An implementation analysis on the program of hypertension disease service in Talaud islands district

INTRODUCTION

Health development in Indonesia continues to be carried out by involving various components including the government, the private sector, the community, professional organizations, and community organizations. The increase in life expectancy, the decrease in the prevalence of malnutrition, obesity, as well as infant and maternal mortality during childbirth are not in line with the prevalence of NCDs such as hypertension, diabetes mellitus, and ischemic heart disease.

In the last three decades, there has been a change in the burden of disease from communicable to NCDs. Indonesia experienced a significant increase in cases of NCDs such as diabetes mellitus, hypertension, and ischemic heart disease. This happens due to changes in the socio-economic status of the community which leads to changes in lifestyle.¹ In 2016, about 71% of the causes of death in the world are NCDs which kill 36 million people per year. About 80% of these deaths occur in middle- and low-income countries. The 73% of deaths are currently caused by NCDs, 35% of which are due to heart and blood vessel disease. Basic health research in 2018 showed that there was an increase in the prevalence of high blood pressure in the population aged 18 years and over which increased from 25.8% to 34.1%.^2,3 The prevalence of hypertension will continue to increase sharply, it is predicted that in 2025 around 29% of adults worldwide suffer from hypertension.⁴

Hypertension is a non-communicable disease whose prevalence continues to increase. Previous research had been carried out by researchers in 2020, namely the factors related to the occurrence of hypertension in Talaud district due to the number of cases of hypertension which ranks first for NCDs in Talaud regency in 2019. With the number of cases that ranks first with the level of achievement of indicators that have not been met, then in this study, the researcher analyzed the implementation of the hypertension disease services program in Talaud district.⁵ The purpose of this study was to analyze the implementation of the hypertension service program in Talaud district.

METHODS

This research is qualitative research with in-depth interviews. The research was conducted in Talaud district from June to October 2022. The informants in this study were: Head of the NCDs section at the Talaud district health office, the hypertension program manager at the Talaud district health office, the hypertension program holder at the Lobbo community health center. In addition to in-depth interviews, observations were also made on the implementation of the hypertension program. Interviews in this study using Indonesian. Data analysis was carried out by triangulation of sources, namely by comparing the answers given by informants and triangulation of methods by the tracing existing documents.

This study was approved by the institutional ethics committee.

RESULTS

Input

Human resources

The availability and capabilities of human resources (HR) greatly affect the implementation of a program or activity. In the implementation of the service program for hypertension, the availability of human resources is sufficient. There are 3 people in the Talaud district health office who carry out the hypertension disease service program, namely the head of the field, the head of the section, and the program manager. The hypertension officer at the Talaud district health office is tasked with providing the needs of hypertension services at the community health center as well as monitoring and evaluating hypertension services. The availability of resources at the community health center for the implementation of hypertension disease services at the health center consists of doctors and program managers.

Based on the results of interviews, the implementation of the hypertension disease program at the community health center is carried out with services at the community health center and services at the integrated coaching post. When carrying out services at the integrated coaching post, health workers are assisted by health cadres in each village. Some of the cadres who assist in the implementation of the integrated coaching post have attended training and some have never received special training on hypertension. In carrying out activities, the cadres assist in the implementation of registration, weighing of weight and height, and also provide information about hypertension based on information submitted by health workers.

Infrastructure

The infrastructure used in the service of hypertension is the place for the implementation of the integrated coaching post, KIT of the integrated coaching post consisting of blood pressure measuring devices, scales, height measuring devices, kits of blood sugar, uric acid, and cholesterol test along with sticks. For the availability of infrastructure such as the KIT of the integrated coaching post, not all integrated coaching posts have their own tools, thus 1 KIT of the integrated coaching post can be used in several integrated coaching posts. The availability of blood sugar, uric acid, and cholesterol test sticks is sometimes unavailable.

Fund

Based on the results of interviews, the budget used in the implementation of the hypertension disease program, for monitoring and evaluation activities, reporting by health service officers, and the procurement of KIT of integrated guidance posts sourced from the special allocation fund of the ministry of health. Meanwhile, the budget used by the community health center in the implementation of the program, especially for the implementation of the integrated coaching post, is sourced from the special operational assistance fund.

Implementation method

For the implementation of the hypertension disease service program, the community health center conducts screening of patients with early detection in the implementation of integrated coaching post activities with the 5-table method. After early detection, treatment of the patients is carried out at the community health center by the doctor on duty. The hypertension program manager at the health office monitors and evaluates the activities carried out by the program manager at the community health center and he/she then makes a report.

Process

The process of early detection and case finding

Based on the results of interviews, early detection was conducted with health services at the community health center and health services at the integrated coaching post. Case finding was carried out based on the results of the patient's blood pressure measurement, then followed by supporting examinations, namely weight and height examination, abdominal circumference examination, and examination of blood sugar, uric acid, and cholesterol. Early detection was carried out with a 5-table system, namely: the first table for registration, the second table for interviews, the third table for examination of weight, height and abdominal circumference, the fourth table for checking blood pressure, sugar, uric acid and cholesterol, the fifth table for risk factor identification and counseling.

Barriers encountered in early detection and case finding

Based on the results of interviews, there were still few people who had the awareness to check themselves at the integrated coaching post. This is because those who were served at the integrated coaching post were at productive ages, namely 15 to 59 years old, most of whom felt that at their productive age they were not at risk of developing hypertension. Another obstacle is that the integrated coaching post did not provide medication, thus only a few people came to do the examination. The unavailability of medicines at the integrated coaching post in accordance with the technical instructions for the implementation of the integrated coaching post, namely the integrated coaching post only performs early detection. Another inhibiting factor is the lack of budget allocated during the implementation of the integrated coaching post. The way to overcome these obstacles is that the hypertension management officer continues to conduct socialization and counseling about the importance of carrying out routine health checks to detect disease. This socialization was also carried out by the health cadres in community.

Management of hypertension cases

Based on the results of interviews with patients diagnosed with hypertension either through screening at the community health center or at the integrated coaching post, treatment was carried out at the community health center. Hypertensive patients with complications or who experience an emergency were referred to a regional hospital or referred directly to a hospital in Manado.

Output

Based on the results of interviews, the target for hypertension services has not been achieved. From the target set, the realization of hypertension service achievement for the age >15 years is 57.8%. Some of the obstacles encountered in the service of hypertension are the lack of availability of medicines, limited budget, and lack of public awareness to check themselves to health service facilities.

DISCUSSION

According to Notoadmodjo, health services are a sub-system of health services whose main purpose is preventive (prevention) and promotive (health improvement) services with the target of the community.⁶ As a system, health services consist of several elements that influence the realization of good health services consisting of input, process, and output elements.⁷

Human resources are the first and main factor in the development process and the achievement of organizational goals, HR (Human resources) is the driving force and implementer in the success of a program. Human resources are an integrated ability between the power of thought (mind) that has knowledge and experience with the physical power (skills) of each individual.⁸ In the input element, the availability of human resources in carrying out hypertension services in Talaud district is sufficient, both human resources at the district health office and human resources at the community health service center. In the management of hypertension prevention and control programs established by the ministry of health of the republic of Indonesia, cadres, social workers, community activists, and employees in the workplace can be involved in the early detection of hypertension.⁹ Resources in the implementation of hypertension consist of doctors, nurses, and cadres.

The availability of infrastructure is very supportive in the implementation of hypertension services. The availability of infrastructure will provide satisfaction not only to health workers but also to the patients with hypertension being served.¹⁰ Funding for hypertension services uses funds sourced from special allocation funds and special operational assistance funds. For the implementation of hypertension services, it is carried out by carrying out screening hypertension sufferers at the integrated coaching post (Posbindu) and treatment services for hypertension patients at the community health service center. Through the community health center and integrated coaching post, the community has easy access to detect or monitor their blood pressure.¹¹

Efforts to control NCDs, especially hypertension, are carried out for all people aged 18 years and over in two ways, namely control efforts in community and control efforts at community health centers.¹ Process of implementing screening of hypertension sufferers at integrated coaching post is in accordance with implementation guidelines, namely by conducting interviews, checking blood pressure, measuring weight and height and simple laboratory tests. Not only examining and registering patients but screening activities also provide education to the public about things that can be carried out to prevent hypertension.¹² Hypertension screening services in Talaud islands district are carried out by medical nurses and assisted by cadres. Treatment services for hypertension carried out by doctors.

Based on results of interviews, availability of human resources, funds, and infrastructure in the service of hypertension in Talaud district is sufficient but achievement of target for hypertension services in Talaud islands district has not been achieved. Some of factors causing non-achievement of service targets lack of public awareness to check themselves both for disease screening and treatment. Therefore, providing information about hypertension to public should be carried out continuously thus people can have awareness in checking themselves.

Limitations

Limitation of current study were still a lack of program holder informant at community health centers so for the further research it is necessary to add informants from other community health center.

CONCLUSION

The implementation of the hypertension disease service program in Talaud district is adequate in terms of the availability of human resources and infrastructure, but it is still necessary to add infrastructure and financing to the implementation of the hypertension program. The implementation of the hypertension service program is carried out with a community approach, namely the implementation of integrated coaching posts for early detection of hypertension and health services at community health centers for the treatment of hypertension. Public awareness of carrying out early detection of hypertension is still lacking, therefore it is necessary to continuously educate the public about the importance of early detection of hypertension thus the target coverage of hypertension services can be achieved.

ACKNOWLEDGMENTS

Author would like to thank the head of Talaud district health office who has allowed us to conduct the research. We are grateful for the informants who have provided information and the chairman of the institute for research and community development of Sam Ratulangi university who helped us in carrying out this research.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Health Ministry of Republic of Indonesia. Directorate of Non Infectious Disease Contro Sub Division Control of Heart Disease and Blood Vein. “Technical Guideline of Discovery and Administration of Hypertension”. 2013. Available at: https://p2ptm.kemkes.go.id/dokumen-ptm/pedoman-teknis-penemuan-dan-tatalaksana-hipertensi. Accessed on 12 October 2022.
2. 2. Health Ministry. General Directorate of Prevention and Control of Disease. “Guideline Book of Non Infectious Disease Management”. 2019. Avalaible at: https://p2ptm.kemkes.go.id/uploads/VHcrbkVobjRzUDN3UCs4eUJ0dVBndz09/2019/03/Buku_Pedoman_Manajemen_PTM.pdf. Accessed on 12 October 2022.
3. 3. Health Ministry The Board of Research and Health Development, 2018. "Hasil Utama Riskesdas 2018" Available At: https://repository.dinus.ac.id/docs/ajar/hasil-riskesdas-2018.pdf. Accessed on 22 May 2022.
4. 4. Health Ministry Republic of Indonesia. “Fact and Hypertension Number”. Fakta dan Angka Hipertensi -Direktorat P2PTM. Avalaible At: kemkes.go.id. Accessed on 5 February 2021
5. 5. Kolibu F, Mandagi C, Kawatu P. Factors associated with the occurrence of hypertension in the Talaud islands regency. Avalaible At: https://www.ijcmph.com/index.php/ijcmph/article/view/7565. Accessed on 22 May 2022.
6. 6. Notoatmodjo S. Ilmu Perilaku Kesehatan. Jakarta: Rineka Cipta. 2010.
7. 7. Azwar A. Pengantar Administrasi Kesehatan. Binarupa Aksara. Jakarta. 1998.
8. 8. Hasibuan M. Manajemen Sumber Daya Manusia. Jakarta: PT. Bumi Aksara. 2000.
9. 9. Health Ministry Republic of Indonesia Sub Directorate for Heart and Blood Vessel Diseases Directorateof P2PTM Directorate General of Disease Prevention and Control. Avalaible At: https://p2ptm.kemkes.go.id/uploads/VHcrbkVobjRzUDN3UCs4eUJ0dVBndz09/2018/05/Manajemen_Program_Hipertensi_2018_Subdit_PJPD_Ditjen_P2PTM.pdf’. Accessed on 12 October 2022.
10. 10. Kolibu DKK. Factors associated with the quality of health services for hypertension patients at adow community health center, Central Pinolosian Sub District South Bolaang Mongondow Regency. Int J Community Med Public Heal. 2022;9:2.
11. 11. Artyasari A. Pelaksanaan Program Intervensi Pada Penyakit Hipertensi di Puskesmas Purwoyoso Kota Semarang. J Kesehatan Masyarakat. 2021;9(3).
12. 12. Kiranti M. 2022. Implementation Analysis of Hypertension Control Program Based on Community Approach. Avalaible at: https://www.researchgate.net/publication/361357363_Analisis_Pelaksanaan_Program_Pengendalian_Hipertensi_Berbasis_Pendekatan_Masyarakat/link/62abe54d40d84c1401b09539/download. Accessed on 15 October 2022.