URBAN CITIZENSHIP: POTRET PERJUANGAN MASYARAKAT MISKIN KOTA DALAM MENGAKSES PROGRAM KESEHATAN DI KAMPUNG CODE YOGYAKARTA

MIA SARMIASIH, Amalinda Savirani, S.IP. MA.,Ph.D

2022 | Tesis | MAGISTER POLITIK DAN PEMERINTAHAN

Kesehatan merupakan hak asasi manusia yang mendasari hak lainnya sehingga ia diperlukan untuk meningkatkan derajat kesehatan masyarakat dan menjadi landasan pembangunan nasional. Negara sebagai pemegang kedaulatan tertinggi berkewajiban memberikan hak akses layanan kesehatan terhadap warganya. Namun demikian, sejauh ini kebijakan negara belum mampu memenuhi hak akses warga miskin kota pendatang, dikarenakan atas pola kerja akses kesehatan yang berbasis administratif-formal. Penelitian ini bertujuan melihat perjuangan akses kesehatan warga miskin di kampung Jetisharjo, kawasan Code Yogyakarta sebagai representasi kantong kemiskinan di kota ini. Dengan meminjam konsep citizens of politics atau politik kewargaan (Hiariej dan Stokke, 2018) penulis mendalami bagaimana upaya perjuangan warga dalam memperoleh hak dasar kesehatan. Adapun dalam penelitian ini menggunakan metode kualitatif dengan pendekatan studi kasus dan mini etnografi yang melibatkan beberapa warga kampung Jetisharjo RW 5-7 sebagai partisipan. Temuan penelitian ini menujukkan terdapat beberapa siasat keterlibatan warga dalam mengatasi masalah ketidakadilan akses kesehatan di Kota Yogyakarta; Pertama secara kolektif dalam bentuk gerakan solidaritas komunal yang dilakukan melalui aksi serkileran (tolong menolong sesama warga) yang digerakkan oleh warga peduli dengan menggalang iuran sukarela bagi warga yang mengalami sakit. Temuan kedua, warga miskin kota terlibat menjadi menjadi perantara atau broker, yang dianggap sebagai saluran politik informal baru menjadi alternatif untuk mengatasi situasi dari panjangnya proses pengaturan dokumen di satu sisi dan disisi lain karena keterbatasan pengetahuan warga atas liku-liku pengurusan dokumen administratif. Lebih lanjut broker dalam praktiknya membantu mengadvokasi layanan kesehatan yang bermasalah, dengan cara melobi dan mamangkas alur birokrasi agar warga bisa secara cepat memperoleh akses layanan kesehatan. Demikian bahwa saluran informal baru (broker) masih sangat relevan bekerja untuk menjawab masalah ketimpangan akses layanan kesehatan yang sulit dijangkau warga di akar rumput. Sedangkan di luar itu, juga terdapat keikutsertaan warga pada program pemerintah termasuk dalam program jamkesda maupun JKN yang diselenggarakan oleh BPJS. Meskipun jika dicermati pola kerja JKN berbasis administratif dan terdapat indikasi komersialisasi kesehatan atau pendekatan pada rezim pasar.

Health is a human right that underlies other rights so that it is needed to improve the health status of the community and become the basis of national development. The state as the holder of the highest sovereignty is obliged to provide access to health services for its citizens. However, so far, state policies have not been able to fulfill the access rights of the urban poor, due to the administrative-formal-based work pattern of access to health. This study aims to look at the struggle for access to health for the poor in Jetisharjo village, Code Yogyakarta area as a representation of pockets of poverty in this city. By borrowing the concept of citizens of politics or citizenship politics (Hiariej and Stokke, 2018) the author explores how citizens struggle to obtain basic health rights. As for this research, using qualitative methods with a case study approach and mini ethnography involving several residents of Jetisharjo village RW 5-7 as participants. The findings of this study indicate that there are several strategies of citizen involvement in overcoming the problem of unfair access to health in the city of Yogyakarta; First, collectively in the form of communal solidarity movements which are carried out through serkileran actions (please help fellow citizens) which are driven by caring citizens by raising voluntary contributions for residents who are sick. The second finding is that the urban poor are involved in becoming intermediaries or brokers, which is considered a new informal political channel as an alternative to overcome the situation due to the lengthy process of arranging documents on the one hand and on the other hand due to the limited knowledge of residents on the intricacies of managing administrative documents. Furthermore, brokers in practice help advocate for problematic health services, by lobbying and cutting bureaucratic flows so that citizens can quickly gain access to health services. Thus, the new informal channel (broker) is still very relevant to work to answer the problem of inequality in access to health services that are difficult for residents to reach at the grassroots. Meanwhile, beyond that, there is also citizen participation in government programs including the Jamkesda and JKN programs organized by BPJS. Even if we look closely, the JKN work pattern is administratively based and there are indications of commercialization of health or an approach to the market regimeHealth is a human right that underlies other rights so that it is needed to improve the health status of the community and become the basis of national development. The state as the holder of the highest sovereignty is obliged to provide access to health services for its citizens. However, so far, state policies have not been able to fulfill the access rights of the urban poor, due to the administrative-formal-based work pattern of access to health. This study aims to look at the struggle for access to health for the poor in Jetisharjo village, Code Yogyakarta area as a representation of pockets of poverty in this city. By borrowing the concept of citizens of politics or citizenship politics (Hiariej and Stokke, 2018) the author explores how citizens struggle to obtain basic health rights. As for this research, using qualitative methods with a case study approach and mini ethnography involving several residents of Jetisharjo village RW 5-7 as participants.The findings of this study indicate that there are several strategies of citizen involvement in overcoming the problem of unfair access to health in the city of Yogyakarta; First, collectively in the form of communal solidarity movements which are carried out through serkileran actions (please help fellow citizens) which are driven by caring citizens by raising voluntary contributions for residents who are sick. The second finding is that the urban poor are involved in becoming intermediaries or brokers, which is considered a new informal political channel as an alternative to overcome the situation due to the lengthy process of arranging documents on the one hand and on the other hand due to the limited knowledge of residents on the intricacies of managing administrative documents. Furthermore, brokers in practice help advocate for problematic health services, by lobbying and cutting bureaucratic flows so that citizens can quickly gain access to health services. Thus, the new informal channel (broker) is still very relevant to work to answer the problem of inequality in access to health services that are difficult for residents to reach at the grassroots. Meanwhile, beyond that, there is also citizen participation in government programs including the Jamkesda and JKN programs organized by BPJS. Even if we look closely, the JKN work pattern is administratively based and there are indications of commercialization of health or an approach to the market regime.

Kata Kunci : Akses kesehatan, Urban Citizenship, Solidaritas Komunal, Broker.