Analisis Penerimaan Jejaring Layanan Tuberkulosis (Public-Private Mix) di Fasilitas Pelayanan Kesehatan Tingkat Pertama di Kabupaten Gunungkidul

Shabrina Riskya Madjid, dr. Riris Andono Ahmad, MPH., PhD ; dr. Ahmad Watsiq Maula, MPH

2026 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Cakupan penemuan kasus tuberkulosis (TBC) Kabupaten Gunungkidul terendah di Daerah Istimewa Yogyakarta sejak tahun 2020, dengan cakupan kurang dari 50%. Terduga TBC masih didominasi puskesmas, sedangkan keterlibatan fasyankes swasta masih rendah hanya 35% klinik swasta dan 11% praktik mandiri dokter pada tahun 2024. Penelitian ini bertujuan menilai penerimaan program Public-Private Mix (PPM) pada fasyankes tingkat pertama selain puskesmas di Kabupaten Gunungkidul.

Metode: Penelitian observasional dengan pendekatan cross-sectional ini mencakup evaluasi program PPM menggunakan logic model, evaluasi sistem surveilans berdasarkan kerangka WHO, serta analisis penerimaan program PPM menggunakan desain mixed-method sequential explanatory berdasarkan Theoretical Framework of Acceptability. Evaluasi program melibatkan 27 informan, evaluasi surveilans 18 informan, serta analisis penerimaan terhadap 172 fasyankes tingkat pertama selain puskesmas yang dilanjutkan dengan wawancara mendalam pada 12 responden. Data dianalisis menggunakan distribusi frekuensi, confirmatory factor analysis (CFA) regresi Poisson, dan analisis tematik.

Hasil: Implementasi program PPM di fasyankes tingkat pertama selain puskesmas di Kabupaten Gunungkidul belum optimal akibat keterbatasan implementasi regulasi, belum tersedianya standar prosedur operasional jejaring eksternal, serta terbatasnya pelatihan, monitoring, dan evaluasi. Sistem surveilans juga belum mendukung implementasi PPM, karena terdapat variasi penjaringan terduga TBC, lemahnya koordinasi rujukan, serta kendala pencatatan dan pelaporan melalui Sistem Informasi Tuberkulosis (SITB). Sebagian besar fasyankes tingkat pertama memiliki kesiapan sarana prasarana tinggi, dan menunjukkan proporsi 3,02 menerima program PPM. Penerimaan didukung oleh motivasi kemanusiaan, persepsi manfaat program, dan dukungan lintas sektor. Sedangkan beban administratif pencatatan dan pelaporan, lemahnya regulasi dan koordinasi, serta rendahnya keyakinan terhadap kesinambungan rujukan menjadi hambatan utama penerimaan program.

Kesimpulan: Implementasi program PPM dan sistem surveilans TBC di Kabupaten Gunungkidul belum optimal. Penguatan tata kelola, koordinasi jejaring layanan, dan penyederhanaan pelaporan diperlukan untuk meningkatkan keterlibatan fasyankes tingkat pertama selain puskesmas dalam penemuan dan pelaporan kasus TBC.

Kata Kunci: Tuberkulosis, public-private mix, fasilitas kesehatan tingkat pertama, Notifikasi TB  

ABSTRACT

Background: Case detection coverage in Gunungkidul Regency has recorded be the lowest tuberculosis (TB) in the Special Region of Yogyakarta since 2020, with coverage below 50%. TB presumptive identification remains dominated by primary health centers (puskesmas), while private health facility involvement remains low — only 35% of private clinics and 11% of independent medical practices participated in 2024. This study aims to assess the acceptability of the                      Public-Private Mix (PPM) TB program among private health facilities in Gunungkidul Regency.

Methods: This cross-sectional observational study included PPM program evaluation using a logic model, surveillance system evaluation based on the WHO framework, and PPM acceptability assessment using a sequential explanatory mixed-methods design based on the Theoretical Framework of Acceptability. Program and surveillance evaluations involved 27 and 18 informants, respectively. Acceptability was assessed among 172 primary healthcare facilities, followed by in-depth interviews with 12 respondents. Data were analyzed using frequency distributions, confirmatory factor analysis (CFA), Poisson regression, and thematic analysis.

Results: PPM implementation was suboptimal due to limited implementation of regulations, absence of standard operating procedures for external service networks, and inadequate training, monitoring, and evaluation. The surveillance system did not adequately support PPM implementation because of variations in TB presumptive screening, weak referral coordination, and challenges in recording and reporting through the Tuberculosis Information System (SITB). Most facilities had high infrastructure readiness and showed a 3.02-fold higher prevalence of PPM acceptance. Acceptance was supported by humanitarian motivation, perceived program benefits, and cross-sectoral support. Administrative reporting burden, weak regulation and coordination, and low confidence in referral continuity were major barriers.

Conclusion: PPM program implementation and TB surveillance in Gunungkidul Regency remain suboptimal. Strengthening governance, service network coordination, and simplification of SITB are needed to enhance private health facility engagement in TB case finding and notification.

Keywords: Tuberculosis, public-private mix, primary health care, TB notification  

Kata Kunci : Tuberkulosis, public-private mix, fasilitas kesehatan tingkat pertama, Notifikasi TB