MONITORING PENETAPAN KINERJA (TAPKIN) DALAM RANGKA PENINGKATAN CAKUPAN PELAYANAN KESEHATAN IBU DI KABUPATEN SIGI PROVINSI SULAWESI TENGAH

HANNA JUNIAR, Prof. dr. Laksono Trisnantoro, MSc, PhD.; Dr. dr. Dwi Handono Sulistyo, M.Kes.

2017 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang : Pelaksanaan kontrak kinerja sangat memerlukan manajemen kontrak untuk menjamin pelayanan dilakukan dalam standar-standar yang spesifik dan biaya yang telah ditetapkan. Aspek monitoring Tapkin merupakan proses yang sangat krusial akibat adanya kendala pengawasan seperti rentang kendali yang sangat besar serta tantangan geografis di lapangan. Kajian terhadap monitoring Tapkin mampu memberikan gambaran kritis sejauh mana monitoring Tapkin dilakukan oleh Dinas Kesehatan Kabupaten Sigi. Tujuan : Mengetahui monitoring Tapkin dalam rangka peningkatan cakupan pelayanan kesehatan ibu serta faktor-faktor pendukung dan penghambat dalam proses monitoring di Kabupaten Sigi Provinsi Sulawesi Tengah. Metode : Penelitian ini menggunakan pendekatan kualitatif dengan jenis penelitian deskriptif . Pengumpulan data dilakukan dengan menggunakan wawancara mendalam (in-depth interview). Cara analisis data dalam penelitian ini akan dilakukan secara kualitatif. Hasil : Monitoring kontrak kinerja (Tapkin) dilaksanakan dalam bentuk monitoring langsung dan tidak langsung. Mapping wilayah monitoring hanya dilakukan oleh Dinas Kesehatan serta ada pelibatan aparat desa dalam pengawasan absensi bidan pelaksana. Pelaksanaan monitoring Dinas Kesehatan menggunakan standar sistem monitoring namun masih terdapat gap. Aspek sistem monitoring kontrak yang belum ada mencakup pelatihan bagi supervisor monitoring, penetapan rencana kontigensi, pengukuran kepuasan pelanggan, akses terhadap data pencapaian kinerja, prosedur pengecualian dan peninjauan paska kontrak. Kesimpulan : Pelaksanaan kebijakan dan pemberian pelayanan untuk kesehatan ibu sudah didukung dengan kebijakan kontrak kinerja. Terdapat kesenjangan yang bervariasi antara standar monitoring dan standar yang digunakan oleh Dinas Kesehatan Kabupaten Sigi. Kendala yang dihadapi selama monitoring yaitu hambatan geografis, masalah komunikasi, masalah transportasi, target yang diberikan Dinas kesehatan tidak sesuai dengan data lapangan serta masih terjadi asymetric information, masalah pendanaan dan span of control serta adanya potensi adverse selection dan Moral Hazard.

Background: Implementation on performance contract requires contract management to ensure all services are applied within specified standard and established cost. Monitoring aspect of performance determination is a crucial process due to the constraints of control such as huge span of control and geographical challenges. Review of monitoring of performance determination review will provide critical overview of monitoring performance determination has been conducted by district health office in Sigi district Objective: Understanding implementation monitoring of performance determination to increases maternal health services coverage also supporting factors and obstacle on monitoring in Sigi District, Province of Central Sulawesi. Method: Type of study was descriptive by qualitative approach. Collecting data through indepth interview. Analysis data will be conducted by qualitative approach. Result: Monitoring toward performance contract has conducted direct and indirect. Mapping of monitoring areas only conducted by District Health Office and involved village officials to monitored absent of midwife. Implementation of monitoring according to standard of monitoring system, but during implementation still faced some obtacles. Unclear contract system monitoring aspect such as training for supervisor, established planning of contingency, measurement of customer satisfaction, access towards performance achievement data, exception procedur and observation after implementation of contract. Conclusion: Policy implementation and providing service for maternal health has been supported by performance contract policy. There are various disparity between monitoring standard and standard used by District Health Office in Sigi. The obstacles such as geographical barriers, communication and transportation problems, target determination by District Health Office does not appropriate with field data also often occured asymmetric information, funding and span of control issues also possibility of adverse selection and moral hazard.

Kata Kunci : Monitoring, TAPKIN, Kematian Ibu, Monitoring, Performace Based Contracting (TAPKIN), Maternal mortality