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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

Arjuna Subject : -

Articles 7 Documents

Search results for , issue "Vol 2, No 4 (2013)" : 7 Documents clear

HUBUNGAN ANTARA REALISASI DANA BANTUAN OPERASIONAL KESEHATAN DENGAN INDIKATOR GIZI KIA DI KABUPATEN/KOTA PROVINSI JAWA TENGAH TAHUN 2012 Ulma Putri Septyantie Malik Cahyadin
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 4 (2013)
Publisher : Center for Health Policy and Management

Background: Health Operational Fund (HOF) is a grant fromcentral government through the Ministry of Health. The goal isto help local governments for implementing health servicesbased on Minimum Service Standards (MSS) in the field ofhealth to accelerate the achievement of the MillenniumDevelopment Goals (MDGs). Health development policies in2010-2014 are directed to enable availability of fundamemntalhelalth access that cheap and affordable especially for thelower-middle gorups. This is indicated by increasing lifeexpectancy, infant mortality and maternal mortality. One of thehealth priority programs is Nutrition Program and the Maternaland Child Health (MCH).Methods: This research is quantitative research. Analysismethod uses a simple regression. Research data are secondarydata in 2012 of 35 districts/cities in Central Java Province.Results: The realization of Health Operational Fund (HOF) issignificant ( Sig.0,000 < ±=1%) on neonatus first visit/KN1, therealization of Health Operational Fund (HOF) is significant (Sig.0,000 < ±=1%) on assistance by skilled health personnel/Pn, and the realization of Health Operational Fund (HOF) issignificant ( Sig.0,000 < ±=1%) on children weighing or D/S.Coefficient of determination (r ²) is 0.629 for the effect of HOFon KN1, 0.636 for the effect of HOF on Pn, and 0.690 for HOFon D/S. The result of classical assumptions shows that residualvariables are normally distributed, despite heteroscedasticityand despite autoccorelation.Conclusion: HOF has positive effect and significant on KN1,HOF has positive effect and significant on Pn, and HOF haspositive effect and significant on D/SKey Words: HOF, MCH Nutrition, Simple Regression, CentralJava

STUDI EFEKTIVITAS PENERAPAN KEBIJAKAN PERDA KOTA TENTANG KAWASAN TANPA ROKOK (KTR) DALAM UPAYA MENURUNKAN PEROKOK AKTIF DI SUMATERA BARAT TAHUN 2013 Nizwardi Azkha
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 4 (2013)
Publisher : Center for Health Policy and Management

Background: Area free from tobacco (AFT) policy is the onlyeffective and inexpensive way to protect the public from thedangers of second hand smoke. In West Sumatra there arethree cities that have local regulation on this, namely Padang,Panjang Padang, and Payakumbuh, but in reality the policy hasnot been able to reduce the active smokers. This study aims todetermine the effectiveness of AFT policy in reducing smokersactive beside its effectiveness to protect the public from thedangers of second hand smoker in West Sumatera.Methods: The study was conducted with the method, a mixof quantitative and qualitative research with explanatory design.Data collection was conducted in the city of Padang, PadangPanjang and Payakumbuh. Quantitative data from 100 personswere collected using a questionnaire, while the qualitativedata was collected through in-depth interviews. Informants ineach city are representatives of Department of Health,professional organizations, community leaders, smokers andfocus group discussions. Some secondary data are obtainedthrough documents review related to the implementation ofAFT. The quantitative data is analysed using univariate analysis,and the qualitative data is analysed using content analysis.Results: Based on the quantitative data it can be seen that inthree cities in West Sumatera the smoker rate are 59%. InPadang Panjang, the regulation has been proceeded succesfulydue to the commitment of the Mayor and the legislative parlementin implementing the policies that there should not be any tobaccoadvertising as well as sanctions for smokers, especially foremployees who smoke at the office or at school, according tothe law no. 8/2009; suf ficient funds are available forsocialization and supervision AFT, a total of Rp75.000.000,00collected from tobbacco fundation and Rp24.000.000,00 fromthe budget. In Payakumbuh there is also the commitment of theMayor and the support of the Health Department according tothe Regulation of Area Free tobbacco no 15/2011. Establishmentof Supervisory Team for AFT with funds allocated forsocialization and supervision, a total amount ofRp341.278.129,00. Padang has not yet applying the AFT policyin government offices and schools, only in private sector suchas bank. Tobacco advertising still exists and there is no sanctionfor smokers despite the existing Regulation No. AFF 14/2011with accompanying funds provided Rp85.000.000,00.The study shows that the majority (60%) public opinion supportthe implementation of AFT. Some (51%) of the public say thatAFT is effective enough to reduce active smoker, over half ofrespondents thought AFT should apply to a particular location.According to 59% of respondents, smoking in public placesshould be given sanction. In Padang Panjang there is amonitoring service via SMS and phone to report breach of theregulation so that the Mayor may impose sanctions. InPayakumbuh a similar system exist through reports and spotchecks. Violaters of the regulation are given sanction by themayor. In Padang city, sanctions have not been given. Thelocal government regulation in banning advertising andpromotion of cigarettes is implemented in two cities, the city ofPadang Panjang and Payakumbuh. Some factors that affectthe implementation of AFT are dependent on the commitmentand the role of District mayor, as well as the need for communityempowerment..Conclusion: It is concluded that the AFT policy without thecommitment and support of all parties to the implementation ofAFT difficult. AFT can be effective to protect the second handsmokers and it has potential to reduce active smokers.Keywords: Effective, AFT Policy, Reducing active smokers.

IMPLEMENTASI KEBIJAKAN SUBSIDI PELAYANAN KESEHATAN DASAR TERHADAP KUALITAS PELAYANAN PUSKESMAS DI KOTA SINGKAWANG R. Hendri Apriyanto Tjahjono Kuntjoro Lutfhan Lazuardi
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 4 (2013)
Publisher : Center for Health Policy and Management

Background: Health sector is inseparable from thedecentralized system of local autonomy. Health sector is aresponsibility of the local government, even though it isfrequently included in the political policies of a leader. Thedirection of healthcare service development, particularly atthe level of Health Center, has been maintained in the Mayor'sDecree of Singkawang No. 82/2009 on the subsidiary ofhealthcare in Kota Singkawang.Objective: To find out the quality of healthcare at the HealthCenters in relation to the primary healthcare subsidy based onthe perception of society, control/supervision of Local HealthOffice, management, service time, service capacity/type, andattitude of the health center staffs.Method: A descriptive research with case study design wasconducted in three Health Centers: Singkawang Tengah, SingkawangTimur, and Singkawang Utara Health Centers. Subjectsof the research were 15 health staffs and 111 patients.The data were collected using questionnaire, observation, andinterviews.Results: The research found a score of 3.3 for the healthcarein Singkawang Tengah, Singkawang Timur, and SingkawangUtara Health Centers. It means that the Health Center providedrelatively high quality healthcare. From the Reliability dimension,a score of 2.92 was found for Point 2 quick examinationservice with reference to the standard procedure and a scoreof 2.97 for Point 5, the timeliness of healthcare. From the Responsivenessdimension, a score of 2.77 was found for Point 3– the patients did not wait long to get the healthcare service –and a score of 2.94 for Point 4 – the working hour of the HealthCenter. Qualitative analysis showed that the Local Health Officecontrolled/supervised the Health Centers by means of utilization/visit reports and management. It was found that servicetime was frequently ignored and that service type/capacity atthe Health Centers was constrained by the availability of reagentsand medication. The health staffs tended to ignore servicequality and time and there was an indication of deviation inthe utilization/visit reports sent by the Health Centers.Conclusion: The Local Health Office did not have adequatetools to control/supervise the Health Centers, as evident fromthe aspect of management, service time, service type/capacity,and health staff attitude. Procurement of healthcare supplieswas hampered by bidding process and the health staffs needcontinuous training and development.Keywords: Health Office, Health Centers, Public Perception,and Healthcare quality

DETERMINAN KINERJA PELAYANAN KESEHATAN IBU DAN ANAK DI RUMAH SAKIT PEMERINTAH INDONESIA (ANALISIS DATA RIFASKES 2011) Demsa Simbolon Djazuli Chalidyanto Ernawati
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 4 (2013)
Publisher : Center for Health Policy and Management

Background: The hospital has quite an important role inreducing IMR and MMR because hospitals as providers ofplenary personal health services including maternal and childhealth (MCH). However, until now the IMR and MMR Indonesiais still high compared to other ASEAN countries. The maincauses of maternal mortality are obstetric complications ordisease as a complication that arises during pregnancy, childbirthand postpartum. This factor was experienced by approximately20% of all pregnant women, while complication cases thatwere treated well are less than 10%.Objective: The research aims to identify the effect of hospitalcharacteristics, management of MCH services, humanresources for MCH, MCH services, and MCH equipment on theperformance of MCH services in government hospitals inIndonesia.Methods:Research is using secondary data of Health FacilitiesResearch 2011 (RIFASKES) with a cross sectional study.Population and sample is the entire Indonesian governmenthospitals (685 hospitals). The research variables wereidentified from the available variables in the questionnaireRIFASKES. Performance measurement of the compositevariable proportion of maternal deaths due to hemorhage d”1%, d” 10% pre-eclampsia, sepsis d” 0.2%, d” 20% secariasection, the proportion of stillborn d” 4%, and the proportion ofLBW handling 100% based SPM hospital. Multivariate logisticregression was used to obtain a model determinants ofperformance MCH services.Results: The majority (66.3%) government hospitals inIndonesian has less than optimal performance. As thedeterminant is unaccredited status (OR = 2.99: 1.43 to 6.28),the hospital is not a vehicle of education (OR = 1.78; 1.11 to2.85), team PONEK is incomplete (OR = 1.89; 1.27 to 2.82),there is no PONEK-trained doctor in the ER (OR = 1.89; 1.27 to2.82), there is no team ready to perform the operation or taskthough on call (OR = 2.16; 1.32 to 3.53). The most dominantfactor is the unaccredited status.Conclusions: Suboptimal performances of MCH at Indonesiangovernment hospitals are influenced by the low hospital servicecharacteristics and incomplete of human resources. TheMinistry of Health needs to support improvement in all types ofservices to complete an accredited hospitals (16 types ofservices), not just 5 or 12 services. They also need to makethe government hospital as a vehicle of education, increasethe quantity and quality of human resources are trained inPONEK-skill, ensure availability of PONEK-trained doctor inemergency, provide the team that are ready to perform theoperation or task though on call, and increase organizationalcommitment to overall performance improvement.Keywords: Performance, Maternal and Child Health Services,Government Hospital

MANAJEMEN PERUBAHAN DI LEMBAGA PEMERINTAH: STUDI KASUS IMPLEMENTASI KEBIJAKAN PELAKSANAAN PPK-BLUD DI RUMAH SAKIT JIWA PROVINSI NTB Julastri Rondonuwu Laksono Trisnantoro
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 4 (2013)
Publisher : Center for Health Policy and Management

Background: NTB Mental Hospital as the only major referralcenter for mental health services in NTB was required to servethe community, to develop and be self-sufficient, while at thesame time must be able to compete in providing quality andaffordable services to the community. In order to fulfill thesedemands, since January 29, 2011 NTB Mental Hospital hasreceived full endorsement as a Mental Hospital with FinancialManagement Patterns of Local Public Service Agency (PPKBLUD).Therefore, indepth review of the implementation ofPPK-BLUD policy in NTB Provincial Mental Hospital (RSJP) isrequired.Objectives: To explore the transformation process andimplementation of PPK-BLUD policy in RSJP.Methods: The design of this study is a qualitative researchcase study to describe the dynamics of the change processand implementation of PPK-BLUD policy in RSJP.Results and Discussion: The phase of transformationprocess was not running as expected. The implementation ofPPK-BLUD policy is not optimal because some flexibility as ahospital privileges with BLUD financial pattern have not beenimplemented yet. The f inance manager was hesitant toimplement the flexible financial management and still followingthe local government financial management mechanisms. Forexternal stakeholders, the implementation of PPK-BLUD policyimplementation in RSJP did not harm local fiscal policy becausethe revenue of RSJP was still counted as revenue for localgovernment, as opposed to independent PPK-BLUD. A surveywas conducted, consisting of community satisfaction towardsthe services in RSJP, data of revenue and budgettingmanagement and distribution of fee services to employees inRSJP. The survey result described that the implementation ofPPK-BLUD policy in RSJP gives positive impacts on financial,services and benefits performances to RSJP. The positiveimpacts were an increase in the number of income, increasedof service indicators measurement and increased incentive toall employees.Conclusion: Management changes in the transformationprocess were not running optimal so that the PPK-BLUD policyin RSJP is not fully implemented, although there were someperceived positive results.Keywords: Local Public Service Agency, policy, changemanagement.

PROBLEM DAN TANTANGAN PUSKESMAS DAN RUMAH SAKIT UMUM DAERAH DALAM MENDUKUNG SISTEM RUJUKAN MATERNAL DI KABUPATEN KARIMUN PROVINSI KEPRI TAHUN 2012 Zulhadi Laksono Trisnantoro Siti Noor Zaenab
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 4 (2013)
Publisher : Center for Health Policy and Management

Background: Strengthening referral system is a method toaccelerate decrease of maternal mortality rate. The main factorsaffecting referral system are facilities, staff, team work, andbudget that need seroius attention from all stakeholdersinvolved in the program of maternal health. By strengtheningthe system of maternal health the problem and the challenge ofhealth center to support of maternal referral can be addressed.Objective: The study aimed to evaluate referral system ofmaternal health at District of Karimun Province of KepulauanRiau.Method: This was a qualitative case study undertaken atKarimun Hospital and 2 health centers with high maternal andinfant mortality rate, i.e. Meral and Moro Health Center thatwere located at both urban and rural areas. Data were obtainedthrough in-depth interview, focus group discussion,observation, checklist and document study.Result: The result of the study showed there was limitation ofresources at primary health service such as facilities andequipments and hospital limited ability to provide comprehensiveemergency neonatal and obstetric management despite beingoperated 24 hours. There were lack of team coordicationacross referral levels involving district health office, hospitaland health centers, incomplete standard operating procedures,weak information system and bypassing referral procedure.Community participation in referral system was very highthough some labor was assisted by traditional childbirthattendants. This condition was mainly due to cultural factors/reasons.Conclusion: There are some problems and challenges in bothprimary health service and hospitals to support maternalreferral system in Karimun District. Some policies are requiredas a first step toward better referral system in Karimun District,for instance accelerating a functioning CMOC hospital,strengthening the teamwork across referral system, andestablishing SOP for maternal cases including its referralprocedures.Keywords: Problem, Challenge, Maternal referral system,Health Center, Distric Goverment Hospital.

SINERGI KEBIJAKAN UPAYA PENGHEMATAN ANGGARAN BELANJA JAMINAN KESEHATAN DI PERANCIS Shita Listya Dewi
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 4 (2013)
Publisher : Center for Health Policy and Management

Menjelang diberlakukannya Jaminan KesehatanSemesta 2014, Indonesia menghadapi berbagai tantanganterkait kesiapannya. Walaupun prioritas pemerintahsaat ini adalah pada perluasan cakupan/kepesertaan, berbagai isu terkait selayaknya tetapmenjadi perhatian kita. Isu seperti 1) seberapa dalammanfaat pelayanan kesehatan yang akan dijamin,2) seberapa besar proporsi urun biaya yang masihharus dikeluarkan oleh peserta jaminan kesehatanketika mendapatkan manfaat, 3) bagaimana kesiapankuantitas dan kualitas sistem pelayanan kesehatan,fasilitas dan SDM kesehatan serta pemerataandistribusinya di berbagai daerah, 4) bagaimanakebijakan dan regulasi diperkuat untuk mendukungsistem jaminan kesehatan semesta, 5) bagaimanaevaluasi dan monitoring dilakukan, 6) bagaimanamengajak sektor swasta untuk berperan serta, danbanyak hal lain masih tetap perlu dikaji dan dicermati.Bahkan di negara lain dimana sistem jaminankesehatan semesta telah dijalankan, isu-isu sepertidi atas tetap menjadi perhatian dan terus menerusdiawasi. Pada beberapa editorial yang lalu telah dibahasbagaimana sistem jaminan kesehatan semestadijalankan di Perancis. Menjelang akhir tahun, pemerintahmengevaluasi berbagai dimensi pelaksanaanjaminan kesehatan semestanya misalnya kualitaspelayanan, distribusi SDM, besarnya anggaran, dllserta proposal yang diajukan untuk upaya perbaikannya.Bulan September lalu, pengelola jaminan kesehatansemesta di Perancis mengajukan laporan tahunantermasuk proposal upaya penghematan senilai2,48 milyar euro untuk menekan pertumbuhan anggaranbelanja jaminan kesehatan dikisaran 2,4%(pertumbuhan anggaran pada tahun 2012 adalah2,5% sementara pada tahun 2013 adalah 2,7%). Situasiperekonomian Eropa telah menekan berbagainegara termasuk Perancis untuk melakukan penghematananggaran belanja, sehingga wacana penghematananggaran belanja kesehatan merupakan isuyang cukup disorot.Anggaran belanja kesehatan di Perancis adalahsekitar 12% dari GDP, dan beberapa tahun terakhirmengalami defisit lebih besar dari yang diproyeksikan.Pada awal tahun 2013, misalnya, defisit diperkirakansebesar 11,4 juta euro, tetapi laporan tahunan2013 menyatakan bahwa riil defisitnya adalah 14,7juta euro. Hal ini juga disebabkan oleh tekanan situasiekonomi yang membuat sekelompok peserta jaminanyang tadinya termasuk di dalam peserta denganurun biaya berubah menjadi peserta tanpa urun biaya(ditanggung penuh pemerintah) karena kehilanganpekerjaan. Diperkirakan jumlah peserta tanpa urunbiaya ini akan lebih besar pada tahun-tahun mendatangselama krisis ekonomi di Eropa belum berakhir.Oleh karena itu, pemerintah sangat berkepentinganuntuk memastikan kecukupan anggaran untuk menyediakanpelayanan bagi mereka.Proposal penghematan yang diajukan mencakupkebijakan harga untuk berbagai obat (diharapkanakan menghasilkan penghematan senilai 750jutaeuro), serta kebijakan yang membatasi dokter dalammeresepkan obat mahal/branded dan menggantinyadengan obat generik (diharapkan akan menghasilkanpenghematan senilai 600juta euro), dan kebijakanyang membatasi transportasi untuk rujukan yangtidak perlu, dan kebijakan yang mendorong perluasanone-day surgery untuk menghindari biaya rawatinap. Salah satu target dari kebijakan one-day surgeryini adalah operasi katarak yang merupakan salahsatu operasi yang paling sering dilakukan diPerancis (sekitar 700,000 di tahun 2012) yang sebelumnyatidak dilakukan sebagai one-day surgery.Penghematan juga akan dilakukan dalam bentukstrategic purchasing untuk peralatan kesehatanmisalnya insulin pumps, prostheses, respirators, dll.Diharapkan dengan kebijakan strategic purchasingini penghematan yang dihasilkan adalah senilai 220juta euro (untuk level rumah sakit) dan 150juta euro(untuk level klinik/fasilitas kesehatan primer). Yangmenarik adalah bagaimana proposal ini didukungoleh berbagai kebijakan yang mengikutinya. Dokter,misalnya, diharuskan untuk menulis setidaknya 25%bagian dari resepnya berupa formula kimia dari molekulaktif obat, dan bukan brand name-nya. Hal inidilakukan untuk mendongkrak penjualan obat generikdi Perancis yang saat ini masih berkisar 14%(dalam nilai uang) atau 26% (dalam kuantitas) padatahun 2012 lalu. Sebagai perbandingan, share penjualanobat generik di Jerman atau Inggris adalahsekitar 50%.Kebijakan lain yang juga terkait adalahkebijakan redistribusi ketersediaan tenaga medis,seperti yang telah dibahas pula pada editorial lalu.Hasilnya ternyata cukup menggembirakan. Secarakeseluruhan, jumlah dokter bertambah 0.9 % namunsecara riil jumlah dokter di beberapa tempat yangtelah padat berkurang (misalnya di region Centerberkurang 2.3 %, dan di region Ile- de- France berkurang4.2%) dan sebaliknya meningkat di daerah yangsebelumnya kekurangan (misalnya di region Paysde-Loire meningkat 4.7% dan di region Rhône –Alpes meningkat 4.5%). Ketersediaan tenaga medisdi daerah-daerah yang kekurangan diharapkan dapatmengurangi unnecessary referral antar-region danmengurangi biaya transpor rujukan.Selain kebijakan yang mendukung, prosesevaluasi yang dilakukan terhadap fasilitas kesehatan(klinik dan rumah sakit) di Perancis baik fasilitaspemerintah maupun swasta juga mencerminkandukungan terhadap upaya penghematan anggarankesehatan seperti yang diusulkan. Dari beragamkomponen penilaian dan evaluasi tersebut misalnyajuga dimasukkan variabel rendahnya LOS di rumahsakit dan seberapa banyak ambulatory care dilakukan.Hasil dan ranking penilaian untuk seluruh rumahsakit ini, baik rumah sakit pemerintah maupun swasta,diumumkan setiap tahun sehingga masyarakatdapat secara terbuka melihat ranking dari rumahsakit di daerahnya. Dengan demikian rumah sakitdan klinik dipacu untuk mengembangkan layananone-day surgery yang lebih cost-effective danmengurangi LOS.Dari cerita singkat di atas dapat ditarik pelajaranbahwa pemerintah Indonesia pun perlu melihatsistem kesehatannya secara utuh dan mencarisinergi antar kebijakan agar saling mendukung. Halini khususnya menjadi semakin penting di erajaminan kesehatan semesta. Apabila sinergi antarkebijakan ini belum terjadi maka perlu dicari solusiatau alternatif kebijakannya. Apabila telah adakebijakan yang digulirkan, maka perlu pula dikajisejauh mana efektifitas pelaksanaannya di lapangan.Di sinilah letak pentingnya kajian kebijakan danevaluasi kebijakan dalam memainkan peran sebagai‘feeder’ terhadap komunitas kebijakan khususnyapengambil kebijakan. Selaras dengan itu, berbagaiartikel dalam JKKI kali ini akan berupaya menyorotiberbagai implementasi kebijakan dan memberikanrekomendasi perbaikan. Selamat membaca.

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