PELAKSANAAN PROGRAM KELURAHAN SIAGA SEHAT JIWA DI WILAYAH KERJA PUSKESMAS KOTAGEDE I KOTA YOGYAKARTA

ANISA WIJAYANTI, Drs. Hadriyanus Suharyanto, M.Si.

2016 | Skripsi | S1 ILMU ADMINISTRASI NEGARA (MANAJEMEN DAN KEBIJAKAN PUBLIK)

Program KSSJ wilayah kerja Puskesmas Kotagede I digagas oleh RSJ Grhasia sejak tahun 2013 karena banyak kasus rujukan pasien gangguan jiwa dan karakteristik masyarakatnya yang dinilai memiliki solidaritas tinggi. Hingga tiga tahun berjalan, program ini belum memiliki pedoman teknis dan belum pernah dievaluasi oleh Puskesmas maupun Dinas Kesehatan Kota Yogyakarta. Fokus penelitian ini adalah menganalisis implementasi Program KSSJ dan faktor-faktor yang mempengaruhi pelaksanaannya untuk melihat sejauh mana program mampu meningkatkan derajat kesehatan jiwa masyarakat di wilayah. Metode penelitian kualitatif dipilih untuk melihat implementasi program dan menganalisis faktor yang berpengaruh, yaitu kondisi lingkungan, sumber daya, karakteristik aktor, dan hubungan antar aktor. Informan penelitian adalah dari Dinas Kesehatan Kota Yogyakarta, Puskesmas Kotagede I, kader kesehatan jiwa KSSJ Prenggan dan Purbayan, dan pasien serta keluarga pasien dengan teknik pengumpulan data observasi, wawancara mendalam, dan dokumentasi. Hasil penelitian menunjukkan implementasi Program KSSJ oleh kader keswa dan Koordinator Program Jiwa sudah memenuhi kriteria KSSJ, yaitu deteksi dini, penggerakan masyarakat, kunjungan rumah, program rujukan, dan pencatatan serta pelaporan. Namun masih terdapat beberapa hambatan, yaitu data deteksi dini yang belum mencakup seluruh masyarakat dan masih ada stigma negatif terhadap masalah kejiwaan. Evaluasi belum pernah dilakukan sehingga perkembangan program belum diketahui secara pasti. Faktor yang paling berpengaruh adalah kondisi lingkungan dan hubungan antar aktor terkait koordinasi dan komunikasi. Hambatannya adalah belum ada SOP, kurangnya pemantauan dan evaluasi program di wilayah oleh Dinas Kesehatan Kota Yogyakarta, kurangnya partisipasi dari tokoh masyarakat dan lintas sektor wilayah, kurangnya tenaga kesehatan jiwa, dan keterbatasan dana. Saran yang dapat direkomendasikan, antara lain: (1) Perbaruan data deteksi dini dengan lebih meningkatkan pengawasan dan kerjasama di wilayah; (2) Pengadaan evaluasi internal rutin dan penguatan komitmen antara puskesmas dan kader keswa; (3) Apresiasi kinerja pelaksana teknis program; (4) Sosialisasi yang lebih mencakup seluruh masyarakat; (5) Penyusunan SOP dan penyelesaian buku petunjuk teknis Kesi oleh Dinas Kesehatan Kota Yogyakarta; dan (6) Dinas Kesehatan membantu kerjasama puskesmas dengan institusi pendidikan untuk mendatangkan tenaga tambahan terlatih kesehatan jiwa.

KSSJ Program in Puskesmas Kotagede I regional area were initiated by Grhasia Mental Hospital in 2013 because there were many mental disorder cases and public’s characteristics were considered to have a high solidarity. In three years, the technical guidelines for this program has not been designed yet and it has not been evaluated by the primary health center and Yogyakarta Public Health Office. The focuses of this study are to analyze the implementation of the KSSJ Program and the factors that influence its implementation in order to see how far the program is able to improve the mental health of the community in the region. Qualitative research method was selected to perceive the implementation of the program and to analyze the influential factors, such as environmental conditions, resources, characteristics of the actors, and the relationship between actors. The informants were from Yogyakarta Public Health Office, Puskesmas Kotagede I, cadres of mental health in KSSJ Prenggan and Purbayan, patient and families of patient with data collection techniques, namely observational, in-depth interviews, and documentation. The results of the research showed that the implementation of KSSJ Program by mental health cadres and Program Coordinator has met the program criterias, namely early detection, community movement, home visits, referral programs, and data recording and reporting. However, there are still several obstacles, for example, data of early detection is not able to cover the entire society. Other problem is a negative stigma to the psychiatric problems. Evaluation has not been performed yet, so the progress of the program is uncertainly known. The most influential factors are environmental conditions and the relationship between actors who were related to coordination and communication. Another obstacles are the absence of SOP (Standard Operating Procedure), the lackness of monitoring and evaluation of the programs in the region from Yogyakarta Public Health Office, the lackness of participation of community leaders and cross-sector actors in region, the lackness of mental health professionals, and the fund insufficiency. Suggestions that can be recommended, among others are: (1) Updating the data of early detection by improve the control and cooperation in the region; (2) Provisioning regular internal evaluation and strengthening commitment between Puskesmas and mental health cadres; (3) Appreciating the performance of the technical implementer of the program; (4) Socializing to the entire community; (5) Establishing SOP and completing Kelurahan Siaga technical manuals by Yogyakarta Public Health Office; and (6) Giving aid by Yogyakarta Public Health Office in term of cooperation with educational institutions in order to request additional mental-health staffs.

Kata Kunci : Implementasi, kebijakan, kelurahan siaga sehat jiwa, program, puskesmas