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Mobile Hospital for Specialistic Health Care of Lampung Province in Indonesia
Health Office of Lampung Province

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The total area of Lampung Province are 35,288.35 km ². It is one of the provinces in Indonesia which has difficult geographical conditions that often get disaster whether caused by natural, non-natural and human factors. Besides Lampung Province has so many ethnic that often cause ethnic conflict. It can cause fatalities, environmental damage, loss of property and psychological impact so it hinder national development. To prevent and anticipate such condition, we should develop preparedness and disaster management. In 2011, the Lampung province has develop new aoutonomy district (Pesisir Barat, Mesuji dan Tulang Bawang Barat). Those district are located in the area prone to disaster and prone to conflict. Beside those district also doesn’t have good infrastructure especially health facility such as hospital. The referral data from new autonomy region to the general hospital in the nearest district or to the provincial hospital show that the number of referral in 2010, 2011 and 2012 as follow 1,525 visits, 1,995 visits, and 2,646 visits respectively. Difficult geographic condition and wide area render them to get specialistic care on time during referral. In case their citizen need specialistic health service, they should go to hospital in the nearby district or in the capital of Lampung province. It create more problem for the poor people who can’t afford to pay for transportation to go to the hospital and when their family are admitted. The problem for the people in Pesisir Barat, Tulang Bawang Barat and Mesuji are the distance to the nearest hospital located 33,1 Km , 23 Km and 76,5 Km and to the provincial hospital 242,2 Km, 119 Km and 183 Km respectively. But during raining season, the main road to those area are often obstructed and heavily damage that cause time travel become longer. The number of population in Pesisir Barat, Tulang Bawang Barat and Mesuji are 163.321, 255,833 and 191.221 respectively. If many people in the new district hava to go to the nearest hospital in their neighbour district, those hospital will be overloaded so that the health worker can not provide health service according to the standard. Even if they can reach the nearest hospital, in certain case the patient who need operation, the patient should wait two or three months to get operated due to high demand for operation. Public demand on health service especially specialistic care will continue to increase due to the increase of population therefore there should be an innovation that can increase public access to the qualified health service especially for the poor who live in the remote area where the hospital is not available.

B. Strategic Approach

 2. What was the solution?
We should bring specialistic service near to the public through mobile hospital. The service provided by hospital should be effective, efficient, affordable and on regular time. This program should be supported by provincial and local government, health provider and all community.
 3. How did the initiative solve the problem and improve people’s lives?
Mobile hospital is a solution to increase public access to specialistic health service in the new autonomy region that doesn’t have hospital and area prone to disaster and conflict. It is also the main program of the Governor of Lampung to provide specialistic health services to the community. This program refers to Law 36 of 2009 on Health as outlined in the Governor Regulation on the Guidelines for Mobile Clinic No. 16 of 2013 which regulates about the human resources, finance and operations. This hospital is designed to be easily moveable so it can be moved to any places that need this mobile hospital anytime and anywhere. Therefore the service in this mobile hospital provided in five bus that can be used as consultation room, operating room, recovery room, radiology & laboratory and medical personnel transport. This bus also equipped with medical equipment including instrument to support operation, water disposal, plumbing, electrical installation, sterile air circulation. This hospital has recruited four basic specialist (paedetrician, gynecologist, physician, surgeons and other specialists), who work in the nearby hospital in certain district. Therefore Health Office of Lampung province develop MoU with certain hospital (Menggala General Hospital, Tulang Bawang, dr. A. Dadi Tjokrodipo Bandar Lampung, Liwa General hospital Lampung Barat and dr. H. Abdul Moeloek Lampung Province). While for the doctors and nurses, we cooperate with the local health center where the service are provided. All the cost for this program is funded by provincial budget. The purpose of this mobile hospital is to provide comprehensive health service to the community especially in four basic specialistic health service (pediatric, internal medicine, obstetrics, surgical) and other specialistic to the people of Lampung Province, especially the new autonomy regions that do not have hospitals, disaster-prone areas and in emergency conditions. In normal condition this mobile hospital is operated by cooperating with Inpatient Health Center and placed near Inpatient Health Center. However in disaster situation, this mobile hospital can be transferred any time near the area. In the implementation of mobile hospital, the health office of Lampung province will request district health office to coordinate with the health center to identify the patient who need specialistic care or referral. The main target in this program is the poor people and vulnerable group who can go to the nearest hospital due to certain condition. And then the district health office will coordinate with provincial health office to arrange the schedule for mobile hospital visit. This program make the people easy to access basic specialistic health service and for the people who are on the waiting list for operation , they should not wait longer that can render them to work or perform daily activity. For the poor people, the expense for health service can be minimized. It also increase the public health center officer knowledge and skill in handling certain cases that actually doesn’t need referral. Referral case to the nearest hospital and provincial hospital are also decreasing so there will not be patient overloaded in the hospital.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
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.
 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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.
 6. How was the strategy implemented and what resources were mobilized?
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.
 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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.
 8. What were the most successful outputs and why was the initiative effective?
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
 9. What were the main obstacles encountered and how were they overcome?
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.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The main benefits of this initiative is to facilitate public access to specialistic and referrals services in disaster prone areas and new autonomy regions that do not have a hospital. People can easily access the services because we bring the health facilities closer to the people. In the implementation of this mobile clinic is the most visible impacts of this program is high number of patient visit who really need specialistic service. During the three years of mobile hospital operation, the public perception about mobile hospital are very good. It is measured by the number of patient visit in the mobile hospital. 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). Even some district request for more specialistic service in the mobile hospital but due to limited budget the service still focus on four basic specialistic and nose, throat and ear specialist. Some district who have hospital also request operational of mobile hospital especially in the remote area so in 2017 the provincial health office allocate more budget for mobile hospital operational.
 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
This mobile hospital is one of form of efforts to improve the quality of public services in order to increase the integrity or accountability of public services. The process of mobile hospital and medical equipment procurement held by bureau of procurement and presented in the newspaper so all public can participate in the procurement. The schedule of mobile hospital visit was also informed to the public through health center so all the citizen who are qualified can participate in the program. The service given in the mobile hospital is free of charge to make sure that there is no fee given to the health personnel. All the health personnel involved in providing health service also receive incentive to prevent them to ask payment from the patient.
 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
To make sure that women and girl get benefit from this program, the mobile hospital provide obstetric & gynecology and paediatric health service. And to improve situation of the poorest and most vulnerable, this mobile hospital focus on providing service for the poor and most vulnerable people who can’t access hospital outside the district.

Contact Information

Institution Name:   Health Office of Lampung Province
Institution Type:   Local Government  
Contact Person:   Reihana Wijayanto
Title:   Head of Health Office of Lampung Province  
Telephone/ Fax:   +62721-264091 (Telp & Fax), +62721269375
Institution's / Project's Website:  
E-mail:   zulius1975@yahoo.co.id  
Address:   Jl. Dr. Susilo No 44 Pahoman
Postal Code:   35213
City:   Bandar Lampung
State/Province:   Lampung
Country:  

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