| 4. In which ways is the initiative creative and innovative?
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The program is being very creative because it is able to answer people’ health problems in Makassar during this time. Home Care has penetrated many bulkheads that make people difficult to access health care previously. Creative ideas of Makassar City Government indirectly save the lives of its people who have been neglected. The program is also very innovative because it creates a new breakthrough in the world of health. Health cares which have been considered to only be obtained by visiting health care centers can be enjoyed with no need to get out of bed. Health care with the same facilities comes into homes and solve problems of health of its people.
One of our creative solution to support Home Care program are created Dottoto’ta’ car or our doctor’s car. The car is a City Car type and was modified so that it can move freely entering the alley in Makassar. Makassar City Government deliberately chose a small four-wheeled car because geographically, Makassar City has a lot of narrow alleyways. This is also what makes this program unique and it looks very friendly.
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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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Health Office of makassar as Leading Sector for being the main responsible of health care in the City of Makassar. Health Department provides funding, human resources and facilities. In essence, the health department becomes the determinant factor in the success of the Home Care program. To support this program we have technical support and human resources are obtained from 46 community health center that spread throughout Makassar City, which is in total 144 health practioner. Technically, health officers in Makassar are ready to face the challenges of this program.
Since January 2015, our data shown the numbers of treated patients are increased sharply from time to time. The number of treated people by Home Care Program in the beginning of its establishment on December 2014 is 0 (zero). While until the end of 2015 the number of treated people are 2.266 people, and on December 2016 increase as 4,685 people
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| 6. How was the strategy implemented and what resources were mobilized?
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Our key developments program which is part of main activities, related to Home Care Team (Doctor, Nurse, Physical Therapist, Speech pathologist) plan a schedule of patient care according to the type of treatment, type of disease, gradation of disease and the patients’ clinical condition based procedure of treatment. This type of treatment includes:
1. curative treatment,
2. supportive treatment,
3. rehabilitative treatment,
4. emergency treatment.
Futhermore, we apply the flow of monitoring and evaluation of Home Care patient such as:
- Home Care Team of community health centers is required to conduct monitoring and evaluation of the patient’s condition
- Monitoring and evaluation of patient is carried out according to the implementation plan of Home Care agreed by Home Care team and the patient
- Monitoring and evaluation of patient is documented in the patient’s follow-up sheet and other supporting documentation
- If the results of monitoring and evaluation of patient is considered to worsen, Home Care team refers the patient to hospital
- If the results of monitoring and evaluation of patient is considered to improved, the team will then continue Home Care service in accordance to the schedule
From financial capital we have budget available for Home Care in 2015 was USD$405.800 (IDR. 5.427.101.000,)-. Then in 2016 home care budget was USD$430.315 (IDR. 5.754.680.500,-), and in 2017 become USD$173.261 (IDR. 2.317.038.100,-)
The program is supported by 46 health centers, each health center has doctors, and medical personnel who have been trained.
As we all know, the success of a program have to be supported by good financial support. However, the Home Care program is not a program with high and special cost needs. This happens because the program can actually go hand in hand with other programs in the Health Department of Makassar City which activities are side by side with the Home Care program. Financing in the form of Home Care operational vehicles, for example, can be covered with the support of operational costs that are already available in each community health center that implements the program. Facilities in Home care vehicles can also be modified by taking some medical equipment which has not widely used in the community health center. In fact, on some Home Care vehicles, medical device is portable so that it can be assembled. For health workers, Department of Health also does not need additional work force. This is possible because the health workers in community health center are still adequate to have double duty as health workers in community health center and also mobile if there is a call.
Regarding project funding to support this program, in the Budget Implementation
Document (DPA) Department of Health Makassar since 2016 already allocated a budget in the amount of USD$430.315 (IDR 5.754.680.500,-) and in the year of 2017 the amount of USD$173.201 (IDR. 2.137.038.100) to ensure the sustainability of the program, including incentive for all health care workers as their transportation expense in total of USD$80 (IDR. 1.077.000,-) each person per month, so that they will be encouraged in carrying out this program.
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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 the Home Care program are:
1. Mayor of Makassar Mr. Moh. Ramdhan Pomanto that plays an important role in finding a formula so that the health unit can be closer to the people, hence the concept of Home Care was born
2. Head of Makassar City Health Department, dr.Hj.A. Naisyah T.Azikin, M.Kes, acts as Leading Sector for being the main responsible of health care in the City of Makassar. Health Department provides funding, human resources and facilities. In essence, the health department becomes the determinant factor in the success of the Home Care program.
3. Government and private hospitals also play an important role. They become a point of reference if there are health problems that overwhelm Home Care workers. Makassar City Health Department has worked with almost all the hospitals in Makassar to ensure that Home Care patients can be served quickly if referenced.
4. 14 districts and 46 “PUSKESMAS”:
5. Elements of society, such as;
• a cadre of community health centers,
• local Neighborhood
• Community Association,
6. Department of Information and Telecomunication by Call centre 112
7. The most important support is expected from the community itself. Therefore, socialization and guidance are also conducted by the Department of Health accompanying Home Care Program. It is expected that with socialization and intensive counseling can increase the awareness of Makassar residents on the importance of accessing health care and Home Care. Awareness of Makassar City people are also expected to play a major role in the awareness for the surrounding environment by quickly report to a health worker if there are people who experience health problems but remained in his house.
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| 8. What were the most successful outputs and why was the initiative effective?
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This Home Care Program has program outputs as follows
1. The fulfillment of health care reach the whole community quickly, including increase the independence of patients and families in maintaining their health care. As a result citizen can improve their knowledge of the health.
2. This program has a Lower financing budgeting, as an ilustration In the first year of its implementation in 2015, Home Care run by using funds that attached to other programs such as visit services to homes. At that time, this program was not included in the budgeted activities by Health Department of Makassar City in Budget (DPA) 2014. However, the program can still run and got positif responses from citizen. Although there is no exact budget, this program is continued up to one year. This is also to measure people’s responds for this program.
3. The numbers of treated patients are increased sharply from time to time. The number of treated people by Home Care Program in the beginning of its establishment on December 2014 is 0 (zero). While until the end of 2015 the number of treated people are 2.266 people, and on December 2016 increase as 4,685 people.
4. The number of health workers involved in this program increases followed by the number of requests a Home Care visit. From the beginning (2014) of the program Home Care until 2015, the number of health workers involved by 144 officers. Currently, 46 community health centers in Makassar City can be used to support the implementation of Home Care. At each community health center there is a Home Care fleet complete with medical equipment along with health care professionals,
5. To support the effectiveness of the program, Makassar City Government has made additional Home Care fleet called Dottoro'ta Car. Until now, the numbers of Home Care fleet are 48 vehicles and will be added after the evaluation activities in accordance to the needs of people in 2016.
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| 9. What were the main obstacles encountered and how were they overcome?
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In the health field, almost all of the problems faced are the priorities which resolve are cannot be delayed. If neglected, the problems in health field always create new problems which in the evaluation indicators always create some classic strategic issues. From the lacking of human resources, infrastructure, service accessibility to services management and public health protection. Some of the obstacle that this program facing are:
1. At the beginning of the program, officers felt their mistrust of society to Home Care services. This happens because the program is relatively new. Society has not believe the program's ability to overcome various health problems of their families.
2. The program is also initially constrained on the situation and the state of the environment as well as transportation access. Some of the service area are located in the narrow alleys.
3. Another obstacle is the lack of number qualified health personnel in implementing home care services. This obstacle is handled by regularly conduct special training for the implementation of Home Care.
4. In addition to the ability of the competence of health personnel, lack of health personnel constraints also become one of the obstacles. This obstacle is overcame by recruiting more new health personnel to be specially trained to serve as Home Care programs.
5. There are often calls of visit that is not necessarily important. There are people who actually had health problems which is minor or mild, and they can resolve themselves, but they are calling Home Care. This certainly will be a waste of time, effort and cost. This obstacle is overcame by conducting check and confirmation first before the armada departed. Re-check calling by contacting the phone number used by caller.
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