Questions/Answers

Tangerang is a metropolitan city that is directly adjacent to the capital city of the State of Indonesia,with an area of 164.55 Km2, with the population of 1,091,787 men and 1,048,104 women, 565,489 households with a density of 13,005 per Km2 residents in 2017. Tangerang City has multicultural conditions, high mobility, and is a densely populated urban area. Based on data, currently the level of life expectancy that reflects the health status of the people of Tangerang City has only reached 71.38. Tangerang nicknamed the city of 1000 industries plus its demographic bonus at productive age, making the health problems that must be addressed by the Tangerang City Health Agency is very complex. There are still maternal and child deaths and services that are not yet optimal, the morbidity rate for infectious diseases such as tuberculosis, HIV/AIDS and non-communicable diseases such as hypertension, is still quite high. So far, health services are still not well integrated where the Individual Health Efforts which are curative become more dominant and are carried out only in buildings at the Community Health Center in Tangerang. Even though Tangerang is an urban area, the community is still constrained by time and transportation, which is quite expensive to come to the Community Health Centre Home.CAGEUR JASA (Collaboration for home visit on integrated healthy family approach) addresses public health problems in obtaining their rights to access health services. This innovation integrates Individual Health Efforts and Community Health Efforts on an ongoing basis through a family approach through house-to-house visits by health workers to carry out data collection, education, screening and health services. This innovation is expected to be able to increase early case finding and also overcomes the access limitation problem over health services both in terms of transportation and time limitation.

Cageur Jasa provides home visit health services, door to door, evenly across all age groups regardless of social status, economy, religion, ethnicity, race or sex for the people. To support activities to be effective and efficient, this innovation is equipped with digital tools and information technology support . This innovation aims to increase the affordability of access to health services in all areas.. Cageur Jasa involves a variety of cross-sectoral ranging from cross-regional apparatus organizations, villages, sub-regencies, health cadres, and community leaders. Cageur Services make it easier for the underprivileged and with special needs to get individual health service

This innovation is in line with the goal of SDGs 3, by achieving the target of reducing maternal mortality from 19 per 100,000 live births in 2017 to 15 per 100,000 live births in 2019 (SDGs indicator3.1.1). Deliveries (100%) were assisted by health personnel in 2019 (SDGs indicator 3.1.2). The underfive mortality rate also decreased, from 2 per 1000 live births in 2017 to 1 per 1000 live births in 2019 (SDGs indicator 3.2.1). After two years, It has had a significant impact, namely an increase in the discovery of new HIV/AIDS cases from 0.07 in 2017 to 0.09 in 2019 per 1,000 population (SDGs indicator 3.3.1). Tuberculosis case detection increased from 121 per 100,000 population in 2017 to 320 per 100,000 population in 2019 (SDGs indicator 3.3.2). This innovation actively visits the community to provide education, case finding, inviting the public to prevent transmission of tuberculosis In non-communicable diseases, hypertension cases out of 168,401 screened in 2017, 88,916 cases were found and in 2019 out of 823,484 screened cases found 255,013 cases (SDGs indicator 3.4). Screening of people with mental disorders in 2017 found 562 cases, in 2018 found 883 cases, in 2019 found 1482 cases (SDGs indicator 3.4)

As an industrial city, this triggers complex heatth problem, requiring a dynamic health service effort to face urban development. Cageur Jasa for healthy family integration home visits is an effort to answer the needs of health services comprehensively in urban environments. This innovation has received very good acceptance in the community because it has tangible results in improving the quality of family health. It also makes easier for people without having to visit health facilities, so that it is helped from the economic aspect, especially vulnerable communities, which can ensure the sustainability of innovation both from social and economic aspects

Cageur Jasa in the local language of Tangerang means "Very Healthy", through Cageur Jasa services, it is hoped that the people of Tangerang city will remain healthy. By visiting Cageur Jasa officers from door to door, the community feels individual health services and increases public trust in health workers in communicating their health problems. The implementation of service innovation for Cageur Jasa's home visits plays an important role in improving governance through the collaboration of the Health Agency, Community Health Centers, Districts, Villages, Health Cadres, Community Leaders, Cross Regional Organizations, Healthy Tangerang City Forum and other Stake Holders. All those involved in this innovation have the same commitment to improving the health status of the community. This innovation involves cross-program cooperation by integrating Individual Health Efforts and Community Health Efforts on an ongoing basis using a family approach through house-to-house visits by health workers to collect data, screening, education, and health services so as to improve access to public services and reduce registration administration at Health Center. For officers, it will be easier to plan health service governance and contributes to improving the administrative quality of recording, reporting and validating health data, so early case finding can be increased.

Cageur Jasa reaches all levels of society regardless of community economic status, education, ethnicity, religion, gender, disability, age and covers the entire human life cycle (fetus, infant, toddler, adolescent, productive age, pregnant and elderly women), which amounts to 2,139,891 people, consisting of 1,048,104 women and 1,091,787 men, 565,489 households. To date, 822,971 women and girls have received services. Health services that are obtained for women include immunization for future brides, examinations for pregnant women, health promotion for reproductive health among young women. And complete basic immunization given to all infants, both boys and girls.

The target of this innovation covers the population of Tangerang City regardless of economic status, gender, disability and covers the entire life cycle (fetus, infant, toddler, adolescent, productive age, pregnant women and the elderly). During 2017 there were 50,277 households visited, in 2018 there were 70,074, in 2019 there were 192,836 of the target of 565,489 households. Innovation services also cover the poor, whose number has decreased from 4.95% in 2017 to 4.43% in 2019 of the total population in Tangerang City. Health workers visit all households to carry out screening, health services, education and data collection. And services are carried out comprehensively including promotive, preventive, curative and rehabilitative. If a case is found that requires further handling of service facilities, referral health services will be carried out through the Integrated Referral System. The public will have more confidence in health workers so that they are more open in communicating health problems, such as cases of HIV/AIDS, mental disorders, tuberculosis. In addition, asymptomatic diseases (silent disease) can be detected more quickly and are expected to reduce morbidity and mortality. The community is also increasingly aware of having regular check-ups and treatment to prevent and control non-communicable diseases.

In line with the increasing needs of the community for access to health services and to accommodate the ease of transportation and the availability of time, the Cageur Jasa innovation was initiated. Cageur Jasa was first inaugurated as an innovation by the Mayor of Tangerang in 2017. Since then all health centers in Tangerang City have started to carry out duties and functions of Cageur Jasa according to their respective needs through the "10 Steps to Implement Cageur Jasa" as follows : A. Planning Stage: 1. Identifying and analyzing community needs for health services. 2. Designing programs and formulating policies and budget requirements related to Cageur Jasa innovation B. Implementation Stage: 3. Coordinating across programs through monthly mini-workshops. 4. Carrying out advocacy and coordination with cross-sector through Tribulant Workshops. 5. Preparing instruments, materials and applications that will be used for implementing Cageur Jasa innovation. 6. Conducting training for Cageur Jasa officers. 7. Arranging a schedule for Cageur Jasa visits by dividing into teams and Service Zones. 8. Carrying out house-to-house visits according to the targets and schedules that have been determined in the working area of Health Center. C. Evaluation Stage: 9. Recording, analyzing, and reporting the results of Cageur Jasa activities. 10. Monitoring and evaluating Cageur Jasa by Health Center and Health Agency If it cannot be resolved and referral to advanced health facilities is needed, it will be integrated through the Integrated Referral System (SISRUTE). All health workers are trained on the stages of implementing this Cageur Jasa. The results of these activities are then recorded, reported, monitored and evaluated periodically at both the Puskesmas and the Health Agency levels.

In practise, there are still several obstacles faced in the field such as refusal from the target families who do not know the purpose and purpose of the home visit. Efforts to get around this were carried out by coordinating with community leaders, cadres and cross-sectoral workers who were already known in the area to inform the community about the benefits of Cageur Jasa. Limited personnel resources are also an obstacle in this innovation so that proper scheduling and collaboration with cross-sectoral and health cadres is needed, whose number is increasing from 5360 cadres in 2017 to 5415 in 2019.

Cageur Jasa is very innovative and has great leverage because it is done directly by health workers from door to door to solve problems of access to health services. This innovation is carried out in a holistic manner including promotive, preventive, curative and rehabilitative efforts. It also increases the finding of health cases in the community, including cases that have not been detected and have not been handled. This innovation also involves cross-program cooperation by integrating individual health efforts and sustainable public health efforts.

Cageur Jasa’s home visit innovation is a collaboration of the "We Come We Serve" Program and the Healthy Indonesia Program with a Family Approach (PIS-PK) which is a Central Government Program. This innovative method integrates promotional, preventive and curative efforts into one form of door-to-door health services. This service was developed not only for data collection on health problems, but for direct intervention during visits. If it cannot be resolved and referral to advanced health facilities is needed, it will be integrated through the Integrated Referral System (SISRUTE).

This innovation is equipped with digital technology support, where each officer is provided with a device in the form of a tablet/laptop/mobile phone which includes a recording and reporting application for the Healthy Indonesia Family Approach Program (PIS-PK). Meanwhile, if the community at that time needed a referral to an advanced health facility, there were the SISRUTE (Integrated Referral Information System) , SIJARIMAS (Maternal Neonatal Referral System) applications, the application for maternal data collection, namely EMAK IDEP (Integrated and integrated pregnancy monitoring system), and SIRONA (sistem informasi Corona) Si Cageur Jago (Information System for Cageur Services Keeping People Without Symptoms)

This innovation has the potential to be applied in other areas and in demand by other regions with comparative studies conducted in several regions such as Jambi, South Lampung, Gorontalo, Kupang, Tegal and Solo.

Cageur Jasa home visits can be carried out in all regions of Indonesia because in general they have the same resources and objectives, namely to improve the degree of public health with strategies to solve problems that exist in the community both promotive, preventive and curative, as well as bringing access to public services in general to the community. These innovations can be transferred by other agencies such as the communication and information office with potential in terms of promotion, regional development planning agencies through the budgeting system in the health sector. This innovation can be implemented by other Local Goverment Organizations such as bringing closer to population services, family food security, social protection and others.

This innovation is supported by resources from the Tangerang City government, namely 52 key officials across agencies, 114 medical personnel, 228 paramedics, 76 administrative staff. Local government budget support for facilitating home visits in 2017 amounting to 42,525,000 Rupiah increased to 140,600,000 Rupiah in 2019. Facilities in the form of motorized vehicles totaling 66 motorbikes and communication facilities in the form of tablets/cellphones/laptops for officers who have embedded applications Non-government resources, namely health cadres totaling 5415 people. For incentives for cadres, the total funds in 2019 from the Tangerang city government amount to 925,650,000 Rupiah

This sustainability of innovation has been supported by regional regulations such as the Decree of the Mayor of Tangerang Number 440/Kep.441-Dinkes/2018 concerning the Determination of Innovations in the Health Sector in the Tangerang City Government and the Decree of the Head of the Tangerang City Health Agency Number: 800/Kep.75 VIII/Dinkes/2017 regarding Cageur Services Home Visit Services. Cageur Jasa is included in the Tangerang City regional strategic program as outlined in the Regional Medium-Term Development Plan (RPJMD) and the Strategic Plan (Renstra) of the Tangerang City Health Service 2019-2023.

Yes

This innovation is evaluated regularly . The results of innovation are discussed in each Public Health Center Monthly Mini Workshop, every quarter by the Health Agency and through a cross-sectoral joint of quarterly mini-workshop involving representatives of health cadres. The evaluation also discussed efforts to improve the implementation of innovation and joint follow-up plans across programs and across sectors. The Mayor of Tangerang also conducted an evaluation in the Tangerang City development evaluation meeting. To find out the community's feedback, a Feedback Survey was conducted through a questionnaire that was filled out by the community.

The indicator used in the innovation evaluation is the coverage of the number of home visits. The coverage of screening for non-communicable diseases (hypertension and mental health cases) has increased and its prevalence has decreased, the coverage of new case finding of Tuberculosis, HIV / AIDS, and the coverage of success rates has increased. An evaluation was also carried out on indicators of community satisfaction with health services which resulted in the community satisfaction index. In terms of human resources, the number of visiting activities, the availability and competence of health workers involved in home visits

The main results of the evaluation obtained from this innovation are the number of family heads visited since 2017 as many as 50,277, in 2018 as many as 70,074, and in 2019 amounting to 192,836 households, and 204,845 heads of households in 2020. To date, 78.53% of heads family who have visited. The increase in the number of households visited is certainly in line with the target case finding of cases of disease that is still hidden (Case Finding), thus accelerating the handling of cases according to standards and reducing morbidity and mortality. In terms of resources, an increase in the number of health cadres involved (5360 cadres in 2017 to 5415 in 2019) and a budget that supports the sustainability of this innovation. In its implementation, this innovation also faces various challenges that are common in metropolitan cities such as fast population mobility, increasing population, and increasingly diverse cultural cultures. The feedback obtained from the community is positive including; as many as 2,460 people stated that Cageur Jasa were useful (99.99%), officers were polite and friendly (97.81%), officers were capable and skilled in conveying health messages (98.77%), the community felt that Cageur Jasa could solve problems (99.79%).

This innovation succeeded in giving a very significant impact because it was able to build an integrated governance system starting from implementation, monitoring and evaluation both internal and external. Internally within the scope of the Health Agency, this innovation is able to build cross-program integration within the Tangerang City Health Agency which includes maternal and child health programs, school-age children and adolescent health programs, productive age programs, elderly programs, disease prevention and control programs, health and food sanitation, as well as health promotion programs. This innovation is also able to integrate across central and regional programs, such as the establishment of a collaborative program for the Healthy Indonesia Family approach with a referral system with a passion for a healthy Tangerang city community in 2030 according to the 3rd SDGs indicator. Apart from internal integration, this innovation is also able to build a balanced collaboration with various other stakeholders in proportion to their respective duties and responsibilities. In its implementation it also involves the role of related Regional Apparatus Organizations such as the Regional Development Planning Agency in budgeting, the Communication Service and information in the collaborative digital information system.

The duties and functions of each stakeholder in planning, implementing and evaluating this innovation are described below: A. Planning Stage 1. Neighborhood association, community association, village and sub-regency contribute to identifying and analyzing community needs for health services 2. Health Center and Health Agency Design programs and formulate policies and budget requirements related to innovation . B. Implementation Stage 3. Health Centers coordinate across programs through monthly mini workshops 4. Sub-regency, Village, Neighborhood Association, Community Association involve advocacy and cross-sector coordination through Monthly Workshop 5. Health Agency and Health Center prepare instrument, material and application which will be used for innovation implementation. 6. Health Agency carries out training for Cageur Jasa officers 7. Health Center makes home visit schedules by dividing teams and service zones 8. Health Center carries out home to home visit according to target. Community organizations such as Tangerang Health City Forum, Karang Taruna, along with health cadres play a role in mobilizing people to have a clean and healthy lifestyle (PHBS) C. Evaluation Stage 9. Health Center makes record and report, analyzes and evaluates the activities results every month 10. Health Agency together with Health Center evaluate and monitoring the activities results

Cageur Jasa has a tremendous impact on the Health Agency and the people of Tangerang City so that many important things can be learned from the implementation of this innovation, namely: 1. Cageur Jasa is one of the spearheads of the success of other health programs, as evidenced by the establishment of optimal collaboration for all national and regional programs related to household-based public health, seen by the integration of cross-programs including maternal and child health programs, school-age child health programs and adolescents, productive age programs, elderly programs, disease prevention and control programs, environmental health and food health programs, health promotion programs, as well as tracing and monitoring activities in overcoming COVID-19 cases. This innovation is supported by digital technology in its implementation. 2. Fulfilling the need for comprehensive health services for all levels of society, some of which still have limited access to health services. 3. Cageur Jasa health services for all people without exception will be easily realized if this innovation is carried out properly, so that all households in Tangerang City get continuous and sustainable health services without exception. 4. Active cross-sectoral involvement can strengthen and accelerate the implementation of this innovation in the field.