Bridging the Gap: Enhancing Wound Care at First-Level Health Facilities in Indonesia

Wound care is a critical component of healthcare, particularly in first-level health facilities, where many patients make their initial visit. In Indonesia, these clinics have specific problems that affect the quality of wound care they deliver. This article emphasizes the significance of effective wound care, key challenges faced by healthcare providers, evidence-based practices, and practical strategies to improve wound care in underserved areas.

 

The Current State of Wound Care in Indonesia

In Indonesia, wound care methods have been implemented in the management of diabetic wounds, burns, and other chronic wounds. This technique enables the healing of severe wounds without the need for amputation. Nurses are required to possess knowledge and skills in wound care, including comprehensive assessment, intervention planning, action implementation, outcome evaluation, and systematic documentation. (Ministry of Health)

In rural areas, wound care accounts for a significant percentage of visits in first-level health facilities. Wound infections are more common in primary health institutions than in more specialized centers due to factors such as insufficient resources and lack of specialized training.

 

Key Statistics:

● Higher Infection Rates: Studies reveal that infection rates in poorly managed wounds can reach up to 30% in rural primary healthcare settings, compared to 5-10% in higher-level facilities

● Limited Access: Approximately 40% of rural populations in Indonesia report difficulty receiving prompt wound treatment, which frequently leads to complications and costly hospital referrals

● Economic Impact: Poor wound management increases healthcare expenses for both patients and hospitals. Moreover, the cost of national healthcare might be significantly reduced with proper wound care in primary settings.

 

Challenges in Wound Care for First-Level Health Facilities

The most common issues encountered by healthcare workers in first-level facilities include resource limits, higher patient volume, limited mobility and accessibility, and knowledge gaps. The lack of essential wound care supplies such as antiseptics, dressings, and sterile instruments often forces providers to improvise, potentially compromising patient safety. Furthermore, large patient loads and limited consultation time impede practitioners’ capacity to do full wound assessments and offer proper follow-up care.

In distant or underserved locations, insufficient infrastructure and transportation alternatives might delay access to wound care, increasing the risk of infection and poor healing. Inadequate training in wound care of many healthcare personnel in first-level facilities also remains as a challenge.

 

Importance of High-Quality Wound Care

High-quality wound care is essential for accelerating recovery and preventing complications. Effective wound management can lower infection rates. Regular and effective wound care decreases the chance of further infection. Appropriate wound management speeds up recovery, allowing patients to resume their usual activities sooner. Moreover, providing early, effective wound care decreases the need for advanced therapies and hospital referrals, saving money for both patients and the medical system.

 

Evidence-Based Practices in Wound Care for First-Level Facilities

First-level healthcare facilities can implement the following practical, evidence-based wound care techniques:

 

1. Standardize Basic Wound Care Procedures: Improving uniformity and safety in wound care can be achieved by establishing basic wound care procedures, such as cleaning, debridement, and infection control techniques. These protocols should be simple, efficient, and feasible with available resources.

2. Train Healthcare Workers in Wound Assessment: Proper wound assessment is the foundation of effective wound care. Training providers on the basics of wound assessment—such as identifying signs of infection, wound staging, and risk factors—enables them to make informed decisions about treatment and referrals.

3. Implement Follow-Up Systems: First-level facilities should implement a basic follow-up system to track wound healing and avoid problems. For patients with more serious or persistent wounds, this can entail planned phone conversations or in-person visits.

4. Use Telemedicine Support: Telemedicine can be utilized to consult on complex cases in conjunction with higher-level facilities or specialists. Remote providers can communicate with wound care experts, get advice, and access helpful resources.

 

Strategies for Expanding Access to Wound Care Services

1. Mobile Health Clinics: Mobile clinics can provide healthcare services to underserved communities without access to permanent health facilities. By bringing wound care services directly to patients, mobile health units can improve timely treatment and reduce travel barriers.

2. Community Education Programs: Educating the community on basic wound care and when to seek medical help can improve early intervention, reducing the risk of complications and the need for hospitalizations.

3. Strengthen Partnerships: Collaboration with the private sector can be achieved through partnerships with pharmaceutical companies to provide affordable wound care supplies, community involvement through organizations like Rawat Luka Indonesia, and the establishment of specialized wound care clinics by private entities as outlined in Ministry of Health Regulation No. 26 of 2018.

 

Improving wound care in first-level health facilities across Indonesia is not only about better patient outcomes—it’s about creating a more resilient healthcare system. First-level facilities can improve the efficiency and timeliness of wound care for those in need by implementing standardized protocols, enhancing wound care training, and expanding access through community and mobile programs.

 

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References:

1. Coombs, N. C., Campbell, D. G., & Caringi, J. (2022). A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Services Research, 22(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8976509/
2. World Health Organization. (2017). The Republic of Indonesia Health System Review. Health Systems in Transition, 17(1). Asia Pacific Observatory on Health Systems and Policies. https://iris.who.int/bitstream/handle/10665/254716/9789290225164-eng.pdf 
3. Wulandari, R. D., Laksono, A. D., Nantabah, Z. K., Rohmah, N., & Zuardin, Z. (2022). Hospital utilization in Indonesia in 2018: do urban–rural disparities exist? BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-07896-5