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IMPLEMENTASI KEBIJAKAN SUBSIDI PELAYANAN KESEHATAN DASAR TERHADAP KUALITAS PELAYANAN PUSKESMAS DI KOTA SINGKAWANG Lutfhan Lazuardi, R. Hendri Apriyanto Tjahjono Kuntjoro
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 04 (2013)
Publisher : Jurnal Kebijakan Kesehatan Indonesia

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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 MayorsDecree 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 3â the patients did not wait long to get the healthcare service âand a score of 2.94 for Point 4 â 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

EVALUASI PENERAPAN KEBIJAKAN BADAN LAYANAN UMUM DAERAH DI RSUD UNDATA PROPINSI SULAWESI TENGAH Laksono Trisnantoro, Surianto
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 01 (2013)
Publisher : Jurnal Kebijakan Kesehatan Indonesia

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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 âEnterprisingthe Govermentâ and the âPublic Service Orientedâ. 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

PELAKSANAAN KEBIJAKAN BANTUAN OPERASIONAL KESEHATAN DI KABUPATEN OGAN ILIR, SUMATERA SELATAN Ainy, Asmaripa
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 01 (2012)
Publisher : Jurnal Kebijakan Kesehatan Indonesia

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ABSTRACTIntroduction: The Ministry of Health of Indonesia Republichas issued a policy on health operational fund (BOK) to increasethe access of service in health centers based on a decree ofthe Minister of Health Number 494/Menkes/SK/IV/2010 updatedthrough the regulation of the Minister of Health Number 210/Menkes/Per/I/2011 dated 31st January 2011 on the technicalguidelines for BOK. Ogan Ilir District has supported that policythrough a decree issued by the head of health office Number440/337/DKES/III/2011 and 440/22/DKES/III/2011, which eachregulates the forming of the management of Jamkesmas,Jampersal, and BOK as well as budget managers. This studyaimed to analyze the implementation of BOK policy in Ogan IlirDistrict.Methods: This study was an analysis of policy. The primarydata were obtained through direct observation and in-depthinterviews to 4 informants: Head of Ogan Ilir Health Office,management staff at Ogan Ilir Health Office, Head of IndralayaHealth Center and management staff at Indralaya Health Center.The secondary data were obtained through review of BOKdocuments.Results: BOK in Ogan Ilir had been implemented in 2010 throughthe social assistance and in April 2011 by co-administration bythe health office. The organizing of BOK referred to thetechnical guideline from the Ministry of Health. Financialmanagement referred to the financial management guidelinefrom the Directorate General of Nutrition and Maternal andChild Health. Disbursement of BOK began from proposing Planof Actions (POA) from health centers to health office to verifythe funds and then proposing disbursement to KPPN. The fundfor implementing program could be taken from BOK treasurer.The allocation of BOK at health centers was adjusted for thenumber of working areas, population, program coverage andgeographical conditions. BOK was prioritized for healthpromotion such as: maternal and child health, nutrition, bodymass index measurement, and communicable diseases. PerApril-June 2011, the fund for secretariat had been disbursedabout 40% used for dissemination, training and transport forhealth center treasurer. Reporting of BOK conducted fromhealth center to health office was on every date 5 thenforwarded to the province and to the Ministry of Health everymonth via online, as well as a written report to KPPN.Conclusion: The implementation of BOK in Ogan Ilir referredto the policy of the Ministry of Health and was followed upwith the policy of district health office. POA proposal is decisivedin the disbursement of BOK so it is recommended to the headof Ogan Ilir District Health Office to routinely ensuredissemination about BOK and guide all health centers inpreparation of POA for implementing policy effectively.Keywords: financing policy, health operational fund, healthcenter

EVALUASI IMPLEMENTASI KEBIJAKAN PERSALINAN BAGI MASYARAKAT MISKIN OLEH BIDAN PRAKTEK SWASTA DI KOTA TANJUNGPINANG Mubasysyir Hasanbasri, Elfrida Tambun
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 02 (2013)
Publisher : Jurnal Kebijakan Kesehatan Indonesia

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Background: Economy factor is one of the factors that couldhampered communityâs access in the utilization of health service.To guarantee effort of poor community access towardhealth service, the government was conducted managed program.The limitation of working hours in primary health carewas causing limited service hours. Therefore, in order to solvethe problem, the government stated that private midwife practiceas one of the health services could be utilized by poorcommunity with budget that was covered by government. Thegovernmentâs policy has not yet able to improve the coverageof delivery attendant by health care provider. Hence, an evaluationto find out the phenomenon occurred in the community isnecessary to solve this problem in order to improve the healthservice in the future.Objective : This research was aimed to find out the descriptionof delivery care for poor community by private midwife inTanjungpinang Municipality.Method: This was a descriptive research that used qualitativeapproach with case study design. The research subjectwas civil servant midwife who had midwifery private practice,head of primary health care, head of health office, headof family health division, and mothers who delivered and hadaskeskin (health insurance for poor community) card. Theselection for midwife and mothers who delivered was usingpurposive sampling technique. Furthermore, the data wascollected by using primary data that was obtained from indepthinterview result that used interview guidance, while the secondarydata was obtained from document observation, andthe data will be analysed qualitatively.Result: The policy of delivery for poor community inTanjungpinang Municipality has not yet obtained optimalsupport.The limited bugdet availability affected in a way thatnot all of the midwives were willing to assist askeskin patientwith cost claim to primary health care. Private practice midwifeasked for fee from askeskin patient. There was no differencethe treatment given between askeskin patient and private/paying patient. However, askeskin patient was satisfiedwith the service given by private practice midwife.Conclusion: The implementation of delivery policy for poorcommunity by private practice midwife has not yet optimal asthere was a lack of support from municipality government,administratively or financially.Keyword: Evaluation, policy implementation, private midwifepractice and poor community

IMPLEMENTASI KEBIJAKAN KESEHATAN âLIBAS 2+â SEBAGAI UPAYA MENURUNKAN ANGKA KEMATIAN IBU DAN BAYI DI KABUPATEN SAMPANG Imron, Ali
Jurnal Kebijakan Kesehatan Indonesia Vol 2, No 03 (2013)
Publisher : Jurnal Kebijakan Kesehatan Indonesia

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Introduction: The issue of MDGs 4 and 5 that targets reducingthe AKI and AKB by three-quarters between 1990 and 2015seems difficult to achieve if there are no immediate concretesteps. Areas with the highest AKI and AKB are SampangRegency. Looking at the empirical conditions, it is necessary toidentify the factors that led to the high AKI and AKB in SampangRegency. There is an existing health policy in Sampang districtthrough LIBAS (Lima Bebas) 2+, but it needs to be monitoredand evaluated to ensure policy implementation went well. Thisstudy aims to assess the implementation of the Libas programsand identify socio-cultural factors that influence health policyimplementation.Methods: This study used qualitative methods that took placeat the Puskesmas Camplong, Sampang Regency. Informantswere selected purposively. The research data was collectedby participating observation, in-depth interviews, and focusgroup discussions. The finding was analyzed using descriptiveanalysis.Results: Sociologically, the implementation of policy to reduceAKI and AKB in Sampang Regency is one of which is influencedby the shaman midwife partnerships, especially in the deliveryprocess. Increasing public confidence in midwives indicatesstrengthening social relations. 5T programs (weigh, tension,tablet Fe, weigh abdominal size, and height) is helpful to controlthe development of maternal pregnancy. âHealthy Babies 24Hoursâ SMS number serves as a control and monitoring indelivery care. Nonetheless, culturally, traditional culturalconstruction of Madura, particularly the coastal communities,still entrenched so that the construction of knowledge aboutreproductive health is still weak. Shaman massage, herbalmedicine, pregnancy myths, and charismatic central figureare prominent. Social relation between local actors is still weak,so is the local actors support.Conclusion: Strong local culture values and weak socialrelationship and support of local actors as a result of programimplementation LIBAS2+ reduce AKI and AKB efforts inSampang Regency had not been effective.Keywords: health policy, LIBAS 2+, social relationship, localculture

KEBIJAKAN DAN IMPLEMENTASI BANTUAN LUAR NEGERI AUSAID DI TIMOR LESTE: EVALUASI TERHADAP PROYEK DUKUNGAN RENCANA STRATEGIK SEKTOR KESEHATAN Retna Siwi Padmawati, Manuela Pereira, Yodi Mahendradhata,
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 01 (2012)
Publisher : Jurnal Kebijakan Kesehatan Indonesia

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Background: The Ministry of Health of Timor-Leste has realizedthat they should work together with other stakeholders toachieve their vision and mission due to insufficient humanresources and budget. Therefore, the Ministry of Health hasestablished collaboration with AusAid and other developmentpartners through mechanism of coordination. However, themechanism is not yet implemented fully.Objective: To evaluate foreign aid policy in coordinating AusAiddonor and development partners to fund human resource developmentprogram (in the HSSP-SP project) through the mechanismof coordination in the Ministry of Health of Timor-Leste.Method: This was a qualitative study with a case-study design.The respondents were 16 people, consisting of 13 personsfrom the Ministry of Health and 3 persons from AusAid,World Bank and development partners.Result and Discussion: The Department of Partnership Managementhad not been optimum in managing and controlling theproject/program and activities of the donors and working partners.The approved action plan and budget were relevantwith the proposal made by the Ministry of Health but planningfor human resource development was unclear and was notbased on the work force gap faced and priority in humanresource development. The project had impact on human resourcedevelopment but the process of staff re-placementwas not in line with the principle of the right man on the rightplace. Regular consultative meeting could facilitate the approvalof action plan and budget for human resource development.However, the mechanism of coordination was less effectivebecause there was no specific instrument or mechanismto do alignment and harmonization and it only focused oncollective gain and there was too much pressure and demandto staff from both the Ministry of Health and partners. Constraintsand challenges from political aspect and human resourcecapacity had hampered the process of coordinatingAusAid and working partners.Conclusion: The implementation of foreign aid policy to coordinateAusAid and development partners to fund human resourcedevelopment (in HSSP-SP project) following the mechanismof coordination in the Ministry of Health of Timor-Lestehad run well enough but still received lack of support fromhuman resource development planning based on institutionaldevelopment.Keywords: policy evaluation, mechanism of coordination,human resource development, donor agency

Kesadaran Pekerja Sektor Informal terhadap Program Jaminan Kesehatan Nasional di Provinsi Daerah Istimewa Yogyakarta Budi Eko Siswoyo; Yayi Suryo Prabandari; Yulita Hendrartini
Jurnal Kebijakan Kesehatan Indonesia Vol 4, No 4 (2015)
Publisher : Center for Health Policy and Management

Background: The subsidized members (PBI) dominate the membership of the National Health Insurance Scheme (JKN) in Indonesia, including in Yogyakarta. The low number of nonwage earners (PBPU) and the decrease in the number of new non-PBI members, doesn’t indicate optimal socialization, but also the lack of a awareness of informal sector workers towards JKN. Public awareness determines the ability and community involvement in support JKN. Objective: To analyze the informal sector workers’ awareness of the JKN programs in Yogyakarta. Method: This study was observational analytic with the cross-sectional design. The subjects are informal workers in Yogyakarta who have not joined JKN, set with quota sampling (200 respondents) and they were selected purposively. The data was collected by questionnaire and analyzed using quantitative and qualitative approaches as univariate, bivariate, and multivariate. Result: Linear regression test showed that the affect of independent variables towards consciousness, namely: the main types of jobs [B = 2,5452 dan (p) = 0,00 < ±]; education [B= 1,6609 dan (p) = 0,00 < ±]; knowledge [B = 1,3944 dan (p) = 0,00 < ±]; age [B = 1,0736 dan (p) = 0,00 < ±]; employment status [B = 1,0451 dan (p) = 0,01 < ±]; and income [B = 0,0001 dan (p) = 0,02 < ±]. Conclusion: Generally, the level of awareness of the informal sector workers towards JKN is considered in the high category. However, most informal sector workers tend to delay membership. Latar belakang: Peserta penerima bantuan iuran (PBI) mendominasi kepesertaan Program Jaminan Kesehatan Nasional (JKN) di Indonesia, termasuk di Provinsi D.I. Yogyakarta. Rendahnya jumlah peserta bukan penerima upah (PBPU) dan turunnya jumlah peserta baru yang non PBI, bukan hanya menjadi indikasi belum optimalnya sosialisasi, tetapi juga belum terbentuknya kesadaran pekerja sektor informal terhadap program JKN. Kesadaran menentukan kesanggupan dan keterlibatan masyarakat dalam mendukung penyelenggaraan program JKN. Tujuan: Menganalisis kesadaran pekerja sektor informal terhadap program JKN di Provinsi D.I. Yogyakarta. Metode Penelitian: Penelitian ini adalah observasional analitik dengan rancangan cross sectional. Subjeknya adalah pekerja informal di Provinsi D.I. Yogyakarta yang belum menjadi peserta JKN yang ditetapkan dengan quota sampling (200 responden) dan dipilih secara purposive. Data dikumpulkan dengan instrumen berupa kuesioner dan dianalisis menggunakan pendekatan kuantitatif dan kualitatif, baik secara univariabel, bivariabel, dan multivariabel. Hasil: Uji regresi linear menunjukkan bahwa pengaruh variabel bebas terhadap kesadaran, yaitu : jenis pekerjaan utama [B = 2,5452 dan (p) = 0,00 < ±]; pendidikan [B = 1,6609 dan (p) = 0,00 < ±]; pengetahuan [B = 1,3944 dan (p) = 0,00 < ±]; umur [B = 1,0736 dan (p) = 0,00 < ±]; status pekerjaan [B = 1,0451 dan (p) = 0,01 < ±]; dan pendapatan [B = 0,0001 dan (p) = 0,02 < ±]. Kesimpulan: Pada umumnya tingkat kesadaran pekerja sektor informal terhadap JKN termasuk kategori tinggi. Sebagian besar pekerja sektor informal cenderung menunda kepesertaan.

Konseling Ibu Hamil pada Bidan Praktik Swasta dan Puskesmas di Kabupaten Bantul Retno Heru; Mubasysyir Hasanbasri; Mohammad Hakimi
Jurnal Kebijakan Kesehatan Indonesia Vol 1, No 3 (2012)
Publisher : Center for Health Policy and Management

Counseling for Pregnant Women at Midwife Practice and Community Health Center in Bantul DistrictBackground: One of the factors of Maternal and Neonatal Mortality is the lack of knowledge on the cause and how to deal with important complications during pregnancy, labor, and post natal. Counseling is an effort to dig and give useful information in order to help pregnant mother to take decisions. Midwife practice and Community Health Center is an organization which aims at giving service to pregnant mother including counseling. Midwife practice an independent organization which is managed privately, whereas Community Health Center is an organization which belongs and runs by the government. Objectives: The objective of the research is to find out the implementation of counseling on pregnant mother which includes, time, places, instruments, materials, problem solving, training efforts, and form of teaching counseling skill on midwife practice and Community Health Center in Bantul district. Method: Research method used in this research is qualitative research method with case study and descriptive method. The analysis unit is the pregnant mother, midwife in charge in midwife practice and in Community Health Center. The data was taken using purposive sampling through interview, observation and library study. Result: Counseling implementation in midwife practice and Community Health Service is done through giving information. The time done for counseling is under the standard which was below 20 minutes. The counseling process is undergone in one place along with the other services, and there are many patients in the room. The instruments used for counseling is just KIA book and there are no other instruments, the information given is merely on the problems which are shared by the pregnant mother. If the pregnant mother doesn’t share her problem, the midwife will not give counseling. The problem which is often faced by the midwife is that pregnant mother has difficulties in intrepreting information given. Problem solving is done through the participation of the husband during the counseling service. Training efforts to increase the counseling skill has not been done officially. The efforts taken so far is by reading books or learn from other coleagues. The form of teaching counseling skill is using roleplay, done in pairs and not more than 45 minutes. Conclusion: The implementation of counseling for pregnant mother is done inappropriately, which is not the same as it is stated in the Standart Service of Midwifery. It makes pregnant mother doesn’t have the necessary information dealing with the pregnancy.Keywords: Counseling, Pregnancy, MidwifeLatar Belakang: Salah satu penyebab tingginya Angka Kematian Bayi dan Angka Kematian Ibu adalah karena kurangnya pengetahuan tentang penanggulangan dan komplikasi-komplikasi penting dalam kehamilan, persalinan, dan nifas. Konseling adalah upaya menggali dan memberikan informasi guna mendapatkan apa yang dibutuhkan dan membantu ibu hamil dalam mengambil keputusan. Bidan Praktik Swasta dan Puskesmas adalah organisasi pelayanan kesehatan yang memberikan pelayanan pada ibu hamil termasuk konseling. BPS adalah organisasi pelayanan kesehatan swasta yang dikelola secara mandiri, sedangkan Puskesmas adalah organisasi pelayanan kesehatan yang di kelola oleh pemerintah. Tujuan: Tujuan penelitian ini adalah untuk mengetahui pelaksanaan konseling pada ibu hamil yang meliputi: praktik konseling, waktu, tempat, alat bantu, materi, cara mengatasi hambatan, upaya peningkatan ketrampilan, dan bentuk pengajaran ketrampilan konseling di pendidikan di BPS dan puskesmas di Kabupaten Bantul. Metode: Metode penelitian adalah metode kualitatif dengan rancangan studi kasus dan bersifat deskriptif. Unit analisis adalah ibu hamil, bidan pelaksana di BPS dan puskesmas. Data diambil secara purposive sampling melalui wawancara mendalam dan lembar pengamatan konseling serta penelusuran dokumen. Hasil: Praktik konseling di BPS dan puskesmas dalam bentuk pemberian informasi. Waktu yang digunakan dalam proses konseling masih kurang yaitu di bawah 20 menit. Tempat yang digunakan untuk proses konseling menjadi satu dengan tempat yang digunakan untuk periksa kehamilan, dan banyak orang yang ada dalam ruangan periksa. Alat bantu yang digunakan untuk konseling sebatas buku KIA dan belum menggunakan alat bantu yang lain. Informasi yang diberikan sebatas pada keluhan yang disampaikan oleh ibu hamil. Jika ibu hamil tidak menyampaikan keluhan, bidan tidak berusaha menggali permasalahan atau memberikan informasi. Hambatan yang paling sering ditemui bidan adalah sulitnya ibu hamil memahami informasi yang diberikan bidan. Cara penyelesaian hambatan dengan cara melibatkan suami dalam proses konseling. Upayapeningkatan ketrampilan konseling secara resmi seperti pelatihan-pelatihan belum ada. Upaya yang dilakukan selama ini adalah dengan membaca buku-buku dan belajar dari teman. Bentuk pengajaran ketrampilan konseling di pendidikan dengan metode roleplay, dilaksanakan dikelas, dan dilakukan dengan teman sendiri. Kesimpulan: Proses konseling pada ibu hamil yang dilakukan oleh bidan pada umumnya tidak berjalan sebagaimana mestinya, yaitu tidak sesuai dengan pedoman yang ada dalam standar pelayanan kebidanan. Dampaknya adalah ibu hamil belum paham dengan segala hal yang berkaitan dengan kehamilan.Kata Kunci: Konseling, Kehamilan, Bidan

Hambatan Birokrasi dan Manajerial dalam Implementasi Kebijakan Asi Eksklusif di Kota Binjai Eka Nenni Jairani; Yayuk Hartriyanti; Detty S. Nurdiati; Mubasysyir Hasanbasri
Jurnal Kebijakan Kesehatan Indonesia Vol 7, No 1 (2018)
Publisher : Center for Health Policy and Management

Background: The coverage of exclusive breastfeeding in Indonesia is still not satisfactory. Based on data from Riskesdas in 2010, exclusive breastfeeding coverage 31,0% and 30,2% in 2013. As for the less than an hour process of breastfeed in 2010 amounted to 29.3% and 34.5% in 2013. Some policies those concerning about exclusive breastfeeding and early initiation of breastfeeding has been established. The established policies at the central level should be implemented and under surveillance in order to have an impact and achieve the goals set. There are many factors that influence the process of implementation including implementing perception, communication, budget, resources, facilities and infrastructure, bureaucratic structures, and unclear technical implementation guidelines. Objective: This research aimed to obtain a representation of the implementation of exclusive breastfeeding policy at Binjai city North Sumatera as well as surveillance and the factors that influence its implementation. Methods: This research use a qualitative method with case study approach. Data collected by indepth interviews, focus groups discussion, observation and document study. Results: Implementation of exclusive breastfeeding policy is still not implemented. This can be seen by inexistence of surveillance to the policy implementation and there are different interpretations in implementing the policy by the policy implementers. Moreover, there is no communication channel, basic quantity of budget, the training for midwives, facilities and supporting infrastructure, bureaucratic structure, as well as the guidelines of technical implementation in this implementation of policy. Conclusion: The implementation of exclusive breastfeeding policy should be initiated with the establishment of derivative policies at the local level so that there are clear regulations in the implementation.ABSTRAKLatar Belakang: Cakupan ASI eksklusif di Indonesia masih belum memuaskan. Berdasarkan data Riskesdas 2010 cakupan ASI eksklusif sebesar 31,0% dan 30,2% pada tahun 2013. Sedangkan untuk proses menyusu kurang dari satu jam (IMD) pada tahun 2010 sebesar 29,3% dan pada tahun 2013 sebesar 34,5%. Beberapa kebijakan mengenai ASI eksklusif dan Inisiasi Menyusu Dini (IMD) telah ditetapkan pemerintah. Kebijakan yang telah ditetapkan dengan baik di tingkat pusat seharusnya diimplementasikan dan dilakukan pengawasan dalam proses implementasinya, agar mempunyai dampak dan mencapai tujuan yang telah ditetapkan. Ada banyak faktor yang mempengaruhi proses implementasi diantaranya persepsi pelaksana, komunikasi, anggaran, sumber daya, sarana dan prasarana, struktur birokrasi, dan pedoman pelaksanaan teknis yang kurang jelas. Tujuan: Penelitian ini bertujuan untuk memperoleh gambaran implementasi kebijakan ASI Eksklusif di Kota Binjai Sumatera Utara serta pengawasannya dan faktor-faktor yang mempengaruhi implementasinya. Metode: Penelitian ini menggunakan metode kualitatif dengan pendekatan studi kasus. Penelitian dilaksanakan di Puskesmas Binjai Kota pada bulan Mei-Juni 2015. Pengumpulan data dilakukan dengan indepth interview, focus group discussion, observasi, dan studi dokumen. Hasil: Implementasi kebijakan ASI Eksklusif masih belum dilaksanakan dengan baik. Tidak adanya pengawasan terhadap implementasi kebijakan, penafsiran yang berbeda dalam mengimplementasikan kebijakan oleh implementer kebijakan. Selain itu tidak adanya saluran komunikasi, besaran anggaran, pelatihan bagi bidan, sarana dan prasarana pendukung, struktur birokrasi, serta pedoman pelaksanaan teknis, menyebabkan belum tercapainya tujuan kebijakan yang diharapkan. Kesimpulan: Implementasi kebijakan ASI Eksklusif sebaiknya diawali dengan dibuatnya kebijakan turunan di tingkat daerah sehingga ada regulasi yang jelas dalam pelaksanaannya.

Pengelolaan dan Pemanfaatan Dana Kapitasi (Monitoring dan Evaluasi Jaminan Kesehatan Nasional di Indonesia) M. Faozi Kurniawan; Budi Eko Siswoyo; Faisal Mansyur; Wan Aisyah; Dedy Revelino; Welly Gadistina
Jurnal Kebijakan Kesehatan Indonesia Vol 5, No 3 (2016)
Publisher : Center for Health Policy and Management

ABSTRACTBackground: The Indonesian National Health Insurance (JKN)was commenced in early 2014. BPJS Kesehatan (parastatal organization appointed as JKN management entity) and the primary health centers (PHCs) are dealing with challenges and bottlenecks in providing quality health service to JKN beneficiaries. One of the challenges is the management and utilization of the capitation fund, which is used as the payment model for PHC. The monitoring and evaluation of the capitation fund are imperative to improve the attainment of universal health coverage through JKN program.Objective: To analyze the management and utilization of capitation fund in PHC including the bottlenecks and to generate solutions in the implementation of JKN.Method: This is a descriptive study using quantitative and qualitative approaches. A total of 384 PHCs in 7 regionals and 20 districts were selected using random sampling. Primary data were collected through series of interviews and FGDs using a standardized questionnaire. Secondary data on capitation fund and health care services (2014-mid 2015) were collected from primary health centers and BPJS Kesehatan database. Qualitative data were analyzed using thematic approach and quantitative data were descriptively analyzed to show the capitation fund and health care utilization trend at PHC level.Result: Although an increase in overall income from capitation fund was observed in the majority of PHCs, there was a higher increase in patient utilization leading to lower actual capitation income generated by PHCs. Such finding is applicable morely to Private GP Practice (Dokter Praktik Perorangan) and Private Primary Clinic (Klinik Pratama). Quantitative findings show that most private PHCs experienced deficit. Most Puskesmas used Head of District decree/district regulation as the main legal basis for capitation fund management and utilization. However, many of the local regulations are not completely in line with central-level mainly because of the rapid changes at the central-level. Such disconnection of policies between levels of government has led to confusion at the PHC level in fund management and use. As the sole purchaser, BPJS Kesehatan is considered to be not yet well involved in district capitation fund planning and budgeting. Such practices were perceived to be even less condusive in the monitoring and evaluation of capitation fund usage.Conclusion: To ensure the quality of care and the sustainability of PHCs as JKN providers, capitation fund should be increased. Local government needs to support JKN implementation by issuing clear guidelines that follow central policies on how PHCs should plan and manage capitation fund. Continuous monitoring and evaluation of capitation fund is important to ensure that JKN program targets are achieved at the primary care level.Keywords: capitation, management, utilizationABSTRAKLatar Belakang: Jaminan Kesehatan Nasional (JKN) mulai diselenggarakan di Indonesia sejak tahun 2014. BPJS Kesehatan (badan yang ditunjuk sebagai penyelenggara JKN)dan fasilitas kesehatan tingkat pertama (FKTP) menghadapi tantangan dan hambatan dalam penyediaan pelayanan kesehatan yang berkualitas kepada peserta JKN. Salah satu tantangannya adalah dalam pengelolaan dan pemanfaatan dana kapitasi sebagai model pembayaran FKTP. Monitoring dan evaluasi penyelenggaran dana kapitasi menjadi penting untuk meningkatkan capaian jaminan kesehatan semesta melalui program JKN.Tujuan: Menganalisis pengelolaan dan pemanfaatan dana kapitasi di FKTP, termasuk kendala dan alternatif solusi dalam penyelenggaraan JKN.Metode: Studi deskriptif ini menggunakan pendekatan kuantitatif dan kualitatif. Sampel 384 FKTP di 7 regional dan 20 kabupaten/ kota dipilih secara acak. Data primer dikumpulkan melalui serangkaian wawancara dan FGD dengan kuesioner terstan- dar. Data sekunder terkait dana kapitasi dan pelayanan kese- hatan (2014 – pertengahan 2015) dikumpulkan dari FKTP dan BPJS Kesehatan. Data kualitatif dianalisis menggunakan pendekatan tematik sementara data kuantitatif dianalisis secara deskriptif untuk menunjukkan tren dana kapitasi dan utilisasi pelayanan kesehatan di FKTP.Hasil: Meski peningkatan penerimaan dari dana kapitasi ditemukan di sebagian besar FKTP, namun tingginya utilisasi pasien cenderung menurunkan kapitasi aktual di FKTP. Temuan tersebut terutama dialami dokter praktek perorangan dan klinik pratama. Analisis kuantitatif juga menunjukkan sebagian besar FKTP swasta mengalami defisit. Sebagian besar Puskesmas menggunakan SK Bupati/ Peraturan Daerah (Perda) sebagai dasar hukum utama dalam pengelolaan dan pemanfaatan dana kapitasi. Namun, banyak kebijakan dari Perda yang tidak sepenuhnya sejalan dengan kebijakan Pusat, terutama karena perubahan kebijakan yang cepat di tingkat Pusat. Kondisi ini menyebabkan kebingungan bagi FKTP dalam mengelola dan memanfaatkan dana kapitasi. Sebagai satu-satunya pembayar, BPJS Kesehatan dianggap belum terlalu terlibat dalam perencanaan dan penganggaran dana kapitasi di daerah. Hal ini kurang kondusif dalam mendukung monitoring dan evaluasi penggunaan dana kapitasi.Kesimpulan: Untuk memastikan kualitas pelayanan kesehatan dan keberlanjutan FKTP sebagai penyedia layanan, dana kapitasi sebaiknya ditingkatkan. Perda juga diperlukan untuk mendukung penyelenggaraan JKN dengan menerbitkan pedoman yang jelas dan mengikuti kebijakan Pusat terkait bagaimana FKTP sebaiknya merencanakan dan mengelola dana kapitasi. Monitoring dan evaluasi kapitasi secara berkelanjutan sangat penting untuk memastikan ketercapaian sasaran program JKN di tingkat pelayanan primer.Kata Kunci: dana kapitasi, pengelolaan, pemanfaatan

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Home Page

OAI Link

Editorial Team

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Google Scholar

Contact Name Shita Dewi

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Location Kab. sleman, Daerah istimewa yogyakarta INDONESIA

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Contact Name
Shita Dewi

Contact Email
-

Phone
-

Journal Mail Official
jkki.fk@ugm.ac.id

Editorial Address
-

Location
Kab. sleman,

Daerah istimewa yogyakarta

INDONESIA