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Jurnal Manajemen Pelayanan Kesehatan
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TINGKAT PEMANFAATAN TEMPAT TIDUR PADA RUMAH SAKIT UMUM DAERAH Arsyad, M. Lukman
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 04 (2010)
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Background: The background of this study is want to knowthe execution of automony dezentralized, and health policyafter the execution of that and to know affected of free healthprogram services from Government of South SulawesiProvince together with Districts and Town Government startedyear 2008.Method: The method of this study by Rapid Evaluation Method(REM) using record review data (data extraction), directobservation and observation out of buiding. This study will bemeasure of efficiency and effectivity of District Hospitals wichindicator bed exploiting or bed occupancy rate (BOR) anduseful as science clarification to community.Result: The result of this study fixed year 2008 shows aboutfrom 4 District Hospitals, 3 from it increasing bed occupancyrate (BOR) above 100% (extreme), but in year 2009, 2 districthospitals decrease it BOR between 60-85%, and 2 the otherdistricts hospital with BOR to low about 60%.Conclusion: The result of research above, can be conclutionthat happened extreme data year 2007 especially year 2008.Because free health program organizer make becomeincreasing services and medicine to get much fund, while 1 of4 districts hospitas from year 2005 to year 2009 with BORextreme, this causes by Local Regent of District madebreakthrough policy which that must be executed direct toVillages for cures of all kind of disease to communit and freehealth services.Key words: bed occupancy rate of district hospital, free healthservices
KESEHATAN KERJA PEMAKAI BIKE LIFT BUATAN PADA BENGKEL SEPEDA MOTOR KONVENSIONAL DI KOTAMADIA PADANG Arief, Amrizal
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 04 (2010)
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Background: Maintenance of motorcycle is undertaken bymechanics of authorized and conventional garages.Mechanics of authorized garage use standing position(standard working position), mechanics of conventional garageuse squating position. Either standing or squating position arestatic working position that does not meet the requirement ofhealthy work.Objective: The study aimed to improve static position andsitting-standing position (dynamic position) using bike lift ofmotorcycle with device for sitting.Method: The study was experiment that used pretest-posttestEquivalent Group Design. Location of the study wasconventional garage at Jalan Hercules No. 2 Tanggul Hitam ofPadang Municipality. Subject of the experiment consisted of 16mechanics of conventional garage (16 people) and subject ofcontrol consisted of 16 people of Honda Main Dealer (C.V.Hayati) at Jalan Pemuda 35 Padang. The dependent variableswere weight assessed using Digital Camry Scale, strength ofhand muscles assessed using Dynamometer, workload withpulse indicator assessed using Personal ECG Recorder EP-200©, fatigue with indicator of blood lactate acid assessedusing Accutrend® Lactate. Statistical analysis to identify thedifference used covariance analysis and t-paired test to identifythe difference.Result: 1) There was significant difference in weight betweendynamic position and standard position (p<0.05). Decrease ofweight in dynamic position was less than in standard position,2) there was significant difference in strength of hand musclebetween dynamic position and standard position (p<0.05).Decrease of strength of hand muscle in dynamic positive wasless than in standard position, 3) there was significantdifference in pulse between dynamic position and standardposition (p<0.05). Increase of pulse in dynamic position waslower than in standard position, 4) there was significantdifference in muscle fatigue between dynamic position andstandard position (p<0.05). Increase of muscle fatigue indynamic position was less than in standard position.Conclusion: Dynamic position, viewed from changes invariable of weight, strength of hand muscle, workload, andmuscle fatigue, was better than standard position. Thereforeit was suggested to use dynamic position while working. Forthe government recommended: a). Increasing cooperationamong all motorcycle mechanic in improving the health andsafety, help motorcycle mechanic on preventive and promotiveso avoid accidents. b). Promote and integrate safety and healthprogram between formal and informal mechanics that can beof mutual benefit in the form of increased productivity andresearch and further studies and approaches and the beststrategy to improve the health and safety.Keywords: weight, strength of hand muscle, pulse, fatigue
KINERJA PENERAPAN SISTEM MANAJEMEN KESELAMATAN DAN KESEHATAN KERJA, HUBUNGANNYA DENGAN ANGKA KEKERAPAN KECELAKAAN KERJA DAN JAMINAN KECELAKAAN KERJA Silaban, Gerry
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 04 (2010)
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Background: The number of occupational accidents andoccupational accident benefits at enterprises classified intobusiness group III were the highest compared to four otherbusiness groups, which were the members of OccupationalAccident Benefits Program of PT Jamsostek Medan BranchOff ice in 2005. This condition is inseparable f rom theimplementation problems of Occupational Health and SafetyManagement System (OHSMS). The objectives of the researchare to figure out the OHSMS implementation performance andto study its relationship with the occupational accidentfrequency rate and occupational accident benef its atenterprises classified into business group III, which were themembers of Occupational Accident Benefits Program of PTJamsostek Branch Office of Medan.Method: This is a survey research with cross-sectionaldesign. Samples of the study were fifty-five enterprisesclassified into business group III, which were the members ofOccupational Accident Benefits Program of PT JamsostekMedan Branch Office in 2005, whose employees experiencedoccupational accidents during one year (January 1st untilDecember 31st, 2005). Data on occupational accidents andoccupational accident benefits were collected from JamsostekForm 3 Type K.K.3 and from Jamsostek Form 3a Type K.K.3,meanwhile the accident frequency rate was calculated basedon the data on the number of occupational accidents andworking hours. The OHSMS implementation performance wasmeasured through OHSMS audit using audit checklists thatconsisted of 12 elements with 166 OHSMS audit criteria.Analysis of variance (repeated measure) followed by multiplecomparison was used to test the performance differencesamong 12 OHSMS audit elements and 5 OHSMS implementationprinciples related to the accident frequency rate andoccupational accident benefits.Result: The research f indings show that the OHSMSimplementation performance is strongly low based on theachievement level of OHSMS audit criteria. Two (3.64%)enterprises met 60% - 84% of 166 OHSMS audit criteria andfifty-three (96.36%) enterprises met 0% - 60% of 166 OHSMSaudit criteria. There is a difference in performance of 12 OHSMSaudit criteria; in which performance of element 5 (purchasing)is significantly the highest of all (p < 0.01). There is a significantdifference (p < 0.01) in the performance of 5 OHSMSimplementation principles, in which the performance of principle3 (implementing occupational health and safety policy) issignificantly the highest (p < 0.01). There is a significantrelationship (p < 0.05) between 12 OHSMS audit elements andthe accident frequency rate. There is a significant relationship(p < 0.05) between 5 OHSMS implementation principles andthe accident frequency rate. There is no significant relationship(p > 0.05) between the performance of 12 OHSMS auditelements and 5 OHSMS implementation principles with theoccupational accident benefits.Conclusion: It can be concluded that the OHSMSimplementation had not been comprehensive, consistent, andsustainable. Therefore, it is a must for the management toreview the implementation of OHSMS as an effort of realizingzero accident which in turn reduces the accident frequencyrate and occupational accident benefits. In addition, intensivedevelopment and monitoring of OHSMS implementation byoccupational health and safety inspectors and participation ofthe related and competent parties in helping implementingOHSMS are required.Keywords: performance of occupational health andmanagement system, accident frequency rate, occupationalaccident benefit
EVALUASI IMPLEMENTASI KEBIJAKAN KEWAJIBAN MENULISKAN RESEP OBAT GENERIK DI RUMAH SAKIT UMUM CILEGON TAHUN 2007 Ayuningtyas, Dumilah
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 04 (2010)
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Background: To anticipate the medicine price hikes, theIndonesian Ministry of Health (MoH), representating thegoverment of Indonesia, through the decree of Permenkes RIno. 085/Menkes/Per/I/1989 regarding the obligation to writethe medical prescription and the usage of generic medicine inall goverment health care units. This generic medicinesocialization should be supported by all public components, asthis program seems to encountered a big hurdle which can beseen from the social and economic aspects.Purposes: This study is designed to explore the descriptionand factors related to the implementation of generic medicineprescription policy at the Cilegon District Hospital in the year of 2007.Method: The study used quantitative and qualitative methodwith primary data which collected directly by in-depth interviewfrom the informants, and the secondary data which weregathered from documents exploration by collecting 379 genericmedicine prescription papers from the out-patient clients.Result: Qualitatively, the study showed that generally theimplementation of Permenkes RI No. 085/Menkes/Per/I/1989 hasnot performed as it should be. The average percentage of thegeneric medicine utilization by out-patient clients in Cilegondistrict hospital is only 52%. This result qualitatively showedthat the Director of the Hospital, the Pharmacy and TherapyCommittee, and the Pharmacy Installation have not performedas well as what is stated on the Permenkes RI No. 085/Menkes/Per/I/1989.Conclusion: There exist a requirement on increasing thegeneric medicine socialization that involved the medicalpractitioners and the community, a method that regulate theimplementation of the policy which can be evaluated andrevised, supervision toward the implementation, and also theapplication of reward and punishment mechanism.Keywords: implementation, policy, prescription genericmedicine
IDEOLOGI APA YANG DIANUT OLEH KEBIJAKAN KESEHATAN DI INDONESIA? Trisnantoro, Laksono
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 04 (2010)
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Ada pertanyaan menarik: sebenarnya ideologiapa yang dianut oleh pemerintah Indonesia dalampenerapan kebijakan kesehatannya? Apakahsosialisme, kapitalisme, etatisme, neoliberal, atauPancasila? Sebuah pertanyaan yang cukup sulitdijawab karena ternyata dalam perjalanan sejarahterjadi pergeseran bahkan pencampuran berbagaiideologi. Hal ini nampak contohnya dalam kebijakanpendirian rumah sakit swasta. Sejak jaman Belanda,pihak swasta diberi peran yang cukup signifikanuntuk turut serta dalam membangun rumah sakit.Dengan demikian, sejak awal berdirinya, sebenarnyaIndonesia sudah mempunyai ideologi yang berbasispasar. Hal ini juga tampak dari adanya kelas-kelas(VIP, kelas 1, kelas 2, dan kelas 3) dalam rumahsakit yang menunjukkan adanya pengakuan akanstruktur masyarakat yang didasarkan pada hierarkisosial ekonomi.Ideologi berbasis pasar ini semakin tampakpada masa orde baru yang semakin lama semakinmengurangi peran pemerintah. Contohnyaberkurangnya subsidi negara dan didorongnya“kemandirian” dan peran serta masyarakat dalammembiayai pengobatan sehingga RS bolehmemungut tarif dari masyarakat langsung. Dari tahunke tahun, tampak bahwa pembangunan RS swastayang berbentuk PT semakin meningkat. Antara tahun2002 sampai dengan 2008, ada penambahan 25 RSberbentuk PT yang tadinya berasal dari bentukYayasan. Sebaliknya hanya 5 PT berubah bentukmenjadi Yayasan. Tidak mengherankan bahwa RSberbentuk PT ini melayani kelompok pasarmenengah atas.Namun menarik untuk diamati bahwa dalambeberapa tahun belakangan ini, terjadi penguatanperan pemerintah yang mencerminkan ideologi yangtidak menyerahkan ke pasar. Sebagai contoh adalahprogram Jaminan Kesehatan Masyarakat(Jamkesmas) yang dananya berasal dari pemerintahpusat dan berfungsi “membeli” premi asuransikesehatan bagi orang miskin. Kebijakan inimenunjukkan bahwa pemerintah merasa perlu untuklebih berperan dalam pembiayaan kesehatan.Adanya pemilihan presiden dan kepala daerahlangsung nampaknya juga berpengaruh terhadapkebijakan yang cenderung mengandung ciri-ciri“welfare-state” ini. Hal ini nampak pada janji janjikampanye yang seringkali berupa “pengobatangratis”. Kemudian disusul dengan adanya programJaminan Persalinan (Jampersal) yang bahkanmembolehkan mereka yang tidak miskin untukdigratiskan biaya persalinannya asal mau dirawat dikelas 3 RS yang dikontrak. Pada saat yang samaPemerintah Indonesia melalui Kementrian Kesehatanmenggulirkan 7 Reformasi Pembangunan Kesehatanyaitu: 1) revitalisasi pelayanan kesehatan, 2)ketersediaan, distribusi, retensi dan mutusumberdaya manusia, 3) mengupayakanketersediaan, distribusi, keamanan, mutu, efektivitas,keterjangkauan obat, vaksin dan alkes, 4) Jaminankesehatan, 5) keberpihakan kepada daerah tertinggalperbatasan dan kepulauan (DTPK) dan daerahbermasalah kesehatan (DBK), 6) reformasi birokrasi,dan 7) world class health care.Bila dicermati dari ketujuh reformasi ini terdapatideologi berbasis pasar dan sosialis sekaligus. Butirkeberpihakan pada daerah tertinggal danpemerataan mencerminkan ideologi sosial liberalnamun “world class health care” cenderung berbasispada intervensi pemerintah terhadap pasar dengancara memberikan subsidi agar mampu bersaingdalam pasar kesehatan Asia Tenggara yang semakinbebas.Penerapan beberapa ideologi dalam satu negaraini berkembang menarik. Terdapat negara yangmenerapkan multi ideologi seperti Cina yang sistempolitiknya komunis dan sosialis ternyata sistemekonominya kapitalis. Amerika Serikat yangkapitalis juga cenderung ke “kiri” atau “sosialis”dengan UU reformasi kesehatan yang meningkatkanperan pemerintah dalam kesehatan.Ideologi sebagai pedoman penetapankebijakan dan pelaksanaanyaKebijakan kesehatan memerlukan mekanismekontrol dan pola pengelolaan yang tepat. Dalam halini ideologi dapat dipergunakan menjadi pedoman.Sebagai gambaran dalam Jampersal diharapkan,“jangan sampai orang kaya masuk VIP sebuah RSlalu meminta Jampersal membiayai persalinannyadi kelas 3, dan dia membayar selisihnya”. Hal inipenting ditekankan karena Indonesia yang sangatluas ini mempunyai infrastruktur layanan kesehatanyang amat beragam. Daerah NTT dan Papuakekurangan dokter dan fasilitas kesehatan yangmemadai sehingga Jampersal atau pelayanankesehatan gratis tidak akan dirasakan manfaatnyaoleh masyarakat jika di daerahnya tidak ada fasilitaskesehatan yang memadai dan tenaga kesehatanyang cukup. Bila orang kaya menggunakanJampersal tanpa kontrol, maka akan ada kegagalanJampersal untuk meratakan pelayanan ke daerahsulit. Dana Jampersal akan tersedot oleh masyarakatkaya atau yang tinggal di dekat sarana dan SDMkesehatan.Untuk itu, sebenarnya Jamkesmas danJampersal saja tidak cukup kalau tidak diiringipembangunan infrastruktur kesehatan. Pemerintahharus juga memikirkan alokasi biaya investasi danpemerataan SDM kesehatan, bukan hanya biayaoperasional saja. Dengan pedoman ideologi,kebijakan pemerintah dalam konteks Jampersal inidapat lebih terarah untuk membantu masyarakatyang memang perlu dibantu. (Laksono Trisnantorodan Sigit Riyarto).
PERILAKU DAN RISIKO PENYAKIT HIV-AIDS DI MASYARAKAT PAPUA STUDI PENGEMBANGAN MODEL LOKAL KEBIJAKAN HIV-AIDS Markus Zeth, Arwam Hermanus
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 04 (2010)
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Backround: Disease of HIV-AIDS at Papua more seriouslybecause sufferer total HIV-AIDS from year to year then increasesince year 1979. Augmenting again with society culture Papuacondition with the lowly education level that join in to subsidizerisk disease of HIV-AIDS at Papua. Despitefully there anothertrigger factor likes factor broken home, economy and life style.Government has tried with decide national wisdom ABC orabstinancy, be faithful and condom in order to tackling HIV-AIDSbut until so far not yet show result that have a meaning, evenseveral watchfulness recommend necessary watchfulnessexistences about tackling local model HIV-AIDS at Papua. Thismatter is actually that pushes researcher to look for local modelform in the hook with tackling HIV-AIDS at Papua.Method: This research descriptive method. Location ofresearch at prolific regency Biak Numfor with sample total forsufferer HIV-AIDS as much as 50 person contact AIDS diseases(ODHA) and 50 person not contact AIDS as standards. Customsociety Papua number 200 person represent 7 custom areasPapua with 10 religion figures represents 5 big religions atPapua. Data collecting technique by interview, registration andobservation to get primary data also secondary. Watchfulnessvariable covers free variable that is free sex behaviour, habitdrinks alcoholic drink, drug consumption habit, erudition, attitudeand weak religion teachings practice with negative culturehabit. Bound variable risk disease HIV-AIDS with sub eruditionvariable, attitude and behaviour with moderator variable thatcover economy, life style and broken home. And last liaisonvariable that is disease development HIV-AIDS.Technique and data collecting stage is divided to be 3 stagesthat is: (1) cause factors identification HIV-AIDS, (2) modellocation the testing and (3) model evaluation.Result: At the (time) of problem identification, watchfulnessresult shows that society behaviour factor Papua like free sexbehaviour, decrease it religion value and negative culture habitat prolific has risk towards disease HIV-AIDS. Moderator variablethat is economy/occupation, life style, has influence towardsdisease of HIV-AIDS. Specific local program that can bedeveloped” model H” consist of 2 main concepts, that is:Abstinancy and Be faithful or AB and after done test tries duringapproximately 3 year so model and this program is enougheffective to overcomings risk disease HIV-AIDS at Papua. Testingand first model evaluation is done in ODHA with the statisticstest result descriptively have a meaning with Chi-kuadrat testand McNemar p <0,05 and Cohran’s Q p <0.05 while secondtesting towards society of Papua where descriptively have ameaning with test Willcoxon p <0,05 and Friedman p <0,05.Conclusion: be taken that specific local model that can bedeveloped” H model” and suggested to Government Provinceof Papua and Papua Legislative (DPRP) to make legal fundamentin the form of by law to support this model.Keywords: behaviour, local wisdom AIDS-HIV, disease riskAIDS-HIV
KADER POSYANDU: PERANAN DAN TANTANGAN PEMBERDAYAANNYA DALAM USAHA PENINGKATAN GIZI ANAK DI INDONESIA Iswarawanti, Dwi Nastiti
Jurnal Manajemen Pelayanan Kesehatan Vol 13, No 04 (2010)
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Children nutritional status is remain a public health problem inIndonesia. The magnitude of problem depends on thecontribution of local cadres of integrated health office (calledas Kader Posyandu) in the area. Kader Posyandu is assignedbased on voluntary; and should be appointed, agreed andtrusted by the local community in their working area. KaderPosyandu is expected to empower the community to solvetheir own health and nutrition problems especially among thefamily with under-five year children. However, there iscontradictory dilemma that they do not necessitate to haveappropriate knowledge and skill on health and nutrition toperform their tasks properly. Limited incentive, material andnon-material supports frequently become their performancesconstraints. No exclusive breastfeeding, too early or too latecomplementary feeding practices, inadequate and unsafecomplementary food are commonly cause of growth impairmentamong under-five children. Posyandu revitalization programpromoted by the government is not optimal executed by thelocal governments. The implementation of nutrition training issporadic so that it is not reach throughout Indonesia area.Therefore, a comprehensive and systematic solution toempower Kader Posyandu is required. Development ofeducation program for community health worker is one of theoptions to solve the problem. The program could produceeducators or teachers who able to train community healthworker to perform their tasks effectively and optimal.Keywords: kader Posyandu, nutrition education, nutritionalstatus, under-five children, complementary feeding, foodsafety

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