Monitoring Pelaksanaan Kebijakan Bantuan Operasional Kesehatan di Daerah Terpencil, Perbatasan, dan Kepulauan

Background: Currently, health development efforts are focused on achieving the MDG targets through several priority programs such as health insurance expansion; equitable access to health services in Remote Areas, Borders, and Islands (DTPK Areas); increase of promotion – preventive measures, and response to diseases. One of the strategic steps taken by the government to achieve that goal is by issuing Health Operational Assistance Policy (BOK). In recent years, increase in budget for health has occurred at the central level. Although on one hand the increment has not reached 5 % of total the state budget, on the other hand the budget absorption is low, i.e. not reaching 100 %. Most budget absorption takes place within the last quarter of the fiscal year. This indicates that there are serious problems in the implementation of the health system, one of which is inefficiencies. This phenomenon also occurs in the implementation of BOK policy. The proportion of BOK funds has increased in recent years, but the amount absorption does not reach 100 %. This of course would cumulatively affect the achievement of health system performance. Objective: This study aimed to explore the implementation of BOK policy at the primary health care level, identifying the factors that contribute to inefficiencies in the implementation of BOK policy, and assess the effectiveness of BOK policy in achieving the target of minimum services standard of health (SPM). Methods: This study was a descriptive study using a case study research strategy. The location was in Sabu Raijua Regency, East Nusa Tenggara Province while the research period was from June to August 2013. Results and Discussion: BOK Fund is the only source of funds to finance the implementation of preventive and promotion programs at health center level. There is no fund allocated by local government (APBD) due to its limited amount and high allocation to finance other sectors. The study identified several factors contributing to inefficiency in the use of BOK funds in the DTPK area, including the limited number and quality of human resources in health centers to run the programs. The result are dual task that implies a high workload (service/ care and administrative); delay of Technical Guide issuance and its subsequent socialization by the central government and district health offices to primary health centers; poor management capacity of health authorities in the implementation of the BOK fund due to varied understanding of the allocation of BOK fund; lack of data or evidence use in developing activity plans, and delays in disbursement of funds which resulted in the accumulation of funds to be disbursed in the 4th quarter of a fiscal year. Other findings also show that there was no significant change in the coverage of services and programs at the health center level when compared to the national target of SPM. Conclusions: The implementation of BOK policy has yet to show significant impact on the improvement of health system performance in the sub national level. At the central level, an in-depth and systematic evaluation is required for the allocation of BOK funds. At the local level, it requires significant improvement on the input side and on the process of planning and oversight mechanisms for community health centers and health authorities – which is integrated in nature - so that the BOK’s policy implementation could pose significant impacts on the improvement of the local health system performance. Latar belakang: Saat ini, pembangunan kesehatan terfokus pada upaya pencapaian target MDGs melalui beberapa pro- gram prioritas seperti perluasan jaminan kesehatan; pemerataan akses terhadap pelayanan kesehatan di Daerah Terpencil, Perbatasan, dan Kepulauan (DTPK); peningkatan upaya promotif-preventif; dan penanggulangan penyakit. Salah satu langkah strategis yang dilakukan pemerintah untuk mencapai tujuan itu dilakukan dengan mengeluarkan Kebijakan Bantuan Operasional Kesehatan. Dalam beberapa tahun terakhir, terjadi kenaikan anggaran kesehatan di tingkat pemerintah pusat. Kenaikan tersebut di satu sisi secara proporsi belum mencapai ukuran 5% dari APBN namun di sisi lain penyerapan anggaran yang sedikit tersebut ternyata tidak mencapai 100%. Sebagian besar anggaran tersebut lebih banyak diserap pada kuartal terakhir. Hal ini mengindikasikan bahwa ada problem serius dalam pelaksanaan sistem kesehatan yakni inefisiensi. Fenomena ini juga terjadi dalam implementasi kebijakan BOK. Proporsi dana BOK dalam beberapa tahun terakhir makin meningkat namun jumlah yang diserap tidak mencapai 100%. Hal ini tentunya secara kumulatif akan sangat mempengaruhi pencapaian kinerja sistem kesehatan. Tujuan: Penelitian ini bertujuan untuk mengeksplorasi pelaksanaan kebijakan BOK di tingkat puskesmas terkait faktor- faktor yang berkontribusi terhadap inefisiensi pelaksanaan kebijakan BOK sekaligus menilai efektivitas dari kebijakan BOK dalam pencapaian target SPM bidang kesehatan. Metode: Penelitian ini adalah penelitian deskriptif dengan menggunakan strategi penelitian studi kasus. Lokasinya di Kabupaten Sabu Raijua, Provinsi Nusa Tenggara Timur dengan waktu penelitian selama ± 3 bulan yakni dari Bulan Juni sampai Bulan Agustus tahun 2013. Hasil dan Bahasan: Dana BOK adalah satu-satunya sumber dana yang membiayai pelaksanaan program promotif dan preventif di tingkat puskesmas. Alokasi dari dana APBD tidak ada karena dana yang tersedia dalam APBD sangat terbatas jumlahnya. Dengan adanya dana BOK, maka dana daerah yang terbatas tersebut dipakai untuk membiayai sektor lain. Penelitian ini menemukan beberapa faktor yang berkontribusi terhadap inefisiensi penggunaan dana BOK di daerah DTPK antara lain keterbatasan jumlah dan kualitas sumber daya manusia untuk menjalankan program-program puskesmas sehingga terjadi rangkap tugas yang berimplikasi pada tingginya beban kerja (pelayanan dan administrasi); keterlambatan Juknis BOK dan sosialisasinya dari pemerintah pusat dan kabupaten kepada puskesmas terkait pemanfaatan dana BOK; lemahnya kapasitas manajemen dinas kesehatan dalam mengelola manajemen pe- laksanaan dana BOK karena adanya variasi pemahaman seca- ra internal tentang peruntukan dana BOK; kurangnya penggu- naan data atau evidence dalam penyusunan rencana kegiatan; dan keterlambatan pencairan dana yakni sering menumpuk pada kuartal ke-4 (akhir tahun). Temuan lainnya juga menunjuk- kan bahwa tidak ada perubahan yang cukup berarti dalam hal cakupan pelayanan dan program di tingkat puskesmas jika dibandingkan dengan target SPM secara nasional. Kesimpulan: Pelaksanaan kebijakan BOK di Daerah DTPK belum menghasilkan dampak yang signifikan bagi peningkatan kinerja sistem kesehatan di daerah. Di tingkat pusat, diperlukan adanya evaluasi secara mendalam dan sistematis terkait mekanisme pengalokasian dana BOK ke daerah. Di tingkat daerah, diperlukan perbaikan yang signifikan pada sisi input, proses perencanaan dan mekanisme pengawasan untuk puskesmas dan dinas kesehatan - yang sifatnya integratif - sehingga implementasi kebijakan BOK ini nantinya dapat memberi dampak berarti bagi peningkatan kinerja sistem kesehatan daerah

The Analysis of Government Support on The Implementation of Community-based Total Sanitation Programs in Sabu Raijua District

There was an increase of diarrhea as many as 145,031 cases in East Nusa Tenggara, specifically in Sabu Raijua regency there were 2,070 cases. The government’s efforts to reduce diarrhea cases by the community-based total sanitation program. This study aims to analyze local government support in implementing the CBTS program in Sabu Raijua Regency for the period 2017-2019. This is a qualitative study with a descriptive approach. In the enabling environment for local government support related to policies based on the minister of health regulation number 3 in 2014 concerning CBTS and instruction from the Regent of Sabu Raijua Number 050/189/BAP-SR/IX/2014, for human resources, is still lacking and for the budget sourced from the National and Regional Expenditure Budget. Demand creation for the CBTS portion has been carried out to the RT/RW levels, and triggering have been carried out in all hamlets. In supply improvement technology, latrine sanitation facilities are available which are sold by entrepreneurs at affordable prices, to increase the capacity of sanitation market players, the government collaborates with NGOs to provide training on latrine construction, and the entrepreneurial sanitation market network is still having difficulty expanding the market. There is local government support in the form of Regent’s instruction, budget support, promotion, triggering, and availability of latrine at affordable prices as well as training for entrepreneurs in collaboration with NGOs, while this program has experienced constraints on the availability of human resources and difficulty in expanding the market

Description of the Utilization of Village Funds for Covid-19 Countermeasures in Wee Paboba Village, North Wewewa Subdistrict

Pada tahun 2021, muncul 5 kasus COVID-19 di Desa Wee Paboba dan meningkat menjadi 35 kasus di tahun 2022. Desa juga tidak menyediakan ruangan isolasi sesuai dengan kebijakan yang ditetapkan pemerintah. Tujuan penelitian ini untuk mengetahui pemanfaatan dana desa untuk penanggulangan COVID-19 di Desa Wee Paboba, meliputi pemanfaatan dana desa untuk desa tanggap COVID-19, dan hambatan dalam pemanfaatan dana desa untuk penanggulangan COVID-19. Penelitian ini menggunakan metode kualitatif. Pengumpulan data dilakukan dengan wawancara mendalam dan dokumentasi. Hasil penelitian menunjukkan adanya penggunaan dana desa untuk penanggulangan COVID-19 di Desa Wee Paboba sebesar 4,19% pada tahun 2020 dan 8% pada tahun 2021, sedangkan untuk tahun 2022 targetnya 8% tapi yang terealisasi sampai bulan Juni adalah 2,52%. Pemanfaatan dana desa untuk BLT pada tahun 2020 sebesar Rp.561.600.000, tahun 2021 sebesar Rp.583.200.000 dan untuk tahun 2022 sampai dengan bulan Juni sebesar Rp.298.800.000. Hambatan yang dialami pemerintah desa dalam penanggulangan COVID-19 dari tahun 2020 hingga tahun 2022 adalah jalan yang belum bisa dilalui kendaraan. Tim relawan harus berjalan kaki untuk melakukan pendataan dan pembagian masker ke rumah masyarakat

Description of School Health Program in SDI Oesapa Kecil I Kupang, East Nusa Tenggara

School Health Program (UKS) is the main channel for health education in schools to improve the ability to live healthily, and subsequently from healthy living behaviors, which will result in the optimal health status of students. At the time in October 2019, the implementation of UKS at SDI Oesapa Kecil I was not fully following the standards of a healthy school. This study aimed to determine the description of health education, health services, and the development of a healthy school environment in the healthy school model at SDI Oesapa Kecil I. This is a descriptive study and was carried out at SDI Oesapa Kecil I, Oesapa Barat. The research population is teachers and students in classes V and VI. This study used a probability sampling technique, namely proportionate stratified random sampling. Sample size is 71 people. The results showed not all routine activities of the school health program in the health education section were carried out, such as the use of health literacy hours, nutritious breakfast together and students brushing teeth together at school. The program for the health services section of this school also was not carried out all routine activities, such as the absence of reports on the results of health screening and periodic examinations from the health center to the school or from school to parents or guardians

Monitoring of the implementation of BOK (Health Operational Assistance) policy in remote areas, borders and islands

Background: Currently, health development efforts are focused on achieving the MDG targets through several priority programs such as health insurance expansion; equitable access to health services in Remote Areas, Borders, and Islands (DTPK Areas); increase of promotion – preventive measures, and response to diseases. One of the strategic steps taken by the government to achieve that goal is by issuing Health Operational Assistance Policy (BOK). In recent years, increase in budget for health has occurred at the central level. Although on one hand the increment has not reached 5 % of total the state budget, on the other hand the budget absorption is low, i.e. not reaching 100 %. Most budget absorption takes place within the last quarter of the fiscal year. This indicates that there are serious problems in the implementation of the health system, one of which is inefficiencies. This phenomenon also occurs in the implementation of BOK policy. The proportion of BOK funds has increased in recent years, but the amount absorption does not reach 100 %. This of course would cumulatively affect the achievement of health system performance. Objective: This study aimed to explore the implementation of BOK policy at the primary health care level, identifying the factors that contribute to inefficiencies in the implementation of BOK policy, and assess the effectiveness of BOK policy in achieving the target of minimum services standard of health (SPM). Methods: This study was a descriptive study using a case study research strategy. The location was in Sabu Raijua Regency, East Nusa Tenggara Province while the research period was from June to August 2013. Results and Discussion: BOK Fund is the only source of funds to finance the implementation of preventive and promotion programs at health center level. There is no fund allocated by local government (APBD) due to its limited amount and high allocation to finance other sectors. The study identified several factors contributing to inefficiency in the use of BOK funds in the DTPK area, including the limited number and quality of human resources in health centers to run the programs. The result are dual task that implies a high workload (service/ care and administrative); delay of Technical Guide issuance and its subsequent socialization by the central government and district health offices to primary health centers; poor management capacity of health authorities in the implementation of the BOK fund due to varied understanding of the allocation of BOK fund; lack of data or evidence use in developing activity plans, and delays in disbursement of funds which resulted in the accumulation of funds to be disbursed in the 4th quarter of a fiscal year. Other findings also show that there was no significant change in the coverage of services and programs at the health center level when compared to the national target of SPM. Conclusions: The implementation of BOK policy has yet to show significant impact on the improvement of health system performance in the sub national level. At the central level, an in-depth and systematic evaluation is required for the allocation of BOK funds. At the local level, it requires significant improvement on the input side and on the process of planning and oversight mechanisms for community health centers and health authorities – which is integrated in nature - so that the BOK’s policy implementation could pose significant impacts on the improvement of the local health system performance

Factors Affecting Acute Pesticide Poisoning Farmers in Nenu Village Manggarai Regency

Farmers often use pesticides to prevent pests and diseases that damage crops and disrupt agricultural yields. Improper use of pesticides can cause poisoning to farmers. This study aimed to determine what factors affect farmers' acute pesticide poisoning. This research was analytical survey research with a cross-sectional design. The research location was in Nenu Village, Cibal District, Manggarai Regency, with the research period from January to November 2020. The population in this study amounted to 106 people, with a total sample of 51 farmers, obtained by simple random technique. The dependent variable was acute pesticide poisoning, while the independent variables consisted of knowledge, application method, spraying frequency, and farmer's behavior. Data were analyzed using the chi-square test. The results showed that knowledge (p-value=0.038), pesticide application methods (p-value=0.017), and farmer behavior (p-value=0.019) related to acute pesticide poisoning. In contrast, spraying frequency does not relate to pesticide poisoning (p-value=0.574). Agricultural extension workers need to assist farmers in using pesticides according to the provisions. Through the public health center, the health service needs to conduct periodic blood checks on farmers to determine the level of pesticide poisoning

Implementation of the Pulmonary TB Control Program in Noebeba Health Centre, Noebeba District, South Central Timor Regency

Angka penemuan kasus TB Paru di Puskesmas Noebeba masih rendah dan belum mencapai target minimal nasional yang ditetapkan yaitu 70%. Penelitian ini bertujuan untuk mendeskripsikan pelaksanaan program pengendalian TB Paru di Puskesmas Noebeba Kecamatan Noebeba Kabupaten TTS Tahun 2021. Jenis penelitian ini merupakan penelitian kualitatif dengan pendekatan studi kasus. Informan pada penelitian berjumlah 4 orang yaitu Kepala Puskesmas/Dokter, Pengelola Program TB, dan 2 Perawat yang ditentukan menggunakan teknik purposive sampling berdasarkan kriteria yang telah ditetapkan. Kriteria dalam penelitian ini yaitu orang-orang yang terlibat langsung dalam program pengendalian TB Paru di Puskesmas Noebeba dan bersedia menjadi informan penelitian. Pengumpulan data menggunakan teknik wawancara, observasi, dan dokumentasi. Analisis data dilakukan dengan cara reduksi data, penyajian data, dan penarikan kesimpulan dan verifikasi. Penelitian ini dilaksanakan pada bulan Desember 2021 hingga Januari 2022. Hasil penelitian menunjukkan bahwa Puskesmas mengalami kekurangan dana dan mikroskop belum tersedia, kesulitan ekonomi untuk biaya transportasi pemeriksaan, kurangnya pengetahuan dan kesadaran masyarakat untuk mau berobat atau memeriksakan dirinya ke Puskesmas. Diharapkan lebih meningkatkan upaya penemuan kasus secara aktif, pengadaan mikroskop, dan penyuluhan. &nbsp