studies that try to portray the daily life of this religious group, the majority of previous studies focused on formal institutions and male Salafi. Very few studies have addressed the lives of Salafi women. This is likely due to the difficulty of approaching this group because of their exclusivity, and their restrictions on interacting with the outside world. Using Macleod’s theory of ‘accommodating protest’ within the framework of everyday politics, agency, and power relations, this research found that young millennial Salafi-niqabi have a unique method of negotiating with the modern and globalized world. Through what Macleod calls an accommodation which is at the same time a protest, young Salafi-niqabi have experienced hijrah as a form of negotiation of their millennial identity.
Application of arbuscular mycorrhizal fungi accelerates the growth of shoot r...UniversitasGadjahMada
This document summarizes a study that examined the effects of applying different doses of arbuscular mycorrhizal fungi (AMF) inoculum on shoot root growth of five sugarcane clones. The key findings are:
1) Application of 2-3 g of AMF inoculum/bud chips resulted in faster and greater root colonization compared to the control, reaching 57-100% colonization within 5 days.
2) AMF inoculation significantly increased shoot root traits like root length, surface area, and number of shoot roots, especially for clones BL, VMC, and PS864.
3) AMF application of 2-3 g/bud chips also significantly increased seedling
SHAME AS A CULTURAL INDEX OF ILLNESS AND RECOVERY FROM PSYCHOTIC ILLNESS IN JAVAUniversitasGadjahMada
Most studies of shame have focused on stigma as a form of social response and a socio-psychological consequence of mental illness. This study aims at exploring more complex Javanese meanings of shame in relation to psychotic illness. Six psychotic patients and their family members participated in this research. Ethnographic fieldwork was conducted in Yogyakarta, Indonesia. Thematic analysis of the data showed that participants used shame in three different ways. First, as a cultural index of illness and recovery. Family members identified their member as being ill when they had lost their sense of shame. If a patient exhibited behavior that indicated the reemergence of shame, the family saw this as an indication of recovery. Second, as an indication of relapse. Third, as a barrier toward recovery. In conclusion, shame is used as a cultural index of illness and recovery because it associated with the moral-behavioral control. Shame may also be regarded as a form of consciousness associated with the emergence of insight. Further study with a larger group of sample is needed to explore shame as a ‘socio-cultural marker’ for psychotic illness in Java.
Frequency and Risk-Factors Analysis of Escherichia coli O157:H7 in Bali-CattleUniversitasGadjahMada
Cattle are known as the main reservoir of zoonotic agents verocytotoxin producing Escherichia coli. These bacteria are usually isolated from calves with diarrhea and / or mucus and blood. Tolerance of these agents to the environmental conditions will strengthen of their transmission among livestock. A total of 238 cattle fecal samples from four sub-districts in Badung, Bali were used in this study. Epidemiological data observed include cattle age, sex, cattle rearing system, the source of drinking water, weather, altitude, and type of cage floor, the cleanliness of cage floor, the slope of cage floor, and the level of cattle cleanliness. The study was initiated by culturing of samples onto eosin methylene blue agar, then Gram stained, and tested for indole, methyl-red, voges proskauer, and citrate, Potential E.coli isolates were then cultured onto sorbitol MacConkey agar, and further tested using O157 latex agglutination test and H7 antisera. Molecular identification was performed by analysis of the 16S rRNA gene, and epidemiological data was analyzed using
STATA 12.0 software. The results showed, the prevalence of E. coli O157:H7 in cattle at Badung regency was 6.30% (15/238) covering four sub districts i.e. Petang, Abiansemal, Mengwi, and Kuta which their prevalence was 8.62%(5/58), 10%(6/60), 3.33%(2/60), and 3.33(2/60)%, respectively. The analysis of 16S rRNA gene confirmed of isolates as an E. coli O157:H7 strain with 99% similarities. Furthermore, the risk factors analysis showed that the slope of the cage floor has a highly significant effect (P<0.05) to the distribution of infection. Consequently, implementing this factor must be concerned in order to decrease of infection.
Exploring the Benefits of Binaural Hearing: Why Two Hearing Aids Are Better T...Ear Solutions (ESPL)
Binaural hearing using two hearing aids instead of one offers numerous advantages, including improved sound localization, enhanced sound quality, better speech understanding in noise, reduced listening effort, and greater overall satisfaction. By leveraging the brain’s natural ability to process sound from both ears, binaural hearing aids provide a more balanced, clear, and comfortable hearing experience. If you or a loved one is considering hearing aids, consult with a hearing care professional at Ear Solutions hearing aid clinic in Mumbai to explore the benefits of binaural hearing and determine the best solution for your hearing needs. Embracing binaural hearing can lead to a richer, more engaging auditory experience and significantly improve your quality of life.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
GEMMA Wean has an optimised nutritional balance and physical quality so that it flows more freely and spreads readily on the water surface. The balance of phospholipid classes to- gether with the production technology based on a low temperature extrusion process improve the physical aspect of the pellets while still retaining the high phospholipid content.
GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
Key Areas Covered:
Texting and Email Communication: Understand the compliance requirements for electronic communication.
Encryption Standards: Learn what is necessary and what is overhyped.
Medical Messaging and Voice Data: Ensure secure handling of sensitive information.
IT Risk Factors: Identify and mitigate risks related to your IT infrastructure.
Why Attend:
Expert Instructor: Brian Tuttle, with over 20 years in Health IT and Compliance Consulting, brings invaluable experience and knowledge, including insights from over 1000 risk assessments and direct dealings with Office of Civil Rights HIPAA auditors.
Actionable Insights: Receive practical advice on preparing for audits and avoiding common mistakes.
Clarity on Compliance: Clear up misconceptions and understand the reality of HIPAA regulations.
Ensure your compliance strategy is up-to-date and effective. Enroll now and be prepared for the 2024 HIPAA audits.
Enroll Now to secure your spot in this crucial training session and ensure your HIPAA compliance is robust and audit-ready.
https://conferencepanel.com/conference/hipaa-training-for-the-compliance-officer-2024-updates
Chandrima Spa Ajman is one of the leading Massage Center in Ajman, which is open 24 hours exclusively for men. Being one of the most affordable Spa in Ajman, we offer Body to Body massage, Kerala Massage, Malayali Massage, Indian Massage, Pakistani Massage Russian massage, Thai massage, Swedish massage, Hot Stone Massage, Deep Tissue Massage, and many more. Indulge in the ultimate massage experience and book your appointment today. We are confident that you will leave our Massage spa feeling refreshed, rejuvenated, and ready to take on the world.
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International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
Your mindset is the way you make sense of the world around you. This lens influences the way you think, the way you feel, and how you might behave in certain situations. Let's talk about mindset myths that can get us into trouble and ways to cultivate a mindset to support your cancer survivorship in authentic ways. Let’s Talk About It!
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2. Page 2 of 8Ekawati et al. Asia Pac Fam Med (2018) 17:10
primary care. The training was stipulated in Medical
Education Act number 20-year 2013 [5]. In this regula-
tion, the terminology of ‘primary care physician’ (PCP)
was introduced as a doctor having an equivalent posi-
tion as a specialist. To be recognized as a PCP doctor,
the GPs have to follow a formal postgraduate train-
ing in primary care conducted by 17 medical facul-
ties licensed by the Indonesian Ministry of Education.
The PCP curriculum content was designed according
to international recommendations of family medicine
training, consisting of advanced training for the GPs
to have more person-centred care, continuity of care,
community-oriented, holistic and comprehensive care
for their patients, leadership in general practice, and
primary care management [6, 7].
The formal primary care doctor training for Indone-
sian doctors is arranged with a workplace-based learn-
ing methods (WBL) [8] developed by the Indonesian
National Board of PCP (the representative members
of the 17 medical faculties). The WBL scheme aimed to
specifically train the future doctors to reflect and learn
medical cases from their practice settings. There are
two sub-schemes in WBL methods: the first scheme is
designed for those physicians who already graduated
from the university and have had at minimum of 5-years
practice in primary care. This mechanism is also known
as the “Recognition Prior Learning” (RPL) model, in
which the doctors only need to accumulate credits by
taking a 6-month PCP training at assigned universities.
The RPL will be completed by 2030 to provide adequate
opportunities for the current GPs to join this scheme. The
second scheme of WBL is the regular 2–3 years training
scheme, which is designed for newly graduate GPs with
less than 5 years practice experience. To do the training,
the junior GPs need to be registered as PCP residents at a
licenced university.
Unfortunately, until 4 years since the medical educa-
tion act was published, the formal postgraduate train-
ing in primary care was not fully established. There had
been strong national debates related to this law from
the Indonesian Doctors Association [9, 10]. A juridical
review was proposed by the Indonesian Medical Asso-
ciation and claiming that the practice skills had actually
been included in undergraduate medical curriculum.
Subsequently, the association notified the government to
take more consideration before the training was launched
nationally [9]. The Indonesian medical education experts
constrained this claim by stating that the essence of pri-
mary care practice was different from the undergradu-
ate degree. They added that the PCP training would help
doctors to improve their skills [11–13] and would equip
them with an advanced focused clinical professional
development (CPD) in primary care practice [14].
Until this publication was written, very limited evi-
dence was available to explore the Indonesian doctors’
perspectives about this formal postgraduate training.
The local investigation about the GPs views related to
the training was insufficient and were dominantly from
news or media releases [15, 16]. Being intrigued by the
debates, this study sought to deeply investigate the Indo-
nesian GPs’ views on this training, specifically, what are
their arguments to follow or not to follow the govern-
ment intention to upgrade their knowledge and skills in
primary care.
Methods
This research applied a phenomenology approach to
develop a comprehensive understanding of the GP par-
ticipants’ views [17]. Consistent with this methodology,
the data collection was conducted using semi-structured
interviews to provide greater opportunities for the par-
ticipants to express their views.
This study took place in Yogyakarta from January to
December 2016. A purposive maximum variation sam-
pling strategy was applied to ensure adequate encap-
sulation of the participants’ perspectives. The GPs
recruitment process was done in both private and public
primary care clinics from five Yogyakarta regions (Kulo-
nprogo, Sleman, Yogyakarta city, Bantul, and Gunung
Kidul). The recruitment process is described as follows:
FME (first author) advertised this study in Yogyakarta
general practitioners’ networks and mailing lists-with
more than 150 GPs members. The GPs who were inter-
ested to join the interview, were advised to contact
FME, and FME then contacted back the GPs personally
for the interview scheduling. Written informed consent
was obtained from all GP participants, including their
consent that this research would be published in a jour-
nal board using their anonymous identity. All the inter-
views were held in a private room in the GP’s clinics. All
the interviews were audiotape-recorded. Each partici-
pant was given a small souvenir bag as a token of their
participation.
All the interviews were based on a topic guide. At the
beginning the GP participants were explained about the
aims and any related information regarding this study.
Then, three main guiding questions were asked to them:
(1) their general views related the formal PCP training,
(2) their concerns related to the PCP training and (3)
their expectation for the training. Prompts were also
applied to explore more on the GPs views, such as: silent
pause, and minimum engagement, (i.e. ‘what do you
think…’, ‘tell me more…’) [12].
The interviews were transcribed and analyzed using
Interpretative Phenomenological Analysis (IPA)
approach for moderate scale participants. It is an
3. Page 3 of 8Ekawati et al. Asia Pac Fam Med (2018) 17:10
analytical method to deeply understand the participants’
views combined with the researcher analysis behind the
participants’ quotes. The steps of IPA analysis were sys-
tematically applied as had been suggested by Smith and
Osborn [18]: (1) First, FME and MC (Co-author) read
all the transcribed texts independently, to be familiar
with the participants’ views. (2) Notable quotes were
noted and discussed in three separate meetings. (3) The
quotes were then grouped into themes and superordinate
themes. Finally, (4) the emerging themes were discussed
and crosschecked amongst the other co-authors with pri-
mary care backgrounds [12, 18].
Results
Nineteen GPs were recruited. Most them were females,
practicing in rural areas, aged 30–40 years, and having
more than 5 years’ experience practicing as a GP in pri-
mary care practices. The participants had an equal pro-
portion of GPs who practiced in Puskesmas (Indonesian
Public Primary Care Clinics) and those who ran private
practices. Ten GPs did not have any previous exposure
to family medicine/primary care focused trainings, while
nine GPs in this study had exposure to family medicine/
primary care courses. Eight of the participants had joined
the Universitas Gadjah Mada’s (UGM University-Indone-
sia) Weekly Clinical Updates®
-family medicine postgradu-
ate course for 1 year, and one GP participant was a Master
of Family Medicine graduate from the university. The
details of the participants are presented in Tables 1 and 2.
The interviews went well. FME had no difficulties to
have the interviews with the participants. All of them
had also been informed that their participation would
not affect their relationships with the FME or other co-
authors’ institution, now or in the future [12].
Three superordinate themes were identified as unfamil-
iarity, resistance, and positivism. Unfamiliarity referred
to the doctors who were unfamiliar with the PCP pro-
gram: about what it was, for whom, and if they would
have any compensation related to the training they would
have in the future. Resistance reflected the participants’
perspectives and pessimistic thought that the training
could improve the health system. However, some physi-
cians who had previous primary care training acknowl-
edged that this training benefited their knowledge and
practice skills in primary care.
Unfamiliarity
Almost all doctors in this study expressed their unfa-
miliarity related to the PCP terminology. They were
unclear about: who were the PCPs? and What made the
PCP doctors different from current general practition-
ers, as both kinds of physicians would work in the same
clinics. The doctors were also unsure if they would have
a different recognition in front of their patients, as what
had been said by Doctor 6: “How is the position of the
PCP doctors? Where are their positions? Would they
practice in the different clinic than us in Puskesmas? Do
we treat different patients?” (Doctor 6, urban practice).
While it was stipulated in the regulation that to
become primary care doctors the GPs should take a
formal postgraduate training, the doctors were unsure
about the clarity of the training. They questioned if the
training was compulsory or a voluntary; and whether it
would require them to leave their practice and take an
on-campus training as similar to other specialist train-
ings. Unfortunately, with those questions, the doctors
felt that there was limited information available for
them. Without adequate explanation and clarification,
their unfamiliarity resulted in doubts to go into training.
“So, for the future of the training, I do not know
about the length of the training. Do we have to
take a 6-month training or is this just an alterna-
tive? Do we have to also leave our practice? I want
to know about this. Otherwise, I could not decide
what is the best for myself” (Doctor 13, rural prac-
tice)
Table 1 Maximum variation sample details
Characteristic Number
Gender
Women 13
Men 6
Age
25–40 13
41–55 4
56–70 2
Practice setting
Rural 14
Urban 5
Practice type
Public 9
Private 10
Practice duration
Less than 5 years 4
5–10 years 7
10–15 years 3
> 15 years 5
Practice location
Kotamadya 3
Sleman 6
Bantul 3
Gunungkidul 4
Kulonprogo 3
4. Page 4 of 8Ekawati et al. Asia Pac Fam Med (2018) 17:10
Resistance
After expressing their unfamiliarity with the PCP pro-
gram, half of the GP participants expressed their resist-
ance to take the postgraduate training program. This was
particularly expressed by doctors who felt that they were
competent enough already. They thought that they had
mastered and had given their best performance, referring
to the list of GPs’ competencies, such as health promo-
tion and prevention. They thought that there were no
further additional skills needed for primary care doc-
tors; as what had been said by Doctor 9: “We had given
our best performance in primary care, in our undergradu-
ate curriculum we have been trained with the skills as a
GP well. We had done the comprehensive care; we did the
health promotion and prevention, we had also expressed
our objection to this training” (Doctor 9, rural practice).
These doctors also felt resistance and being pessimis-
tic that their efforts to follow the PCP program would
improve their practice because of the limited resources
available in primary care. The doctors argued that their
undergraduate skills were already adequate to tackle
the patients’ problems, but the facilities prevented
them to perform well. They thought that the training
would not result in any improvement unless the gov-
ernment improves the facilities.
“I may not be good at patient care. However, I
think this is the best I can do. We already have
adequate skills as GPs [from the undergraduate
education]. But, look, why couldn’t we treat the
hypertensive patients well? [because] We only have
captopril in our clinic. I also agree that maybe half
our patients are psychosomatic patients; we need a
long time to gain that information. We do not have
time to do that. Even for the doctors; we do not
have enough doctors here. Only one doctor practic-
ing in the clinic, another doctor went to a meeting
to health office” (Doctor 2, rural practice)
In addition, the GPs thought that the training would
burden their economics situation. They argued that
their undergraduate training in medical school was long
enough to get good salaries compared to engineers or
businessmen training. Furthermore, there were no such
of a registrar’s salary in Indonesian medical training.
“I am afraid that it would delay the time for the
future GPs to be able to practice. You know that so
far, we needed to finish our 4 years training in an
undergraduate degree, after that we continued to
another 2 years of clinical rotation. Not enough, we
also had 1 year of the internship program. Now we
Table 2 Characteristic of each participant
Name Practice setting Practice duration Experience of following a
primary care/family medicine
course(s)
Doctor 1 Urban Less than 5 years No
Doctor 2 Rural 5–10 years No
Doctor 3 Rural > 15 years No
Doctor 4 Urban 5–10 years No
Doctor 5 Urban 5–10 years No
Doctor 6 Urban Less than 5 years No
Doctor 7 Rural > 15 years Yes (1 year)
Doctor 8 Rural > 15 years Yes (1 year)
Doctor 9 Rural 5–10 years Yes (1 year)
Doctor 10 Rural > 15 years Yes (1 year)
Doctor 11 Rural > 15 years Yes (1 year)
Doctor 12 Rural 10–15 years No
Doctor 13 Rural 10–15 years Yes (1 year)
Doctor 14 Rural 10–15 years Yes (MSc in Family Medicine)
Doctor 15 Rural Less than 5 years No
Doctor 16 Rural Less than 5 years Yes (1 year)
Doctor 17 Urban 5–10 years Yes (1 year)
Doctor 18 Rural 5–10 years No
Doctor 19 Rural 5–10 years No
5. Page 5 of 8Ekawati et al. Asia Pac Fam Med (2018) 17:10
have to have another training to be able to practice?
I cannot imagine. In another country, they have
salaries for the residents, but here we pay the resi-
dency with our money. See that engineers, business-
men they only need 4 years to work, we would need
8 years to practice, that is too long…why don’t we
just have a short course on this?” (Doctor 15, rural
practice).
For this question, interestingly, when the GPs were
given a prompt to some GPs if she got a chance to follow
another specialization training, with the similar situation
of no payment for the residents, the doctors replied with
“Yes, I am interested. I want to pursue a specialist train-
ing, that is my dream. I adore this specialization since I
was in Med-school” (Doctor 19, rural practice).
This study also found an interesting argument that the
continuation of PCP program was constrained by groups
of doctors in the country. One GP commented this situ-
ation that there were doctors who did not support this
PCP program exist.
“This is interesting, I know that this program is dis-
rupted by other doctors, this is ridiculous. Some
doctors didn’t like their colleagues to upgrade their
skills. I also knew that some doctors who constrained
this training were actually not practicing in pri-
mary care, what are their problems? Some people in
the Association also strongly debate this program.
I think we just need to keep this going’ (Doctor 11,
rural practice).
Positivism
Different perspectives were expressed by half of the doc-
tors who already had more exposure to any family medi-
cine trainings. Doctors who practiced in the rural areas
expressed their gratitude as they already missed any
training in general practice and believed that the train-
ing could improve their practice in primary care, as sug-
gested by Doctor 19: “I am happy with the training. So far,
I’ve been practicing in rural areas, this is superb to remind
us of the skills in primary care” (Doctor 19, rural practice)
Some doctors told us more practical aspects of their
course experience helped them to appropriately man-
age their patients in primary care. A doctor expressed
his experience that his prescription to chronic disease
patients changed significantly after he took his training in
family medicine. After taking the training, he felt that he
had another perspective on the patients’ care. Lately, he
considered more aspects in his patient care.
“I felt significant changes in myself as a doctor, previ-
ously I only met my hypertensive patients and gave
the pills. I did not care about anything else. However,
now, I feel that they need more my attention, I feel
that I am responsible for their continuing medica-
tion, I should know that they have a risk of compli-
cations, stroke, heart attack, which may burden their
lives and families. I am feeling like a real doctor, who
not only need trust from the JKN insurance but more
importantly from my patients and to manage their
conditions” (Doctor 14, rural practice).
Another GP in this study also promoted that the train-
ing could help the GPs’ practices during the implemen-
tation of JKN as Indonesian Universal Health Coverage
(JKN). He wondered if the GPs could perform well in the
clinic, the unnecessary referrals could be avoided and the
patients would receive a more appropriate care.
“I think the training would be more beneficial for our
graduate doctors. I experienced it in my clinic. There
are some newly graduate doctors working with us
and to be honest, they did not have a similar experi-
ence as I do. They loved to refer patients to second-
ary care, that may be right, but I have a different
opinion, this might also lead to unnecessary treat-
ment to the hospital. What I expect is they evalu-
ate the patients first, knowing their needs and treat
them comprehensively” (Doctor 11, rural practice)
Discussion
This study has identified interesting perspectives from
the Indonesian GPs about the PCP training that the clar-
ity of the PCP information influenced the doctors’ views
towards the training. It was mentioned that the doctors
still questioned about the details of the training: such as
its contents, length, the different authorities of PCP doc-
tors and their future incentives compared to the current
GPs. In addition, the practice supports and the medical
association debates also challenged the doctors to opt in
the training. Regarding this finding, the Indonesian gov-
ernment had actually disseminated information related
to primary care doctors’ training. The Frequently Asked
Questions (FAQ), the training schemes, the PCP com-
petencies had been published [19]. Some scholarships
to support the training were also offered [7]. However,
seemed that the distribution and the clarity of those
information inadequately reached the primary care
doctors.
It also appeared at the result section (Resistance) that
the doctors perspectives were framed with their current
knowledge of general practice and accused its develop-
ment by comparing the training with the facilities limita-
tion in practice settings [14]. The views that the doctors
were admiring the other specialist trainings might
also show that they lacked abstraction and doubt the
6. Page 6 of 8Ekawati et al. Asia Pac Fam Med (2018) 17:10
prospects of PCP graduates compared to other speciali-
zation. Moreover, the medical association did not fully
support the training and published their objection [9].
Interestingly, it is showed that exposure to a formal
training could be a powerful strategy to change the doc-
tors’ perspectives about the primary care practice. Half of
the participants who already followed the formal train-
ing in family medicine had better insights of the train-
ing compared to the other doctors who didn’t not have
any exposures to family medicine courses. The doctors
expressed that the training improved their practice per-
spectives, from treating the acute care to a more compre-
hensive and holistic care. From a disease-based treatment
to a more personal care for the patients, and how to
finally see the primary care as a macro system on its rela-
tionship with secondary care [20, 21]. While the formal
training seem to be suspended because of the national
medical association resistance, facilities improvement
and supports for the trained doctors (such as: additional
incentives) could change the situation [22, 23].
This phenomena of the Indonesian doctors’ reluctance
to the PCP training is in line with an article from Haq,
Ventres [23] that stated that family doctor programs in
developing countries were lacking of recognition as a spe-
cialist training. In connection to this study finding, Indo-
nesia is now left behind from other Asia Pacific countries
for the establishment of family medicine as specialist
training. The country still focused its primary care train-
ing materials in undergraduate level [24] and the current
doctors have limited abstraction of family medicine as a
unique specialisation. Therefore, massive considerations
need to be taken by the Indonesian doctors and the gov-
ernment about the benefits of the developed primary
care research and education, that the training could con-
tribute to improve the health system as well as to provide
a high quality health care for all people [14, 25] (Fig. 1).
As shown in the above findings of this research dem-
onstrating that the current need for GP continuing
education programs, the Indonesian government’s inten-
tion to upgrade the GPs quality with formal postgradu-
ate training is currently on the appropriate decision [1,
14, 26–29]. In addition to offering annual postgraduate
workshops, clear competence reviews and appropri-
ate allocation of CPD credits for PCP courses/seminars/
conferences are essential supports for the training pro-
gram [30]. The leadership from the government sectors
and extensive information dissemination are also needed
to ensure the correct understanding of the GPs and to
balance the resonance of the medical association resist-
ance [15]. By these efforts, it is expected that the GPs can
better understand the values of the PCP training and its
impact on patients and the healthcare system [27, 28].
It is also strongly suggested that the government, GPs,
and medical associations could create a plan together to
Fig. 1 Practice supports, massive information dissemination, and leadership from both government and universities are potential to minimise the
GPs’resistance of PCP training in Indonesia
7. Page 7 of 8Ekawati et al. Asia Pac Fam Med (2018) 17:10
minimize the tension and provide assistances for GPs
who wish to take the PCP training.
Lastly, this research provided a foundation to further
investigate the specialist doctors’ and other stakehold-
ers’ views about Indonesian postgraduate training in pri-
mary care, to explore the challenges and any initiatives
which may endorse the recruitment of PCP trainee in
Indonesia.
Strengths and limitations
This study was the first academic study to explore the
Indonesian GPs views related to the PCP training. It was
a small qualitative study with 19 GPs participants from
Yogyakarta, Indonesia. The findings in this study should
be appropriately interpreted and may not represent a
nationwide range of doctors’ perspectives. However,
the participants’ variation sampling strategy was able to
achieve data collection from a range of sources, and the
IPA analysis approach is valuable to strengthen the con-
clusions from the findings.
Authors’contributions
All the authors were involved in the study design. FME did the data collec-
tion, interpretation, and data analysis. MC, WI, ADS, HK were responsible for
FME’s research. MC, WI, ADS, and HK were involved in the construction of the
emerging themes and provided essential comments during the analysis, the
interpretation of the data, and revised the publication drafts. All authors read
and approved the final manuscript.
Author details
1
Department of Family, Community Medicine and Bioethics, Faculty of Medi-
cine, Public Health and Nursing, Universitas Gadjah Mada, Radioputro 1st
Floor, Jalan Farmako Sekip Utara, Sleman, Yogyakarta, Indonesia. 2
Depart-
ment of General Practice, University of Melbourne, Melbourne, VIC, Australia.
3
Department of Medical Education, Faculty of Medicine, Public Health
and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Acknowledgements
Thank you for our reviewers for their comments and suggestions; also Ms.
Riadiani, Mr. Erik Hookom, and Mr. Frits Haryadi for their assistance during our
data collection and manuscript preparation.
Competing interests
The authors declare that they have no competing interests.
Availability of data and supporting materials
Please contact authors’correspondence for any requests for data and support-
ing materials.
Consent for publication
All the participants have given their consent for participation and academic
publications using their anonymous identity.
Declaration
This study’s ethic had been approved by the Ethics Committee of the Faculty
of Medicine, Public Health and Nursing, Universitas Gadjah Mada number KE/
FK/10/EC/2016.
Funding
This research was funded under the scheme of the Allison Sudrajat Prize
awarded by the Department of Foreign Affairs and Trade, Australia.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub-
lished maps and institutional affiliations.
Received: 11 April 2017 Accepted: 8 November 2018
References
1. WHO. Primary health care: now more than ever. Geneva: WHO; 2008. p.
1–120.
2. World Health Assembly. Social health insurance: sustainable health
financing, universal coverage and social health insurance: report by the
Secretariat. In: 58th World Health Assembly, 2005, World Health Assembly,
Geneva.
3. Indonesia, The Parliament of Republic and The President of Republic
Indonesia. The Indonesian Law Number 24 about National Social Security
Agency. 2011. p. 1–68. http://www.bkkbn.go.id/Documents/JKN/UU%20
No.24%20Tahun%202011%20Tentang%20Penyelenggaraan%20BPJS.pdf.
Accessed 20 May 2016.
4. Kesehatan BPJS. Panduan praktis Pelayanan Kesehatan. 2014. http://bpjs-
Kesehatan.go.id/bpjs/index.php/arsip/categories/OQ/manlak-jkn-bpjs-
kesehatan. Accessed 5 May 2015.
5. Indonesia, The President of Republic and The Indonesian Parliament.
Indonesian Law of Medical Education. 2013. p. 59. http://sipuu.setkab.go.
id/PUUdoc/173839/UU0202013.pdf. Accessed 20 May 2016.
6. Euract. The European definition of general practice/family medicine.
2005.
7. Primer, Pokja Percepatan Pendidikan Dokter Layanan. Standar Pendidikan,
Standar Penelitian, Standar Pengabdian Masyarakat Dokter Layanan
Primer. Department of Health-Department of Research and Hinger
Education, editor. Jakarta, Indonesia. 2016. p. 22–23.
8. Helyer R. Learning through reflection: the critical role of reflection in
work-based learning (WBL). J Work Appl Manag. 2015;7(1):15–27.
9. Agustin YN. Ahli dan Saksi: Dokter Layanan Primer Rugikan Profesi Dokter
Umum. A concern that primary care doctor program would disadvan-
tage the general practitioners. 2015. http://www.mahkamahkonstitusi.
go.id/index.php?page=web.Berita&id=10512#.VkFU_rcrLcs. Accessed 28
Nov 2015.
10. Agustin YN. Ahli Pemerintah: Dokter Layanan Primer Dapat Tingkatkan
Layanan Kesehatan Masyarakat. 2015. http://www.mahkamahkonstitusi.
go.id/index.php?page=web.Berita&id=10577#.VkFWubcrLcs. Accessed 3
Feb 2015.
11. Sutomo AH, Claramita M, Ekawati FM, Istiono W, Raharjo TS, Praman-
tara DP, Sutomo R, Sitaremi M, Prawitasasri S. Kelayakan Kasus Klinik di
Pelayanan Primer Sebagai Skenario Kasus di Proses Pembelajaran Berbasis
Kompetensi. The appropriateness of clinical cases in primary care to be
implemented in the scenario of competence based curriculum 2012,
Yogyakarta: Gadjah Mada University. p. 56.
12. Ekawati FM, Claramita M, Hort K, Furler J, Licqurish S, Gunn J. Patients’
experience of using primary care services in the context of Indonesian
universal health coverage reforms. Asia Pac Fam Med. 2017;16:4.
13. Istiono W, Claramita M, Ekawati FM, Gayatri A, Sutomo AH, Kusnanto H,
Graber MA. Physician’s self-perceived abilities at primary care settings in
Indonesia. J Fam Med Primary Care. 2015;4:551.
14. Kidd M. The contribution of family medicine to improving health systems:
a guidebook from the world organization of family doctors, vol. 1. 2nd ed.
Auckland: WONCA; 2013. p. 320.
15. Ganiem LM. Belum Saatnya Dokter Layanan Primer. 2016.
16. Association, Indonesian Medical. Peluncuran Buku Putih DLP: IDI Pertegas
Penolakan Atas DLP. 2017. http://www.idionline.org/berita/peluncuran
-buku-putih-dlp-idi-pertegas-penolakan-atas-dlp/. Accessed 5 Sept 2017.
17. Smith JA, Larkin MH, Flowers P. Interpretative phenomenological analysis:
theory, method and research. London: SAGE; 2009. p. 2009.
18. Smith JA, Osborn M. Interpretative phenomenological analysis, in qualita-
tive psychology: a practical guide to research methods. In: Smith JA,
editor. Thousand Oaks: Sage Publications, Inc. 2003. p. 51–80.
19. Vidiawati D. Dokter Layanan Primer: Upaya Mengejar Keterlambatan
Pergerakan Peningkatan Kualitas Layanan Primer di Indonesia, vol. 2, no.
8. Page 8 of 8Ekawati et al. Asia Pac Fam Med (2018) 17:10
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3. 2014. http://download.portalgaruda.org/article.php?article=32481
5&val=5027&title=Dokter%20Layanan%20Primer:%20Upaya%20Men
gejar%20Keterlambatan%20Pergerakan%20Peningkatan%20Kualitas
%20Layanan%20Primer%20%20di%20Indonesia. Accessed Dece 2014.
20. Wang HH, Wang JJ, Zhou ZH, Wang XW, Xu L. General practice educa-
tion and training in southern China: recent development and ongo-
ing challenges under the health care reform. Malays Fam Physician.
2013;8(3):2–10.
21. Sandars J, Huang Y, Gibbs T. The challenge of training for family medicine
across different contexts: insights from providing training in China. Fam
Med Commun Health. 2016;4(2):47.
22. van der Voort CTM, van Kasteren G, Chege P, Dinant GJ. What challenges
hamper Kenyan family physicians in pursuing their family medicine man-
date? A qualitative study among family physicians and their colleagues.
BMC Fam Pract. 2012;13:32.
23. Haq C, Ventres W, Hunt V, Mull D, Thompson R, Rivo M, Johnson P. Where
there is no family doctor: the development of family practice around the
world. Acad Med. 1995;70(5):370–80.
24. Ng CJ, Teng CL, Abdullah A, Wong CH, Hanafi NS, Phoa SSY, Tong WT. The
status of family medicine training programs in the Asia Pacific. Fam Med.
2016;48(3):194–202.
25. Kruk ME, Porignon D, Rockers PC, Van Lerberghe W. The contribution of
primary care to health and health systems in low- and middle-income
countries: a critical review of major primary care initiatives. Soc Sci Med.
2010;70(6):904–11.
26. Starfield B, Shi L, Macinko J. Contribution of primary care to health sys-
tems and health. Milbank Q. 2005;3:457.
27. Starfield B. Primary care: an increasingly important contributor to effec-
tiveness, equity, and efficiency of health services SESPAS report 2012.
Gaceta Sanitaria. 2012;26(Supplement 1):20–6.
28. Starfield B. The importance of primary health care in health systems. In:
Qatar-EMRO primary health care conference, Doha-Qatar. 2008.
29. De Maeseneer J, Moosa S, Pongsupap Y, Kaufman A. Primary health care
in a changing world. Br J Gen Pract. 2008;58(556):806.
30. Balch GI. The stick, the carrot, and other strategies: a theoretical analysis
of governmental intervention. Law Policy. 1980;2(1):35.