Otonomi khusus Papua dan kapasitas implementasi dinas kesehatan dalam kebijakan puskesmas di Kabupaten Fakfak Papua Barat

TEURUPUN, Fredrik Oktavianus, dr. Mubasysyir Hasanbasri, MA

2009 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Otonomi Khusus Papua belum membawa perubahan signifikan dalam pembangunan kesehatan. Terbukti puskesmas masih menghadapi masalah kinerja pada sistem manajemen meskipun pilihan terbaiknya melalui pemberdayaan dan optimalisasi puskesmas karena kemampuannya menjangkau terisolirnya penduduk Papua. Akan tetapi, semua tergantung pada seberapa besar kemampuan Dinas Kesehatan Fakfak melaksanakan kebijakan Otsus Papua. Tujuan Penelitian: Mengetahui kapasitas implementasi Dinas Kesehatan Fakfak melaksanakan UU No.21/2001 untuk optimalisasi fungsi puskesmas melalui penyediaan input, apakah berjalan sesuai policy guideline yang telah ditentukan. Metode: Penelitian deskriptif dengan rancangan studi kasus menggunakan metode kualitatif. Informan penelitian adalah kepala dinas kesehatan, empat kepala sub dinas kesehatan, satu kepala seksi dan kepala sub bagian pada dinas kesehatan, Bappeda, DPRD dan seluruh Kepala Puskesmas di Kabupaten Fakfak. Alat penelitian yang digunakan adalah pedoman wawancara (Interview Guide). Hasil: Dari 30 jabatan di struktur dinas kesehatan orang asli Papua hanya sebanyak 11 orang. Dalam memaknai Otsus Papua timbul persepsi menyimpang, seperti orientasi jabatan, orientasi fasilitas, dan pengangkatan pejabat yang tidak sesuai bidang kerja. Belum diakomodir sepenuhnya pasal-pasal dalam UU No.21/2001 menjadi program pembangunan. Dinas kesehatan menjadi pengelola terbesar anggaran Otsus, yakni 91,97%. Struktur dan organisasi puskesmas mengikuti PP No.84/2004 yang tidak lagi diberlakukan. Pertambahan Peralatan masih diikuti persoalan hilang dan rusak. Dukungan Bappeda dan DPRD masih terkendala cara pandang pada paradigma sakit. Birokrat dinas kesehatan bekerja dengan kapasitas rendah karena terpusatnya kekuasaan dan kewenangan pada pimpinan puncak Dinas Kesehatan Fakfak. Kesimpulan: Dinas Kesehatan Kabupaten Fakfak tidak memiliki kapasitas implementasi yang memadai untuk melaksanakan keputusan kebijakan Undang-undang Nomor.21/2001 tentang Otsus Papua dalam mengoptimalisasi fungsi dan peran puskesmas. Selain itu, disarankan dalam membahas RAPBD agar menggunakan daftar pada lampiran satu berisi isu-isu pembangunan tentang kesehatan yang disarikan dari UU No.21/2001.

Background: Special autonomy of Papua has not brought significant changes in health development. Health Centers still have problems in the performance of management system although the best option is to empower and optimize health centers because of its ability to reach population in isolated areas of Papua. However this depends on the capacity of Fakfak District Health Office to implement special autonomy policy of Papua. Objective: To identify the capacity of Fakfak Health Office in implementing Act No. 21/2001 to optimize the function of health centers through the provision of input and find out whether the implementation was relevant with the specified policy guideline. Method: This descriptive study used a case study design and qualitative method. Informen of the study consisted of head of the health office, head of 4 sub health offices, one head of section and head of sub department in the health office, local planning and development council, local parliament and heads of all health centers at District of Fakfak. Data were obtained through indepth interview. Result: Out of 30 posts in the organizational structure of the health office 11 were the local people of Papua. There was digressing perception in understanding special autonomy of Papua such as orientation of position, facility and the recruitment of a position that was irrelevant with educational background. Articles in Act No. 21/2001 had not been fully accommodated in the development programs. The health office was the major user of special autonomy in budget (91.97%). The structure and organization of health centers adopted Regulation No. 84/2004 that was no longer in use. Procurement of facilities was still related with the problem of lost or damaged facilities. The support of local planning and development council and local parliament was still inhibited by illness paradigm. Health Office bureaucrats worked at low capacity due to centralized power and authority of the top management at Fakfak Health Office. Conclusion: Fakfak Health Office had inadequate capacity to implement Act No. 21/2001 on Special Autonomy of Papua in optimizing the function and role of health centers. It was suggested to refer to list of enclosures on health development issues abstracted from Act No. 21/2001 in the proposition of local revenue and expenditure budget planning.

Kata Kunci : Otonomi khusus Papua,Kapasitas implementasi,Dinas kesehatan dan puskesmas,special autonomy,health office,health policy,health center