IDENTIFIKASI DAN EKSPLORASI FAKTOR-FAKTOR YANG MEMPENGARUHI RENDAHNYA CASE DETECTION RATE DALAM PROGRAM TUBERCULOSIS DI KELURAHAN CIPINANG, JAKARTA T

Written by Luxi Riajuni Pasaribu

Abstract. Indonesia has adopted the DOTS strategy since 1994, but it still has the third largest TB cases in the world. The DOTS facilities population coveraged was 98% in 2000, but the Case Detection Rate (CDR) which is one of the key objectives in eliminating TB, was only 19% in 2000 and 21% in 2001. Jakarta has significant TB problem and the CDR is only about 36.18% in 2001 and 39.44% in 2002. This is requires urgent improvement. This research identifies and explores factors that contribute to the low CDR by investigating whether there were economic, social, and cultural circumstances impacting on the community, health system and practice of TB Case Detection in Kelurahan Cipinang, East Jakarta. Such environments have also been investigated. This research applied case study method and data collected by in-depth semi-structured, individual interviews on 13 community participants included patients, suspected TB persons, relapsed TB persons, housewife, teachers, and health cadres; 6 formal and informal community leaders; and 3 health providers of the community health centre (Puskesmas). The major problem found was the poverty in the community. These poor people experience social, physical, psychological, and behavioural disadvantages that were linked to each other and relevant to the research questions. The social circumstances that were found in the community were lack of education, the religious and cultural beliefs, homelessness, poor quality of housing, bad water and sanitation of the canal, and no money for transport, for the registration fee at the Puskesmas, and for the laboratory examination fee. The physical circumstances that were found were: poor nutrition, TB symptoms, and emaciated. The psychological circumstances found were low self-worth, stress, anxiety, stigma, and no family support. The behavioural circumstances that occurred were delaying visiting the Puskesmas, seeking help from friends, smoking, gambling, and drugs. Meanwhile, the Puskesmas did not have adequate infrastructure and facilities to provide accurate examination and to have safe work environment. Inadequate training had lead to a lack of teamwork between staffs. Lack of communication between health providers and community leaders contributed to the lack of political commitment in the system and practice of the DOTS strategy. Strategies developed from the participants' suggestions were recommended to address the problems and to alleviate the poverty.

Key words: Tuberculosis, Case Detection Rate (CDR), factors contribute to low TB-CDR,community health centre, Jakarta