| 4. In which ways is the initiative creative and innovative?
The Smart Thumb Facility initiative is creative and innovative, because of:
• The registration for repeated visit patients do not need identity card or medical card, and could be conducted independently through fingerscan / independent registration machine (Anjungan Loket Mandiri-ALM)
• Fingerscan is used for patient identification and determine the queuing number
Generally, fingerscan is used by the institutions or corporation for the staff presence, but Puskesmas Sumberasih succeed to develop and utilize this fingerscan technology for patient registration, and integrated by puskesmas information system (simpustronik) that covered all patient medical records.
• Paperless services
The integration of fingerscan and electronic information system enable all the services at Puskesmas Sumberasih became paperless.
This paperless service consists of:
1) Paperless outpatient registration service
2) Paperless medical record
3) Paperless doctor’s prescription
4) Paperless medicine management
• All patient medical record save in the electronic information system database and could be accessed by health workers fastly and easily, so the treatment could be effective and appropriately.
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Puskesmas Sumberasih is the implementator of Smart Thumb Services or integrated fingerscan-electronic information system, supported by Probolinggo Local Government (especially Probolinggo District Health Office/DHO) and multi stakeholder forum, as the representative of religious leader, community leader, community organization and KINERJA USAID support.
This initiative also provides a significant impact for all 46,294 patients visited at Puskesmas Sumberasih.
The increased number of served patients at Puskesmas Sumberasih also increase significantly (15.3%), and the average visited patients at last 3 years (after this initiative) reaches 45,306 patients/year.
Data 2016, showed the number of patients visited at Puskesmas Sumberasih is 46,294 patients, with the composition of :18,289 is the poor (39.5%), elderly patient of 1,709 (3.7%) and 723 pregnant women.
Besides that, the number of patients from outside Puskesmas Sumberasih service area is relatively high, reaches 6,303 people/year or 13.6% from total patients at Puskesmas Sumberasih.
This initiative has also be replicated at others 19 community health center/puskesmas in Probolinggo district, and this Smart Thumb Services has benefitted for 162,766 patients or 22.6% of total visited patients at all community health center in Probolinggo district.
| 6. How was the strategy implemented and what resources were mobilized?
• Starting with the strong commitment of Puskesmas Sumberasih to provide an excellent service, Puskesmas Sumberasih opened itself to know any community complaints, and formed Public Service Improvement Team that includes complaint handling team.
• Initial Meeting for Public Service Improvement
Multi stakeholder meeting, incorporated in Healthy Probolinggo Forum, consisting community leaders in village, sub district and district level together with Puskesmas Sumberasih, facilitated by KINERJA-USAID Program, was a starting poin to change community perception.
They agreed that service users have rights to involve in health service policy, oversight, and puskesmas needs community inputs to improve the services. Complaint survey as one of efforts to accommodate the community complaints on Puskesmas Sumberasih’s service.
• Multi Stakeholder Forum (MSF) Establishment
Then, Puskesmas Sumberasih established MSF on Novermber 2012, as the representatives of service users that has role & function to mobilize community to give inputs for puskesmas services, overseeing and monitoring the service improvements and conducting the advocacy to Local Government to support the items that couldn’t be conducted by Puskesmas.
MSF also actively participate in community complaint survey, involve in analyzing complaint survey results, and the preparation of service charters as the response of community complaints.
• Workshop: Complaint Handling and Questionaire Preparation
The workshop discussed community complaint handling and preparing complaint survey questionnaire, attended by all MSF and community representatives at Puskesmas Sumberasih working area.
Questionare was prepared in participatory manner, by accommodating all complaints that frequent experienced or often complained by Puskesmas Sumberasih patients.
• Community Complaint Survey, Puskesmas Sumberasih in cooperation with MSF held the complaint survey by interview method on January 2013. Total of 140 respondents (pregnant women/ mother who has baby under 2 years, and other patients who got the puskesmas services) were randomly interviewed.
Then, MSF tabulated the survey results into Community Complaint Index, and analysed the most frequent complaints as the priority of solution.
One of the frequent complaint was: Long Queuing at Registration Counter.
• Workshop: Analysis of Complaint Survey Results. Complaint survey results was analysed by Puskesmas Sumberasih together with MSF. Each cause of frequent complaints was analysed, to find solution alternatives
• Preparation & Service Charter and Technical Recommendation Signing
Complaints which could be solved internally was included into Service Charter, as the reference for service improvements, while some items that couldn’t be solved internally, were included in Technical Recommendation of Service Improvement and formally submitted to DHO.
• Service improvement efforts to realize the Service Charter
Refer to the commitment of the service charter, Puskesmas Sumberasih conducted improvements, preparing human resources, structure /infrastructure and trials the new initiative idea as agreed, including Smart Thumb Facilities.
The improvement, development and trial conducted within 6 months.
• Monitoring and Evaluation the Implementation of Service Charter and Technical Recommendation conducted by MSF
It is aimed to control the service charter and technical recommendation realization. The results were reported to the head of Puskesmas, then MSF conducted advocacy for unrealized items.
• Research through Working Culture Group (KBK)
Puskesmas Sumberasih assigned KBK to held a research to prove the customer satisfaction changes. The result shows the significant changes, from 81.97 (before innitative) became 96.2 after initiative conducted.
Resources to realize the initiative were:
- Preparation step (workshops, complaint survey) was funded by Puskesmas supported by MSF and KINERJA-USAID technical assistance
- Implementation step:
Structure/infrastructure procurement (computer, fingerscan, software application, LAN cable): Rp. 60 million (Local Budget 2014).
Human resources capacity building (trainings, technical assistance): Rp. 5 million under Puskesmas budget
- Development step:
Independent Registration Machine: Rp. 41 million (Local Budget 2016)
- Maintenance /operational: Rp. 12 million/year under Puskesmas fund.
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The stakeholders involved were:
(1) Main actors of Smart Thumb Facility:
• The Head of Puskesmas Sumberasih and working culture team (KBK) designed the initiative to integrate fingerscan and electronic puskesmas information system (simpustronik). The implementor of this initiative, at once conducts the monitoring, evaluation and systemic sustainable development to keep and improve the quality service.
• Multi stakeholder forum (MSF) who actively sounding the community complaints and involve at the discussion of this initiative, disseminate the initiative and conduct the monitoring of puskesmas services. Ensuring that the service chaters have been implemented as the response of community complaints.
(2) Working units:
• Probolinggo District Health Office (DHO), supported the procurement of fingerscan, computers and provide technical guideline, budget and human resources neede for the implementation. DHO also raised the policy to replicate Smart Thumb Facility to all community health center (puskesmas)
• Probolinggo District Organization and Governance Division office, who facilitated several cross sectoral and motivated puskesmas to conduct the innovation for public service quality improvements.
• Sumberasih sub district leader discussion (Musyawarah Pimpinan Kecamatan-Muspika) together with religious and community leader, women activators and community organizations participating for disseminating this innitiative to the community.
• Supporting Organization
Kinerja-USAID and Probolinggo Child Protection Organization (Lembaga Perlindungan Anak (LPA), supported the technical assistance for public service improvement and the effort for decreasing mother and baby mortality rate.
| 8. What were the most successful outputs and why was the initiative effective?
The real outputs achieved through this initiative are:
1) A set of integrated thumb scan/fingerscan with simpustronik has been provided and functioned, which able to guarantee the fairness, transparent and accountable health services for all society, especially for vulnerable people, who have difficulties to access the health facilities, caused by their limitation, e.g : the poor, illiterate, disability, women and elderly groups. The team who handle the thumb scan- simpustronik was legitimated by Probolinggo District Head Decree.
2) Better service and monitoring system:
a) Service System
The initiative creates a new system of registration services up to medicine management in paperless services by utilizing information technology of finger scan – simpustronik, a simplified procedure and ease patients to receive the best services, and to facilitate the officer in delivering the best services as well.
b) Monitoring System
There are 3 (three) new monitoring system established:
• Computerized Monitoring, this initiative is able to monitor the queuing number, number of patients and number of medicine stock, is a new case at puskemas service.
• Internal Monitoring, through the establishment of Manager on Duty (MOD) team, who conducted a daily direct monitoring to the service process to the patient.
• External Monitoring, through multi stakeholder forum, endorsed by sub district head.
3) Provided Standard Operational Prosedur (SOP) to optimally the services at Puskesmas Sumberasih, e.g :
SOP for patient registration
SOP of general clinical services
SOP of Mother & Child Services
SOP of Farmacy /medicine Services
SOP of Medical Record Management
SOP of Medicine Management at Warehouse
SOP of Manager On Duty (MOD)
The obedience officers in delivering the services based on SOP at Puskesmas Sumberasih guarantees that all patients without any discrimination will be served by the applicable standard, to provide an excellent service and the faster health recovery.
4) The availability of Public Service Improvement Team, that includes complaint handling services team, who is fully caring to the services at Puskesmas Sumberasih, especially for vulnerable people who requires extra services of their limitations, and always ready to reveive the community complaints as the inputs for better services.
5) Better partnership among Puskesmas, cross sectoral and community, formally tide by Head of Puskesmas Decree on Multi stakeholder forum (MSF) establishment, which also known as Badan Pertimbangan Kesehatan Kecamatan (BPKK), and the Memorandum of Understanding (MoU) between Puskesmas and BPKK as the representation of service users.
| 9. What were the main obstacles encountered and how were they overcome?
• Technical obstacle:
Thumb Service Facility is an initiative based on finger scan-simpustronik information technology. As usual, the utilization of new technology raised the technical obstacle both from software and hardware as well.
The main factors are human resource (operator) skills, who still not mastery the application yet, and the software trouble caused by the virus or limited capacity.
This problem just raised at the beginning of implementation, and when operators have better skills, this problem could be soluted.
The overcome was conducting capacity building for puskesmas officer through some intensive trainings to all operators, and cooperation with third party for technical assistance support during the trial process.
Puskesmas Sumberasih also recruited special IT operator, and provided a programmer and network training to officer who has a specific interest to information technology aspects.
For the time being, all technical obstacle could be handled independently and quickly by Puskesmas.
• Part of staff’s commitment is low at the beginning of implementation.
This is natural, not every people ready for changes, the lack of understanding of its beneficiaries is the main factor of this low commitment.
The manager of Puskesmas Sumberasih continually ensured the staff/officer that this initiative is not just the demand of users that should be fulfilled, but furthermore, this initiative benefitted the officers to deliver the service easily and very useful for any other tasks. Now, the officers be motivated.
• Patients felt strange with this initiative
At first, some patients were afraid to use the fingerscan, and some of them were confusing how to use Independent Registration Machine (Anjungan Loket Mandiri-ALM).
The solution is: every day Puskesmas Sumberasih assigned one staff as Manager on Duty (MOD) to assist patients who have difficulties in technology (elderly, illiterate, disability) and guiding them personaly.
Finally, they were familiar and very comfortable.