HOME CARE ( HEALTH SERVICES FOR 24 HOUR IN MAKASSAR CITY)
HEALTH OFFICE OF MAKASSAR CITY

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The program is conducted because there are certain members of the society who cannot receive their rightful health care service since the city is only provided by 46 health care centers for 1,398,804 residents. It is known that one health center can only serves around 30,409 citizens. Therefore, most of Makassar citizens cannot receive their rightful adequate health care service. People keep complaining about having difficulties in accessing health care service that is near them, giving fast response, and affordable, hence hold them to go to the Public Health Center (Puskesmas). The number of patients being treated in 46 Puskesmas has been increasing from 2014 (1,316,693 patients), 2015 (1,367,787 patients), to 2016 (1,243,437 patients). Based on such data, Home Care program is required to expand the public access to health care service, so that all the citizens will be well-served in their own houses. There are many health problems of people that are newly known after the mass media reporting in Makassar. It is due to lack of people awareness to report the condition, especially if there are other sickpeople who are sick. The difficulty is people are more convinced in alternative medicines that target many hallways which are not afforded by health unit in Makassar. In many cases, health workers know the health condition of a people when he/she is already in a critical stage. As a result, health workers are difficult to handle the patient. The handling becomes obstructed and the patient is difficult to cure immediately. The disease is severe and harder to treat when a health worker knew. The number of poor people who cannot afford to community health centers, although health unit care is given free, is due to they do not have the ability to obtain rapid transport to health care and the remote area of the patient

B. Strategic Approach

 2. What was the solution?
Segment of society that has not met the needs of health care services leads to the inception of innovative and creative home care, the approach of Home Care program is conducted by direct care which makes this program as the most effective health care service ever existed. Direct care includes biological, psychological, sociological, and spiritual with direct physical examination, observation, and direct interviews, to determine the health care issues and plan the proper direct care treatment to conduct. Hence, the health care service will be very detailed and completed, the Home Care program is a program which is intended to move the standard health care service from Public Health Service to each home is favorable by the citizens of Makassar.

 3. How did the initiative solve the problem and improve people’s lives?
The number of poor people who cannot afford to community health centers, although health unit care is given free, is due to they do not have the ability to obtain rapid transport to health care and the remote area of the patient. Poverty and health are the two things that are very related to each other. While poverty and health are not related, but the relationship between them can now be studied. In a society, the classification of rich, middle and poor people must be distinguished. The existence of such classification has also an impact on the aspect of life, including the aspect of health. For example, the quality of life of a rich family will be much better, including in matter of health. This is clearly contrary to low-income families, they are even difficult for meals . The initiative of Makassar local government to develop this program is based on the number of health care issues occur in Makassar. The Home Care program is intended to make the health care service in Makassar more perfect, holistic, and comprehensive. Hopefully, the needs of each patient will be fulfilled so that they will become more comfortable and satisfied with the current health care system. This program is also intended to synergize the various kinds of health care workers, including doctors, midwives, nurses, dietitians, pharmacists, sanitarians, and other professional workers. To solve the main problems of health access which is most of citizens cannot afford getting their rightful, adequate health care service in Puskesmas because it is difficult to access a health care service that gives them fast response and is within distance. Home Care service is the best option to bring the health care service to the house of the patient in need, by cutting the distance and expanding the service. Eventually, this program does not require the patient to pay for the health care service they need. Taking the far one closer and shortening the distance mean that patient who lives far away can be served quickly so that the patient will still get health care for the visit of health worker to the home. Our targets is because of the number of patients being treated in 46 Puskesmas has been increasing from 2014 (1,316,693 patients), 2015 (1,367,787 patients), to 2016 (1,243,437 patients). Based on such data, Home Care program is required to expand the public access to health care service, so that all the citizens will be well-served in their own houses. As a result the objectives of Home Care program including to fulfill the need of health care service for every aspect of the society in no time by increasing the independence of the patients and their families in getting health care service they can easily afford

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
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.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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
 6. How was the strategy implemented and what resources were mobilized?
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.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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.

 8. What were the most successful outputs and why was the initiative effective?
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.

 9. What were the main obstacles encountered and how were they overcome?
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.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
It is obvious that huge impact derived from the existence of the Home Care program in Makassar. There are so many significant change when compared to the prior existence of the program. Some of these effects can be explained as follows: 1. For patients and families: a. Home Care Program can help offset the cost of hospitalization which is more costly. This happens because the program can reduce the cost of patient accommodation, transport and consumption of the family. b. Patients also always be close to all the family members, so psychologically could help healing. c. By being treated in their own homes, of course, the patient becomes more comfortable because the patient is not interfered with other patients or other activities if hospitalized. d. The presence of a nurse in the house directly will help because usually, other families at the same time was working. 2. For Nurses: a. It is providing variety of work environments, so they are not saturated with the environment remains the same. b. Can get to know the client and the environment well, so that the health education provided is in accordance with the client's situation and condition of the house, so the nurse job satisfaction will increase. 3. For Makassar City Government: a. The trust of citizens on the government increase because they feel paid an attention. In the end, the city government can easily lower its policies for citizens because they already believe in various government programs. b. Makassar City Government could purchase prefabricated evaluate in terms of services that have been performed. This happens because the program could easily detect the extent to which the received power of citizens in the program. Therefore, the Government of Makassar is developing the sustainability of the Home Care program. Hence the local government has prepared various activities so that this program is not merely a ceremonial program implemented only for a moment. Home Care problem should be maintained because it already has a huge impact on the lives of Makassar people. The Home Care program provides answers to providing the best health care service. The Home Care program in Makassar has been able to fulfill the need for health care service as one of the basic problems that burdens the society.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
In order to ensure the sustainability of the Home Care program, Makassar local government already set up a Mayor Regulation (Perwali) Act No. 63 Year 2015 on Home Care program as 24 hours health services in Makassar City. In sustaining the Home Care program, it is important to manage the database in order to measure the performance of the on-going program. By conducting continuous planning and budgeting, it is expected to decrease the incoming complaints against the difficulty of the citizens in accessing health service care. The program has a sustainability accountability indicator of the commitment and ownership of Makassar local government over the Home Care program report to citizen as an accountability government report. In the budget provision, the sustainability of this program has been attempted by establishing a commitment between the local government of Makassar and the city parliament as a representative of citizen. Basically, the budget for Home Care is not really a problem, because it is included in the vision and mission Moh. Ramdhan Pomanto - Syamsu Rizal when they run for Makassar Mayor and Vice Mayor. Their vision and mission is later put into RPJMD (Regional Development Planning Document in Medium-Term) Makassar 2014-2019. Besides the budgetary guarantee to gain a clean Governance and to diminished corruption, Makassar local government is designing institutional and regulatory systems that will protect the program. A Mayor Regulation (Perwali) Act No. 63 Year 2015 on Home Care program has been designed so that this program has a legal basis and implementation guide. The issuance of the Mayor Regulation may guarantee the sustainability of this program. In addition, the Home Care program is also designed to serve as a special program under the Makassar Department of Health, so that the implementation of this program can cover the whole society and maximise the objective of the program. In addition to strengthen a “Perwali”, Home care program has been designed to serve as a special program under the Department of Health of Makassar, so that the implementation of this program can touch the whole society. It will make the Home Care service will be maximal.

 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)
Home care 24 hour service, giving a home service to all community including women and girls in Makassar. Home care service it self contribute a positif impact to all health issues, especially for women and girls health problems, which can be served in house. As a result all data and self protection of women can protect and confidential as privacy. Some of Women health conditions can protect by this Home Care system. Healt problems such as women abuses, or whitish disease can be solve at home and they do not need to go to hospital. Also the doctor and Home Care team plan supporting diagnostic examination and follow-up if needed, such as: 1. laboratory, 2. ECG, etc Home Care practitioner prepares advice and infrastructures, including: 1. sphygmomanometer, 2. infusion sets, 3. intravenous catch, 4. intravenous fluids, 5. syringes, 6. needle, 7. nebulizer, 8. and other based on the needs of each case.

Contact Information

Institution Name:   HEALTH OFFICE OF MAKASSAR CITY
Institution Type:   Local Government  
Contact Person:   ANDI NAISYAH AZIKIN
Title:   HEAD OF HEALTH OFFICE  
Telephone/ Fax:   +62811462373
Institution's / Project's Website:  
E-mail:   yafiat_28@yahoo.com  
Address:   JALAN TEDUH BERSINAR NO 1 MAKASSAR
Postal Code:   90222
City:   MAKASSAR
State/Province:   SOUTH SULAWESI
Country:  

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