implementing social determinant of health
TRANSCRIPT
Machmud,R1 , Azkha,N2 , Masrul1, Symond,D2 , Semiarti,R1
1Faculty of Medicine, Andalas University, West Sumatera, Indonesia2Faculty of Public Health, Andalas University, West Sumatera, Indonesia
Implementing Social determinant of Health through Social capital and Empowerment of the Jati Village to Reduce Inequities in Health
Presented in the 8th National Public Health Conference 2016. 2-4 August 2016. Hotel Equatorial Melaka
PROBLEMS▪ The weakness of community level health service is a
major concern for health promotion in Indonesia.
▪ These services barely maintain current community healthcare needs and struggle to generate long-term changes.
▪ The development of sustainable local health programs and services is critical.
GOALS▪ To identify implementation processes in Jati Village,
Indonesia that strengthen community-based health services and
▪ To evaluate the 5-year health impacts and sustainability.
CONCEPT RELATED
WHAT IS SOCIAL CAPITAL ?DEFINITION
Putnam, Leonardi & Nanenetti (1993:167) define social capital as those “features of social organization, such as trust, norms, and networks that can improve the efficiency of society by facilitating coordinated actions”.
Social capital describes the pattern and intensity of networks among people and the shared values which arise from those networks.
SOCIAL CAPITAL
Community Social CapitalModelUniversity
Minnesota 2009
METHOD
Applying the 4 pillars of the action health model empowerment, capacity building, equipment & attractive activity
Deliberating and brainstorming with the community about their problems to co-produce solutions
Mapping the determinant of health problem ; 400 respondents including key container-pupal survey
Phase 1 Phase 2 Phase 3
Phase 1
Mapping the determinant of health problem
The Potential problem at Jati villageObservation & Interviews
The attitude of the community : Throwing away all garbage in the environment
THE GRAPH OF MALNOUSRISHED CHILDREN UNDER 5-YEARS OLD AT EVERY DIVISION OF SUB DISTRICT AT JATI VILLAGE
0
5
10
15
20
25
RW 1 RW 2 RW 3 RW 4 RW 5 RW 7 RW 8 RW 9 RW 10
6 6
20
1817
24
1819
11
01
4
01
32
01
NORMAL MALNOURISHED
11
There are pregnant women with high-risk bearing (25,9%)
Malnutrition in Children under 5-years old
(8,5%)
High risk26%
Low risk74%
Pregnant women
High risk Low risk
Normal 91%
Malnourished
9%
Malnourished
Normal Malnourished
12
PUPAL SURVEY
Deliberating and brainstorming with the community Phase 2
VILLAGE SOCIETY MEETING
▪ The citizen are curious and enthusiastic to discuss the solution of their problems
15
BRAINSTORMING▪ The chief of Jati village, with the
citizens & society figures, is committed to establish groups to manage & coordinate the interfering activities of the primary problem, existing in Jati village
▪ The chief announced to establish working groups to manage all social activities in the environment as well as society health in Jati village
16
Phase 3
Applying the 4 pillars of the action health model
THE ACTION HEALTH MODELS
EMPOWERMENT
CAPACITY BUILDING
EQUIPMENT
ATTRACTIVE ACTIVITIESCOMPANY LOGO
No Plan of activities Time Target Person in charge Goals
1. Jati village society meeting aboutsociety empowerment
Date: 17-02-2010 time:20.00 WIB.
Society figure &youth
Collagestudent &chief of thevillage
To make commitment together howimportant the organization is
2. Encouraging society throughcooperation from the youth centrelocation to their own house
Date: 21-02-2010Time: 09.00 AM
Society & youth Collegestudent
To increase the participation as wellas the solidity of the exsisstingproject
3. Empowering the society throughthe planting of the herbal plants intheir house yard
Date:21-02-2010Time: 09.00 AM
Society & youth Collegestudent
To empower the appointed society
4. Running The green program bypartnership approach, with Padangcleanliness & gardening office. Asimpact, the community received50 young palm trees then with theyouth do the planting
Date: 21-02-2010Time:09.00 AM
Society & youth Collegestudent
To established partnership approachwith Padang cleanliness & gardeningoffice in ordered to increase theparticipation of the youth
5. Guiding the young generationthrough setting up a simple sportcourt
Date: 21-02-2010 time:09.00 WIB
Society & youth Collegestudent
To re-function the simple sport courtas a mean of society sport centre
6. Building a public toilet at youthcentre
Date: 21-02-2010Time: 10.00 AM
Society & youth Collegestudent
To support society activities at youthcentre
7. Refreshing the cadre of BuahDelima I & IV integrated healthservice
Date:23-02-2010Time:02.00 PM
Cadre Collegestudent &public healthcentre officer
To increase the cadre knowledgeabouth the five table system of theintegrated health centre
19
No Plan of activities Time Target Person in
charge Goals
8. Counseling about entepreneurship in suporting health programs.
Date: 25-02-2010 Time: 7.00 PM
The 3rd SubGroup of Jativilage
EnterpreneurJCC
to motívate the citizen and theyouth to be enterpreuner.
9. Creating and setting the boardof integrated service post and youth
Date: 28-02-2010 time: 09.00 AM
Youth centre College student There is a name board of the youth center.
10 Creating and sticking healthposter.
Date:28-02-2010time: 09.00 AM
Youth centre College student As health information in youthcentre
11 Creating and sticking societyorganization chart.
Date:28-02-2010time: 09.00 AM
The youth andsocietyorganization
College student Empowering to each existingorganization.
12 Counceling the behavior ofclean & healty life style insupporting the increase ofthe health of society
Date: 28-02-2010time: 04.00 PM
The youth andsociety
College student The improvement of theknowledge of the society inorder that they are able to beactive in health field.
13 Activiating “the distributingthousand for health” eachhouse hold
Date: 04-03-2010time : 01.00 PM
society College student& Public healthcentre
Searching the potencial fundsin society.
14 Relocating integrated servicefor health “ buah Delima 1” toyouth centre
Date:04-03-2010Time :10.00 AM
cadre Collegestudent, Publichealth centre &chief of subdistrict
To optimallize the use of youthcentre
15 Counseling as well asrecycling about all garbage
Date:04-03-2010time:11.00 AM
society College student To motivate citizen & youth toenterpreune
20
▪ Growing the family-herbal plants (TOGA)
▪ Performing social working cooperation with citizens and college students
Guiding the young generation in restoring the sport youth centre “volley courtyard”
Counselling also included information about garbage recycling.
Counselling on the behavior of clean & healty life style.
Relocating integrated service for health service center “ buahDelima 1” to youth centre
Activating “the thousand rupiahs charity for health” from each house hold
2010-2015
SUSTAINABILITY-AFTER 5 YEARS
PRE SCHOOL EDUCATION CALLED PAUD
THE CHILDREN AGED 2-5 YEARS ARE IN SCHOOL 3 TIMES IN A
WEEK
2010
Start of the project 2009 – new building 2011 – fences 2012 – continue until 2016
28
ADDITIONAL BUILDING FOR THE MULTIPURPOSE
ACTIVITY 2011
BUILDING BASED ON COMMUNITY FUNDING AID
2011
The inauguration of the business unit by The former ministry of
welfare in 2012
The community members donated some money to the business unit,
and the agency manages the turnover of the money. Some of the profits will be used for community
development in 2012
2012
New building in 2013, the development continues each year
Sustainability and development of public utility 2009 -2015
2009
2015
33
This environment after being renovated
They separate between organic and
inorganic rubbish
The environment is clean, no
garbage in ditch
OUTPUTS
Succeed to initiate and drive the processes of
social changes
The Improvement of living conditions
conducive to health
Get Multiplier Effects
OUTCOMES
Fostering the growth of some other community based actions
The availability of health care for
senior citizen
The availability of pre school
education
The availability of income generating activities
IMPACTS
Community demonstrates
trust and confidence in each other
Community helps each other and
enables them to be the
member of social group
Community becomes
successful in social, cultural,
and health terms
RESULTS
▪ Result of the pupal survey in pre and post intervention within 6 month showed that the number of positive containers decreased from 33.3% into 4%.
▪ The occurrence of dengue hemorrhagic fever in Jati village has decreased within 5 years and become null.
0
5
10
15
20
25
30
35
40
45
Pre-Intervension Post-Intervention
Negative 30 43Positive 15 2
Negative
Positive
CONCLUSIONSCreating community based health service programs with lasting effects requires a deliberate, thoughtful approach to planning, leading &collaborating.
Building an effective, integrated & sustainable system from bottom-up is an important step in improving the overall health & well-being of a community.
Activities as the foundations for a well-balanced social system, health literacy at the individual and community levels, social capital which favors mutual collaboration between social agencies, all generate sustainability of this system itself
