Desain Organisasi Dalam Pelaksanaan Program Malaria di Kabupaten Nias
AMAZIHONO, Ismed Krisman, dr. Mubasysyir Hasanbasri, MA
2008 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar Belakang Masalah: Kabupaten Nias sebagai salah satu daerah endemis malaria.Angka kesakitan malaria masih tinggi dengan Annual Malaria Incidence (AMI) pada tahun 2004 (85.78‰), 2005 (52,02‰), tahun 2006 (42,12‰). Pada tahun 2005 telah terjadi KLB malaria di Kecamatan Lahewa sejumlah 253 kasus, kematian 2 orang dengan CFR 0,79%. Pendanaan program pemberantasan malaria masih mengharapkan bantuan dari luar. Sumber dana dari APBD Kabupaten Nias untuk mendukung program pemberantasan penyakit malaria sangat kurang kemudian sumber daya manusia yang berhubungan dengan penanganan penyakit masih kurang. Tujuan Penelitian: untuk mengidentifikasi bagaimana pengorganisasian (desain organisasi) dalam pelaksanaan kegiatan program malaria di Kabupaten Nias. Metode Penelitian: penelitian deskriptif dengan rancangan studi kasus. Sumber informasi penelitian ini adalah Kepala Dinas Kesehatan Kabupaten Nias, Kepala Seksi Pemberantasan Penyakit, Wasor Malaria Kabupaten dan 4 Kepala Puskesmas serta masing masing 4 tenaga pengelola program malaria di puskesmas, petugas laboratorium dan petugas poliklinik puskesmas. Data dikumpulkan melalui wawancara mendalam dengan menggunakan panduan wawancara mendalam. Hasil: kegiatan program pemberantasan malaria masih belum memadai dimana puskesmas belum seluruhnya melaksanakan, yang sudah dilakukan yaitu penemuan dan pengobatan malaria serta pencatatan dan pelaporan sedangkan kegiatan yang belum merata dilakukan di puskesmas adalah pemberantasan vektor dan supervisi hal ini terjadi karena keterbatasan dana dari pemerintah. Dinas Kesehatan Kabupaten Nias menggunakan desain penggorganisasian birokrasi mesin. Keterlibatan/kemitraan stakeholder atau sektor lain sangat kurang dalam pemberantasan malaria dan yang mendukung kegiatan malaria adalah funding luar: GF-ATM, Unicef. Kesimpulan: desain organisasi yang digunakan dalam pelaksanaan program malaria adalah birokrasi mesin karena masih efektif dan tidak dapat dihindari oleh karena dana dari pendonor sudah sangat tegas dalam pelaksanaan kegiatan, namun dibutuhkan supervisi yang kuat dan operating core yang tinggi. Penguatan stakeholder lokal dalam pembiayaan malaria harus diperkuat sehingga dana-dana lokal dapat dialokasikan dalam pelaksanaan program malaria.
Background: Nias Disrict is considered as an endemic area of malaria. The annual malaria incidence (AMI) from 2004 to 2006 are 85,78‰, 52,02‰ and 42,12‰, respectively. In the year 2005 there was an outbreak with 253 cases and caused 2 peoples dead, CFR 0,79% The main funding sources for malaria eradication is largely depend on international aid. There is still no local funding that has been allocated to support malaria program activities and it has been identified that there is also lack of human resources. So far, the organization design of Nias district health office which may contribute to the successfulness of every health program particularly for malaria program has never been studied. Objective:. The objective of this study was to identify the organizational design in relation with malaria program activities at Nias district. Method: This study was a descriptive applied case study approach. The data were collected through in depth interview. The subjects were chief of the Nias District Health Office, the chief of the diseases eradication program, wasor malaria and the head of the primary health centers (puskesmas) as well as the malaria program officer, the laboratory staffs and staffs at the primary health centers (puskesmas). Result: It has been observed that the malaria eradication program at the primary health centers (puskesmas) level is not yet adequate. Only partly of activities regarding malaria eradication were conducted such as case finding and treatment as well as recording and reporting of the malaria cases. The activities that are considered important but not yet implemented in every puskesmas are malaria's vector eradication and supervision. It was identified that these activities were not done due to the lack of funding especially a local funding. One of the finding of this study showed that Nias District Health Office has been identified fit with machine bureaucracy design. It also has been observed that there is lack of participation from other local stakeholders in malaria eradication program and the main funding are largely depend on international aid such as from GFATM and Unicef. Conclusion: The organization design implemented at Nias District Health Office for malaria eradication program is machine bureaucracy. This design is considered suitable due to the fact that the funding is still depend on outside donors, however the good and effective supervision have to be implemented as well as an improvement of the operating core. It is also suggested that the partnership with local stakeholders need to be improved and the local funding has to be allocated.
Kata Kunci : Program Pelaksanaan Malaria,Desain Organisasi, implementation of malaria program, organization design.
