KAPASITAS SUSTAINABILITY PELIBATAN FKTP SWASTA DALAM STRATEGI DISTRICT-BASED PUBLIC-PRIVATE MIX (DPPM) TUBERKULOSIS DI KOTA DEPOK

Dhea Keyle Fortunandha, Prof. dr. Yodi Mahendradhata, M.Sc, Ph.D, FRSPH

2025 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar Belakang: Indonesia merupakan negara dengan beban tuberkulosis (TBC) tertinggi kedua di dunia. Sebagian besar masyarakat mengakses layanan kesehatan primer dari fasilitas swasta, menjadikan keterlibatan FKTP swasta sebagai elemen krusial dalam strategi penanggulangan TBC. Strategi District-Based Public-Private Mix (DPPM) dikembangkan untuk memperluas akses layanan melalui kolaborasi antara sektor publik dan swasta. Di Kota Depok, strategi ini telah diimplementasikan sejak tahun 2021 dengan dukungan The Global Fund, namun keberlanjutan pelibatan FKTP swasta masih menjadi tantangan, terutama dalam menghadapi masa transisi pasca-hibah donor. 

Metode: Penelitian ini menggunakan pendekatan kualitatif dengan desain studi kasus tunggal. Data diperoleh melalui wawancara mendalam dengan berbagai pemangku kepentingan dari sektor pemerintah, legislatif, fasilitas kesehatan, organisasi profesi, lembaga akreditasi, penyedia jaminan kesehatan dan komunitas. Data dianalisis secara tematik menggunakan software Nvivo mengacu pada kerangka Program Capacity for Sustainability yang mencakup delapan domain utama. 

Hasil: Pelibatan FKTP swasta dalam strategi DPPM di Kota Depok menunjukkan capaian positif, namun belum ditunjang kapasitas keberlanjutan yang memadai. Dukungan politik dan pendanaan belum stabil; kemitraan strategis belum terlembaga; serta tata kelola organisasi, evaluasi program, komunikasi, dan perencanaan strategis masih lemah. Meskipun terdapat fleksibilitas adaptasi, mekanisme tersebut belum terintegrasi dalam sistem kelembagaan. 

Kesimpulan: Secara keseluruhan, semua domain kapasitas berkontribusi terhadap keberlanjutan pelibatan FKTP swasta dalam strategi DPPM TBC. Namun, stabilitas pendanaan dan perencanaan strategis teridentifikasi sebagai dua elemen kunci yang paling menentukan. Untuk itu, komitmen pemerintah daerah diperlukan dalam menyusun roadmap keberlanjutan, memperkuat koordinasi lintas sektor, serta mengembangkan skema insentif dan pembiayaan jangka panjang.

Background: Indonesia ranks second globally in tuberculosis (TB) incidence, with private primary health care facilities (PHC) playing a significant role in patient pathways. The District-Based Public-Private Mix (DPPM) strategy was developed to strengthen TB case finding and treatment through systematic engagement of both public and private health providers. In Depok City, which has implemented DPPM since 2021 with support from The Global Fund, concerns remain about the sustainability of private sector engagement, especially after donor support ends. 

Methods: This study uses a qualitative approach with a single case study design. Data was obtained through in-depth interviews with various stakeholders from the government, legislature, health facilities, professional organisations, accreditation agencies, health insurance providers, and communities. Data were analyzed thematically using NVivo software, referring to the Public Health Program Capacity for Sustainability Framework, which covers eight domains. 

Results: The study found that the sustainability capacity of private PHC engagement in DPPM remains inadequate across most domains. Political support is limited to verbal commitment; funding is overly reliant on donor sources without a clear transition plan. Strategic partnerships, institutional governance, program evaluation, communication, and strategic planning remain underdeveloped. Although program adaptation was relatively flexible, it was not systematized. 

Conclusion: Overall, all capacity domains contribute to the sustainability of private PHC involvement in the DPPM-TB strategy. However, financial stability and strategic planning emerged as the two most critical elements, as they serve as the foundation for the sustained functioning of other program capacities. Therefore, it is essential for local governments to commit to developing a sustainability roadmap, strengthening cross-sectoral coordination, and creating incentive and financing schemes that can support long-term engagement of the private sector.

Kata Kunci : Tuberkulosis, Public-Private Mix, Keberlanjutan, Pelibatan Sektor Swasta