Primary health care in the era of HIV/AIDS. Some implications for health systems reform

2002 ◽  
Vol 55 (6) ◽  
pp. 1005-1013 ◽  
Author(s):  
Inge Petersen ◽  
Leslie Swartz
Author(s):  
Ranti Suciati ◽  
Mujiati Mujiati ◽  
Novianti Novianti

Abstrak Semakin meningkatnya jumlah kasus HIV/AIDS di Indonesia, berdampak tidak hanya pada masalah kesehatan, memacu pemerintah untuk melibatkan masyarakat sipil dalam Organisasi Berbasis Komunitas (OBK) untuk ikut berperan dalam upaya pencegahan dan penanggulangan HIV/AIDS. Pentingnya identifikasi kendala atau hambatan yang dihadapi oleh OBK memunculkan strategi atau alternatif solusi untuk mengatasi kendala, serta memberikan gambaran model intervensi yang lebih sinkron antara pemerintah dan masyarakat. Desain penelitian adalah kualitatif dengan melakukan studi kasus di dua LSM Peduli AIDS di Jakarta. Informan dipilih secara purposive sampling yaitu pengurus, anggota/petugas, dan dampingan dari dua OBK. Pengumpulan informasi dengan wawancara mendalam berdasarkan pedoman wawancara dan diolah menggunakan metode content analysis. Kendala yang dihadapi OBK yaitu alur rujukan BPJS yang mengikuti domisili sehingga memberatkan pasien, kurang optimalnya koordinasi dan kerjasama antara OBK dengan Puskesmas, belum meratanya kualitas dan kapasitas SDM anggota OBK, persoalan administratif organisasi, sumber dana yang tidak selalu kontinu, adanya perbedaan kepentingan antara OBK dengan pihak kepolisian, serta masih tingginya stigma masyarakat terhadap penderita HIV/AIDS. Solusi mengatasi kendala OBK dilakukan dengan peningkatan efektifitas pelaksanaan program pemerintah melalui OBK, antara lain dengan penerapan fleksibilitas pengelolaan dana berdasarkan kinerja OBK, peningkatan kapasitas SDM, pemantapan sistem manajerial, pemahaman alur layanan kesehatan di Puskesmas, serta social support bagi penderita HIV/AIDS. Kata kunci: organisasi berbasis komunitas, LSM, HIV/AIDS Abstract The increasing number of HIV/AIDS cases in Indonesia that impact not only on health issues, spur the Government to involve civil society in community-based organizations (OBK) to play a role in HIV/AIDS prevention program. Identification of constraints or obstacles faced by OBK do as they can generate alternative strategies or solutions to overcome these constraints, and provide a more synchronous model of intervention between the government and the community. This type of research is a case study at two AIDS Awareness NGOs in Jakarta. The informants were chosen by purposive sampling ie the board, members/officers, and assistants from the two NGOs. Information collection with by in-depth interview based on interview guideline and processed using content analysis method. Constraints faced by the OBK is the issue of referral flow pathways that follow the domicile so burdensome patients, less optimal coordination and cooperation between OBK with primary health care, uneven quality and capacity of human resources of NGO members, organizational administrative issues, sources of funds that are not always continuous, different interests between the OBK with the police department, and the stigma. Reduction of obstacles faced by OBK can be done by increasing the effectiveness of government program implementation through OBK, among others by applying flexibility of fund management based on OBK performance, human resource capacity building, managerial system strengthening, understanding of health service flow in primary health care, and social support for patient HIV/AIDS. Keywords: community-based organizations, NGOs, HIV/AIDS


2002 ◽  
Vol 8 (2) ◽  
pp. 94
Author(s):  
Bala Mudaly

In November 2002, I undertook an extended visit to Thailand. I toured the urban centres and rural areas of north and north eastern Thailand. From reading the local newspapers, talking to local people, and from personal observations, I gained a sense of the more urgent social issues troubling this country: rural poverty, HIV/AIDS, the low status ofwomen, and corruption.


2006 ◽  
Vol 12 (3) ◽  
pp. 34 ◽  
Author(s):  
Christopher A Pankonin

HIV/AIDS continues to spread globally and deeply affecting resource-poor settings, with over 90% of cases occurring in developing countries. In these areas, primary health care remains the preferred model of health care delivery; advocating core principles including community involvement, equity, and an emphasis on disease prevention while providing basic medical treatment. The harm reduction paradigm shares key principles with primary health care, and as this paper will argue, a combined comprehensive HIV prevention strategy would provide a holistic and particularly effective approach to HIV prevention. The most important improvement achieved through a combined HIV prevention strategy is by providing the community with an increased number of social services including housing and employment services, financial counselling, mental health counselling, and referrals to additional medical services. In also addressing the social determinants of health, a combined primary health care and harm reduction approach act to provide a holistic disease prevention strategy that also seeks to address the conditions that lead to increased risk-taking behaviours. Additional evidence indicating a successful comprehensive prevention strategy remains closely tied to measures of effectiveness, including improvements in HIV prevalence and incidence rates, needle and syringe coverage, and treatment services for HIV/AIDS patients.


2014 ◽  
Vol 48 (spe) ◽  
pp. 145-151 ◽  
Author(s):  
Luciane Ferreira do Val ◽  
Lucia Yasuko Izumi Nichiata




This study aimed to identify programmatic vulnerability to STDs/HIV/AIDS in primary health centers (PHCs). This is a descrip - tive and quantitative study carried out in the city of São Paulo. An online survey was applied (FormSUS platform), involving administrators from 442 PHCs in the city, with responses received from 328 of them (74.2%), of which 53.6% were nurses. At - tention was raised in relation to program - matic vulnerability in the PHCs regarding certain items of infrastructure, prevention, treatment, prenatal care and integration among services on STDs/HIV/AIDS care. It was concluded that in order to reach comprehensiveness of actions for HIV/ AIDS in primary health care, it is necessary to consider programmatic vulnerability, in addition to more investment and reor - ganization of services in a dialogue with the stakeholders (users, multidisciplinary teams, and managers, among others).





2021 ◽  
Vol 16 (1) ◽  
pp. 31-38
Author(s):  
Yuen Ching Chan ◽  
Maliza Mawardi ◽  
Adibah Hanim Ismail@Daud

Background: Stigmatizing attitudes expressed by health care providers prevent some members of at-risk populations from accessing human immunodeficiency virus (HIV) screening and care. This attitude contributes to the continuity of the infection dissemination within our community, which gives an impact on the healthcare service and the curtailment of the global HIV/acquired immunodeficiency syndrome (AIDS) pandemic. Objective: This study was conducted to identify stigmatizing attitudes toward people living with HIV/AIDS (PLWHA) and their determinants among primary health care providers in Kinta District, Perak. Methodology: A cross-sectional study was conducted in 36 primary care clinics in Kinta District, Perak. Using stratified random sampling, 365 primary health care providers were recruited into the study. A validated self-administered questionnaire was used to obtain sociodemographic data as well as information on the healthcare experiences of healthcare providers, their knowledge of HIV/AIDS, and attitudes toward PLWHA. Determinants were identified using multiple linear regression. Results: More than half of the respondents (54.1%) had never provided care to HIV/AIDS patients. A minority (29.9%) had received training on HIV/AIDS. This study shows that doctors (Coef.= -9.50, 95% CI: -18.93, -0.07, p= 0.048), respondents with HIV-positive relatives, (Coef.= -5.61, 95% CI: -10.57, -0.65, p= 0.027), those who had provided care to HIV/AIDS patients (Coef.= -2.38, 95% CI: -4.31, -0.45, p= 0.016), and those with a higher knowledge score on HIV/AIDS (Coef.= -0.86, 95% CI: -1.59, -0.13, p= 0.021) were less likely to show stigmatizing attitudes toward PLWHA. Conclusion: The issue of stigmatizing attitudes toward PLWHA among primary health care providers needs to be addressed. This study finds that knowledge, profession, experiences with caring for PLWHA, gender, and having HIV-positive relatives are significant predictors of stigmatizing attitudes toward PLWHA among primary health care providers in Kinta District, Perak. Interventional programs to improve knowledge and awareness, as well as decrease stigma toward PLWHA, should be implemented among all health care providers, especially those who have no opportunity to provide direct care.


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