Jurnal Manajemen Pelayanan Kesehatan
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INOVASI DALAM PEMBERIAN PELAYANAN BERDASARKAN KONTRAK DI RSD CUT NYA’DIEN KABUPATEN ACEH BARAT DAN DI KABUPATEN BERAU KALIMANTAN TIMUR
Full text linkHuman resources shortage is a chronic problem in remote anddifficult areas in Indonesia. The current policy is to send humanresources based on individual contract by central governmentto the remote areas and government employees by localgovernment. After years of implementation, this policy has nosignificant impact to problem. Therefore, an innovative policyis needed. This paper aims to discuss the innovative programfor fulfilling the human resources through contractingmechanism in Aceh Barat District (after tsunami) and BerauDistrict in East Kalimantan Province. These cases show manyobstacles in implementing contracting. One of big problems isto find the suitable contractor for this policy. There is nocontractor available, although the budget for human resourcesdeployment through contrcting-out had been approved by localgovernment and local parliament.The West Aceh experienceshowed positive result. The deployment of human resourcesthrough contracting mechanism can be done, although itdemanded strong resources, including f inance. If thecontracting mechanism is implemented in other districts, themain problem is to find the financial resources. Who will paythe contract? Central or local government.The availability ofcontractor is another concern. Furthermore, the contractingpolicy needs more detailed regulation at central and localgovernment.Keywords: health human resources; policy for remote anddifficult areas; contracting mechanis
KINERJA TENAGA PELAKSANA GIZI PUSKESMAS HUBUNGANNYA DENGAN EFEKTIVITAS PROGRAM MAKANAN PENDAMPING AIR SUSU IBU PADA ANAK BAWAH DUA TAHUN DENGAN GIZI BURUK DI KABUPATEN KARIMUN, KEPULAUAN RIAU
Full text linkBackground: Complementary breastfeeding program is aprogram implemented at health centers which is meant toimprove nutrition status of the community and this is a duty ofnutrition staff at health centers. The prevalence of cases ofcomplementary breastfeeding side effects may be due toinappropriate storage and supply as performance of nutritionstaff of health centers.Objective: To identify the relationship between theperformance of nutrition staff of health centers with theeffectiveness of complementary breastfeeding program amongchildren less than two years from poor families with poornutrition.Method: The study was observational with cohort design,applied to children under two years from poor families withpoor nutrition who got complementary breastfeeding.Qualitative method and descriptive analysis were used toidentify the distribution system of complementary breastfeedingthrough in-depth interview using questionnaires with openquestions. Location of the study was in the District of Karimunand the analysis unit was District Health Office of Karimun.Subject of the study consisted of 9 nutrition staff of healthcenter and 15 malnourished children under two. Data analysisof complementary breastfeeding distribution system was donedescriptively.Result: The program of complementary breastfeeding whichhad been implemented for 3 months to malnourished childrenless than two years did not improve nutrition status frommalnourished to good nutrition status. The performance ofnutrition staff at the health center in the program ofcomplementary breastfeeding was low in the specification oftarget age, the amount of complementary breastfeeding portionand in the preparation of complementary breastfeeding. Thedistribution of complementary breastfeeding at the health officeand health center did not comply to complementarybreastfeeding distribution and management guidelines, suchas in aspects of target specif ication, complementarybreastfeeding preparation information, and monitoring ofcomplementary breastfeeding distribution.Conclusion: The program of complementary breastfeedingwas ineffective in improving nutrition status of children lessthan two years from malnourished to good nutrition status.The performance of nutrition staff at the health center incomplementary breastfeeding program was low.Complementary breastfeeding distribution and managementsystem at the health office and health center at District ofKarimun had not run well.Keywords: nutrition staff, performance, complementarybreastfeeding, children under two, malnutritio
PENJAMINAN PELAYANAN KESEHATAN, PERDEBATAN KURATIF VERSUS PREVENTIF, DAN KEADILAN GEOGRAFIS
Full text linkPelayanan kesehatan gratis sampai ke rumahsakit (RS) menjadi isu hangat yang diperdebatkanoleh berbagai pihak. Menarik menyimak diskusimengenai pelayanan kesehatan gratis melalui berbagaiprogram penjaminan pemerintah pusat dan daerah.Dalam editorial ini isu pelayanan kesehatan gratisakan dibahas dengan perspektif pemerataanpelayanan kesehatan. Ada pendapat yangmenyatakan tidak setuju pelayanan gratis karena akanmeningkatkan anggaran kuratif, sedangkan pelayanankesehatan preventif akan kekurangan dana. Pendapatini terutama berasal dari ahli kesehatan masyarakat.Dalam menyikapi perdebatan ini dikhawatirkanakan terjebak perdebatan yang kurang produktif karenamenekankan dikotomis antara pelayanan kesehatankuratif dan preventif. Kita sadar benar bahwa preventifmerupakan yang terbaik. Akan tetapi disadari pulabahwa ada berbagai kondisi yang membutuhkanpenanganan medik, dan bahkan justru meningkatketika kemajuan teknologi berkembang pesat.Sebagai gambaran, angka kecelakaan lalu lintas saatini meningkat tinggi. Kenapa celaka? Sepeda motorsemakin banyak, mesin kendaraan semakin besar,dan ruas jalan relatif semakin sedikit. Korbankecelakaan merupakan masalah kesehatanmasyarakat. Di samping itu, ada berbagai penyakityang memang ada dan sulit pencegahannya sepertiTB, Ca, diabetes, termasuk pula simptom sepertihipertensi yang semakin banyak.Perkembangan berbagai penyakit di masyarakattersebut membutuhkan penanganan medik.Celakanya, tidak semua daerah yang ada sepedamotornya (hanya sebagai ilustrasi) mempunyai tenagadokter bedah atau rumah sakit. Di Kabupaten Niasyang merupakan daerah terpencil, sampai pada tahun2007 tidak ada dokter bedah. Sementara itu jumlahkendaraan bermotor meningkat tajam, jalan rayadiperhalus dengan aspal hot-mix. Akibatnya jumlahkecelakaan meningkat, namun penanganan traumatidak cukup karena tidak ada dokter ahli bedah danahli bedah tulang. Sementara itu di Kabupaten Slemandi Yogyakarta, jumlah dokter bedah banyak. Dalamkonteks penyakit kardiovaskuler, tidak semua propinsimempunyai ahli jantung, atau tidak ada ahli anastesi.Akibatnya mereka yang menderita penyakit jantungakan kesulitan akses ke dokter. Apakah kita diamsaja kalau di sebuah kabupaten para korbankecelakaan, penderita diabetes, penyakit jantung, danlain-lain tidak dapat ditangani sementara di Jawa ataudi berbagai tempat yang dekat dengan RS dan tenagakesehatan dapat mendapatkannya. Atau mutupelayanan RS yang merawat pasien TB ternyatarendah, sehingga RS menjadi sumber penularan TB.Sebagai negara kesatuan, situasi pelayanankesehatan yang berbeda ini memang sungguh buruk.Ketidakadilan geografis di Indonesia saat inikarena tidak adanya pemerataan tenaga dokter dantenaga kesehatan lain dikhawatirkan akan memburukdalam era Jamkesmas yang bertumpu pada danapemerintah pusat. Di Jakarta 1 spesialis melayanisekitar 3000 orang, sementara di berbagai Propinsidi luar Jawa melayani 47.000 orang (data KKI).Keadaan ini membutuhkan pembangunan sektorkuratif di Indonesia dalam konteks pemerataanpelayanan kesehatan.Dalam konteks pelayanan kesehatan gratis, jikatidak ada usaha pemerataan tenaga dan fasilitaskesehatan maka kebijakan penjaminan pelayanankesehatan dengan dana pemerintah pusat akan lebihdinikmati mereka yang berada di dekat fasilitas tenagamedik dan RS. Ini berarti dana akan tersedot ke kotabesar dan pula Jawa.Bersamaan dengan program menggratiskanpelayanan kesehatan ke semua lapisan masyarakatdengan berbagai program penjaminan, ketimpangangeografis ini perlu diperbaiki dulu. Di berbagai propinsi,perlu ada penambahan dana untuk penambahanfasilitas RS. Perlu penambahan tenaga dokter, dokterspesialis, perawat serta fasilitasnya. Hal ini berartipendanaan pelayanan kuratif di DepartemenKesehatan masih perlu ditingkatkan, terutama untukmenyeimbangkan pelayanan kesehatan antar wilayahdi Indonesia. Memang benar bahwa anggaran preventifperlu meningkat. Akan tetapi anggaran preventif dapatjuga berada di Departemen lain, misalnya DepartemenPekerjaan Umum untuk infrastruktur air minum,Departemen Pendidikan untuk mendidik hidup sehat;Departemen Perhubungan untuk mengurangi emisigas buang, dan sebagainya. Patut dicatatDepartemen Kesehatan adalah satu-satunyaDepartemen di kabinet yang mengurusi orang sakit.Oleh karena itu, jangan sampai anggaran kuratif diDepKes dikurangi. Anggaran kuratif masih dibutuhkanuntuk menyeimbangkan pemerataan tenaga medikdan sarana pelayanan kesehatan.Sudah saatnya ahli-ahli kesehatan masyarakatmempunyai pandangan bahwa RS, tenaga kuratifseperti dokter dan spesialis, merupakan bagian darisistem kesehatan masyarakat yang perlu dirancangdan dikelola sebaik-baiknya secara terintegrasidengan aspek preventif dan promotifnya. LaksonoTrisnantoro ([email protected]
Pencegahan keterlambatan rujukan maternal di Kabupaten Majene
Full text linkBackground: The geography, distances and infrastructuresfactors are highly affecting community accessibility to moderntransportation. In general, obstetric emergency cases failed tobe managed because of the low accuracy in routine pregnancyfollow up and delay in referral. One limiting factor in obstetricreferral is the unavailability of an effective mode of moderntransportation to reach remote residential area. Autonomy ofthe clinics and willingness of health staff are the key factors inmedical referral system. Unfortunately, the transportation whichconnects between community and health facilities and amongfacilities has not become parts of a professional integratedreferral system. This research studies the strategies toovercome delay in delivery assistance in remote areas whichare far from health facilities. It tries to prove that referralmanagement should become a focus and a part of governmentagenda.Method: This research uses case study design. Data wereobtained from village midwives, important public figures, headsof community health service, the head of health department,the director of public hospital, the head of hospital emergencyunit, the local head of Indonesia Red Cross Organization, localfield coordinator of Red Cross Organization and the patientsof obstetric emergency units in Kabupaten Majene. Thisresearch was conducted from August to December 2007.Result: The patients and their family play the main role inmanaging the emergency of obstetric problems. Family financialcapability and distances are some of the problems in managingthe obstetric emergency for patients who live far from healthfacilities. The efforts to overcome those problems are still inthe hand of service providers and health service units. Theyheavily depend on the patient and family financial capability.The patients who can afford to pay the services will be able toovercome their problems. Most of the families who live in ruralarea which are far from health facilities will face unsecureddif ficult situation. Every ambulance which is owned bycommunity health services, hospital and Red CrossOrganization are managed by the head of their units. Thehospital itself has a special ambulance service unit which isseparated from its emergency unit.Conclusion: Even though the management of transportationmode has already become a part of health department andgovernment agenda, it is still hand over informal sectors.Community is helping in providing transportation servicespontaneously. The management of transportation mode is stillsimple and undertaken by each health facility.Suggestion: The initiatives to manage ambulance in integratedway become a must to develop local health system. Theseefforts could be supported by all available ambulance in everyhealth service. The presence of units which manage thecooperation between every available obstetric service in oneregional integrated system should become the main agenda.Keywords: maternal referral delay, traditional referral, serviceregionalizatio
STRATEGI PENGEMBANGAN JAMINAN PEMELIHARAAN KESEHATAN MANDIRI KABUPATEN HULU SUNGAI SELATAN PROPINSI KALIMANTAN SELATAN
Full text linkBackground: Environmental changes, internal and externalproblems, and the decree of Constitution Court, which givesthe opportunity for the managing council of healthcareinsurance for poor communities to become a social insuranceinstitution, demand Pre Managing Council of Kandangan Sehatto respond to them by formulating strategies relevant for theDevelopment of Self-Supported Healthcare insurance at Districtof Hulu Sungai Selatan. To formulate the strategies for theDevelopment of Self-Supported Healthcare Insurance of theDistrict of Hulu Sungai Selatan.Method: This was a descriptive case study. Data wereobtained from observation, focus group discussion, indepthinterview and the result of secondary data search. Therewere as many as 39 respondents, Consisting of Head of HealthCenter, Participants and Former Participants of Self-SupportedHealthcare Insurance, Local Government Secretary, Head ofCommission I of Local Parliament, Head of AdministrativeDepartment of Brigjend. H. Hassan Basry Hospital ofKandangan, Head of Health Office and All Staff of Pre ManagingCouncil of Kandangan Sehat. Data were analyzedquantitatively and qualitatively to identify strengths,weaknesses, opportunities and threats (SWOT). The result ofSWOT analysis was used to decide the intended strategies.Result: Pre Managing Council of Kandangan Sehat had biggerstrengths than weakness and had bigger opportunities thanthreats so that both strength and opportunities could beoptimized at their best.Conclusion: The position of Pre Managing Council ofKandangan Sehat was located at quadrant I; therefore it wassuggested to formulate build and grow strategies throughproduct development, diversification and market penetration.Keywords: SWOT analysis, healthcare insurance, strategydevelopmen
Evaluasi kebijakan penempatan tenaga kesehatan di puskesmas sangat terpencil di Kabupaten Buton
Full text linkBackground: One of the important elements and verydetermining for becoming innovator in the effort of increasingthe quality of health service is the health force. The deploymentof health force especially in the very remote public healthcenter is meant for the generalization of health service, but infact the placement of health force policy in the very remotepublic health center in Buton Regency is not yet flattened yet.Besides, the interest and motivation of those who are placedin the are very low.Purpose: Analyse the placement of health force policy in thevery remote public health center in Buton Regency.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 of doctor, nurse, and midwife policy inthe very remote public health center should be supported bysupporting facilities namely office and office vehicle. Theplacement policy is influenced by geographical factor and theintervention of stakeholders in the regency. Doctor, nurse andmidwife forces placed in the very remote public health centerdo not have retention to stay and work in the very remotepublic health center.Conclusion: The deployment of health force policy can notovercome the lack of health force in the very remote publichealth center yet. The small incentive and the indefinite ofcarrier development and the low appreciation are the mainreason why the health forces do not have retention, so thatthe very remote public health center lacks of health force.Keywords: placement policy, financial, supporting facilities,force retentio
ANALISIS KESIAPAN POS KESEHATAN DESA DALAM PENGEMBANGAN DESA SIAGA DI KABUPATEN KEPULAUAN MENTAWAI PROVINSI SUMATERA BARAT TAHUN 2008
Full text linkBackgroud: There were 14 units of rural health center in thedistrict of Mentawai archipelago that planned to be built in2007, but it was failed in the implementation. In 2008, therewere 12 units rural health center planned to be built, followingthe determining of Desa Siaga development policy. Therefore,the readiness has to be known first.Methods: The research was conducted to study thereadiness of rural health center in the development of DesaSiaga. Qualitative research method was used, by indepthinterview to the person in charge program in the health andfamily planning board in the district, Puskesmas and staff ofrural health center, that their the village is proclaimed as DesaSiaga, and through the study of rural health center in thedevelopment of Desa Siaga readiness documents.Result : There is variation of readiness in rural health center/ Poskesdes which is located in Mentawai. The variation rangefrom ready, quite ready, until not ready. But there are 5 variableswhich are ready: Rural health center physical infrastructure,instrument and logistic, budgeting, planning and monitoring.Eventhough not 100% fit to the standard of Health Department.For the rural health center physic/construction model, therewere built with special design which suitable for the isolated,retarded and archipelago area.Conclusion: Rural health center model developed by HealthDepartment can not be applied in the Mentawai archipelagoand need modification. The Health Departement is suggestedto analyze the model of rural health center in Mentawai, andthe health and family planning board in the district of Mentawaiarchipelago are suggested to accelerate the realization of thephysical infrastructure building with its equipments.Keywords: rural health center, development, Desa Siag
Pendekatan sistem dalam perencanaan program kesehatan daerah
No full textManajer dan peneliti manajemen telah lama mempelajari pendekatan sistem dalam evaluasi dan membangun program kesehatan masyarakat. Pendekatan ini mengacu pada konsep input-proses-output-outcome dan konsep-konsep tentang efektivitas, efisien, dan sustainabilitas. Manajer dinas kesehatan kabupaten biasanya menjadi implementor dari program-program top-down dari pemerintah pusat. Mereka jarang memiliki kesempatan mendesain program yang sesuai dengan kapasitas daerah dan yang sesuai dengan kebutuhan spesifik dari populasi. Meskipun menggunakan analisis sistem, mereka biasanya menerapkannya dalam pengertian yang tidak-kritis. Tulisan ini menguraikan unsur-unsur dari analisis sistem dan manfaatnya dalam evaluasi dan pengembangan dari program. Ia juga menguraikan konsep-konsep dan contoh-contoh dari efektivitas, efisiensi, dan sustainabilitas. Paper ini menekankan penggunaan analisis sistem dalam era otonomi daerah dengan memperhatikan penggunaan sumber-sumber daya yang tersedia di daerah, pentingnya menganalisis kebutuhan spesifik untuk kelompok sasaran, dan titik-titik lemah yang harus diatasi dalam pelaksanaan program. Application of System Analysis Approach to District Health Programs Managers and management researchers have long been studying the systems approach in evaluating and establishing public health programs. This approach refers to the concept of input-process-output-outcome and the concepts of effectiveness, efficient, and sustainability. District health office manager usually be the implementor of programs top-down from the central government. They rarely have the opportunity to design a program that fits local capacity and to suit the specific needs of the population. Although some district managers have been trained to apply systems analysis in their program, they commonly do it a non-critical sense. This paper outlines the elements of system analysis and its applications in evaluation and development of the program. It also describes concepts and examples of effectiveness, efficiency, and sustainability. The paper emphasizes the application of systems analysis in the era of regional autonomy with regard to (1) use of existing resources available to the district in designing public health programs, (2) the importance of analyzing the specific needs of the target group, and (3) weak points to be addressed in the implementation of the program.