A Room for Improvement:

Looking at Quality of Care of Tuberculosis through Patient Eyes

Parihatin

1
A,

Probandari

2,3
A ,

Alwi

1
B,

Riana

4
DA

1 KNCV

Tuberculosis Foundation, Indonesia

2 Department of Public Health, Faculty of Medicine, Sebelas Maret University, Indonesia
3 Tuberculosis Operational Research Group, Sub directorate of Tuberculosis Control, Ministry of Health, Republic of Indonesia
4 Sub directorate of Tuberculosis Control, Ministry of Health, Republic of Indonesia

Contact:
ari.probandari@fk.uns.ac.id

Background

Methods

Tuberculosis (TB) control program in Indonesia has escalated to

exceed global target on Case Detection Rate and Treatment
Success Rate. Innovation has made through many initiatives to
overcome new challenges. National TB control program
provides free TB treatment to all patients. Capturing patient
perspective is an approach to provide balance information on
how patient perceived the quality of care. The objective of the
study was describing information on patients perception
toward TB services.

We applied a mixed methods research with concurrent

triangulation design at three districts in West Java province
from December 2012 to January 2013. Data was collected
by interviewing 285 TB patients using close-ended
questionnaires (QUOTE TB Light, patient cost), in-depth
interviews to six TB patients, four local primary health
providers and four health cadres. Two focus group
discussions were also conducted among TB patients and
community members. Quantitative data was analyzed
descriptively. We used content analysis technique for the
qualitative data. Finally, we integrated the results of the
quantitative and qualitative data analyses.

Results
TB patients preferred to visit private practitioners (37%), public
health center (32%), public hospitals (12%) and pharmacy
(10%) when they have symptoms of TB.
222 (73%) respondents said that they learned about TB from
health care facilities, but 96% of them never heard about
Patient Charter.
Professional competence, patient provider interaction and
counseling, communication and information are three areas
received highest importance by TB patients.

81.9% respondents admit that they never seen

discrimination because of TB and 90.4% never
experienced violation because of TB.
Soft stigma on TB still exist in the community and
preserved by health providers.
100%
90%
80%
70%

Do patients perceive higher

expenses due to TB?
Yes

60%

No answer
Don't know
Disagree
Agree

50%

No
Sexual
Separated problem
from spouse 0.46%
0.46%

29%

Divorce
0.46%

71%

Supports from the Government which

TB Patients Expect

40%

Impact of TB to Patients' Life

30%
20%

Others
8.80%

10%
0%

Lost of
occupation
33.80%

Willing to share a
Willing to interact
The equipments
meal with a person with neighbors who used by TB patients
with TB
had history of TB
should be burned
None
56.02%

Usually patient more familiar with KP (Koch Pneumonia) and not

TB, to make patient responsible, I will ask patient in the beginning
do you want to live or do you want to die? (Health provider,
female, 47 years old).

Transporta
tion
18%

Others
13%

Dont say that they [TB patients] suffered from TB, because they
will just run away and dont want to come to Puskesmas [public
health center] (Health provider, male, 56 years old).

Food
15%
Affordable
TB services
54%

Conclusions
Strengthening the capacity of health provider in communication is necessary to improve patient-provider interaction and to
enhance the delivery of TB related information. Community should be involved and considered in intervention to create dialogue
between patient and health provider in order to have better understanding on Patient Charter and to erase the stigma.
Intervention need to be made align with the TB health seeking behavior to private practitioner/hospital to reduce the indirect cost
created.
th
44

Union World Conference on Lung Health

30 October-3 November 2013 Paris, France