Studi Kasus Pembiayaan Pelaksanaan Program Tuberkulosis Saat Pandemi Covid-19 di Kota Medan

SYAFRIANA SITORUS, dr. Yodi Mahendradhata, M.Sc., Ph.D., FRSPH dan M. Faozi Kurniawan, S.E., Akt., MPH

2022 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Latar Belakang: Tuberkulosis (TB) masih menjadi penyakit global dengan tingkat morbiditas dan mortalitas dan yang tinggi (1,2 juta meninggal tahun 2019). Selain itu, dunia justru dihadapkan dengan permasalahan kesehatan baru yaitu coronavirus disease 2019 (COVID-19) yang mempengaruhi semua sektor kesehatan termasuk di Indonesia. Kota Medan memiliki kasus COVID-19 yang tinggi (90.717 kasus dengan 2.166 meninggal dunia). Peningkatan kasus COVID-19 memberikan dampak terhadap cakupan penemuan kasus dan keberhasilan pengobatan TB (35,2% dari target 65% tahun 2020). Adanya refocusing anggaran pengendalian TB menghambat realisasi pengadaan dan kegiatan yang telah direncanakan. Pelayanan TB di fasilitas kesehatan juga terganggu. Tujuan: Menganalisis pembiayaan pelaksanaan program Tuberkulosis saat adanya pandemi COVID-19 di Kota Medan. Metode Penelitian: Penelitian menggunakan studi kasus dengan single case design (embedded) di Dinas Kesehatan Kota Medan dan BPJS Kesehatan Kota Medan. Subjek penelitian berjumlah 8 orang yang dipilih menggunakan teknik purposive sampling. Pengumpulan data melalui enam sumber yaitu dokumenentasi, arsip, wawancara terfokus, observasi langsung, dan perangkat fisik. Analisis data dianalisa menggunakan teknik pattern matching dan analisa deret waktu. Hasil: Pembiayaan untuk program TB bersumber dari Dana APBN, APBD provinsi, kab/kota mengalami penurunan di tahun 2020 akibat efisiensi/ refocusing untuk kegiatan COVID-19 (kegiatan investigasi kontak puskemas ke rumah pasien). Namun, alokasi APBD ini menigkat tahun 2021. Dana sektor swasta (USAID-TBPS, YKI, Lions Club, dan sektor lainnya) sangat membantu dalam mencapai target program TB. Peran sektor swasta yang bekerjasama dengan pemerintah daerah dan Dinkes Kota Medan mulai tahun 2021. Dana BPJS Kesehatan, pembiayaan klaim INA CBG�s di rumah sakit (FKRTL) yang mengalami penurunan tahun 2020 dan 2021. Pelaksaanan program TB saat adanya pandemi COVID-19 mengalami kendala pada tahun 2020 terkait penjaringan suspek akibat dari kebijakan lockdown dan PSBB di Kota Medan. Kegiatan diagnosa dan pengobatan membaik di tahun 2021 dengan adanya peningkatan kualitas pemeriksaan dan pengobatan TB di faskes. Indikator Angka Notifikasi Kasus (Case Notification Rate) mengalami penurunan secara drastis dari sebelum adanya COVID-19 dan Angka Keberhasilan Pengobatan (Success Rate) TB tidak terlalu terdampak (mencapai target).

Background: Tuberculosis (TB) is still a global disease with high morbidity and mortality rates (1.2 million died in 2019). In addition, the world is actually faced with a new health problem, namely the coronavirus disease 2019 (COVID-19) which affects all health sectors including Indonesia. The city of Medan has a high number of COVID-19 cases (90,717 cases with 2,166 deaths). COVID-19 cases have an impact on increasing case finding and successful TB treatment (35.2% of the 65% target by 2020). There is refocusing of TB control on the realization of procurement and planned activities. TB services in health facilities are also disrupted. Objective: To analyze the financing for the implementation of the Tuberculosis program during the COVID-19 pandemic in the city of Medan. Research Methods: This study uses a case study with a single case design (embedded) at the Medan City Health Office and Medan City Health BPJS. The research subjects found 8 people who were selected using purposive sampling technique. Collecting data through six sources, namely documentation, archives, focused interviews, direct observation, and physical devices. Data was analyzed using pattern matching techniques and time series analysis. Results: Financing for the TB program sourced from national budget (APBN), regency budget (APBD) decreased in 2020 efficiency/refocusing for COVID-19 activities (investigation activities for health center contacts to patients homes). However, the APBD allocation will increase in 2021. Private sector funds (USAID-TBS, YKI, Lions Club, and other sectors) are very helpful in achieving TB program targets. The role of the private sector that reaches the local government and the Medan City Health Office starting in 2021. BPJS Health funds, financing INA CBG's claims in hospitals (FKRTL) which have decreased in 2020 and 2021. The TB implementation program during the COVID-19 pandemic experienced problems in 2020 related to the screening of suspects as a result of the lockdown and PSBB policies in the city of Medan. Diagnostic and treatment activities will improve in 2021 with an increase in the quality of TB examinations and treatment at health facilities. The Case Notification Rate indicator has decreased drastically from before COVID-19 and the TB Treatment Success Rate is not very successful (achieved the target).

Kata Kunci : Covid-19, tuberculosis, tuberculosis financing, TB case finding, TB treatment success