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Hospital Preparedness for COVID-19 in Indonesia: A Case Study in Three Types

Hospital

Preprint · February 2021

DOI: 10.13140/RG.2.2.24834.20166

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Airlangga University Ministry of Health, Indonesia
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 Hospital Preparedness for COVID-19 in Indonesia:
A Case Study in Three Types Hospital
Kristina Dewi1, Djazuly Chalidyanto1, *Agung Dwi Laksono3
1
Magister Student, Master of Health Policy and Administration Faculty of Public Health,
Universitas Airlangga, Surabaya, Indonesia
2
Lecturer, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
3
Researcher, National Institute of Health Research and Development, the Indonesia Ministry
of Health, Jakarta, Indonesia

*Corresponding Author:
Agung Dwi Laksono
Email: [email protected]

ABSTRACT

Background: The increase in COVID-19 cases demands hospital preparedness in handling

COVID-19 to provide quality services by prioritizing patient safety and health personnel
factors. The purpose of this study is to analyze hospital preparedness in providing COVID-19
services comprehensively.
Method: The study is a cross-sectional design. The research objects are public, private, and
police hospitals. The review uses the checklist from the CDC. Observation and interviews with
hospital leaders carried out data collection. Data were analyzed descriptively.
Result: From the results of filling out the inventory, the preparedness of public, private, and
police hospitals in Banjarmasin was low on average. In detail, it showed average scores that
public hospital (2.83), private hospital (2.70), and Police hospital (2.63). Police hospital is better
prepared than the private and public hospital. Public and private hospitals have the lowest scores
on the written COVID-19 Development of written COVID-19 Plan component. Meanwhile, the
Police hospital had the lowest scores on consumable and durable medical equipment and
supplies.
Conclusion: It concluded the private, public, and police hospitals have a low level of
preparedness for COVID-19 services.

Keywords: hospital preparedness, COVID-19, hospital, pandemic disaster management

INTRODUCTION
SARS-CoV-2 has implications for the largest coronavirus outbreak on record to date.
Initially, most of the cases of Coronavirus Disease 2019 (COVID 19) in China, but the virus
has spread to more than 184 countries worldwide1. COVID-19 has been designated as a
particular emerging infectious disease that causes outbreaks and causes a public health
emergency2. WHO has designated this outbreak as a Pubic Health emergency. Besides, WHO
has declared COVID-19 a pandemic. Indonesia is one of the countries affected by this outbreak
among hundreds of other countries in the world3,4. The Indonesian government, on March 31,
2020, has designated COVID-19 as a Public Health Emergency through Presidential Decree

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Number 11 of 2020, and this was followed by Presidential Decree Number 12 of 2020
concerning Determination of Non-Natural Disasters for the Spread of COVID-19 as a national
disaster on April 13, 20205. The risk of death due to non-natural disasters is 1.5 times higher
than natural disasters6.
Incident COVID-19 in Indonesia, according to the official website of the Indonesian
COVID-19 Task Force (www.covid19.go.id), from day to day, it is increasing, and now it has
entered the ninth month. Update as of December 2, 2020, from distribution data COVID-19 in
Indonesia. The patient is positive and reached 549.508 people, and the patient has declared
healed 458.880 people and died from 17,199 people. Epidemics/pandemics cause enormous
losses, both in the health and social and economic fields. The existence of an
epidemic/pandemic can threaten humanity's health and safety if not treated immediately.
Another effect, this condition, also impacts social and economic aspects, which can cause
colossal losses7.
The government has defined 835 hospitals as referrals for handling COVID-19 with
details of the national referral hospitals designated by the Ministry of Health and 703
Provincial/Regency/City referral hospitals defined by the Governor5. Every hospital must be
ready for emergency response. The hospital design must be considered to handle disaster
patients, and disaster planning must be included in the hospital's service system. Hospitals need
to form a disaster-related information network, conduct simulations, and monitor disasters'
effects on patients handled by the hospital8,9.
Based on the response to the COVID-19 pandemic that is currently happening globally,
the Centers for Disease Control and Prevention (CDC) has issued a guide in the form of a
checklist that can be used to determine hospital preparedness in the face of the COVID-19
pandemic. The guidance including handling patients who are positively infected with COVID-
1910.
During a limited meeting, the news channel CNN Indonesia reported that President Joko
Widodo ordered priority handling of the COVID-19 in eight provinces where the number of
cases is still high. The president said these eight provinces contributed 74% of the total positive
cases of COVID-19 in Indonesia. One of them is South Kalimantan Province11. The purpose of
this study was to identify the preparedness of private, police, and public hospital in
Banjarmasin, South Kalimantan, to more comprehensively for the COVID-19 pandemic by
using the COVID-19.

MATERIALS AND METHODS

Design study with a cross-section approach. The study collects data using a
questionnaire. The questionnaire was taken from the CDC to measure hospital preparedness10.
The hospital preparedness consists of:

1) Structure of Planning and Decision-Making,

2) Development of a written COVID-19 Plan,
3) Elements of a COVID-19 Plan in general,
4) Elements of a COVID-19 Communication Facility,
5) Consumable and durable medical equipment and supplies,
6) Identification and management of ill patients,
7) Visitors access and movement within the facility,
8) Occupational health,
9) Education and training,
10) Healthcare service/surge capacity.

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 The study was carried out in three types of hospitals. The three hospitals are 1 public
hospital, 1 private hospital, and 1 police hospital. The source of information for each hospital
is the Director.
As for the criteria regarding the preparedness of three hospitals Banjarmasin, South
Kalimantan for Pandemic COVID-19, by using Comprehensive Hospital Preparedness
Checklist for Coronavirus Disease 2019 (COVID-19), and will give values 1 to 4, with the
following criteria:

1 = There are documents, and it is implemented

2 = There are documents and not implemented
3 = No records and implemented
4 = No documents and not implemented

Each indicator's scoring criteria are determined based on "the highest score minus the
lowest score, divided by the indicator range". The scoring criteria consist of:
< 1.75 : High
1.75-2.49 : Middle
2.50-3.24 : Low
> 3.24 : Very Low

Data analysis used a descriptive method, which describes the average results of measuring
the variables or the main components of hospital preparedness for handling COVID-19
according to the assessment criteria.

RESULTS AND DISCUSSION

The hospital preparedness measurement studied was an equivalent hospital, namely a

class C hospital located in Banjarmasin, South Kalimantan province, and outpatient services
for COVID-19 patients. The private hospital's bed capacity has 151 beds, while for Police
hospital and the public hospital has 100 beds.
The police and public hospital are referral hospitals for handling COVID-19 determined
by the Governor of South Kalimantan, while the private hospital is not COVID-19 referral
hospitals in South Kalimantan.
The private hospital was established in 1970. Meanwhile, the police hospital was
established in 1994. Besides, the public hospital has been established since 2018. In terms of
the number of beds, the Isolation Room for COVID-19 Patients in private hospitals has 30
beds, the police hospital has 46 beds, and the public hospital with 40 beds.
Based on Table 1, the second variable's measurement results are the component of the
Development of a written COVID-19 Plan for Public hospital has a score of 3.67. Most of them
do not have written planning documents covering COVID-19 preparedness plans, facility
planning, and critical personnel implementation. The situation could be because the Public
hospital was established two years. Planning for a community outbreak of COVID-19 is crucial
for maintaining healthcare services during a response10. To quickly deal with COVID-19,
disaster management planning is needed; this planning is expected to reduce the disease
transmission and mortality rate12.
During a pandemic disaster, public facilities, especially hospitals, have an essential role
in providing health services. Given the importance of an efficient response to emergencies and
the need for a functional health care infrastructure in the aftermath of a disaster, hospital
administrators must consider all aspects of the hospital vulnerability13.

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Table 1. Description of private, police, and public hospital in Banjarmasin in 2020
No. Hospital Profile Private Hospital Police Hospital Public Hospital
1. Hospital Class C C C
2. Accreditation Status Plenary Plenary Intermediate
3. Number of Beds 151 100 100
4. Number of Special Isolation 30 46 40
Room Beds
5. Number of Doctors (General 87 53 46
Practitioners and Specialists)
6. Number of nurses 123 95 113
7. The number of other health 65 56 41
workers
8. Number of Volunteers 0 0 22
9. Ownership Foundation Police City government
10. Established in 1970 1994 2018
11. Referral Hospital for Handling Not Yes Yes
COVID-19

Based on Table 1, the results show the average score of the fifth variable. Consumables
and durable medical equipment supplies for public hospitals the average score is 3.50. This
result is low because the Public Hospital is still the regional integrated service unit of the
Banjarmasin City Health Service, so the planning for the supply of medical supplies is still not
optimal. Based on the Director-General of Health Services' appeal in 2020, the hospital provides
services to COVID-19 patients. It completes all the completeness of handling COVID-19 cases
and Personal Protective Equipment (PPE) for all health workers according to their respective
criteria for each service room/service risk. Previous research has suggested that to prevent the
spread of COVID-19 from infected patients, one of which is the use of personal protective
equipment14. Disaster management plans should have guidelines/protocols in providing stocks
of both health workers, health materials, and medical supplies needed in a pandemic, for
example, providing a large number of personal protective equipment before a pandemic disaster
occurs15.
The next measurement results show the next variable's average score is the identification
and management of ill patients, and the three hospitals have the same score of 2.50. CDC states
that the hospital has a location setting regulation to separate the triage of COVID-19 and non-
COVID-19 suspects, establish face-to-face triage alternatives, and establish criteria for
accepting critical a process for referral of COVID-19 patients. The measurement results show
that the next variable's average score is visitor access and movement within the facility. The
three hospitals have the same score (2.50)10. Hospitals must have a plan for visitor access and
conditioning, have visitor restriction criteria and protocols, establish processes to allow long-
distance communication between patients and visitors when implementing visitor restrictions.
For occupational health variables, the three hospitals have the same score (2.87). The
hospital must plan to monitor and set work limits for health workers, have a respiratory
protection program, and have a PPE compliance audit process for COVID 19 preparedness. The
conditions because health workers have a high risk of acquiring infections while carrying out
treatment for patients exposed to COVID-1916.
The three hospitals' education and training variables have the same score (2.83). This
score is in a low category. All hospitals must ensure that their staff is trained, equipped with
medical equipment/PPE, and have comprehensive capabilities in handling COVID-19 in health
facilities10. To prevent potential exposure to contaminated patients who come to the hospital
and limit the spread of contamination, 95% of hospital staff in the front-line services should

4
receive training regarding contaminated patients and emergency response measures included in
hazardous materials management planning. Refresher training should be conducted annually17.
The last variable is the surge capacity, and the three hospitals have the same score of
3.00. The surge capacity is an organization's ability to respond to the demand for increased
health services18. Hospitals must have a program to anticipate capacity increases. The program
includes strategies to maintain the hospital's core mission, continue to care for patients with
chronic diseases, increase bed capacity, and maximize staff numbers. Besides, emergency room
strategies accommodate additional patients, logistical support, telemedicine services, staffing
contingency plans, and cross-sectoral coordination with local governments10. The measurement
of preparedness components/variables for private, police, and public hospital for COVID-19
can be seen in Table 2.

Table 2. Results of measurement of preparedness components/variables for private, police,

and public hospital in Banjarmasin for COVID-19 in 2020
Private Police Public
Variable
Hospital Hospital Hospital
Structure for Planning and Decision Making 3.00 2.14 2.71
Development of written the COVID-19 Plan 3.33 2.83 3.67
Elements of the Covid Plan 19 general 1.85 2.71 3.0
Facilities Communication 1.85 1.85 2.14
Consumable & durable medical equipment and
supplies 3.17 3.00 3.50
Identification and management of sick patients 2.50 2.50 2.50
Visitors Access and movement within the
facility 2.60 2.60 2.60
Occupational Health 2.87 2.87 2.87
Education and training 2.83 2.83 2.83
Health services / surge capacity 3.00 3.00 3.00
Average 2.70 2.63 2.88

Health service facilities' availability for handling COVID-19 must be accompanied by

providing good service quality, prioritizing patients' safety, and occupational health19. The
readiness of health service facilities, especially hospitals, in handling COVID-19 by
maintaining the quality of health services is the right way to overcome the COVID-19
pandemic5. The average preparedness of private, police, and public hospital is in a low category.
This study's results align with previous research that found that most Nepal hospitals are down
and unprepared for COVID-193.

CONCLUSIONS

The results of measuring hospital preparedness for the COVID-19 pandemic at private,
police, and public hospital located in Banjarmasin are still low level of readiness. Regarding
the hospitals' limitations, it is possible to input several parties concerned for further
comprehensive improvement efforts, both by the hospital and related stakeholders.

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Acknowledgment: We would like to thank you to the Centers for Disease Control and
Prevention provide the checklist questionnaire used in the study. The author also expressed his
gratitude to the Hospital Director who helped in completing this study.

Source of Funding: Self-funding

Conflict of Interests: Nil

Ethical Clearance: This study has passed the Ethics Committee's test at Universitas Airlangga
Surabaya, Indonesia. The respondents' identities have all been deleted from the dataset.
Respondents have provided written approval for their involvement in the study.

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