Digital Health to Strengthen District-Based Public–Private Mix Tuberculosis Control in Purwakarta District, Indonesia: A Qualitative Research
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Setting
2.2. Study Design and Sampling Method
2.3. Data Collection
2.4. Data Analysis
2.5. Ethics
3. Results
3.1. The Problem
3.1.1. Under-Reporting of TB Cases in the Private Health Sector
“All TB cases that I report to SITB were only CHC patients, private clinics in our work area have never reported TB cases to us.”(an NTP staff member in a CHC)
3.1.2. Lack of Awareness
“We didn’t know that TB cases had to be reported by name by address, I only report the top ten disease in my clinic to CHC.”(a doctor in private clinic)
“I only examine patients, if anyone is diagnosed with TB, I write it down in the medical record. I don’t know about TB case recording and reporting.”(a doctor in private clinic)
“We have never known or used a WIFI TB application.”(private physician)
3.1.3. Lack of Communication
“Referral patients with incomplete data will be a problem in reporting system, I gave the medicine but I didn’t enter patient data into SITB.”(an NTP staff member in a CHC)
“Patient referrals are not accompanied by clear information about treatment categories, history of examinations and medications that were given to patients, it makes us confused to continue patient’s treatment”(an NTP staff member in a CHC)
“I have a child patient with TB meningitis, there must be adult TB patients around the child. Who is in charge of conducting contact investigation? I can’t do it.”(a pediatrician)
3.1.4. Limitation of Existing Information System
“Currently SITB can only be accessed by regional general hospital, 20 CHCs, and 5 private hospitals that already have an MoU with NTP.”(an NTP staff member in DHO)
“Yes, I have heard about the WIFI TB application, but I can’t see TB patient data reported by private doctors.”(an NTP staff member in DHO)
3.2. Expectations of Digital Health
3.2.1. Ethical Issues
“TB patient data should not be open to all application users, patient can be angry and embarrassed.”(a doctor in CHC)
“My cadre and I once conducted a contacts investigation around the TB patient’s house. We asked the head of the neighborhood for permission. But the patient became angry because the head of the neighborhood knew his illness.”(an NTP staff member in a CHC)
3.2.2. Avoid Redundancy
“I prefer using the application for TB case reporting, paper-based reporting is a hassle for me. I hope I don’t have to report using paper anymore.”(private physician)
“Can the new information system be connected to SITB? Lest we have to repeatedly input TB patient data.”(a doctor in CHC)
3.2.3. User-Friendly
“I hope the application is easy to use by all ages, both young and old, because many health workers are old.”(a doctor in public hospital)
“I don’t have time to come to CHC, I’m too busy taking care of patients. If there is an application, I can easily report TB cases.”(a doctor in private clinic)
3.2.4. Intervention Package
“There needs to be an understanding between private and public health sectors otherwise any program will not work no matter how good it is.”(an NTP staff member in DHO)
“Private doctors need to be explained about their role in the TB program and there needs a MoU to strengthen their commitment.”(an NTP staff member in a CHC)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
CHC | Community health center |
DPPM | District-based public–private mix |
FGD | Focused group discussion |
GP | General practitioner |
MDR-TB | Multidrug-resistant tuberculosis |
MoU | Memorandum of understanding |
NTP | National tuberculosis control program |
SITB | Sistem informasi tuberkulosis |
SITT | Sistem informasi tuberkulosis terpadu |
TB | Tuberculosis |
XDR-TB | Extensively drug-resistant tuberculosis |
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In-Depth Interview | Focus Group Discussion | ||||
---|---|---|---|---|---|
N | Percentage (%) | n | Percentage (%) | ||
Gender | Male | 12 | 26.1 | 1 | 11.1 |
Female | 34 | 73.9 | 8 | 88.9 | |
Profession | Doctor | 34 | 74 | 7 | 77.7 |
Nurse/midwife | 6 | 13 | - | - | |
NTP staff | 6 | 13 | 2 | 22.3 | |
Sector | Public | 23 | 50 | 4 | 44.4 |
Private | 23 | 50 | 5 | 55.6 | |
Institution | CHC | 20 | 43.5 | 4 | 44.4 |
Private physician | 10 | 21.7 | 2 | 22.2 | |
Private clinic | 8 | 17.4 | 2 | 22.2 | |
District Health Office | 8 | 17.4 | 1 | 11.2 |
Category | Source of Information |
---|---|
The problem | |
| NTP staff (6 persons) Private physician (3 persons) Private clinic (2 persons) |
| NTP staff (6 persons) Private physician (4 persons) Private clinic (4 persons) |
| NTP staff (6 persons) Private physician (4 persons) Private clinic (3 persons) |
| NTP staff (6 persons) Private physician (4 persons) Private clinic (2 persons) |
Expectation of digital health | |
| NTP staff (2 persons) Doctor in CHC (2 persons) Private physician (1 person) |
| NTP staff (2 persons) Doctor in CHC (2 persons) Private clinic (1 person) |
| Doctor in CHC (1 person) Private physician (2 persons) |
| NTP staff (2 persons) |
Health Care Facilities | 2018 | 2019 | 2020 |
---|---|---|---|
Public | |||
Community health centres | 1073 | 1120 | 1012 |
Public hospital | 103 | 294 | 254 |
Private | |||
Private hospital | 0 | 735 | 353 |
Private clinic and private physician | 0 | 0 | 0 |
Total | 1176 | 2149 | 1619 |
Stakeholder | Public | Private |
---|---|---|
Primary health care | All CHC have used (20 CHC) | No one has access yet (57 private physician and 92 private clinics) |
Secondary health care | Regional general hospital has used (the only one hospital) | Only 5 from 11 hospital have used |
Pharmacy | Already have access but have not used it (20 units public pharmacies at CHC and 1 unit at regional general hospital) | No one has access yet |
Laboratory | All laboratories have used (20 units public laboratory at CHC and 1 unit at regional general hospital) | No one has access yet |
Cadre | - | No one has access yet |
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Share and Cite
Paskaria, C.; Sunjaya, D.K.; Parwati, I.; Bestari, M.B. Digital Health to Strengthen District-Based Public–Private Mix Tuberculosis Control in Purwakarta District, Indonesia: A Qualitative Research. Int. J. Environ. Res. Public Health 2022, 19, 12097. https://doi.org/10.3390/ijerph191912097
Paskaria C, Sunjaya DK, Parwati I, Bestari MB. Digital Health to Strengthen District-Based Public–Private Mix Tuberculosis Control in Purwakarta District, Indonesia: A Qualitative Research. International Journal of Environmental Research and Public Health. 2022; 19(19):12097. https://doi.org/10.3390/ijerph191912097
Chicago/Turabian StylePaskaria, Cindra, Deni Kurniadi Sunjaya, Ida Parwati, and Muhammad Begawan Bestari. 2022. "Digital Health to Strengthen District-Based Public–Private Mix Tuberculosis Control in Purwakarta District, Indonesia: A Qualitative Research" International Journal of Environmental Research and Public Health 19, no. 19: 12097. https://doi.org/10.3390/ijerph191912097