ASSESSING FIDELITY OF COMMUNITY BASED DOTS PROGRAM IMPLEMENTATION AND PATIENT SATISFACTION TOWARDS COMMUNITY BASED DOTS IN DISTRICT WITH HIGH TREATMENT SUCCESS RATE AND LOW TREATMENT SUCCESS RATE OF NEPAL: A QUALITATIVE RESEARCH

Merina Joshi, DR.Dra. Retna Siwi Padmawati, MA

2018 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Latar Belakang: DOTS Berbasis Masyarakat sedang dilaksanakan di 21 kabupaten dengan visi untuk memperluas di semua 75 distrik pada 2021. Namun, bahkan setelah implementasi CB-DOTS, tidak semua kabupaten menunjukkan peningkatan TSR, dengan beberapa kabupaten menunjukkan penurunan tren, yang menyoroti bahwa baik CB-DOTS belum dimulai di seluruh kesehatan fasilitas di distrik atau mungkin belum diimplementasikan secara efektif. Oleh karena itu penting untuk mengetahui bagaimana CB-DOTS sedang dilaksanakan di Nepal dengan mengukur kesetiaan implementasi. Kami mengeksplorasi kepatuhan terhadap pedoman CB-DOTS nasional oleh Penyedia DOTS, kualitas layanan yang diberikan oleh pengawas pengobatan dan pasien kepuasan terhadap CB-DOTS di kabupaten-kabupaten dengan TSR rendah dan tinggi. Metode: Penelitian kualitatif dilakukan di 8 fasilitas kesehatan dari Chitwan (TSR rendah) dan distrik Palpa (TSR tinggi). Delapan wawancara mendalam (IDIs) dengan orang fokus DOTS, 5 diskusi kelompok dan 3 FGD mini dilakukan dengan FCHV dan 18 IDI dengan TB pasien dilakukan. Data sekunder juga dinilai untuk jangka waktu 1 tahun. Hasil: Data sekunder menunjukkan tingkat keberhasilan pengobatan adalah 100% dan pengobatan interupsi tidak berarti. Ada sedikit variasi dalam kepatuhan terhadap CB-DOTS panduan antara 2 kabupaten. Namun di kedua kabupaten itu ada keseragaman pemilihan pengawas pasien dan pengobatan, pasokan obat untuk pengobatan pengawas dan pencatatan dan pelaporan. Kurangnya pelatihan untuk pengobatan pengawas di kedua kabupaten. Pada beberapa pasien ada keterlambatan diagnosis dan inisiasi pengobatan. Namun pasien sangat puas dengan CB-DOTS karena ketersediaan obat dekat ke rumah mereka dan dukungan dan perawatan yang diterima dari perawatan pengawas. Kesimpulan: CB-DOTS dikaitkan dengan tingkat keberhasilan pengobatan yang tinggi. DOTS kepatuhan penyedia terhadap pedoman CB-DOTS adalah suboptimal. Dari penelitian ini kami juga menangkap kebutuhan untuk perbaikan dalam pemberian layanan oleh pengawas pengobatan. Secara keseluruhan, kepuasan pasien terhadap CB-DOTS di kedua kabupaten itu tinggi.

Background: Community Based DOTS is being implemented in 21 districts with a vision to expand in all 75 districts by 2021. However even after implementation of CB-DOTS, not all of the districts shows improved TSR, with some districts showing decreasing trend, which highlights that either CB-DOTS hasnt been initiated throughout all health facilities in the districts or may be it hasnt been effectively implemented. Hence it is important to find out how CB-DOTS is being implemented in Nepal by measuring implementation fidelity. We explore the adherence to national CB-DOTS guideline by DOTS providers, the quality of service provided by treatment supervisors and patient satisfaction towards CB-DOTS in districts with low and high TSR. Method: A qualitative study was conducted in 8 health facilities from Chitwan (low TSR) and Palpa (high TSR) district. Eight in- depth interviews (IDIs) with DOTS focal person, 5 group discussions and 3 mini FGDs were conducted with FCHVs and 18 IDIs with TB patients were conducted. Secondary data was also assessed for time period of 1 year. Result: Secondary data indicated the treatment success rate was 100% and treatment interruption was negligible. There was slight variation in adherence to CB- DOTS guideline between 2 districts. However in both the districts there was uniformity in selection of patient and treatment supervisors, supply of medicine to treatment supervisors and recording and reporting. There was lack of training to treatment supervisors in both the districts. In some patient there was delay in diagnosis and treatment initiation. However patients were highly satisfied with the CB-DOTS due to availability of medicine near to their home and support and care received from treatment supervisors. Conclusion: CB-DOTS was associated with high treatment success rate. DOTS providers adherence to CB-DOTS guideline was suboptimal. From the present study we also captured the need for improvements in delivery of service by treatment supervisors. Overall, patient satisfaction towards CB-DOTS in both districts was high.

Kata Kunci : TB, community based, fidelity, adherence, guideline, quality of service, patient satisfaction, qualitative, barriers