There is a high demand for publication in the form of scientific articles in reputable journals in the academic world in Indonesia. Research publication in reputable or accredited national journals is required for graduation from tertiary institutions for master level students.Publication in reputable international journals is also a requirement for doctoral-level students graduation. For teaching staff, research publication in the form of peer reviewed journal articles is also a requirement for higher levels in the academic career. The increasing demand for scientific publication also reported globally. Furthermore, various reported reasons for publication include adding work resumes, for job promotion, obtaining funding grants, competition among colleagues or proving supremacy, and even in some universities, the history of  publications is used as the criteria for determining dissertation internal and external examiners.

There is a high demand for publication in the form of scientific articles in reputable journals in the academic world in Indonesia. Research publication in reputable or accredited national journals is required for graduation from tertiary institutions for master level students.Publication in reputable international journals is also a requirement for doctoral-level students graduation. For teaching staff, research publication in the form of peer reviewed journal articles is also a requirement for higher levels in the academic career. The increasing demand for scientific publication also reported globally. Furthermore, various reported reasons for publication include adding work resumes, for job promotion, obtaining funding grants, competition among colleagues or proving supremacy, and even in some universities, the history of  publications is used as the criteria for determining dissertation internal and external examiners.

Background: Globally, the unmet need for family planning remains high. The proportion of unmet needs for family planning (FP) in Indonesia was found to have declined but was still higher than the set target. In the last 5 years there have been significant development in Indonesia including infrastructure, the National Health Insurance Program and the increasing allocation of funds to all villages throughout Indonesia. This study aims to determine the factors associated with unmet needs for family planning in Indonesia.

Methods: This study uses secondary data from the 2017 Indonesia Demographic and Health Survey (IDHS) that was carried out in 34 provinces in Indonesia. The number of the analyzed samples was 26,479 of the total 2017 IDHS sample of 35,681 women aged between 15-49 years. The dependent variable is the unmet need for FP, while the independent variables consist of four core variables namely individual, household, community and programmatic variables. Data analysis was performed with a binary logistic regression to obtain the adjusted odd ratio of each factor.

Results: The proportion of unmet needs in this analysis was 14.3% (95%CI: 13.9-14.7%). Factors related to unmet needs are maternal age 25-34 years (AOR=1.17; 95%CI=1.01-1.36), 35-44 years (AOR=1.46; 95%CI=1.23-1.73), ≥45 years (AOR=2.20; 95%CI=1.81-2.68), age of last child ≥10 years (AOR=1.28; 95%CI=1.14-1.42), number of living children <2 (AOR=1.68; 95%CI=1.51-1.87), ideal number of children >2 (AOR=1.34; 95%CI=1.24-1.45), have >1 son (AOR=1.12; 95% CI=1.00-1.25), husband not working (AOR=1.90; 95%CI=1.45-2.49), lack of knowledge about family planning methods (AOR=1.36; 95%CI=1.19-1.55), higher wealth index (AOR=1.13; 95% CI=1.03-1.24), not discussing family planning with partners (AOR=1.11; 95%CI=1.02-1.20), low women's autonomy (AOR=1.13; 95%CI=1.04-1.24), living in urban area (AOR=1.26; 95%CI=1.17-1.37) and regions with TFR >2.4 (AOR=1.62; 95%CI=1.46-1.81).

Conclusion: The proportion of unmet needs in Indonesia is still high and the dominant associated factor is the age of the mother ≥45 years. In order to decrease the FP unmet needs, the intervention programs should be targeted to groups of women who are at risk of experiencing such unmet needs.

Background and purpose: Primary health care services (PHCS) are the entry point for health services in an insurance-based health financing system, including the National Health Insurance Program or Jaminan Kesehatan Nasional (JKN) in Indonesia. This study aims to understand the association between structural factors in health service management with PHCS selection among JKN participants.

Methods: The study used a cross sectional analytic design, conducted with 273 JKN participants in Denpasar as respondents. The samples were selected using multistage random sampling. Data was collected from April to May 2018 with interviews using a questionnaire covering the characteristics of respondents and perceptions on the importance of health care facilities, the capabilities of health providers, service distance, operational time, availability of drugs and medical equipment. Data analysis was carried out with multinomial logistic regression to determine the structural factors of health service management associated with the selection of PHCS.

Results: Most respondents (65.9%) chose private clinics, 21.3% chose public health centres (PHCs) and 12.8% chose general practitioners. Multivariate analysis showed that the variables which significantly associated with the selection of PHCS among JKN participants were the perceived importance of the health care facilities at PHCs and private clinics, each with AOR=7.83 (95%CI: 2.72–22.54) and AOR=7.18 (95%CI: 2.76–18.68), the perceived importance of the capability of health workers in private clinics with AOR=0.29 (95%CI: 0.12–0.77), the perceived importance of health service time in private clinics with AOR=2.67 (95% CI: 1.05–6.74) and a history of examinations at private clinics with AOR=4.51 (95%CI: 1.86–10.96).

Conclusion: Structural factors are associated with the selection of PHCS among JKN participants. Attention to the quality and quantity of structural factors in the management of health services is important to improve the equitable distribution of JKN membership in the registered PHCS.

ABSTRACT

Background and purpose: Premarital sexual relations in adolescents and early marriage tends to increase in Indonesia. One of the programs implemented in Indonesia to reduce these problems is the reproductive health program for adolescents in schools. The Youth World Spirit Module or called SEmangaT duniA RemajA (SETARA) is used as a tool for teaching and learning activities in pilot projects in several cities in Indonesia, including Denpasar. This study aims to determine the implementation of the program in Denpasar.

Methods: This study employed a qualitative approach conducted at junior high schools in Denpasar City. Data collection was carried out with six focus group discussions (FGDs) consisting of three FGDs with 20 students aged 13-15 years and three FGDs with 15 teachers who were appointed as a facilitator of the program. In addition, in-depth interviews were also conducted with three junior high school principals. FGDs and in-depth interviews were recorded, transcribed and analysed thematically using the Miles and Huberman Technique.

Results: The study showed that the provision of the SETARA module was able to change the impression of taboo and broaden adolescent insights on reproductive health material. The implementation of this module is slightly different between schools due to differences in time allocation, number of activities in schools and the absence of standardised implementation guidelines. However, teachers and schools continue to support the implementation of this module.

Conclusion: This module is quite effective in providing information so as to eliminate the taboo impression from reproductive health material.

Background and purpose: The coverage of exclusive breastfeeding is reported to be low. The aim of this study was to explore the extent of the roles of midwives during pregnancy, childbirth and postpartum in efforts to increase exclusive breastfeeding.

Methods: This study used a qualitative approach with in-depth interviews using interview guidelines to explore the role of midwives in increasing exclusive breastfeeding during pregnancy, childbirth and postpartum. The study was conducted in the working area of Kuta I Public Health Center (PHC), Badung District, Bali Province from October 2017-July 2018. Interviews were conducted with 12 informants chosen purposively, namely three PHC midwives, two private practice midwives, one nutrition program manager, four mothers who managed to provide exclusive breastfeeding and two who did not. Data were analyzed with a thematic approach.

Results: This study shows that the roles of midwives are not optimal. The role that has been carried out during pregnancy is to provide information about breast care but not to practice breast care. During labor, the midwife facilitated the initiation of early breastfeeding except for mothers who experienced childbirth complications. During the postpartum period the midwife provides information about breastfeeding to working mothers and monitors exclusive breastfeeding at the integrated health services centers or in Indonesia called pos pelayanan terpadu (posyandu) until the infant reach the age of six months. Midwives provide information about breast care and how to overcome problems in breastfeeding, but do not facilitate the practice of both. All midwives do not make home visits for several reasons, namely distance to residents' homes, high burden of tasks and lack of human resources. Midwives also provide counselling at posyandu on maternal and child nutrition but do not focus on exclusive breastfeeding.

Conclusion: The roles of midwives in facilitating exclusive breastfeeding during pregnancy, childbirth and postpartum are still superficial and not in accordance with the guidelines for obstetric care. The roles of midwives need to be enhanced to increase exclusive breastfeeding.

Background and purpose: Patient centered care in hospitals has yet to be well implemented. The role of case managers is very important in the implementation of patient centered care in hospitals. Research publications on the role of case managers in patient centered care in Indonesia remain limited. This study aims to explore the roles of case managers and problems encountered in the implementation of patient centered care in hospitals.

Methods: This study used a qualitative design with a case study approach conducted at Bangli District Hospital in Bali in April 2019. Data was collected through in-depth interviews with seventeen purposively selected informants consisting of ten case managers, one deputy director of medical services, two patient's family members, two specialist doctors and two implementing nurses at Bangli District Hospital. This study uses the Patient Centered Care Framework from Greene which consists of three dimensions in patient centered care namely interpersonal, clinical and structural dimensions. Data was analyzed thematically using deductive and inductive techniques. Data validation was conducted through triangulation of data based on different sources, member checking and peer debriefing.

Results: In this study, five main themes were found regarding the role of case managers in the implementation of patient centered care in hospitals, namely interpersonal, clinical and structural dimensions, support and expectations of case managers. The identified role of the case manager in the interpersonal dimension consisted of listening to patients and families actively, coordination and collaboration in problem solving, providing accurate and easy to understand information about care. Problems encountered included lack of communication between the service provider components and between the service provider with patients and their families. Roles of case manager in the clinical dimension are to hold meetings with a professional team of care givers and continuous monitoring of services to patients, while the issue encountered is the mismatch of time of service provision by specialist doctors. Roles of case managers in the structural dimension is coordination with policy holders, use of information technology and patient reporting. Problems encountered were inappropriate recruitment of case managers, lack of training of case managers, incomplete facilities, inconvenience of services and inadequate incentives. Supports from hospitals for case managers were support of facilities and legality as case managers. Expectations of case managers include case manager training, rewarding, and career development opportunities.

Conclusion: The roles of case managers in implementing patient centered care in Bangli District Hospital are not optimal. Efforts to address issues in the interpersonal, clinical and structural dimensions need to be carried out by the hospital management to enhance the role of case managers in the implementation of patient centered care.