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Jurnal Kebijakan Kesehatan Indonesia

jkki
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Published by Universitas Gadjah Mada

ISSN : 2089 2624 EISSN : 2620 4703 DOI : -

Core Subject : Health,

Public Health

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Articles 7 Documents

Search results for , issue "Vol 2, No 1 (2013)" : 7 Documents clear

EVALUASI PENERAPAN KEBIJAKAN BADAN LAYANAN UMUM DAERAH DI RSUD UNDATA PROPINSI SULAWESI TENGAH Surianto Laksono Trisnantoro
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 1 (2013)
Publisher : Center for Health Policy and Management

Background: One of the important things forchange is a sequentialcharacteristic or the phase of time for a change. Suchas the change stipulated by BLUD (Publis Service Agency)policy of the State Regional Hospital (RSUD) to become BLUD.The implementation of BLUD in the regional public hospital(RSUD) of Undata is generally based on the regulation of TheDepartement of Internal Affairs No 61 year 2007. The newparadigm as BLUD must be balancedof both the “Enterprisingthe Goverment” and the “Public Service Oriented”. The backgroundof Undata Hospital before becoming BLUD were theproblem of health care cost was getting expensive whilst thetariffs imposed had to be competitive, and the demand of goodquality of services to care for the patients. All of this could beachieved if Undata hospital applies the financial managementsystem of the regional public service agency (PPK-BLUD).Method Of Research:Thisresearch uses a descriptive analysiswith the case study design. The samplings conducted inthis research are purposive sampling. Method of data colectionobtained through in depth interview, observation, utilization ofdocuments.Research Result: The implentation of regional public serviceagency (BLUD) based on the result of evaluation study inUndata hospital and in the health departement of CentralSulawesi Province shows that: The implementation based onthe standard, namely governance, business strategy plan,and the report of financial management has been implementedwell. Whereas the implementation which is not in accordanceyet with the BLUD criteria is the minimum service standardrelated to indicator and criteria of SPM. Also the role of healthdepartement as the supervisory board has yet to be implementedbecause there is no supervisory board.Conclusion: It shows the governance, business strategyplan and financial report are already in accordance with standard,set while the minimum service standard and the supervisoryboard have not run optimally within the standard andcriteria set.Key words: PPK-BLUD, implementation of BLUD, Hospital,Stakeholders

KEBIJAKAN NASIONAL DALAM KONTEKS LOKAL: TANTANGAN IMPLEMENTASI KEBIJAKAN DESA SIAGA DAN RUJUKAN PELAYANAN KESEHATAN DI KABUPATEN KEPULAUAN YAPEN PAPUA Yosef Maing; Supriyati Supriyati; Deni Kurniadi Sunjaya
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 1 (2013)
Publisher : Center for Health Policy and Management

Background:One of the policies in health to achieve IndonesiaSehat 2010 was the development of desa siaga that wasbased on Decree of Ministry of Health number 564/MENKES/SK/VIII/2006 regarding the guidance on the implementation ofDesa Siaga. Desa Siaga is a community based health effortthat involved community self funding agency such as PKK,religious organization, and private sector.Method:This was a qualitative descriptive research that usedexplanatory analysis with case study design. The researchinformant was district government, health office, communityleaders and public figure as well as health care provider. Thedata was collected with interview, observation anddocumentation. Data analysis was conducted with case studyanalysis.Result: This research showed that the implementation of DesaSiaga was with top–down method that used social mobilizationapproach. The district government and community was verymuch supporting the policy of Desa Siaga. Difficult geographiclocation, limited human resources in health and limited fundingwere the main obstacles in the implementation of Desa Siagapolicy and health service referral. The main problem of referralimplementation was transportation and funding. The readinessof community and village aparatur to assist the poor communitywas still very minimum.Conclusion: This research proven that Desa Siaga programwas very important for community in the district of Yapenarchipelago. Nevertheless, difficulties in geographiccondition,limited human resources in health as well as limited fundinghas resulted in difficulties in the implementation of Desa Siagapolicy and health service referral in the district of Yapenarchipelago. The regional and central government have notbeen able to respond to the needs of Desa Siaga.Keyword: Policy Implementation, Desa siaga, Papua.

Pelatihan seperti apa yang dapat mendukung implementasi kebijakan: perspektif peserta - evaluasi training manajer mid-level untuk imunisasi di Kota Banda Aceh Alfian R Munthe; Mubasysyir Hasanbasri; Hari Kusnanto
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 1 (2013)
Publisher : Center for Health Policy and Management

Background: Training is an effort to develop knowledge andskills and change attitudes through learning experiences toachieve effective perfomance in an activity or range ofactivities. Tsunami disaster on December, 26th 2004 attackedAceh Province, in 2007-2009, the Ministry of Health incollaboration with UNICEF/PATH conducted mid levelmanagement training on immunization in Aceh Province withthe main objective to improve performance of health workerswho served as manager in implementing the policy of nationalprogram on immunization service at the provincial level, district/city and clinic.Research: This is a case study design using descriptivequalitative and quantitative analysis. The unit of analysis is themanagers of the immunization in District Health Office and inthe health centres that have been trained in Banda Aceh. Themethods of data collection are brainstorming, in-depthinterviews, focus group discussions, reports and documents,and assesment.Result: Immunization managers have a good knowledge ofmanagement and type of the vaccine, vaccine logistics, placeand schedule of vaccinations. The number of cases ofdiseases preventable by immunization have decreased andresults coverage of routine immunization has been increasingafter mid-level management training.Conclusion: Trainees have a positive reaction to training,results of immunization coverage and knowledge wereincreased and behavioral change occured.Keywords: Evaluation, Training Mid Level Management,Immunization.

ANALISIS KEBIJAKAN DALAM MENGATASI KEKURANGAN BIDAN DESA DI KABUPATEN NATUNA Imam Syafari Dwi Handono Sulistyo Kristiani
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 1 (2013)
Publisher : Center for Health Policy and Management

Background: Geographical condition of Natuna Islands whichis not in accordance with health development affects thequantity and availability of midwives distributed in villages inthe District of Natuna. In fact, the ratio between the number ofvillages and the number of midwives in the district has not metthe standard proposed by the Ministry of Health. Unfortunately,there are still around 13 villages from 51 villages that have nomidwives serving in those villages. The location of 13 villagesare separate Island, and it caused lack of provide access toquality health care services. One of efforts done by the localgovernment is to attract midwives’ interest through a varietyof strategies and policies in several fields such as financing,incentive, regulation, organization, and stakeholders’ behaviors.Method: This was a descriptive study with study-case designby using qualitative method. Study case in this study was asingle holistic study case. The informants were head of healthoffice, head of health empowerment and promotion division,head of general affairs and employment sub division, head ofBKD, head of Local Development Planning Agency, theCommission Two of Local Legislative, heads of communityhealth centers, and village midwives. The study case designaimed to know policies in overcoming the lack of midwives inthe District of Natuna.Results: The local government financing policy allocated thebudget or health less than 15%, which was only 3-4% usedfor improving the health workers’ capacity. The incentive givingfor midwives was relatively small compared to the incentiveregulated by the Ministry of Health. There was no specificregulation from the local government, so that the policy wasconsidered not optimal. In the organizational level, the role ofstakeholders was in accordance with their duty and provision;however, the f inal decision was dependent upon LocalLegislative and the local government’s leader. Lastly, midwives’low interest to work in Natuna was caused by its geographicalcondition.Conclusion: Local government’s policy in the field of financing,incentive, organization, regulation, and behavior in overcomingthe lack of village midwives was considered not optimalbecause of the absence of specific policy from the localgovernment in this matter. In addition, midwives’ low interest towork in Natuna contributed the lack of midwives in this district.Keywords: policy analysis, the lack of village midwives

SITUASI PERAWAT PEGAWAI TIDAK TETAP DI DAERAH TERPENCIL PEGUNUNGAN MERATUS KABUPATEN HULU SUNGAI TENGAH – SEBUAH EVALUASI TERHADAP IMPLEMENTASI KEBIJAKAN Rahmatullah Laksono Trisnantoro Dwi Handono Sulistyo
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 1 (2013)
Publisher : Center for Health Policy and Management

Background: The operation of mobile health center activitiesis currently unable to increase the coverage and provide equaldistribution of basic health service for people in isolated areas.The cost for mobile health center activities is relativelyhigh; it needs lots of staff and the service hours are limited. Asthe budget for mobile health center operation is limited, thefrequency of mobile health center activities is relatively low.Further consequence is that the implementation of survaillanceand priority program is constrained. To improve health servicefor people living in isolated areas of Meratus Mountain theDistrict Government of Hulu Sungai Tengah in 2002 issued apolicy on Non Permanent Staff Nurses. This policy is aimed toprovide continuous and accessible basic health service forthe community whenever they need it.Method: This was a descriptive qualitative study that used acase study design and was carried out at 4 villages that gotallocation of non permanent staff nurses with as many as 14informants. Primary data were obtained from indepth interviewwhereas secondary data were obtained from documentsearch particularly documents at Hulu Sungai Tengah districthealth office and health centers. Observation was also madeto get information not covered in indepth interview.Result: The result shows improvement in availability of basicservices to the community. On the other hand limited facilitiesare made available to the non permanent staff nurses, alongwith inadequate equipment, supplies, and vehicle to do theirwork. Also there is lack of additional incentive and regularmonitoring to support them.Conclusion: Basic health service was available more continuouslyand more accessible for people at isolated areas.However, findings also suggest that the policy of non permanentstaff nurses for isolated areas of Meratus Mountain, Districtof Hulu Sungai Tengah had not been fully supported bynecessary facilities, equipment, additional incentives and monitoring.Keywords: policy evalution, non permanent staff nurses, isolatedareas,

KEBIJAKAN UNTUK DAERAH DENGAN JUMLAH TENAGA KESEHATAN RENDAH Shita Listya Dewi
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 1 (2013)
Publisher : Center for Health Policy and Management

Ketidakmerataan distribusi tenaga kesehatan(khususnya, namun tidak terbatas pada dokter dandokter spesialis) di Indonesia merupakan salah satuhambatan dalam upaya peningkatan akses terhadaplayanan kesehatan. Tenaga kesehatan menumpukdi daerah urban sementara Daerah Terpencil, Perbatasandan Kepulauan (DTPK) mengalami resesi tenaga.Pemerintah Indonesia telah mencoba mengatasihal ini dengan berbagai kebijakan. Situasi ini sebenarnyatidak hanya terjadi di Indonesia. Di Negaramaju seperti Prancis pun, fenomena ini terjadi.Menteri Kesehatan Perancis menyebut beberapadaerah di region-region pedalaman Perancismengalami “les déserts médicaux” (gurun pasir tenagakesehatan). Secara keseluruhan jumlah dokterdi Perancis memang bertambah 30% dalam 20 tahunterakhir, ratio saat ini adalah 337 dokter per 100,000penduduk. Perancis memiliki sistem gatekeepingyang ketat dan sistem kesehatan difokuskan padaakses terhadap dokter umum. Rata-rata jarak yangditempuh untuk menemukan dokter umum adalah 5km (8 menit dengan kendaraan). Hanya di regionpedalaman tertentu saja (biasanya di daerah pegunungan)dibutuhkan waktu tempuh 15 menit berkendarauntuk menemukan dokter umum, misalnya diregion Alps atau Pyrenees.Namun tidak berarti Perancis bebas dari isudistribusi tenaga medis. Densitas tertinggi ada diregion urban Île-de-France (367 dokter per 100,000penduduk), sementara terendah ada di pedalaman,misalnya di region Eure (118 dokter per 100,000 penduduk).Perbandingannya rata-rata adalah 1:2 untukdokter umum (1 dokter di daerah pedalaman, 2dokter di daerah urban), dan 1:8 untuk dokterspesialis (1 dokter spesialis di daerah pedalaman,8 dokter spesialis di daerah urban). Akibatnya adalahtingginya antrian untuk konsultasi di daerah yangtermasuk dalam les déserts médicaux, dibutuhkanwaktu tunggu 18 hari untuk konsultasi dengan dokteranak, 40 hari untuk konsultasi dengan dokter obsgyn,dan 133 hari untuk dokter mata.Hal ini diperparah dengan dua fakta, bahwa: 1)25% dari jumlah dokter saat ini akan pensiun dalam5 tahun ke depan, dan 2) hasil riset di kalangan mahasiswakedokteran menunjukkan 63% mahasiswakedokteran tidak berniat untuk bekerja di daerahpedalaman. Pada bulan Desember 2012 lalu, MenteriKesehatan Perancis mengumumkan bahwa pemerintahsedang membuat beberapa kebijakan baru untukmengatasi hal ini. Pengumuman ini disampaikan dihadapanasosiasi walikota Perancis (AMF). Beberapakebijakan lama yang bersifat binding dikoreksidan akan diganti oleh kebijakan baru yang bersifatmemberi insentif. Misalnya: 1) Tersedia alokasi untuk200 dokter pemula yang akan ditempatkan didaerah pedalaman dengan gaji bersih €55,000/tahununtuk kontrak dua tahun (bandingkan dengan gajibersih dokter pemula di rumah sakit yang adalah€40,645/tahun), 2) Pengunaan véhicules santé pluriprofessionnelsyaitu tim multiprofesi (dokter umum,ophthalmologists, cardiologists, perawat, physiotherapists)yang akan melayani daerah-daerah denganakses terbatas, 3) Menciptakan profesi baru: AgentManagement And Interface (AGI) sebagai tenagaadministrative/kesekretariatan yang mengambil alihbeban administrasi dari dokter di pedalaman. TenagaAGI ini akan dibiayai sebagian oleh sécurité socialedan sebagian oleh dokter, dan 4) Pembentukan komitenasional telemedicine untuk mendukung pelayanandi daerah pedalaman.Pengumuman ini mendapat sambutan baik dariAMF. Sambutan baik juga datang dari berbagai asosiasiprofesi dan asosiasi mahasiswa kedokteran,yang disampaikan melalui media social termasukakun twitter milik Menteri Kesehatan. Beberapaminggu setelah itu, Menteri Kesehatan mengundangberbagai asosiasi profesi dan asosiasi mahasiswakedokteran untuk melakukan dialog dan brainstormingmengenai rumusan kebijakan tersebut. Dialogtersebut, telah terkumpul beberapa usulan, antaralain: 1) Usulan untuk disediakannya insentif bagi doktersenior yang tertarik untuk pensiun di daerah pedalaman.Beberapa dokter senior telah mengemukakankeinginan mereka untuk memiliki kualitas hidup lebihbaik di pedalaman, karena mereka ingin mengurangibeban kerja dan sudah tidak ingin lagi melayani 60-70 pasien per hari, 2) Usulan untuk mendelegasikanwewenang tindakan ke profesi tenaga kesehatan lain;hal ini mengantisipasi kesulitan menempatkan 1dokter di setiap desa, dan 3) Usulan perbaikan kondisi perumahan untuk dokter di daerah pedalaman,dan fasilitas di rumah sakit daerah yang perluditingkatkan (diusulkan untuk setara dengan rumahsakit pendidikan).AMF juga menekankan keinginan mereka untukdilibatkan dalam rencana implementasinya untuklebih me’lokal’kan beberapa pendekatan yang terdapatdalam kebijakan nasional. AMF mengakui perlunyaperan mereka dalam meningkatkan perekonomianlokal untuk lebih meluaskan lapangan kerja sehinggasuami/istri dokter bisa memperoleh pekerjaandi daerah. Di sisi lain, AMF juga mengusulkan untuklebih membatasi kebebasan dokter di daerah perkotaanuntuk memilih skema dua (tariff di luar ambangreimbursement oleh sécurité sociale) untuk mengurangikesenjangan pendapatan dokter di perkotaandan dokter di pedalaman.Sebagai catatan, tarif yang dikenakan dokterdan rumah sakit di Perancis untuk pelayanan apapun terdiri dari tiga pilihan: 1) skema 1, yaitu tarifyang ditetapkan oleh sécurité sociale, artinya, pasienakan menerima full reimbursement dari biaya yangdikeluarkannya, 2) skema 2, yaitu tarif di atas ambangyang ditetapkan oleh sécurité sociale, artinya,pasien harus ditanggung sebagian oleh sécuritésociale dan sebagian lagi oleh asuransi pribadi, dan3) skema 3, yaitu tarif private, artinya, pasien tidakmenerima reimbursement apa pun dari sécuritésociale. Kebebasan dokter untuk memilih skema 2dibatasi oleh beberapa persyaratan yang telah ditetapkanpada tahun 1998, tidak semua dokter diperbolehkanmengenakan skema 2. Sebagai gambaran,92.3% dari dokter umum berada di skema 1, 6,8%berada di skema 2, dan hanya kurang dari 1% yangberada di skema 3 (di luar sistem sécurité sociale).Pada sisi lain, pemerintah juga akan mengambilbeberapa kebijakan pada tingkat Nasional untukmemperbaiki sistem sécurité sociale di tahun 2013ini. Sebagai contoh, harga obat dan pemeriksaanlab akan turun sekitar 7%. Sécurité sociale juga mendorongdokter dan rumah sakit untuk lebih banyakmenggunakan obat generik, dan one-day surgery.Peningkatan anggaran untuk Sécurité Sociale akandiambil dari kenaikan pajak tembakau dan pajakmiras. Pada awal bulan Februari 2013, muncul rekomendasipokja yang dibentuk di Senat untuk membahaskebijakan mengatasi les déserts médicaux.Rekomendasi tersebut bertolakbelakang denganusulan yang disampaikan oleh Menteri Kesehatanpada bulan Desember 2012 lalu. Rekomendasi pokjalebih mengambil pendekatan ‘coercive’, yaitu: 1)Membatasi praktek pribadi dokter yang telah melebihijumlah tertentu di suatu daerah. Hal ini telahditerapkan untuk profesi medis lain (perawat, farmasi,fisioterapis, bidan, dll) dan telah terbukti meningkatkanpenempatan perawat di daerah sebanyak 30%dalam 3 tahun terakhir, 2) Menetapkan wajib kerjadi daerah selama minimal 2 tahun untuk dokter spesialisyang baru lulus, dan 3) Mulai mensosialisasikepada mahasiswa kedokteran bahwa mereka akanmenjalani wajib kerja di daerah apabila masalah lesdéserts médicaux tidak teratasi.Pada Minggu lalu, Perdana Menteri Perancistelah menegaskan kembali komitmennya untukmengambil kebijakan mengatasi masalah les désertsmédicaux ini. Dari sudut pandang analisis kebijakan,dinamika dan dialog kebijakan yang terjadi di Perancisdalam hal ini cukup menarik untuk diikuti. Kitamelihat berbagai aktor yang terlibat dalam mencobamengatasi masalah les déserts médicaux di daerahpedalaman. Menarik pula untuk melihat spectrumkebijakan yang diambil dan saran yang diberikanoleh para aktor kebijakan ini.Pada edisi Jurnal Kebijakan Kesehatan Indonesia(JKKI) kali ini, beberapa artikel membahaskebijakan untuk penempatan tenaga kesehatan didaerah terpencil. Topik ini pula menjadi salah satutopik yang diangkat dalam Annual Scientific Meeting(ASM) di Fakultas Kedokteran Universitas GadjahMada. Jelaslah bahwa kita semua menyadari pentingnyamengambil langkah strategis untuk mengatasimasalah ini.*) Semua data diolah dari situs Kementrian Sosialdan Kesehatan Perancis, dan dari Direction de larecherche, des études, de l’évaluation et desstatistiques (DREES).

EVALUASI KEBIJAKAN PENEMPATAN TENAGA KESEHATAN DI PUSKESMAS SANGAT TERPENCIL DI KABUPATEN BUTON Mubasysyir Hasanbasri, Herman Laksono Trisnantoro
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 1 (2013)
Publisher : Center for Health Policy and Management

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkki.3223

Background: One of the important elements and verydetermining and expected can become innovator in the effortof increasing the quality of health service is health force. Theplacement of health force especially in the very remote publichealth center is meant for the equalization of access to healthservice, but in fact the placement of health force policy in thevery remote public health center in Buton Regency is not yetfully implemented. Besides, the interest and motivation of thosewho are placed in the very remote areas are very low, althoughthey are placed, they will not stay for long. We observe thehigh demand for request to transfer to the urban area, resultingin the accumulation of health force in the urban public healthcenter.Method: It is a descriptive research, with qualitative methodto evaluate the placement of health force policy in the veryremote public health center in Buton Regency.Result: The placement policy is influenced by geographicalfactor and the intervention of stakeholders in the Regency.Doctor, nurse and midwife forces placed in the very remotepublic health center do not have high retention rate to stay andwork in the very remote public health center. The small incomeproduced due to unavailability of additional incentive, the unclearcarrier development pattern and lack of appreciation for thosewho work in the very remote public health center are the mainreason to request for a transfer. The transfer is conducted tothe other public health center in the same region or to the otherregency. The provision of supporting facilities policy is notable to make the health forces have motivation to stay andwork in the very remote public health center.Conclusion: The placement of health force policy can notovercome the lack of health force in the very remote publichealth center yet. The unavailability of incentives and unclearcarrier development and lack of appreciation are the mainreason why the health forces do not stay for long, resulting inlow health force number in the very remote public health center.Keyword: Placement policy, financial, supporting facilities,retention

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