Implications Of The Covid-19 Pandemic On The Fulfillment Of The Right To Health Of Toddlers In Integrated Health Post In Indonesia
Ontran Sumantri Riyanto1*, Retno Mawarini Sukmariningsih 2, Sri Mulyani 3, David Maharya Ardyantara4
1, 2, 3,4 Universitas 17 Agustus 1945 Semarang Indonesia
Every child has the right to obtain a decent condition to grow and develop healthily. In the current situation of the COVID-19 pandemic, health services for children, especially toddlers in Indonesia, are not fulfilled to the maximum, due to fears from parents of toddlers to bring their toddlers to the Integrated health post. This is precisely the right of the child to health is not fulfilled. The participation of the government and society during the covid-19 pandemic should still pay attention to the rights of children, especially the right to health. The right to health of toddlers during the covid-19 pandemic can still be fulfilled if integrated health post and parents of toddlers continue to apply health protocols by wearing masks, keeping their distance and washing hands with soap. The role of integrated health post is crucial in realizing community independence through community empowerment in changing behaviours and the environment, especially for health services for toddlers. The research method used is normative juridical by utilizing the provisions of human rights law that places children's rights, especially toddlers, as an essential part of fulfilling the right to health. Research shows that the guarantee and protection of the right to health of toddlers need to be done in a planned manner by the government and health service providers even during the pandemic. Things that happened in the field seemed that the legal policy issued by the government during the pandemic covid-19 was not able to be adequately implemented because the community, especially the parents of toddlers, are still afraid and worried about bringing their toddlers to get health services in posyandu, even though posyandu has been implemented by health protocol.
Keywords: Integrated Health Post, Children's rights, right to health, toddlers, covid-19
Health development is one of the issues that cannot be separated from national development efforts(Kemenkes RI 2019). The success of health development will affect the availability of quality human resources in a country. Indonesia's health development in the period 2015-2019 is a Healthy Indonesia program to improve the community's health and nutritional status. The results of primary health research (RISKESDAS 2014) stated that the data of underweight toddlers is 19.6%, with the prevalence of stunting (short and very short) in children and clowns (under two years) of 32.9%. The malnutrition rate increased compared to RISKESDAS data in 2010 of 17.9% and RISKESDAS 2007 of 18.4%(National Institute for Health Research &
Nutritional status can be an indicator in determining the degree of health in children(World Health Organization 2017), especially toddlers. The United Nations International Children's Emergency Fund (UNICEF) explains two direct causes of malnutrition in children(UNICEF, WHO, and World Bank 2020): the lack of nutritional intake from food consumed and diseases
resulting in infection. The nutritional status of toddlers, which is an indicator of health, will indirectly affect the infant mortality rate.
Every child has the right to enjoy a prosperous life(wearmouth, 2012), in the sense of obtaining decent conditions to grow and develop healthily. One way in achieving child welfare is that every child is entitled to health services by law no. 35 of 2014 on child protection. One of the efforts made by the government is through the integrated health posts program. Integrated health post (Setiawan and Christiani 2018) is a form of community resource health efforts managed and organized by the community and for the community in carrying out health development, empowering the community, and providing convenience to the community in obtaining essential health services for mothers and toddlers.
Integrated health posts , as the spearhead of health services throughout indonesia, is also the vanguard in breaking the chain of covid-19 transmission because it is located in every village and has a regional concept. In this covid-19 pandemic(Daniel 2020), integrated health posts needs to make various efforts in handling the prevention and restriction of infection transmission. The role of integrated health posts is vital in realizing community independence through community empowerment in changing behavior and environment, especially for health services for toddlers(Welasasih et al. 2012).s
Effective anticipation planning will prepare the way for the health system's transformation(mardiansyah, 2018) and make the health system better prepared to deal with disruptions and reduce the potential risk of such disorders in the future. Adaptation must be oriented towards strengthening service toughness and rapidly increasing the potential for rapid development of covid-19(chen et al., 2020) treatment capacity while ensuring safe access to quality essential health services.
Frontline service providers need to expand covid-19 screening and isolation capacity as well as triage for all patients, including the reorganization of premises and collecting reserves of personal protective equipment (ppe) and appropriate infection prevention and control (ppi) supplies(who, 2020), such as hand hygiene products and disinfectants for environmental decontamination.
Consultations with health workers need to be scheduled to avoid crowds in the waiting room if this practice permits. The waiting room must be rearranged to maintain physical distance. The number of visitors and visiting hours should be severely limited. Where possible, to minimize unnecessary contact between patients and staff, facilities need to rearrange processes and rooms so that visitor traffic flows can go one way.
The approach method used in this research is a sociological juridical approach, which is a study that can discuss the juridical aspects and, at the same time, discuss the social factors that cover specific legal symptoms. The research conducted is explanative. This study aims to connect variables about juridical studies of integrated health posts role during the covid-19 pandemic to fulfill the right to health in children under five years old. The data collection method in this research uses interviews and qualitative documentation studies.
Results and Discussion
The covid-19 pandemic is a sudden and rapid situation(ji et al., 2020). The condition is certainly very influential for human life. During the covid-19 pandemic(liu et al., 2020), public health efforts continue to be implemented about the priority scale. Integrated health posts continues to carry out essential services to meet the needs of the community for health services in toddlers, carried out by different methods or techniques, postponed implementation, or completely unable to be implemented, of course by paying attention to the rules of infection prevention and control (ppi) and physical distancing to break the chain of transmission. Integrated health posts can be implemented with strict requirements such as applying ppi and physical distancing principles by the letter of the minister of home affairs to the governor and regent / mayor no. 094/1737/bpd dated april 27, 2020, concerning integrated health post operations (integrated health posts ) in preventing the spread of covid-19.
The role of integrated health posts (tse et al., 2017) is vital in efforts to fulfill health rights in toddlers because integrated health posts can monitor nutritional status (psg). Nutrition screening in children under five can be an early indicator in determining the degree of health and additional programs with immunotherapy, vitamins, and supplementation feeding in integrated health posts . Integrated health posts is an efficient effort in improving better health for toddlers.
Implementation so that integrated health posts servants as expected in the community, the government of indonesia has published a regulation on guidelines for integration of basic social services in integrated service posts. Integrated health posts established in each region is developed according to the needs, problems, and capabilities of existing resources. Integrated health posts activities include registration, weighing, recording, health services, health counseling, accelerating food diversity, and improving the family economy(handajani et al., 2012). Essential social services in integrated health posts also provides direction to the community, especially for mothers and toddlers, namely: (a) nutrition and health coaching aimed at mothers, infants, and toddlers. (b) disease control and environmental health. (c) clean and healthy living behavior. (d) family development of toddlers (bkb) for children aged 0 to 5 years and pregnant women. (e) early childhood education post (paud) for children aged 0 to 6 years fulfill.
In its implementation integrated health posts , which has been integrated, dramatically affects efforts to fulfill the right to health in toddlers optimally in integrated health posts services.
Integrated health posts has not been integrated, or integrated health posts with primary status, average, and children's full privileges in obtaining health services have been fulfilled but not optimally.
Community and rural empowerment agency (bapermasdes) is an institution that regulates integrated health posts planning programs and is cross-sectoral from the health office and has a role in planning integrated health posts programs. Community empowerment agency and pedesan make various efforts in improving the degree of health, namely the existence of an
integrated integrated health posts program by the regulation of the minister of home affairs no.
19 of 2011 on guidelines for integration of basic social services in integrated health posts .
In integrated health posts , cadres are volunteers recruited from by and for the community who are tasked with helping the smooth running of health services and are willing to move the organization to carry out and follow integrated health posts activities. Cadres also play a role in determining the success of the achievement of integrated integrated health posts programs derived from integrated health posts , bkb, and paud by the mutual agreement, as well as mothers of toddlers who are mothers who have children 0-5 years old who live in specific regions and are willing to participate in integrated health posts activities. This is by article 1, number 12 of the minister of health regulation no. 25 of 2014 concerning children's health efforts.
In the role of integrated health posts cadres who actively motivate mothers of toddlers to continue to follow and bring their children to come to integrated health posts held once a month by giving rewards to mothers of toddlers if in a year they can follow integrated health posts eight times. This is one form of cadres' activeness in improving health, especially children under five in the community.
As a form of increasing cadres' independence, it is necessary to conduct training, training cadres on integrated health posts activities, and the need for a regular schedule in the implementation of integrated health posts activities. Cadres need to be explained about the function of integrated health posts and integrated health posts benefits for cadres and mothers who use integrated health posts activities as a form of good social sense and beneficial for the environment so that the cadres will get a positive response from mothers who have toddlers so that they seem friendly and useful and service regularly. This encourages mothers to visit integrated health posts diligently.
Thus, the existence of integrated health posts is beneficial, namely(carolina et al., 2019):
Obtaining the ease of getting necessary health information and services, especially related to the decrease in maternal health figures and infant mortality. Obtain professional assistance in solving health problems, especially maternal and child health. Efficiency in obtaining integrated health services and other associated sectors.
b. Cadres, integrated health posts management, and community leaders
Get previous information about health efforts related to the decrease in maternal health figures and infant mortality rates. Able to realize the actualization of itself in helping the community solve health problems related to the decrease in maternal health figures and infant mortality.
c. Community health center (Puskesmas)
Optimization of health centers' function as the driving center of health-oriented development, community empowerment centers, first strata health care centers. Can more specifically help the community in solving health problems according to local conditions. Improving the efficiency of time, energy, and funds through integrated service delivery
The government of indonesia has designated coronavirus disease 2019 (covid-19) as a non- natural disaster in the form of an outbreak or pandemic(hassan et al., 2020); this determination is
followed by efforts to prevent the spread of the coronavirus through social restrictions including crowd restrictions(nicola et al., 2020), travel restrictions, the enforcement of isolation, delays and cancellations of events, as well as the closure of facilities and public service arrangements. In many places, temporary dismissal of specific health services will result in a large build-up of unmet health care needs. Stalled prevention programs, including screening, may require follow- up campaigns to catch-up, for example, for immunization. On the other hand, procedures that were initially seen as elective procedures may soon turn into an urgent need. Due to the need for health workers, close contacts, and related material resources, such as operating tables and complete personal protective equipment (ppe), the return of operating services requires a well- coordinated and well-planned strategy. The possibility of increasing the number of requests and urgency of health services compared to the necessary conditions (baseline) that occur in a prolonged period needs to be considered in the planning.
This condition also affects health services' schedule and procedures in integrated health posts , puskesmas, and other health facilities, including the private sector. Some parents are worried about coming to integrated health posts , such as immunizing toddlers, and not a few health workers are hesitant to conduct immunization services amid the covid-19 pandemic.
Different countries have different policies for public health and social measures implemented to limit the transmission of covid-19, and their approaches to loosening such standards also vary.
Policies that restrict movement to contain information can create barriers to access to health care and will affect the road map of returning services as before.
Essential health services in integrated health posts (saepuddin et al., 2018) are part of efforts to fulfill the right to health to toddlers. Every baby and toddler has the request from the womb, born to grow. With conditions that are still very weak, babies must be given protection by the state with the regulation that every child has the right to live, grow and develop by paying attention to the health and nutritional intake received by the baby. The role of integrated health posts as a form of government cooperation with the community is constructive in providing information and health services to mothers and toddlers. This is done to reduce maternal and child mortality.
The right to children's health(unicef, 2016) is part of every person's request when he/she is born into the world and has since attached himself to the human right as a living human being. So that toddlers also have the same rights in getting good health services in integrated health posts . Maintaining the health of toddlers(riley et al., 2018) is also inseparable from the attention to nutritional intake obtained for toddlers. The government always reminds them through health services in the community, integrated health posts , to implement an exclusive breast milk program to maintain health for toddlers. Efforts to preserve toddlers' health should be aimed at preparing future generations who are healthy, intelligent, and qualified and to lower infant and child mortality rates. This health maintenance effort is carried out since the child is still in the womb, born, after birth, and until the age of 18 (eighteen) years. Efforts to maintain toddlers' health(fontana et al., 2011) are also carried out by immunizations aimed at maintaining immunity for the toddler.
Further immunizations were also given to children aged 18 months, namely dpt/hb/hib and measles immunizations in children aged 24 months. Maintaining the condition of toddler resilience is also a necessary intake of vitamins. Vitamin a capsules are administered once for children aged 6 (six) months to 11 (eleven) months and 2 (two) times a year for children aged 12 (twelve) months to 60 (sixty) months. In addition to vitamins, supplemented feeding other than breast milk or so-called breastfeeding (mp-breast milk) is carried out at the age of 6 (six) months to 24 (twenty-four) months.
Baby and child health care efforts(who, 2017), aim to prepare future generations of healthy, intelligent quality from still in the womb until the age of 18, which is the responsibility and obligation of parents, families, communities, and government to reduce infant and child mortality. So the need for good parenting patterns by looking at monitoring growth, development, and monitoring of developmental disorders to keep children entitled to health.
The role of integrated health posts in efforts to fulfill the right to health in toddlers during the covid-19 pandemic continues to run by health protocols. However, in the implementation, there are still some mothers who have not been active in controlling their toddlers to integrated health posts . For integrated health posts , whose performance has not been integrated due to various factors, namely the region's condition, the activeness of cadres, the activeness of mothers of toddlers, the level of education of cadres and mothers of toddlers, and so on. The barriers that integrated health posts experienced during the covid-19 pandemic to fulfill the right to health in toddlers due to factors in the number of cadres, the regeneration of cadres, and the interest of community participation to become integrated health posts cadres. Also, some tasks are carried out by cadres and even economic problems. Integrated health posts cadres work socially so that many mothers prefer to make a living, especially during the covid-19 pandemic where there is a decrease in economic power in all communities, including cadres' financial condition. Also, it is expected that every cadre in integrated health posts should continue to participate in training held at puskesmas in preparing the implementation of tasks in integrated health posts related to essential health and nutrition in children under five during the covid-19 pandemic.
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