4. In which ways is the initiative creative and innovative?
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This initiative is creative and innovative because it bring the specialistic and referral service closer to the public. It is also moveable and can be transferred anywhere, anytime to the community who need the specialistic service especially in the remote area where there is no hospital or far from the hospital.
The procedure to get the service are easier compared to normal procedure and the service is also given free for the public. During the implementation, it involved all the health personnel in the health center so they can learn how to handle certain cases who actually doesn’t need referral. Beside they also learn how to handle patient who should be admitted after certain procedure by the guidance of specialist.
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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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Initiatives implemented by the Governor of Lampung through Provincial Health Office that are supported by the head of district, National Health Insurance Bureau (BPJS) Health and nearby Hospital. It also involve district health office and all health center in the district to identify the patient who need referral or specialistic service.
The number of population in Pesisir Barat, Tulang Bawang Barat and Mesuji are 163.321, 255.833 and 191.221 respectively. The poverty rate in those area 13.8 % where 15.24 % in the rural area and 10.15 % in urban area. It means this initiative will give benefit to 22.538, 35.304 and 26.388 poor people in the Pesisir Barat, Tulang Bawang Barat and Mesuji respectively.
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6. How was the strategy implemented and what resources were mobilized?
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To start this innovation, the health office purpose the procurement of bus and medical equipment to perform mobile hospital. It is started in 2012 and funded by provincial government. The government of Lampung province issue the Governor Regulation on Guidelines for Mobile Hospital on human resources, finance, operations and to provide license to operate hospital in all area in Lampung province. In March 22, 2013 the provincial government launched the Mobile Hospital. It is held Panaragan Jaya Health Center, Tulang Bawang Barat. In that occasion, the provincial health office signed Memorandum of Understanding (MoU) among the Provincial Health Office of Lampung with four hospitals namely provincial hospital of Abdul Muluk, Menggala general hospital, dr. A. Dadi Tjokrodipo general hospital, and Liwa general hospital to contribute and support the operational of mobile hospital. The the Memorandum of Understanding (MoU) are renewed yearly.
In the beginning, the mobile hospital only provide four basic specialistic health service but in 2015 it increase the specialistic service including screening cases of Ear Nose Throat (ENT), laboratory tests and examination of Radiology and Health Education. For the mobile hospital operational, the health office allocate budget annually though provincial budget. Total budget spent for bus and medical equipment are 8.8 billion rupiah and total cost for mobile hospital operational in one district are 143 billion rupiah. Usually the mobile hospital will operate four times yearly in several district. The provincial government anually allocate budget for mobile hospital operational as follow : In 2013 : Rp. 1.544.733.200; 2014 : Rp. 1.232.000.000, 2015: Rp. 1.819.619.000, 2016 : 936.226.200, 2017 : 4.439.984.000,-
Prior to the mobile hospital service, the health office of Lampung province will coordinate with district health office to arrange the schedule for mobile hospital visit. They will also coordinate with nearest district hospital and provincial hospital to support the service by providing health personnel during the mobile hospital service. District health office will instruct health center to identify the people who need referral for specialistic service.
Mobile hospital will be operated according to the schedule that was decided by the district health office. Usually it will operate near the in patient health center so the patient who has been operated will be admitted in the in patient health center. The mobile hospital will be operated for three day. In the first day, they will provide screening and medical consultation, and in the the second day they will perform minor and major surgery. In the last day all specialist will visit in patient who admitted in the health center and other personnel will complete all documentation.
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7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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Stakeholders involved in designing this program are the Governor of Lampung province, Regents Mesuji, Regent of the Pesisir Barat and the Regent of West Tulang Bawang) and the Chief of Provincial Health Office, District Health Office of Tulang Bawang Barat, District Health Office of the Pesisir Barat and the District Health Office of Mesuji and National Health Insurance Bureau.
To get budget allocation for procurement of bus, medical equipment and mobile hospital operational, the health office of Lampung province should coordinate with the house of representative, the provincial bureau of planning & development and provincial bureau of budgeting.
During the implementation of mobile hospital service, the health office of Lampung also collaborate with provincial hospital, district health office, nearby district hospital and health center in district.
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8. What were the most successful outputs and why was the initiative effective?
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The successful output of this initiative are :
1. The number of patient visits to get health service in mobile hospital in the last four years (in 2013: 1,591 patients, 2014: 1,135 patients, 2015: 817 and 2016 patients: 1,464 patients)
2. The number of patient visits to midwifery clinic in mobile hospital in the last four years (in 2013: 241 patients, 2014: 143 patients, 2015: 138 and 2016 patients: 221 patients)
3. The number of patient visits to pediatric clinic in mobile hospital in the last four years (in 2013: 180 patients, 2014: 115 patients, 2015: 115 and 2016 patients: 183 patients)
4. The number of patient visits for minor surgery, major surgery, ear nose throat clinic, (ENT) Surgery and Radiology in mobile hospital in the last 4 years since 2013–2016.
5. The number of patient visits to Internal Medicine clinic in mobile hospital in the last four years(2013: 215 patients, 2014: 246 patients, 2015: 239 and 2016 patients: 240 patients)
This initiative is effective because it reduce referral to the nearest hospital and provincial hospital to avoid patient overload in the nearest hospital
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9. What were the main obstacles encountered and how were they overcome?
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The main obstacle in operating mobile hospital is the limited number of human resources especially health specialist
To overcome this problems, health office of Lampung province develop MoU with some hospital so their personnel can be used during the operational of mobile hospital. The hospital that have MoU with the health office of Lampung province are Abdul Moeloek hospital (Provincial hospital), Menggala Hospital, dr. A. Dadi Tjokrodipo, Liwa hospital). For the nurses dan general practitioner can be recruited from health personnel work in the health office of Lampung province and health center in the district where the mobile hospital operated. To increase their participation in mobile hospital, the health office of Lampung province give incentive for all health personnel involved during mobile hospital health service.
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