Questions/Answers

Tangerang City is a metropolitan city that borders directly with the national capital of Indonesia, located in Banten Province with an area of 164.55 Km2, with a population of 2,139,891 people with a distribution of 1,091,787 men and 1,048,104 women, 104 sub-districts, 565,489 households with a population density of 13,005 per Km2 in 2017. This causes the City of Tangerang to have multicultural conditions and high mobility with diverse health problems that demand fast, precise and accurate handling. Based on Tangerang City Data in Numbers, the level of education is in the middle level, but there is still a negative stigma among the people regarding diseases such as; HIV / AIDS, mental disorders (People with Severe Mental Disorders - ODGJ), or Tuberculosis (TB). This causes the public to be less open in delivering health problems related to the disease, while the disease is not contagious and asymptomatic so is still largely undetected. All this time, health services have been more dominant through curative and rehabilitative Individual Health Efforts (UKP). Home Visit Services CAGEUR JASA (Collaboration of Healthy Family Integration Home Visits) is here to address community health issues in obtaining their rights to health services. This innovation integrates the Individual Health Efforts (UKP) and the Public Health Efforts (UKM) on an ongoing basis through a family approach and continuum of care through health care visits door to door to collect data, education, screening and health services. Cageur Jasa's innovation is in line with one of the goals of the SDGs, which is to provide inclusive and equitable services for everyone, because this innovation serves all households in Tangerang City to overcome the problem of limited access to health services both in terms of transportation and time constraints.

Cageur Jasa innovation is in line with the category of inclusive and fair service delivery for everyone. Cageur Jasa Innovation provides services for all age groups in the household in line with the 3rd objective of the SDGs, namely ensuring a healthy life and supporting welfare for all age groups. Health workers implementing the innovation Cageur Jasa do not distinguish economic status, ethnicity, religion, race or gender. Cageur Jasa innovation is also in line with the 3 Pillars of Healthy Indonesia, namely the Healthy Life Paradigm, Strengthening Health Services and National Health Insurance.

This innovation was initiated on the basis of the Tangerang City Commitment to realize the third goal of Indonesia's Sustainable Development Goals. The output is expected to end the HIV / AIDS and Tuberculosis (TB) epidemic by 2030. Also in regards to TB, the case finding has increased from 121 per 100,000 population in 2017 to 206 per 100,000 population in 2018. This happened since the innovation actively visits the community to provide education, case finding that remains a stigma in the community and also encourage the public to play an active role in preventing TB. There were 88,916 cases of Hypertension found of the 168,401 screened in 2017. In 2018 out of 376,119 screened, 105,413 cases were found. Meanwhile the selection of cases of Mental Disorders (ODGJ) in 2017 was found 562 cases, while in 2018 was found 883 cases. Through this innovation, the Tangerang City Government is optimistic about achieving the target of 0 new HIV / AIDS infections, loss of stigma and discrimination, a reduction in the incidence of TB by 80%, controlled Hypertension, and 100% Mental Disorders treated by 2030.

This innovation was initiated by the "We Come We Serve" program initiated by Tangerang City Health Office, which then developed into Cageur Jasa Home Visit Service. It is supported by the Tangerang City Government through The Mayor Decree Number 440/Kep.441-Dinkes/2018 concerning the Determination of Health Sector Innovations in Tangerang City Government Environment and Decree of Head of Tangerang City Health Office Number: 800/Kep.75/VIII/Dinkes/2017 concerning Cageur Jasa Home Visit Services. This innovation has improved the quality of family health, making it easy for the community to check on their health without having to visit health facilities, thus is economically sustainable.

Innovative implementation of Cageur Jasa's home visit services plays an important role in improving governance through collaboration with the Health Office, Puskesmas, districts, subdistricts, health cadres, community leaders across the Regional Government Organization (OPD) and other stakeholders. This innovation also involves cross-program collaboration by integrating Individual Health Efforts (UKP) and Community Health Efforts (UKM) on an ongoing basis using family approach through visits from health workers from house to house to conduct screening, health services, education and data collection so that this innovation can also improve access to public services and cut administrative registration at the Puskesmas. With the visit of Cageur Jasa officers from house to house, the community will experience individual health services. This also has an impact on increasing public confidence in health workers in conveying their health problems. For officers, this makes it easier to plan health service governance. In terms of general administration, this innovation contributes to the improvement of recording and reporting, early case finding and validation of health data. This innovation also utilizes the application of the Healthy Indonesia Program with the Family Approach (PIS-PK) and the Integrated Referral System (SISRUTE) from the Ministry of Health of the Republic of Indonesia.

This innovation can reach all levels of Tangerang City people without differentiating the status of the individuals, namely education, ethnicity, religion, gender, disability, and covers people from all stages of life (fetuses, infants, toddlers, teens, productive ages, pregnant women and elderly), totaling 2,139,891 people, consisting of 1,048,104 women and 1,091,787 men and 565,489 households. This innovation in line with the Regional Action Plan set out in Tangerang City Regulation Number 5 of 2018 concerning Gender Mainstreaming and Mayor Regulation Number 91 of 2018 concerning Guidelines for Implementing Gender Mainstreaming in Development in Tangerang City.

The target groups of the Cageur Jasa's service covers all residents of Tangerang City without considering the community’s economic status, gender, disability, age. In this innovation, health workers consist of at least 1 Doctor, 1 Midwife and 1 Nurse from 36 Community Health Centers throughout Tangerang City visit all households to do screenings, provide health services, education and carry out data collection. If a case is found that requires the handling of advanced service facilities, referral health services will be carried out through an integrated referral system (SISRUTE). Through this innovation, people have more confidence in health workers to be more open in conveying health problems related to stigma, such as in cases of HIV / AIDS, Mental Disorders, and Tuberculosis. Besides non-communicable and asymptomatic diseases can be detected more quickly which is expected to reduce mortality rates. This innovation makes society aware of checking their medical condition to prevent and control non-communicable diseases.

Cageur Jasa is a development of home visit activity which was named "We Come We Serve" in 2016. In line with the increasing needs of the community for access to health services, Cageur Jasa was first inaugurated as an innovation by Tangerang City Mayor in 2017. Since then, all Puskesmas (Public Health Centers) in Tangerang City began to carry out the duties and functions of Cageur Jasa according to their individual needs through the "10 Steps Implementation of Cageur Jasa" as follows: 1. To identify and analyze the community needs for health services. 2. To develop policies and budget requirements related to Cageur Jasa's innovation. 3. To coordinate across programs through monthly mini workshops. 4. To advocate and coordinate across sectors through a quarterly Workshop. 5. To prepare instruments, materials and the application to be used in the performance of the Cageur Jasa innovation. 6. To carry out training for Cageur Jasa officers. 7. To prepare a Cageur Jasa visit schedule by dividing into teams and Service Zone. 8. To implement the Cageur Jasa innovation. 9. To record, analyze, and report on the results of Cageur Jasa's activities. 10. To do monitoring and evaluate Cageur Jasa by Puskesmas (Public Health Center) and Tangerang City Health Office To strengthen the sustainability of this innovation, it is necessary to formulate a policy and budget needed in the implementation of Cageur Jasa. The instrument used was the Prokesga Form (Family Health Profile Data) from the Indonesian Ministry of Health, which was then analyzed, and inputted into the PIS-PK application. If a case is found that requires further treatment, it will be intervened directly during the visit. If it cannot be overcome and a referral to an advanced health facility is needed, it will be integrated through SISRUTE.

The innovation of Cageur Jasa has succeeded in providing tangible benefits for the community. However, in the implementation there are still some obstacles encountered in the field, such as refusal from the target family since they are unaware about the purpose of the arrival of the Cageur Jasa officers. Limited personnel resources are another obstacle in setting up the proper scheduling and collaboration with networks. Policy support has also been included in the Regional Medium-Term Development Plan (RPJMD) and the Tangerang City Health Office Strategic Plan in 2014-2018 and 2019-2023 in health service program.

The Cageur Jasa is very innovative and has great leverage because it is done directly by health workers from house to house, involving collaboration between the Tangerang City Health Office, Puskesmas, districts, subdistricts, health cadres, community leaders, across Regional Government Organizations (OPD) and other stake holders. This innovation also involves cross-program collaboration by integrating individual Health Efforts (UKP) and Public Health Efforts (UKM) on an ongoing basis and supported by six working days a week at 36 Puskesmas (Public Health Center) in 104 Sub-districts in Tangerang City.

Cageur Jasa innovation is a collaboration between the "We Come We Serve" Program and the Healthy Indonesia - Family Approach Program (PIS-PK) which is the Central Government Program. This innovative method integrates promotive, preventive and curative efforts into one form of health care from house to house. This service was developed not only for data collection on health problems, but directly intervened during the visit. If it cannot be overcome, a referral to an advanced health facility is needed and it will be integrated through the Integrated Referral System (SISRUTE).

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The Cageur Jasa 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 promotive, preventive and curative methods and creating closer access to public services for the community. This innovation has been in great demand by other regions as evidenced by the existence of comparative studies conducted by several regions such as the cities of Jambi, South Lampung, Gorontalo, Kupang, Tegal and Solo, and it also can be implemented by other Regional Government Organizations (OPD).

This innovation is supported by human resources, infrastructure, funding sources, and an integrated application system. Cageur Jasa's team consists of medical staff assisted by paramedics, midwives, nurses and also supported by local community leaders and organizations as well as health cadres. This innovation additionally uses two-wheeled motorized vehicles to reach the target location and all operational budgets come from the Regional Budget (APBD). To compile and analyze data the innovation refers to an application published by Indonesian Ministry of Health in the form of the Healthy Indonesia - Family Approach Program (PIS-PK) application.

The sustainability of this innovation has been supported by regional regulations such as Tangerang City Mayor Decree Number 440/Kep.441-Dinkes/2018 regarding the Determination of Innovation in the Health Sector in Tangerang City Government and Decree of Head of the Tangerang City Health Office Number: 800/Kep.75/VIII/Dinkes/2017 concerning Cageur Jasa Home Visit Service. Cageur Jasa has also been included in the Tangerang City Regional Strategic Program outlined in the Regional Medium-Term Development Plan (RPJMD) and the Strategic Plan (Renstra) of the Tangerang City Health Office in 2019-2023 in the public health service program.

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In order for this innovation to run well, regular evaluations are carried out on a gradual basis starting from evaluating the performance of the Public Health Center (Puskesmas) and the Tangerang City Health Office. The results of this innovation are presented and discussed every month in the Mini Monthly Workshop activities at Puskesmas with across sector. In addition, the Government Internal Supervisory Apparatus (APIP) also conducts routine supervision every year to discuss efforts to improve the implementation of innovation and joint action plans both across programs and across sector.

Evaluating this innovation included using indicators such as the number of home visits by health workers, the coverage of non-communicable diseases screening (Hypertension and Mental Disorder cases) and the prevalence and coverage of new Tuberculosis and HIV / AIDS case finding, technical indicators were used including the evaluation of community satisfaction on health services carried out by health workers as a public satisfaction index. Human resource indicators include the number of visiting activities, the availability and competency of health workers, the availability of tool kits for home visit services and medical devices in meeting the requirements.

After two years this innovation has had a significant impact, namely an increase in the discovery of new cases of HIV / AIDS infection from 0.07 to 0.09 per 1,000 people. The Tuberculosis case finding increased from 121 per 100,000 people in 2017 to 206 per 100,000 people in 2018. In terms of non-communicable diseases, for Hypertension cases, of 168,401 who were screened, 88,916 cases were found in 2017. In 2018 out of 376,119 screened, 105,413 cases were found. For the selection of cases of people with mental disorders, 562 cases were found in 2017, while 883 cases were found in 2018. In terms of resources there are additional health workers on duty, additional procurement of medical equipment, and a budget that supports the sustainability of this innovation. The implementation of this innovation also faces various challenges that are common to metropolitan cities such as rapid population mobility, increasing population, and increasingly diverse cultures. Positive feedback was obtained from the community: 2,460 people stated that Cageur Jasa was useful (99.99%), officers were polite and friendly (97.81%), officers were capable and skilled at delivering health messages (98.77%) and the community felt Cageur Jasa could solve problems (99.79 %).

This innovation succeeded in delivering a significant impact because it was able to built an integrated governance system starting from the implementation with internal and external monitoring and evaluation. Internally, within the scope of the Tangerang City Health Office this innovation is able to build integration across programs which includes maternal and child health programs, health programs for school-age and adolescent, productive age programs, elderly programs, disease prevention and control programs, health and food sanitation programs, and health promotion programs. This innovation is also able to integrate across central and regional programs such as the establishment of collaborative PIS-PK programs with referrals and so on with enthusiasm towards a Healthy Tangerang City in 2030 according to the 3rd global SDGs indicator. In addition to internal integration, this innovation is also able to build balanced collaboration with various other stakeholders proportionally according to their respective duties and responsibilities. This external integration is also proven to have a significant impact on the successful implementation of this innovation in Tangerang City. Integration and collaboration are the main keywords that must be present in every activity carried out so that it will have a significant impact.

This innovation is very relevant to the SDGs agenda of 2030 which focuses on collaboration, cooperation, partnership and participation. This spirit has been set forth in the Decree of the Head Tangerang City Health Office Number 800/Kep.75/VIII/Dinkes/2017 regarding the House Visit Service of Cageur Jasa and the Tangerang City Mayor Decree Number 440/Kep.441-Dinkes/2018 regarding the Determination of Innovations in the Health Sector in Environment of Tangerang City Government. The policy has outlined and described as follow: 1. Neighborhood Association (RT) / Community Association (RW) assist in mapping the location for Cageur Jasa's visits and socialize these services. 2. Districts and subdistricts move the related parties and coordinate Neighborhood Association (RT) / Community Association (RW) to assist the implementation and socialization of Cageur Jasa. 3. Community organizations promote the community to engage in a Clean and Healthy Life Behavior (PHBS). 4. The Public Health Center and Tangerang City Health Office are actively involved in each process of this innovation service including coordination, providing human resources, monitoring and evaluation. 5. The community receives health services provided by Cageur Jasa innovation. 6. Evaluation is carried out by Public Health Center together with stakeholders in quarterly Mini Workshop meetings, through periodic evaluations to improve the activities.

The Cageur Jasa innovation provides an extraordinary impact for the Tangerang City Health Office and Tangerang City Community as the important lessons learned as follows: 1. The optimal collaboration for all national and regional programs related to household-based public health through the integration of cross-programs; 2. Eliminating the stigma surrounding certain diseases such as Tuberculosis, HIV / AIDS, mental disorders in the midst of modern society who live directly adjacent to the capital city of Indonesia. 3. Health services for all communities through house to house service will be easily done through this innovation to promote sustainable health services; 4 . Actively cross sector involvement with districts Heads, subdistricts Heads, Health Cadres, community leaders, and non-governmental organizations or local community organizations can strengthen and accelerate the implementation of this innovation in the field. In the future, it is expected that the results of Cageur Jasa can be integrated with applications in Tangerang, City namely Tangerang Live, as information and feed-back for the community which can be replicated by the Ministry of Health of the Republic of Indonesia.