Implementasi Kebijakan Standar Pelayanan Minimal dimensi Kesehatan Dasar dalam rangka menjamin kualitas pelayanan Puskesmas Kota Gede II Yogyakarta Tahun 2004
TARIGAN, Fauzi Ibsa, Dr. Muhadjir Darwin
2005 | Tesis | Magister Administrasi PublikSebagian besar masyarakat Indonesia diyakini telah menerima pelayanan kesehatan dasar melalui Puskesmas. Namun diduga hanya sebagian kecil masyarakat yang paham tentang pelayanan kesehatan dasar yang tersedia di Puskesmas dan bagaimana kualitas pelayanan kesehatan diterima semestinya dan layak bagi masyarakat berdasarkan hak yang disepakati oleh Negara dalam bentuk aturan kebijakan formal pelayanan yang diselenggarakan petugas pelayan publik. Penelitian ini akan menyajikan gambaran kegiatan pelayanan kesehatan dasar di lokasi pelayanan paling kritis yaitu Puskesmas Kota Gede II Yogyakarta tahun 2004. Meskipun belum sempurna tetapi pemerintah telah mengupayakan berbagai jenis dan pilihan pelayanan agar dapat memenuhi kebutuhan masyarakat dari berbagai tingkat ekonomi-sosial masyarakat di wilayah puskesmas. Memenuhi Kebutuhan masyarakat merupakan paradigma baru di lingkungan kesehatan akibat adanya perrgeseran di era Otonomi Daerah berupa desentralisasi kesehatan. Paradigma kesehatan yang kini telah berubah dari pandangan lama pemberi jasa pelayanan yang sangat berjasa kepada penerima layanan berubah menjadi pandangan pelayan jasa yang menganggap pengunjung layanan sebagai pelanggan (Costumer oriented) berdasarkan akuntabilitas publik yang harmonis. Secara posisi teoritik kebijakan, paradigma ini tertampung oleh kebijakan Standar Pelayanan Minimal (SPM) Kesehatan Propinsi Yogyakarta Nomor 123 tahun 2003 Dimensi pelayanan Kesehatan Dasar. Sesuai dengan fokusnya, penelitian ini menggunakan metode deskriptif, untuk menggambarkan keadaan subjek/objek penelitian berdasarkan fakta-fakta yang tampak atau sebagaimana adanya (fact finding). Pengumpulan data dilakukan dengan teknik observasi Cheklist, kuisioner, wawancara, dan teknik dokumentasi Hasil penelitian menunjukkan bahwa Implementasi kebijakan SPM Dimensi Kesehatan Dasar telah mencapai angka absolut standar kinerja pelayanan yang Tinggi sebesar 91,2 % dan kualitas pelayanan hanya mencapai Cukup Memuaskan 43,9%. Implementasi kebijakan dirasakan belum optimal, karena ditemukan ketidak seimbangan antara efektivitas (kuantitas) dan efisiensi (kualitas) pelayanan seperti yang diharapkan oleh kebijakan. Setelah dianalisis ternyata ditemukan empat penyebab yang mempengaruhi kinerja Puskesmas Kota Gede II Yogyakarta dalam melaksanakan tugas pokok dan fungsinya yaitu: a) Situasi pelayanan belum menampung aspirasi petugas yang mengetahui prioritas pelayanan utama dilapangan, b) Kekurang puasan pelanggan terhadap kondisi Puskesmas baik secara kuantitas maupun kualitas pelayanan, c) belum memadainya anggaran untuk mendukung kegiatan pelayanan dan d) Kondisi SDM petugas kesehatan yang masih mendapatkan kebijakan giliran rotasi (pindah kerja) yang relatif cepat diikuti dengan sosialisasi kebijakan SPM yang belum maksimal. Dengan demikian, saran-saran yang direkomendasikan : 1) Sosialisasi kebijakan dan legal drafting SPM untuk kebutuhan tingkat Kota Yogyakarta berdasarkan pertimbangan situasi kritis di lapangan pelayanan seperti di unit Puskesmas Kota Gede II Yogyakarta, 2) menguatkan penegakan hukum untuk mengurangi pelanggaran demi menjamin hak pelanggan, 3) distribusi anggaran memadai untuk pelaksanaan penyelenggaraan berdasarkan beban kinerja yang ditargetkan terhadap unit pelayanan, 4) perlunya optimalisasi kondisi penempatan SDM secepatnya agar mendapatkan kestabilan kerja dan tanggung jawab petugas menuju profesionalisme, dan 5) merekrut tenaga pelayanan bidang medis yang menguasai tugasnya untuk memenuhi kebutuhan rasio petugas, Pustu, Pusling, dengan kondisi masyarakat diwilayah kerjanya.
It is believed that the majority of Indonesian society has been receiving a basic health service provided by Public Health Center. However, it is predicted that only a small number of society that understand the basic health service available in Public Health Center and how should the quality of health service be accepted and proper for society, based on the rights agreed by the state in the form of regulations on service formal policy performed by public service official. This research shall present the description of basic health service activities in the critical service of Public Health Center at Kota Gede II Yogyakarta in 2004. Even though it has not been perfect yet, the government has taken efforts of various kinds and alternatives of service in order to fulfill public necessity from all sorts of social economic strata in society around the Public Health Center area. Fulfilling public necessity has been a new paradigm in health environment as a result of the replacement in Regional Autonomy era in the form of health decentralization. Nowadays, health paradigm has been changed, from the old perspective in which the service provider has rendered much service to the service acceptor, to the perspective in which the service provider considers the acceptor as customer (customer oriented) based on a harmony public accountability On the theoretical position of the policy, this paradigm has been contained in the policy of Health Minimum Service Standard (SPM) of Jogjakarta Province No. 123 the year 2003 on the Dimension of Basic Health Service. In accordance with its focus, this research used the descriptive method to describe the condition of research subject/object based on facts or fact finding. Collecting data was conducted by checklist observation techniques, questionnaire, interview, and documentation technique. Results of this research indicate that the application of SPM policy of Basic Health Dimension has obtained absolute rate of high service performance Standard as amount as 91.2 % and the quality of service has only reached Quite Satisfying of 43.9 %. It is felt that implementation of the policy has not been optimum since there is an imbalance between the effectiveness (quantity) and efficiency (quality) of service expected by the policy. After being analyzed, it has been revealed four reasons that influence the performance of Public Health Center of Kota Gede II Jogjakarta in carrying out the principal duty and function as follows: a) The condition of service has not accommodated the aspiration of officials who understand the main service priority in the field, b) customers have not been satisfied due to the condition of Public Health Center’s service, both quantitatively and qualitatively, c) Insufficient budget to support service activities, and d) the condition of human resources of health personnel that has been affected by rotation shifting policy (the rotation of duty) that relatively too early, followed by lack of socialization of SPM policy. Therefore, there are several suggestions recommended: 1) the socialization of the policy and legal drafting of SPM to the level of necessity in Jogjakarta based on the consideration of critical situation in the serving field such as in Public Health Center Unit in Kota Gede, Jogjakarta, (2) Law enforcement to reduce the violation for the sake of guaranteeing customer’s rights, 3) the distribution of sufficient budget to undertake its implementation based on the responsibility targeted to the service unit. (4). It is necessitated the optimizing of human resource placement condition immediately in order to obtain job stability and officer’s responsibility toward professionalism, and 5) the recruitment of professional medical service personnel in order to fulfill the necessity of personnel ratio, Pustu, Pusling, with the social condition in their working area.
Kata Kunci : Kebijakan Pemerintah,Standar Layanan,Puskesmas
