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The use portable study desk that is designed to be easy moved still make complaints in muscles and bones give risk for posture. Design improvements can be based on measurements results of static anthropometric and dynamic anthropometric to identify the risk of posture. The method used in this reaserch is a Rapid Upper Limb Assessment (RULA) method to analyze the risk of posture users of portable study desk, while for the design of study desk using anthropometric data, The purpose of this study was to design a portable study table and analyze the risk posture that occur when users use a portable study desk using the RULA method. The results of study show that design desk study using anthropometric data obtained dimensions of 800 mm in length and 420 mm in width. The table height from the floor to the table surface is 220 mm high. a place to put a D100 mm glass, and there is a place to put a 400 mm cell phone or iPad along with a hole for the cable, there is a Diameter 40 mm. The 2-dimensional and 3-dimensional design process uses Catia software. The results of the Rapid Upper Limb Assessment (RULA) analysis show that the user's posture risk is indicated in green color, which means that there is no posture that needs to be corrected and that posture is acceptable except for the posture muscles (muscles) which are are indicated red color so needed move as soon possible or muscle stretching, this is in line with Osha (2020) who states that static postures are recommended for stretching muscles to avoid muscle fatigue.

Semakin berkembang pesatnya dunia industri kecil mandiri menawarkan tingkat persaingan berbagai produk. Banyak produk sejenis ditawarkan kepada pelanggan, dimana salah satu pembeda produk yang sejenis adalah dengan kemasan yang berbeda Matrik pugh merupakan salah satu metode yang digunakan untuk menciptakan desain dari beberapa kriteria yang ditawarkan dengan menyaring beberapa konsep hingga diperoleh konsep terpilih sesuai keinginan pengguna. Tujuan penelitian ini adalah untuk mengidentifikasi kriteria kemasan keripik singkong dan menganalisis desain kemasan keripik singkong dengan menggunakan matrik pugh. Berdasarkan hasil penelitian, diketahui bahwa hasil identifikasi keinginan pengguna kemasan keripik menginginkan Kemasan keripik singkong selain berfungsi melindungi produk, juga mudah digunakan, tidak mudah rusak, produk yang dikemas terlihat dari luar kemasan dan memiliki ilustrasi yang menarik. Hasil net score pada penyaringan konsep dengan menggunakan matrix pugh diperoleh ranking penilaian terbesar adalah konsep B, pilihan combinasi (C) kriteria konsep dimana pilihan combinasi C2 adalah kombinasi antara konsep C,D,E. konsep desain kemasan keripik terpilih adalah bahwa kemasan menggunakan plastik propetilen transparan dengan bagian atas berbentuk pouch yang artinya bisa dibuka dan ditutup rapat kembali sehingga memudahkan pengguna, plastik yang transparan memungkinkan produk yang dikemas terlihat dari bagian luar yang tidak tertutup label, pada label menginformasikan nama merk keripik yang dijual, rumah produksi yang memproduksi, bahan yang terkandung dalam keripik singkong, serta tanggal expaire produk yang dikemas.

Kegiatan material handling menjadi kegiatan penting dalam penanganan material mulai dari loading bahan baku hingga kegiatan unloading. perusahaan x menggunakan forklif sebagai salah satu alat angkut untuk memindahkan material dalam operasi produksinya, Tingginya kerusakan pada alat angkut dapat menyebabkan turunnya produktivitas perusahaan dalam mencapai keuntungan. Metode overall equipment effectivenes (OEE) merupakan salah satu metode yang digunakan untuk mengukur kinerja peralatan industri dengan mempertimbangkan availability, performance dan rate of quality alat angkut yang digunakan, penelitian ini bertujuan untuk menghitung kinerja forklif dengan menggunakan metode overall equipment effectivenes. Berdasarkan hasil penelitian diketahui bahwa selama 6 bulan periode waktu kerusakan forklif bervariasi dengan waktu kerusakan terlama pada bulan Juni mencapai 360 menit atau setara dengan 6 jam. Nilai rata-rata availability forklif selama 6 bulan periode adalah sebesar 97,85 % dimana waktu operasi selama 6000 menit atau setara dengan 20 jam per bulan. Nilai rata-rata performance forklif adalah sebesar 97,60% dengan banyaknya piano yang berhasil diangkut rata-rata per bulan adalah sebanyak 1152 unit. Nilai rata- rata rate of quality forklif adalah sebesar 98,71 % dengan banyaknya jumlah produk piano yang diangkut adalah sebanyak 1152 unit per bulan, sedangkan jumlah produk cacat yang gagal diangkut hanya mencapai 14,67 atau setara dengan 15 produk per bulan, Nilai kinerja forklif berdasarkan metode overall equipment effectivenes diperoleh sebesar 98,14 % dimana menurut Nakajima (1988) ketua institut perawatan jepang (JIPM) menetapkan batasan ideal dari indeks nilai OEE untuk perusahaan world class yang telah menerapkan TPM, yaitu 85% dan nilai hasil kinerja forklif perusahaan bernilai diatas nilai standar yang ditetapkan sebesar 98,14%.

Scuba mask is a type mask which made from a tight and elastic type of fabric that provides comfort when used. PT. Cahaya Digital Printing is one of companies engaged in digital printing that produces masks which are currently used by the public. The purpose of this study was to analyze production process of scuba masks from raw materials to mask products. The scuba mask production process uses scuba cloth as raw material which though a printing process on a digital printing machine which has a print area of up to 1.5 m with a print speed of up to 15 m2 per hour to print according design to customer requirement, manual press process to cut the mask to size and scuba printing and sewing and overlay processes using a sewing machine that has a stitch length of 0-5 mm and a sewing speed of up to 4500 s.p.m to sew the edges of the mask to make look neat and not stringy.

Mpok Imeh Chips is an Independent small business that produces Balado cassava chips in Jakarta, where cassava chips are packaged using plain plastic so that it has an unattractive impression. This research focuses on developing packaging designs that are following customer desires using the quality function deployment (QFD) method. Based on the results of the study, it is known that the customer's requirement for cassava chip packaging produced by UKM Mpok Imah includes cassava chip packaging that functions to protect the product, a medium packaging size. The form packaging is a standing pouch. Cassava chips packaging is made of polypropylene plastic transparent packaging. There is product information on the packaging. The packaging design is based on the house of quality (HOQ) in QFD and uses polypropylene plastic materials, size (14 x 22) cm, a weight of 250 grams, cassava chips illustration, transparent and a standing pouch packing, description on the label shown on the front view design shows a visualization of the chip's packaging, there is some information about the product including the product name, net weight, address of the producing party and the halal logo. On the back packaging shown, there is information about the composition, storage rules and how used the packaging information expiration date of the packaged product.

Acute respiratory infection (ARI) is a common disease in the community. Riskesdas 2018 stated that ARI prevalence was 4.4% and the highest was in 1-4 years old children (8%). The capitation payment system in clinics collaborated with BPJS Kesehatan demands the physician to prescribe as effective and as efficient as possible. On the other hand, the capitation tariff obtained by clinics is considered as too low, thus constrains of the prescription leading to irrational prescribing is likely to occur. This study analyses further the prescribing pattern for ARI children in clinics and its rationality based on the difference in source of funding. A cross sectional research using retrospective method was conducted. Data were gathered from 409 medical records and or patients’ prescription of children between 1-12 years old and diagnosed as having non pneumonia ARI during 1st January to 30th November 2019. Result showed that non pneumonia ARI patients were mostly boys (54,3%) aged 1-5 years old (6.0%). The average number of items for BPJS patients was 3,45, the percentage of generic prescribing was twofold higher for BPJS group (63.94%), the percentage of essential medicine prescribing was 63.96% while the percentage of antibiotic use was lower (48.50%). Dosage propriety for BPJS patients was 70.80% which was slightly higher than non-BPJS group. Overall, the prescribing indicators and dosage properness for BPJS patients were better than non-BPJS patients.

Fasilitas pelayanan kesehatan dasar pemerintah dan swasta memiliki peran penting dalam menjaga mutu vaksin sebelum diberikan kepada sasaran imunisasi. Vaksin yang berkualitas menentukan keberhasilan program imunisasi. Dalam penelitian ini evaluasi dilakukan terhadap faktor-faktor yang mempengaruhi kualitas vaksin di Puskesmas dan Praktik Mandiri Bidan (PMB) di Kabupaten Lampung Timur. Desain penelitian adalah potong lintang dengan populasi berupa instansi atau fasilitas pengelola vaksin imunisasi dasar, sedangkan sampel meliputi 10 Puskesmas dan 30 PMB yang dipilih secara purposif. Pengumpulan data dilakukan melalui pengisian kuesioner mandiri, wawancara mendalam dan observasi. Wawancara mendalam dilakukan terhadap 16 orang pengelola vaksin puskesmas dan PMB yang dipilih secara purposif berdasarkan kesediaan mereka menjadi informan. Analisis data kuantitatif dilakukan secara deskriptif sedangkan data kualitatif diolah dengan metode konten analisis. Kegiatan diakhiri dengan focus group discussion (FGD) terhadap 20 orang informan secara purposif. Penelitian dilakukan pada bulan Agustus sampai Desember 2020 di 10 kecamatan di Kabupaten Lampung Timur. Berdasarkan hasil observasi, seluruh vaksin memiliki mutu yang baik di 10 puskesmas dan 20 Praktik Mandiri Bidan (PMB). Akan tetapi tingkat pengetahuan, sarana prasarana penyimpanan dan distribusi vaksin, SOP, proses pelatihan, sosialisasi, supervisi dan bimbingan teknis belum optimal khususnya di PMB. Secara umum kualitas vaksin masih memenuhi syarat namun pengetahuan pengelola vaksin, penyediaan dan kepatuhan SOP perlu ditingkatkan baik di puskesmas maupun di PMB. Selain itu, perlu peningkatan ketersediaan sarana parasarana penyimpanan dan distribusi vaksin terutama di PMB. Peningkatan kapasitas pengelolaan vaksin perlu dilakukan melalui proses pelatihan, supervisi dan bimbingan teknis bekerjasama dengan organisasi profesi. Kata Kunci: Mutu Vaksin, Puskesmas, PMB, Lampung Timur Abstract Both public and private basic health care facilities play an important role in maintaining the quality of vaccines which determines the success of the immunization program. In this study, an evaluation was carried out on the factors influencing the quality of vaccines at the community health center (CHC) and the Independent Midwife Practice (IMP) in the East Lampung Regency. The research design was cross-sectional using the population of institutions or facilities managing basic immunization vaccines and purposively selected samples of 10 Puskesmas and 30 IMPs. Data were collected through self-administered questionnaires, in-depth interviews, and observations. Depth, interviews were conducted with 16 vaccine managers at the Puskesmas and IMPs who were also selected purposively. Quantitative data was processed descriptively while qualitative data were analyzed using the content analysis method and finalized by a focus group discussion (FGD) for 20 purposively chosen informants. The study was conducted from August to December 2020 in 10 sub-districts in East Lampung Regency. Based on the observations, all vaccines had good quality in 10 Puskesmas and 20 IMPs. However, the level of knowledge, facilities for storing and distributing vaccines, SOPs, training processes, socialization, supervision, and technical guidance have not been optimal, especially in IMPs. The quality of vaccines is generally still as the requirements, yet the knowledge of vaccine managers as well as the provision and compliance with SOPs needs to be improved in both CHCs and IMPs. The availability of vaccine storage and distribution facilities at PMB and strengthening SOPs related to vaccine management are necessary. Capacity building needs to be done through training, supervision, and technical guidance in collaboration with professional organizations. Keywords: vaccine quality, Community Health Center, Independent Midwife Practice, East Lampung Regency

Aim: This study aimed to identify medicine management in district health offices and primary health care centres (PHCs) after the national health insurance (JKN) programme implementation. Methods: A cross-sectional study was carried out by collecting documents related to medication management and in-depth interviews with the head of the PHC officials and JKN medicine management officers at the PHC in four provinces of Indonesia. Results: The results showed no regional policies related to medicine management; all policies were based on central policies. Medicine management in districts follows the procurement planning suggested by PHCs, which relies on disease patterns. Medicine procurement at PHCs is done by e-purchasing using an e-catalog. Medicines above IDR 200 million are purchased through catalogs provided by the procurement service unit (ULP), and those under IDR 200 million are obtained through a direct appointment. Conclusion: The storage of medicine requires more space and air humidity controlling. The reporting and monitoring of medications e-logistic system are based on 20 indicators and have not been carried out regularly. It is necessary to improve reporting and monitoring systems.

Objective To evaluate the implementation of the Minister of Health of Indonesia Decree No 72/2016 regarding the standards of pharmaceutical services in the hospital. Methods This cross-sectional study is a prospective, quantitative study done in 43 hospitals in 11 provinces in Indonesia in 2017. Result The implementation of the standards of pharmaceutical management ranged over 97.0%. Despite the important role of clinical pharmacy service for patient safety, the implementation of the standards of clinical pharmacy ranged only around 53.5% and predominantly worse in terms of monitoring of drug blood level. A high proportion of hospitals still have not met standard ratios of pharmacists to bed to conduct both managerial and clinical activities. Conclusion There is a need to increase the number of pharmacists and their knowledge through training by professional organizations and breakthrough efforts to increase the ratio of pharmacists per bed.

Peraturan Menteri Kesehatan Nomor 73 tahun 2016 tentang Standar Pelayanan Kefarmasian di Apotek antara lain menyatakan bahwa apoteker dalam menjalankan pekerjaan kefarmasian di apotek harus menerapkan standar pelayanan kefarmasian. Penelitian ini bertujuan untuk mengetahui pelaksanaan standar pelayanan kefarmasian di apotek. Desain penelitian yang digunakan adalah potong lintang (cross sectional) dilakukan pada Februari-November 2017. Lokasi penelitian dipilih secara purposif berdasarkan sistem regionalisasi Badan Pengelola Jaminan Sosial (BPJS) bidang kesehatan, yaitu ibukota Provinsi Jawa Barat, Jawa Timur, Sumatera Selatan. Nusa Tenggara Barat, Aceh, Sulawesi Utara, Sulawesi Selatan, Kalimantan Selatan, Kalimantan Tengah, Maluku Utara dan Papua. Sampel meliputi 21 apotek yang bekerjasama dengan BPJS Kesehatan di 11 ibu kota provinsi penelitian. Alat pengumpul data berupa daftar tilik standar pelayanan kefarmasian di apotek. Analisis data dilakukan secara deskriptif. Hasil penelitian menunjukkan bahwa rasio jumlah apoteker per apotek 1,8 dan kecukupan apoteker untuk pelayanan resep pasien per hari tanpa bantuan tenaga teknis kefarmasian sebesar 66,7%. Standar Pelayanan Kefarmasian di Apotek belum dilaksanakan secara lengkap, rerata pelaksanaan standar pengelolaan sediaan farmasi (98,4%) lebih tinggi daripada pelaksanaan standar pelayanan farmasi klinik (73,8%). Dalam upaya meningkatkan pelaksanaan SPKA disarankan agar apoteker meningkatkan kompetensi pelayanan kefarmasian di apotek, organisasi profesi melakukan pendidikan berkelanjutan terhadap apoteker dan Dinas Kesehatan Kabupaten/Kota membuat kebijakan, melakukan pembinaan dan monitoring/evaluasi secara berkala. Kata kunci: apotek, farmasi klinik, pengelolaan sediaan farmasi, tenaga kefarmasian Abstract Minister of Health Regulation No. 73 of 2016 on the Pharmaceutical Service Standards in Pharmacy, states that pharmacists should comply and apply the standards. This study aims to identify the implementation of pharmaceutical service standards in pharmacies. The research was cross-sectional and conducted in February-November 2017. The selection of research locations was conducted purposively based on the regionalization system of the BPJS Kesehatan. They were 11 capital cities of provinces, namely West Java, East Java, South Sumatra, West Nusa Tenggara, Special regional of Aceh, North Sulawesi, South Sulawesi, South Kalimantan, Central Kalimantan, North Maluku, and Papua. The sample included 21 pharmacies in collaboration with BPJS Kesehatan (Social Security Administrator for Health) in 11 capital cities of the provinces. Data were collected by using a checklist of pharmacy service standards. Data analysis was performed descriptively. The results showed that the ratio of the number of pharmacists per pharmacy was 1.8 and the adequacy of pharmacists for prescription services for patients per day without the help of pharmaceutical technical personnel was 66.7%. Pharmaceutical Service Standards in Pharmacy have not been fully implemented. The average implementation of pharmaceutical preparation management standards (98.4%) is higher than the implementation of clinical pharmaceutical service standards (73.8%). In order to improve the implementation of Pharmaceutical Service Standards, it is recommended that pharmacists increase the competency of services in pharmacies, professional organizations conduct continuing education of pharmacists and the District Health Office should develop policies, conducts training, and periodically strengthen the monitoring and evaluation on the compliance to this standard. Keywords: pharmacy, clinical pharmacy, pharmaceutical management, pharmaceutical personnel

Pharmaceutical services have been gradually applied in primary health services both in terms of pharmaceutical management and clinical pharmacy services. In order to support the implementation, the standard has been amended several times, resulting Permenkes Number 74 of 2016 Concerning the Pharmaceutical Services Standard in Public Health Centre (puskesmas) as the most updated one. This study aimed to determine the suitability of the implementation of pharmaceutical service standards in the management of medicine and clinical pharmacy at the puskesmas. The cross-sectional research design was conducted in February-November 2017. The selection of provincial locations was carried out purposively. Data collection tools were questionnaires and a list of standard pharmacy services at the puskesmas. Data were analyzed descriptively. The results showed that 54.5% of the puskesmas did not have pharmacists as the responsible person and only 18.2% of the puskesmas had sufficient pharmacist and pharmaceutical technical staff for both drug management activities and clinical pharmacy services. Comprehensive drug management activities in accordance with pharmaceutical service standards at the puskesmas have been implemented in 96.7% of puskesmas with pharmacists. Comprehensive clinical pharmacy service activities according to pharmacy service standards at puskesmas are only applied in 23.3% of puskesmas with pharmacists. The availability and ability of pharmacists in providing clinical pharmacy services in puskesmas need to be a concern. Abstrak Pelayanan kefarmasian secara bertahap telah mulai diterapkan di pelayanan kesehatan dasar, baik dalam kewajiban pengelolaan farmasi maupun pelayanan farmasi klinis. Untuk mendukung hal tersebut, standar pelayanan kefarmasian di puskesmas telah beberapa kali mengalami perubahan dan terakhir diperbaharui dengan Permenkes Nomor 74 Tahun 2016 Tentang Standar Pelayanan Kefarmasian di puskesmas. Studi ini bertujuan mengetahui kesesuaian pelaksanaan standar pelayanan kefarmasian dalam pengelolaan obat dan farmasi klinik di puskesmas. Desain penelitian potong lintang dilakukan pada bulan Februari-November 2017. Pemilihan lokasi provinsi dilakukan secara purposif. Alat pengumpul data berupa kuesioner dan daftar tilik standar pelayanan kefarmasian di puskesmas. Analisis data dilakukan secara deskriptif. Hasil studi menunjukkan bahwa sebanyak 54,5% puskesmas belum mempunyai tenaga apoteker sebagai penanggung jawabnya dan hanya 18,2% puskesmas yang jumlah apoteker dan tenaga teknis kefarmasiannya mencukupi untuk kegiatan pengelolaan obat dan pelayanan farmasi klinik. Kegiatan pengelolaan obat yang komprehensif sesuai dengan standar pelayanan kefarmasian di puskesmas sudah diterapkan di 96,7% puskesmas yang memiliki apoteker. Kegiatan pelayanan farmasi klinis yang komprehensif sesuai standar pelayanan kefarmasian di puskesmas hanya diterapkan di 23,3% puskesmas yang memiliki apoteker. Ketersediaan dan kemampuan apoteker dalam memberikan pelayanan farmasi klinik di puskesmas perlu menjadi perhatian.

Promotive, preventive, curative, and rehabilitative efforts that are comprehensive, integrated, and sustainable are employed to enhance the health state of the global population. Within this context, however, the quality of primary health care depends on job satisfaction, which leads to the happiness of human resources in the health sector. Therefore, this study aimed to analyze and formulate a job satisfaction model among primary health care midwives in Indonesia. This study was an advanced secondary data analysis of a cross-sectional study conducted in 2017 by the National Institute of Health Research and Development, Ministry of Health of the Republic of Indonesia. A total of 87,341 midwives from all 9,669 primary health cares in Indonesia participated in this study. Data were collected by distributing the Minnesota Satisfaction Questionnaire, elaborating on the satisfaction level and relevant contributing factors. The prefilled Likert scale questionnaire was analyzed using logistic regression. The findings suggested a model indicating that motivation, work area (region), history of salary delay, and training received were important for their job satisfaction, whereas the motivation aspect contributed the most. Therefore, the local and central governments must consider these factors in the human resource policymaking process.

Background: The World Health Organization reported Indonesia as one of the countries with the most prevalent cases of diphtheria worldwide. The microbiological aspects of diphtheria-inducing bacteria are of great significance in tracing disease transmission and case management. However, clinical aspects are critical for updating clinical features and case management in the field, which may sometimes differ from theoretical foundations. Objectives: This study aimed to identify the microbiological and clinical aspects, including molecular typing and case fatality rates, in diphtheria-confirmed cases from the capital city of Indonesia, Jakarta, and surrounding areas in 2017. Methods: The microbiological aspect of 40 diphtheria-confirmed cases were obtained by re-identify diphtheria-inducing bacteria isolated from the samples, while the clinical aspects of the cases were obtained from the medical records and epidemiological data. The chi-square test was used to examine the correlation between fatal cases and myocarditis and diphtheria antitoxin administration delay. In this study, P ≤ 0.05 was set as the significance level. Results: All 40 diphtheria confirmed cases were induced by toxigenic Corynebacterium diphtheriae with two biotypes, namely intermedius (60.0%) and mitis (40.0%). There are six sequence types of bacteria with two main sequence types, ie, ST534 (46.4%) and ST377 (35.7%). The proportions of cases that had a fever and sore throat were 72.5% and 77.5%, respectively; however, the prevalence rates of the cases with pseudomembrane and bull neck were 100% and 47%, respectively. Most cases were administered a combination of penicillin or erythromycin with other antibiotics (40%), and 22.5% of the cases only received penicillin. Myocarditis was noticed in three fatal cases, and their relationship was statistically significant (P = 0.000). All five fatal cases (12.5% of cases) received diphtheria antitoxin (DAT) lately or had not received it yet. Conclusions: Toxigenic C. diphtheriae with two biotypes (namely mitis and intermedius) and two main sequence types (ie, ST534 and ST377) was the causative agent of diphtheria-confirmed cases from Jakarta and surrounding areas in 2017. It was also concluded that those fatal cases were correlated with myocarditis complications.

Pharmaceutical services is a direct service and responsible to patients relating to pharmaceutical products aimed to improve the quality of life of patients. Quality of pharmaceutical services can be assessed based on outpatient satisfaction. The aim of the study was to compare the satisfaction of outpatients with pharmaceutical services in hospitals and primary health care. This study used a cross-sectional comparative study design and was conducted in February-November 2017 in 11 provinces, each province consisting of 2 districts/cities selected purposively. Samples were outpatients who got medicines in hospitals or primary health care at least 31 patients in each pharmacy. Satisfaction was assessed by the dimension of responsiveness, reliability, collateral, friendliness, and physical evidence. Data was collected by the questionnaires and analyzed using chi-square test. The results of the study show that outpatient satisfaction with pharmaceutical services in hospital and primary health care was 90,9% and 96.6%, respectively. The largest percentage of outpatients in hospitals and primary health care are in the age group of 40-59 years, female, has further education, and not working/housewives. There were significant differences in the age group, gender, and education of outpatients between hospitals and primary health care. There was no significant relationship between the characteristics (age, sex, education, occupation) of outpatients and satisfaction with pharmaceutical services in hospitals and primary health care

Latar belakang: Pengobatan pada anak yang terinfeksi HIV merupakan beban bagi para orang tua/pengasuh karena berbagai permasalahan menyangkut kesehatan mereka. Metode: Penelitian untuk mengeksplorasi pengalaman dan dukungan sosial pada pengobatan anak terinfeksi HIV dilakukan di 5 provinsi di Indonesia dengan prevalensi HIV tertinggi. Total sampel anak sebanyak 239 orang dari sejumlah 267 orang yang direncanakan. Data dikumpulkan dengan wawancara semi terstruktur dengan orang tua/pengasuhnya. Analisis dilakukan terhadap 16 anak berusia 2-14 tahun yang telah mendapatkan terapi obat antiretroviral. Hasil: Dari sejumlah 160 anak, sebanyak 62,5% anak mengkonsumsi 1-2 item obat dan 36,9% mengkonsumsi 3 5 item. Efek samping yang paling sering terjadi adalah kulit kemerahan, mual dan muntah. Kesulitan yang paling sering dihadapi adalah rasa bosan dan anak mempertanyakan minum obat. Orangtua/pengasuh berusaha melanjutkan pengobatan dengan mengingatkan jadwal minum obat, membujuk, memberikan penjelasan bahkan memaksa atau mengancam mereka untuk minum obat. Kesulitan tersebut makin bertambah seiring meningkatnya usia anak. Dukungan yang paling sering berasal dari orang tua dan keluarga besar seperti nenek atau paman, khususnya untuk anak yang sudah yatim. Kesimpulan: Pemahaman hambatan pengobatan pada anak terinfeksi HIV dapat membantu untuk menyediakan intervensi yang tepat untuk meningkatkan kepatuhan yang akan mendorong kesuksesan terapi mereka. Kata kunci: anak terinfeksi HIV, antiretroviral, dukungan social, pengobatan, kesulitan Abstract Background: The treatment of HIV infected children is a burden to their caregiver due to many existing problems related with their health. Methods: A research to explore the experience and social support on the treatment of HIV infected children was conducted in 5 provinces in Indonesia with highest prevalence of HIV. Total children sample was 239 out of previous 267 planned. Data was collected through semi structured interview with caregivers of the children. Analysis was conducted to 160 children aged 2-14 years old who were on antiretroviral therapy. Results: Among those 160 children, 62.5% took 1-2 items of medicines and 36.9% took 3-5 items. The most frequent adverse events were skin rash followed by nausea and vomiting. Boredom and questioning were the most frequent difficulties. The caregivers attempted to continue the treatment by reminding the children on schedule to take medicines, wheedling, explaining, forcing or even threatening them. The difficulties appeared more as the children grew older. The most frequent supports mainly came from parents, and extended family such as grandmother or uncle especially for orphaned children. Conclusion: Understanding obstacles in HIV infected children will help to do proper interventions to improve adherence that will lead to successful therapy. Keywords: HIV infected children, antiretroviral, social support, treatment, difficulties

Introduction: Antibiotic use needs to be monitored. Its irrational use causes resistance. Research aims to determine trends in antibiotic use. Methods: Observational research with retrospective data collection. Cross-sectional research design. Data about the availability of antibiotics from 2014 to 2017 in hospitals, health offices and PHCs in the city of Manado. Results: Trends of antibiotics used in PHC and health office in 2014–2017 were betalactam, macrolide, sulfamethoxazole-trimethoprim, and quinolone groups. Trends in secondary hospital were betalactam, sulfamethoxazole-trimethoprim, and quinolone groups. Trends in tertiary hospital are betalactam, quinolones, and other groups. Conclusion: Based on the data of five major antibiotics use in Manado City, there was a change in the pattern of antibiotic use, and this pattern tended to increase.

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

Ministry of Health estimates there are 9,000 pregnant women HIV positive who give birth every year in Indonesia. HIV-positive pregnant women must get Anti Retroviral treatment with a minimum level adherence to the use of anti-retroviral drugs of 90 - 95% drug to get a response to suppresing the virus by 85% . Physiological changes during pregnancy and breastfeeding can affects the drug kinetics in pregnant and lactating women. In children, non-compliance can be caused by saturation, limited drug preparation for children, side effects and other diseases that accompany it. In this article, we will analyze the extent to which pharmacists act as counselors for HIV-AIDS treatment for mothers and children. Data were taken from 2 qualitative studies, namely Implementation Study of Prevention of mother-to-child transmission (PMTCT) Program at HIV-AIDS Referral Hospital in West Java Province in 2014 and Study on Access of HIV-AIDS and Opportunistic Infection Treatment for Children in Ten Districts of Indonesia in 2015. Data collection was carried out by in-depth interviews with pharmacists and doctors who handled pregnant women and children with HIV-AIDS. Data were analyzed using triangulation and content analysis method. The results showed that pharmacists had not been involved as drug counselors and support from the management of the hospitals did not yet exist, so the pharmacist could not yet as a counselor as a form of pharmaceutical services according to standards set by the government Therefore, the role of pharmacist as counselor needs to be improved, because the success of the treatment is highly dependent on the successful collaboration of doctors, nurses, and pharmacists. In order for the pharmacists play a role, it is necessary to get training on HIV-AIDS treatment. In addition, the government needs to advocate for hospital management to facilitate the pharmacist’s counseling as form of counselor. Abstrak Kementerian Kesehatan memperkirakan terdapat 9.000 ibu hamil HIV positif yang melahirkan di Indonesia setiap tahun. Ibu hamil dengan HIV positif harus mendapatkan pengobatan anti retroviral dengan minimal tingkat kepatuhan penggunaan obat Anti Retroviral sebesar 90 - 95% untuk mendapatkan respon penekanan jumlah virus sebesar 85%. Perubahan fisiologi selama kehamilan dan menyusui dapat berpengaruh terhadap kinetika obat pada ibu hamil dan menyusui. Pada anak, ketidakpatuhan dapat disebabkan karena jenuh, sediaan obat untuk anak yang terbatas, efek samping, dan penyakit lain yang menyertai. Pada artikel ini dianalisis sejauh mana apoteker berperan sebagai konselor pengobatan HIVAIDS pada ibu dan anak. Data diambil dari dua penelitian kualitatif yaitu penelitian Studi Implementasi Layanan Pencegahan Penularan HIV dari Ibu ke Anak (PPIA) pada Rumah Sakit Rujukan HIV-AIDS di Provinsi Jawa Barat Tahun 2014 dan Penelitian Akses Pengobatan HIV/AIDS dan Infeksi Oportunistik pada Anak di Sepuluh Kabupaten/Kota di Indonesia Tahun 2015. Pengumpulan data dilakukan dengan wawancara mendalam dengan apoteker dan dokter yang menangani ibu hamil dan anak dengan HIVAIDS. Analisis data dengan tri angulasi dan analisis konten. Hasil penelitian menyimpulkan bahwa apoteker belum dilibatkan sebagai konselor obat dan dukungan dari pihak manajemen RS belum ada, sehingga apoteker belum dapat berperan sebagai konselor sebagai salah satu bentuk pelayanan kefarmasian sesuai standar yang telah ditetapkan pemerintah. Oleh karena itu peran apoteker sebagai konselor perlu ditingkatkan karena keberhasilan pengobatan sangat tergantung keberhasilan kolaborasi dokter, perawat,dan apoteker. Agar apoteker dapat lebih berperan maka perlu mendapatkan pelatihan tentang pengobatan HIV-AIDS. Selain itu pemerintah perlu melakukan advokasi kepada manajemen RS untuk memfasilitasi apoteker melakukan konseling sebagai bentuk konselor.

Dana Alokasi Khusus (DAK) subbidang pelayanan kefarmasian diberikan pada provinsi dan kabupaten/kota tertentu di Indonesia yang bertujuan untuk penyediaan obat dan perbekalan kesehatan serta pengadaan atau rehabilitasi instalasi farmasi. Tujuan dari kajian ini yaitu untuk menelaah kebijakan, efektivitas dan efisiensi serta permasalahan yang terkait dengan DAK subbidang pelayanan kefarmasian. Kajian dilakukan melalui telaah kebijakan, pengolahan data sekunder dan pertemuan dengan pemangku kepentingan terkait. Hasil kajian menunjukkan bahwa berbagai kebijakan terkait DAK telah dibuat dan diperbarui setiap tahun untuk memudahkan teknis pelaksanaannya, namun masih ada masalah-masalah terkait dengan alokasi dan perencanaan, penggunaan, pelaporan serta ketersediaan sumber daya untuk pengelolaan DAK subbidang pelayanan kefarmasian. Efektivitas DAK subbidang pelayanan kefarmasian pada tahun 2014 yaitu yaitu 51,25% di tingkat Kabupaten/Kota dan 50% di tingkat Provinsi. Efisiensi hanya dapat dilihat dari realisasi penggunaan dana yaitu 87% di tingkat kabupaten/kota dan 84% di tingkat provinsi. Peraturan dan inovasi khusus diperlukan agar petugas daerah dapat mengerjakan laporan tepat waktu dengan prosedur yang lebih mudah. Dengan adanya perubahan kebijakan perencanaan dan pengalokasian DAK tahun 2016 maka perlu pertimbangan dalam penetapan faktor-faktor penentuan alokasi DAK. Kata kunci: DAK, subbidang pelayanan kefarmasian, pengadaan obat, instalasi farmasi Abstract The pharmaceutical services specific allocated fund has been given to selected provinces and districts in Indonesia, which is aimed to provide drugs and health equipment and build or renovate pharmaceutical installation. The study aimed to review the regulations, the effectiveness and efficiency, and problems related with pharmaceutical services specfic allocated fund. Study was conducted by reviewing the regulations, analyzing secondary data, and discussion with related stakeholders. The result showed that although several regulations were made and renewed every year to simplify the technical implementation, some problems were still exist in term of allocation and planning, utilization, reporting, and the availability of necessary resources for managing the fund. The effectiveness of pharmaceutical services specific allocated fund in 2014 was 51.25% in district level and 50% provincial level. The efficiency could only be analyzed through the realization of the fund that reached 87% in district level and 84% in provincial level. It is necessary to stipulate special regulation and innovation in order to encourage the local staff to report on time with an easier procedure. It is necessary to have consideration regarding the determination of allocating factors of the specific allocated fund, due to changes in the planning and allocating regulation since 2016 onward. Keywords: Specific allocation fund, pharmaceutical services, drug procurement, pharmaceutical installation

Tujuan penelitian ini adalah untuk mengetahui penggunaan model Picture and Picture dapat meningkatkan kemampuan siswa pada materi bangun ruang sisi lengkung. Penelitian ini menggunakan Penelitian Tindakan Kelas (PTK) dengan melakukan 2 (dua) siklus tindakan, yang pada setiap siklus dilakukan melalui tahapan perencanaan, pelaksanaan, pengamatan dan refleksi. Pengumpulan data dilakukan dengan cara observasi, wawancara dan tes hasil belajar. Hasil enelitian ini menunjukkan bahwa penggunaan model Picture and Picture terbukti dapat meningkatkan kemampuan siswa pada materi bangun ruang sisi lengkung. Hal ini dibuktikan dengan adanya peningkatan jumlah siswa yang melampaui KKM dibandingkan dengan pra tindakan.Proses pembelajaran pada siklus I pertemuan ke-2 meningkat sebesar 22% menjadi 68% pada siklus II pertemuan ke-1. Demikian pula pada siklus II pertemuan ke-1 meningkat sebesar 14% menjadi 82% pada akhir siklus II pertemuan ke-2.Hasil belajar dan kemampuan siswa pada materi bangun ruang sisi lengkung pada siklus I pertemuan ke-2 sebesar 51% meningkat sebesar 25% menjadi 76% pada siklus II pertemuan ke-1. Demikian pula hasil belajar dan kemampuan siswa pada siklus pada siklus II pertemuan ke-1 meningkat sebesar 6% menjadi 82% pada akhir siklus II pertemuan ke-2.Persentase ketuntasan klasikal pada siklus I pertemuan ke-2 sebesar 5% meningkat sebesar 58% menjadi 63% pada siklus II pertemuan ke-1. Demikian pula perentase ketuntasan klasikal pada siklus II pertemuan ke-1 meningkat sebesar 10% menjadi 75% pada akhir siklus II pertemuan ke-2.Pada mumnya siswa merespon dengan baik penggunaan model Picture and Picture. Hal ini dibuktikan dari hasil pengamatan terhadap aktivitas siswa dalam kegiatan proses pembelajaran pada pertemuan dan siklus ke siklus menunjukkan kemajuan dan peningkatan. Aktivitas siswa pada siklus I pertemuan ke-2 sebesar 50% meningkat sebesar 15% menjadi 65% pada siklus II pertemuan ke-1. Demikian pula aktivitas siswa pada siklus II pertemuan ke-1 meningkat sebesar 6% menjadi 82% pada akhir siklus II pertemuan ke-2.

Pharmacy is a place where a pharmacist provides pharmaceutical services. To improve services, it is necessary to carry out an evaluation of patients’s or consumers’ satisfaction on pharmaceutical services.This research aimed to assess the satisfaction of the patients covered by national health insurance programme (JKN) and to find out the relationship of patients’ characteristics and their satisfaction. This research used a cross sectional survey design, conducted for patients visiting pharmacy to redeem the prescribed drug in Tangerang Selatan city, Serang district, Bekasi city, Bogor district, Yogyakarta city, Bantul district, Solo city, and Sragen district. The sample was 152 adult JKN patients chosen by accidental sampling. Data were collected using self assessment questionnaire analyzed using chi square analysis. This study found that the highest level of dimension of pharmaceutical services satisfaction was empathy and the lowest one was assurance, in term of the availability of drugs and the number of drugs that was covered by JKN scheme. Among 5 characteristics (i.e: age, sex, marriage status, education, and occupation), only occupation variable that had significant correlation with satisfaction. The pharmacy management should communicate with the JKN provider regarding the kinds of drugs covered and concern with the drugs availability in the pharmacy

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.

Home yard has been used to plant certain medicinal plants, also as known as TOGA program. This research was aimed to study the implementation of TOGA program and community tradition in planting and using medicinal plants. A qualitative research was conducted in West Java, Central Java, East Java and Bali which based on National Basic Health Research 2010 data had the highest percentage of jamu usage. Data was collected in 2011 through in depth interview and focus group discussion with related stakeholder and observation in research location. Result in Bogor district showed TOGA program has been included in Family Welfare Development Program and similar program was also developed in some villages. There was no certain TOGA program in Karanganyar, Sumenep and Gianyar districts. TOGA program in Karanganyar was inserted in other program due to economic needs while in Gianyar the program was originated from ornamental plants. The community usually used medicinal plants for the prime medication before going to health facility. Planting medicinal plants is an inherited tradition where parents become the main source of planting and usage information. The Agriculture Office and village officials had more significant roles to guide the community while the Health office only suggested or monitored them

Background: The escalation of HIV-AIDS epidemic needs a comprehensive control efforts including the treatmentstage. ARV is inevitably needed to control the development of HIV-AIDS infection. The availability and accessibility of ARVis crucial to reach the successful treatment. Objective: To identify the implementation of logistic management process inthe central level. Methods: Conducting in depth interviews with informants from AIDS and Infectious Disease sub divisionof the Directorate General of Disease Prevention and Control-MoH, Directorate General Pharmacy and Medical Devices,GF-ATM, and PT. Kimia Farma as the manufacturer of ARV in Indonesia. Data was collected in Jakarta during May-August2011. Result: Source of fund procurement of ARV drugs in Indonesia comes from the national budget and Global Fund.Kimia Farma is the only national manufacture of 5-drugs firts line of ARV, while second line ARV is import include rawmaterials of ARVs. Logistics management consists of planning, procurement and storage, and distribution. Conclusion:Logistic management of ARV in the central level has run in accordance to drug logistic cycle. Unfortunately, most rawactive materials and final second line of ARVs product were still being imported. The government has planned an exitstrategy to reduce the dependency on the donor funding. The report and coordination process among the government,PT. Kimia Farma and end user (hospitals) has not worked well and synchronized. Recommendation: The governmenthave to encourage the local pharmaceutical industries to be able to produce ARV, especially the second line. All relatedstakeholders should enhance good coordination through periodic monitoring and evaluation in ARV distribution processand human resources capability in reporting mechanism.

Prescribing indicator is an easy core indicator to evaluate drug utilization as stated in WHO guideline. Rational prescribing pattern is important to improve rational use of drugs whereas irrational prescribing pattern can lead to irrational drug use. This study aimed to assess the prescribing pattern in public and private primary healthcare facilities which were included in the National Health Insurance Program in Indonesia. This study has been conducted using the cross sectional research design, quantitative and retrospective method in four provinces in Java island (West Java, Banten, DIY and Central Java provinces) from May to July 2014. The method of retrospective data collection were collected 757 prescriptions from 26 PHCs and 900 prescriptions from 30 clinics or General Practitioners (GPs). All data in the prescribing form were analyzed manually using Microsoft Excel 2007. The average number of item in public and private facilities was 3.31 and 3.06 respectively. The percentage of generic prescribing was 93.3% and 62.0%, the percentage of drugs in accordance with the 2013 national formulary was 89.0% and 64.5%, the percentage of antibiotic per total number of encounter was 42.8% and 39.4%, while the percentage of injection per total encounter was only 0.7% and 2.2%. Paracetamol and dexamethasone were the most frequently prescribed drugs while for antibiotic group were amoxicillin, ciprofloxacin, cotrimoxazole and cefadroxil.The average number of items per encounter and antibiotic were not met the WHO standard(≤3 for average number and less than 30% for antibiotic percentage). Suitable interventions are needed to improve the prescribing practices in Indonesia.

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.

Implementation of the National Health Insurance program causes various effects, including an increased number of visits to primary health facilities, so it takes an adequate distribution of human resources.The aims of this study is to describe the availability of human resources for health in primary health centers in the era of National Health Insurance. Type of research is quantitative-qualitative method withcross sectional approach. Data collecting has done by interviews and round table discussion. Researchlocations were selected purposively in eight districts/cities, namely Bekasi City and Bogor District (WestJava), South Tangerang City and Serang District (Banten), Yogyakarta City and Bantul District (DIY),Surakarta City and Sragen District (Central Java). Informants are leaders/representatives of primaryhealth centers, clinics, physicians and the district/city health office. The quantitative data were analyzed descriptively and qualitative data using content analysis. Health centers in eight districts/cities do notall have the human resources for health in accordance of Permenkes RI No. 75/2014, but general practitioners, midwives and nurses have been available in all health centers though the amount isstill lacking. With the exception of Bogor, the number of medical personnel throughout the clinic is inconformity with Permenkes RI No. 9/2014, but other types of human resources for health is still a lot that has not been available. Meanwhile, throughout the medical practitioners, the most human resources widely available are general practitioners and nurses. There are changes in procurement planning ofhuman resources in the era of National Health Insurance, increased workload and working hours, sothat it is needed planning and procurement of human resources based on needs. Keywords: human resources, primary health facilities, national health insurance Abstrak Pelaksanaan program Jaminan Kesehatan Nasional (JKN) menimbulkan berbagai dampak, termasuk meningkatnya jumlah kunjungan ke Fasilitas Kesehatan Tingkat Pertama (FKTP), sehingga dibutuhkan sumber daya manusia (SDM) kesehatan yang memadai. Tujuan penelitian adalah untuk memberi gambaran tentang ketersediaan SDM kesehatan di FKTP dalam era JKN. Jenis penelitian adalah kuantitatif-kualitatif dengan pendekatan cross sectional. Pengumpulan data dengan wawancara dan round table discussion. Lokasi penelitian dipilih secara purposive di 8 kabupaten/kota yaitu Kota Bekasi dan Kabupaten Bogor (Jawa Barat), Kota Tangerang Selatan dan Kabupaten Serang (Banten), KotaYogyakarta dan Kabupaten Bantul (DIY), serta Kota Surakarta dan Kabupaten Sragen (Jawa Tengah). Informan yaitu pimpinan/wakil institusi puskesmas, klinik, dan praktik dokter serta dinas kesehatan kabupaten/kota. Analisa data kuantitatif dilakukan secara deskriptif dan analisa data kualitatif dengan content analysis. Puskesmas di 8 kabupaten/kota belum seluruhnya memiliki SDM kesehatan sesuaiPermenkes RI Nomor 75 tahun 2014, namun dokter umum, bidan dan perawat telah tersedia di seluruh puskesmas meskipun dengan jumlah yang masih kurang. Kecuali Kabupaten Bogor, jumlah tenaga medis di seluruh klinik sudah sesuai Permenkes RI Nomor 9 Tahun 2014, namun jenis SDM kesehatan lain masih banyak yang belum tersedia. Sedangkan di seluruh praktik dokter, SDM kesehatan yangpaling banyak tersedia yaitu dokter umum dan perawat. Terdapat perubahan dalam perencanaan pengadaan SDM di daerah sesudah JKN, peningkatan beban kerja dan jam kerja, sehingga diperlukan perencanaan dan pengadaan SDM berbasis kebutuhan. Kata Kunci: SDM, FKTP, JKN

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

ISPA (Infeksi Saluran Pernafasan Akut) adalah (Acute Respiratory Infection) salah satu penyakit utama pada anak. Pada umumnya perilaku pencarian pengobatan untuk ISPA berakhir dengan penggunaan obat. Efikasi obat tidak hanya merupakan pengetahuan medis tetapi merupakan konstruksi budaya. Penelitian dilakukan untuk memahami bagaimana obat diinterpretasikan oleh orang awam di wilayah kumuh perkotaan. Penelitian dilakukan pada bulan Oktober 2009 di sebuah komunitas pemulung yang tinggal di kota Depok. Data dikumpulkan dengan melakukan wawancara mendalam terhadap 20 orang ibu yang memiliki balita dengan gejala ISPA dalam waktu paling lama sebulan sebelum penelitian dilakukan. Informan diwawancarai mengenai pengalaman dalam menangani balita dengan gejala ISPA, pengobatan yang dilakukan dan bagaimana mereka mengevaluasi obat yang digunakan. Hasil menunjukkan bahwa dalam menghadapi balita ISPA, para ibu melakukan pengobatan sendiri, membawa anak ke Puskesmas atau praktek swasta yang semuanya berujung pada penggunaan obat. Istilah “cocok” merupakan kata kunci dalam mengevaluasi efikasi dan kompatibilitas obat.

Background: Antiretroviral (ARV) is the drug to reduce varemia and enhances CD4+ level. ARV cannot cure HIVAIDSbut it increases the life expectancy of people living with HIV-AIDS (PLHA). ARV is a lifetime treatment that needs ahigh adherence. The meaning of ARV which vulnerable to low adherence is related to stigma and discrimination. It is alsorelated to the changing of life pattern in which taking ARV is considered as a burden. This research suggests the needto include the meaning of ARV for a successful therapy. Because using ARV for a long time can make PLHAs feel boringand sometimes they drop out the treatment. Method: The research was conducted in Bandung, Cimahi, Denpasar andBadung districts in 2011. The subjects were 17 PLHAs consist of 9 females and 8 males, aged 20-42 years. Data werecollected by doing in depth interview which then analyzed with content analysis method. Results: The meanings of ARVwhich give positive impact on adherence including the function of ARV that not merely as medical stuff but also have thefunction related to psychological or spiritual meaning (miracle); the changing on life pattern (consider as a habit); and thehope for life (the second chance) Recommendations: The study recommends to include the meaning of ARV related to the function on spiritual/psychological matter, the changing on life pattern and the hope for life other than just give councellingon medical function of ARVs and handling side effects.

Latar belakang: Peraturan Pemerintah Republik Indonesia Nomor 51 Tahun 2009 tentang Pekerjaan Kefarmasian menyatakan bahwa tenaga kefarmasian adalah tenaga yang melakukan pekerjaan kefarmasian, yang terdiri atas apoteker dan tenaga teknis kefarmasian. Berdasarkan pasal 21, pelayanan resep atau penyerahan obat resep dokter di puskesmas, harus dilakukan oleh apoteker. Masalah penelitian adalah belum diketahui kondisi ketersediaan tenaga kefarmasian dalam kaitannya dengan karakteristik dan Praktik kefarmasian di puskesmas. Metode: Studi ini merupakan analisis lanjut data sekunder Riset Fasilitas Kesehatan Tahun 2011 yang menggunakan pendekatan survei (cross-sectional) terhadap puskesmas di kabupaten/kota terkait ketersediaan tenaga kefarmasian di puskesmas dan dilakukan pada bulan Agustus–September 2012. Tujuan analisis adalah mendapatkan informasi tentang ketersediaan tenaga kefarmasian di puskesmas, ketersediaan tenaga kefarmasian berdasarkan karakteristik puskesmas dan Praktik kefarmasian berdasarkan ketersediaan tenaga kefarmasian di puskesmas. Konfirmasi data dilakukan melalui wawancara mendalam dengan Bagian Kepegawaian Dinas Kesehatan Kota Bogor dan Kota Bekasi serta tenaga kefarmasian pengelola obat di Puskesmas. Pengolahan data dilakukan dengan membandingkan ketersediaan tenaga kefarmasian berdasarkan karakteristik puskesmas dan Praktik kefarmasian berdasarkan ketersediaan tenaga kefarmasian di puskesmas. Analisis data berupa distribusi frekuensi, uji Mann-Whitney, uji Kruskal-Wallis dan uji Kendalls tau b. Hasil: Hasil penelitian analisis lanjut terhadap seluruh puskesmas di Indonesia menunjukkan bahwa hanya 17,5% puskesmas di Indonesia memiliki apoteker dan ada 32,2% puskesmas yang tidak memiliki tenaga kefarmasian sama sekali. Ada perbedaan ketersediaan tenaga kefarmasian antar puskesmas berdasarkan lokasi puskesmas, jenis puskesmas, keterpencilan wilayah dan status kepegawaian tenaga kefarmasian. Apoteker berperan lebih baik dalam memberikan pelayanan farmasi, mengelola obat dan menyusun LP-LPO dengan lengkap dibandingkan dengan tenaga teknis kefarmasian dan tenaga teknis kefarmasian juga berperan lebih baik dibandingkan dengan tenaga non-farmasi dalam hal yang sama.

Background: The village medicine post (POD) program had been introduced in 1991, and legalized in 2004 by KepMenKes No. 983/2004, known as Village Medicine Shop (WOD). This program should be evaluated in order to know its implementation. Methods: The research was carried out in 2006, in Karanganyar District and Subang District. This research aimed to elaborate the condition of WOD, and their supporting, as well as inhibiting factors. The data were collected by round table discussion to the communities, in depth interviewed to the Primary Health Care officers, village midwives, WOD cadres. Besides, WOD observation and secondary data collection also have been done. Results: Result showed that there was not any implemented WOD followed to the KepMenKes No. 983/2004. They were still POD types as former concept. In Karanganyar District, some of PODs were still active, they were located in the cadre’s house, and only managed limited number of medicines. In Subang District there were many inactive POD, some of them developed their business through a common shop, change into medical centre, drug store or dispensary. The supporting factors were detected, such as remote villages, the distance of health facilities, as well as the community’s trust to the cadres. While the inhibiting factors detected were the availability of developing shop which also sell medicines surrounding the POD location. In Karanganyar District, the supporting factors detected were the availability of financing group, called “dana sehat”, active cadres, village midwives, Primary Health Care, and communities. Meanwhile in Subang District, the important supporting factors were the availability of cheap price of medicines, besides active and trained cadres. The inhibiting factor in Karanganyar District was limited number of the available medicines types. The inhibiting factors in Subang District were mismanagement of POD, limited budget, medical practice regulation, uncertain legality of POD, and attitude of the cadres. Key words: Village Medicine Shop, Village Medicine Post

Background: A study to analyze data of Basic Health Research 2010 (Riskesdas 2010) was done to describe the profile of household using self-made herbal medicines and to identify the characteristics of household members that related to use of self-made herbal medicines. Methods: The sampel was individuals aged fifteen years old or more and who use self-made herbal medicine i.e. 177,927 people from selected household in 33 Indonesian provinces. Data was collected by interviewing the respondent that use structured questionnaire, including age, sex, marital status, education, job, household monthly expenditure, residence, province and self-made herbal medicines usage. The data were analyzed by proportion and Chi square test and multiple logistic regression method. Results: Results of data analysis shows that nearly ten percents of household that ever used herbal medicines are those using self-made herbal medicines. A greater proportion of them used either Kaemferia sp. and or Zingiber sp. as raw material in liquid formulation and got the benefit of using it as well as living in North Maluku, Bali and East Nusa Tenggara. About seventeen percents of household members who ever used herbal medicines are those using self-made herbal medicines. Conclusion: Factors related to self-made herbal medicines are married/divorce (OR= 1.76; CI = 1.63-1.90), urban residence (OR= 1.45; CI = 1.38-1.53), female (OR= 1.43; CI = 1.363-1.50) dan higher economic group (OR= 1.34; CI = 1.27-1.40). Keywords: self-made herbal medicines, traditional medicine, household

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