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EVALUASI KEBIJAKAN PEMBANGUNAN PUSKESMAS PEMBANTU DI PROPINSI KALIMANTAN TENGAH Deni Kurniadi Sunjaya, Kus Winarno Mubasysyir Hasanbasri
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 02 (2013)
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Background: The objective of health development is improvingcommunity health status through increasing public access tohealth services. One of strategy is by supporting facilities forhealth service by developing auxiliary health center for allremote district at Central Kalimantan Province. CentralKalimantan Province with 1,9 million of population, consistedof 14 district, 1348 villages, 805 auxiliary health center. It meansthat only 59% village have facilities for health service such asauxiliary health center.Objectives: This research aimed to know how formulationprocess and implementation of policy of developing auxiliaryhealth center by using provincial funds.Method: It was descriptive case study using mainly methodqualitative designed by semi structured in-depth interview anddocument study. Research subject is stakeholder at levelprovince and chosen district. This research executed inProvince Public Health Service of Central Kalimantan and onechosen district.Result: Development of secondary health center in CentralKalimantan Province is the realization of Central KalimantanProvince local decree number 12 and 13 year 2005 fulfilmenton RPJPD and RPJMD. Initially, the budgeting concept wasplanned by Tugas Pembantuan mechanism, but this mechanismwas not agreed. This scheme was a top down program fromprovince government. Problems occurred in the implementationare 1). Bad monitoring, 2). Lack of reporting by developer, 3).Remote location of, 4). Varieties in cost of production, 5).Shortage health care workforce, 6). Equipments unmatchedthe need of health care provider. Evaluation is executed, butonly concerning physical progress problem. In the meantime,there was increased allocation of DAK fund in each district.Conclusion: Development of auxiliary health center in CentralKalimantan Province which funded by province fund, is notrequired by district. There was no agenda surroundingdevelopment of auxiliary health center. The role of stakeholderin compilation of agenda setting for this policy was only anormative role.Keyword. Auxiliary health center policy, evaluation,decentralization, central Kalimantan

ANALISIS KEBIJAKAN DESA SIAGA DI KABUPATEN SLEMAN YOGYAKARTA Kusuma, Reni Merta
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 03 (2013)
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Background: Mortality rate is one of indicators andrepresentations of welfare of an area. In order to solve highmortality rate problem, the government of Daerah IstimewaYogyakarta (DIY), including District of Sleman, is carrying outthe policy of alert village.Method: The study used literature review based onreferences and field data which were issued by Health Office.Result: The policy of alert village has less positive impact indecreasing maternal mortality rate and neonatal mortality rate,because health assurance scheme still does not meet theneeds of the people, both physical and non-physical. Thedegree of health still has not improved significantly. The policyof alert village needs inter-sectoral financial support. Financialallocation is still mistargeting. People needs vary from onevillage to another, so it is necessary to have competent andsmart health workers as the implementing agents of HealthDepartment. The policy of alert village is still not able to satisfyall stakeholders (government, health workers, and people),because the concept of satisfaction is closely related to theprinciple of justice.Conclusion: The policy of alert village is an effort to empowerthe people to be independent in overcoming their healthproblems. But, in District of Sleman the policy of alert village isclassified into unsuccessfull policy. This failure is caused byinsufficiet support in implementating the policy.Keyword: Policy of alert village, Health Office of District Sleman

STUDI EFEKTIVITAS PENERAPAN KEBIJAKAN PERDA KOTA TENTANG KAWASAN TANPA ROKOK (KTR) DALAM UPAYA MENURUNKAN PEROKOK AKTIF DI SUMATERA BARAT TAHUN 2013 Azkha, Nizwardi
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 04 (2013)
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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.

SITUASI PERAWAT PEGAWAI TIDAK TETAP DI DAERAH TERPENCIL PEGUNUNGAN MERATUS KABUPATEN HULU SUNGAI TENGAH â SEBUAH EVALUASI TERHADAP IMPLEMENTASI KEBIJAKAN Dwi Handono Sulistyo, Rahmatullah Laksono Trisnantoro
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 01 (2013)
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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,

EVALUASI PROGRAM SKRINING STATUS TETANUS TOXOID WANITA USIA SUBUR DI JEMBER TAHUN 2010 Ahmad Falih, Abu Khoiri, Dewi Rokhmah,
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 01 (2012)
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Background: Cases and deaths due to Tetanus Neonatorum(TN) in Jember District within the period of 2005 to 2009 with aCase Fatality Rate (CFR) were greater than 50%. CFR with arate of more than or equal to 50% indicates a high share ofdeaths. Jember District Health Office implemented a screeningprogram for childbearing womenâs TT status in early 2010.However, not until the end of 2010 there were already 6 casesand 3 deaths due to TN (CFR = 50%). This suggested that theimplementation of the screening program had already beenrunning but not optimal; thus, an evaluation for this programneeded conducting.Objective: To evaluate the screening program for childbearingwomenâs TT status by describing the capacity and motivationof personnel, implementation and results of the screeningprogram in Jember District in 2010.Method: This was a descriptive-evaluation study. It wasconducted in January-February 2011 in five health centers ofJember District. The population was midwives as persons incharge of implementing the screening program.Result: Most respondents (59%) had a moderate level ofcapacity. Most respondents had a high level of intrinsic andextrinsic motivation, namely 71% and 53%, respectively. Thescreening implementation for childbearing womenâs TT statusby the respondents had not been in accordance with the twooperational procedures. The results of the screening programshowed that five health centers were still experiencing thesame problem, i.e., not identified TT status of all women andunmet target coverage of T5 childbearing women and T2 pluspregnant women.Conclusion: Technically, some obstacles in the implementationof the screening program are still present; therefore, there is aneed for conducting training procedures for the personnel ofthe screening program for childbearing womenâs TT statusand conducting an evaluation for the program periodically andcontinuously.Keywords: evaluation, tetanus toxoid, childbearing women

PELAKSANAAN KEBIJAKAN OBAT GENERIK DI APOTEK KABUPATEN PELALAWAN PROVINSI RIAU Nunung Priyatni, Aini Suryani Mubasysyir Hasanbasri
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 02 (2013)
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Background: Medicine is an integral part of community healthservice. Therefore it must be available in sufficient quantity,types and adeqaute quality, properly distributed and accessiblefor community when its needed. In order to meet thecommunityâs need for medicine and to guarantee medicineaccessibility, the government released generic medicine policy.Although the price of the generic medicine has already beenset up and fixed by government, there are variety of the pricestill can be found on implementation of the generic medicinesold in the pharmacy store or in the market, and can causeprice uncertainty for community in finding medicine they need.That is why a research needs to be conduct towardimplementation of the generic medicine price policy on thedistribution channel especially at the pharmacy store.onPelalawan District in Riau Province.Method: This research is non experimental/observationalresearch with qualitative and quantitative method using crosssectional design, data analyzed descriptively.Result: Research result indicates that access to genericmedicine at pharmacy store for available medicine are 99,3%,for un available medicine are 0,7% and for replaced medicineare 0,5%. Average availability of the medicine at the pharmacystore are 4-7,3 months. Highest availability rate for medicine isHidrocortison cream 2,5% for 7,3 months and the lowest isPirazinamid tablet 500 mg for 4 months. Pharmacy store thathave an expired medicine are PR (0,7%) and KH (2%). Everypharmacy store have no damaged medicine, 0% percentage.Almost all pharmacy store experiencing out of supply formedicine between 4 to 90 days. Price of the medicine soldaveragely increasing from its pharmacy store Highest RetailPrice (HRP). But there are several medicine that sold under theHRP The highest price medicine that are sold higher than itsHRP is Clorfeniramin Maleat (CTM) tablet by 515,4% increaseand Dexametason tablet is the lowest price sold under HRP by65,2%. Even so they are Alopurinol, Digoksin, and Ranitidin.From in depth interviews with patients, can be learn that theyhave a purchase ability for generic medicine.Conclusion: Implementation of generic drug price on Pelalawandistrict is good. It can be seen from generic medicine accessby community that are high after the release of regulation fromHealth Department of Republic Indonesia, the level of availabilityof generic medicine on pharmacy store at Pelalawan Districtare low but there are no expired or damaged medicine. Theprice of generic medicine at Pelalawan District are variable butthe community still can afford to buy them.Keyword: Generic medicine, availability and affordability.

DAPATKAH KITA BERPERAN SERTA MENJAWAB TANTANGAN KEBUTUHAN KEBIJAKAN BERBASIS BUKTI? Dewi, Shita Listya
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 03 (2013)
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Para pembuat kebijakan perlu mempertimbangkanbanyak faktor untuk membuat kebijakan sistemkesehatan (misalnya, hambatan kelembagaan, konflikkepentintangn para pemangku kepentingankepentinganyang dipengaruhi oleh suatu kebijakan,dan nilai-nilai serta preferensi publik), namun hasilpenelitian empiris juga dapat membantu. Hasil penelitianempiris dapat menyediakan dukungan buktiatas apa yang efisien dan efektif dan apa yang tidakefisien dan tidak efektif serta strategi apa yang direkomendasikanuntuk mengatasinya. Dengan katalain, hasil penelitian empiris akan memberitahu merekauntuk memperkuat atau memperbaiki secaraterus menerus upaya reformasi sistem kesehatanagar mencapati efektivitas dan efisiensi program,layanan, dan obat-obatan secara optimal untuk masyarakattarget yang membutuhkan. Harapannya,kebijakan yang dihasilkan dengan mendapatmasukan dari penelitian empiris akan merupakankebijakan berbasis bukti.Oleh karena itu, para pembuat kebijakan danpara stakeholder memerlukan akses langsung keberbagai jenis penelitian empiris untuk mengambilkeputusan berdasarkan informasi yang lengkap tentangberbagai pertanyaan dan masalah yang merekamiliki mengenai sistem kesehatan, tata kelola danstrategi implementasi. Di lain pihak, para penelitikebijakan dan lembaga penelitian perlu mendukungdan mengupayakan penggunaan hasil penelitianempiris pada tingkat masyarakat, penyedia, organisasi,dan pembuat kebijakan. Namun, adanya hasilpenelitian empiris dan adanya akses terhadap hasilpenelitian empiris tidak serta merta menjawab kebutuhanpara pengambil kebijakan. Ketepatan waktudari hasil penelitian adalah salah satu dari dua faktoryang penting. Para peneliti dan lembaga penelitianperlu secara sistematis mengidentifikasi gap didalam pengetahuan dan literature tentang sistemkesehatan kemudian melakukan serta menghasilkanmasukan penelitian baru sesuai dengan konteksnyadan tepat waktu.Faktor kedua yang juga penting adalah: parapembuat kebijakan akan menilai seberapa banyakkepercayaan dapat mereka tempatkan terhadapkualitas dari penelitian tersebut, local applicabilitynya,serta nilai tambah (value added) dari hasil penelitiantersebut dibanding penelitian-penelitian sejenislain atau sebelumnya.Dengan demikian, upaya lebih besar harus diarahkanpada beberapa prioritas untuk meningkatkankegunaan dari penelitian tentang sistem kesehatandan dukungan yang diperlukan oleh para pembuatkebijakan dan para pemangku kepentingan. Pertama,ada kebutuhan untuk mendukung upaya-upayasistematis untuk melakukan penelitian kontekstualyang tepat waktu secara teratur. Kedua, perlunyaupaya advokasi hasil penelitian empiris untukmemastikan bahwa para pembuat kebijakan dan parastakeholder memiliki akses ke terbaru terhadap hasilpenelitian empiris. Ketiga, ada kebutuhan untuk meningkatkankualitas dari penelitian itu sendiri. Terakhir,ada kebutuhan untuk ketersediaan serangkaianberbagai topik-topik yang berhubungan dengantata kelola, keuangan dan pelayanan di dalam sistemkesehatan termasuk topik-topik yang selama ini masihkurang âdisentuhâ misalnya pelayanan long termcare, geriatric, dsb, serta strategi implementasi yangdapat mendukung perubahan dalam sistemkesehatan.Sepanjang tahun 2012-2013 ini, Pusat Kebijakandan Manajemen Kesehatan telah melangsungkanpelatihan berbasis web bagi para peneliti kebijakankesehatan. Penelitian telah berlangsung untuk beberapaangkatan. Pelatihan mencakup pengenalanterhadap konsep penelitian kebijakan, perspektif penelitiankebijakan, serta advokasi hasil penelitiankebijakan. Dari setiap angkatan yang mengikuti pelatihanini, telah dipilih lima peserta yang mendapatkandukungan dana untuk melakukan penelitiankebijakan sesuai proposal yang disusunnya. Parapemenang kemudian disaring lagi untuk menentukansiapa yang memperoleh beasiswa untuk mempresentasikanhasil penelitiannya di Forum NasionalIV Jaringan Kebijakan Kesehatan Indonesia di Kupangpada bulan September 2013. Namun, bagi yangbelum terpilih untuk melakukan presentasi, tetap diberisarana untuk mendiseminasikan hasil penelitianmereka yaitu melalui edisi JKKI kali ini dan edisiberikutnya.Walau pun masih jauh dari sempurna, namunini merupakan sebagian kecil dari sumbangsih untukmenjawab empat tantangan yang telah diuraikan sebelumnya, dengan cara (1) mendukung dilakukannyapenelitian kontekstual yang tepat waktu, (2) menyediakansarana untuk diseminasi dan advokasihasil penelitian kebijakan, (3) berupaya meningkatkankualitas penelitian kebijakan, dan (4) memastikantersedianya berbagai ragam topik penelitiankebijakan. Semoga terselenggaranya kegiatan inimendorong dan memotivasi para peneliti kebijakandan lembaga penelitian kesehatan untuk terus memperjuangkanupaya perbaikan sistem kesehatan.Selamat membaca.

KOORDINASI PELAKSANAAN PEMBIAYAAN PROGRAM KESEHATAN IBU DAN ANAK DI KABUPATEN LOMBOK TENGAH PROVINSI NUSA TENGGARA BARAT TAHUN 2011 Tudiono, Lalu Najmul Erpan, Laksono Trisnantoro,
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 01 (2012)
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Background: Health financing provided by the governmentgreatly helps the implementation of health system in the decentralizedera. General Allocation Fund and Local Revenueand Expenditure Budget are apparently inadequate to financehealth service. Some efforts have been made to finance healthservice such as Community Health Insurance (Jamkesmas),Childbirth Insurance (Jampersal), and Health Operational Fund(Bantuan Operasional Kesehatan/BOK). These are meant toachieve Millennium Development Goals in 2015. The practiceof coordination from planning to implementation and stakeholdersâcommitment can affect the process of maternal and childhealth service. Coordination is definitely needed to run theprogram policy and prevent the overlapping financing in orderthat the objective of the program can be achieved.Objective: To evaluate coordination of planning, implementationand stakeholdersâ commitment in relation to maternal andchild health (MCH) service in Lombok Tengah District.Method: This was a descriptive-analytical study with a qualitativeapproach and a case-study design. Samples were takenpurposively. The data were obtained through in-depth interview,observation and documentation analysis.Result: The planning coordination of MCH health financinghad not been optimal, even despite the involvement of crosssector and program. However, the organizations of healthprofessionals were not involved in program planning. The coordinationof health financing implementation had not been optimalas well. Even though there was no overlapping financingfrom some different sources, in the policy implementation therewas cost sharing for referral and drugs. Private sectors werenot involved in the implementation of Jampersal. Stakeholdersâcommitment was relatively optimum as reflected from the policyand action in health development acceleration particularly MCH.The process of MCH service at both primary and secondarylevel could run well.Conclusion: Coordination of MCH financing implementation inLombok Tengah District through BOK, Jampersal, Jamkesmas,Community Empowerment National Program of Healthy andSmart Generation and Local Revenue and Expenditure Budgethad not been optimal; therefore, it needed to be improved toeliminate cost sharing. Professional organizations and privatehealth providers were not yet involved in the program planningand implementation.Keywords: coordination, stakeholdersâ commitment, healthfinancing, maternal and child health, program evaluation

DAMPAK KEBIJAKAN PELAYANAN KESEHATAN GRATIS TERHADAP KEPUASAN PASIEN DALAM MENERIMA PELAYANAN KESEHATAN PUSKESMAS DI KOTA AMBON Lutfan Lazuardi, Lintje Sintje Corputty Hari Kusnanto
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 02 (2013)
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Background: The Mayor of Ambon City, in order to improvethe welfare of society especially the health sector has made apolicy too free basic health services costs at health centersand its network for all communities. In implementing this policy,there are many problems both tecnical and operational.Objectives: The objective of this research was to determinethe performance of officers in providing free health servicesto the public in accordance with the level of satisfaction interms of free health care.Methods: This research is descriptive analysis with aqualitative approach and conducted at five sub districtcoordinator public health services.Research data obtained byin-depth interviews and focused group discussion.For dataanalysis,qualitative techniques were used, that is, narrativeinterpretations, conclusions and data validation by triangulationtechniques.Results: The results show that on giving free services,officerdoes not show any improvement in their performance. Thiswas the result of the absence of incentives or specialcompensation for them. Material and non material compensationis expected to increase work motivation. Supporting facilitiessuch as logistics and health facilities should be prepared toimprove provision of free services, thus in turn increasingpatientâs satisfaction.Keywords: Free Health Services Policy, Performance,Incentive and Compensation, Patient Satisfaction.

STUDI PELAKSANAAN KEBIJAKAN PERATURAN DAERAH JAMINAN KESEHATAN DAERAH SUMATERA BARAT SAKATO DALAM MENGHADAPI UNDANG-UNDANG SISTEM JAMINAN SOSIAL NASIONAL DAN UNDANGUNDANG BADAN PENYELENGGARA JAMINAN SOSIAL TAHUN 2013 Ernawati, Tuty
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 03 (2013)
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ABSTRACTBackground: Local health insurance (Jamkesda) is an effortmade by the Government of West Sumatra province to improvethe accessibility of health services for the poor or near poorwho are not accommodated in the quota of public healthinsurance (Jamkesmas). Jamkesda was implemented at thestart of 2007 until in 2011 using Governor Regulation WestSumatera Number 40 and Number 41 in 2007. After runningfor five years, there are still many problems in theimplementation. Later in 2011, the provincial parliament of WestSumatera exercised its rights of initiative and enacted LocalLegislation Number 10 year 2011 regarding the implementationof the Health Insurance West Sumatra Sakato. Afterwards,the implementation of Jamkesda West Sumatera Sakato refersto these regulations. The purpose of this study is to evaluatethe implementation of the new regulation of the Jamkesda WestSumatera Sakato in 2013.Methods : This study is a descriptive analysis with a qualitativeusing case study. Data collection is done at the ProvincialHealth Office / District Health Office / City selected, PT HealthInsurance, regional planning agency (Bappeda), and healthprovider. Qualitative data were collected through in-depthinterviews, and secondary data were collected throughdocument review.Result: The results of the study shows that implementation ofhealth insurance on West Sumatra Sakato still had not beenoptimal, namely how the selection of the participants; a lowpremium that is Rp.6.000/month/member by sharing fundingbetween provincial and district budgets / City budgets; thebenefits are not yet comprehensive enough; health providersis still limited in the region of West Sumatra province and onlyin public facilities; health workers has not been evenlydistributed; the team is still not functioning well; the monitoringand evaluation at every level Administrative as well associalization of Jamkesda are not optimal; and the existingpolicy has not referred to higher level policy.Conclusion: Implementation of Jamkesda West SumatraSakato does not go according to the existing policy. Amongothers, the selection of membership, quality of health care,lowpremiums, health facilities are limited, health workers have notbeen evenly distributed, and the monitoring and evaluationteam has not been established as per the guidelines.Suggestion: There is a need to evaluate Jamkesda WestSumatera Sakato policy so that the policies are notcontradicting. There is a need to form a Monev Team forJamkesda so that all parties have a sense of sharedresponsibility.Keywords: Local Regulation of Jamkesda, health financing,Provider Jamkesda.

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