IMPLEMENTASI OTORITAS VETERINER DALAM KEBIJAKAN PENANGGULANGAN RABIES DI PROVINSI BANTEN

JOKO ISMADI, Pror. Dr. drh. Bambang Sumiarto, SU., M.Sc; Dr. drh. Widagdo Sri Nugroho, MP; Erwan Agus Purwanto, M.Si., Ph.D

2019 | Disertasi | DOKTOR SAINS VETERINER

Kebijakan penanggulangan rabies di Provinsi Banten belum menunjukkan hasil yang maksimal, indikasinya adalah belum dicapainya status bebas rabies bagi Provinsi Banten. Salah satu hambatan yang dihadapi adalah implementasi Otoritas Veteriner yang belum berjalan dengan baik. Tujuan penelitian ini adalah : 1) Mendiskripsikan struktur organisasi perangkat daerah (OPD) dinas teknis keswan/kesmavet, terkait implementasi Otoritas Veteriner; 2) Mendiskripsikan pengetahuan dan pemahaman tentang rabies, OPD Dinas Teknis keswan/kesmavet, Dinas Kesehatan, Badan Perencanaan Pembangunan Daerah (Bappeda), Badan Kepegawaian Daerah (BKD), dan pemangku kepentingan terkait dengan implementasi otoritas veteriner; 3) Mendiskripsikan penilaian implementasi otoritas veteriner, dari OPD Dinas Teknis keswan/kesmavet Dinas Kesehatan, Bappeda, BKD, serta pemangku kepentingan dalam kebijakan penanggulangan rabies. Mencari asosiasi antara faktor pengetahuan rabies yang mempengaruhi penilaian terhadap otoritas veteriner; 4) Menganalisa tingkat pengetahuan, sikap dan praktek (KAP), serta Analisis Jalur (Path Analysis) mengenai rabies yang dimiliki oleh dokter hewan dinas, serta dokter/dokter gigi dinas provinsi, kabupaen/kota di Provinsi Banten Materi penelitian ini adalah 36 OPD terkait Otoritas Veteriner, yaitu 9 Dinas Teknis Keswan/Kesmavet, 9 Dinas Kesehatan, 9 Bappeda, dan 9 BKD provinsi, kabupaten/kota. Pemangku kepentingan dengan responden 53 dokter hewan dinas, 94 dokter hewan non dinas, dan 18 dokter/dokter gigi dinas di Provinsi Banten. Pengumpulan data dengan metode sensus dan sampling melalui kuesioner, wawancara, dan data sekunder dari OPD. Data dianalisis secara deskriptif dalam bentuk persentase, uji Chi-square, dan analisis jalur (path analysis). Penelitian terdiri dari 4 bagian sesuai dengan tujuan penelitian Hasil penelitian menunjukan OPD Dinas Teknis Keswan/Kesmavet provinsi, kabupaten/kota di Provinsi Banten, tidak ada yang nomenklakturnya menyebut Dinas Kesehatan Hewan dan/atau Dinas Kesehatan Masyarakat Veteriner. Belum ada dokter hewan yang menduduki jabatan tertinggi otoritas veteriner atau sebagai Kepala OPD/eselon II. Nomenklaktur yang menyebut Keswan/Kesmavet ada di posisi bidang. Kedudukan tertinggi dokter hewan adalah sebagai Kepala Bidang. Dinas Teknis provinsi, kabupaen/kota di wilayah Provinsi Banten masih kekurangan dokter hewan. Hasil skoring dari 36 OPD yaitu Dinas Teknis, Dinas Kesehatan, Bappeda, dan BKD 30,56% OPD yang mempunyai pengetahuan rabies dan penilaian otoritas veteriner baik, 22,22% OPD yang pengetahuan rabies baik tetapi penilaian otoritas veterinernya kurang baik, 11,11% OPD yang pengetahuan rabies kurang baik tetapi penilaian otoritas veterinernya baik, 36,11%, OPD mempunyai pengetahuan rabies dan penilaian otoritas veterinernya kurang baik. Pemangku kepentimgan (dokter hewan dinas, dokter hewan non dinas, dokter/dokter gigi), 52,12% yang pengetahuan rabies baik dan 47,88% pengetahuan kurang baik, 40,0% yang penilaian otoritas veteriner baik dan 60,0% penilaian otoritas veteriner kurang baik. Hasil skoring tentang penilaian otovet dari 53 dokter hewan dinas, 37,74% memberi penilaian baik, dan 62,26% memberi penilaian kurang baik, 94 dokter hewan non dinas 50% memberi penilaian baik, 50% memberi penilaian kurang baik, 18 dokter/dokter gigi 50% memberi penilaian baik, dan 50% kurang baik. Pengetahuan rabies, 53 dokter hewan dinas 16,97% yang pengetahuan rabies baik, 15,15% kurang baik, 10,30% penilaian otoritas veteriner baik dan 21,82% kurang baik. Dokter hewan non dinas 30,30% yang pengetahuan rabies baik dan 26,67% kurang baik, 24,85% penilaian otoritas veteriner baik, 32,12% kurang baik. Dokter/dokter gigi 4,84% yang pengetahuan rabies baik dan 6,06% kurang baik, 4,84% yang penilaian otovet baik dan 6,06% kurang baik. Provinsi Banten dinyatakan kembali sebagai daerah tertular rabies mempunyai asosiasi yang bermakna dengan penilaian terhadap otoritas veteriner (P = 0,003) dengan kekuatan asosiasi sangat kuat dengan nilai OR = 8,8. Pencegahan utama rabies adalah dengan meningkatkan cakupan vaksinasi (coverage vaccine) untuk meningkatkan kekebalan kelompok (herd immunity) dan juga eliminasi terhadap HPR, mempunyai asosiasi yang bermakna dengan penilaian terhadap otoritas veteriner (P = 0,017) dengan kekuatan asosiasi sangat kuat dengan nilai OR=10,5. Kebiasaan masyarakat pemilik anjing di Kabupaten Lebak yang menggunakan anjing piaraannya untuk berburu babi hutan yang menganggu lahan pertanian Moro mempunyai asosiasi yang bermakna dengan penilaian terhadap otoritas veteriner (P = 0,031) dengan kekuatan asosiasi yang kuat dengan nilai OR = 5,9. Gejala klinis pada anjing yang terkena rabies mempunyai asosiasi yang bermakna dengan penilaian terhadap otoritas veteriner (P = 0,049) dengan kekuatan asosiasi yang kuat dengan nilai OR = 4,8. Provinsi Banten dinyatakan kembali sebagai daerah tertular rabies mempunyai asosiasi yang bermakna dengan penilaian terhadap otoritas veteriner (P = 0,026) dengan kekuatan asosiasi yang kuat dengan nilai OR = 2,1. Tingkat pengetahuan tentang rabies dokter hewan dinas memiliki perbedaan yang segnifikan/berbeda nyata (P = 0,007) dengan dokter/dokter gigi dinas. Tingkat sikap terkait rabies yang dimiliki oleh dokter hewan dinas memiliki perbedaan yang segnifikan (P = 0,006) dengan tingkat sikap yang dimiliki oleh dokter/dokter gigi dinas. Ada perbedaan yang signifikan antara tingkat praktik penanggulangan rabies dokter hewan dinas dan dokter/dokter gigi dinas (P = 0,000). Kesimpulan dari penelitian adalah struktur kelembagaan Otoritas Veteriner tidak sinkron antara pemerintah pusat dengan pemerintah daerah karena kendala birokrasi di daerah akibat daerah mempunya otonomi tersendiri. Faktor yang mempengaruhi kurang berhasilnya implementasi Otoritas Veteriner dalam penanggulangan rabies di Provinsi Banten adalah rendahnya pengetahuan tentang rabies dan kurang baiknya penilaian terhadap Otoritas Veteriner OPD dan pemangku kepentingan.

The policy of rabies prevention in Banten has not show maximum result, the indication is the status of Banten as a non-rabies-free province in Indonesia. Once of the obstacle is the poor implementation of Veterinary Authority in the region. The purpose of this research are: 1) To describe the organizational structure of Regional Device Organization (OPD) Technical agency Animal Health (AH)/Veterinary Public Health (VPH) in correlation with the implementation of Veterinary Authority. 2) To describe the knowledge and understanding about rabies, Technical Agency OPD AH/VPH, Health Agency, Regional Development and Planning Agency (Bappeda). Regional Staffing Agency (BKD), and the stakeholders of Veterinary Authority implementation.. 3) To describe the assessment of Veterinary Authority implementation, from the perspective of Technical Agency OPD AH/VPH, Healthcare Agency, Bappeda, BKD, and the stakeholders of rabies prevention policy. 4) To analyse the level of knowledge, attitude and practice (KAP), and Path Analysis about rabies among government's veterinary, and doctor/dentist that works under both province's and city's healthcare agency in Banten. The research material consists of 36 OPD related to Veterinary Authority, which are: 9 Technical Agency for AH/VPH, 9 Health Agency, 9 Bappeda, and 9 BKD both in province and city level. The stakeholders are respondent from 53 government veterinary officer, 94 non-government veterinary, and 18 government doctors/dentist officer of Banten Province. Data collection using census and sampling methods through questionnaires, interviews, and secondary data from OPD. The data is being analyzed in descriptive format in the form of percentage, path analysis and Chi-square. The research consists of 4 parts that correlate with the research purposes. The result show that OPD Technical Agency AH/VPH both in Province and District/City level of Banten, there is no nomenclature that mentioned Animal Healthcare Agency and/or Veterinary Society Healthcare Agency. There is no veterinary that occupy on the highest position of Veterinary Authority or as the head of OPD/echelon II. The nomenclature that mentioned Keswan/Kesmavet are founded at the division level. The highest position of veterinary is as the Head of Division. The Technical Agency in province and districts of Banten are still insufficient of veterinary. The score result from 36 OPD which are : Technical Agency, Healthcare Agency, Bappeda and BKD show 30,56% OPD has the rabies knowledge and good Veterinary Authority assessment score, 22,22% OPD has good rabies knowledge but poor Veterinary Authority assessment score, 11,11% OPD with poor rabies knowledge and good Veterinary Authority assessment score, 36,11%, OPD with poor rabies knowledge and poor Veterinary Authority assessment score. Stakeholders (government veterinary officer, non-government veterinary, doctor/dentist), 52,12% possess good rabies knowledge and 47,88% possess poor rabies knowledge, 40,0% showed good Veterinary Authority assessment score and 60,0% showed poor score. The scoring result of Veterinary Authority assessment from 53 agency veterinary showed 37,74% gives good score, and 62,26% gives poor score, 94 non-government veterinary 50% gives good score, and 50% gives poor score, while 18 doctor/dentist 50% gives good score, and 50% gives poor score. The rabies knowledge of 53 agency veterinary showed 16,97% with good rabies knowledge, 15,15% poor rabies knowledge, 10,30% good Veterinary Authority assessment score, and 21,82% poor Veterinary Authority assessment score. Non-government veterinary showed 30,30% possess good rabies knowledge and 26,67% has poor knowledge, 24,85% good Veterinary Authority assessment score and 32,12% poor Veterinary Authority assessment score. Doctor/Dentist showed 4,84% possess good rabies knowledge and 6,06% possess poor rabies knowledge, 4,84% possess good Veterinary Authority assessment score and 6,06% are poor . Research result shows that the provincial/regency Technical OPD AH/VPH in Banten province doesn't mention Animal Health Agency and/or Public Health Agency Veterinary in their nomenclature. There are no veterinary that occupy the highest position in veterinary authority or as the head of OPD/echelon II. Nomenclature that mentions AH/VPH is at the division position. Highest position for veterinary is as the Head of Division. Provincial and regency technical agency in Banten Province is still lacking veterinary. Scoring result from 36 OPD : the Technical Agency, Health Agency, Bappeda, and BKD 30,56% OPD has the rabies knowledge and good veterinary authority score, 22,22% OPD has good rabies knowledge but poor veterinary authority, 11,11% OPD with poor rabies knowledge but good veterinary authority score, 36,11%, OPD with poor rabies knowledge and poor veterinary authority score. Stakeholders (agency veterinary, non-agency veterinary, doctor/dentist), 52,12% with good rabies knowledge and 47,88% poor knowledge, 40,0% with good veterinary authority score and 60,0% with poor. Scoring result about otovet assessment from 53 agency veterinary, 37,74% gives good score, and 62,26% gives poor score, 94 non-agency veterinary 50% gives good score, and 50% gives poor score, while 18 doctor/dentist 50% gives good score, and 50% gives poor score. Rabies knowledge, 53 agency veterinary 16,97% with good rabies knowledge, 15,15% poor rabies knowledge, 10,30% good veterinary authority score 21,82% poor veterinary authority score. Non-agency veterinary 30,30% with good rabies knowledge and 26,67% poor rabies knowledge, 24,85% good veterinary authority score and 32,12% poor veterinary authority score. Doctor/Dentist 4,84% with good rabies knowledge and 6,06% poor rabies knowledge, 4,84% with good otovet score and 6,06% are poor. The Banten province is reinstated as a rabies-contracting region has a meaningful association with strong assessment towards Veterinary Authority (P = 0,003) with strongest association strength with OR = 8,8. The main rabies prevention is by increasing the vaccination coverage in order to improve herd immunity and eliminating HPR has a meaningful association with assessment towards Veterinary Authority (P = 0,017) with strongest association strength with OR value of 10,5. Dog owners habit in Lebak regency who use their dogs to hunt boars that disturbs the farmland productivity in Moro has a meaningful association with assessment towards Veterinary Authority (P = 0,031) with strong association strength of OR = 5,9. Clinical symptoms on dogs contracting rabies has a meaningful association with assessment towards Veterinary Authority (P = 0,049) with strong association strength with OR value = 4,8. The reinstatement of Banten Province as a rabies-contracting region has a meaningful association with assessment towards Veterinary Authority (P = 0,026) with strong association strength with OR = 2,1. Rabies knowledge level on government veterinary officer has a significant difference (P = 0,007) with government doctors/dentists. Rabies attitude level for government veterinary officer has a significant difference (P = 0,006) with governemtn doctors/dentists. There is a significant difference between the practice level of rabies countermeasure by government veterinary compare with government doctors/dentists (P = 0,000). The conclusion of the research is the structure of Veterinary Authority are out of sync between the central government with local authorities because of the local bureaucratic constraints in where the local authorities has local autonomy. The factors that effect on poor implementation of the Veterinary Authority in Banten province rabies prevention was the low level of knowledge of rabies and poor assessment of the Veterinary Authority OPD and stakeholders.

Kata Kunci : Implementasi, otoritas veteriner, rabies, organisasi perangkat daerah