Alternatif Strategi Pelaksanaan Peran Regulasi Pascadesentralisasi Di Daerah = Alternative Strategies To Implement Regulatory Function Post Decentralization At The Provincial And District Level

Background: Several reports and observations have urged the need to strengthen regulatory function in decentralization era. This is not unexpected as regulation is not only a new role for the provincial and district health office, but also regulation is not perceived as an important role. Limited literature in this field motivates the author to compose this review paper, with the objective to define regulatory function and its activities, and to discuss strategies to strengthen this function. Subject and methods: This policy paper reviews regulatory concepts in the context of decen¬tralization in health. Empirical papers and on-going projects related to development of this regulatory function is presented to illustrate the concept. Results: Regulatory function differs from provision of services in terms of its objective, unit of analysis, consequence and requirement. The objective of regulation is to ensure quality of service provided by health care facilities. The unit of analysis is, therefore, not only government facilities but also those that are privately owned.The scope of regulation covers modern, comple¬mentary and alternative medicine. Consequently, this function should be implemented in a credible and objective way, either through licensing, certification and accreditation. Two strate¬gies were presented to develop this regulatory function, i.e. strengthening the capacity of pro¬vincial-district health offices or building alliance with an independent body. Conclusions: This paper has presented the definition and breadth of regulatory function in terms of its scope and activities. Taking into consideration the design, information, capacity, authority and context, an appropriate strategy should be explored and determined by the pro¬vincial or district health offices. Future development of the strategy should then be based on a multiyears planning. Keywords: decentralization, regulatory function, healthcare service delivery, development strateg

Penanganan diare di pusat pelayanan kesehatan masyarakar

Keywords: penyakit diare, tingkat kematian, layanan masyarakat, pengobatan-penangana

MEN'S INVOLVEMENT IN FAMILY PLANNING: A GENDER PERSPECTIVE

Akhir-akhir ini, keterlibatan pria dalam kesehatan reproduksi secara umum mulai banyak mendapat sorotan. Tulisan ini terutama membahas apakah keterlibatan tersebut berartimempersempit kesenjangan antara pria dan wanita secara umum. Dengan perspektif gender, keterlibatan pria dan wanita dianalisis dalam 3 tingkatan, yaitu pada tingkat kebijakan internasional, tingkat program dan tingkat individu. Hasil studi pustaka ini menunjukkan bahwa proses pembuatan keputusan yang berkaitan dengan keluarga berencana belum banyak dibahas, berbeda halnya dengan jenis keputusan dan pembuat keputusan. Untuk menyatakan bahwa keterlibatan pria berakibat positif terhadap kesetaraan gender (gender equality), diperlukan pemahaman yang lebih mendalam mengenai proses pembuatan keputusan sebagai titik kritis ke arah kesetaraan jender

Men\u27s Involvement In Family Planning: A Gender Perspective

ABSTRAK Akhir-akhir ini, keterlibatan pria dalam kesehatan reproduksi secara umum mulai banyak mendapat sorotan. Tulisan ini terutama membahas apakah keterlibatan tersebut berarti mempersempit kesenjangan antara pria dan wanita secara umum. Dengan perspektif gender, keterlibatan pria dan wanita dianalisis dalam 3 tingkatan, yaitu pada tingkat kebijakan internasional, tingkat program dan tingkat individu. Hasil studi pustaka ini menunjukkan bahwa proses pembuatan keputusan yang berkaitan dengan keluarga berencana belum banyak dibahas, berbeda halnya dengan jenis keputusan dan pembuat keputusan. Untuk menyatakan bahwa keterlibatan pria berakibat positif terhadap kesetaraan gender (gender equality), diperlukan pemahaman yang lebih mendalam mengenai proses pembuatan keputusan sebagai titik kritis ke arah kesetaraan jende

GELOMBANG KEDUA PENGEMBANGAN JURNAL MANAJEMEN PELAYANAN KESEHATAN

Jurnal Manajemen Pelayanan Kesehatan(JMPK) telah mencapai tahun ke 15 penerbitannyadan merupakan satu-satunya jurnal di Indonesia yangmendedikasikan isinya untuk pengembangan kebijakandan manajemen pelayanan kesehatan. Berawaldari naskah-naskah yang disusun oleh penulisdari kalangan internal Fakultas Kedokteran UGM(termasuk kontribusi dari peserta yang sedang menempuhpendidikan berbagai program), selamabeberapa tahun terakhir kontribusi naskah telahberasal dari berbagai penjuru dan institusi di Indonesia.Dalam setiap penerbitan, separoh halamanjurnal diperuntukkan bagi penulis di luar FakultasKedokteran UGM. Hal ini menunjukkan bahwaeksistensi JMPK telah diterima dan dibutuhkansecara nasional.Sejak tahun 1998, Prof Laksono Trisnantoro sebagaipemimpin redaksi JMPK telah menginisiasi,mengembangkan, meningkatkan profil dan kualitasjurnal yang dibuktikan melalui status akreditasibersama tim editor: Prof. dr. Adi Utarini, M.Sc.,MPH.,Ph.D., Prof.dr. Hari Kusnanto, SU., Dr.PH.,Dr. Dra. Sri Suryawati, Apt., drg. Yulita Hendrartini,M.Kes., dr. Mubasysyir Hasanbasri, MA., dan dr.Yodi Mahendradhata, M.Sc, Ph. D.Sejumlah 483 artikel telah diterbitkan di JMPKsejak dimulainya penerbitan jurnal ini. Kami mengucapkanterima kasih atas dedikasi tim editor selamaini untuk JMPK, dan tetap mengharapkan kontribusinyasebagai mitra bestari dalam perjalanan panjangjurnal ini selanjutnya. Semoga jurnal baru yang akandirintis, yaitu Jurnal Kebijakan Kesehatan, akan segerahadir di Indonesia untuk mendorong pengembanganilmu dan implementasi kebijakan kesehatan.Dengan rencana penerbitan jurnal baru tersebut,maka sesuai dengan namanya, JMPK akan memfokuskanmisinya untuk menyebarluaskan dan mendiskusikanberbagai tulisan ilmiah mengenai manajemenpelayanan kesehatan. Isi jurnal berupa artikelhasil penelitian yang berkaitan dengan manajemenrumah sakit, manajemen pelayanan kesehatan, manajemenpelayanan klinis, asuransi kesehatan, danmasalah yang relevan dengan manajemen pelayanankesehatan. Rubrik makalah kebijakan menjadiditiadakan. Mulai edisi Juni 2012, naskah-naskahyang lebih mengarah pada kebijakan kesehatan akandikirim ke Jurnal Kebijakan Kesehatan dan terdapatrevisi petunjuk bagi penulis. Selain naskah berupahasil penelitian, kami tetap mengharapkan kontribusiaktif para penulis/pembaca untuk resensi buku-bukubaru yang terbit dua tahun terakhir dan korespondensi.Saran-saran terhadap pengembangan JMPKsecara umum juga sangat diharapkan.Bagaimana pengembangan jurnal ini ke depan?Beberapa pemikiran untuk pengembangan padagelombang JMPK selanjutnya akan berfokus padaupaya untuk: (1) Mendorong sistem yang mempermudahkomunikasi antara pengelola jurnal, mitra bestaridan penulis sehingga penulis dapat mengetahuistatus review naskahnya, yaitu melalui sistemonline-submission; (2) Membuat call for paper untuktopik-topik khusus dalam manajemen pelayanankesehatan secara periodik; (3) Meningkatkan kerjasama dengan pihak lain untuk penerbitan edisikhusus; (4) Meningkatkan kualitas artikel yang terbitdi JMPK melalui proses review yang berkesinambungandan edukatif untuk mendukung para penulis.Keempat pengembangan tersebut diharapkan dapatkami kembangkan bersama tim editor JMPK yangbaru, dengan meningkatkan keterlibatan perguruantinggi di luar UGM. Terima kasih kepada, dr, AriProbandari MPH, PhD (Universitas Sebelas MaretSurakarta), dr. Vierra Wardhani M.Kes (UniversitasBrawijaya), akan kesediaannya untuk bergabungdalam tim editorial JMPK serta kepada dr. YodiMahendradhata MSc, PhD (Universitas GadjahMada), Prof.dr. Hari Kusnanto, SU., Dr. PH (UniversitasGadjah Mada) yang tetap bergabung dalamtim. Kami percaya bahwa pengalaman tim editorserta pengembangan riset manajemen pelayanankesehatan yang semakin kuat akan membawa energibaru untuk menghasilkan sinergi yang kuat dalammempertahankan kelangsungan JMPK.Akhir kata, edisi Desember 2012 akan mengangkattema manajemen pelayanan kesehatan dankeselamatan pasien. Untuk itu, kami mendorong parapenulis dari berbagai institusi pendidikan, penelitian,organisasi pelayanan kesehatan (rumah sakit,Puskesmas dan lainnya), Kementerian Kesehatan,Dinas Kesehatan, lembaga asuransi kesehatan sertaasosiasi profesi untuk mengirimkan naskahnya yangsesuai dengan tema tersebut

Mengapa Wanita Tidak Memilih Bersalin Di Rumah Sakit?

ABSTRACT Pre-natal interventions have been widely implemented as the main strategy to reduce maternal mortality and morbidity. This strategy, however, is not sufficient to attack the problem due to inparticular, inappropriate referral system and untimely intervention. Recognition of these problems combined with a relatively high proportion of unknown cause of maternal death has led to different priorities in Safe Motherhood Initiative, among those are to improve access to emergency obstetric care. This consequently means to remove any obstacles in the utilization of such services. This study aims to identify service factors which perceived by the user to influence household decision making in the utilisation of district hospital delivery facilities. A qualitative study using an indepth interview was performed in Klaten district hospital to collect information regarding reasons for choosing a particular facility to give birth. interviews of 23 women who had experienced at least two deliveries revealed 2 categories of barriers. Service delivery, namely regulations for visitors, negative staff attitude, and care for the newborn, was expressed as a substantial barrier for women to give birth at the hospital. Surprisingly, distance and cost appeared not to be the main obstacle. These findings imply that service factors may have a significant influence in the decision to use a hospital maternity service on the subsequent pregnancy. The relatively less importance of distance and cost in relation to utilisation may suggest further hypothesis, that is if cultural factors are to be incorporated into the provision of a modern maternity service, women may be more capable to overcome problems associated with distance and cost. Key words: utilisation, hospital maternity service, user perspectiv

Clinical Outcomes of Geriatric Care in Cipto Mangunkusumo Hospital, Before and After the Implementation of National Health Insurance Program

Background: the National Health Insurance (NIH/JKN) has been enacted since January 2014. Various outcomes of geriatric patient care, such as improved functional status and quality of life have not been evaluated. Prolonged hospitalization and re-hospitalization are potentially affecting the efficiency care of this vulnarable group. This study aimed to identify the differences of functional status improvement, quality of life improvement, length of stay, and hospitalization of geriatric patients admitted to CMH between prior to and after NHI implementation.Methods: a cohort study with historical control was conducted among geriatric patients admitted to Acute Geriatric Ward CMH Hospital on two periods of time: January-December 2013 (pre-NHI implementation) and June 2014-May 2015 (after NHI implementation). Patients who died within 24 hours of hospital admission, those with APPACHE II score >24, advance stage cancer, transfer to other wards before they were discharged or have incomplete record were excluded from the study. Data on demographical and clinical characteristics, functional status, quality of life, length of stay, and re-hospitalization were taken from patient’s medical record. The differences of studied outcomes were analyzed using t-test or Mann-Whitney test.Results: there were 102 subjects in pre-NHI and 135 subjects in NHI groups included in the study. Median lengths of stay were not different between two groups (12.5 days in pre-NHI and 10 days in NHI groups, p=0.087), although the proportion of patients with in-hospital stay less than 14 days was higher in NHI group. The difference of functional status of discharged patients in pre-NHI and NHI groups were 3 and 3 (p=0.149) respectively, whereas for health-related quality of life, although NHI group in the beginning showed a lower quality of life compared to the pre-NHI (0.163 [0.480] vs. 0.243 [0.550]; p=0.012). However, after incorporating comprehensive geriatric assessment (CGA) the quality of life improved significantly by the end of in-hospital care in both groups. Re-hospitalization incidence in NHI group was lower compared to pre-NHI (7 [5.2%] vs. 13 [12.7%]; p=0.038).Conclusion: our study shows that there was  no  significant difference regarding length of stay, functional status, and health-related quality of life between prior to and after national health insurance implementation on admitted geriatric patients. Rehospitalization incidence showed better results in NHI group and hence NHI implementation is favored

Life of a partnership: The process of collaboration between the National Tuberculosis Program and the hospitals in Yogyakarta, Indonesia

Public–private partnerships (PPP) for improving the health of populations are currently attracting attention in many countries with limited resources. The Public–Private Mix for Tuberculosis Control is an example of an internationally supported PPP that aims to engage all providers, including hospitals, to implement standardized diagnosis and treatment. This paper explores mainly the local actors’ views and experiences of the process of PPP in delivering TB care in hospitals in Yogyakarta Province, Indonesia. The study used a qualitative research design. By maximum variation sampling, 33 informants were purposefully selected. The informants were involved in the Public–Private Mix for Tuberculosis Control in Yogyakarta Province. Data were collected during 2008–2009 by in-depth interview and analyzed using content analysis techniques. Triangulation, reference group checking and peer debriefing were conducted to improve the trustworthiness of the data. This analysis showed that the process of partnership was dynamic. In the early phase of partnership, the National Tuberculosis Program and hospital actors perceived barriers to interaction such as low enthusiasm, lack of confidence, mistrust and inequality of relationships. The existence of an intermediary actor was important for approaching the National Tuberculosis Program and hospitals. After intensive interactions, compromises and acceptance were reached among the actors and even enabled the growth of mutual respect and feelings of programme ownership. However, the partnership faced declining interactions when faced with scarce resources and weak governance. The strategies, power and interactions between actors are important aspects of the process of collaboration. We conclude that good partnership governance is needed for the partnership to be effective and sustainable