Orientasi kebijakan kesehatan daerah di Kabupaten Belitung Timur

YULHAIDIR, Muhamad, Arie Sujito, S.Sos.,M.Si

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebij. dan Manaj. Pe

Latar Belakang: Dinas Kesehatan Kabupaten Belitung Timur Tahun Anggaran 2005 memperbaiki sarana fisik puskesmas, puskesmas pembantu dan polindes sebanyak 27 unit bersumber dari DAK dan APBD. Kenyataan yang terjadi pemerintah daerah maupun DPRD masih lemah dalam menerapkan anggaran kesehatan berdasarkan perencanaan strategis daerah, maka perlu diketahui gambaran komitmen politik daerah untuk menyusun perencanaan dan penganggaran terhadap orientasi kebijakan kesehatan daerah. Tujuan penelitian ini untuk mengetahui keterlibatan stakeholders dalam orientasi kebijakan kesehatan dan mekanisme pengelolaan perencanaan dan penganggaran di Kabupaten Belitung Timur. Metode: Jenis penelitian ini adalah penelitian deskriptif rancangan studi kasus dengan pendekatan kualitatif. Subjek dalam penelitian adalah Stakeholders, Bupati, Asisten II, Bappeda, Kabag Keuangan, Kabag Ekbang, Kabag Tata Pemerintahan, Kabag Hukum, KaDinkes, Ketua DPRD, Wakil Ketua DPRD, Ketua Komisi A, Ketua Komisi B, Ketua Komisi C, Camat Manggar, Camat Kelapa Kampit dan Direktur RSUD. Penelitian ini mengandalkan data sekunder dari dokumen-dokumen laporan yang tersedia di Dinas Kesehatan dan pemerintah daerah. Hasil: Puskesmas lebih menyukai program vertikal dibandingkan program horizontal, peran aktor–aktor dan tarik menarik kepentingan kelompok dalam penyusunan anggaran APBD masih kuat; terbatasnya kualitas SDM perencanaan dalam menyusun anggaran, lemahnya kemampuan beradvokasi dan melobi; ketergantungan terhadap dana-dana pusat besar (78%); persentase anggaran fisik terhadap total anggaran APBD sebesar 81% Kesimpulan: Puskesmas lebih menyukai program vertikal; DPRD dan Pemda mengutamakan program fisik dan pengadaan sarana prasarana peningkatan pelayanan puskesmas, pustu dan polindes daripada program preventif dan promotif; tingkat pemahaman panitia anggaran eksekutif dan legislatif kesehatan terhadap advokasi program rendah; ketergantungan terhadap dana pusat besar;

Background: District Health Office of Belitung Timur in the fiscal year 2005 renovated physical facilities of health center, secondary health centers and village polyclinics as many as 27 units supported by special allocation fund and local revenue and expenditure budget. The fact is that both local government and parliament have low capacity in the implementation of health budget based on local strategic planning. Therefore it is necessary to identify commitment of local politics in the planning and budgeting of local health policy orientation. Objective: The study aimed to identify commitment of stakeholders in health policy orientation and planning and budgeting management mechanism at District of Belitung Timur. Method: This was a descriptive case study which used qualitative approach. Subject of the study were stakeholders Regent, Regent Assistant II, Local Planning Council, Head of Finance Department, Head of Economic Development, Head of Governance, Head of Legal Affairs, Head of Health Office, Head and Vice Head of Local Parliament, Heads of Commission A, B, and C, Head of Manggar and Kelapa Kampit Subdistrict and Director of Local Hospital. The study used secondary data from document of reports available at the health office and local government. Result: Health centers preferred vertical programs to horizontal programs; there were strong Vested interests among the group in the proposal of local revenue and expenditure budget; there was limited capacity of human resources in budget planning; capacity for advocacy and lobbying was relatively weak; there was heavy reliance on central funding (78%); the percentage of physical budget was as much as 81%. Conclusion: Health centers preferred vertical programs; local parliament and government put more priorities on physical programs and procurement of facilities for improving services of health centers and village polyclinics than on preventive and promotive programs; executive and legislative budget committee on health had limited understanding about program advocacy; there was heavy reliance on central budget.

Kata Kunci : Kebijakan Kesehatan,Komitmen Politik