WASTE MANAGEMENT IN INDONESIAN PUBLIC HEALTH CENTRES: FACTORS ASSOCIATED WITH WASTE SEGREGATION PRACTICES AND DISPOSAL METHODS
Abstract
ABSTRAK
Pada tahun 2014 Indonesia mulai menerapkan Universal Health Coverage (UHC), yang akan meningkatkan cakupan asuransi kesehatan. Artinya bahwa pemanfaatan layanan kesehatan akan meningkat juga, sehingga pengelolaan limbah medis di pusat kesehatan masyarakat (puskesmas) akan menjadi semakin penting. Artikel ini merupakan analisis data Riset Fasilitas Kesehatan (Rifaskes) yang dilakukan oleh Badan Litbang Kesehatan tahun 2011 tentang faktor-faktor yang mempengaruhi pemisahan limbah dan pembuangan akhir limbah layanan kesehatan di Puskesmas. Jumlah sampel adalah 8.599 Puskesmas. Variabel yang dianalisis meliputi sistem pembuangan limbah, perilaku pemisahan limbah, dan pengolahan limbah dengan cara dibakar. Analisis data dilakukan secara multivariat dengan model logistik biner multivariabel dan regresi multinomial pada tingkat signifikansi 0,05. Hasil analisis regresi multivariabel menemukan bahwa ada ketidaksetaraan berbasis geografis di mana Puskesmas yang terletak di wilayah Jawa-Bali, di daerah perkotaan, bukan di daerah terpencil, dan di pulau-pulau utama, cenderung melakukan pemisahan limbah medis, dan cenderung tidak melakukan praktik pembakaran terbuka. Puskesmas yang memiliki sistem pembuangan limbah yang layak, mengindikasikan bahwa memiliki kecenderungan mempraktikkan pemisahan limbah medis (tidak pembakaran terbuka). Sebaliknya puskesmas di daerah pedesaan, tidak melakukan pemilahan limbah dan cenderung mengelola sampah dengan cara dibakar. Hal ini mengindikasikan bahwa sumber daya untuk menerapkan pengelolaan limbah layanan kesehatan yang tepat di Puskesmas, termasuk fasilitas dasar, pelaksanaan pemisahan di sumber, dan pengolahan serta pembuangan limbah yang tepat menjadi sangat penting.
Kata kunci: Limbah medis, fasilitas kesehatan, analisis regresi, pengelolaan limbah, Indonesia
ABSTRACT
In 2014, Indonesia started implementing Universal Health Coverage (UHC). As coverage of health insurance expands, healthcare utilisation will increase. Therefore, sustainable healthcare waste management (HCWM) in public health centres (PHCs) will become more important. This paper addresses the drivers of waste segregation and the final disposal of healthcare wastes. We obtained data on health care waste management (HCWM) in 8,599 PHCs from the 2011 Health Facility Research (Rifaskes). We then fitted multivariable binary logistic and multinomial regression models at the 0.05 level of significance. The multivariable regression analyses found that there were geographically based inequalities where PHCs located in JavaBali region, in the urban area, not in the remote area, in main islands, were more likely to practice medical waste segregation, and less likely to practice open burning. Owning a sewerage system corresponds to a higher likelihood of practising medical waste segregation and lower likelihood of open burning. Moreover, PHCs with better basic amenities were more likely to segregate their waste and less likely to practice open burning. This paper recommends the importance of resource for establishing proper HCWM in PHCs including basic amenities, implementation of segregation at source, and appropriate waste treatment and disposal.
Keywords: Medical waste; health facilities; regression analysis; waste management; Indonesia
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