5.Panel4 PPT Budi Aji UNSOED

(1)

Creating the right to access to

quality health care for the

poor: A case study at a

restructured hospital with

no-class wards policy in Indonesia

Presented by:

Dr.sc.hum. Budi Aji, SKM, M.Sc.

(2)

2 2

This research was supported by

the World Health Organization

(WHO) Geneva

Gender, Equity and Human Rights

under Grant HQGER1408785

Year 2015

School of Public Health Faculty of Health Sciences

Jenderal Soedirman University

World Health Organization Gender, Equity and Human

(3)

Overview

• Background

• Purpose of the study

• Research methods

• Results and discussion

(4)

3rd class ward “free“: for poor people

VIP class “private“ : in the capital city

Background

Health services gap

(5)

Background

Challange toward increasing access to quality hospital care for the poor

•

Policy innovation to create hospital

without class ward is implemented at

Wates Hospital in the District of

Kulonprogo-Yogyakarta

• _{Admission rate among the poor increased from 39.60%}

in 2011 to 43.42% in 2012 and 56.35% in 2013

• _{Significant for future model/design for hospital system}

(6)

Study objectives

• To gain a better understanding of the

experience of the poor and non-poor patients after the implementation of no-class wards policy.

• To gain a better understanding of hospital

behavior towards the treatment patients under no-class wards policy.

• To determine the possible impact of no-ward class policy on the poor and non-poor patients with respect to the government and hospital commitments to enhance nondiscrimination in provision and quality of care.

• _{To formulate recommendations for the} improvement of the policy.

(7)

Theoretical framework

Research methods Restructu red hospital with no-class wards policy Addressin g the full scope of impacts

Evaluation of impact that is guided by human rights considerations Internal hospital management Adopting 6 areas of

interest of the accessibility to quality healthcare: - Non-discriminatio n - Physical accessibility - Economic accessibility - _Information accessibility - Prompt attention - _Adequate treatment Healthcare

(8)

Study design, sites & informants

8

• _{Research design: qualitative study} • _{Study sited: District of Kulonprogo,}

Yogyakarta, Indonesia, especially at Wates Hospital

• _{The data collections in 3 phases:}

– _{First: in-depth interviews with 19 patients or}

their family members (carers)

– _{Second: in-depth interviews with 3 stakeholders}

– _{Third: FGD with hospital professionals}

(9)

Data management & analysis

•

Qualitative study:

–

In-depth & FGDs

–

Data analysis: thematic framework

analysis

–

Sorting and coding: Qualitative software

MAXQDA 11

(10)

Ethical considerations

10

•

Ethical issues: informed consent,

confidentiality of information,

voluntary participation and response

to health emergencies while carrying

out interviews

•

Full ethical review: ethical

committee, local government

approval

(11)

Study results & discussion

(12)

Conclusion

 _{No-class ward policy at Wates Hospital had}

effectively reduced the experiences of

patients on discriminatory treatment as well as improved quality of services.

 _{The policy had an impact on increasing}

hospital utilization significantly among both the poor and non-poor patients that support the success of the UHC program

 _{The policy had also improved the assurance}

of quality of services through building a

trustful relationship; patient empowerment and right; and developing clinical pathways.

12

(13)



Policy replication becomes an important

issue to scale up the policy to other

hospitals in the different regions in

Indonesia.



Future research needs to expand on our

work to compare the implementation of

no-class wards policy in other hospitals in

different regions in Indonesia considering

different local context.

(14)