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17% of all people living with HIV in Indonesia who are in need of antiretroviral treatment (ART) actually receive the treatment. The cost of ART based on three CD4 cell count groups (e.g., 0-200, 201-350,350 cells/mm

Background: As a developing country, Indonesia maintains a low level of welfare for hygiene, as exemplified by Indonesia’s poor access facilities to clean water and lack of proper sanitation for households. Meanwhile, a proper supply of water and sanitation will help in reducing morbidity and mortality rates of diarrhea in children. Other risk factors such as socio-economic and socio-demographic conditions, helps improving the quality of life of households, thus lowering the risk of various diseases, including diarrhea.Methods: This study uses a Logistic Regression Analysis (Logit) model with Cross-sectional design using data collected from the 5th wave of the Indonesian Family Life Survey (IFLS-5) in 2014. The study population was children aged 2-10 years with a total of 2446 observations.Result: The result shows that there was a relationship between father's education in elementary school level (p=0.013), father's education in junior high school level (p=0.015), father's education in high school level (p=0.001), father's education at the university level (p=0.012), income (p=0.051), children’s age (p=0.000), and children’s gender (p=0.033) with the rate of diarrhea in children.Conclusion: This research concludes that water consumption factors (sources of drinking water, drinking water boiling process before consumption) and sanitation facilities factors (household toilet types) have insignificant results on the diarrhea rate of children in urban areas of Indonesia. However, socio-economic factors (fathers' education and household income) and socio-demographic factors (children’s gender and children’s age) have a significant effect on the diarrhea rates of children in urban areas of Indonesia.

Background Providing an enabling environment for breastfeeding is hampered by the inequitable implementation of paid maternity leave, primarily due to perceived or actual financial costs. To estimate the real cost of paid maternity leave requires using reliable methods. We compared methods utilized in two recent studies in Indonesia. Study A estimated the financial need of providing paid maternity leave in the formal sector with a 10-year forecast at 21% coverage of eligible mothers, while study B estimated similar costs for the informal sector at 100% coverage annually. Results are critical for guiding future application of either method to inform paid maternity leave policies. Methods We compared number of covered mothers working informally, total annual cost, and cost per mother. We modified some parameters used in study A (method A) to be similar to study B (method B) for comparison, namely the period of estimate (annual), coverage (100%), estimate of women potentially breastfeeding, exchange rate, female labor force participation rate, the percentage of women working in the informal sector, and adding administration cost. Results The methods differ in determining the number of mothers working in the informal sector who gave birth, the minimum wage as unit cost, and administrative cost. Both studies estimated the cost at various lengths of leave period. Method A requires more macro (e.g. national/regional) level data, while method B involves (e.g. individual) micro level data. We compared the results of method A with method B, respectively: 1) number of covered mothers working informally were 1,425,589 vs. 1,147,204; 2) total annual costs including administrative costs were US$650,230,167 vs. US$633,942,726, and; 3) cost/mother was US$456 vs US$553. Conclusion Certain flexibilities can be applied to both methods, namely using parameters specific to respective regions (e.g. provincial level parameters), flexible period of analysis, and the use of administrative cost. In a setting where micro data is scarce and not easily accessible, method A provides a feasible approach, while method B will be most appropriate if suitable micro data is available. Future comparison studies in other settings are needed to provide further evidence on the strengths and weaknesses of both methods.

This study aims to find the effect of district health spending on disease rates namely dengue fever, diarrhea, and tuberculosis in 130 districts in Sumatra Island in 2016. A quantitative approach with 3 multiple linear regression (MLR) methods that employ robust standard errors is used for this study. The study finds that district health spending reduces the number of dengue fever, diarrhea, and tuberculosis, but not significantly. This condition can be caused by the inefficient use of district health expenditure. This study finds the number of health centers has negative and significant effect on the number of dengue fever, diarrhea, and tuberculosis. Conversely, population and population density have a positive and significant effect on dengue fever, diarrhea, and tuberculosis. Economic losses due to diseases like dengue fever, diarrhea, and tuberculosis are very high. Therefore, the government must use effective and various policies to overcome the problem of existing diseases, one of which is to improve the efficiency of using the health budget. The government should also control birth rates to reduce population growth and encourage transmigration to reduce population density.

Indonesia:Menurut World Federation Mental Health, 1 dari 5 orang di dunia mengalami gangguan mental. Menurut beberapa studi yang sudah dilakukan, salah satu faktor penyebabnya adalah faktor status sosial ekonomi yang masih rendah di negara-negara berkembang. Oleh karena itu, penenilitian ini dilakukan untuk mengetahui bagaimana pengaruh faktor status sosial ekonomi terhadap gangguan mental gejala depresi yang ada di salah satu negara berkembang yaitu Indonesia. Penelitian ini menggunakan metode kuantitatif berbasis data sekunder yang diambil dari data Indonesia Family Life Survey (IFLS) menggunakan kuesioner CESD-10 untuk variabel gejala depresi. Variable Gejala Depresi yang didapat dari IFLS terlebih dahulu diolah menggunakan rasch model lalu seluruh variabel diolah menggunakan metode regresi logistik. Hasilnya, terdapat hubungan negatif antara faktor status sosial ekonomi dengan gangguan mental gejala depresi di Indonesia. Faktor status sosial ekonomi berpengaruh secara signifikan terhadap gangguan mental gejala depresi di Indonesia yang berarti setiap terjadi peningkatan dari status sosial ekonomi yang dalam hal ini mencangkup pendidikan, kekayaan, dan status pekerjaan seseorang, akan menurunkan tingkat gangguan mental gejala depresi di Indonesia.English:According to the World Federation of Mental Health, 1 in 5 people in the world experience mental disorders. According to several studies, one of the contributing factors is the low socioeconomic status factor in developing countries. Therefore, this study was conducted to find out how the influence of socioeconomic status factors on mental disorders (depressive symptoms) in one of the developing countries, Indonesia. This study uses quantitative methods based on secondary data taken from Indonesia Family Life Survey (IFLS) using the CESD-10 questionnaire for depressive symptom variables. Depressive Symptoms variable obtained from the IFLS are first processed using the Rasch model then all variables are processed using the logistic regression method. As a result, there is a negative relationship between socioeconomic status factors and mental disorders (depressive symptoms) in Indonesia. Socioeconomic status factors significantly affect the mental disorders of depressive symptoms in Indonesia, which means that any increase in socioeconomic status which in this case covers the education, wealthy, and employment status of a person, will reduce the level of mental disorders of depressive symptoms in Indonesia.

Fenomena berat badan lebih dan obesitas menjadi masalah yang serius di berbagai negara khususnya di Indonesia. Menurut WHO, pada tahun 2016 terdapat 2,8 juta orang yang meninggal akibat masalah berat badan lebih dan obesitas, sedangkan menurut Kementerian Kesehatan Indonesia prevalensi berat badan lebih dan obesitas di Indonesia pada tahun 2018 mencapai angka 13,6% dan 21,8%. Salah satu faktor penyebab berat badan lebih dan obesitas adalah faktor sosial ekonomi. Namun sering terdapat perbedaan mengenai pengaruh status sosial ekonomi terhadap obesitas di negara berkembang dan negara maju. Penelitian ini bertujuan untuk mengetahui determinan dari status sosial ekonomi terhadap berat badan lebih dan obesitas. Data yang digunakan berasal dari Indonesian Family Life Survey (IFLS) 5 tahun 2014 pada sampel berusia lebih dari 18 tahun. Analisis dilakukan dengan model Ordered Logistic Regression . Hasil penelitian ini menunjukkan bahwa secara statistik individu dengan status sosial ekonomi yang lebih tinggi memiliki peluang yang lebih tinggi untuk mengalami berat badan lebih dan obesitas. Oleh karena itu, sosialisasi program layanan kesehatan perlu ditingkatkan khususnya di lingkungan masyarakat dan sekolah guna meningkatkan pengetahuan, kesadaran, dan merubah pola hidup menjadi lebih sehat. Abstract The phenomenon of overweight and obesity has become a serious problem in various countries, especially in Indonesia . According to WHO in 2016 there were 2.8 million people who died due to the problem of overweight and obesity, while according to the Indonesian Ministry of Health the prevalence of overweight and o besity in Indonesia in 2018 reached 13,6% and 21.8%. One of the factors that caus e overweight and obesity is socio-economic status . However, there are often differences regarding the effect of socioeconomic status on obesity in developing and developed countries. This study aims to identify the determinant factors of socioeconomic status on overweight and obesity. The data used comes from the Indonesian Family Life Survey (IFLS) 5 in 2014 with samples are aged more than 18 years . The analysis was conducted by using the Ordered Logistic Regression model. The results of this study indicate that statistically, individuals with higher socioeconomic status have a higher chance of experience overweight and obesity. Therefore, the socialization of health care programs needs to be improved, especially in the community and schools to increase knowledge, awareness, and change lifestyles to be healthier .

Background Health care personnel (HCP) who demonstrated close contact with Corona virus disease (COVID-19) patients might experience a higher risk of infection and psychological problems. This study aims to explore depressive, anxiety, and burnout symptoms among HCP with a higher risk for psychological trauma. Methods This study was a cross-sectional study using secondary data from an online assessment, which was conducted 1 month after the COVID-19 outbreak. A total of 544 respondents from 21 provinces in Indonesia were included. Data on depressive, anxiety, and burnout symptoms were transformed first using the Rasch model and then categorized. Data from HCP in the higher risk group and the lower risk group were analyzed. Results A higher percentage of HCP experiencing depressive symptoms (22.8%), anxiety (28.1%), and burnout (26.8%) are found in the higher risk group. The chance for the higher risk group’s HCP to present with moderate and severe depressive symptoms, anxiety, and burnout are: 5.28 (Confidence interval (CI): 2.01–13.89; p p > 0.05), and 3.92 (CI: 2.08–7.40; p p Conclusions HCP with direct contact and responsibility to treat COVID-19 patients exhibit a higher risk to experience depressive symptoms and burnout. Communication with peers and staying in contact with family needs to be encouraged. Psychological well-being should be considered for high-risk HCP. Incentive or insurance guaranteed by the government or institution is essential as a reward and compensation during this period.

Background: Health personnel who demonstrated close contact with patients with COVID-19, might experience a higher risk of infection and psychological problems. This study aims to explore depressive, anxiety, and burnout symptoms among health care personnel with a higher risk for psychological trauma.Methods: This study was a cross-sectional study using secondary data from an online assessment, which was conducted one month after the COVID-19 outbreak. A total of 544 respondents from 21 provinces in Indonesia were included. Data on depressive, anxiety, and burnout symptoms were transformed first using the Rasch model and then categorized. Data from health professionals in the higher risk group and the lower risk group were analyzed.Results: A higher percentage of health professionals experiencing depressive symptoms (22.8%), anxiety (28.1%), and burnout (26.8%) are found in the higher risk group. The chance for the higher risk group’s personnel to present with moderate and severe depressive symptoms, anxiety, and burnout are 5.28 (CI: 2.01–13.89; p < 0.05), 1.36 (CI: 0.09–1.96; p > 0.05), and 3.92 (CI: 2.08–7.40; p < 0.05) times higher, respectively. The probability for patient-induced burnout is 2.13 (CI: 1.51–3.007; p < 0.05) times higher and highest among the other burn out dimensions. The depressive symptoms complained were similar between groups: loneliness, sleep disturbances, difficulty concentrating, and inability to initiate activities. Loneliness demonstrates the highest logit value among the symptoms.Conclusions: Health professionals with direct contact and responsibility to treat COVID-19 patients exhibit a higher risk to experience depressive symptoms and burnout. Communication with peers and staying in contact with family needs to be encouraged. Physiological well-being should be considered for high-risk health personnel. Incentive or insurance guaranteed by the government or institution is essential as a reward and compensation during this period.

Background The economic cost of not breastfeeding in Indonesia is estimated at US$1.5–9.4 billion annually, the highest in South East Asia. Half of the 33.6 million working women of reproductive age (WRA) in Indonesia (15–49 years) are informal employees, meaning they are working as casual workers or they are self-employed (small scale business) and assisted by unpaid/family worker(s). No specific maternity protection entitlements are currently available for WRA working informally in Indonesia. This study aims to estimate the financing need of providing maternity leave cash transfer (MCT) for WRA working in the informal sector in Indonesia. Method The costing methodology used is the adapted version of the World Bank methodology by Vilar-Compte et al, following pre-set steps to estimate costs using national secondary data. We used the 2018 Indonesian National Socio-Economic Survey to estimate the number of women working informally who gave birth within the last year. The population covered, potential cash transfer’s unitary cost, the incremental coverage of the policy in terms of time and coverage, and the administrative costs were used to estimate the cost of MCT for the informal sector. Result At 100% coverage for 13 weeks of leave, the yearly financing need of MCT ranged from US$175million (US$152/woman) to US$669million (US$583/woman). The share of the yearly financing need did not exceed 0.5% of Indonesian Gross Domestic Product (GDP). Conclusions The yearly financing need of providing MCT for eligible WRA working in the informal sector is economically attractive as it amounts to less than 0.5% of GDP nominal of Indonesia. While such a program would be perceived as a marked increase from current public health spending at the onset, such an investment could substantially contribute to the success of breastfeeding and substantial corresponding public health savings given that more than half of working Indonesian WRA are employed in the informal sector. Such policies should be further explored while taking into consideration realistic budget constraints and implementation capacity.

Penelitian ini bertujuan untuk menganalisis faktor yang mempengaruhi pengeluaran rokok elektrik di Kota Bandung. Penelitian ini menggunakan Convenience Sampling dan formula Slovin, melakukan wawancara terhadap 200 pengguna rokok elektrik di Kota Bandung. Penelitian ini menggunakan metode Regresi Linear Berganda dengan STATA 12. Variabel yang digunakan adalah total pengeluaran rokok elektrik per bulan, harga alat mesin isap rokok elektrik, motivasi penggunaan rokok elektrik, jumlah rasa cairan rokok elektrik, pengetahuan mengenai resiko penggunaan rokok elektrik, dan status penggunaan ganda rokok konvensional dan rokok elektrik. Hasil regresi menunjukkan bahwa harga alat mesin isap rokok elektrik, motivasi penggunaan rokok elektrik, jumlah rasa cairan rokok elektrik berpengaruh positif dan signifikan pada peningkatan pengeluaran rokok elektrik di Kota Bandung. Sedangkan pengetahuan mengenai resiko penggunaan rokok elektrik tidak signifikan mengurangi tingkat pengeluaran rokok elektrik di kota Bandung. Penelitian ini juga menemukan bahwa status pengguna ganda rokok elektrik dan rokok konvensional berpengaruh negatif tetapi tidak signifikan pada pengeluaran rokok elektrik. Untuk mengurangi penggunaan rokok elektrik di Kota Bandung, pemerintah perlu meningkatkan kampanye kesehatan mengenai bahaya penggunaan rokok elektrik. Bahkan pemerintah seharusnya melarang penggunaan rokok elektrik karena pengaruh pengetahuan rokok elektrik yang tidak signifikan mengurangi konsumsi rokok elektrik.AbstractThis research aims to analyze the factors that affect expenditure decision on electronic cigarettes in Bandung. This research uses the Convenience Sampling and Slovin formula, interviews 200 users of e-cigarettes in Bandung. This paper uses Multiple Linear Regression (MLR) with STATA 12. Total expenditure per month in electronic cigarettes, the price of electronic cigarette suction machine tools, motivation in using electronic cigarettes, the amount of electronic cigarettes liquid taste, knowledge about the risk of using electronic cigarettes, and the status dual user of conventional cigarettes and electronic cigarettes are has been used as variables in this research. The regression result shows that the price of electronic cigarettes, motivation to use electronic cigarettes, the amount of electronic cigarettes liquid taste are positively and significantly correlated with the total expenditure per month for electronic cigarettes in Bandung. In the other hand, knowledge about the risk of using electronic cigarettes not significantly reduces electronic cigarette expenditure. This study also finds that the status of dual users of electronic cigarettes and conventional cigarettes has a negative but not significant effect on electronic cigarette expenditure. To reduce the use of electronic cigarettes, the government needs to increase health campaigns regarding the dangers of electronic cigarettes.Even the government must bans the use of electronic cigarettes because knowledge about electronic cigarettes risk has insignificant effect to reduce consumption of electronic cigarettes.

Background: There are currently 14% independent participants in Indonesia's National Health Insurance (INHI) from the overall (199 millions) participants. However, around 43.8% of them do not comply in paying the insurance premium. The purpose of the study is to explore factors that influence delinquent payment of contributions. Methods : The research design was qualitative study with phenomenology approach and constructivism paradigm. Data collected by in-depth interview and using theoretical sampling approach. We recruited 16 respondents of unpaid worker participants who arrear and who obey to pay the premiums from 4 difference cities/ districts. Triangulation was done trough 15 respondents from various stakeholders. We constructed substantive theory from data trough coding, cathegorizing and pattern matching. Results: Compliance of paying insurance premium is affected by the intention to pay for contribution. Meanwhile, the intention to pay is influenced by the understanding of INHI program, financial ability, self attitude, operational system and service quality. These constructs consist of 5 to 8 indicators. To improve payment contribution of independent participants, INHI program has to pay attention for factors originating internally from the participants themselves and also externally: social and institutional environment support and the quality of health care and financing system. Conclusions: INHI program need to improve a proper socialization, mechanisms for collecting beneficiary contributions, and strengthening the healthcare system, both for services and the implementation of the financing system.

Objective International guidelines recommend countries to expand antiretroviral therapy (ART) to all HIV-infected individuals and establish local-level priorities in relation to other treatment, prevention and mitigation interventions through fair processes. However, no practical guidance is provided for such priority-setting processes. Evidence-informed deliberative processes (EDPs) fill this gap and combine stakeholder deliberation to incorporate relevant social values with rational decision-making informed by evidence on these values. This study reports on the first-time implementation and evaluation of an EDP in HIV control, organised to support the AIDS Commission in West Java province, Indonesia, in the development of its strategic plan for 2014–2018. Methods Under the responsibility of the provincial AIDS Commission, an EDP was implemented to select priority interventions using six steps: (i) situational analysis; (ii) formation of a multistakeholder Consultation Panel; (iii) selection of criteria; (iv) identification and assessment of interventions’ performance; (v) deliberation; and (vi) selection of funding and implementing institutions. An independent researcher conducted in-depth interviews (n = 21) with panel members to evaluate the process. Results The Consultation Panel included 23 stakeholders. They identified 50 interventions and these were evaluated against four criteria: impact on the epidemic, stigma reduction, cost-effectiveness and universal coverage. After a deliberative discussion, the Consultation Panel prioritised a combination of several treatment, prevention and mitigation interventions. Conclusion The EDP improved both stakeholder involvement and the evidence base for the strategic planning process. EDPs fill an important gap which international guidelines and current tools for strategic planning in HIV control leave unaddressed.

Background Prevalence of depression in Indonesia is estimated at about 3.7% of the total population, although the actual may be higher. Studies worldwide have linked the environment where people live to their mental health status. However, little research is found in Indonesia regarding this link. We examined the association between individuals’ perception towards their neighborhood and their depression symptoms. Methods Social trust was measured at the individual (level 1) and community (level 2) levels based on the Indonesian Family Life Survey 5 (IFLS5) in 2014. Depression was measured using the 10-item Center for Epidemiologic Studies-Depression Scale Revised (CESD-R-10) and the scores were transformed into logit form using the Rasch model. Multilevel regression was used to determine correlations. Results Of the total sample of 14,227 respondents in this study, about 19.4% had experienced severe depression symptoms in the past week. Social trust was found to be significantly associated with severe depression symptoms. The weaker the individuals’ social trust towards their neighbourhood, the higher the probability of experiencing severe depression symptoms would be. Conclusions This study shows that social trust is associated with the severity of depression symptoms: the higher the social trust, the lower the probability of having severe depression symptoms is. Depression symptoms may also be attributed to significant differences between communities.

Tuberculosis remains a major global health problem and ranks as the second leading cause of death from infectious disease worldwide. Countries devote their budgets to overcome the tuberculosis problem. An efficient use of these budgets will arguably reduce the number of tuberculosis cases and eventually give a positive impact to the economy. This paper aims it aims to estimate the technical efficiency scores of tuberculosis funds on high-burden countries by using Data Envelopment Analysis (DEA) method. Further, this study analyzes other environmental factors that are crucial to increase the efficiency scores by using Tobit method. DEA shows that some countries exhibit high efficiency scores while others exhibit low efficiency scores. It also informs how countries use funds to maximize their results. Meanwhile, the Tobit estimation shows that taxing cigarettes and committing budgets to control tobaccos have positive marginal effects on technical efficiency scores.

Rates of exclusive breastfeeding are slowly increasing, but remain suboptimal globally despite the health and economic benefits. This study estimates the costs of not breastfeeding across seven countries in Southeast Asia and presents a cost-benefit analysis of a modeled comprehensive breastfeeding strategy in Viet Nam, based on a large programme. There have been very few such studies previously for low- and middle-income countries. The estimates used published data on disease prevalence and breastfeeding patterns for the seven countries, supplemented by information on healthcare costs from representative institutions. Modelling of costs of not breastfeeding used estimated effects obtained from systematic reviews and meta-analyses. Modelling of cost-benefit for Viet Nam used programme data on costs combined with effects from a large-scale cluster randomized breastfeeding promotion intervention with controls. This study found that over 12 400 preventable child and maternal deaths per year in the seven countries could be attributed to inadequate breastfeeding. The economic benefits associated with potential improvements in cognition alone, through higher IQ and earnings, total $1.6 billion annually. The loss exceeds 0.5% of Gross National Income in the country with the lowest exclusive breastfeeding rate (Thailand). The potential savings in health care treatment costs ($0.3 billion annually) from reducing the incidence of diarrhoea and pneumonia could help offset the cost of breastfeeding promotion. Based on the data available and authors' assumptions, investing in a national breastfeeding promotion strategy in Viet Nam could result in preventing 200 child deaths per year and generate monetary benefits of US$2.39 for every US$1, or a 139% return on investment. These encouraging results suggest that there are feasible and affordable opportunities to accelerate progress towards achieving the Global Nutrition Target for exclusive breastfeeding by 2025.

Background Almost half of all Indonesian children under 6 months of age were not exclusive breastfed in 2017. Optimizing maternity protection programs may result in increased breastfeeding rates. This study aims to: estimate the potential cost implications of optimizing the current paid maternity protection program, estimate budgets needed to increase coverage of lactation rooms in mid and large firms, and explore challenges in its implementation in Indonesia. Methods The potential cost implication of the current and increased maternity leave length (three and 6 months) as well as the potential budget impact to the government were estimated for 2020 to 2030. The cost of setting up lactation rooms in formal sector companies was estimated using the Alive & Thrive standards. Interviews were conducted in five different provinces to 29 respondents in 2016 to identify current and potential challenges in implementing both existing and improved maternity protection policies. Results The costs of expanding paid maternity leave from three to 6 months and incorporating standardized lactation rooms in 80% of medium and large size firms in Indonesia was estimated at US$1.0 billion (US$616.4/mother per year) from 2020 to 2030, covering roughly 1.7 million females. The cost of setting up a basic lactation room in 80% of medium and large companies may reach US$18.1 million over 10 years. The three main barriers to increasing breastfeeding rates were: breastmilk substitutes marketing practices, the lack of lactation rooms in workplaces, and local customs that may hamper breastfeeding according to recommendations. Conclusions The cost of expanding paid maternity leave is lower than the potential cost savings of US$ 1.5 billion from decreased child mortality and morbidity, maternal cancer rates and cognitive loss. Sharing the cost of paid maternity leave between government and the private sector may provide a feasible economic solution. The main barriers to increasing breastfeeding need to be overcome to reap the benefits of recommended breastfeeding practices. Electronic supplementary material The online version of this article (10.1186/s13006-019-0221-1) contains supplementary material, which is available to authorized users.

In Indonesia, priority setting questions have arisen in the context of HIV/AIDS control as it faces one of Asia's fastest growing HIV/AIDS epidemics and resources are scarce. In 2013, an estimated 610,000 people were living with HIV/AIDS (PLWHA) and it is estimated that this number will increase to 1,500,000 by 2020 if the right measures are not taken (1;2). While the government seems to have the epidemic among people who inject drugs (PWID) under control, the prevalence is increasing among female sex workers (FSW) and their clients, men having sex with men (MSM), and the general population. The budget for HIV/AIDS control is far from sufficient; in 2010, only US$ 69 million was spent on HIV/AIDS, while US$ 152 million was estimated to be needed (3;4). Both issues urge for a wise choice between HIV/AIDS interventions and allocation of resources. Based on the National AIDS Spending Assessment, most resources on national level were spent on curative services (36 percent compared with 28 percent on preventive services) in 2012 (5). At provincial and district level, the allocation of domestic resources is poorly reported and the process of priority setting of interventions could be improved (6). The AIDS commissions (established at national, provincial and district level) is challenged to coordinate the HIV/AIDS response among multiple stakeholders. It aims to develop strategic plans to guide the local planning board on how to allocate the local budget among different government offices. However, the involvement of stakeholders opinion in the strategic planning process could be improved. Also, while various criteria seemed to guide the HIV/AIDS priorities in Indonesia (for example, the impact of interventions on the HIV/AIDS epidemic, adherence to national guidelines and cultural and political acceptability) these remain implicit. Systematic analysis of how different stakeholders value the importance of various criteria could contribute to more systematic, transparent, and accountable priority setting of the HIV/AIDS response and thereby improve the allocation of resources. Most methods that were introduced to guide resource allocation decisions in health (that is, evidence-based medicine, cost-effectiveness analysis, burden of disease, and equity analysis, rely on one single criteria (mostly cost and cost-effectiveness), while in reality many criteria can play a role (for example, feasibility, equity, cultural, and political factors) (7). Therefore, multi-criteria decision analysis (MCDA) is put forward as one of the most important methods for priority setting, and it provides a systematic process for clarifying what is being taken into account (the “criteria”), how each of those criteria should be measured, and how much importance (“weight”) to put on each (7). It has been successful in various case studies, for example in Ghana, Nepal, and Thailand, where it contributed to transparent and accountable policy making and brought a step forward in rational decision making. However, only a few empirical priority setting studies have included the views of different stakeholders, such as patients and the general population, besides those of policy makers (8;9). In HIV/AIDS field, the recognition of multiple criteria has risen and is reflected in the WHO programmatic guidance for antiretroviral therapy (ART) that recommends taking besides health impact also equity and feasibility criteria into consideration (10). However, only a few studies have tried to measure explicitly the importance of multiple criteria for HIV/AIDS priority setting (11;12) and worldwide, the main focus remains on how to reduce new infections and AIDS related death. Against this background, this study aims to describe the views of multiple stakeholders on the importance of various criteria for priority setting in HIV/AIDS control in Indonesia.

the costs of HIV/AIDS interventions in Indonesia are largely unknown. Knowing these costs is an important input for policy makers in the decision-making of setting priorities among HIV/AIDS interventions. The aim of this analysis is to determine the costs of four HIV/AIDS interventions in Bandung, Indonesia in 2015, to inform the local AIDS commission.data on utilization and costs of the different interventions were collected in a sexual transmitted infections (STI)-clinic and the KPA, the local HIV/AIDS commission, for the period of January 2015-December 2015. The costs were estimated from a societal perspective, using a micro-costing approach.the total annualized costs for condom distribution, mobile voluntary counselling and testing (VCT), religious based information, communication, and education (IEC) and STI services equalled US$56,926, US$2,985, US$1,963 and US$5,865, respectively.this analysis has provided cost estimates of four different HIV/AIDS interventions in Bandung, Indonesia. Additionally, it has estimated the costs of scaling up these interventions. Together, this provides important information for policy makers vis-à-vis the implementation of these interventions. However, an evaluation of the effectiveness of these interventions is needed to estimate the cost-effectiveness.

BackgroundIndonesia has one of the fastest growing HIV epidemics in Asia, which mainly concentrates within risk groups. Several strategies are available to combat this epidemic, like outreach to Men who have Sex with Men (MSM) and transgender, Harm Reduction Community Meetings (HRCMs) for Injecting Drug Users (IDUs), and Information, Education and Communication (IEC) programs at Maternal & Child Health Posts (MCHPs). Reliable cost data are currently not present, hampering HIV/AIDS priority setting. The aim of this study thus is to assess the societal costs of outreach programs to MSM and transgender, HRCMs for IDUs and IEC at MCHPs in Bandung, Indonesia in 2016.MethodsThe societal costs were collected in Bandung from April until May 2017. Health care costs were collected by interviewing stakeholders, using a micro-costing approach. Non-health care costs were determined by conducting surveys within the target groups of the interventions.ResultsThe societal costs of the outreach program were US$ 347,199.03 in 2016 and US$ 73.72 per reached individual. Moreover, the cost of HRCM for IDUs were US$ 48,618.31 in 2016 and US$ 365.55 per community meeting. For the IEC program at MCHPs, US$ 337.13 was paid in 2016 and the cost per visitor were US$ 0.51.ConclusionThis study provides valuable insights in the costs of outreach to MSM and transgender, HRCMs for IDUs and IEC at MCHPs. Policy makers can use these results in setting priorities within Indonesia. Data on effectiveness of interventions is necessary to make conclusive statements regarding cost-effectiveness and priority of interventions.

The knowledge of the importance of exclusive breastfeeding is still low in East Nusa Tenggara. Many families have started providing complementary foods like bananas or porridge, to their babies when they are only 2 months old. Providing complementary foods since babies 2 months old will increase the possibility of diarrhea and pneumonia/respiratory of babies. This study has three objectives. The first objective tries to estimate the economic impact of non-breastfeeding in East Nusa Tenggara. The second objective tries to calculate the health system medical cost and the third objective tries to calculate the patient/non-medical cost. This paper calculates the patient cost from 153 patient data collected from Kupang district in 2016. This paper estimates the economic impact by combining the health system cost, patient/non-medical cost with the prevalence data from IDHS 2012. This study finds that total economic losses caused by non-exclusive breastfeeding due to diarrhea and pneumonia/respiratory about US$ 2,718,497. This study finds the average cost due to non-exclusive breastfeeding for diarrhea cases about US$ 9.3 and PRD cases about US$8.4.

Contains fulltext : 170051.pdf (Publisher’s version ) (Closed access)

OBJECTIVE To evaluate costs and outcomes of voluntary counselling and testing (VCT) service delivery models in urban Indonesia. METHODS We collected primary data on utilization, costs and outcomes of VCT services in a hospital clinic (568 clients), HIV community clinic (28 clients), sexually transmitted infection (STI) community clinic (784 clients) and prison clinic (574 clients) in Bandung, Indonesia, in the period January 2008-April 2009. RESULTS The hospital clinic diagnosed the highest proportion and absolute number of HIV infections, but with the lowest average CD4 cell count and with the highest associated travelling and waiting time. The prison clinic detected fewer cases, but at an earlier stage, and all enrolled in HIV care. The community clinics detected the smallest number of cases, and only 0-8% enrolled in HIV care. The unit cost per VCT was highest in the hospital clinic (US$74), followed by the STI community clinic (US$65), the HIV community clinic (US$39) and the prison (US$23). CONCLUSION We propose a reorientation of the delivery models for VCT and related HIV/AIDS treatment in this setting. We call for the scaling up of community clinics for VCT to improve access, promote earlier detection and to perform (early) treatment activities. This would reduce the burden of the hospital clinic to orient itself towards the treatment of AIDS patients. This is one of very few studies addressing this issue in Asia and the first of its kind in Indonesia, which has a rapidly growing HIV epidemic. The conceptual framework and overall conclusions may be relevant to other low-income settings.

Contains fulltext : 87302.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To assess the cost of hospital-based methadone maintenance treatment (MMT) for injecting drug users (IDUs) in Bandung, Indonesia; to address concerns of financial sustainability at the hospital level and financial accessibility and economic attractiveness at the health care policy level. METHODS: In a 1 year observation period in 2006-2007, MMT service delivery costs were estimated on the basis of a micro-costing approach. Patient costs were estimated on the basis of a survey among 48 methadone clients. RESULTS: A total number of 129 clients attended the MMT clinic, resulting in a total of 16,335 client visits. Total annual societal costs of running the MMT clinic equalled Rp 1130 mln (US$123,672), or Rp 69,206 (US$7.57) per client visit. Of total costs, patient costs established the largest share (65%), followed by that of central government (20%), and the hospital (15%). Present consultation tariffs already cover hospital costs and the patient costs of accessing MMT services constitute almost 70% of their income. CONCLUSION: Under current circumstances, MMT services are financially sustainable to the hospital. MMT services are subsidized by the central government, and this is warranted considering the important role of the program in HIV/AIDS among IDUs. Still, the present user fee seems a barrier to utilization, and a higher level of subsidy might be justified to reduce the cost to the patient. 01 april 2010

Contains fulltext : 153730.pdf (Publisher’s version ) (Closed access) BACKGROUND: Indonesia has insufficient resources to adequately respond to the HIV/AIDS epidemic, and thus faces a great challenge in prioritizing interventions. In many countries, such priority setting processes are typically ad hoc and not transparent leading to unfair decisions. Here, we evaluated the priority setting process in HIV/AIDS control in West Java province against the four conditions of the accountability for reasonableness (A4R) framework: relevance, publicity, appeals and revision, and enforcement. METHODS: We reviewed government documents and conducted semi-structured qualitative interviews based on the A4R framework with 22 participants of the 5-year HIV/AIDS strategy development for 2008-13 (West Java province) and 2007-11 (Bandung). RESULTS: We found that criteria for priority setting were used implicitly and that the strategies included a wide range of programmes. Many stakeholders were involved in the process but their contribution could be improved and particularly the public and people living with HIV/AIDS could be better engaged. The use of appeal and publicity mechanisms could be more transparent and formally stated. Public regulations are not yet installed to ensure fair priority setting. CONCLUSIONS: To increase fairness in HIV/AIDS priority setting, West Java should make improvements on all four conditions of the A4R framework.

Contains fulltext : 154897.pdf (Publisher’s version ) (Open Access) BACKGROUND: We report an economic analysis of Human Immunodeficiency Virus (HIV) care and treatment in Indonesia to assess the options and limitations of costs reduction, improving access, and scaling up services. METHODS: We calculated the cost of providing HIV care and treatment in a main referral hospital in West Java, Indonesia from 2008 to 2010, differentiated by initiation of treatment at different CD4 cell count levels (0-50, 50-100, 100-150, 150-200, and >200 cells/mm(3)); time of treatment; HIV care and opportunistic infections cost components; and the costs of patients for seeking and undergoing care. DISCUSSION: Before antiretroviral treatment (ART) initiation, costs were dominated by laboratory tests (>65 %), and after initiation, by antiretroviral drugs (>/=60 %). Average treatment costs per patient decreased with time on treatment (e.g. from US$580 per patient in the first 6 month to US$473 per patient in months 19-24 for those with CD4 cell counts under 50 cells/mm(3)). Higher CD4 cell counts at initiation resulted in lower laboratory and opportunistic infection treatment costs. Transportation cost dominated the costs of patients for seeking and undergoing care (>40 %). CONCLUSIONS: Costs of providing ART are highest during the early phase of treatment. Costs reductions can potentially be realized by early treatment initiation and applying alternative laboratory tests with caution. Scaling up ART at the community level in certain high prevalence settings may improve early uptake, adherence, and reduce transportation costs.

To evaluate costs and outcomes of voluntary counselling and testing (VCT) service delivery models in urban Indonesia.We collected primary data on utilization, costs and outcomes of VCT services in a hospital clinic (568 clients), HIV community clinic (28 clients), sexually transmitted infection (STI) community clinic (784 clients) and prison clinic (574 clients) in Bandung, Indonesia, in the period January 2008-April 2009.The hospital clinic diagnosed the highest proportion and absolute number of HIV infections, but with the lowest average CD4 cell count and with the highest associated travelling and waiting time. The prison clinic detected fewer cases, but at an earlier stage, and all enrolled in HIV care. The community clinics detected the smallest number of cases, and only 0-8% enrolled in HIV care. The unit cost per VCT was highest in the hospital clinic (US$74), followed by the STI community clinic (US$65), the HIV community clinic (US$39) and the prison (US$23).We propose a reorientation of the delivery models for VCT and related HIV/AIDS treatment in this setting. We call for the scaling up of community clinics for VCT to improve access, promote earlier detection and to perform (early) treatment activities. This would reduce the burden of the hospital clinic to orient itself towards the treatment of AIDS patients. This is one of very few studies addressing this issue in Asia and the first of its kind in Indonesia, which has a rapidly growing HIV epidemic. The conceptual framework and overall conclusions may be relevant to other low-income settings.

The HIV epidemic in Indonesia is among the fastest growing in Asia, and limited funding is available for HIV/AIDS control. This raises a number of important policy questions, about the adequacy of the level of available funding, the appropriateness of its use, and its financial sustainability. This paper puts these questions in context of the present Indonesian health system. The Indonesian health policy response to HIV/AIDS faces a number of challenges. The nature of the Indonesian HIV epidemic (increasing overall prevalence, with different epidemic profiles); the characteristics of the Indonesian health system (decentralized policy making, low and inequitable funding), and the low and highly internationalized funding of HIV/AIDS control (resulting in low service coverage and questions of sustainability) draw out a very specific health environment of HIV/AIDS. Economic analyses in health are instrumental to guide policy makers on the best use of scarce resources, and holds as such also large potential in this context. However, very little information on the costs and effects of HIV/AIDS control in Indonesia is available, and we call for a broader application.