Analisis kebijakan dalam mengatasi kekurangan bidan desa di kabupaten Natuna

SYAFARI, Imam, dr. Dwi Handono Sulistyo, M.Kes

2009 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Kondisi geografis kepulauan, yang tidak diimbangi dengan pembangunan di bidang kesehatan berdampak terhadap jumlah dan ketersediaan bidan desa di Kabupaten Natuna. Rasio bidan desa dibandingkan jumlah desa belum memenuhi standar Departemen Kesehatan. Masih terdapat sekitar 13 desa dari 51 desa yang belum terdapat tenaga bidan membutuhkan tenaga bidan desa, karena 13 desa tersebut letaknya di pulau-pulau terpisah dari ibu kota kecamatan, sehingga mempengaruhi akses masyarakat untuk mendapatkan pelayanan kesehatan. Salah satu upaya yang dilakukan pemerintah daerah adalah menarik minat tenaga bidan melalui berbagai strategi dan kebijakan di berbagai bidang, diantaranya pembiayaan, pemberian insentif, regulasi, organisasi dan perilaku stakeholder. Tujuan penelitian: Untuk menganalisis kebijakan dalam mengatasi kekurangan bidan desa di Kabupaten Natuna. Metode: Jenis penelitian ini adalah penelitian deskriptif dengan rancangan studi kasus menggunakan metode kualitatif. Studi kasus dalam penelitian ini adalah studi kasus tunggal holistik. Informan penelitian ini adalah Kepala Dinas Kesehatan, Kabid. Pemberdayaan dan Promosi Kesehatan, Kasubag. Umum dan Kepegawaian, Kepala BKD, Kepala Bapeda, DPRD Komisi Dua, kepala puskesmas, dan bidan desa. Rancangan studi kasus bertujuan untuk mengetahui kebijakan dalam mengatasi kekurangan bidan desa di Kabupaten Natuna. Hasil Penelitian: Kebijakan pembiayaan pemerintah daerah dalam mengalokasikan anggaran kesehatan kurang dari 15% dan hanya sekitar 3-4% digunakan untuk peningkatan kapasitas tenaga kesehatan dan belum ada pembiayaan khusus untuk mengatasi kekurangan bidan desa. Pemberian insentif bagi bidan desa masih relatif kecil apabila dibandingkan dengan insentif yang ditetapkan oleh Depkes. Belum ada regulasi khusus dari pemerintah daerah, sehingga kebijakan ini belum optimal. Dalam tingkat organisasi peran hubungan stakeholder sesuai dengan tugas dan kewenangan masing-masing, meskipun keputusan akhir tergantung kepada DPRD dan kepala daerah. Perilaku rendahnya minat bidan bekerja di Natuna disebabkan kondisi geografis Natuna yang berupa kepulauan. Kesimpulan: Kebijakan pemerintah daerah dalam bidang pembiayaan, insentif, organisasi, regulasi, dan perilaku, dalam mengatasi kekurangan bidan desa belum optimal, karena belum ada kebijakan khusus dari pemerintah daerah dalam menangani kekurangan bidan desa, Disamping itu juga karena rendahnya minat bidan bekerja di Natuna.

Background: Geographical condition of Natuna Islands which is not in accordance with health development affects the quantity and availability of midwives distributed in villages in the District of Natuna. In fact, the ratio between the number of villages and the number of midwives in the district has not met the standard proposed by the Ministry of Health. Unfortunately, there are still around 13 villages from 51 villages that have no midwives serving in those villages. The location of 13 villages are separate Island, and it caused lack of provide access to quality health care services. One of efforts done by the local government is to attract midwives’ interest through a variety of strategies and policies in several fields such as financing, incentive, regulation, organization, and stakeholders’ behaviors. Objective: To analyze a policy in overcoming the lack of midwives in the District of Natuna. Method: This was a descriptive study with study-case design by using qualitative method. Study case in this study was a single holistic study case. The informants were head of health office, head of health empowerment and promotion division, head of general affairs and employment sub division, head of BKD, head of Local Development Planning Agency, the Commission Two of Local Legislative, heads of community health centers, and village midwives. The study case design aimed to know policies in overcoming the lack of midwives in the District of Natuna. Results: The local government financing policy allocated the budget or health less than 15%, which was only 3-4% used for improving the health workers’ capacity. The incentive giving for midwives was relatively small compared to the incentive regulated by the Ministry of Health. There was no specific regulation from the local government, so that the policy was considered not optimal. In the rganizational level, the role of stakeholders was in accordance with their duty and provision; however, the final decision was dependent upon Local Legislative and the local government’s leader. Lastly, midwives’ low interest to work in Natuna was caused by its geographical condition. Conclusion: Local government’s policy in the field of financing, incentive, organization, regulation, and behavior in overcoming the lack of village midwives was considered not optimal because of the absence of specific policy from the local government in this matter. In addition, midwives’ low interest to work in Natuna contributed the lack of midwives in this district.

Kata Kunci : Analisis kebijakan,Kekurangan bidan desa, policy analysis, the lack of village midwives