Evaluasi metode pengadaan obat untuk pelayanan kesehatan dasar di Propinsi Daerah Istimewa Yogyakarta
WAHYUNI, Siti, Dr.,Dra. Sri Suryawati, Apt
2006 | Tesis | S2 Ilmu Kesehatan Masyarakat (Manajemen dan KebijaLatar Belakang. Pengadaan obat pelayanan kesehatan dasar pada era sentralisasi dilaksanakan secara terpusat dengan dana APBN dan sejak diberlakukannya desentralisasi dilaksanakan di masing-masing kabupaten/kota dengan dana APBD. Di Propinsi DIY pengadaan obat tersebut dilaksanakan dengan metode yang bervariasi yaitu: Kota Yogyakarta menggunakan metoda pelelangan dengan pasca prakualifikasi, Kabupaten Bantul dan Kulonprogo menggunakan metode pelelangan dengan prakualifikasi, Kabupaten Gunungkidul menggunakan metode penunjukan langsung dan pelelangan dengan pasca kualifikasi dan Kabupaten Sleman menggunakan metode Kemitraan. Pengadaan obat yang dilaksanakan oleh sumber daya manusia yang berbeda serta dipengaruhi lingkungan dan kebijakan masing-masing daerah, sehingga dimungkinkan akan mempunyai efektifitas dan efisiensi yang berbeda-beda. Metode Penelitian. Jenis penelitian ini adalah diskriptif, menggunakan rancangan case study, data diambil secara retrospektif. Data kuantitatif didapat dari dokumen pengadaan dan dokumen pemeriksaan/penerimaan obat di Dinas Kesehatan Kabupaten/Kota se Propinsi DIY tahun 2004, data kualitatif diambil dari wawancara mendalam kepada Kepala Dinas Kesehatan, Ketua/Sekretaris Panitia Pengadaan, Ketua/Sekretaris Panitia Pemeriksa/ Penerima Obat di kabupaten/kota se Propinsi DIY. Hasil Penelitian. Rata-rata deviasi harga satuan: dengan metode pelelangan di Kota Yogyakarta 6,18 %, Kabupaten Bantul -2,57 %, Kabupaten Kulonprogo 0,01 % dan Kabupaten Gunungkidul 10,34 %. Sedangkan dengan metode penunjukan langsung yang dilaksanakan oleh Kabupaten Gunungkidul adalah - 0,79 % dan dengan metode kemitraan yang dilaksanakan oleh Kabupaten Sleman adalah -7,20 %. Biaya pengadaan bila dibanding dengan anggaran pengadaan obat yang diadakan di kota Yogyakarta 0,39 %, Kabupaten Bantul 1,4 %, Kabupaten Kulonprogo 0,65 %, Kabupaten Gunungkidul metode lelang 0,83 % dan metode penunjukan 1,70 % sedangkan Kabupaten Sleman 0,42 %. Waktu pengadaan di Kota Yogyakarta 30 hari, Kabupaten Bantul 59 hari, Kabupaten Kulonprogo 60 hari, Kabupaten Gunungkidul 39 hari (pelelangan) dan 50 hari (penunjukan langsung) serta Kabupaten Sleman 9 hari.Tidak ditemukan obat rusak maupun obat kadaluwarsa pada semua metode. Metode pengadaan tidak mempengaruhi jenis obat yang diadakan karena jenis obat disusun oleh tim perencana obat. Berdasar harga, waktu pengadaan dan risiko kerusakan metode kemitraan merupakan metode paling efektif dan efisien. Dilakukan forcasting seandainya pengadaan obat di seluruh kabupaten/kota dilakukan dengan metode kemitraan akan menghemat biaya sebesar Rp 461.491.825,- Kesimpulan. Metode kemitraan berdasarkan faktor harga, waktu pengadaan dan resiko kerusakan adalah paling efisien, namun kelemahannya belum didukung dasar hukum yang kuat. Metode pelelangan dan penunjukan langsung faktor harga, waktu pengadaan dan resiko kerusakan kurang efisien dibanding kemitraan namun didukung dasar hukum yang kuat.
Background: Drugs procurement of basic health service in the centralization era is implemented centrally with APBN funding since the decentralization in each district/municipality is implemented with APBD funding. In Yogyakarta special province (DIY), drugs procurement is implemented with various method: Yogyakarta municipality using auction with post prequalification, Bantul and Kulonprogo districts using auction method with prequalification, Gunungkidul district using direct appointment and auction methods with post qualification and Sleman district using partnership method. Drugs procurement is implemented with different human resources as well as influenced by environment and policy of each area, hence, it will create various effectiveness and efficiency. Method: This was a descriptive research that used case study design and the data was taken retrospectively. Quantitative data was taken from procurement document and drugs acceptance/examination document in the district/municipality health office in DIY in 2004. Qualitative data was taken with in-depth interview to the head of health office, head/secretary of procurement organizing committee, head/secretary of drugs acceptance/examination organizing committee in the district/municipality health office in DIY. Result: The coverage of deviation rate: with auction method in Yogyakarta municipality was 6,18%, Bantul district was -2,57%, Kulonprogo district was 0,01% and Gunungkidul district was 10,34%. In addition, with direct appointment that was implemented by Gunungkidul district was - 0,79% and with partnership method which was implemented by Sleman district was -7,20%. The budget for drugs procurement in Yogyakarta municipality was 0,39%, Bantul district was 1,4%, Kulonprogo district was 0,65%, Gunungkidul district with auction method was 0,83% and appointment method was 1,70% while Sleman district was 0,42%. The time of procurement in Yogyakarta municipality was 30 days, Bantul district was 59 days, Kulonprogo district was 60 days, Gunungkidul district was 39 days (auction) and 50 days (direct appointment) and Sleman district was 9 days. There was no destroyed or expired drugs found in all methods. The supplies method did not influenced the type of drugs provided because the type of drugs is arranged by the drugs planning team. Based on price, the time of procurement and damage risk of partnership method were the most effective and efficient methods. It is estimated that if drugs procurement in the districts/municipality is implemented with partnership method, it will saving cost of Rp 461.491.823,00. Conclusion: Partnership method based on the factors of price, time of procurement and damage risk is the most efficient and yet its’ weakness is not supported with a strong law. Auction method and direct appointment, price, time of procurement and damage risk was less efficient rather partnership, however, it is supported with strong law.
Kata Kunci : Layanan Kesehatan,Pengelolaan Obat,Metode Pengadaan, Drugs procurement, efficiency, effectiveness
