Koordinasi kegiatan program TB.Paru di Dinas Kesehatan Kabupaten Lampung Timur

BUDIARNI, Tri, Prof.dr. Hari Kusnanto J., DrPH

2005 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Kabupaten Lampung Timur telah melaksanakan kegiatan program TB paru dengan menggunakan strategi Directly Observed Treatment Shortcourse (DOTS), sejak tahun 1995, tetapi dilihat dari indikator keberhasilan program masih jauh di bawah target nasional. Kabupaten Lampung Timur tahun 2002 telah menerbitkan SK gerdunas- TB, yaitu gerakan terpadu dan menyeluruh (koordinasi) yang dalam pengorganisasiannya mengadakan kerjasama lintas sektor, lintas program di lingkungan dinas kesehatan, LSM, profesi di setiap tingkatan organisasi. Tujuan dari penelitian ini adalah untuk mengetahui bagaimana proses koordinasi dan bagaimana dengan komunikasi, kepemimpinan, aturan dan prosedur kerja, serta standarisasi ketrampilan yang ada. Metode penelitian: penelitian ini merupakan penelitian deskriptif menggunakan metode kualitatif, rancangan studi kasus. Subyek penelitian 15 orang, yang terdiri dari 9 orang pejabat struktural, 4 orang pengelola program, 1 orang dokter praktek swasta, dan 1 orang pengelola balai pengobatan swasta, dengan menggunakan observasi, diskusi kelompok terarah, dan wawancara mendalam. Hasil penelitian: Koordinasi program TB dengan lintas program, lintas sektor belum ada, peran swasta baru satu balai pengobatan yang dilibatkan, tidak ada komunikasi dengan instansi horisontal, dengan puskesmas masih kurangnya komunikasi pada kegiatan supervisi, lemahnya sistem pencatatan dan pelaporan, masih kurangnya pertemuan, kepemimpinan di Dinas Kesehatan Lampung Timur tidak bisa mengambil keputusan mandiri, masih tergantung dari propinsi, puskesmas kurang dilibatkan dalam masalah perencanaan, Belum ada aturan dan prosedur kerja yang jelas bagi intansi horisontal, puskesmas sudah ada aturan dan prosedur kerja, tetapi buku yang menjadi panduan tidak tersedia di semua puskesmas. Keterampilan dan pengetahuan yang dimiliki petugas masih kurang. Kesimpulan dan saran : Pelaksanaan koordinasi program TB paru, di Kabupaten Lampung Timur, belum terlaksana sebagaimana mestinya, diperlukan adanya dukungan pemerintah daerah, serta meningkatkan hubungan koordinasi. Meningkatkan komunikasi pada kegiatan supervisi, pertemuan rutin, membenahi sistem pencatatan dan pelaporan. Melibatkan puskesmas dalam menetapkan kegiatan perencanaan, Perlu dirumuskan aturan dan prosedur kerja yang jelas, meningkatkan pengetahuan dan ketrampilan sumber daya manusia.

Setting: Lampung Timur District has been implementing tuberculosis programme by means of Directly Observed Treatment Shortcourse (DOTS) strategy since 1995, but the result is far below national target so long as programme success indicators are concerned. As a matter of fact, by 2002 Lampung Timur authority has issued a decree of Gerdunas-TB, which encourage an integrated and comprehensive movement involving any party concerned such as government, private institutions, and community members. In order to organize the movement those stakeholders coordinated inter-sectors and inter-programmes cooperation between health office, NGOs, and professional organizations at all levels. Objective: to find out how coordination was carried out and to describe the existing communications, leadership, work rule and procedures, as well standardized skills. Method: the research is descriptive which used qualitative method and a case study design. The were 15 research subjects that comprise of 9 stuructural officials 4 programme managers, 1 privately practice doctor, and 1 manager of private cere facility. All of them were in-depth interviewed, involved in focus group discussions and observation. Result: TB programme coordination by means of cross progamme and cross sector does not exist, in view of private rule only one health care facility was involved, no communications with horizontal institutions were estabilished. These fact were exacerbated by the short of communications on progamme supervision, The defects of recording and reporting system, the relatively rare of meetings, leadership on Health Office of Lampung Timur Distric could not make decision independently, district health office remains heavily dependent on province office, public health centres were not fully involved in programme planing. Morever, definite work rules and procedures are still absent.Actually public health centres, unfortunately do not have books available in any public health centre. Skill and knowledge that staffs have are insufficient . Conclusion : The implementation of tuberculosis programme of Lampung Timur District has not been properly realized. Local government support and coordination improvement are of necessity. Furthermore, it is important to improve communication on activities supervision, regular meetings, fine-tuning recording and reporting system. Other important things to do are involving public health centres to define activities planing, formulation of definite work rule and procedure, improvement of human resources knowledge and skill.

Kata Kunci : Layanan Kesehatan,Dinas Kesehatan,Program TB Paru,Koordinasi Program