| 4. In which ways is the initiative creative and innovative?
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The elements of the action plan that has been developed are as follows:
1. General Emergency Life Support (GELS) training for doctors, Basic Trauma Cardiac Life Support (BTCLS) for nurses and midwifes, and Medical First Responder (MFR) for the general public. This training will result in increasing the capacity of officers in handling emergency cases and provide knowledge to the general public regarding the initial treatment for traffic accident cases;
2. Formulating Minimum Service Standards (SPM), Standard Operating Procedures (SOP), and Public Service Standards (SPP) which aims to provide a certainty of time to the community based on the zone specified referring to the response time that has been established;
3. Equipping ambulances with basic and advanced emergency kit;
4. Preparing sufficient operational costs through the Regional Government Budget (APBD). To ensure sufficient financial support for BSB operations;
5. Setting job descriptions, schedule for each officer.
6. Provide peace of work for officers by offering monthly incentives.
The key steps that must be agreed upon are the commitment and integrity of the stakeholders providing health service. The service conducted by BSB is based on the vision namely to Achieve a Healthy, Independent, Good Quality Bantaeng in 2015. This vision is carried out through the mission namely:
1. Equalization and improvement of the quality of service by the Disaster Response Brigade
2. Improving the quality, facilities and infrastructure of the Disaster Response Brigade.
3. Improving the health information system.
4. Equalization and expansion of the range.
In order to increase the service accountability for women and for ease in obtaining information on government programs, an information dissemination session is conducted for the public regarding the BSB program and how to contact the BSB via Call Center 113. Likewise, to ensure the continuity of services an information and communication network between the Puskesmas and its network are established with the BSB, hence a sustainable service system can be established.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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This initiative will involve three Regional Government Agencies (SKPD) namely the Department of Health, Department of Social Services, and Regional Environmental Impact Management Agency (Bapedalda) as a joint Emergency Response Unit. . In addition, this initiative involves several socio-religious organizations, youth organizations, community leaders, religious leaders and others.
The achievement of the millennium development goals (MDGs) is inseparable from the role of civil society organizations, the private sector and others. Religious organizations and youth organizations play a role in providing counseling about the importance of nutrition for pregnant women, labor and delivery process with health professionals, healthy life style and acts as a facilitator between the pregnant women and health-care facilities.
In addition to the involvement of the parties above, the operation of BSB facilities also involve several parties, namely:
1. The Japanese Government granted operational vehicles i.e. 6 ambulances equipped with fully equipped emergency care facilities. Therefore, the BSB vehicle resembles a mini Intensive Care Unit (ICU).
2. PT ASKES (Persero) granted an operational vehicle i.e. fully equipped ambulance.
3. The Public Service Center (PSC) for the Eastern region of Indonesia through cooperation to improve human resources, particularly in the emergency sector.
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| 6. How was the strategy implemented and what resources were mobilized?
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The Regional Government in collaboration with Health Organisations, the Indonesian Doctors Association (IDI), Indonesian National Nurses Association (PPNI), and others in the mobilization of medical personnel. Operational costs required for delivering emergency services derive from Bantaeng Regency APBD II. APBD II funds the continuity of services such as vehicle operations (fuel, vehicle maintenance cost), food and drinks for the BSB duty officers, monthly incentives for BSB officers.
In addition to the Banteng Regency APBD II, the BSB funding is also supported by the APBN through the National Health Insurance Program (Jamkesmas), Regional Health Insurance Program (Jamkesda) and Social Access. Health insurance is a health care payment assistance program provided by the Bantaeng Regional Government to the community. With the agreement has been established between Puskesmas under the Department of Health and BSB, that after providing health services for a patient whose health care is guaranteed by health insurance, the BSB has the right to claim payment for the services provided by the BSB Team for patients with health insurance. The proceeds of this claim is medical services reserved for all health care providers in the BSB, ranging from doctors, nurses and non-nurses.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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Within 4 years since the Disaster Response Brigade (BSB) was formed, 2008-2012, the BSB has successfully improved the health services for the community particularly women as the most vulnerable group. Several health indicators in Bantaeng Regency display significant improvement:
1. Maternal Mortality Ratio
Since 2008, the Maternal Mortality Ratio (AKI) in Bantaeng Regency is as follows: there are 17 maternal deaths of which 12 cases (70.59%) were caused by four delay factors, i.e. late discovery, late diagnosis, late treatment and late referral. Through BSB operations in providing services for the referral for pregnant and maternal women, the delay factors have successfully been anticipated, therefore at the end of 2012, the number of maternal mortality cases has been reduced to zero.
2. Infant Mortality Rate
Based on data from the health survey held in 2008, the infant mortality rate (AKB) in Bantaeng Regency occurred in 38 cases, the presence of the Disaster Response Brigade (BSB) with its trained and skilled personnel managed to reduce infant mortality to 11 cases in 2012.
3. Number of Malnutrition Cases
The health condition in Bantaeng Regency in 2008 is still relatively low. This is reflected by the existence of malnutrition cases. Based on the health survey of that particular year, there were 16 malnutrition cases. The BSB collaborated with a number of parties associated with the issue, primarily through consultation and information dissemination sessions. As a result Bantaeng Regency had eradicated malnutrition cases in 2011.
4. The Incidence of Environmentally Based Diseases Decreases
Based on the health survey in 2008, 2.7% of the total population Bantaeng Regency i.e. 172,849 people experienced diarrhea; and 0.09% of the total population or 256 cases experienced dengue hemorrhagic fever. The figure above obliviously becomes a problem in the health sector particularly in the effort to eradicate infectious diseases. Through promotion and preventive activities that synergize with the Public Health Center (Puskemas), community leaders, religious leaders, and other public components, in 2012, the incidence of environmentally based diseases can be reduce. IN 2012, diarrhea cases affected 1.7% of the total population and Dengue Hemorrhagic Fever of only 0.003% of the total population or 6 cases.
5. Increased Life Expectancy.
In 2008, the life expectancy in Bantaeng Regency was 67.9 years. After the BSB commenced its operations, the health problems in Bantaeng Regency decreased each day. This condition obviously provided security and comfort for the community, particularly in terms of the availability of good quality health services in Bantaeng Regency. This plays an important role in increasing life expectancy in Bantaeng Regency to 72.5 years in 2012.
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| 8. What were the most successful outputs and why was the initiative effective?
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The system used to evaluate this activity, are as follows:
1. For mother and child activities through the Local Maternal and Child Health Monitoring (PWS-KIA), Local Nutrition Monitoring (PWS Gizi) which is performed every month in the Department of Health by inviting pediatricians and obstetricians from the Prof. H.M. Anwar Makkatutu Regional Public Hospital;
2. Perform monthly monitoring and evaluation of the Disaster Response Brigade (BSB);
3. Conduct monthly Regency level coordination meeting to discuss the program in the Puskemas, in synergy with the Disaster Response Brigade activities; and
4. Hold annual Regional Health Meeting (RAKERKESDA).
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| 9. What were the main obstacles encountered and how were they overcome?
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The BSB health services implementation, includes some geographically challenging/difficult to reach areas, such as mountains, valley, and others. For topographically flat urban areas, geographical problems are not an impediment factor. However, the prolonged decision making process often causes a delay in the delivery of services. To overcome this problem, we will implement the following strategies:
1. For home visits, we equip the BSB team with 1 doctor, 2 nurses and 1 driver, so they can provide answers to all the questions from the community about the state of the patient and this will foster public confidence to immediately make a right and quick decision.
2. In overcoming this problem, we work closely with the civil society and religious organizations. The organization serves as a motivator to invite people to use the health facilities and participate and provide input in the decision making process.
3. Provide certainty of cost, time, and healthcare personnel.
In areas with mountainous topography which requires a response time of more than 20 minutes, the government will build new quarters for the BSB in Uluere Sub-district located in Loka Mountain. Therefore, decreasing the response time for the surrounding three sub-districts to less than 15 minutes. In 2014, new quarters for the BSB will be built in Tompobulu which has a response time of over 20 minutes, hence the response time for the 3 surrounding sub-districts will hopefully be shorter.
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