MONITORING KINERJA PUSKESMAS DALAM SISTEM KONTRAK INTERNAL KEPALA PUSKESMAS DI DKI JAKARTA

EKO SRIYANTO, DR. dr. Mubasysyir Hasanbasri, MA.; DR. dr. Dwi Handono Sulistyo, MKes.

2016 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Pemerintah Provinsi DKI Jakarta melakukan upaya revitalisasi puskesmas kecamatan dengan merekrut kepala puskesmas melalui kontrak internal berbentuk seleksi terbuka (lelang jabatan) pada 44 puskesmas kecamatan. Kebijakan tersebut didukung dengan strategi pemberian tunjangan kinerja daerah berdasarkan kinerja yang diberikan secara individual dengan nilai yang cukup besar dibanding daerah lain di Indonesia. Pemerintah Provinsi DKI Jakarta mengharapkan terjadi perbaikan pelayanan kesehatan di puskesmas. Disisi lain, upaya monitoring ketat diperlukan guna kesuksesan tujuan kebijakan tersebut. Monitoring secara elektronik sebagai pemanfaatan teknologi berbasis web dilakukan sebagai bentuk intervensi dalam upaya mengendalikan produktivitas kerja petugas. Monitoring yang berefek pada nilai gaji yang diterima diimplementasikan sebagai upaya mencegah moral hazard pegawai terutama dalam segi kehadiran disamping upaya monitoring eksternal dengan menggunakan masyarakat sebagai steward dalam mengawasi kinerja puskesmas. Tujuan Penelitian: Mendeskripsikan mekanisme kontrol berupa upaya monitoring secara elektronik berbasis internet dan permasalahan yang terjadi pada pelaksanaan kebijakan tersebut serta alternatif solusinya dengan mengambil contoh purposiv pada BLUD Puskesmas Kecamatan Menteng Kota Administratif Jakarta Pusat. Metode Penelitian: Penelitian kualitatif dengan teknik eksploratif menggunakan wawancara semi-terstruktur, observasi dan telaahan dokumen. Subjek penelitian berjumlah 12 orang. Informan dipilih secara purposive sampling yang berhubungan langsung dengan kebijakan monitoring yang diambil. Analisis data menggunakan metode content analisys. Hasil Penelitian: Absensi dan kinerja petugas yang terekam dalam sistem membantu tugas manajerial, item-item pekerjaan telah distandarkan pada aplikasi e-kinerja beserta poin insentifnya, jumlah SDM kurang, kelalaian time limit entry kinerja yang mengakibatkan tidak dibayarnya insentif mendorong petugas melaporkan hasil kegiatannya tepat waktu, adanya moral hazard masyarakat berupa aduan palsu namun ada mekanisme filter terhadap aduan palsu tersebut. Kesimpulan: Hasil penelitian menunjukan sulit bagi puskesmas melakukan moral hazard dengan adanya sistem monitoring berlapis baik internal maupun eksternal. Fakta lain yang diperoleh adalah bahwa prinsip lain untuk mengatasi moral hazard adalah adanya insentif (janji) berdasarkan kinerja (performance-based incentive)dimana dalam kasus di DKI Jakarta, insentif yang diberikan bernilai besar, sehingga petugas merasa rugi jika terlambat atau membolos. Pemerintah Provinsi DKI Jakarta berhasil mengatasi moral hazard dengan menerapkan agency theory sehingga kinerja (absensi) yang tinggi dapat tercapai.

Background: The Special Capital Region of Jakarta Government doing to revitalize the district health centers to recruit heads of primary health centers through internal contracts form an open selection (lelang jabatan)to 44 district health centers. The policy is supported by the strategy of regional performance benefits based on the performance of a given individual with considerable value compared to other regions in Indonesia. The Special Capital Region of Jakarta Government expects an improvement of health services in health centers. On the other hand, strict monitoring efforts necessary to the success of the policy objectives. Monitoring electronically as the use of web-based technology is done as a form of intervention in an attempt to control officer work productivity. Monitoring the effect on the value of their salary implemented as an effort to prevent moral hazard, especially in terms of attendance of employees in addition to external monitoring efforts by using the community as a steward in monitoring the performance of health centers. Objective: To describe the control mechanism which takes the in form of Internet-based electronic monitoring and the problems that occurred in the implementation of the policy as an alternative solution by taking the purposive sampling at BLUD Puskesmas Menteng primary health center on Central Jakarta Administrative City. Methods: Qualitative research with exploratory technique using semi-structured interviews, observation and document research paper. Subjects numbered 12 people. Informants selected by purposive sampling directly related to policy monitoring were taking place. Data analysis using content analisys. Results: Attendance and performance of staff recorded in the system helps managerial duties, the items of work have been standardized on the application of e-kinerja together with the points incentive, less of human resources, time limit omissions which resulted in non-payment of incentives which encourage officers report the activities in proper time, the community in the form of moral hazard false complaints but no filter mechanism against the false complaint. Conclusion: The results shown that it was difficult for health centers to did moral hazard in the presence of layered monitoring system both internally and externally. Another fact is that obtained by other principles to address moral hazard is the lack of incentives (promise) based on the performance (performancebased contracting) in which case in Jakarta, the incentives provided great value, so that the workers feel the loss if late or ditching. The Special Region of Jakarta Government managed to overcome the moral hazard by applying agency theory so performance (attendance) is high can be achieved.

Kata Kunci : internal contracts, auctions position (lelang jabatan)of primary health centers head, performance-based incentive, monitoring