Diskusi bulanan yang keempat dilaksanakan pada Kamis (22/5/2014) dan diawali dengan review dari diskusi sebelumnya. Pada Januari atau diskusi bulanan pertama, telah dibahas manfaat Knowledge Management (KM) untuk lingkungan di luar organiasi yang mengadakan KM (policy making). Hasil riset ini bisa digunakan untuk pembuatan kebijakan di lokal, pusat, dan unit-unit. Hal ini biasanya digunakan oleh para praktisi, ketika penelitian tersebut ada hasilnya maka digunakan organisasi profesi dan akan digunakan untuk mempengaruhi pembuat keputusan. Diskusi kedua membahas tentang mencegah kehilangan pengetahuan, meningkatkan daya saing, reorganisasi, dan lain-lain.

Bulan ketiga, diskusi bulanan membahas tentang produksi dan difusi pengetahuan yaitu penelitian lalu publikasi penelitian diikuti telaah sistematik dan telaah TS lalu baru EBDM. Kali ini, atau minggu keempat mengambil tema produksi dan diseminasi pengetahuan. Pengambilan keputusan berdasarkan bukti dilakukan melalui beberapa tahap, yaitu literature review, systematic review (ada sistem untuk menjaring masalah-critical appraisal-sintesa-disimpulkan), state wide survey (survey seluruh negara bagian) dan key information review.

Diskusi kali ini akan banyak membahas tentang diseminasi. Diseminasi yang dimaksud sifatnya lebih aktif. Sementara, difusi bersifat secara pasif menyediakan pengetahuan dan siapa saja dipersilakan menggunakan hasil penelitian. Manfaat diseminasi antara lain: meningkatkan kemampuan menemukan, membangkitkan budaya EBDM dalam organisasi-organisasi Pemda (berbasis bukti), dan lain-lain.

Jika melihat kasus Indonesia, hal yang harus disadari ialah penyakit tidak bisa hilang, dan penyakit tidak berhubungan langsung dengan kemiskinan. Melalui penyakit terabaikan (neglected) program lintas sektoral dan lintas program dapat mulai dilakukan. Mengapa yang terabaikan? Pertama, karena tidak diperhatikan oleh yang berwenang, misalnya cacingan, lepra, trachoma (daftar ini bukan penyakit prioritas). Penyakit terabaikan berkembang di lingkungan yang buruk atau perumahan kumuh. Alasan kedua, pencegahan primordial dan primernya sama. Kegiatan yang terintegrasi seperti apa? Harapannya, kegiatan yang terintegrasi lebih terbatas atau terarah. Hal yang dilakukan ialah systematic review, proyek-proyek menganggap laporannya rahasia. Ada survey yang melibatkan Pemda untuk melihat kebutuhan setempat. Sektoral Dinkes Yogya dan PMPK pernah memiliki ruang pembuatan keputusan untuk fasilitasi hasil surveilans. Namun hal tersebut kurang dimanfaatkan dengan baik.

DISKUSI

Deni Harbianto menyampaikan menurut pengalaman kami sebagai konsultan, riset yang cukup bagus, namun ketika dibawa ke Kemkes ada semacam blocking dari mereka karena menganggap pemerintah memiliki data yang lebih bagus. Namun hal ini tanpa disebutkan surveilans yang valid atau tidak dan data the best-nya di-keep oleh stakeholder. Apa yang sebaiknya dilakukan?

Kemudian Rossi Sanusi memberikan pendapatnya, dampak riset lebih tampak di level lokal. Hal yang sering terjadi, pusat akan lebih resist pada penelitian semacam ini. Ke depannya, telaah sistematik akan lebih banyak dilihat. Jika hasil penelitian sudah dijaring, maka tidak ada alasan untuk menolak. Misalnya dilakukan penapisan yang meliputi: laporan 10 tahun terakhir, negara berkembang dan ditulis dalam bahasa Inggris. Laporan kemudian di-critical appraisal, disintesa dan ditarik kesimpulannya. Bukti penelitiannya lemah/kuat akan dipengaruhi organisasi yang besar misal Mac Master. Ada satu cara untuk melacak hal ini, yaitu masuk ke situs Search Engine dan cari dengan kata kunci 'Systematic Review Website'. Ada semacam review, intervensi ini gamblang/tidak, atau apa yang sebaiknya dilakukan. Jika mengusulkan intervensi, apa bukti sebelumnya? Jadi tidak mulai dari 0 dan ada perlindungan legal. Sayangnya, budaya kita mengingat, bukan membaca. Hal ini terkait dengan kemampuan menerima pendapat orang lain. Maka, harus belajar toleransi yaitu budaya berbeda pendapat sejak kecil.

dr. Sutjipto menyampaikan pertanyaannya yaitu kemampuan Dinkes untuk melakukan interpretasi dan menggunakan data lemah, apa yang bisa disarankan akademisi atau Pusat Studi? Lalu, bagaimana untuk meningkatkan kemmapuan advokasi dan negosiasinya. Menganalisa hasil surveilans-mulai dai pengumpulan data baik surveilans kasus maupun surveilans sindromik. Bagaimana melibatkan orang setempat. Menganalisa dan membuat keputusan. Perlu membuat intervensi apa? Misal bakteria bachi uji coba di Sleman, lalu ada pengurus RT/RW yang ragu. Maka, seharusnya diisodorkan bukti jika hal tersebut aman/tidak di dunia? Dewan riset yang sudah ada seharusnya menyediakan info dengan mengumpulkan dan mengolah.

Digna Purwaningrum menyampaikan pengalamannya yaitu ia pernah terlibat dalam penyusunan keputusan berbasis bukti hasil penelitian di Jogja. Dari segi pengambil kebijakan, sangat membutuhkan hal tersebut. Apakah PT bisa memberikan bentuk data yang lebih mudah, tidak banyak yang bisa mengartikan data. Usulan dari Pemda: ada website khusus tentang hal ini, ada update tentang data yang diolah dari Pusat Studi/kajian dan aparat pemda. Tanggapan dari dr. Rossi Sanusi, evaluator harus dilibatkan dari awal menyusun proyek. Saran untuk PKMK yaitu struktur mengikuti fungsi, yaitu menghasilkan penelitian dan diolah (hasil penelitian Indonesia dan dunia).

Group V
Communicable Desease

14 May 2014

In The 8th Postgraduate Forum on Health Systems and Policy held at UGM, Rahmat Bahtiar on the second day revealed that the rate of detection of TB cases in the province of East Kalimantan is below the national target . On the other hand , in line with WHO in order to create a strategy that emphasizes strategies for develop case finding in patients with TB, in 2008 the provincial health authority has also made several interventions.

According to focus on the problems found, intervention efforts that have been made by the medical center did not show an increase in case detection. This is because the implementation of case finding is not consistent due to constrained by the resources ( budget ), lack of monitoring and evaluation in the implementation and the lack of feedback from the district health authorities. 

Unlike the previous speaker, Wienta Diarsvitri last speaker in the session as well Communicable Disease ( DC ) chose the theme of the risk of HIV among key populations. Research conducted at the Hospital Dr Ramlan Surabaya and Sidoarjo District Government Hospital as many as 70 HIV treatment. In males accounted for 51.4 %, the remaining women with a mean age of 34.4 years of age respondents Lowest 19 years.

Viewed from the perspective of education, Housewives have higher education while on Women Sex Workers ( FSW ) with a basic education. Yet both are only of 45.8 % that has the knowledge and aware of the risks of HIV infection in general. This fact is compounded by not wearing a condom during intercourse with a partner either permanent or casual. According to him , the people and the government should be more concerned about the risk group . Realizing all of this of course is very important to strengthen HIV prevention programs, especially at -risk groups need to increase education and counseling governing law.

Group II
ASEAN Homework For Welcomed the ASEAN Economic Community 2015

14 May 2014

PKMK-Yogyakarta. Oral presentations have taken place in the Main Conference of the Faculty of Yogyakarta, with the theme of non-communicable disease. This presentation as a continuation of the second day of the 8th Postgraduate Forum on Health Systems and Policy was moderated by dr. Fatwa Tetra Sari Dewi, MPH., Ph.D. Forum held with featuring five presentan are from Indonesia, Malaysia and Thailand.

Forum initiated by the presentation of this white elephant country with the title Prevalence of Diabetes Mellitus in HIV-Infected Thai patient. The results of the study Rungruangrong Seubmongkolchai, RN, M.Sc revealed an association with the use of antiretroviral drugs prevalence of Diabetes Mellitus (DM) in Thailand. A total of 205 809 AIDS patients in Thailand were infected during the 4:11 ± 2.72 years was diagnosed with DM 25.645 people.

The second presentation raised the issue of the rapid industry in Malaysia which have an impact on respiratory disorders , with the title of Relationship between Ambient Air Pollution in an Industrial Area and Respiratory Symptoms among School children in Malacca , Malaysia . Mohammad Adam Adman identify an association between air pollution and FeNO concentrations in middle school children . Researchers compared the concentration of the air in the school with a radius of 3 km from Malacca to control school in Putrajaya. FeNO is used to identify the presence of respiratory tract infections .

The third presentation by Supriyati ( Indonesia ) titled Multilevel Analysis of Social Determinants of Smoking Behavior in Indonesia . The data showed no significant relationship between social demographics such as sex, age, place of residence, education level, occupation, socioeconomic status and smoking behavior. Recommendations of this study suggest local governments issuing local regulations related to tobacco control.

Oral presentation sessions followed by Komang Yuni Rahyani of the island, with the title and Premarital Sexual Initiation among Adolescent Contraception Services Policy in Bali. Komang discloses the use of contraception among men is higher than women. Half of the sample of 121 women answered the initiation of premarital sex being forced, threatened, and raped by a spouse or boyfriend. This presentation attracted the attention of the audience to ask, that this study used birth control pills for women before intercourse and condom for men.

Presentations last closed S3 students from Malaysia, with the title of Factors Associated with Fall Injury at Home among Children Under 5 Years Old in Yemen. Al - Abed Ali Ahmed reveals about the culture of consuming khat leaves incidence risk children under five years fell. Cultural consuming khat leaves a problem in caring for children, it is certainly because there is no supervision from parents or caregivers .

From various research results from the three countries showed that policies can be set and evaluate existing policies and new policies made to welcome the migration of physicians in 2015.

The last session was closed with five participants shared photos oral presentation with dr. Fatwa Tetra Sari Dewi, MPH., Ph.D.

Oleh: Eva Tirtabayu Hasri S.Kep., MPH

Group I: Human Resources Classroom

14 May 2014

Yogyakarta - PKMK . This session begins with a brief summary of the first day of the meeting from Prof. Laksono Trisnantoro , M.Sc. , P.hD. This session reminded the participants that there are different challenges in medical care and medical curriculum that needs to be developed in the two types of communities ( rural and urban ) ASEAN. At the end of the opening session, the class is very lively with some discussion and exposure of the audience about the picture of the migration of doctors in Japan.

Oral presentation session with the theme of Human Resources presented the six papers of four papers from Thailand, Malaysia and Indonesia each one paper. The following is his review:

Session 1 : The availability of health care professionals in Indonesia, its migration and the right to health

Presenter: Ahmad Fuady , Department of Community Medicine , Medical Faculty of Indonesia University

This session is unique to the digging of the right to health. Background of this study flicked that the right to health is not only limited to the right to be healthy. Further disclosed is no government obligation to fulfill the availability of health personnel to fulfill the right to health. In the other hand, migration is also seen enough help to fulfill the right to health. This study uses a method sytematic literature review of the 1998-2013 year, both locally and internationally . This study adopts the assessment guidelines of Hunt (2006 ) .

The study found the existence of inequality of health professionals, especially in rural areas. The main problem is the emptiness of primary care physicians as the leading services. The existence of health insurance as if it is less useful because this inequality. Looking to the upstrea, there are production problems doctors , especially in some pockets of the city physician. Inequality causes the migration of patients, so that migration is done with the promise of many professional incentive large enough to compensate for these conditions. The study concludes migration does not always improve the achievement of the right to the highest attainable standard of health.

Session 2 : Incentives to retain Physicians in public settings: the case of Phitsanulok province , Thailand

By : Pudtan Phanthunane, Naresuan University

This session identifies the type of incentive for physicians to maintain your health in general. Utilization of outpatient services and inpatient continues to increase, however, is not matched by the number of doctors who are willing to provide services in government hospitals into the background of the main points of this study. study design was cross-sectional. Respondents were physicians from teaching hospitals, private hospitals, community hospitals ( in Indonesian hospitals similar type D / C) and general hospitals .

Interesting finding of this study is the incentives become important factors that affect the decision. Incentive factor is also very important for male respondents. The study found there is a considerable gap between the incentives of private doctors and doctors of civil servants. the opportunity for career enhancement becomes important at teaching hospital. The creation of a good atmosphere between colleagues the safety of life and social recognition is also a non - financial reasons to retain doctors in government service. Unfortunately, a civil servant not a major factor . The study concludes incentives play an important role in maintaining the doctor, but the hospital has a limited budget can get around by creating a good social conditions among co-workers.

Session 3 : Demand for specialists in community hospitals : From finding to policy change

By : Pudtan Phanthunane , Supasit Panarunothai , Naresuan University

This study is motivated by the lack of in-depth exploration of the needs of specialist physicians include surgeons, pediatricians, obstetricians and gynecologists ( OG ) , and internists. This condition becomes unbalanced look at the demand of medical services continues to increase. Demand a specialist in community hospitals (community hospital ) is calculated based on the demand of health care providers (based disease classification refers to the DRG) and the time required of the working process and working hours. The analysis will result in the total hours required specialist who then added hours worked per person per year. These results will be referred to their specialist needs smasing.

Surprising findings of this study, the calculation of demand specialists with this method showed a great need for specialists to be filled. Thailand is still experiencing a shortage of surgeons in 1761 , 1170 and 640 pediatrician. This study captures one of the problems of lack of specialists graduate each year. The study concludes that the solution while providing effective recommendations to address the high demand for specialists is to produce a family physician who is able to provide comprehensive medical care in a community hospital .

Session 4 : The Current demand of Community nurse in hospitals in Thailand

By : Jiraluck Nontarak , Pudtan Phanthunane , Supasit Panarunothai

The issue of an increase in chronic diseases, the composition of the population movement towards the elderly population and the implementation of UHC gives additional workload, especially the nurses in Thailand. The condition is the reason behind this study to identify the demand for nurses at a community hospital. Requests need health nurse adopt demand method by Segal and combine with the calculation of the percentage of unmet need of the Department of Public Health and welfare Health survey in 2010, as well as the workload index are excluded from Thailand Nursing and Midwives Council.

This study describes the findings for active nurses need supply 36 271 nurses Supply of nurses will be different depending on the percentage of direct care nurses. The higher proposrsi full-time care, the demand decreases, an opposite correlation. The study concluded there was no change despite new nurse graduates continues to increase.

Session 5 : Labor Price Index for Physician in Thailand

By : Phatthanawilai Inmai , Pudtan Phanthunane , Supasit Panarunothai

Unlike other developed countries, such as America, Australia, New Zealand and Canada, Labour Price Index ( LPI ) has not been implemented in Thailand. There are no indicators that can monitor labor costs in the health sector in Thailand today. The reason is what lies behind this research . These studies aim at doctors in private and public sectors. Constructing LPI, the first estimate of aggregate weighted with sources from the Council of the National Economic and Social Development . Weight ratio of physicians per total wages wages in the public and private sectors and classification of hospitals into consideration in this calculation. Second , do the computation of LPI using Laspeyres per hour .

The findings of this study account for nearly 4-7 % increase in compensation. Weight difference between the public and private sectors can also be explained, there is a big weight difference. Weights reflecting the share of labor costs and the relative importance of physician ownership in the sector. This study presented a tendency LPI stagnant existence in the public sector and an increase in the private sector began in 2011-2013. Thus, policy makers can use LPI to estimate labor costs for the healthcare market in the next year. LPI for other health professionals need to be considered.

Session 6 : Evaluating local effects of Emigration of medical professions in South Asia

By : Syed Emdadul Haque , Jose Siri , Atsuro Tsutsumi , Anthony Capon , United Nations University - International Institute for Global Health ( UNU - IIGH ) , Malaysia

Inequality is the condition of being in the spotlight . Inequality in health personnel is directly proportional to the chances of migration , " Brain Drain " or " Brand Gain ". Like a double-edged sword, migration can be a positive and negative impact locally . Conditions that lies behind this study. Using the methods of literature review, this study aimed to characterize trends in the migration of health workers in Asia sSlatan and contribute what is given in the development of the health system.

This study highlights three main points to explain the impact of migration in South Asia, including labor and financial losses, skill and remmitance. Migration of medical personnel created a crisis of skilled medical personnel in South Asia. The impact is seen in financial losses and have to face the health vulnerability of these conditions. On the other hand, migration is able to improve the skills of medical professionals and bring remmitance big enough for the state medical suppliers. Thus, decision makers need to better understand the costs and benefits of such emigration and their relative magnitudes.

Free Paper Oral Presentation Session II
Group III : Universal Health Coverage

14 May 2014

Once established this practice in 2014 , Indonesia continues to undergo assessment and improvement efforts of Universal Health Coverage ( UHC ) , especially health policy researchers . Post Graduate Forum ( PGF ) and systems related to health policy - 8 in 2014, UHC is also raised as a topic in an oral paper presentation sessions . Presenters came from Thailand and Malaysia to deliver his paper on this occasion . Presenter Thailand delivered three papers with research sites in the country of Thailand . While the presenter Malaysia delivered two research papers which are located in the country of Malaysia and Indonesia .

Three papers from Thailand using the Hospital as a research location . It is relevant to state that Thailand has implemented UHC advance . So the assessment has reached the stage of realization in the field . Aungsumalee Pholpark and colleagues as the first presenter of this session related research convey the level of satisfaction of users of various health insurance schemes in Thailand . The findings show the user group Universal Coverage Scheme ( UCS ) increasingly lower levels of education and the elderly tend to have higher levels of satisfaction . This group has the character helpless , less able to express their opinions , and have no expectations or demands more . Although the results of this study are not much different from other studies , but the fact of the vulnerable groups identified but difficult to be an interesting thing to note .

Weena Promporaset and colleagues delivered a paper titled Accessibility and Utilization in Registration of Geographical Variable Universal Coverage Scheme at Referral Hospital , Bangkok . Researchers examined whether the accessibility and utilization patterns associated with health outcomes (outcomes ) in patients with diabetes who have a different geographic registration of the system of universal coverage . The next presenter , Arnat Wannasari deliver his paper , Hospitalization Rates for Ambulatory Care Sensitive Conditions : Measuring the Accessibility and Quality of Primary Care under the Universal Coverage Scheme , Thailand . The findings show the rates of hospitalization for acute conditions the highest category compared with other ACSC .

Azimatun Aizuddin Noor and colleagues to share experiences in the field in eliciting Willingness to Pay ( WTP ) in the related field. The majority of respondents are willing to pay a contribution to the national health financing scheme . However , the majority of respondents are not willing to pay more for subsidized health services . Last presenter , Ade Suzana Eka Putri and colleagues , through his paper entitled Social Health Insurance for Universal Health Coverage in City of Padang , Indonesia : Protection Against Catastrophic Health Expenditure show of some kind of health insurance in Indonesia Out of Pocket ( OOP ) is still JAMKESMAS high and Jamkesda . One is the limited budget penyebnya ( Local Government ) can not include the number of users of the collateral . Variety of Indonesian health insurance in 2012 attracted the participants , one of which is the implications of this research results on the measures taken by the Government of Indonesia . Hopefully that health policy-related research has considerable implications for the government into consideration in policy and programs launched in the health sector . Universal Health Coverage ( UHC ), which is currently under way in Indonesia should also continue to consider the results of studies of health insurance policies in the previous era . So that the problem does not recur earlier and be perfected in the era of the UHC .

Group IV
Unlimited Health Economics In One Sector

14 May 2014

Health economics has now become one of the important topics being discussed publicly , for initiating this Gadjah Mada University ( UGM ) in collaboration with the World Health Organization ( WHO ) moved to hold discussions on the show titled The 8th Postgraduate Forum on Health Systems and Policy ( Medical Doctors Migration and Health System Development in South East Asia : Implication for Medical Doctor and Specialists Education ) . In the second session held on Wednesday, May 14, 2014 this became the talk of health economics major by presenting five presentan from various countries as well as material that is not only limited to one sector only. In addition , this session was also attended by academics from various institutions and Professor Dato ' Dr . Syed Mohamed Aljunid as a health economist and chairman of the International Centre for casemix and Clinical Coding is the role of moderator .

Three presentan which is part of the Health Insurance System Research Office ( HISRO ) Thailand alternately submit material that is also the research they are doing , all three describe the state of health of the economy in their country . Utoomporn presentan Wongsin who became Thailand's first discuss the estimated unit cost per day of long-term care for the elderly . With the same demographic background , Noble Tharachompoo as presentan similar material that exposes both the projected long-term care spending for the elderly . Unlike the others , Passakorn Suanrueang as third presentan from Thailand is focusing his research on measures promoting the use of drugs with high costs in hospitals associated with the medical benefits of civil servants .

" Noise causes hearing loss is a problem that is reportedly the highest in the industry and become a major economic burden , " said Tahir Noraita who is the speaker of the United Nations University - International Institute for Global Health ( UNU - IIGH ) Malaysia . Point of view of the major health problems that occur in the work area becomes more attractive when he was associating with economic aspects . Promotion and prevention is the most appropriate way for the case relating to the occupational health .

In this event the international level , Haerawati Idris from Indonesia is also not to be outdone in expressing the results of research on the demand for evidence in Indonesian traditional medicine practice . Results of research conducted on 1,794 personal with over 40 years of age criteria is proving that the income and expenditure , education , activities of daily living , chronic disease , and age affect the demand for traditional medicine is now rife in Indonesia such as acupuncture , herbal medicine , to treatment based religion . Not only in Indonesia , both industrialized countries and developing countries , traditional medicine has now become an alternative solution for the community : 70 % Canadian , 40 % Chinese , 80 % African , 49 % French and 42 % American with a variety of treatment methods . When associated with the problems highlighted throughout presentan in this session , it is evident that economic health is not limited to certain sectors and activities is also expected to be a ' scolding ' for other institutions as well as the starting point for the public interest in sectors of the economy to health care .

Reporter: Triana Primadewi

Prof . Laksono Trisnantoro wishes for Post Graduate Forum last seven years can be distributed through the website or is submitted to the BMC . Then in the future , the website will be developed that will accommodate documentation of activities per year Post Graduate Forum .

Post Graduate Forum Ninth (2015 ) will be held in Kuala Lumpur with the theme of health financing reform in ASEAN : Impact and Lessons Learned : DRG , capitation , Fee for Service and Global Budget . The collaboration of three existing state will be expanded to Vietnam , Laos , Cambodia , the Philippines , China and India .

Poster winner , DRG System is Siti Zawiyah Awirah of University Kebangsaan Malaysia ( UKM ) Medical Center . The poster with the theme of Communicable Disease Quality won by Wienta Diasvitri ( Surabaya / Indonesia) . Winners poster with Ladafa Zengga temaUHC is titled Community-Based Insurance South Thailand . Then , a poster with the theme of Health Economics ( Effectivemess Cost Analysis) won by Rasidah Abdul Rashid . Last poster with the theme of the General Health Policy Kaneth won by Soumtanouk.

Conclusion Meeting Day 1.

14 May 2014

Note by: Prof. Laksono Trisnantoro

Meeting Day 1 of the Physician Migration in conjunction with the Health System in South East Asia as well as the implications on curriculum concludes :

1. Southeast Asian countries has two poles of different communities, namely : (1) in remote areas or difficult; and (2) in an area that has direct access to the international health system. The second area has a health care system that is largely determined by the laws of the market, and have service levels such as five-star hotels or jasmine.
2. Demographics and disease patterns in Southeast Asian communities closer to equality, there are convergence.
3. Based on the data in the speaker presentations and needs, physicians who perform the migration is the dynamic moving specialists , especially in areas that have international access and there are a lot of people can afford. Remote areas usually for international migration of doctors in primary care level, which is supported by international funding agencies or foreign governments who want to serve. Activity in this area is not based on the principle of market mechanism.
4. Situation is mainly an impact on resident education ( PPDS1 , specialists ) and fellow ( PPDS2 , sub - specialists). International atmosphere must go into resident education, although in medical education (undergraduate) should also be given international development. But in Indonesia, the need for doctors in remote areas must also be met.

In overall: Educational physician , resident , and fellow users in Indonesia is facing two different extremes : ( 1 ) the needs of international medical services including medical tourism ; and ( 2 ) the need for medical services in remote areas . How strategies to improve the quality and capabilities of graduates ? This is a challenge that has a faculty of medicine (FK-FK) accreditation (which is authorized to conduct residency education).