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Strategi Komunikasi dalam peningkatan cakupan imunisasi rutin SEKSI SURVEILANS DAN KESEHATAN MATRA DINAS KESEHATAN PROVINSI RIAU

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  • Strategi Komunikasi dalam peningkatan cakupan imunisasi rutin

    SEKSI SURVEILANS DAN KESEHATAN MATRADINAS KESEHATAN PROVINSI RIAU

  • Key Issues Findings, 2011-2012 Java Drop Out Survey Kurangnya pengetahuan dan kesadaran tentang pentingnya imunisasiInformasi terkait imunisasi yang beredar banyak yang tidak tepatPetugas kesehatan tidak memberikan informasi tentang imunisasi, Pesan yang tidak efektif, tidak sesuai kebutuhan masyarakatKurangnya dukungan dari tokoh masyarakat dan tokoh agama setempat.

  • Crosscutting ThemesPendekatan berdasarkan HAM (Hak Azasi Manusia)Persamaan genderPartisipasi Masyarakat

  • Pendekatan Strategi Komunikasi

    Berdasarkan data dan faktaBerorientasi HasilBermitra dengan potensial lokal groupSharing informasi dengan publik dan masyarakatSebagai instrumen yg efektif untuk mempengaruhi perilaku seseorang

  • Pentingnya Strategi Komunikasi ImunisasiAgar memastikan orang tua dan pengasuh :Terinformasi manfaat imunisasi dan bahayanya jika tidak mendapatkan imunisasi lengkap.Mengetahui ketersediaan akses pelayanan imunisasi di wilayahnya (jumlah kunjungan dan jarak waktu mendapatkan imunisasi lengkap)Mengetahui peran dan tanggung jawab dalam melindungi kesehatan tumbuh kembang anaknya.Termotivasi untuk mengimunisasikan anaknya secara lengkap

  • Social Ecological Model

    Figure 1. The Social Ecological Model (source: UNICEF /EAPRO Regional Communication Guide 2013)

  • Level Individu dan InterpersonalMasyarakat , kader, nakes dengan tingkat pendidikan yang rendah

    Masyarakat di daerah terpencil susah terjangkau

    Kurangnya pengetahuan orang tua/pengasuh tentang imunisasi dan jadwalnya

    Kurangnya keterlibatan ayah/kakek terutama daerah yang menganut patriarki

    Informasi yang kurang

    Kurangnya komunikasi antara nakes dengan orang tua terutama terkait penggunaan bahasa lokal

  • MasyarakatKurangnya dukungan dari TOMA, TOGA

    Informasi yang salah tentang keamanan vaksin dengan alasan budaya dan agama

    Partisipasi di tingkat masyarakat masih rendah terutama para pemangku kepentingan di masyarakat, TOMA, TOGA, orang tua,

    Kurangnya koordinasi antara nakes dan kader

  • Level OrganisasiKetidakhadiran nakes dan kader karena faktor geografis terutama akses yang sulit dan jauh.

    Jarak yang jauh ke Posyandu/Puskesmas

    Jadwal imunisasi yang tidak fleksibel

    Tidak adanya kegiatan monitoring dan evaluasi intervensi komunikasi di masyarakat

  • KebijakanKebijakan pemerintah dalam menyediakan layanan imunisasi gratis.

    Masih ada layanan imunisasi yang mengharuskan orang tua membayar.

    Pentingnya penguatan kebijakan terutama di daerah dengan cakupan imunisasi rendah.

  • Media Analisis

  • Media Cetak

    Masih sedikit masyarakat yang terpapar media cetakMedia cetak yang ada tidak menjangkau ke daerah-daerahKetersediaan media cetak masih sedikit.Belum spesifik lokal.Beberapa promkes di daerah sudah membuat media cetak, tapi tidak di desain dengan baik.Media cetak yang spesifik lokal sangat dibutuhkan

  • Audio and audio-visual media

    Media audio-visual seperti TV spot dan radio spot sudah pernah diproduksi tapi terbatas pada campaign saja. Radio spot sudah ada yang lokal spesifik, spot TV belum ada.Media TV yang spesifik lokal juga dibutuhkan

  • Mass mediaStasiun Radio mempunyai Jangkauan terbatas terutama di daerah terpencilPrsentasi rumah tangga yang mendengarkan radio bervariasi antar daerah.Penggunaan radio menurun terutama di daerah dengan jakngkauan televisi. Radio masih efektif di daerah yang tidak ada listrik.

  • Mass Media lainnya170 koran harian dan 40 TV stasiun swasta nasionalInternet dan sosial media tidak mampu sendiri menjawab kebutuhan komunikasi layanan imunisasiIklan layanan masyarakat baik Radio dan TV dapat meningkatkan kesadaran dalam imunisasi. Namun demikian, daerah terpencil yang tidak mempunyai akses masih banyak sehingga tidak terpapar pesan tersebut.Pesan singkat (SMS) juga bisa digunakan, tetapi ada daerah dengan jangkauan sinyal lemah, sehingga tidak dapat mengakses SMS. Masih banyak pula masyarakat dengan tingkat baca rendah.

  • Inter-personal and small group communication

    Komunikasi interpersonal masih efektif dalam merubah perilaku. Juga dapat menyakinkan orang tau dan pengasuh untuk mengimunisasikan anaknya.Komunikasi Face to Face masih sangat relevan dengan budaya Indonesia. Apalagi difasilitasi oleh TOMA/TOGA.Pentingnya menjaga Trust dengan masyarakat. Komunikasi interpersonal sudah banyak digunakan tetapi kualitasnya masih kurang.

  • GOALBerkontribusi pada target nasional yaitu 90 % anak-anak dari 80% target sasaran lokasi diimunisasi lengkap pada usia satu tahun di tahun 2015. (proxy indicator from EPI programme)

  • TUJUAN KHUSUSPada tahun 2015 :90 % orang tua dan pengasuh membawa anak mereka yang dibawah satu tahun ke pelayanan kesehatan setidaknya 5 kali untuk imunisasi lengkap.90% orang tua dan pengasuh membawaanak merekan yang dibawah satu tahun mengetahui dua manfaat kesehatan dari imunisasi lengkap.80 % orang tua dan pengasuh mengetahui setidaknya dua efek samping yang biasa terjadi dari imunisasi (contoh demam)

    Pada tahun 2014 :90% Nakes dan Kader secara sistematis menginformasikan setidaknya (3) tiga pesan imunisasi selama interaksi dengan pengasuh dan orang tua

  • Sasaran PrimerOrang tua dan pengasuhTenaga Kesehatan

    (Upaya yang dilakukan difokuskan dengan intervensi Komunikasi Perubahan Perilaku)

  • Kaders dan tenaga sukarelaTokoh masyarakatTokoh AgamaKomunitas peduli kesehatan, komunitas agama, dllAnggota masyarakat yang lain.

    Upaya yang dilakukan mobilisasi sosialSasaran Sekunder

  • Sasaran TersierPara Decision Makers, kepala daerah, dllBidan, dokter spesialis anak, dokter praktik swastaMedia Lembaga donorUpaya berupa advokasi dan penyebarluasan informasi

  • Pesan Kunci

    Imunisasi dapat menyelamatkan hidup anak andaImunisasi melindungi anak anda dari kecacatan5 kali kunjungan ke pelayanan kesehatan untuk mendapatkan vaksinasi lengkap untuk perlindungan anak anadaDemam ringan setelah imunisasi adalah normal dan tidak perlu khawatirAman bagi anak anda jika diimunisasi ketika demam ringan Hib adalah vaksin baru untuk meningkatkan perlindungan anak anda.

  • Vaksin itu amanSebagai orang tua yag baik, lindungi anak anda dengan imunisasi lengkapJagalah kartu imunizasi anak andaVaksinasilah anak anda sesuai jadwalnyaImunisasi didapatkan di...........pada........dalam berapa kali

    Pesan Pendukung

  • Prioritas Intervensi AdvokasiMobilisasi SosialKomunikasi Perubahan Perilaku

  • Target Advokasi

    PemerintahTokoh agama dan organisasi sosial ProfesionalPihak SwastamediaPengambil keputusan(Kementerian Kesehatan, Kementerian Dalam Negeri)-Organisasi Keagamaan Muhammadiyah (Aisyiyah, Alhidayah), NU (Fatayah NU and Muslimat NU) and others -Organisasi Perempuan (e.g. YABII, PERWANAS, DWP, KOWANI)-PramukaIDIIDAIIBI PPNI POGI, dll-Biofarma -GSK-NovartisKoran , TV, stasiun Radio tk. Nasional, Propinsi dan Kab/Kota

  • Mobilisasi Sosial

    Mobilisasi anggota masyarakat dan jejaringnya dalam mendukung imunisasi rutin.Kader, Toma, Toga dan lembaga sosial juga perlu terlibat

  • Behaviour change communication

    Komunikasi perubahan perilaku dapat efektif pada level individu. Lebih efektif lagi jika ada lingkungan yang kondusif dan mendapatkan dukungan dari tokoh setempatPerlu strategi dan intervensi yang spesifik terutama dengan metode yang bersifat partisipatif Komunikasi interpersonal

  • Saluran yang akan digunakan

  • Saluran

    Komunikasi Interpesonal(-mainly to prompt behaviour change) Diskusi kelompok kecil (-mainly used for social mobilization and advocacy)Media Cetak (-mainly for awareness-raising on immunization benefits)Media tradisional (-mainly for edutaining awareness-raising on immunization benefits)Media Massa (mainly for awareness-raising)a) Radio b) Small-scale communication toolsc) Audio-visual media d) Public information and media relations

  • Peningkatan KapasitasPelatihan kepada petugas pusat, propinsi dan kab/kota terkait strategi komunikasi dan rencana aksi di wilayah masing-masingDirekomendasikan untuk melatih lagi kepada lokal counterparts dan kaders tentang implementasi rencana aksi, mobilisasi sosial, komunikasi interpesonal dan media terkait

  • KOORDINASI DAN KEMITRAAN

    Perlunya koordinasi dan bermitra dengan seluruh stakeholder dalam peningkatan cakupan imunisasi lengkap

  • TERIMA KASIH

    Kurangnya pengetahuan dan kesadaran tentang pentingnya imunisasiInformasi terkait imunisasi yang beredar banyak yang tidak tepatPetugas kesehatan tidak memberikan informasi tentang imunisasi,Pesan yang tidak efektif, tidak sesuai kebutuhan masyarakatKurangnya dukungan dari tokoh masyarakat dan tokoh agama setempat.

    *Strategi KomunikasiPendeketan berdasarkan data dan faktaBerorientasi HasilBermitra dengan potensial lokal groupSharing informasi dengan publik dan masyarakatSebagai instrumen yg efektif untuk mempengaruhi perilaku seseorang

    *Mengapa Strategi Komunikasi Penting Untuk memastikan orang tua dan pengasuh :Terinformasikan tentang manfaat imunisasi dan bahayanya jika tidak mendapatkan imunisasi lengkap.Mengetahui ketersediaan akses pelayanan imunisasi di wilayahnya (jumlah kunjungan dan jarak waktu mendapatkan imunisasi lengkap)Mengetahui peran dan tanggung jawab dalam melindungi kesehatan tumbuh kembang anaknya.Termotivasi untuk mengimunisasikan anaknya secara lengkap

    *a caregiver (mother, father or other carer) of a small child who needs immunization coverage. In order for the child to receive vaccines, her caregiver needs to be aware of immunization and know that these services are available to her. The caregiver also needs to be motivated enough to actually take the child to the point-of-service. While the decision to provide immunization protection for the child is personal, the four other levels can greatly influence the realization of this decision and, hence, will also need to be addressed in order to guarantee full immunization protection for this or any- child. At this level, behaviour change communication is used to influence the individual.

    The immediately surrounding interpersonal level forms the social and cultural environment in which the caregiver operates. This is where interaction with family members and friends takes place, and where social norms are reinforced. This is also the level where health care workers at points-of-service communicate with the caregiver about everything related to immunization. All these interactions have the potential of influencing individual behaviour change either by reinforcing or conflicting the views of the carer. In strategic communication efforts, both behaviour change or social change communication are used to influence these interactions. At the community level the caregiver is exposed to further influence from being a member of a certain community or a local social group (e.g. womens group, church group or work place), or by belonging to a certain ethnic group with distinct traditional beliefs. The many shared and internalized rules of these groups create a social environment, which supports immunization behaviours, is indifferent of immunization or works against it consciously or unconsciously. In an enabling social environment, the carer is more likely to trust her decision of immunizing her child. Social change communication is used to prompt collective change of cultural norms, attitudes and knowledge in such an environment.Finally, the policy level provides the big picture for the national immunization programme through policies that are developed and implemented at national, provincial, district and community levels. For example, the policy on full immunization coverage being offered by the Government free of charge to all children -in principle- removes the barrier of anyone needing to skip immunization due to its high costs. However, the availability of vaccineservices does not ensure that the service is being used by all which is why the other four levels of influence need to be addressed simultaneously. Advocacy efforts provide an opportunity to influence and engage decision-makers at policy levels to ensure the application of rights-based goals such as equity in immunization services.

    *One of the most commonly used communication channel for immunization interventions included the use of printed materials (e.g. the Pink Book for mothers; posters; fliers). However, field assessments revealed that beyond the Pink Book, very few people had currently exposure to these printed materials or messages. They had been used in previous campaigns, but many of the materials had never reached the local levels. Currently, hardly any such material was neither available nor visible. Also, the materials had been centrally developed and in Bahasa Indonesia, which made it difficult for those with illiteracy or a mother tongue other than Bahasa to understand these text-heavy communication tools. In provinces such as Papua, most locals could not identify with the pictures used in these materials since their facial features alone were dramatically different due to their unique ethnic characteristics. Some government district health promotion teams had developed their own, locally more relevant materials, but availability of technical expertise in design and high printing costs alongside small communication budgets greatlyThere is a need for new, culturally relevant printed materials.

    *

    Along with print media, broadcast media products such as radio spots and television spots had been produced and used in the past, but their use was strictly limited to campaigns. Slightly more than with print media, there was slightly more variety of local languages used in these centrally-developed audio recordings while audio-visual materials were only available in Bahasa IndonesiaAs with print media, a greater selection of culturally relevant materials that address key local barriers would be welcome

    *The coverage of these radio stations remains limited in more isolated rural areas. Despite these limitations, the use of radio stations to spread immunization messaging for awareness-raising may at times be the only way to reach more isolated populations, The percentage of households listening to the radio frequently either through their own household radio or while visiting neighbours, as well as radio ownership itself varied greatly from one district to the next. Radio audiences, in general, are declining in place of extended television coverage, can radio still remain a relevant channel - especially in the least developed areas of the country where electricity is lacking.

    The coverage of these radio stations remains limited in more isolated rural areas. Despite these limitations, the use of radio stations to spread immunization messaging for awareness-raising may at times be the only way to reach more isolated populations, The percentage of households listening to the radio frequently either through their own household radio or while visiting neighbours, as well as radio ownership itself varied greatly from one district to the next. Radio audiences, in general, are declining in place of extended television coverage, can radio still remain a relevant channel - especially in the least developed areas of the country where electricity is lacking.

    * While broadcasting of public service announcements (PSAs), radio or TV spots can be helpful in increasing awareness on immunization services, these channels will not reach large populations that are most vulnerable or isolated and hence at the greatest risk of catching a vaccine preventable diseaseThe Internet and social media, The stand alone use of these channels is not the answer to most of the communication challenges on immunizationWhile broadcasting of public service announcements (PSAs), radio or TV spots can be helpful in increasing awareness on immunization services, these channels will not reach large populations that are most vulnerable or isolated and hence at the greatest risk of catching a vaccine preventable diseaseThe same applies to mobile text messaging (SMS), coverage remains weak or absent in the most isolated corners of the country. low literacy rates often limit the usefulness of text messaging for information-sharing,

    170 daily newspapers and 40 TV stations

    **Primary audience: (to be targeted mainly through behaviour change communication efforts)

    *Secondary audience: (to be targeted mainly through social mobilization efforts)

    *Tertiary audience: (to be targeted mainly through advocacy and public information measures)

    *Decision-makers at the ministries of Finance, Home Affairs and Healths budgeting departments could be met to raise awareness on the importance of strategic communication in determining immunization results and to request for increased and sustained budget allocations for implementation of local communication plans Vaccine manufacturers may be asked to engage in coordination efforts where immunization messages are prioritized and harmonized across information materials to ensure synchronized messaging in guidelines and public information materials that is shared also private health professionals. Also, they may be invited to plan for their corporate social responsibility efforts in coordination with the Governments local plans to support, avoid duplication and maximise use of funds of communication efforts (e.g. trainings of kaders in social mobilization and interpersonal communication skills) Religious groups may be invited to attend government fora (e.g. media workshops) to clarify and reinforce messaging on vaccine safety from halal-point of view while influencing local level religious leaders to do the same in their communitiesSocial groups such as the Scout movement and local womens groups may be invited to engage in local level social mobilization activities and incorporate immunization messaging into their interactions with communities Professional medical and paramedical groups will be shared with key information on vaccines to ensure harmonized and accurate messaging in support of routine immunizationMedia representatives may be engaged in the immunization programme through media trainings and press briefings

    *