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Benefits of Fornas are guidance in determining drug use, increasing rational drug use, quality control and treatment costs and optimizing services. The use of antibiotics is regulated according to the category of health service facilities. Therefore it is necessary to evaluate the suitability between the availability of antibiotic drugs and national formulary. The study design was cross sectional. This type of research is quantitative followed by qualitative data collection. Quantitative data in the form of secondary data on the availability of antibiotics for the period 2014-2017 at the North Sulawesi Provincial Health Office, Manado City Health Office, and 2 Health Centers in Manado City. The average percentage of suitability of antibiotics with the national formulary from 2014 to 2017 at level 1 health facilities was 61.77% in the Provincial Health Office, 61.59% in the City Health Office, 50.14% in the Puskesmas Bahu, 56.85% in the Tikala Health Center. The low percentage of conformity with fornas in the Provincial Health Office, Manado City Health Office and 2 Health Centers was dominated by the large number of antibiotic use which can only be used for level 2 and 3 health facilities. There needs to be escorting the process of socialization, implementation and supervision. It is necessary to consider forming a particular system, for example reward and punishment for doctors who write prescriptions. Keywords: JKN, Antibiotics, National Formulary, FKTP Abstrak Manfaat Fornas yaitu acuan penetapan penggunaan obat dalam JKN, meningkatkan penggunaan obat rasional, kendali mutu dan biaya pengobatan dan mengoptimalkan pelayanan. Penggunaan antibiotik diatur berdasarkan kategori fasilitas pelayanan kesehatan. Oleh karena itu perlu dilakukan evaluasi kesesuaian antara ketersediaan obat antibiotik dan formularium nasional. Desain penelitian adalah cross sectional. Jenis penelitian ini adalah kuantitatif yang diikuti oleh pengumpulan data kualitatif. Data kuantitatif berupa data sekunder ketersediaan antibiotik selama periode 2014 – 2017 di Dinas Kesehatan Provinsi Sulut, Dinkes Kota Manado, dan 2 Puskesmas di Kota Manado. Rata-rata persentase kesesuaian antibiotik dengan formularium nasional dari tahun 2014 – 2017 pada faskes tingkat 1 adalah 61,77% di Dinkes Provinsi, 61,59% di Dinkes Kota, 50,14% di Puskesmas Bahu, 56,85% di Puskesmas Tikala. Rendahnya persentase kesesuaian dengan fornas di Dinkes Provinsi, Dinkes Kota Manado dan 2 Puskesmas lebih didominasi karena banyaknya penggunaan antibiotik yang hanya boleh digunakan untuk faskes tingkat 2 dan 3. Perlu ada pengawalan terhadap proses sosialisasi, implementasi dan pengawasan. Perlu dipertimbangkan untuk membentuk sistem tertentu, misalnya reward and punishment terhadap dokter yang menulis resep. Kata kunci: JKN, Antibiotik, Formularium Nasional, FKTP

Latar Belakang: Kelahiran prematur merupakan salah satu penyebab utama kematian bayi terkait dengan komplikasi yang terjadi khususnya sindrom gagal nafas. Pemberian antenatal corticosteroid (ACS) merupakan intervensi yang efektif untuk mencegah gangguan pernafasan pada bayi prematur. Cakupan pemberian ACS diperkirakan hanya 10 persen dari yang membutuhkan. Tujuan: Kajian ini dilakukan untuk mengumpulkan data mengenai kebijakan, manfaat dan kerugian ACS, serta rekomendasi berbagai organisasi profesi terkait pemberian ACS. Metode: Data dikumpulkan melalui penelusuran data kebijakan, penelusuran literatur secara online untuk dibuat telaah secara sistematik serta pertemuan dengan narasumber dari organisasi profesi terkait. Hasil: Kebijakan yang sudah ada belum menjadi landasan hukum pemberian ACS dan belum ada prosedur teknis pelaksanaannya. ACS terbukti bermanfaat untuk membantu pematangan paru-paru pada janin sehingga mengurangi risiko komplikasi pada bayi prematur dan tidak memberikan komplikasi yang serius pada ibu. Pemberian ACS harus dilakukan sebagai satu paket komprehensif oleh tenaga kesehatan yang meliputi proses deteksi dini, pemberian tokolitik, pemberian ACS dan diikuti dengan rujukan ke fasilitas yang memadai. Pemahaman dan kompetensi tenaga kesehatan baik di rumah sakit maupun puskesmas perlu ditingkatkan dan didukung dengan peraturan yang memadai. Kesimpulan: Peningkatan cakupan pemberian ACS memerlukan dukungan kebijakan pemerintah serta peran organisasi profesi dan tenaga kesehatan.

The Vaccines is a biological preparation that improves immunity to a particular disease.immunization program will effectively work only if the vaccines were distributed equally and the quality is highly maintained. Some questions need to be answered by the availability of accurate data, such asvaccine inventory management systems and cold chain. It is because vaccine has a limited period and requires special treatment. Is the quality and quantity vaccine adequate?and how the role and coordination of central and local government in vaccine management? The research was a cross sectional research conducted in two provinces. It is conducted to identify factors that affect access and quality of vaccines at the health center. Data were collected by conducting in depth interview, secondary data collections and observation. Result showed that appropriate vaccines management based on the standard of immunization delivery was only in provincial level, while there was still a lot of lacking in district and PHCs level. Three out of six district health offices and eight out of eighteen PHCs have not yet had any freeze tag. Ten out of eighteen PHCs have not had electricity generator set, even though four of them had 24 hours electricity supply. Distribution of the vaccine is still has problems, it is seen from the uneven supply at same province. Based on the result, it is suggested that the information system accommodating all stages including procurement, receiving, inventory, and distribution is urgently required. In addition, the vaccine chain management mainly in district and PHCs level must be improved by conducting training and fixing up the facilities for inventory and distributionby monitoring the vaccine inventory report intensively, so thevaccine stock can be maintained and prevent risk of expiration.Keyword: vaccine, management, distribution, stock, cold chain.AbstrakVaksin adalah sediaan biologi yang dapat meningkatkan kekebalan pada beberapa penyakit. Imunisasi dapat mencegah terjadinya penyakit jika vaksin terdistribusi secara merata dan mutu vaksin terjaga dengan baik.Beberapa pertanyaan perlu dijawab dengan ketersediaan data yang akurat, diantaranya adalah bagaimana sistem manajemen dan persediaan vaksin di daerah? Hal ini mengingat masa edar vaksin yang terbatas dan vaksin membutuhkan perlakuan khusus. Apakah kualitas vaksin cukup baik dan apakah Cold chain memadai? Serta bagaimana peran instansi pemerintah pusat dan daerah terkait dengan pengelolaan vaksin? Penelitian ini dilakukan secara potong lintang di 2 Provinsi yang bertujuan untuk mengidentifikasi faktor-faktor yang mempengaruhi akses dan kualitas vaksin di Puskesmas. Pengumpulan data dilakukan melalui wawancara mendalam, penelusuran data sekunder dan observasi. Hasil penelitian menunjukkan bahwa pengelolaan vaksin yang sesuai pedoman penyelenggaraan imunisasi hanya ditemukan di Dinkes Provinsi, sementara di Dinkes Kab/Kota dan Puskesmas masih banyak kekurangan. Tiga dari enam Dinkes Kab/Kota dan 8 dari 18 Puskesmas yang di observasi tidak memiliki freeze tag.Sepuluh dari delapan belas Puskesmas tidak memiliki genset, padahal empat Puskesmas diantaranya tidak memiliki pasokan listrik 24 jam dari PLN. Distribusi vaksin juga masih bermasalah, hal ini terlihat dari persediaan yang tidak merata dalam satu Provinsi. Berdasarkan hasil penelitian tersebut diperlukan sistem informasi yang mengakomodasi sistem pengadaan, penerimaan, penyimpanan dan pendistribusian dan memperbaiki rantai vaksin terutama di Dinkes Kab/Kota dan puskesmas dengan melakukan pengawasan terhadap laporan persediaan vaksin secara intensif, sehingga stok vaksin dapat terjaga dengan baik dan mencegah resiko terjadinya kadaluwarsa.Kata Kunci: vaksin, manajemen, distribusi, persediaan, rantai vaksin

Hasil Riskesdas 2007 menunjukkan kasus Tuberkulosis (TB) Paru ditemukan merata di seluruh provinsi di Indonesia, sedangkan hasil Riskesdas 2010 menunjukkan prevalensi TB paru nasional adalah 725 per 100.000 penduduk. Salah satu penyebab putusnya terapi adalah efek samping obat. Hal ini menimbulkan resistensi kuman sehingga memperberat penyakit. Penelitian ini bertujuan untuk mendapatkan informasi efek samping akibat penggunaan obat antituberkulosis(OAT) dan kepatuhan pasien. Jenis penelitian adalah time series, dilakukan terhadap pasien baru penderita tuberkulosis di 10 puskesmas di Provinsi Banten dan Jawa Barat pada bulan Mei 2011. Pasien diikuti selama 6 bulan hingga periode penelitian berakhir. Pasien diwawancara mengenai efek samping obat yang dialaminya setiap bulan saat mengambil obat atau kunjungan ke rumah oleh petugas puskesmas. Pemantauan kepatuhan dilakukan dengan menghitung obatsisa yang disimpan oleh pasien. Jumlah sampel dalam penelitian ini adalah 92 pasien, semuanya masih patuh dalam menjalani terapi. Frekuensi kejadian efek samping yang paling sering timbul pada bulan pertama dan kelima yaitu mual; pada bulan kedua pusing; serta pada bulan ketiga, keempat dan keenam nyeri sendi. Efek samping lain yang sering timbul akibat penggunaan OAT yaitu mengantuk dan lemas pada bulan pertama, kedua dan ketiga. Berdasarkan hasil penelitian dapat disimpulkan bahwa dengan adanya pemantauan yang dilakukan petugas, efek samping yang terjadi dapat terdata dan tidak menyebabkan menurunnya kepatuhan pasien. Hal ini dapat terjadi karena adanya komunikasi yang baik antara pasien dengan petugas mengenai proses pengobatan TB. Disarankan agar pemantauan efek sampingdan kepatuhan dilakukan dengan menekankan pada komunikasi pasien dengan petugas. Selain itu perlu dilakukan pemantauan laboratorium secara rutin.Kata Kunci: Efek Samping, Obat Antituberkulosis (OAT), Tuberkulosis (TB) paruAbstractThe result of Basic Health Research in 2007 shown that lung tuberculosis cases spread out all over Indonesia. Meanwhile, the 2010 Basic Health Research shown the prevalence of lung TB was 725 per 100,000 populations. Side effects are among the causes of therapy drop out thus resulted in bacterial resistance which further caused the severityof TB. This research aimed to explore the information of side effects experiences caused by TB drugs therapy as well as to monitor adherence. The research was a time series research, conducted to new patients diagnosed as having lung TB in 10 public health centers (PHCs) in Banten and West Java provinces on May 2011. Those patients were followed up to6 months until the research was terminated. Patients’ experiences of side effects were collected by monthly interview, when they came to the PHCs to take drugs or during patient’s home visit by the PHC staff. Monitoring of adherence was conducted by counting the tablet at patients’ home. The sample was 92 patients, whom all were counted as adhering thetherapy. The most frequent side effect in the first and fifth months was nausea; in the second month was dizziness; and in the third, fourth and sixth month was neuromyalgia. Other side effects reported were drowsiness and weakness in the first three months. Based on the result, it is concluded that by health provider monitoring, the side effects can beidentified and had not caused low adherence. This can be the result of good communication between patients and health provider about TB therapy. It is recommended that side effects and adherence monitoring should be conducted by emphasizing on patients and provider communication. In addition, laboratory monitoring should be conductedperiodically.Keywords : side effects, antituberculosis drugs, lung tuberculosis

Adherence to ARV (antiretroviral) was aimed to siginificantly prolong the life expectancy of people living with HIV AIDS (PLHIV). ARVs fight against the infection by slowing down the reproduction of HIV in human body. This research aimed to identify the internal and external factors that support adherence to ARV therapy. Submit : 25-05-2012 Review : 26-06-2012 Review : 10-07-2012 revisi : 10–09-2012 This research was a qualitative research conducted in Bandung and Cimahi districts, West Java province from September to November 2011. Data collected by doing in depth interview with related stakeholders, they were district health office staffs in Bandung and Cimahi, Local AIDS Commission staffs in Bandung and Cimahi, Bungsu hospital in Bandung, Cibabat hospital in Cimahi, NGO staff, and 10 PLHIVs who ever or still consuming ARV. Data were analyzed descriptively by triangulation and content analysis methods. It was concluded that the internal supporting factors of adherence to ARV were the motivation to live longer, the eagerness to get cured and to be healthy, considering ARV as vitamin, and the faith in their own religion. Besides, the availability of ARV and social supports were other supporting factors. The social supports were support from family, responsibility and affection for their children, willingness to get married, support from peer groups, NGO staffs, and religion figures, and good relationship with health provider staffs. The internal factors should be improved by motivating PLHIVs while external factors should include family, peer groups, NGO staff and health provider, provide better accessibility and affordability to ARV, and educate the society. Keywords: PLHIV, Adherence, ARV Abstrak Kepatuhan Penggunaan ARV (antiretroviral) merupakan salah satu faktor yang dapat memperpanjang umur harapan hidup ODHA (orang dengan HIV AIDS) secara bermakna. ARV bekerja melawan infeksi dengan cara memperlambat reproduksi HIV dalam tubuh. Penelitian bertujuan untuk mengidentifikasi faktor-faktor yang mempengaruhi kepatuhan ODHA dalam mengkonsumsi ARV. Studi ini merupakan penelitian kualitatif di Kota Bandung dan Kota Cimahi, provinsi Jawa Barat dari bulan September–November 2011. Pengumpulan data dilakukan melalui wawancara mendalam dengan pihak-pihak yang terkait dalam penanggulangan AIDS yaitu Dinkes Kota Bandung dan Cimahi, KPA Daerah Kota Bandung dan Cimahi, RS Bungsu dan RS Cibabat, LSM PKBI Jawa Barat serta ODHA yang pernah atau masih menggunakan ARV. Jumlah ODHA yang diwawancara sebanyak 10 orang. Analisis data dilakukan secara deskriptif dengan metoda triangulasi dan content analysis. Hasil analisis mengungkapkan bahwa faktor faktor pendukung kepatuhan minum ARV yang berasal dari dalam diri sendiri yaitu motivasi untuk hidup, keinginan sembuh/sehat, menganggap obat sebagai vitamin dan keyakinan terhadap agama. Selain itu faktor ketersediaan obat ARV dan dukungan sosial juga mendukung kepatuhan ODHA. Faktor dukungan sosial yaitu dukungan keluarga, rasa tanggung jawab dan kasih sayang terhadap anak, keinginan menikah, dukungan teman-teman di KDS (Kelompok Dukungan Sebaya), LSM dan dari tokoh agama serta hubungan baik dengan tenaga kesehatan. Faktor internal perlu ditingkatkan dengan memotivasi ODHA. Faktor eksternal ditingkatkan dengan melibatkan peran keluarga, KDS, LSM dan tenaga kesehatan serta memperbaiki akses, keterjangkauan dan edukasi kepada masyarakat. Kata Kunci : ODHA, Kepatuhan, ARV

Indonesia is facing shortage of pharmacist in public health centers (PHCs), therefore the local government and PHCs have to cope with this problem. This paper aimed to describe the pharmaceutical manpower availability in PHCs, the problems occurred and potential applied solutions. Data was taken from National Health Facility Research 201. Quantitative data related to pharmaceutical manpower in PHCs was analyzed descriptively based on regions. Supporting qualitative data through in-depth interviews with the health office staffs in Bogor and Bekasi and pharmacists in four PHCs were conducted and being analyzed using thematic analysis. It was found that Sulawesi had the highest percentage of PHCs having pharmacist (29.1%) while Eastern Indonesia 51.5% of PHCs didn’t have any staff with pharmacy related educational background. The highest percentages of staff composition were pharmacy technician followed by nurse. The main problem was due to high workload with limited manpower available. The proposed solutions are recruitment of new pharmacists, but in case it is not possible then placing pharmacist in certain type of PHCs with urgent needs is a priority. Empowering pharmacy technician, all available trained staff and other resources such as on job students are other feasible choices.Indonesia masih menghadapi keterbatasan jumlah apoteker di puskesmas, sehingga pihak pemerintah daerah dan puskesmas harus berupaya mengatasi permasalahan tersebut. Penelitian ini bertujuan untuk menggambarkan ketersediaan dan distribusi tenaga pelayanan kefarmasian di puskesmas serta permasalahan dan alternatif pemecahannya. Data diambil dari hasil Riset Fasilitas Kesehatan (Rifaskes) tahun 2011I. Data kuantitatif tentang tenaga pelayanan kefarmasian di puskesmas dianalisis secara deskriptif berdasarkan regional. Data kualitatif sebagai pendukung diperoleh melalui wawancara mendalam dengan bagian kepegawaian dinas kesehatan dan apoteker empat puskesmas di Kota Bogor dan Bekasi, 3 kemudian dianalisis dengan metode analisis tema. Hasil analisis menunjukkan bahwa Sulawesi memiliki persentase puskesmas dengan tenaga apoteker tertinggi (29,1%) sedangkan Indonesia Timur memiliki persentase puskesmas tertinggi dengan tenaga pelayanan kefarmasian tanpa latar belakang pendidikan farmasi (51,5%). Persentase tenaga kefarmasian terbesar di puskesmas adalah tenaga teknis kefarmasian kemudian perawat. Permasalahan utama yang dihadapi puskesmas adalah beban kerja yang berat dengan kondisi tenaga yang terbatas. Alternatif pemecahan masalah yaitu pengangkatan apoteker baru, namun jika tidak memungkinkan maka penempatan apoteker pada puskesmas dengan kebutuhan mendesak merupakan prioritas utama. Pilihan lain yang memungkinkan adalah pemberdayaan tenaga teknis kefarmasian dan staf lain yang sudah dilatih atau memanfaatkan tenaga siswa magang.

Latar belakang : Jumlah penderita HIV di Indonesia hingga Juni 2012 mencapai 86.762 orang dan untuk penderita AIDS 32.103 orang. Secara nasional, provinsi Jawa Barat termasuk salah satu dari 5 provinsi dengan kasus HIV-AIDS tertinggi di Indonesia. Tujuan : Mengetahui tingkat kepatuhan ODHA dalam mengkonsumsi obat ARV dan faktor-faktor yang mendukung ODHA dalam hal minum obat ARV. Metode : Penelitian ini menggunakan metode kualitatif dan kuantitatif. Pengambilan data dilakukan dengan wawancara mendalam dan observasi pada ODHA dan Pengawas Minum Obat (PMO) ODHA yang menjadi sampel penelitian. Hasil : Sebanyak 9 dari 11 ODHA memiliki tingkat kepatuhan ODHA minum obat ARV > 95%. Faktor-faktor yang mendukung ODHA dalam minum obat ARV adalah faktor keluarga, teman, Forum WPA (Warga Peduli AIDS) dan faktor internal dalam diri ODHA. Sedangkan faktor yang menghambat adalah rasa bosan dan jenuh minum obat, efek samping obat, stigma masyarakat dan biaya pengobatan. Kesimpulan : Untuk mencapai tingkat kepatuhan minum obat ARV > 95%, diperlukan dukungan dari keluarga, teman dan Forum WPA, serta faktor internal dalam diri ODHA seperti motivasi diri untuk tetap hidup dan melakukan aktifitas yang baik. Kata kunci : ARV, Kepatuhan, ODHA

Pos Kesehatan Desa (poskesdes) is a form of village community effort to make primary health care closer. Poskesdes is expected to become a development center and a coordinate various community effort, such as pos pelayanan terpadu (posyandu) and warung obat desa (WOD). The objective of this study is to develop indicator and assess to the activity of existing WOD as well as supporting factors and resisting factors of the WOD activity. Research design is a qualitative study at community which related to WOD condition in 7 districts, namely: Banjar, South Denpasar, Karanganyar, South Konawe, West Lombok, Subang, and Temanggung. Data were collected by indepth interview, focussed group discussion and observation at the activity of WOD. lnformans for indepth interview are head of District Health Office, head of community health center, midwife at poskesdes and WOD cadre. lnformans for the focussed group discussion are elite figure at community; i.e official village, orchard head, religion figure, official member of PKK, teacher, health cadre, and drug seller. Data were analyzed by triangulation based on source of data and way of data collection. Result of the study shows that: I) Indicator activity of WOD: (a) input indicators: the location is in village where is no health service, there is health cadre, available medicine as required by community, daily service time, there is support from head village and there is councel by head of community health center, (b) process indicators; fonctioning WOD for the community, and functioning WOD for Poskesdes, and (c) output indicators: there is record of community who had medicine and record of community who had medicine consultation. 2) There is two kind of WOD (a) the old WOD to support self medication in community and (b) the new WOD to support selfmedication and source of medicine at midwife service. Both of them are not qualified based on indicator that has just been developed. 3) Supporting factors of WOD are (a) available health cadre at village, (b) the location is near or a health cadre home. 4) Resisting factors of WOD are (a) there is drug seller or health proftssional service in the location, (b) limited an available medicine as required by community because of fund (c) not open daily because less buyer, (d) less socialization from head villageization, (e) less instruction from head of community health center because of awareness that probability of medication misuse, (f) the price of medicine is higher than drug seller, and (g) low formal education of cadre so that they are lack the community trust. Keyword: Poskesdes (village health unit), WOD (village medicine service), indicator

Drug is one of the essential elements in healthcare that should be effectively and efficiently managed. Following the decentralization in 2001 in Indonesia, drug management has changed in district drug management units and also in District General Hospitals. Certainly this condition influences the sustainability of drug access in primary health care such as in Community Health Center and District General Hospital, especially in drug financing policy. A cross sectional descriptive study to obtain information on drug management in public healthcare in district had been carried out between July and December 2006 in 10 District Public Drug Management Units from 10 district health offices and 9 district general hospitals as samples. Data were collected by interviewing heads of Drug Section in District Health Offices and heads of Hospital Pharmacies using structured questionnaires and observing drug storage in District Drug Management Units, Community Health Centers, and Hospital Pharmacies. Results of the study show that drug planning in District Health Offices and General Hospitals did not meet the basic real need in some districts nor District Hospitals. The minimum health service standards had not been achieved yet. Furthermore, drug procurement, storage and recording as well as reporting was not good enough either, such as shown by the existence of expired drugs. Lead time for drug delivery to community health centers in some districts was longer than the average of lead time in the past 3 years.