Jurnal Kebijakan Kesehatan Indonesia : JKKI
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KOORDINASI PELAKSANAAN PEMBIAYAAN PROGRAM KESEHATAN IBU DAN ANAK DI KABUPATEN LOMBOK TENGAH PROVINSI NUSA TENGGARA BARAT TAHUN 2011
Get PDFBackground: 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 stakeholders’commitment 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 stakeholders’ 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. Stakeholders’commitment 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, stakeholders’ commitment, healthfinancing, maternal and child health, program evaluatio
EVALUASI PROGRAM SKRINING STATUS TETANUS TOXOID WANITA USIA SUBUR DI JEMBER TAHUN 2010
Get PDFBackground: 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 women’s 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 childbearingwomen’s 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 women’s 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 women’s TT statusand conducting an evaluation for the program periodically andcontinuously.Keywords: evaluation, tetanus toxoid, childbearing wome
EFEKTIFITAS DAN EFISIENSI PEMANFAATAN DANA BANTUAN OPERASIONAL KESEHATAN DENGAN PENERAPAN METODE ANALYTIC HIERARCHY PROCESS
Get PDFBackground: Millennium Development Goals (MDGs) is a globalcommitment that must be realized by all countries by 2015,to accelerate the goal then the health ministries of BantuanOperasional Kesehatan (BOK) in helping the distric implementappropriate health services by improving the performance ofSPM Puskesmas and networks as well as Upaya KesehatanBersumber Masyarakat (UKBM) in carrying out preventive andpromotive health services. Utilization of funds is an authorityof the BOK clinic, it is necessary for an effective method indetermining program priorities. Along with the progress of scienceand technology in the field of public health and medicine,has provided a wide range of alternatives that can be used tosolve the health problems that occur in the community today.Objective: to determine the utilization of funds BOK interventionis most effective, with metodogi analitic using a modelsystem of decision makers using AHP.Methods: Analytic Hierarchy Process (AHP) is a model approachthat provides an opportunity for planners and programmanagers in health to be able to build the ideas or the ideasand define problems that exist in a way to make assumptionsand then get the desired solution.Results: Based on the analysis by using the AHP model, it canproduce an alternative to the use of program funds BOK highlyeffective in community health centers. By using the AHP modelthen any program that will be implemented with clearly definedpriorities, compared to using Hanlon, Delbeq and PEARL whichhas been used by the manager of health programs in ProvinceWest Sulawesi in Indonesia.Conclusion: It is recommended to use the AHP method indetermining the intervention/program BOK utilization of fundsand benefit the most effective and acceptable to all stakeholders.Keywords: Analytic Hierarchy Process, Program BO
PELAKSANAAN KEBIJAKAN BANTUAN OPERASIONAL KESEHATAN DI KABUPATEN OGAN ILIR, SUMATERA SELATAN
Get PDFABSTRACTIntroduction: 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, healthcente
Evaluasi kebijakan pembangunan puskesmas pembantu di Propinsi Kalimantan Tengah
Get PDFBackground: The objective of health development is improving community health status through increasing public access to health services. One of strategy is by supporting facilities forhealth service by developing auxiliary health center for all remote district at Central Kalimantan Province. Central Kalimantan Province with 1,9 million of population, consisted of 14 district, 1348 villages, 805 auxiliary health center. It means that only 59% village have facilities for health service such as auxiliary health center.Objectives: This research aimed to know how formulation process and implementation of policy of developing auxiliary health center by using provincial funds.Method: It was descriptive case study using mainly method qualitative designed by semi structured in-depth interview and document study. Research subject is stakeholder at levelprovince and chosen district. This research executed in Province Public Health Service of Central Kalimantan and one chosen district.Result: Development of secondary health center in Central Kalimantan Province is the realization of Central Kalimantan Province local decree number 12 and 13 year 2005 fulfilmenton RPJPD and RPJMD. Initially, the budgeting concept was planned by Tugas Pembantuan mechanism, but this mechanism was not agreed. This scheme was a top down program fromprovince government. Problems occurred in the implementation are 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 unmatched the need of health care provider. Evaluation is executed, but only concerning physical progress problem. In the meantime, there was increased allocation of DAK fund in each district.Conclusion: Development of auxiliary health center in Central Kalimantan Province which funded by province fund, is not required by district. There was no agenda surrounding development of auxiliary health center. The role of stakeholder in compilation of agenda setting for this policy was only a normative role
EDISI PERTAMA JURNAL KEBIJAKAN KESEHATAN INDONESIA
Get PDFoai:jurnal.ugm.ac.id:article/3068Edisi ini merupakan penerbitan pertama JurnalKebijakan Kesehatan Indonesia yang berdiri tahun2012. Mengapa diperlukan jurnal ini? Pada pertemuannasional II Jaringan Kebijakan Kesehatan Indonesiadi Makassar tahun 2011, telah disepakatipenerbitan Jurnal Kebijakan Kesehatan Indonesia.Jurnal yang mengambil bentuk e-journal dan cetak(dua versi) akan dikelola oleh Jaringan KebijakanKesehatan Indonesia, bekerja sama dengan ProgramStudi Ilmu Kesehatan Masyarakat, Minat Kebijakandan Manajemen Pelayanan Kesehatan UniversitasGadjah Mada. Pertemuan di Makassar memandangperlu adanya sebuah jurnal yang fokus pada pengembangankebijakan kesehatan di Indonesia.Apa materi jurnal ini? Dengan berfokus padakebijakan kesehatan maka materi akan berada padaproses penyusunan kebijakan, mulai dari penyusunanide dan agenda sampai ke evaluasi pelaksanaankebijakan. Terkait dengan penyusunan kebijakan,ada dua kelompok topik yang dapat dicermati. Pertamaadalah kelompok topik yang sudah mempunyaikebijakan publik. Kebijakan publik tersebut dapatberada di level pusat dalam bentuk Undang-Undang,Peraturan Pemerintah, Peraturan Presiden, PeraturanMenteri Kesehatan, dan sebagainya. Di level propinsiadalah Peraturan Daerah, Peraturan Gubernurdan sebagainya. Demikian pula di level kabupaten/kota. Contoh topik kebijakan di kelompok ini adalahUU SJSN di tahun 2004 dan UU BPJS di tahun 2011.Kelompok kedua, adalah berbagai topik kesehatanyang belum mempunyai kebijakan. Sebagai gambaranadalah topik “medical-tourism” yang belummempunyai kebijakan publik sama sekali. Kelompokini juga studi mengenai persiapan penyusunankebijakan publik di level Peraturan Pemerintahsebagai perintah dari sebuah UU.Berbagai kebijakan di level internasional yangperlu dicermati ada kebijakan yang mengikat sepertiTreaty, namun juga ada berbagai kebijakan di levelinternasional yang lebih banyak menghimbau.Kebijakan formal yang dapat dilihat berdasarkan tatahukum nasional dan internasional, dikenal pulaberbagai kebijakan lokal yang informal. Gambarankebijakan informal diberbagai kelompok masyarakatyang menolak vaksinasi merupakan hal menarikuntuk ditulis dalam jurnal ini. Kecocokan, dan ketidakcocokan antara kebijakan kesehatan formal dan informaldi berbagai tempat merupakan isu penelitianyang menarik.Pertanyaan yang sering muncul adalah siapayang akan membaca jurnal ini? Pertanyaanberikutnya adalah: siapa yang akan menulis di jurnalini? Diperkirakan pembaca jurnal ini adalahpengambil kebijakan kesehatan di Indonesia yangberada di Kementerian Kesehatan dan berbagaikementerian terkait kesehatan. Adanya kebijakandesentralisasi, tentunya ada ribuan pengambilkebijakan di propinsi dan kabupaten yang diharapkanmembaca jurnal ini. Dengan mengambil kriteriapembaca adalah level kepala bidang ke atas, makadiperkirakan akan ada 2500 pembaca di daerah dansekitar 300 di pusat. Ada pengajar dan penelitikebijakan kesehatan di berbagai universitas danlembaga penelitian yang akan membaca dansekaligus menulis artikel-artikel penelitian. Edisipertama ini kami menghimbau para calon penulisuntuk mengirimkan naskah ke Jurnal KebijakanKesehatan Indonesia. Topik-topik naskah tersebuttentunya terkait dengan proses kebijakan yang sudahdi bahas di atas. Kami tunggu naskahnya. (LaksonoTrisnantoro,
Evaluasi Implementasi Kebijakan Persalinan bagi Masyarakat Miskin oleh Bidan Praktik Swasta di Kota Tanjungpinang
Get PDFLatar belakang: Faktor ekonomi merupakan salah satu faktor yang menghambat akses masyarakat dalam pemanfaatan pelayanan kesehatan. Dalam upaya menjamin akses masyarakat miskin terhadap pelayanan kesehatan pemerintah menyelenggarakan jaminan kesehatan masyarakat. Adanya keterbatasan jam kerja puskesmas mengakibatkan jam pelayanan terbatas. Mengatasi hal ini pemerintah menetapkan praktek bidan swasta salah satu pelayanan kesehatan yang dapat digunakan masyarakat miskin dengan biaya pelayanan ditanggung oleh pemerintah. Kebijakan pemerintah ini belum berhasil meningkatkan cakupan pertolongan persalinan oleh tenaga kesehatan. Untuk itu perlu dilakukan suatu evaluasi untuk mengetahui fenomena yang terjadi di masyarakat agar dapat dicarikan pemecahan masalah dalam upaya perbaikan pelayanan kesehatan di masa mendatang.Tujuan Penelitian: Untuk mengetahui gambaran implementasi kebijakan pertolongan persalinan bagi masyarakat miskin oleh bidan swasta di Kota Tanjungpinang.Metode: Jenis penelitian ini adalah penelitian deskriptif dengan pendekatan kualitatif dengan rancangan studi kasus. Subjek penelitian adalah bidan PNS yang melakukan praktek kebidanan, Kepala Puskesmas, Kepala Dinas Kesehatan, Kepala Bidang Kesehatan Keluarga, dan ibu bersalin pengguna kartu askeskin. Pemilihan responden untuk bidan dan ibu bersalin digunakan tehnik purposive sampling. Jenis data yang dikumpulkan meliputi data primer yang diperoleh dari hasil wawancara mendalam dengan menggunakan panduan wawancara, sedangkan data sekunder diperoleh dengan telaah dokumen. Data dianalisis secara kualitatif. Hasil: Kebijakan persalinan masyarakat miskin di Kota Tanjungpinang belum mendapat dukungan secara optimal dari pemerintah daerah. Plafon biaya yang kecil membuat tidak semua bidan bersedia menolong pasien askeskin dengan klaim biaya ke puskesmas. Bidan praktek swasta melakukan iur biaya dari pasien askeskin. Tidak ada perbedaan jenis pertolongan yang diberikan bidan praktek swasta antara pasien askeskin dan masyarakat umum. Pasien askeskin merasa puas dengan pelayanan yang diberikan bidan praktek swasta.Kesimpulan: Bidan praktek swasta tidak semuanya bersedia memberikan pelayanan pertolongan persalinan bagi masyarakat miskin dengan mengajukan klaim ke puskesmas. Dukungan Pemerintah Kota Tanjungpinang terhadap implementasi askeskin diwujudnyatakan dengan pengembangan dua unit puskesmas menjadi puskesmas perawatan. Pelayanan pertolongan persalinan bagi masyarakat miskin yang diberikan bidan praktek swasta tidak berbeda dengan pasien umum. Plafon klaim biaya jasa persalinan bagi masyarakat miskin dinilai para bidan praktek swasta terlalu minim dan mengakibatkan adanya iur biaya dari pasien. Pengajuan klaim biaya jasa pertolongan persalinan oleh bidan praktek swasta cepat dan mudah. ABSTRACT: BIrth delivery practices for the poor in Tanjung Pinang Indonesia: evaluation of private midwife practitionersBackground: Economy factor is one of the factors that could hampered community’s access in the utilization of health service. In the guarantee effort of poor community access toward health service, the government was conducted managed program. The limitation of working hours in primary health care was causing limited service hours. Therefore, in order to solve the problem, the government stated that private midwife practice as one of the health services could be utilized by poor community with budget that was covered by government. The government’s policy has not yet able to improve the coverage of delivery attendant by health care provider. Hence, an evaluation to find out the phenomenon occurred in the community is necessary to solve this problem in order to improve the health service in the future.Objective: This research was aimed to find out the description of delivery assistance policy implementation for poor community by private midwife in Tanjungpinang Municipality.Method: This was a descriptive research that used qualitative approach with case study design. The research subject was civil servant midwife who had midwifery practice, head of primary health care, head of health office, head of family health division, and mothers who delivered and had askeskin (health insurance for poor community) card. The selection for midwife and mothers who delivered was using purposive sampling technique. Furthermore, the data was collected by using primary data that was obtained from indepth interview result that used interview guidance, while the secondary data was obtained from document observation, and the data will be analysed qualitatively.Result: The policy of delivery for poor community in Tanjungpinang Municipality has not yet obtained optimal support.The small bugdet availability affected not all of the midwives were willing to assist askeskin patient with cost claim to primary health care. Private practice midwife asked for fee from askeskin patient. There was no difference the treatment given between askeskin patient and common people. However, askeskin patient was satisfied with the service given by private practice midwife.Conclusion: The implementation of delivery policy for poor community by private practice midwife has not yet optimal as there was a lack of support from municipality government, administratively or financially
ANALISIS PEMBIAYAAN PROGRAM KESEHATAN IBU DAN ANAK BERSUMBER PEMERINTAH DENGAN PENDEKATAN HEALTH ACCOUNT
Get PDFBackground: The degree of Maternal and Child Health (MCH)is still a major problem in health development in Indonesia. Onefactor that may be an obstacle in solving this problem is thelimited cost. In this context, planning and cost utilization areessential to improve so that they can produce a great impactfor the improvement of MCH. Therefore, in-depth informationabout the MCH financing situation in regions as an input todevelop efficient activities in improving MCH status is needed.Objective: To analyze health financing situation of MCH programin 2010 which sourced from government and to make policyrecommendations related to the program in Sabu Raijua District,East Nusa Tenggara Province. The situation in question isavailability, budget planning process, expenditure accuracy,and fund flow rate.Method: This was a descriptive research with a case studystrategy.Result: The total cost of MCH program was IDR 450,787,500.It was not sufficient to provide basic health services forpregnant women from early pregnancy until postpartum period.The budget proportion from the central, provincial, and districtgovernments amounted to 79.63%, 3.56%, and 16.78%,respectively. Cost allocation of the district budget was 0.80%.Planning activities of MCH program was from the district budgetthrough the development planning meeting (Musrenbang).Proposed activities in Musrenbang were dominated by physicalactivities. The cost of MCH program was spent more on directactivities and operational cost in villages and sub districts. Theimplementation of the activities was not supported by facilitiesand adequate human resources. The MCH fund disbursementfrom the central government was conducted in October-November while from the provincial and district governmentswere in July to August.Conclusion: The government’s commitment was still low infinancing MCH program as a priority program due to budgetdecentralization. Musrenbang activities had not demonstratedsignificant impacts on quality activities improvement and budgetallocations from the district budget. Availability of personneland health facilities greatly affected the performance of MCHprogram. Delays in funds disbursement disrupted theimplementation of activities and provided opportunities forcorruption. Therefore, the supervision function must beimproved both internal and external.Keywords: financing, maternal and child health program,health account, budget, government
Active Case Treatment Lebih Cost Effective untuk Pengobatan TB Paru Tahap Awal
Get PDFBackground: Estimated one third of world population have been infected with Mycobacterium tuberculosis. Infected per- son will lose 3-4 months work time and will decrease 20%- 30% of income per year. Finding and treating TB patients are the best endeavor to stop TB spreading with a correct inter- vention. Jember Regency is executing Passive Case Treat- ment (PCT), which lung TB patients should come to puskes- mas to take the Tuberculosis Drug (ATD) in a certain day and hour. The method was not effective, proven by the increase of default rate for 3 years: 5.08% in 2007, 5.14% in 2008 and 6.18% in 2009, followed by the decrease of conversion rate for 3 years: 95.26% in 2007, 93.09% in 2008 and 92.08% in 2009. It is raising alertness for increased re-treatment which will lead to MDR, where MDR is clearly affecting TB patients’ quality of life. Afterward, an idea to create an ATD delivery to patients’ homes was executed, it is called Active Case Treat- ment (ACT). Method: This study was a Quasy Experimental Research with a prospective design. Conducted in 16 Puskesmas with default rate more than 5% and conversion rate less than 80% in 2009. Begin in September until November 2010, using total sampling technique. The sample was all lung TB patients who came for treatment in September 2010, with criteria were: new case, 15-50 years of age, did not suffer HIV and Diabe- tes Mellitus, was not malnourished, and was not allergic to ATD. Data collection was done through interview, filling ques- tionnaires and exploring documents. Then followed the calcu- lation of the total cost (direct and indirect cost) and Quality of Life (QoL) of both PCT and ACT. Later, total cost was com- pared to QoL, the lesser amount was considered more cost effective. Result: Research result showed that to increase 1 scale of Quality of Life (QoL) of PCT needed an amount of IDR. 35,295.00, while to increase 1 QoL scale ACT was IDR 14,377.00. ACT was smaller than PCT. Conclution: Conclusion derived from the result was that ACT is more cost effective than PCT. Recommendation to be pre- sented is to endorse lung TB treatment with ACT in Jember Regency particularly in Puskesmas with the same character- istics with this research.Latar belakang: Diperkirakan sepertiga penduduk dunia telah terinfeksi mikrobakterium tuberkulosis. Bila terinfeksi, diperkira- kan akan kehilangan waktu kerja 3-4 bulan dan berkurangnya pendapatan 20-30% pertahun. Menemukan dan menyembuhkan pasien merupakan cara terbaik dalam upaya pencegahan penu- laran TB dengan intervensi yang tepat. Pengobatan TB di Kabu- paten Jember dilakukan dengan cara Pasive Case Treatment (PCT), yang mengharuskan pasien datang ke puskesmas untuk mengambil OAT pada hari dan jam yang telah ditentukan. Cara ini ternyata kurang efektif yang ditandai dengan meningkatnya default selama 3 tahun yaitu: 2007= 5.08%, 2008= 5.14% dan 2009= 6.18%, yang diikuti dengan menurunnya conversion rate selama 3 tahun, yaitu; 2007= 95.26%, 2008= 93.09% dan 2009= 92.08%. Hal ini akan meningkatkan kasus re-treatment yang berakibat munculnya MDR (Multidrugs resistance) dan juga akan mempengaruhi kualitas hidup penderita TB. Kemudian muncul ide untuk menciptakan cara penggobatan dengan meng- antar OAT ke rumah penderita yang dilakukan oleh kader kese- hatan, yang diistilahkan dengan Active Case Treatment (ACT). Metode: Penelitian ini merupakan Quasy Experimental Re- search dengan rancangan prospektif. Dilakukan di 16 Puskes- mas di Kabupaten Jember yang memiliki angka default lebih dari 5% dan conversion rate kurang dari 80% pada tahun 2009. Dilakukan pada awal September sampai akhir Nopember 2010. Sampelnya adalah seluruh pasien TB Paru yang berobat pada bulan september 2010 dengan kriteria; kasus baru, usia 15-50 tahun, tidak HIV dan diabetes, tidak malnutrisi, dan tidak alergi terhadap OAT. Teknik pengumpulan data dilakukan dengan wawancara dan pengisian kuesioner dan penelusuran doku- men. Selanjutnya menghitung biaya total (biaya langsung dan biaya tidak langsung) dan tingkat kualitas hidup penderita TB dari kedua cara pengobatan (PCT dan ACT). Kemudian memban- dingkan antara total cost dengan tingkat kualitas hidup. Angka yang lebih kecil menunjukkan lebih cost effective. Hasil: Hasil penelitian menunjukkan bahwa untuk menaikkan 1 skala Qol dengan cara PCT dibutuhkan dana sebesar Rp. 35,295.00. Sedangkan untuk menaikkan 1 skala Qol dengan cara ACT membutuhkan dana sebesar Rp. 14,377.00. Cara ACT membutuhkan dana lebih kecil dibanding PCT. Kesimpulan: Dari hasil tersebut diatas maka dapat diambil kesimpulan akhir bahwa pengobatan TB paru cara ACT lebih cost effective dibanding dengan pengobatan TB paru cara PCT. Dengan demikian, rekomendasi yang diusulkan adalah memberlakukan pengobatan TB Paru dengan cara ACT di Kabu- paten Jember terutama pada wilayah puskesmas yang memiliki karateristik yang sama dengan penelitian ini.
Maksimasi, Free Rider dan Kegagalan Implementasi Kebijakan
Get PDFJika mempelajari policy making process, kita belajar tentang rational choice theory - bahwa setiap individu dalam organisasi akan mengutamakan kepentingan pribadi mereka. Dalam implementasi, kepentingan dari penduduk sering dikalahkan oleh kepentingan pribadi dari penyelenggara layanan. Jadi implementasi kebijakan sering gagal karena adanya kepentingan pribadi dari penyelenggara layanan. Implementasi kebijakan bagian penting dari policy analysis. Jika kebijakan berhasil dibuat dengan susah payah, tidak selalu berarti kebijakan itu akan terimplementasi begitu saja. Ada banyak tantangan yang membuat kebijakan itu tidak berarti apa-apa - kebijakan di atas kertas - tidak ada implementasinya. Kebijakan yang gagal jika implementasinya tidak ada. Kegagalan implementasi adalah termasuk kegagalan kebijakan. Implementasi adalah ranah dari manajer program. Jika kebijakan ingin berhasil, ia membutuhkan manajer yang efektif. Mereka membuat kebijakan menjadi operasional dan dapat menyajikan layanan kepada penduduk yang membutuhkannya