Journal of Indonesian Health Policy and Administration
Published by Universitas Indonesia
Journal of IHPA (Indonesian Health Policy and Administration) is a scientific journal which presents original articles on knowledge and information of research about the latest delevopment in the field of health, especially related to the issue of health policy and administration. This journal is published by Department of Health Administration and Policy, faculty of Public Health, Universitas Indonesia and IAKMI. The articles or manuscript contained in the journal of IHPA includes the realm of research, case study, or conceptual.
Articles
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Articles
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AN ANALYSIS ON NON-SPECIALIST OUTPATIENT REFERRALS AT BEJI AND DEPOK JAYA HEALTH CENTERS IN 2018

Pertiwi, Tasya Caesarena, Masyitoh, Masyitoh

Journal of Indonesian Health Policy and Administration Vol 3, No 2 (2018)
Publisher : Faculty of Public Health Universitas Indonesia

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Abstract

Abstract. The Health Social Security Agency (BPJS kesehatan) is one of the government‚??s efforts to provide quality healthcare for the people. To guarantee its quality and maintain efficiency, a tiered referral system is used. However, there were many problems in its implementation. One of the ways to investigate is to evaluate the non-specialist outpatient referrals (RRNS). Therefore, in March-July 2018, this research was performed in order to analyze whether the system was implemented at Beji and Depok Jaya Health Center. The method used was the qualitative research method, with primary data from in-depth interviews and secondary data from documents. It was discovered that both Centers had optimal RRNS ratios (0%). This was because the doctors at both Centers has provided referrals as indicated and there was feedback on the RRNS total. The civil servant (PNS) doctors at both centers were experienced and skillful, but the number of doctors was insufficient compared to their workload. The non-PNS doctors also were not sufficiently trained. Other problems include insufficient equipment and medication provision.¬†Abstrak. Badan penyelenggara jaminan sosial (BPJS) kesehatan adalah salah satu upaya pemerintah untuk memberikan pelayanan kesehatan yang bermutu bagi rakyatnya. Untuk menjamin kualitas pelayanan yang diberikan sekaligus menjaga efisiensi, maka diterapkan sistem rujukan berjenjang. Tetapi ini mengalami berbagai permasalahan dalam penerapannya. Untuk melihat apa permasalahannya dapat dilihat dari rasio rujukan rawat jalan non-spesialistik (RRNS). Oleh karena itu, penelitian ini dilaksanakan untuk menganalisis apakah sistem tersebut berjalan di Puskesmas Beji dan Puskesmas Depok Jaya pada bulan Maret-Juli 2018. Penelitian ini menggunakan metode kualitatif, dengan data primer berupa wawancara mendalam dan data sekunder berupa telaah dokumen. Hasil penelitian menunjukkan bahwa di Puskesmas Beji dan Puskesmas Depok Jaya memiliki rasio RRNS yang optimal (0%). Hal ini disebabkan karena dokter di kedua puskesmas memberikan rujukan sesuai indikasi dan terdapat feedback mengenai capaian RRNS. Selain itu, dokter PNS di Puskesmas Beji dan Puskesmas Depok Jaya merupakan dokter yang cukup berpengalaman dan terampil, walaupun jumlah dokter di kedua Puskesmas tidak sesuai dengan beban kerjanya. Dokter non PNS juga belum menerima pelatihan yang memadai. Selain itu, peralatan yang tersedia masih kurang lengkap. Obat di kedua puskesmas cukup lengkap namun terkadang terjadi kekosongan obat.

AN ANALYSIS ON THE POLICY IMPLEMENTATION OF ANTIBACTERIAL RESISTANCE CONTROL AT THE HOSPITAL

indriana, Nani, Adisasmito, Wiku Bakti. B

Journal of Indonesian Health Policy and Administration Vol 3, No 2 (2018)
Publisher : Faculty of Public Health Universitas Indonesia

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Abstract

Abstract. In order to control Antibacterial Resistance at the hospital in Indonesia, the Government of Indonesia established an Antibiotics Resistance Control Committee and issued a Regulation from the Ministry of Health, regulation no 8/2015 on an antibiotics resistance control program at the hospital. This is an investigation on the Antibacterial Resistance Control Program (ARCP) at the Hospital, which compares its implementation at a government hospital and a private hospital, Persahabatan Central General Hospital (CGH) and Bogor Indonesian Red Cross Hospital (BIRCH). This was a descriptive study with a qualitative analysis obtained through indepth interviews and documentary research. We discovered that the ARCP was implemented better at Persahabatan CGH compared to BIRCH. Problems include ineffective communication, limited resources, lack of an antibiotic guideline (at BIRCH), lack of coordination between organizations, lack of supervision from the government, and the lack of motivation to implement the policy. These issues can be solved by intensifying the socialization of the policy, conducting more workshops and trainings for private and government hospitals that has not received any, providing an incentive for them to implement the program, such as including ARC into hospital accreditation indicators, and clarifying the benefits of the program to the stakeholders. Abstrak. Salah satu upaya pengendalian resistensi antibiotika di Indonesia adalah pembentukan pembentukan Komite Pengendalian Resisten Antibiotika (KPRA) dan diterbitkannya Permenkes no. 8 Tahun 2015 tentang program pengendalian resistensi antibiotika (PPRA) di rumah sakit (RS). Penelitian ini bertujuan untuk menggali lebih dalam terhadap implementasi kebijakan PPRA di RS dibandingkan antara RS pemerintah dengan RS swasta yaitu RS Persahabatan dan RS PMI. Metode penelitian merupakan studi deskriptif dengan analisis kualitatif melalui wawancara mendalam dan telaah dokumen. Hasil penelitian menyimpulkan bahwa pelaksanaan PPRA di RS Pemerintah lebih baik dari RS Swasta. Saran yang diajukan adalah mempercepat peningkatan kesadaran akan pentingnya PPRA, terutama bagi RS.

AN ANALYSIS OF THE HEALTHCARE CENTER SYSTEM AS A GATEKEEPER IN 2018

Maharanti, Septiana, Oktamianti, Puput

Journal of Indonesian Health Policy and Administration Vol 3, No 2 (2018)
Publisher : Faculty of Public Health Universitas Indonesia

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Abstract

Abstract. In managed care, primary healthcarecare facilities acts as the gatekeepers, and its success is judged from the number of visits. In the year 2016, the Healthcare Centers in Tangerang was unable to meet the targets set by BPJS healthcare, ideally the visit rate should reach >150‚?į and the referral ratio <10%. However, the visit rate only reachd 41‚?į and the referral ratio was 29%. In addition, most healthcare centers the nonspecialised referral ratio was above 5%. The purpose of this research is to analyze the healthcare service system as the gatekeepers in managed care. This research is a descriptive analytical study with a qualitative approach. The data was collected through in-depth interviews, examination of documents and observations. Research conducted at healthcare centers and clinics Pedurenan Pabuaran Tumpeng from May-June 2018. From this research we discovered that the low contact lrate was caused be the low first contact levels, continuity, and comprehensiveness. The registering process was also complicated. We also discovered that the lack of human resources also influences the low contact rate.¬†Abstrak. Dalam managed care, pelayanan primer bertugas sebagai gatekeeper, dan keberhasilannya dinilai dari tingginya angka kunjungan dan angka rujukan. Di tahun 2016, Puskesmas Kota Tangerang memiliki pencapaian yang tidak sesuai dengan target yang ditetapkan oleh BPJS Kesehatan, karena tingkat kunjungan hanya mencapai 41‚?į, idealnya >150‚?į; dan rasio rujukannya sebesar 29%, sedangkan idealnya adalah 10%. Selain itu, sebagian besar Puskesmas memiliki rasio rujukan nonspesialistik diatas 5% yang berarti berada di zona tidak aman. Tujuan penelitian ini adalah menganalisis sistem pelayanan puskesmas sebagai gatekeeper di Kota Tangerang pada tahun 2018. Penelitian ini merupakan penelitian deskriptif analitik dengan menggunakan pendekatan kualitatif.¬† Data dikumpulkan dengan melakukan wawancara mendalam, telaah dokumen dan observasi. Penelitian dilakukan di Puskesmas Pedurenan dan Puskesmas Pabuaran Tumpeng dari bulan Mei-Juni 2018. Dari penelitian ini ditemukan bahwa output angka kontak masih rendah. Pada variabel proses, yang menyebabkan angka kontak rendah adalah angka first contact, continuity, dan comprehensiveness yang rendah, serta proses pendaftaran pasien yang masih rumit. Sedangkan pada variabel input yang menjadi masalah adalah kurangnya sumber daya manusia.

AN EVALUATION ON THE POLICIES ON PUBLIC HEALTH WORKERS AS HEALTH PROFESSIONALS

Muswandar, Muswandar, Junadi, Purnawan

Journal of Indonesian Health Policy and Administration Vol 3, No 2 (2018)
Publisher : Faculty of Public Health Universitas Indonesia

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Abstract

Abstract. Law No. 36 of 2014 is a comprehensive law for health professionals. In that regulation, all health graduates that wish to practice their trade must have a letter of registration (STR). That policy also separated environmental health from public health. This was the reason why we decided to evaluate the policy that is related to public health professionals. This evaluation was a retrospective analysis that used in-depth interviews and literary research, respectively as primary and secondary data. From this research we discovered that public health graduates is has their own profession. And to obtain the right to practice their trade, they must pass the competence standard test. However, according to other regulations, only vocational or professional education graduates can participate in the test. Since there currently are no professional education institutions available for public health professionals, Minister of Health Regulation No. 41/2013 takes over. According to this law, all public health graduates will be provided an STR until there is a professional education institution. We also discovered that environmental health should NOT be separated from public health, since it is a large part of it. And therefore, the law must be amended. Abstrak. Undang-undang (UU) No. 36 Tahun 2014 mengatur tenaga kesehatan secara komprehensif. Dalam UU tersebut, semua tenaga kesehatan yang berpraktek wajib memiliki surat tanda registrasi (STR). Kebijakan juga telah memisahkan kesehatan lingkungan dari kesehatan masyarakat (kesmas). Oleh karena itu peneliti tertarik untuk melakukan evaluasi kebijakan khususnya terhadap konten kebijakan yang berhubungan dengan tenaga kesmas. Evaluasi isi kebijakan ini dilakukan dengan analisis retrospektif yang menggunakan wawancara mendalam dan telaah literatur sebagai data primer dan sekunder. Dari penelitian ini diketahui bahwa tenaga kesehatan masyarakat layak disebut sebagai sebuah profesi. Untuk mendapatkan STR, tenaga kesmas harus lulus ujian kompetensi. Tetapi, menurut peraturan yang berlaku, yang dapat mengikuti ujian kompetensi adalah lulusan pendidikan vokasi atau profesi. Namun, karena belum adanya pendidikan profesi untuk tenaga kesmas, maka untuk sementara Peraturan Menteri Kesehatan Nomor 41 Tahun 2013 digunakan sebagai solusi. Dimana semua lulusan institusi kesmas akan mendapatkan STR hingga terdapat institusi pendidikan yang menyelenggarakan pendidikan profesi. Selain itu ditemukan bahwa kesling sebenarnya merupakan bagian yang penting dari kesmas, baik dalam literatur maupun pendapat para ahli. Sehingga sebaiknya dilakukan revisi atau amandemen untuk UU tersebut.

AN ANALYSIS OF THE HEALTH CENTERS READINESS FOR ACCREDITATION IN BREBES DISTRICT IN 2018

Lourina, Deny Ardi, Ayuningtyas, Dumilah

Journal of Indonesian Health Policy and Administration Vol 3, No 2 (2018)
Publisher : Faculty of Public Health Universitas Indonesia

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Abstract

Abstract. The accreditation of health centers is an endeavor by the Ministry of Health to improve the quality and performance of health centers regulated by Permenkes No. 4/2015. Of the 38 health centers in Brebes, only 10 has been accredited. We wish to discover how prepared are the health centers to be accredited based on the resources available and pre-accreditation survey. Data was obtained through in-depth interviews and documentary research. Results indicated that there was sufficient funds, facilities and equipment for the accreditation. However, the assessment scores for human resources sufficiency and documentary completeness was low. Abstrak. Akreditasi Puskesmas merupakan upaya peningkatan mutu dan kinerja pelayanan puskesmas yang diatur oleh Permenkes Nomor 46 Tahun 2015. Dari 38 puskesmas di Kabupaten Brebes, hanya 10 puskesmas yang sudah terakreditasi. Penelitian ini bertujuan untuk mengetahui seberapa siapkah Puskesmas di Kabupaten Brebes untuk menghadapi akreditasi berdasarkan variabel sumber daya dan tahapan kesiapan survei pra-akreditasi. Data dikumpulkan melalui wawancara mendalam dan telaah dokumen. Hasil penelitian menunjukkan bahwa ketersediaan dana, sarana dan prasarana dinilai cukup siap untuk mendukung penilaian akreditasi puskesmas, namun hasil skoring assessment pada keterpemenuhan kompetensi SDM dan kelengkapan dokumen masih rendah. 

Management, Communication, Partnership, and Innovation Factors in Posbindu PTM Implementation Process in Gunung Batu Bogor City

Parinduri, Siti Khodijah, Pujiyanto, Pujiyanto

Journal of Indonesian Health Policy and Administration Vol 3, No 1 (2018)
Publisher : Faculty of Public Health Universitas Indonesia

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Abstract

By 2015 the deaths due to PTM are 68% and projected in 2030 to increase to 74%. Indonesia in 2013 based on Riskesdas data shows that 69.6% of diabetes mellitus and 63.2% of hypertension are still undiagnosed. The governments proactive efforts are through the implementation of Posbindu PTM which shows a very different number of visits in the target area of the Pasir Mulya Public Health Center. The purpose of this study is to know more in the description of management, communication, partnership and innovation in the implementation of Posbindu PTM and the factors that determine the results of the evaluation of the implementation of Posbindu PTM. This study is a qualitative study with in-depth interviews, focus group discussions (FGD), document review and observation at two Posbindu PTM with the highest and lowest visits to people with similar characteristics. The results of this study indicate that human resource management is a contributing factor in the implementation of Posbindu PTM,  communication and innovation need to be supported by partnership. The implementation of Posbindu PTM is supported by the optimization of management, communication, partnership and innovation factors that are interrelated in improving the successful implementation.

Analysis of Factors Related to Employee Behavior in Implementing Patient Safety Program at Insan Permata Woman and Child Hospital Tangerang

Fransisca, Martha, Darmawan, Ede Surya

Journal of Indonesian Health Policy and Administration Vol 3, No 1 (2018)
Publisher : Faculty of Public Health Universitas Indonesia

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Abstract

Insan Permata Woman and Child Hospital was facing Patient Safety Incidence especially for periode of mid to late 2016 there were 12 incidents and 11 phlebitis cases. This indicated a gap between the conditions in the field and the ideal situation that should be achieved. This study aimed to see how the behavior of employees in implementing patient safety program and the factors that influence it. The sample of this study were 151 respondents as sample, consist of health and non health workers. The patient safety program focused on the accuracy of patient identification, reduction of risk of infection and reduction of risk of falling patients. This research was a quantitative research followed by qualitative method. The results showed that most employees already had good patient safety behavior, age and attitude were the most affecting factors in patient safety behavior. The lack of socialization of accreditation and patient safety, poor monitoring and some incomplete facilities should became the concern for the hospital as it was considered to have great influences in the daily implementation of patient safety program.

Analysis of Policy Implementation for The Improvement Capability of Internal Government Supervisory Apparatus (APIP) at Inspectorate General of Ministry of Health

Sarjono, Ajeng Hadiati, Sulistiadi, Wachyu

Journal of Indonesian Health Policy and Administration Vol 3, No 1 (2018)
Publisher : Faculty of Public Health Universitas Indonesia

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Abstract

The capability of the Internal Government Supervisory Apparatus (APIP) is the ability to carry out supervisory tasks consisting of three interrelated elements: capacity, authority, and competence. The objective of this research is to give policy recommendations for enhanced APIP capability in the Inspectorate General of the Ministry of Health. This research is a descriptive study with qualitative analysis method with in-depth interview and literature study. Results of this research indicate that there are some obstacles: the socialization done only to some employees of Itjen; no Special Team on the process of improving APIP capability; the time and task division is unclear; has no special budget yet; there has not been a derivative rule from the Internal Audit Charter (IAC); no reward and punishment system; no documentation of supervision working papers; the policy has not been internalized. This research concludes that the implementation of the policy has not been reached optimally based on PERKA BPKP Number PER-1633/K/JF/2011. Communication is the most influential factor in the implementation of APIP enhancement policy. The recommendation from this research are consistently socialize to employees within the Inspectorate General, make Standard Operating Procedures (SOP), allocate budget activities in 2018, create memorandum of understanding with other agencies, and self-assessment and program evaluation absolutely must do continuously.

Policy Implementation Analysis on Exclusive Breastfeeding in Working Area of Cicalengka Community Health Center in Bandung Regency West Java

Mardhatillah, Innana, Ilyas, Yaslis

Journal of Indonesian Health Policy and Administration Vol 3, No 1 (2018)
Publisher : Faculty of Public Health Universitas Indonesia

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Abstract

Data and information on the health profile of Indonesia in 2016 showed only 29.5% of infants receive exclusive breastfeeding until 6 months, the low level of exclusive breastfeeding made the government issue a regulation on exclusive breastfeeding in Government Regulation Number 33 of 2012. The study aimed to analyze the policy implementation of exclusive breastfeeding at Cicalengka Community Health Center. The study used qualitative analysis with in-depth interview method, focus group discussion and literature study. The result of this study shows that breastfeeding policy implementation in health centers is not optimal, as seen from the low coverage of exclusive breastfeeding. Socialization of the policy has not been done as a whole, the time and task division is unclear and has no special budget and the standard operating procedures is not really used in carrying out the policy. Communication is the most influential factor in the implementation of the policy. There is no support and commitment from all employees in the implementation of exclusive breastfeeding policy. The suggestion is to consistently socialize to employees and the public, carry out supervision in an effort to secure the policy, run the Standard Operating Procedure (SOP), allocate budget activities in 2018, create a memorandum of understanding with other agencies, and Self-assessment and program evaluation absolutely must do continuously.

Analysis of Partnership of Private Practice Midwife in The National Health Insurance Program in District Bungo Jambi Province

Azwar, Nurlie, Soewondo, Prastuti

Journal of Indonesian Health Policy and Administration Vol 3, No 1 (2018)
Publisher : Faculty of Public Health Universitas Indonesia

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Abstract

On January 1, 2014, the government began to implement the National Health Insurance (NHI) program to realize social welfare for the whole community. Midwifery and neonatal care in the NHI program involves Puskesmas/family doctors and Private Practice Midwife (PPM) as its network. PPM participation in the NHI program in Bungo District was still lacking, only 12 (54.5%) PPM have cooperated with family doctors from 22 existing PPM. This study aimed to get an overview of PPM participation in the NHI program in Bungo District, Jambi Province. The study used qualitative research approach with Rapid Assessment Prosedur design, purposive sampling, and conducted in-depth interview to 10 PPM, Head of Health Office, MPKP BPJS Health Manager, and Chairman of Bungo Regency Section of Indonesian Midwife Organization (IMO). The study was conducted from January to July 2017. The study found that the knowledge, perceptions and attitude towards NHI program were good, but the perceived toward the claim and predetermined tariff procedures were not so good. PPM motivated to join the NHI program as many patients had become NHI participants. Support from the Government, NHI, and IMO were low, either in the form of socialization, or policies. Therefore, the study suggest an improvement in claims procedures, tariffs, and an increase of socialization from government, NHI and IMO on NHI program related to obstetric and neonatal care.