Minggu, 19 Maret 2017
Kamis, 10 Juli 2014
Selasa, 26 Mei 2009
CRITICALLY COMPARE BEHAVIOURAL CHANGE APPROACH AND ECOLOGICAL PUBLIC HEALTH APPROACH IN ADDRESSING MALNUTRITION IN NTT PROVINCE, INDONESIA
ABSTRACT
Behavioural approach and ecological approach are two concepts in managing public health issues. Behavioural approach focuses on individual behaviour. Meanwhile an ecological approach is a comprehensive strategy looking at public health issues through determinants of health environmental, social/structural, cultural, individual and health service.
In terms of the malnutrition issue in NTT Province Indonesia, local authorities are strengthening the implementation program mainly by a behavioural approach. Short-term programs such as providing supplement food packages and health education are the main local government strategies. Partnership with other sectors to address the issue is not yet part of the strategies. However, malnutrition is still one of the main health issues in this region.
Because health has multi determinant factors, an ecological approach is very useful to address this issue by considering some determinants of health, such as, environmental factors, social/structural factors, cultural factors, individual factors. An ecological approach is appropriate to malnutrition in NTT Province.
INTRODUCTION
There are some public health problems in Indonesia. Malnutrition in children under five years of age is one of the public health problems. The Incidence Rate (IR) of malnutrition in children is tending to increase. For example, in 2000 the incidence rate are 26.7%, in 2001, IR: 27.3%, and in 2003 IR : 27.5%. (Hadi, 2004).
In NTT Province, malnutrition in children under 5 years has been huge problem in the last 5 years. For instance, in 2005, around 368 children in NTT Province were suffering malnutrition in categories of marasmus and kwashiorkor. In 2006, around 439 children under five years identified as suffering malnutrition, and 12 children were reported died. In 2007 a total case of malnutrition in NTT Province was 559 cases and 72 children were died in that period (IR:12,59 %, Total Fatality Rate / TFR: 12.8%). (P. H. O. NTT, 2007).
Local authorities conducted four strategies to overcome the malnutrition. Firstly, they provide food packages or food supplements for 12 months particularly for children who were identifying as marasmus and kwashiorkor. Secondly, the government provide vitamins as a supplement for children less than 5 years and pregnant women. Thirdly, the government conducted health promotion or education program, which focused on behavioural change in nutrition consumption. The Health promotion program was delivering by health promoting staff from public health centres and district health offices. The last strategy is to provide Therapeutic Feeding Centre (P. NTT, 2005). Even though the local government conducted some strategies above, malnutrition is still happening in this region.
A comprehensive study analysed policy related to an outbreak of malnutrition in eight districts in 2006 conducted by the Provincial Research and Development Body in NTT Province found some information below:
1. The local government was paying more concern to malnutrition cases, which were happening in their district. It was indicating from good knowledge related to malnutrition. However, the government did not have a comprehensive strategy to address malnutrition issues. They used the action strategy that has developed by the provincial health office. In this action strategy, consisted of technical procedures for nurses, nutritionists or managers to manage their program.
2. Governments in sub district levels did not have sufficient knowledge and awareness about malnutrition. In addition, they did not have particular strategies for malnutrition, but they totally depended on the initiative from public health centres. The data of malnutrition cases was available in public health centres. Reports from public health centres showed that other infectious diseases, such as, malaria, TBC, diarrhoea, tuberculosis, etc, also accompanied some of the malnutrition cases.
3. Cadres (community health volunteers) from community health centres (posyandu) have more understanding about malnutrition than heads of villages and other community leaders.
4. In terms of eating traditions in the family, the adult man has more priority to be serve or to be the first person who will get the food rather than the woman and children. Parents are mostly busy with their jobs and do not have enough time to take care their children. They leave the younger children or babies with their adult children in the home. Other problems at the community levels were poor sanitation, (safe water and toilet). (P. NTT, 2005).
This paper will compare the concepts behavioural change approach and the ecological public health approach to address malnutrition in NTT Province Indonesia. Thus, in the next sections, this paper will explain about the general overview of malnutrition in NTT Province. In the literature review, this paper will describe a behavioural change approach and an ecological approach. In the last sections, this paper will discuss the approach that is appropriate to address malnutrition in NTT Province.
RATIONALE
The World Health Organization (1947) defines health as a state of complete physical, mental, and social wellbeing and not merely the absence of disease and infirmity. Moreover, the World Health Organization, (1998) stated that health is a basic fundamental human right. (Chu, 2009).
Throughout the history of public health, there are some strategies to overcome the challenges or problems in public health. For example, in 19th century, public health focused on prevention medicine to protect human health. Moreover, in 1960-1970, public health focused on the individual life style or behavioural change. In this period, public health creates behavioural approach to address the public health issues. The recent concept of public health in 21st century is an ecological approach. This concept is focusing on determinants of health such as environment, social/structural, culture, lifestyle, and the health care system. (Chu, 2009).
Malnutrition in children under five years is huge problem in NTT province. The recent study indicates that malnutrition is related to low of economic conditions, culture barriers, etc. In 2005, local authorities conducted some strategies to overcome the malnutrition (as explained above) which focused on the individual approach. However, malnutrition is still happening in this province.
LITERATURE REVIEW
Health behavioral change approach
Some definitions of health behaviour is introduced by scientists as explained below. Notoatmodjo (2003) explained that health behaviour refers to the individual responses regarding illness and diseases, response to the health care system, to the food consumption behaviour and to the environment. He argues that there are four factors that influences public health they are environment, behaviour, genetics and health services. Behaviour is the more influential then other factors. By contrast, Blum (cited by Notoatmodjo, 2003) argues that, environment is the main factor to influence public health.
In the broad context, health behaviour is the actions of individuals, groups community and organizations as well-as determinants, correlate and consequences including social changes, policy development implementation, improved coping skills, and enhanced quality of life. (Parkerson and others 1993, cited by (Karen Glanz, 2002).
The health behavioural approach in public health problems has been introduced by Kurt and Lewin (1930) to develop field theory which is the form of intellectual roots of much of today’s health education practice, and also explain behaviour related to tuberculosis screening using Health the Belief Model Hocbaum (1958) in (Karen Glanz, 2002).
Generally, there are some behavioral change theories to address the public health which are Health Belief Model (HBM), reasoned action, trans theoretical model, social cognitive theory (Nancy K. Janz, 2002). The Health Belief Model is a psychological model. There are five elements of the health belief model theory, perceived susceptibility, perceived severity, perceived benefits, perceived barriers and self efficacy. (Nancy K. Janz, 2002). Those key variables explain factors that inffluence the individual behavior change. The health belief model is limited in regard to predicting on the individual behavior.
The health belief model can not predict community behavior. This theory does not cover the comprehensive community needs, and does not involve other variables around the individual such as environmental conditions, economy, and health care facilities. Behavioral based health promotion starts from the premise that in the developed countries the major killers or injuries are linked to life style, sometimes called the diseases of affluence, and that modification of the lifestyles linked to disease or injury will be of benefit to peoples health (Winkler (1986, p.270) cited by Baum (2008.).
In the case of malnutrition contexts in NTT Province, the authorities (government) were paying more attention to this model. It is indicated from the strategy that was conducted to address the issue on malnutrition. For instance to provide food packages for children directly (PMT) who were identified as marasmus and kwashiorkor for 12 month and to provide vitamins as a supplement for children less than 5 years and pregnant women and to provide health promotion or education and Therapeutic Feeding Centres (TFC) (P. NTT, 2005). All of these strategies were focusing on individual behaviour.
Integrated approach (ecological public health)
The integrated approach or ecological public health presumes that human health is caused by multi determinant factors, which are environmental factors, social/cultural factors, structural factors, individual factors, and health care system. All the determinant factors are interrelated. Therefore, it is important to consider the ecological approach to overcome the public health issues. (Chu, 2009).
Environmental determinants
Environmental factors including water supply, disposal systems, food safety and physical, chemical and biological hazards can cause a variety of communicable diseases and non-communicable diseases and traumas. In terms of malnutrition cases, lacks of water supply in the community and food safety are the main issues related to the environmental determinants.
A study in the local community in NTT province that was identifying about the relationship between environmental determinant and malnutrition found that around 72.5% of households who suffered malnutrition did not have access to clean water and only 37.5% households have water closets. (R.H. Kristina, 2006).
Social / structural determinants
Research demonstrates the strong relationship between income per capita and nutrition status in the children less than five years in NTT. (R.H. Kristina, 2006). About 67.5% of households have incomes less than Rp. 200.000 (USD$ 30) per month. Other sociological studies demonstrate that health behaviour and health outcomes are determined by social structure. Health outcomes are a reflection of one’s social position in the society as indicated by their education, income, gender, ethnic group membership, religion, and occupation.(Chu, 2008)
Culture determinants
Culture refers to the belief and system of meaning created by a group of people through their interactions over time. Cultural determinants of health include beliefs, values and norms relating to the conception of health and health behaviour. (Chu, 2008).
Based on the research in local communities in NTT it indicates that local cultures were predisposing factors. There was 67.5% of parents who argued that were particular meat and fish and egg are taboo when the females are pregnant, because they can cause allergic reactions such as itchy skin. There are 70% of household that were suffering malnutrition which indicates that the adult man (father) is the priority in getting the meal first, because father is the head of household, and the one who is looking after the family members. (P. NTT, 2005; R.H. Kristina, 2006).
Individual determinants
Individual determinants of health include genetics, biology or lifestyle factors such as poor eating habits, attitudes and values, physiological risk factors, psychological factors such as personality and behavioural risk factors such as smoking. (Chu, 2009). According to Green (1970) individual knowledge is a predisposing factor in health behaviour. Good knowledge of particular diseases results in supportive behaviour in health (Karen Glanz, 2002). Knowledge is an output of the education system. A study in local communities in NTT province found that most of the mothers who had malnourished children have lower education backgrounds (72.5%) completed or not completed primary school. A factor related to the lower education among these mothers includes lack of money to pay school fees, difficulty to access the school location and some community belief that a girl does not need a high education because they will marry.(R.H. Kristina, 2006).
Health services determinants
Health services determinants of health include whether health services are accessible and available. It also endorses that health services are sensitive to the needs of a given population and are provided in a way that is acceptable to the target population. (Chu, 2009).
Around 87.5% of children who were suffering malnutrition did not have access to health facilities to control weight and to get immunisation appropriately. It happened because of several reasons, such as lack of knowledge about the advantage of immunisation and too far to access health facilities. They needed 1-2 hours to get to health facilities by walking. The other reason is parents were busy with their activities.(P. NTT, 2005; R.H. Kristina, 2006).
Behavioural approach and ecological approach are two concepts in managing public health issues. Behavioural approach focuses on individual behaviour. Meanwhile an ecological approach is a comprehensive strategy looking at public health issues through determinants of health environmental, social/structural, cultural, individual and health service.
In terms of the malnutrition issue in NTT Province Indonesia, local authorities are strengthening the implementation program mainly by a behavioural approach. Short-term programs such as providing supplement food packages and health education are the main local government strategies. Partnership with other sectors to address the issue is not yet part of the strategies. However, malnutrition is still one of the main health issues in this region.
Because health has multi determinant factors, an ecological approach is very useful to address this issue by considering some determinants of health, such as, environmental factors, social/structural factors, cultural factors, individual factors. An ecological approach is appropriate to malnutrition in NTT Province.
INTRODUCTION
There are some public health problems in Indonesia. Malnutrition in children under five years of age is one of the public health problems. The Incidence Rate (IR) of malnutrition in children is tending to increase. For example, in 2000 the incidence rate are 26.7%, in 2001, IR: 27.3%, and in 2003 IR : 27.5%. (Hadi, 2004).
In NTT Province, malnutrition in children under 5 years has been huge problem in the last 5 years. For instance, in 2005, around 368 children in NTT Province were suffering malnutrition in categories of marasmus and kwashiorkor. In 2006, around 439 children under five years identified as suffering malnutrition, and 12 children were reported died. In 2007 a total case of malnutrition in NTT Province was 559 cases and 72 children were died in that period (IR:12,59 %, Total Fatality Rate / TFR: 12.8%). (P. H. O. NTT, 2007).
Local authorities conducted four strategies to overcome the malnutrition. Firstly, they provide food packages or food supplements for 12 months particularly for children who were identifying as marasmus and kwashiorkor. Secondly, the government provide vitamins as a supplement for children less than 5 years and pregnant women. Thirdly, the government conducted health promotion or education program, which focused on behavioural change in nutrition consumption. The Health promotion program was delivering by health promoting staff from public health centres and district health offices. The last strategy is to provide Therapeutic Feeding Centre (P. NTT, 2005). Even though the local government conducted some strategies above, malnutrition is still happening in this region.
A comprehensive study analysed policy related to an outbreak of malnutrition in eight districts in 2006 conducted by the Provincial Research and Development Body in NTT Province found some information below:
1. The local government was paying more concern to malnutrition cases, which were happening in their district. It was indicating from good knowledge related to malnutrition. However, the government did not have a comprehensive strategy to address malnutrition issues. They used the action strategy that has developed by the provincial health office. In this action strategy, consisted of technical procedures for nurses, nutritionists or managers to manage their program.
2. Governments in sub district levels did not have sufficient knowledge and awareness about malnutrition. In addition, they did not have particular strategies for malnutrition, but they totally depended on the initiative from public health centres. The data of malnutrition cases was available in public health centres. Reports from public health centres showed that other infectious diseases, such as, malaria, TBC, diarrhoea, tuberculosis, etc, also accompanied some of the malnutrition cases.
3. Cadres (community health volunteers) from community health centres (posyandu) have more understanding about malnutrition than heads of villages and other community leaders.
4. In terms of eating traditions in the family, the adult man has more priority to be serve or to be the first person who will get the food rather than the woman and children. Parents are mostly busy with their jobs and do not have enough time to take care their children. They leave the younger children or babies with their adult children in the home. Other problems at the community levels were poor sanitation, (safe water and toilet). (P. NTT, 2005).
This paper will compare the concepts behavioural change approach and the ecological public health approach to address malnutrition in NTT Province Indonesia. Thus, in the next sections, this paper will explain about the general overview of malnutrition in NTT Province. In the literature review, this paper will describe a behavioural change approach and an ecological approach. In the last sections, this paper will discuss the approach that is appropriate to address malnutrition in NTT Province.
RATIONALE
The World Health Organization (1947) defines health as a state of complete physical, mental, and social wellbeing and not merely the absence of disease and infirmity. Moreover, the World Health Organization, (1998) stated that health is a basic fundamental human right. (Chu, 2009).
Throughout the history of public health, there are some strategies to overcome the challenges or problems in public health. For example, in 19th century, public health focused on prevention medicine to protect human health. Moreover, in 1960-1970, public health focused on the individual life style or behavioural change. In this period, public health creates behavioural approach to address the public health issues. The recent concept of public health in 21st century is an ecological approach. This concept is focusing on determinants of health such as environment, social/structural, culture, lifestyle, and the health care system. (Chu, 2009).
Malnutrition in children under five years is huge problem in NTT province. The recent study indicates that malnutrition is related to low of economic conditions, culture barriers, etc. In 2005, local authorities conducted some strategies to overcome the malnutrition (as explained above) which focused on the individual approach. However, malnutrition is still happening in this province.
LITERATURE REVIEW
Health behavioral change approach
Some definitions of health behaviour is introduced by scientists as explained below. Notoatmodjo (2003) explained that health behaviour refers to the individual responses regarding illness and diseases, response to the health care system, to the food consumption behaviour and to the environment. He argues that there are four factors that influences public health they are environment, behaviour, genetics and health services. Behaviour is the more influential then other factors. By contrast, Blum (cited by Notoatmodjo, 2003) argues that, environment is the main factor to influence public health.
In the broad context, health behaviour is the actions of individuals, groups community and organizations as well-as determinants, correlate and consequences including social changes, policy development implementation, improved coping skills, and enhanced quality of life. (Parkerson and others 1993, cited by (Karen Glanz, 2002).
The health behavioural approach in public health problems has been introduced by Kurt and Lewin (1930) to develop field theory which is the form of intellectual roots of much of today’s health education practice, and also explain behaviour related to tuberculosis screening using Health the Belief Model Hocbaum (1958) in (Karen Glanz, 2002).
Generally, there are some behavioral change theories to address the public health which are Health Belief Model (HBM), reasoned action, trans theoretical model, social cognitive theory (Nancy K. Janz, 2002). The Health Belief Model is a psychological model. There are five elements of the health belief model theory, perceived susceptibility, perceived severity, perceived benefits, perceived barriers and self efficacy. (Nancy K. Janz, 2002). Those key variables explain factors that inffluence the individual behavior change. The health belief model is limited in regard to predicting on the individual behavior.
The health belief model can not predict community behavior. This theory does not cover the comprehensive community needs, and does not involve other variables around the individual such as environmental conditions, economy, and health care facilities. Behavioral based health promotion starts from the premise that in the developed countries the major killers or injuries are linked to life style, sometimes called the diseases of affluence, and that modification of the lifestyles linked to disease or injury will be of benefit to peoples health (Winkler (1986, p.270) cited by Baum (2008.).
In the case of malnutrition contexts in NTT Province, the authorities (government) were paying more attention to this model. It is indicated from the strategy that was conducted to address the issue on malnutrition. For instance to provide food packages for children directly (PMT) who were identified as marasmus and kwashiorkor for 12 month and to provide vitamins as a supplement for children less than 5 years and pregnant women and to provide health promotion or education and Therapeutic Feeding Centres (TFC) (P. NTT, 2005). All of these strategies were focusing on individual behaviour.
Integrated approach (ecological public health)
The integrated approach or ecological public health presumes that human health is caused by multi determinant factors, which are environmental factors, social/cultural factors, structural factors, individual factors, and health care system. All the determinant factors are interrelated. Therefore, it is important to consider the ecological approach to overcome the public health issues. (Chu, 2009).
Environmental determinants
Environmental factors including water supply, disposal systems, food safety and physical, chemical and biological hazards can cause a variety of communicable diseases and non-communicable diseases and traumas. In terms of malnutrition cases, lacks of water supply in the community and food safety are the main issues related to the environmental determinants.
A study in the local community in NTT province that was identifying about the relationship between environmental determinant and malnutrition found that around 72.5% of households who suffered malnutrition did not have access to clean water and only 37.5% households have water closets. (R.H. Kristina, 2006).
Social / structural determinants
Research demonstrates the strong relationship between income per capita and nutrition status in the children less than five years in NTT. (R.H. Kristina, 2006). About 67.5% of households have incomes less than Rp. 200.000 (USD$ 30) per month. Other sociological studies demonstrate that health behaviour and health outcomes are determined by social structure. Health outcomes are a reflection of one’s social position in the society as indicated by their education, income, gender, ethnic group membership, religion, and occupation.(Chu, 2008)
Culture determinants
Culture refers to the belief and system of meaning created by a group of people through their interactions over time. Cultural determinants of health include beliefs, values and norms relating to the conception of health and health behaviour. (Chu, 2008).
Based on the research in local communities in NTT it indicates that local cultures were predisposing factors. There was 67.5% of parents who argued that were particular meat and fish and egg are taboo when the females are pregnant, because they can cause allergic reactions such as itchy skin. There are 70% of household that were suffering malnutrition which indicates that the adult man (father) is the priority in getting the meal first, because father is the head of household, and the one who is looking after the family members. (P. NTT, 2005; R.H. Kristina, 2006).
Individual determinants
Individual determinants of health include genetics, biology or lifestyle factors such as poor eating habits, attitudes and values, physiological risk factors, psychological factors such as personality and behavioural risk factors such as smoking. (Chu, 2009). According to Green (1970) individual knowledge is a predisposing factor in health behaviour. Good knowledge of particular diseases results in supportive behaviour in health (Karen Glanz, 2002). Knowledge is an output of the education system. A study in local communities in NTT province found that most of the mothers who had malnourished children have lower education backgrounds (72.5%) completed or not completed primary school. A factor related to the lower education among these mothers includes lack of money to pay school fees, difficulty to access the school location and some community belief that a girl does not need a high education because they will marry.(R.H. Kristina, 2006).
Health services determinants
Health services determinants of health include whether health services are accessible and available. It also endorses that health services are sensitive to the needs of a given population and are provided in a way that is acceptable to the target population. (Chu, 2009).
Around 87.5% of children who were suffering malnutrition did not have access to health facilities to control weight and to get immunisation appropriately. It happened because of several reasons, such as lack of knowledge about the advantage of immunisation and too far to access health facilities. They needed 1-2 hours to get to health facilities by walking. The other reason is parents were busy with their activities.(P. NTT, 2005; R.H. Kristina, 2006).
DISCUSSION
The behavioral approach to address the malnutrition issue in NTT Province has some limitations, because this approach just focuses on the individual behavior, which is indicate from the government strategies above. The behavioral approach does not consider the other determinant factors such as environment, economy, health care services/facilities. This approach presumes that modification of individual life styles is linked to reducing malnutrition. This led to “blame the victim” as stated by Richmod (1999) in (Baum, 2008).
The ecological public health approach is a broad context. It is presume that human health is related to multi determinant factors, such as environmental factors, social/cultural, structural, individual, and health care system. Therefore, the Ottawa Charter concept in health promotion is appropriate to address the public health issues including malnutrition. (Chu, 2009). Ottawa charter offers some strategies, which is explains below:
a. Build a Healthy Public Policy. It means that puts health issues on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health.
b. Create Supportive Environments. It is strong relationships between humans and the environment. Creating environment with water supply system and providing public toilet are very important to support health.
c. Strengthen Community Actions. Strengthening communities are important in health programs, because communities are subjects and objects of the health programs. Strengthening community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health are strengthen of community actions.
d. Develop Personal Skills. Developing personal skills in health programs can be conduct through providing information, education for health, and enhancing life skills. Developing personal skills enables people to have more control over their own health and over their environments, and to make choices conducive to health. Develops personal skills can be conducted in school, home, work and community settings.
e. Reorient Health Services. Health services have a main role in public health. Health services should be sensitive and respect individual or community culture needs. Health service should be open channels between the health sector and broader social, political, economic and physical environmental components. Reorienting health services also requires stronger attention to health research as well as changes in professional education and training.
However, McQueen has introduced a critic of the ecological approach that is concern on social determinants of health. He argues that ecological approach has been introduced in hundreds or thousands year ago, and the last was introduced by WHO in 1977. It means that they know the social determinants impact on health, but they do not adopt the approach into the action. In addition, the ecological approach is difficult to measure its effects on health and it is difficult to prove that changing social factors solve the health problems. (V.McQueen, 2009).
Based on the case study of intervention malnutrition in NTT Province and considering the two strategies above, I believe that the ecological approach is an appropriate strategy to address the issue. Based on the research, malnutrition in NTT province is relate to low economic conditions, culture barriers, lack of community knowledge related to food consumption, and lack of comprehensive strategies to address the issue. Therefore, local government should create policy that is involves some sectors to address the issue. It is also important to create supportive environment such as building transportation systems to connect with remote areas; Strengthen the community actions such as basic value systems in the local community (NTT) “Gotong Royong” means together the community to solve the problem; develop personal skills in the community level (mother/father) through training or promotion related to local foods; provide health care services such as improving the health professional skills.
CONCLUSION
Malnutrition is a serious problem in NTT Province. The government has some strategies to overcome the issue. Those strategies were similar to behavioural approach. Meanwhile, the behavioural approach has certain limitations, because it is only concerned with individuals, without considering other factors outside the individual.
Compared with the behavioural approach, the ecological public health approach is the appropriate concept to address malnutrition in NTT Province, because concerned with determinant factors of health; such as environment, social/structural, individual, health sector and economy.
REFERENCES
Baum, F. (2008). New Public Health (Third ed.). USA: Oxford.
Chu, C. (2008). Power Point Presentation : From Need Assessment to Program Planning and Evaluation. Paper presented at the Conference Name. Retrieved Access Date. from URL.
Chu, C. (2009). Lecture Power Point Presentation : Health Promotion Strategies and Practices, : Griffith university.
Hadi, H. (2004). Beban ganda masalah gizi dan implikasinya terhadap kebijakan pembangunan kesehatan nasional (Double burden of malnutrition, and its implication on national health policy)
Paper presented at the seminar on proffesor inauguration Gajah Mada University.
Karen Glanz, B. K. R., Frances Marcus Lewis. (2002). Health Behavior and Health Education (Third ed.). USA: Jossey-Bass.
Nancy K. Janz, V. L. C., Victor J. Strecher (2002). Health Belief Model. In B. K. R. Karen Glanz, Frances Marcus Lewis (Ed.), Health Behavior and Health Education (Third ed.). USA: Jossey Bass.
NTT, P. (2005). Strategi Penanggulangan KLB Gizi Buruk di Provinsi NTT, 2005 (Strategy In Reducing Malnutrition in NTT Province, 2005). Kupang: Biro Bina Sosial Setda Provinsi Nusa Tenggara Timur (Social Bureau, NTT Province Secretary)
NTT, P. H. O. (2007). Rencana Strategis Dinas Kesehatan Provinsi NTT 2005-2009 (Strategic Planning Provincial Health Office, 2005-2009) (No. Unpulished Report). Kupang: Provincial Health Office.
R.H. Kristina, K. N., R. Theodolfi. (2006). Epidemiology status gizi balita pasca intervensi PMT and analisis factor penyebab status gizi balita di desa kuaklalo Kec. Taebenu Kabupaten Kupang, NTT, 2006 (Epidemiology nutrition status on children under five years pasca food package supplement program, and analysisi determinant factors in Kuaklalo village, Taebenu sub district, Kupang, NTT province, 2006) Health Polytechnic of Kupang.
V.McQueen, D. (2009). The challenges fo the social determinants of health pursuit. International Journal Public Health, 54, 1-2.
Ethical Principles in Resources Allocation
Introduction
Ethics attempts to deal with the broad philosophical questions of what we ought to do. It can be a potentially controversial and even divisive area of debate. Ethics is about values and principles, and about the development of rules and guiding principles (criteria) for decision-making. A Set of ethical guidelines can be a valuable decision-making tool. (Chu, 2009).
Need to distinguish between ethics and morals–“ethics”-derived from Greek–“morals”-derived from Latin. Both are concerned with the values and beliefs individuals / groups hold in relation to human behavior, often used interchangeably. Morals tend to refer to standards held by individuals or groups whilst ethics refers to the science or study of morals. Ethic refers to the collective belief-and-value system of any moral community, social or professional group. Ethics serve to identify good, desirable, or acceptable conduct and provide reasons for those conclusions. Ethics relates to practical knowledge and skills in the application of principles on which moral rules and values are based decision-making skills involved in applying moral principles to practical situations decision procedures specific or appropriate to various contexts and situations. (Chu, 2009).
Ethics is moral rules or principles that influence person’s behavior to decide what is right and wrong. (Oxford, 2007). Ethical principles in resources allocation is considering the ethics principles in decision making in resources allocation including distribution of resources among competing programs or people (Brook, 2006). In addition, there are five criteria should manager use for resource allocation decision-making, to resonate across the various disciplines, they are – mission, quality, efficiency, need, and process Singer (1994).
This paper discus the ethical issues in the resources allocation decision making process and it is implementing in the public health decision –making in Health Department Republic of Indonesia.
Ethical principles Public Health decision-making and resource allocation
While a nation’s resource is limited, there are competing demands from different sectors for the money, how should a nation spend the money? How much should a nation spend on health? As health costs increases rapidly, uncontrolled, it will be throwing into a bottomless hole, so how do we control the budget? Those are some issues should be considering in health decision making.
Chu (2009) stated that there are 5 guiding principles (Ethical decisions) for resource allocation in public health.
Health spending, who should benefit from the decision-making.
Who should make decision (process Decision-making )
Individual responsibility or collective responsibility.
Direction of technological development?
Health research funding?
In addition, Brock (2006) stated that ethical principles in the resources allocation generally must satisfy two criteria: cost–effectiveness and equity. Sometimes efficiency and equity coincide; but in many cases, there are moral reasons for an allocation that is not cost–effective. Cost effective analysis (CEA) can provide a framework for decision-makers at all levels for systematically evaluating the implications of resource allocation.
Moreover, Singer (1994) stated that resource allocation is an ethical issue because it most fundamentally involves questions of justice. The goal of resource allocation is to make fair decisions. There is no consensus on what is "fair" means, and this is where the dilemma. For instance, utilitarianism focuses on the maximization of benefit, while egalitarianism focuses on equality. A legal scholar would talk about procedures for decision-making. An economist would focus on economic theories that have a utilitarian basis. A political scientist would focus on democratic theory and participation in decision- making. A management scholar would focus on the mission, program priorities, and quality of care. A health scientist would focus on evidence-based medicine. In addition, Singer (1994) stated that there are five criteria should manager use for resource allocation decision-making, to resonate across the various disciplines, they are – mission, quality, efficiency, need, and process.
Case study resources allocation in Indonesia
In this case study, I will explain some principles which is equity and process decision making and technological driven.
Principle 1: Health spending, who should benefit from the decision-making.
In Indonesia, the government spends money more on individual health rather then on community health. Around 43% of government budget spend on individual health, and 30.9% spend on community health. (World Bank, 2008). In Nusa Tenggara Timur (NTT) Province, around 76% of budged in the health sector, spend on individual health, and 24% spend on community health. (MOH, 2005). Ccommunity health program focus on the provision of public health canters and their networks, including community health canter (Puskesmas), mobile public health canters and village midwives. The community health program also includes immunization, environmental health programs, and other traditional public health activities. And the individual health program is focus on providing hospital care. The question is, should the government spend more budged on the individual health (hospital) rather than on community health? Some activities in the community health are focus on social determinants of health and individual focus on curative?
In this case, my opinion is the government should spend money more on the public health or community health than on individual health. The reason is around 70-80 percent people are need to maintain and increase their health through promotive and preventive program, and around 20% of people in Indonesia is need health care in hospital. Other reason is community health is focus on social determinants of health which can conduct by public health centre (puskesmas), but individual health is focus on curative program.
Principe 2: Who should make decisions?
It is related to the decision making process. The final decision maker in the health sector in Indonesia is Ministry of Health in the national levels and head of provincial health office in provincial levels. In the public health resources allocation, planning and budgeting in the health department in Indonesia is a political process, lobby, not just a technocratic or scientific based. The consequences are some programs known to be less important and cost effective. In the some program in the health department, decision-making just conduct by the leader in the department without involve the other parties in the decision making process.
In my opinion, decision making process should be involved other parties or other department. The reason is the manager may have limited information related to the program. Involving other sectors in the decision-making process can improve the quality of output in the decision-making. More over, decision-making should be scientific based not based on the political process or lobby.
Principle 3: Direction of technological development
In the global context, invest in the technological development is increase in the health sector , for example development technology for reproductive, body image and commercial trends, reproductive functions and aging, cloning etc. (Chu, 2009). In Indonesia, the government spent more budged on the medical technology particularly in hospital. It is important to help the doctor or para medic to make a good decision or an appropriate diagnose to the patient. In this case, I disagree that government spent budget more on in the technological development. The reason is technology approach some time can make people feel dependent to the technology. People don’t think to reduce the determinants of the disease. Some times, technology is harm for the environment because of the waste when the technology are producing in the industry or when the technology can not use and become waste.
Conclusion
Ethical principles in resources allocation is considering the ethics principles in decision making in resources allocation including distribution of resources among competing programs or people. The ethical principles in resources allocation in decision making are equity, effective, fair, etc. There are five criteria should manager use for resource allocation decision-making, to resonate across the various disciplines, they are – mission, quality, efficiency, need, and process.
References
Brock, D.W., Wikle, Daniel. (2006). Ethical issues in resource allocation, research, and new product development. In Dean T. Jamison and Joel G. Breman, at all, 2006. Disease Control Priorities in developing countries , second edition. Oxford University Press New York. Retrieved: May, 21, 2009 from http://www.dcp2.org/pubs/DCP/14/
Chu, C. (2009). Public Health Challenges andEthics In the New Century. Power point presentation in the lecture health determinant and global response, Griffith University. 2009.
MoH. (2005). Draft Final : Rancangan Pembangunan Kesehatan Jangka Panjang 2005-2025 (Final Draft : Long Term Development Health Planning 20005-2025). Jakarya: Heath Department Ministry of Health..
Oxford dictionary. (2007). Oxford Advanced Learners Compass. Cambridge University.
Singer, A. Peter., Mapa, Joseph. (1994). Ethics of resource allocation: dimensions for health care executives. Retrieve May, 20, 2009, from www.longwoods.com/product.php?productid=16387
World Bank Indonesia. (2008). Investing in Indonesia’s health, challenges and opportunities for future public spending. Health public spanding review, 2008. retrieved 21 May, 2009 from http://siteresources.worldbank.org/INTINDONESIA/Resources/Publication/.pdf
Ethics attempts to deal with the broad philosophical questions of what we ought to do. It can be a potentially controversial and even divisive area of debate. Ethics is about values and principles, and about the development of rules and guiding principles (criteria) for decision-making. A Set of ethical guidelines can be a valuable decision-making tool. (Chu, 2009).
Need to distinguish between ethics and morals–“ethics”-derived from Greek–“morals”-derived from Latin. Both are concerned with the values and beliefs individuals / groups hold in relation to human behavior, often used interchangeably. Morals tend to refer to standards held by individuals or groups whilst ethics refers to the science or study of morals. Ethic refers to the collective belief-and-value system of any moral community, social or professional group. Ethics serve to identify good, desirable, or acceptable conduct and provide reasons for those conclusions. Ethics relates to practical knowledge and skills in the application of principles on which moral rules and values are based decision-making skills involved in applying moral principles to practical situations decision procedures specific or appropriate to various contexts and situations. (Chu, 2009).
Ethics is moral rules or principles that influence person’s behavior to decide what is right and wrong. (Oxford, 2007). Ethical principles in resources allocation is considering the ethics principles in decision making in resources allocation including distribution of resources among competing programs or people (Brook, 2006). In addition, there are five criteria should manager use for resource allocation decision-making, to resonate across the various disciplines, they are – mission, quality, efficiency, need, and process Singer (1994).
This paper discus the ethical issues in the resources allocation decision making process and it is implementing in the public health decision –making in Health Department Republic of Indonesia.
Ethical principles Public Health decision-making and resource allocation
While a nation’s resource is limited, there are competing demands from different sectors for the money, how should a nation spend the money? How much should a nation spend on health? As health costs increases rapidly, uncontrolled, it will be throwing into a bottomless hole, so how do we control the budget? Those are some issues should be considering in health decision making.
Chu (2009) stated that there are 5 guiding principles (Ethical decisions) for resource allocation in public health.
Health spending, who should benefit from the decision-making.
Who should make decision (process Decision-making )
Individual responsibility or collective responsibility.
Direction of technological development?
Health research funding?
In addition, Brock (2006) stated that ethical principles in the resources allocation generally must satisfy two criteria: cost–effectiveness and equity. Sometimes efficiency and equity coincide; but in many cases, there are moral reasons for an allocation that is not cost–effective. Cost effective analysis (CEA) can provide a framework for decision-makers at all levels for systematically evaluating the implications of resource allocation.
Moreover, Singer (1994) stated that resource allocation is an ethical issue because it most fundamentally involves questions of justice. The goal of resource allocation is to make fair decisions. There is no consensus on what is "fair" means, and this is where the dilemma. For instance, utilitarianism focuses on the maximization of benefit, while egalitarianism focuses on equality. A legal scholar would talk about procedures for decision-making. An economist would focus on economic theories that have a utilitarian basis. A political scientist would focus on democratic theory and participation in decision- making. A management scholar would focus on the mission, program priorities, and quality of care. A health scientist would focus on evidence-based medicine. In addition, Singer (1994) stated that there are five criteria should manager use for resource allocation decision-making, to resonate across the various disciplines, they are – mission, quality, efficiency, need, and process.
Case study resources allocation in Indonesia
In this case study, I will explain some principles which is equity and process decision making and technological driven.
Principle 1: Health spending, who should benefit from the decision-making.
In Indonesia, the government spends money more on individual health rather then on community health. Around 43% of government budget spend on individual health, and 30.9% spend on community health. (World Bank, 2008). In Nusa Tenggara Timur (NTT) Province, around 76% of budged in the health sector, spend on individual health, and 24% spend on community health. (MOH, 2005). Ccommunity health program focus on the provision of public health canters and their networks, including community health canter (Puskesmas), mobile public health canters and village midwives. The community health program also includes immunization, environmental health programs, and other traditional public health activities. And the individual health program is focus on providing hospital care. The question is, should the government spend more budged on the individual health (hospital) rather than on community health? Some activities in the community health are focus on social determinants of health and individual focus on curative?
In this case, my opinion is the government should spend money more on the public health or community health than on individual health. The reason is around 70-80 percent people are need to maintain and increase their health through promotive and preventive program, and around 20% of people in Indonesia is need health care in hospital. Other reason is community health is focus on social determinants of health which can conduct by public health centre (puskesmas), but individual health is focus on curative program.
Principe 2: Who should make decisions?
It is related to the decision making process. The final decision maker in the health sector in Indonesia is Ministry of Health in the national levels and head of provincial health office in provincial levels. In the public health resources allocation, planning and budgeting in the health department in Indonesia is a political process, lobby, not just a technocratic or scientific based. The consequences are some programs known to be less important and cost effective. In the some program in the health department, decision-making just conduct by the leader in the department without involve the other parties in the decision making process.
In my opinion, decision making process should be involved other parties or other department. The reason is the manager may have limited information related to the program. Involving other sectors in the decision-making process can improve the quality of output in the decision-making. More over, decision-making should be scientific based not based on the political process or lobby.
Principle 3: Direction of technological development
In the global context, invest in the technological development is increase in the health sector , for example development technology for reproductive, body image and commercial trends, reproductive functions and aging, cloning etc. (Chu, 2009). In Indonesia, the government spent more budged on the medical technology particularly in hospital. It is important to help the doctor or para medic to make a good decision or an appropriate diagnose to the patient. In this case, I disagree that government spent budget more on in the technological development. The reason is technology approach some time can make people feel dependent to the technology. People don’t think to reduce the determinants of the disease. Some times, technology is harm for the environment because of the waste when the technology are producing in the industry or when the technology can not use and become waste.
Conclusion
Ethical principles in resources allocation is considering the ethics principles in decision making in resources allocation including distribution of resources among competing programs or people. The ethical principles in resources allocation in decision making are equity, effective, fair, etc. There are five criteria should manager use for resource allocation decision-making, to resonate across the various disciplines, they are – mission, quality, efficiency, need, and process.
References
Brock, D.W., Wikle, Daniel. (2006). Ethical issues in resource allocation, research, and new product development. In Dean T. Jamison and Joel G. Breman, at all, 2006. Disease Control Priorities in developing countries , second edition. Oxford University Press New York. Retrieved: May, 21, 2009 from http://www.dcp2.org/pubs/DCP/14/
Chu, C. (2009). Public Health Challenges andEthics In the New Century. Power point presentation in the lecture health determinant and global response, Griffith University. 2009.
MoH. (2005). Draft Final : Rancangan Pembangunan Kesehatan Jangka Panjang 2005-2025 (Final Draft : Long Term Development Health Planning 20005-2025). Jakarya: Heath Department Ministry of Health..
Oxford dictionary. (2007). Oxford Advanced Learners Compass. Cambridge University.
Singer, A. Peter., Mapa, Joseph. (1994). Ethics of resource allocation: dimensions for health care executives. Retrieve May, 20, 2009, from www.longwoods.com/product.php?productid=16387
World Bank Indonesia. (2008). Investing in Indonesia’s health, challenges and opportunities for future public spending. Health public spanding review, 2008. retrieved 21 May, 2009 from http://siteresources.worldbank.org/INTINDONESIA/Resources/Publication/.pdf
Minggu, 22 Maret 2009
Gebrak DBD di 4 Kelurahan Kota Kupang (R.H.Kristina & Karolus Ngambut)
PENDAHULUAN
Sejak Desember 2003 - Januari 2004 Jumlah kasus DBD di Provinsi NTT sebanyak 251 kasus, dan pada Pebruari 2004 menurun menjadi 118 orang, tetapi penderita yang meninggal dunia sebanyak 18 orang, Case Fatality Rate nya (CFR) sebesar 3,8 %, lebih dari angka nasional 1.9%, yang artinya 10% masyarakat NTT terkena DBD, dan Kota Kupang mempunyai jumlah kasus yang paling banyak, dibandingkan dengan kabupaten lainnya di Provinsi NTT. mengantisipasi memburuknya kondisi tersebut, Jurusan Kesling Poltekkes Kupang bekerja sama dengan Dinkes Provinsi NTT dan Dinkes Kota Kupang ikut ambil bagian dalam upaya memberantas penyakit DBD, dalam suatu bentuk kegiatan pengabdian masyarakat, dalam tema ”GEBRAK DBD”. vektor Penyakit. Kegiatan dilakukan selama 2 tahap, tahap I bln. Januari dan tahap II bln. April 2004. Kegiatan difokuskan pada 4 wilayah Kelurahan yang dinyatakan endemis DBD yaitu Kelurahan Oebufu, Oebobo, Naikoten I dan Naikoten II.
HASIL KEGIATAN
Jenis kegiatan yang dilaksanakan adalah Penyuluhan dengan mobil unit, penyuluhan dari rumah ke rumah, PSN-DBD (3M), Pembagian Abate, Fogging, survei dan identifikasi jentik atau larva yang ditemukan dilapangan.
Gebrak DBD Tahap I
Secara umum hasil kegiatan Gebrak DBD tahap I pada 4 keluran fokus sebagai berikut : jumlah rumah yang diperiksa : 935 rumah, yang ditemukan adanya jentik aedes aegypty 780 rumah, jumlah conteiner yang ditemukan adalah 2457 buah (yang terdiri dari bak air dalam dan luar rumah, drum air), dan semuanya terdapat jentik dan 1175 yang dinyatakan
positif jentik aedes aegypti berdasarkan identifikasi di laboratorium Jurusan Kesehatan Lingkungan Poltekkes Kupang.
Gebrak DBD tahap II
Kelurahan Oebufu
Jumlah rumah yang diperiksa : 186 rumah dan ditemukan jentik 102 rumah (HI: 55%), jumlah conteiner yang ditemukan : 291 dan positif jentik sebanyak 194 (CI : 66,7%).
Kelurahan Oebobo
Jumlah rumah yang diperiksa : 245 rumah, dan positif jentik : 113, (HI: 46,12%). Jumlah Conteiner yang ditemukan ada 413 buah, ada jentik : 203 buah, (CI : 49.15%)
Kelurahan Naikoten I
Jumlah rumah yang diperiksa = 189 rumah, dan positif jentik: 98 rumah (HI:51.85%), conteiner yang ditemukan : 436 buah, yang positif ada jentik = 199 buah (CI: 45.6%).
Kelurahan Naikoten II
Juml rumah yang diperiksa: 198 rumah, dan positif jentik aedes adalah 117 (HI: 59%), conteiner yang ditemukan : 497 buah, dan yang positif ditemukan jentik : 191 buah (CI: 38%).
Sejak Desember 2003 - Januari 2004 Jumlah kasus DBD di Provinsi NTT sebanyak 251 kasus, dan pada Pebruari 2004 menurun menjadi 118 orang, tetapi penderita yang meninggal dunia sebanyak 18 orang, Case Fatality Rate nya (CFR) sebesar 3,8 %, lebih dari angka nasional 1.9%, yang artinya 10% masyarakat NTT terkena DBD, dan Kota Kupang mempunyai jumlah kasus yang paling banyak, dibandingkan dengan kabupaten lainnya di Provinsi NTT. mengantisipasi memburuknya kondisi tersebut, Jurusan Kesling Poltekkes Kupang bekerja sama dengan Dinkes Provinsi NTT dan Dinkes Kota Kupang ikut ambil bagian dalam upaya memberantas penyakit DBD, dalam suatu bentuk kegiatan pengabdian masyarakat, dalam tema ”GEBRAK DBD”. vektor Penyakit. Kegiatan dilakukan selama 2 tahap, tahap I bln. Januari dan tahap II bln. April 2004. Kegiatan difokuskan pada 4 wilayah Kelurahan yang dinyatakan endemis DBD yaitu Kelurahan Oebufu, Oebobo, Naikoten I dan Naikoten II.
HASIL KEGIATAN
Jenis kegiatan yang dilaksanakan adalah Penyuluhan dengan mobil unit, penyuluhan dari rumah ke rumah, PSN-DBD (3M), Pembagian Abate, Fogging, survei dan identifikasi jentik atau larva yang ditemukan dilapangan.
Gebrak DBD Tahap I
Secara umum hasil kegiatan Gebrak DBD tahap I pada 4 keluran fokus sebagai berikut : jumlah rumah yang diperiksa : 935 rumah, yang ditemukan adanya jentik aedes aegypty 780 rumah, jumlah conteiner yang ditemukan adalah 2457 buah (yang terdiri dari bak air dalam dan luar rumah, drum air), dan semuanya terdapat jentik dan 1175 yang dinyatakan
positif jentik aedes aegypti berdasarkan identifikasi di laboratorium Jurusan Kesehatan Lingkungan Poltekkes Kupang.
Gebrak DBD tahap II
Kelurahan Oebufu
Jumlah rumah yang diperiksa : 186 rumah dan ditemukan jentik 102 rumah (HI: 55%), jumlah conteiner yang ditemukan : 291 dan positif jentik sebanyak 194 (CI : 66,7%).
Kelurahan Oebobo
Jumlah rumah yang diperiksa : 245 rumah, dan positif jentik : 113, (HI: 46,12%). Jumlah Conteiner yang ditemukan ada 413 buah, ada jentik : 203 buah, (CI : 49.15%)
Kelurahan Naikoten I
Jumlah rumah yang diperiksa = 189 rumah, dan positif jentik: 98 rumah (HI:51.85%), conteiner yang ditemukan : 436 buah, yang positif ada jentik = 199 buah (CI: 45.6%).
Kelurahan Naikoten II
Juml rumah yang diperiksa: 198 rumah, dan positif jentik aedes adalah 117 (HI: 59%), conteiner yang ditemukan : 497 buah, dan yang positif ditemukan jentik : 191 buah (CI: 38%).
Selaian Kegiatan Survei Kepadatan Jentik, mahasiswa juga melakukan pembagian abate, penyuluhan langsung, penyebaran brosur berisi info singkat ttg. DBD.
KESIMPULAN
- Gebrak DBD tahap 1 (bulan Januari 2004) dianggap cukup berhasil karena terjadi penurunan pada beberapa indeks sebagai indikator DBD, yaitu HI dari 84,43% turun menjadi 53 %, dan BI dari 130,69 % turun menjadi 68,155%. Sedangkan indikator CI mengalami peningkatan dari 48,93 % menjadi 49.9 %
- Meningkatnya angka CI sebagai indikator utama peningkatan populasi nyamuk aedes Aegypti, sehingga perlu waspada dengan keadaan ini.
SARAN
- Gerakan pemberantasan DBD perlu lebih intensif dilakukan dalam bentuk PSN dan Abatisasi serta penyuluhan.
- Khusus untuk kota kupang perlu dicanangkan bulan waspada DBD~terutama 3 bulan sebelum musim penghujan ( Agustus, September dan Oktober) setiap tahun dan pada bulan waspada inilah GebrakDBD / intervensi perlu dilakukan.
- Inti gebrakan DBD yang dianjurkan oleh institusi adalah pemberantasan sarang nyamuk, abatisasi masal, dan penyuluhan intensif pada kelompok atau dari rumah ke rumah (House to house education).
Sabtu, 21 Maret 2009
Sejarah Singkat Jurusan kesehatan Lingkungan Poltekkes Depkes Kupang Provinsi NTT
Cikal bakal adanya Jurusan Kesehatan Lingkungan Politeknik Kesehatan Kupang, dimulai dengan dibukanya Sekolah pembantu penilik Higiene (SPPH) pada tahun 1985 – 1987. karena tujuan dibukanya sekolah ini adalah untuk memenuhi kekurangan tenaga sanitasi di lapagan sehingga tahun 1988 tidak menerima mahasiswa lagi. Tahun 1993 dan 1994 kembali menerima mahasiswa baru.
Selanjutnya pada tanggal 21 Agustus 1995 dengan SK Kepala Kantor Depkes RI Provinsi NTT Nomor 13.521/Q53.DL.02.01.08/ VIII / 1995 dibuka Akademi Kesehatan Terpadu di Kupang yang terdiri dari dua jurusan yaitu Keperawatan dan Kesehatan Lingkungan, dengan kurikulumnya mengacu pada SK. Menkes RI No.: HK.00.06.1.2.01313 tanggal 28 April 1995 dan SK Menkes RI Nomor: HK.00.06.1.2.01311 tanggal 22 April 1995 tentang berlakunya pedoman Penyelenggaraan Program Pendidikan Terpadu Ahli Madya D III Keperawatan, Ahli Medya Gizi dan Ahli Medya Kesehatan Lingkungan.
Pada tahun 2001, terbentuk Politeknik Kesehatan yang terdiri dari Jurusan Kesehatan Lingkungan, Jurusan Keperawatan, dan Kebidanan berdasarkan Surat Keputusan Menkes dan Kesos RI Nomor 298 / MENKES - KESOS RI / SK / IV / 2001 tentang Organisasi dan Tata Kerja Politeknik Kesehatan.
VISI
VISI
Sebagi Pusat penelitian, pengembangan dan pengajaran ilmu Kesehatan Lingkungan khususnya di Provinsi NTT
MISI
- Mendidik mahasiswa dalam bidang ilmu dan teknologi kesehatan lingkungan melalui pendidikan dan pengajaran pang bermutu.
- Melaksanakan riset terapan terhadap masalah kesehatan lingkungan khususnya di Provinsi NTT.
- Mendorong ketercapaian pembangunan kesehatan di Provinsi NTT melalui kegiatan Pengabdian Kepada Masyarakat dalam bidang kesehatan lingkungan.
TUJUAN
Tujuan Pendidikan Diploma III Kesehatan Lingkungan adalah Menghasilkan Tenaga Kesehatan Lingkungan yang terampil, bermutu dan bertangggungjawab dalam merencanakan, melaksanakan, dan mengevaluasi berbagai kegiatan yang berkaitan kesehatan lingkungan yang mempengaruhi derajad kesehatan masyarakat, yang dilandasi dengan ketaqwaan terhadap Tuhan Yang Maha Esa serta berjiwa Pancasila dan UUD 1945.
PERAN LULUSAN
Lulusan Diploma III Kesehatan Lingkungan yang lebih dikenal sebagai sanitarian dapat berperan sebagai :
- Sebagai pelaksana program Kesling
- Sebagai pengelola program Kesehatan Lingkungan
- Sebagai Penyuluh program Kesling
- Sebagai peneliti (pembantu peneliti) masalahan kesling
KOMPETENSI LULUSAN
- Mengambil sample air, udara, tanah, limbah, makanan & minuman untuk pemeriksaan fisik , kimia, mikrobiologi dan parasitologi
- Mengambil sample vector dan binatang pengganggu
- Mengambil sample secara usap untuk pemeriksaan mikrobiologi dan parasitologi
- Menangani dan mengirim sample
- Melakukan pengukuran suhu udara, air dan limbah cair
- Melakukan pengukuran kebisingan
- Melakukan pengukuran kelembaban
- Melakukan pengukuran pencahayaan
- Melakukakan pengukuran kecepatan dan arah angina
- Melakukan pengukuran tingkat kepadatan hunian
- Melakukan pengukuran kuantitas air dan air limbah
- Melakukan pengukuran parameter kimia di udara
- Melakukan pengukuran parameter kimia pada air
- Melakukan pengukuran parameter kimia pada makanan dan minuman
- Melakukan pengukuran parameter kimia limbah
- Melakukan pengukuran perameter kimia tanah
- Melakukan identifikasi vector dan binatang penganggu
- Melakukan identifikasi mikro dan makro bentos di badan air
- Melakukan pemeriksaan kualitas air secara langsung di lapangan
- Melakukan pemeriksaan kualitas air, udara, tanah dan limbah makanan dan minuman secara mikrobiologi
- Melakukan pemeriksaan tanah dan makanan secara mikrobiologi
- Melakukan audit lingkungan untuk risk assessment & evaluasi
- Melakukan analisis hasil pemeriksaan air, udara, tanah, makanan, minuman, dan limbah secara fisik, kimia, mikrobiologi & parasitologi.
- Menganalisis hasil audit lingkunan untuk risk manajemen
- Menganalisis data hasilidentifikasi vector & binatang pengganggu
- Mengelola kesehatan dan keselamatan kerja
- Mengoperasikan alat pemboran air tanah
- Mengoreasikan alat pendugaan air tanah
- Mengoperasikan alat aplikasi pestisida (swingfog, ULV)
- Melakukan fogging
- Mengoerasikan pengambil sample udara sesuai parameter
- Melakukan kegitan penyuluhan, pemberdayaan dan pelatihan
- Melakukan pengendalian potensi bahaya dengan menggunakan APD
- Mengawasi sanitasi pengolahan linen
- Melakukan pengolahan limbah pada sesuai jenisnya.
- Melakukan pengolahan tinja
- Mengawasi pengelolaan limbah B3
- Menentukan breeding places vector dan binatang penggangu
- Melakukan pemetaan wilayah kerja
- Melakukan survey vector dan binatang penggangg
- Melakukan surveilans penyakit karena factor lingkungan
- Melakukan surveylans penyakit karena factor pekerjaan
- Melakukan komunikasi dengan menggunakan media computer
- Berwirausaha dalam bidang kesling.
- Melakukan pemberdayaan masyarakat dlm. Bidang kesling.
- Melakukan pemantauan dampak negative pengelolaan lingkungan
- Menilai kondisi lantai, dinding, atap, ventilasi dan jendela.
- Merancang teknologi tepat guna bidang kesling
===================================================================
GEBRAK DBD OLEH JURUSAN KESLING KUPANG
oleh : Karolus Ngambut & R.H. Kristina
PENDAHULUAN
Sejak Desember 2003 - Januari 2004 Jumlah kasus DBD di Provinsi NTT sebanyak 251 kasus, dan pada Pebruari 2004 menurun menjadi 118 orang, tetapi penderita yang meninggal dunia sebanyak 18 orang, Case Fatality Rate nya (CFR) sebesar 3,8 %, lebih dari angka nasional 1.9%, yang artinya 10% masyarakat NTT terkena DBD, dan Kota Kupang mempunyai jumlah kasus yang paling banyak, dibandingkan dengan kabupaten lainnya di Provinsi NTT. mengantisipasi memburuknya kondisi tersebut, Jurusan Kesling Poltekkes Kupang bekerja sama dengan Dinkes Provinsi NTT dan Dinkes Kota Kupang ikut ambil bagian dalam upaya memberantas penyakit DBD, dalam suatu bentuk kegiatan pengabdian masyarakat, dalam tema ”GEBRAK DBD”. vektor Penyakit. Kegiatan dilakukan selama 2 tahap, tahap I bln. Januari dan tahap II bln. April 2004. Kegiatan difokuskan pada 4 wilayah Kelurahan yang dinyatakan endemis DBD yaitu Kelurahan Oebufu, Oebobo, Naikoten I dan Naikoten II.
B. HASIL KEGIATAN
Jenis kegiatan yang dilaksanakan adalah Penyuluhan dengan mobil unit, penyuluhan dari rumah ke rumah, PSN-DBD (3M), Pembagian Abate, Fogging, survei dan identifikasi jentik atau larva yang ditemukan dilapangan.
Gebrak DBD Tahap I
Secara umum hasil kegiatan Gebrak DBD tahap I pada 4 keluran fokus sebagai berikut : jumlah rumah yang diperiksa : 935 rumah, yang ditemukan adanya jentik aedes aegypty 780 rumah, jumlah conteiner yang ditemukan adalah 2457 buah (yang terdiri dari bak air dalam dan luar rumah, drum air), dan semuanya terdapat jentik dan 1175 yang dinyatakan
positif jentik aedes aegypti berdasarkan identifikasi di laboratorium Jurusan Kesehatan Lingkungan Poltekkes Kupang.
Gebrak DBD tahap II.
a. Kelurahan Oebufu
Jumlah rumah yang diperiksa : 186 rumah dan ditemukan jentik 102 rumah (HI: 55%), jumlah conteiner yang ditemukan : 291 dan positif jentik sebanyak 194 (CI : 66,7%).
b. Kelurahan Oebobo
Jumlah rumah yang diperiksa : 245 rumah, dan positif jentik : 113, (HI: 46,12%). Jumlah Conteiner yang ditemukan ada 413 buah, ada jentik : 203 buah, (CI : 49.15%)
c. Kelurahan Naikoten I
Jumlah rumah yang diperiksa = 189 rumah, dan positif jentik: 98 rumah (HI:51.85%), conteiner yang ditemukan : 436 buah, yang positif ada jentik = 199 buah (CI: 45.6%).
d. Kelurahan Naikoten II
Juml rumah yang diperiksa: 198 rumah, dan positif jentik aedes adalah 117 (HI: 59%), conteiner yang ditemukan : 497 buah, dan yang positif ditemukan jentik : 191 buah (CI: 38%).
Selaian Kegiatan Survei Kepadatan Jentik, mahasiswa juga melakukan pembagian abate, penyuluhan langsung, penyebaran brosur berisi info singkat ttg. DBD.
C. KESIMPULAN .
1. Gebrak DBD tahap 1 (bulan Januari 2004) dianggap cukup berhasil karena terjadi penurunan pada beberapa indeks sebagai indikator DBD, yaitu HI dari 84,43% turun menjadi 53 %, dan BI dari 130,69 % turun menjadi 68,155%. Sedangkan indikator CI mengalami peningkatan dari 48,93 % menjadi 49.9 %.
2.Meningkatnya angka CI sebagai indikator utama peningkatan populasi nyamuk aedes Aegypti, sehingga perlu waspada dengan keadaan ini.
D. SARAN.
1. Gerakan pemberantasan DBD perlu lebih intensif dilakukan dalam bentuk PSN dan Abatisasi serta penyuluhan.
2. Khusus untuk kota kupang perlu dicanangkan bulan waspada DBD~terutama 3 bulan sebelum musim penghujan ( Agustus, September dan Oktober) setiap tahun dan pada bulan waspada inilah GebrakDBD / intervensi perlu dilakukan.
3. Inti gebrakan DBD yang dianjurkan oleh institusi adalah pemberantasan sarang nyamuk, abatisasi masal, dan penyuluhan intensif pada kelompok atau dari rumah ke rumah (House to house education).
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PERILAKU MENGGIGIT NYAMUK Culex Sp
PADA MALAM HARI DI KELUARAHAN SASI TTU
oleh : Karolus Ngambut & R.H.Kristina
Penyakit Filariasis dan Japanese Enchephalitis (JE) masih merupakan salah satu masalah kesehatan, kedua jenis penyakit ini dilaporkan terjadi di kelurahan Sasi Timor Tengah Utara NTT. Vektor penyakit ini adalah genus Culex. Untuk keberhasilan upaya pemberantasan vektor perlu diketahui kepadatan dan perilaku menggigit nyamuk.
Dengan menggunakan survey penangkapan nyamuk Culex pada malam hari dengan menggunakan umpan orang yang dilakukan pada malam hari di lokasi penelitian.
Hasil identifikasi nyamuk yang tertangkap ditemukan species nyamuk culex dengan tingkat kepadatan tertinggi terjadi pada bulan Mei hingga Agustus. Hasil penangkapan nyamuk dalam rumah lebih banyak dari pada penangkapan luar rumah. Ini berarti nyamuk Culex lebih bersifat endofagik dan antrofilik. Hasil ini juga menunjukkan bahwa keluarahan Sasi merupakan daerah yang berpotensi atau lebih mudah terkena filariasis terutama Japanese encephalitis.
KARAKTERISTIK HABITAT LARVA Anopheles Sp
DI DESA PAILELANG KECAMATAN ALOR BARAT DAYA KABUPATEN ALOR
oleh : Karolus Ngambut & R.H.Kristina
Malaria dan filaria merupakan penyakit menular yang sangat dominan di daerah tropis maupun sub tropis. Di kabupaten Alor khususnya di Desa Pailelang kec. Alor Barat daya malaria dan merupakan masalah kesehatan masyarakat yang utama, penyakit malaria lebih dominan ditularkan oleh nyamuk Anopheles Spp. Untuk memberantas vector penyakitnya perlu mengetahui habitatyang paling disukai nyamuk. Penyelidikan dilakukan dengan cara observasi dan pengukuran terhadap tempat perindukan / larva Anopheles Spp
Malaria dan filaria merupakan penyakit menular yang sangat dominan di daerah tropis maupun sub tropis. Di kabupaten Alor khususnya di Desa Pailelang kec. Alor Barat daya malaria dan merupakan masalah kesehatan masyarakat yang utama, penyakit malaria lebih dominan ditularkan oleh nyamuk Anopheles Spp. Untuk memberantas vector penyakitnya perlu mengetahui habitatyang paling disukai nyamuk. Penyelidikan dilakukan dengan cara observasi dan pengukuran terhadap tempat perindukan / larva Anopheles Spp
Hasil penyelidikan menunjukkan bahwa terdapat beberapa jenis habitat larva yang potensial diantaranya rawa-rawa dan sawah, namun keduanya berbeda dimana pada habitat sawah lebih banyak ditemukan jentik dari pada pada habitat rawa-rawa. Hal ini dipengaruhi oleh beberapa factor seperti keberadaan flora dan fauna serta tingkat kekeruhan yang lebih tinggi pada rawa-rawa., suhu dan pH air yang lebih tinggi di rawa-rawa daripada di sawah.
Disarankan agar intervensi untuk pengendalian vector nyamuk malaria lebih ditujukan pada habitat yang ada di rawa-rawa. Disamping itu peran seerta masyarakat teerus diupayakan terutama.
EVALUASI PENYEMPROTAN RUMAH / INDOOR RESUDUAL SPRAYING (IRS) LAMDA CYHALOTRIN (icon) TERHADAP KEMATIAN NYAMUK Anopheles spp
oleh : Karolus Ngambut & R.H. Kristina
A. Pendahuluan
Penyakit malaria`adalah penyakit yang merupakan permasalahan global yang sedang dihadapi saat ini, terutama di Provinsi Nusa Tenggara Timur. Kecamatan Kupang Barat merupakan salah satu daerah endemis malaria di kabupaten Kupang, terutama di desa Tesabela. Untuk memberantas vektor penyakit malaria, maka Dinas Kesehatan melakukan kegiatan penyemprotan rumah, dengan insectisida lamda cyhalothrin (icon). Tujuan penelitian ini adalah untuk mengetahui proses penyemprotan rumah berdasarkan standar penyemprotan rumah yang dilakukan dengan cek list, dan uji bio assay untuk menguji efektifitas penyemprotan.
B. Bahan dan Cara
Jenis Penelitian ini merupakan penelitan deskriptif dengan rancangan penelitian cross sectional study. Sampel diambil dengan teknik purposive random sampling pada 15 rumah di Desa Tesabela.
C. Hasil penelitian.
a. Hasil Penilaian Penyemprotan Rumah
Penilaian menggunakan checklist pada beberapa variabel seperti lokasi, bangunan, teknik penyemperotan rumah, cakupan bangunan yang disemperot, teknik penyemprotan oleh petugas. Pada lokasi penyemperotan penentuan desa tesabela untuk penyemprotan sangat tepat karena merupakan desa endemis malaria, namun desa ini cukup sulit dijangkau petugas, pada aspek bangunan yang disemprot cukup baik karena yang disemprot adalah bangunan/rumah yang ditempati oeh penduduk seperti rumah tinggal, dan pos jaga; pada teknik penyemprotan dinilai sangat baik karena mennggunakan larutan kimia yang dianjurkan WHO untuk membunuh nyamuk Anopheles yaitu Lamda Chihalotrin (icon) dari golongan sintetik peritroit dengan dosis penyemprotan per meter persegi yaitu 40 ml. Alat dan prosedur penyemprotan dilakukan sesuai standart sehingga residu tersebar secara merata, cakupan bangunan yang disemprot meliputi dinding, pintu/jendela, perabot dalam rumah dan teras. Waktu penyemprotan dinilai sesuai yaitu jam 08.00-16.00 dengan rerata setiap rumah disepmrot 1 jam.
b. Hasil uji bio assay test
Uji dilakukan pada 3 jenis rumah yaitu rumah ermanen, semi permanen dan darurat. Hasilnya menunjukkan rumah permanen mempunyai residu tertinggi dari pada kedua tipe rumah lainnya yang diindikasikan dari rerata jumlah nyamuk yang mati setelah penyemprotan lebih banyak pada rumah permanen. Dilihat dari waktu paparan, nyamuk mati lebih banyak setelah disemprot selama 30 menit,ini berkaitan dengan sifat bahan aktif dari icon yang bersifat neuromuscular poison yang menyerang sistem persyarafan nyamuk melalui permukaan kulit yang terpapar dengan insektisda (icon).
Kesimpulan
Pelaksanaan penyemperotan rumah (Indoor residual spraying (IRS) di desa tesa bela dilaksanakan dengan baik oleh petugas kesehatan, dengan hasil bio asay test terhadap nyamuk anopheles tinggi pada rumah permanen daripada rumah semi permanen.
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