MODEL PEMBERDAYAAN POS PEMBINAAN TERPADU PENYAKIT TIDAK MENULAR (POSBINDU PTM) DENGAN MENINGKATKAN PERAN STAKEHOLDER DI PROVINSI BENGKULU

ABSTRAK MODEL PEMBERDAYAAN POS PEMBINAAN TERPADU PENYAKIT TIDAK MENULAR (POSBINDU PTM) DENGAN MENINGKATKAN PERAN STAKEHOLDER DI PROVINSI BENGKULU Penyakit tidak menular (PTM) terutama jantung, diabetes, kanker dan penyakit pernapasan kronis merupakan penyebab utama kematian di dunia termasuk di Indonesia sejak millenium tiga. Di Indonesia mengalami peningkatan cukup tinggi dari 41,7% tahun 1995, menjadi 71% dari sebanyak 1.551.000 jiwa kematian tahun 2012. Upaya pencegahan dan pengendalian PTM dapat dilakukan dengan perilaku hidup sehat sebagaimana rekomendasi oleh WHO. Upaya pencegahan dan pengendalian PTM yang sedang dikembangankan di Indonesia adalah Pos pembinaan terpadu penyakit tidak menular (Posbindu PTM). Masalah penelitian ini adalah bagaimana meningkatkan peran stakeholder dalam pemberdayaan Posbindu PTM. Tujuan umum penelitian ini menyusun model pemberdayaan Posbindu PTM dengan peningkatan peran stakeholder. Penelitian ini menggunakan pendekatan metode kombinasi dengan desain exploratory. Desain exploratory dengan prosedur sequential kombinasi secara berurutan, pertama metode kualitatif dan kedua kuantitatif. Desain exploratory dimulai dengan tahap kualitatif yang utama untuk mengetahui peran stakeholder, pengetahuan masyarakat, dan anggota terhadap Posbindu PTM, dan PTM. Berdasarkan hasil tahap I dilakukan analisis kebijakan pemberdayaan Posbindu PTM dengan peningkatan peran stakeholder. Pada proses pembentukan, persiapan, dan pelaksanaan stakeholder yang berperan adalah Dinas Kesehatan Kabupaten/Kota, Puskesmas, Kader, sebagian Kepala Kelurahan/Kepala Desa dan Ketua RukunTetangga/Kepala Dusun; pada monitoring evaluasi stakeholder yang berperan adalah Dinas Kesehatan Kabupaten/Kota, Puskesmas dan Kader; peserta mendapat manfaat dengan mengikuti kegiatan Posbindu PTM sehingga ingin datang setiap bulan ke Posbindu PTM. Tidak ada hubungan peran stakeholder pada proses pembentukan, persiapan, dan pelaksanaan dengan pemanfaatan Posbindu PTM; Ada hubungan peran stakeholder pada monitoring dan evaluasi dengan pemanfaatan Posbindu PTM. Masyarakat belum mengetahui keberadaan Posbindu PTM sebanyak 96,1%. Setelah diberikan sosialisasi, masyarakat memahami kegiatan dan manfaat Posbindu PTM sebanyak 95,8%. Peran stakeholder dapat diformulasikan dengan menguraikan: tugas, fungsi, kewenangan untuk pemberdayaan masyarakat termasuk bidang kesehatan melalui Posbindu PTM. Kolaborasi mempunyai tujuan organisasi memberdayakan masyarakat secara bersama sama sehingga menghasilkan bentuk kerja sama, kemitraan dan jaringan yang meghasilkan sumber daya yang lebih besar untuk memberdayakan Posbindu PTM. Analisis peran stakeholder terhadap pemberdayaan Posbindu PTM menghasilkan Model pemberdayaan Posbindu PTM dengan meningkatkan peran stakeholder. Kolaborasi dapat dilakukan oleh Dinas Kesehatan Provinsi, Dinas Kabupaten/Kota, Puskesmas, Tim Penggerak Pemberdayaan dan Kesejahteraan Keluarga (TP PKK) Provinsi sampai TP PKK Kelurahan/Desa, bekerja sama dengan BPJS Kesehatan, Forum Kab/kota Sehat, Kepala Kecamatan, Kelurahan, Ketua Rukun Tetangga untuk pemberdayaan Posbindu PTM. Kata Kunci : Peran Stakeholder, Pemberdayaan Posbindu PTM. ABSTRACT EMPOWERMENT MODEL NON- COMMUNICABLE DISEASE INTEGRATED GUIDANCE POST (POSBINDU PTM) BY IMPROVING STAKEHOLDER ROLE IN BENGKULU PROVINCE Non-communicable diseases particularly; heart, diabetes, cancer, and chronic respiratory disease have been pronounced as the worldwide fatal factor of death. Indonesia, During seventeen years (1995-2012) witnessed catastrophic increase approximately 29.3 % from 41,7 % in the year of 1995. Regard to WHO, Preventing and managing this type of disease could be reliable by healthy life. Indonesia, recently, has been Developing program “Non-communicable diseases Integrated Guidance Post” named “POSBINDU PTM”. The problem of this study was the effective strategy to improve stakeholder role in empowering POSBINDU PTM specifically non-communicable diseases (POSBINDU PTM). The general aim of this study was to create an effective model of Posbindu PTM in related to stakeholders’ role improvement. Exploratory design combination had been used by sequential procedure namely qualitative and quantitative respectively. It was started by using qualitative step in order to understand stakeholder role, society and member knowledge toward Posbindu PTM. According to preceding step, the Posbindu PTM empowerment policy had been done by improving stakeholder role. In establishing and preparing stakeholder taken part by healthy department regency, puskesmas, cadre, partially the village/orchard chief or its neighbor; monitoring of evaluation stakeholder which was held by health department regency, puskesmas, cadre; participants gave positive impression and shown their enthusiasm to join Posbindu PTM program every month. The result of this study was; The correlation among stakeholder in the forming process, preparing realization, and utilization of Postbindu PTM was not found; There was a correlation in monitoring between evaluation and utilization of Posbindu PTM. The number Society who have not yet known about existency of Posbindu PTM was 96,1% and it was slightly disease into 95,8% after socialization. The role of stakeholder could be formulated by scattering: task, function, authority in order to empower society including healthy aspect through Posbindu PTM. Collaboration has organization purpose in Empowering society, as a result, make a form of corporation, partnership, and network wich contribute to creating Human resource in Posbindu PTM. The Analysis of stakeholder role toward Posbindu PTM results empowering Posbindu PTM model by improving stakeholder. Collaboration can be accomplished by healthy department province, regency/city, puskesmas, province- Orchard PKK drive team cooperates with BPJS, Regency/City health forum, Consultative Council of Indigenous and Indigenous Institute, Head of the District, Village, Chair of the Neighborhood for empowerment Posbindu PTM. Key words: Stakeholder role, Posbindu PTM Empowermen

Policy and Role Analysis Integrated Health Education Centers for Non-Communicable Diseases Toward The Prevention and Controlling of Hypertension

Integrated Health Education Center for Non-communicable Disease/IHEC for NCDs (Posbindu PTM) is a place of community participation for early detection, preventing and controlling hypertension of noncommunicable diseases. Posbindu PTM is one of the promotional and preventive health efforts that is implemented in an integrated, routine, and periodic, and the non-communicable risk factors that are found immediately refer to basic health care facilities. It is necessary to examine the role of Posbindu PTM in controlling hypertension risk factors. The study used a combination method approach with sequential exploratory design. Exploratory design was begun with the main qualitative method to know the knowledge, attitude and behavior of members of Posbindu PTM to hypertension. The results of qualitative and quantitative methods were analyzed to develop the Integrated Health Education Center for Non-communicable Disease/IHEC for NCDs (Posbindu PTM). People feel useful coming to Posbindu PTM, so want to come every month. The active community who came to Posbindu PTM increased their knowledge about Hypertension and non-communicable disease (PTM). The community who actively coming to Posbindu PTM supported the behavior of preventing and controlling of hypertension. Posbindu PTM can play a role in controlling hypertension for active members

Stakeholder Collaboration Model to Empower Integrated Health Education Centers for Non-communicable Diseases : A Study in Bengkulu

Integrated Health Education Center for Non-communicable Disease (IHEC for NCDs) is a means for a community to participate in doing early detection, prevention, and control of non-communicable diseases. Stakeholders and society play very important role in empowering IHEC for NCDs. This study aims to develop a model of empowering IHEC for NCDs by increasing the role of stakeholders. The study uses a combination approach dan exploratory design and sequential procedures. Qualitative method is used to explore the roles of stakeholders in 10 IHEC for NCDs while quantitative one conducted in 67 IHEC for NCDs is aimed to prove the role of stakeholders in empowering IHEC for NCDs. Stakeholders play a role in the process of formation, preparation for implementation, monitoring and evaluation of the empowerment of IHEC for NCDs using collaboration model. Collaboration model is implemented at all government levels with the aim of empowering people in accordance with the performance indicators of each stakeholder. Stakeholder Collaboration Model for the IHEC for NCDs empowerment has increased early detection, prevention, and control of non-communicable diseases in the community. Keywords : IHEC for NCD, Stakeholder, Community Empowerment, Collaboration Model

Analisis Peran Pemerintah Daerah terhadap Ketersediaan Fasilitas Kesehatan pada Pelaksanaan Jaminan Kesehatan Nasional di Provinsi Bengkulu

AbstrakProgram Jaminan Kesehatan Nasional bertujuan mempermudah masyarakat untuk mengakses pelayanan kesehatan yang bermutu. Bagaimana ketersediaan fasilitas kesehatan, maka perlu dilakukan analisis peran pemerintah daerah terhadap ketersediaan fasilitas kesehatan. Metode penelitian ini adalah analisis formatif yaitu bertujuan menilai peran pemerintah daerah terhadap kebijakan yang sedang dilaksanakan, dan bagaimana pemikiran memodifikasi untuk pengembangan sehingga membawa perbaikan. Hasil yang didapat ialah pada pertengahan tahun 2014 Fasilitas Kesehatan Tingkat Pertama (FKTP) yang bekerja sama dengan Badan Penyelenggara Jaminan Sosial (BPJS) kesehatan sebanyak 229 unit, masih kurang sebanyak 361 unit untuk mencapai kebutuhan tahun 2019. Akses ke pelayanan kesehatan sebagaian masyarakat masih menjadi kendala geografis, waktu paling lama dari menuju puskesmas 90 sd 120 menit, biaya Rp. 200.000,- menggunakan ojek. Rasio fasilitas pelayaan rujukan tertinggi di Kota Bengkulu 1,88 per 100.000 penduduk dan terendah Kabupaten Rejang Lebong 0,40 per 100.000. Ratio dokter spesialis tertinggi 3.61 per 100.000 penduduk dengan rerata biaya rawat inap Rp. 3.595.000,- per pasien, terendah 0,55 per 100.000 pendudukan dengan rerata biaya rawat inap Rp.1.000.000,-. Pemenuhan tenaga terutama dokter umum, dokter gigi di puskesmas sulit terwujud mengingat formasi CPNS sangat kecil. Apabila dilakukan kontrak, Pemerintah Kabupaten/kota tidak mampu.Kata Kunci: kebijakan pemerintah daerah, fasilitas kesehatan, kebijakan jaminan kesehatan nasional.AbstractThe National Health Insurance Scheme aims to facilitate the public's access to quality health services. How does the availability of health facilities, it is necessary to analyze the role of local governments on the availability of health facilities. Methods: formative analysis, assessing the role of local governments on the policies that are being implemented, and how to modify the thinking for development so as to bring improvement. Results: Mid-2014 FKTP in collaboration with the Social Security Agency (BPJS) health as much as 229 units, 361 units are still lacking to achieve the requirements in 2019. Access to health care is still a society in part to geographical constraints, the longest time of the leading health centers 90 up to 120 minutes, costs IDR. 200.000, - use a motorcycle taxi. The ratio of the highest referral ministry facility in the city of Bengkulu 1.88 per 100,000 population, and the lowest Rejang Lebong 0.40 per 100,000. The highest ratio of specialists per 100,000 population is 3.61 with an average cost of hospitalization IDR. 3.595.000,- per patient, the lowest of 0.55 per 100,000 of the occupation with an average hospitalization cost IDR 1.000.000,-. Fulfillment power especially general practitioners, dentists at health centers employess difficult to achieve given the very small formations, if the contract is done district/city can not afford.Keywords: role of local government, availability of health facilities, the national health insurance polic

Analisis Pernikahan Usia Dini di Kabupaten Bengkulu Tengah Tahun 2017

The purpose of this study was to determine the cause of the incidence of early pregnancy recording in Bengkulu Tengah Regency. This study used a qualitative approach by revealing informants as many as 7 people using Purposive Sampling techniques in Central Bengkulu District. The latest information obtained is analyzed. Informants married early because there were no other activities after graduating from school, not understood from getting married, wanting to have a mate, not being a parent, there was encouragement from parents. Public media is used as a communication tool, to determine the date of dating. Environmental factors are the reason for informants to marry early in the morning, assuming marriage at an early age is normal. Lack of attention and sensitivity of parents to the problems being experienced by children due to busy working on plantations. The desire of oneself is also a factor of choice for informants to get married at an early age. The relationship between the KUA, the Health Office, the Education Office to provide assistance to the families of prospective teenagers and adolescents. In addition, the need for activeness from community leaders in controlling adolescents in the village.  Keywords: Early Marriage, Media, Knowledge, Environment, Parent

ANALISIS KEBIJAKAN JAMINAN KESEHATAN KOTA BENGKULU DALAM UPAYA EFISIENSI DAN EFEKTIFITAS PELAYANAN DI PUSKESMAS

Background. Mayor of Bengkulu Regulation Number 13 Year2012 on The Implementation Guidelines for State HealthInsurance Assistance Costs (Jamkeskot) in Bengkulu city ismanaged by the Secretariate of the Government of CommunityWelfare Section in Bengkulu. The cost of referral health carein Provincial General Hospital could be made more efficient byoptimizing the role of community health centers as a curative,preventive and promotive health services. It is hoped to reducethe number of visits for treatment and referral to hospital. Thepurpose of this study is to analyze the City Health Insurancepolicies in an effort to improve the efficiency and effectivenessof primary health care and public health efforts to reduce thenumber of visits for treatment and referral to hospital.Method: The type of research is non-experimental research,or also called qualitative research. It is an exploratory researchto find a new role of the city government and AdministeringAgency to improve the efficiency and effectiveness of healthservices at the health center.Unit of Analysis: 1) Community Health Center Unit 20, 2)organizing: PT. Askes 2 person and Community Welfare section2 person, 3) the City: Head of the Community Welfare Section1 person, Bengkulu City Health Office 2 person. Data is collectedusing interview using questionnaire as the instrument, anddocuments review.Results: Bengkulu Jamkeskot policies have not applied theprinciple of insurance in which the organizers serves to controlthe quality and cost of health care provided in both basicservices/primary and referral services. Most of the healthcenters tend to refer patients (67%) that are still within theirauthorization to provide care. The reason being: the healthcenters have limited equipment and drugs, and some patientsdemanded to be referred due to perceived bad quality of serviceat the health centers. The Community Welfare section has notcoordinated with the City Health Office to conduct training forthe health center in an effort to increase the effectiveness ofservices.Recommendation: The City Government is to establish ateam to conduct technical guidance supervision to healthcenters to ensure that the health centers play the role ofgatekeeper and only refer patients that need complex care,providing medical equipment and drugs to the health centerswith proposed funding from Bengkulu City budget and provincialbudget. The Health Centers are to provide routine counselingon healthy behavior and IEC on nutrition and hygiene to everyposyandu. The City Health Office provides technical guidancein drafting POA for promotive and preventive activities to havemore focus in efforts to control the causes of disease. Improvepolicy management of Jamkeskot by submitting the managementto an administering body, so that the Jamkeskot can apply theinsurance principles where the strong help the weak, thehealthy help the sick, the rich help the poor; and also cancontrol the quality and cost of service.Keywords: Health Policy, Health Insurance, Gatekeepe

Analisis Ketersediaan Fasilitas dan Pembiayaan Kesehatan pada Pelaksanaan Jaminan Kesehatan Nasional di Provinsi Bengkulu

The Background: National health assurance program aims to facilitate community access to quality health services. Health financing toward Universal Coverage is a good breakthrough but it can cause negative effects in the form of injustice. Availability of health facilities, health care personel and geographical condition and the broad population dispersion can magnify the problem of inequities between subdistricts and district/city in Bengkulu province, making it appear unequal in health services and financing. Availability of health facilities with inappropriate amount of power impacting the financing needs of the social security in health facilities in the form of capitation and INA-CBG package, and equitable financing analysis needs to be done in the implementation of the national health assurance policy. The purpose: Assesing the availability of facilities and even distribution of financing health and also to equalize of health facilities and drawing up scenarios of possibility of the future in the implementation of the national health insurance in the Province of Bengkulu. Method: This research uses the formative analysis methods designed to assess how the program/policy is being implemented and how it is thought to modify and develop to bring an improvement. Results: The ratio of first-level health facilities (FKTP), which is likely a general practitioner, according to the road map leading to JKN 2012-2019 should achieve the ratio of general practitioners 1: 3000 inhabitants.Currently the average in Bengkulu is 1 per 7.715 inhabitants, thus the need for first- level health facilities in the province of Bengkulu is 590 units. Beginning in 2014, 229 is available until the year 2019, and is still lacking as much as 361 units. Clinics with magnitudes capitation of Rp. 3,000 up to Rp. 4500 is 51.57% and while capitation of Rp. 6,000 is 13.3%. Capitation quantity is uneven financing that have an impact especially on the health of urban areas due to lack of resources. The value of the contract for one year for the number of participants who choose Clinics as FKTP is 763.165 people which is 82,03% of the maximum value of capitation Rp. 6,000, or less Rp9,87M. The average rate on the 7 (seven) Regional public hospitals district and Province for outpatient is between Rp. 150.000 s. d Rp. 350,000 and hospitalization is Rp. 1.000.000,-until Rp. s. 3.700.000,-, compared to the rates based on regulation of the Minister of health RI Number 69 by 2013, the average price of outpatient service and inpatient medical action is very simple and only for mild categories of diseases. Shortage of specialist doctors in Hospital causes unabsorbed INA-CBG package for major treatment action and severe categories of disease. Financial support the Government district/city and Province in the form of program jamkesda 2014 is IDR 38,36 M to pay for the capitation for the poor who are not covered by central government funding and to ensure treatment for kabupaten/ kota that did not cooperate with the BPJS. Incentive specialist doctor/resident is between IDR10 million to 30 million per month, especially the big four specialists from the local government district is another inequalities that is burdensome to the local government; The fulfillment of resources especially General practitioners and dentists in clinics is difficult to materialize given that CPNS (civil servant) formation are very small; the County Government could offer contracts but they can not afford it and it is not worth the lack of capitation. While the fulfillment specialist doctors in Hospitals is also difficult because there is lack of enthusiasm to become specialist CPNS , and the Country Government could not affort contract for them. Fulfillment needs efforts in health facilities first-level, general practitioners, dentists and specialists required a revision of the regulation of the Minister of health no. 69 year 2013 by observing the rate of capitation and INA-CBG¡¯s package for underserved areas away from urban center, or with small population and vast distribution of people. Conclusion: First-level health facilities and the number of personnel in clinics and specialist doctors in the hospital are still lacking, impacting the small capitation and the claim is limited to a minor treatment and mild disease. Regulation of the Minister of health RI Number 69 by 2013 on Standard Rate of health services need to pay attention to differences in geographical situation where Clinics and public hospitals are in the region. Latar Belakang: Program Jaminan Kesehatan Nasional bertujuan mempermudah masyarakat untuk mengakses pelayanan kesehatan yang bermutu. Pembiayaan kesehatan menuju Universal Coverage merupakan terobosan yang baik tetapi dapat menimbulkan dampak negatif berupa ketidakadilan. Ketidamerataan ketersediaan fasilitas kesehatan, tenaga kesehatan dan kondisi geografis serta penyebaran penduduk yang luas dapat memperbesar masalah ketidakadilan antar kecamatan dan kabupaten/kota di Provinsi Bengkulu, sehingga muncul ketidakmerataan pelayanan dan pembiayaan kesehatan. Ketersedian fasilitas kesehatan dengan jumlah tenaga yang tidak sesuai kebutuhan berdampak pada pembiayaan dari Badan Penyelenggara Jaminan Sosial Kesehatan dalam bentuk kapitasi dan Paket INA-CBG¡¯s, maka perlu dilakukan analisis pemerataan pembiayaan pada kebijakan pelaksanaan jaminan kesehatan nasional. Tujuan: Mengetahui ketersediaan fasilitas dan pemerataan pembiayaan kesehatan serta upaya pemerataan fasilitas kesehatan dan menyusun skenario kemungkinan masa mendatang dalam pelaksanaan jaminan kesehatan nasional di Provinsi Bengkulu. Metode: Penelitian ini menggunakan rancangan metode analisis formatif yang dirancang untuk menilai bagaimana program/kebijakan sedang diimplementasikan dan bagaimana pemikiran untuk memodifikasi serta mengembangkan sehingga membawa perbaikan. Hasil: Rasio fasilitas kesehatan tingkat pertama (FKTP) yang disamakan satu dokter umum, Peta Jalan Menuju JKN 2012- 2019 rasio dokter umum 1 : 3000 penduduk, maka rata-rata 1 per 7.715 penduduk, kebutuhan fasilitas kesehatan tingkat pertama di Provinsi Bengkulu sebanyak 590 unit. Awal tahun 2014 yang tersedia 229 sampai tahun 2019 masih kurang sebanyak 361 unit. Puskesmas dengan besaran kapitasi Rp3000,00 s.d Rp4.500,00 sebanyak 51,57% dan Rp6.000,00 sebanyak 13,3%. Besaran kapitasi berdampak tidak merata pembiayaan terutama di Puskesmas yang jauh dari perkotaan karena kekurangan tenaga. Nilai kontrak selama satu tahun jumlah peserta yang memilih Puskesmas sebagai FKTP sebanyak 763.165 jiwa sebesar 82,03% dari nilai maksimal kapitasi Rp6.000,00 atau kurang 9,87M. Tarif rerata pada tujuh Rumah Sakit Umum Daerah Kabupaten dan Provinsi untuk rawat jalan antara Rp. 150.000 s.d Rp640.000,00 dan rawat inap Rp1.000.000,00 s.d Rp3.700.000,00 dibandingkan tarif berdasarkan Peraturan Menteri Kesehatan RI Nomor 69 Tahun 2013, rata-rata tarif pelayanan rawat jalan dan rawat inap merupakan tarif tindakan medis sangat sederhana dan penyakit- penyakit katagori ringan. Kekurangan dokter spesialis di RSUD menyebabkan tidak terserap paket INA-CB¡¯s untuk tindakan besar dan penyakit katagori berat. Dukungan dana Pemerintah Kabupaten/Kota dan Provinsi dalam bentuk program jamkesda tahun 2014 sebesar 38,36 M untuk membayar kapitasi masyarakat miskin bukan penerima bantuan iuran dan menjamin pengobatan bagi kabupaten/kota yang tidak bekerja sama dengan BPJS. Insentif dokter spesialis/residen antara 10 juta s.d 30 juta per bulan terutama spesialis empat besar dari pemerintah daerah kabupaten merupakan ketidakadilan pembiayaan yang menjadi beban daerah. Pemenuhan tenaga terutama dokter umum, dokter gigi di puskesmas sulit terwujud mengingat formasi CPNS sangat kecil, apabila dilakukan kontrak Pemerintah Kabupaten tidak mampu dan tidak sebanding dengan kekurangan kapitasi. Sedangkan pemenuhan dokter spesialis di RSUD juga sulit terwujud karena peminat CPNS untuk dokter spesialis tidak ada dan apabila dilakukan kontrak sebesar insentif Pemerintah Kabupaten tidak mampu. Upaya pemenuhan kebutuhan fasilitas kesehatan tingkat pertama, dokter umum, dokter gigi dan spesialis diperlukan revisi Peraturan Menteri Kesehatan No.69 tahun 2013 tentang tarif dengan memperhatikan kapitasi dan paket INA-CBG¡¯s di daerah tidak diminati atau jauh dari perkotaan, jumlah penduduk kecil serta sebaran yang luas. Kesimpulan. Fasilitas kesehatan tingkat pertama dan jumlah tenaga di puskesmas dan dokter spesialis di rumah sakit masih kurang, berdampak kecilnya kapitasi dan klaim terbatas pada tindakan kecil serta penyakit yang ringan. Peraturan Menteri Kesehatan RI Nomor 69 Tahun 2013 Tentang Standar Tarif Pelayanan Kesehatan perlu memperhatikan geografis dimana Puskesmas dan Rumah Sakit Umum Daerah