EFEKTIVITAS KONTRAK TENAGA KESEHATAN SECARA TIDAK LANGSUNG DALAM PENYEDIAAN PELAYANAN KESEHATAN: STUDI KASUS DI INDONESIA

Dwi Handono Sulistyo, dr.,M.Kes., Prof.dr.Laksono Trisnantoro, M.Sc, Ph.D ; dr. Tjahjono Koentjoro, MPH, Dr.PH

2013 | Disertasi | S3 Kedokteran Umum

Latar Belakang Meskipun inisiatif contracting out telah banyak dilakukan di berbagai negara, tetapi kebijakan ini belum menjadi isu utama di Indonesia. Akibatnya upaya untuk mengatasi masalah kesehatan khususnya di daerah terpencil tetap menggunakan pendekatan konvensional yaitu melalui pengangkatan PNS atau PTT. Dalam situasi ini 3 daerah di Indonesia berinisiatif untuk melakukan institution-based contracting out dengan pendekatan tim untuk penyediaan pelayanan kesehatan tertentu sekaligus untuk mengatasi masalah kelangkaan tenaga kesehatan. Tujuan studi ini adalah untuk menilai efektivitas inisiatif contracting out tersebut. Metode Studi kasus dilakukan di Puskesmas Kelay, Berau (Kalimantan Timur), RSUD Gunungsitoli, Nias (Sumatera Utara), dan 6 RSUD Kabupaten di Propinsi Nusa Tenggara Timur. Data dikumpulkan melalui wawancara, observasi, dan berbagai dokumen sekunder. Data dianalisis secara deskriptip dan statistik. Tool analisis yang dipakai adalah dengan model logika level program (program-level logic model). Hasil Inisiatif di Berau gagal dilanjutkan karena ketiadaan provider swasta yang memenuhi kriteria, sedangkan insiatif di Nias dan NTT berhasil dilaksanakan. Baik di Nias dan NTT, inisiatif ini berhasil mengatasi kelangkaan tenaga kesehatan tertentu, serta meningkatkan akses dan kualitas pelayanan. Bahkan di NTT, jumlah kematian ibu dan neonatal serta jumlah IUFD secara absolut berhasil diturunkan. Kesimpulan Peningkatan akses dan kualitas pelayanan berhasil tercapai melalui inisiatif institution-based contracting out dengan pendekatan tim di Berau dan NTT. Selain itu, inisiatif tersebut sekaligus dapat mengatasi kelangkaan tenaga kesehatan tertentu di daerah tersebut.

Background Although contracting out initiatives have been carried out in various countries, this policy has not been a major issue in Indonesia. As a result, efforts to address health problems, especially in remote areas, continue to use the conventional approach which is through the appointment of civil servants or temporary health workers. In this situation the three regions of Indonesia took the initiative to do some institution-based contracting out with team-based approach to provide health services and to overcome the shortage of health problems. The objective of this study was to assess the effectiveness of such contracting out initiatives. Method Case study was conducted in Kelay Health Center, Berau (East Kalimantan), Gunungsitoli Local Hospital, Nias (North Sumatra), and Six district hospitals in the Province of East Nusa Tenggara. Data were collected through interviews, observations and secondary documents. Data was analyzed by way of descriptive and statistical methods. Analysis tool used was programlevel logic model and cross-case synthesis. Result Initiatives in Berau failed to proceed due to the absence of private providers that met the criteria, while the initiative in Nias and NTT was successfully implemented. Both in Nias and in NTT, the initiative managed to overcome a shortage of certain health workers, and to improve access and quality of care. Even in NTT, the number of maternal and neonatal deaths and the number of IUFDs were obviously reduced. Conclusion Access and quality of care was successfully improved through institution-based contracting out with team-based approach initiatives in Berau and NTT. Also, both initiatives was successfully to overcome a shortage of certain human resources for health in both area.

Kata Kunci : Institution-based contracting out; Pendekatan Tim; Tenaga Kesehatan; Berau; Nias; NTT