Ditemukan 37998 dokumen yang sesuai dengan query :: Simpan CSV
ABSTRAK Nama : Fikrotul Ulya Program Studi : Ilmu Kesehatan Masyarakat Judul : Efektivitas Biaya Strategi DOTS (Directly Observed Treatment Shortcourse) Program Tuberkulosis Di Rumah Sakit Swasta Kota Depok Tahun 2017-2018. Pembimbing : Prof. dr. Hasbullah Thabrany, MPH, Dr.PH Tesis ini membahas kemampuan mahasiswa Fakultas Psikologi U Angka penemuan kasus menurut Global tuberculosis Report 2016 sebesar 77% dan di kawasan Asia Tenggara sebesar 46,5%. Sedangkan di Indonesia mengalami titik stagnan dalam 5 tahun terakhir di kisaran 32 - 33% kasus. Angka penemuan kasus TBC di Kota Depok tahun 2016 baru tercapai 58% dari target cakupan. Sedangkan di Kota Bekasi, cakupannya sebesar 62%. Sejak tahun 2014 dengan menggunakan strategi PPM (Public Private Mix) di Kota Depok melibatkan fasyankes (Fasilitas Pelayanan Kesehatan) swasta dalam penanganan TBC menggunakan metode DOTS (Directly Observed Treatment Shortcourse). Saat ini, dari 4 RS swasta yang sudah bekerja sama menjangkau 18,7% kasus TBC di seluruh Kota Depok. Beberapa penelitian menunjukkan efektifitas biaya pada penemuan kasus TBC dengan strategi DOTS di fasyankes swasta. Penelitian ini bertujuan untuk mengetahui perbandingan efektifitas biaya penyelenggaraan TBC di Kota Depok tahun 2017-2018. Penelitian ini merupakan penelitian evaluasi ekonomi dengan dengan metode kohort retrospektif. Penelitian ini akan dilakukan pada bulan Oktober – April 2018 dengan melakukan study comparative antara 3 alternatif (Cost Effectiveness Analysis), yaitu Puskesmas yang menggunakan DOTS, RS DOTS dan RS Tanpa DOTS. Peneliti melakukan penghitungan microcosting dari perspektif societal/masyarakat dengan menghitung biaya yang dikeluarkan oleh pasien dan provider pelayanan kesehatan. Output yang dipakai untuk mengukur penanganan TBC adalah angka pengobatan lengkap (Success Rate). Estimasi biaya berdasarkan tarif Rumah Sakit, harga pasar, serta wawancara dari petugas RS. Hasil penelitian dari 36 sampel per kelompok menunjukkan bahwa Success Rate di puskesmas 86,1%, RS dengan DOTS sebesar 77.78 % sedangkan yang non DOTS sebesar 63.89 %. Penambahan biaya provider di puskesmas dan RS DOTS meningkatkan success rate. Biaya societal penatalaksanaan TBC di puskesmas 42% dari biaya di RS swasta. Dari perhitungan ACER (Average Cost Effectiveness Ratio) didapatkan bahwa RS yang melaksanakan strategi DOTS lebih cost effective, dengan nilai ACER di Puskesmas adalah Rp 1.948.284, RS DOTS Rp 3.989.576 dan RS tanpa DOTS sebesar Rp 5.390.323. Untuk menaikkan 1% angka kesuksesan pengobatan membutuhkan biaya Rp 10.084.572 dengan melakukan intervensi program DOTS ke RS Swasta. Analisis bivariat menyatakan bahwa terdapat perbedaan bermakna (p value 0,001) efektivitas biaya perspektif societal pada pengobatan TBC di puskesmas, RS dengan DOTS, dan RS tanpa DOTS . Keywords : Cost effectiveness analysis, DOTS, Fasyankes swasta, Success Rate, ACER, ICER
Tuberculosis is a contagious disease that causes high morbidity and mortality rates and have becoming 10 deadly diseases in the world in 2015. WHO have been estimating the total of 10,4 million new TB cases at the global level in 2017. There are 425.089 new TB cases have been found in Indonesia. The largest number of TB cases has been reported in Jawa Barat, Jawa Timur, and Jawa Tengah which has precentage 43% of all Province. The TB cases in Kabupaten Bogor is about 8.099 cases. In one year, the number of patients with pulmonary TB BTA (+) in the year of 2017 is 3861 people. At the same time, the number of recovery patients with pulmonary TB has decreased from 97% (2015) to 82% (the second quarter in 2018). This Research is intended to ascertain how to implement pulmonary Tuberculosis Disease Countermeasures Program in Puskesmas on Kabupaten Bogor during 2020. The research encompass in many aspect from input component until output component. It’s use qualitative study with data collection through indepth interview, observation and review of documentation. The research data is acquired from 6 puskesmas and Public Health Office in Kabupaten Bogor in range March – July 2020. The informant consist of 6 Heads of Puskesmas, 6 tuberculosis focal persons, 6 laboratory technicians, 6 promkes officer and 1 wasor TB in Public Health Office. The result form this research show that Puskesmas Sukarja and Cibaruyut have met the target at above 70% Suspected Case numbers. Puskesmas Ciawi, Puskesmas Cinagara and Puskesmas Karya Mekar have not reached the target for case founding. The target of successful rate has been fulfilled in Puskesmas Cimandala, Puskesmas Sukaraja and Puskesmas Karyamekar, but not yet in Puskesmas Ciburayut, Puskesmas Ciawi and Puskesmas Cinagara. Puskesmas Cimandala and Puskesmas Sukaraja are quite successful in the TB Programme due to the fulfillment of adequately trained human resources, adequate infrastructure, sufficient funding, integrated of system information, collaboration on sectoral program – cross sectoral and good management in Puskesmas. Puskesmas Karya Mekar and Puskesmas Cinagara have not reached the target due to insufficient of trained human resource, inadequate infrastructures, collaboration of cross sector are not optimally implemented and leak education about health information to the public. The recommendation from this research is that the success achieved through supporting factors can be applied to the other Puskesmas in Kabupaten Bogor.
Health Law Number 36 of 2009 states that every child deserved in basic immunizationaccording the provisions to prevent the occurrence of diseases that can be avoided throughimmunization. The government is also required to provide a complete basic immunizationto every baby and child. In 2017, Depok became outbreak with 12 cases suspectdiphtheria and 1 person died. The city of Depok is an area with high transmission potentialfor communicable diseases due to high population and high mobility. Complete BasicImmunization (IDL) is one of the old immunization policy implemented but has not metthe expected success. Complete Basic Immunization Program is one of the oldimmunization policy programs implemented but has not met the expected success. Theimplementation analysis is intended to see how the implementation of the complete basicimmunization program at the Puskesmas. This research is a qualitative research with in-depth interview technique and related document study which using the policyimplementation theory of Van Meter and Van Horn based on 6 (six) variables. The resultsobtained that the standard and objective have not been fully achieved. Resources areconstrained by incentive indicators that have not been felt optimally in supporting theoptimal implementation of complete basic immunization in Puskesmas. Inter-organizational communication is good. Characteristic of implementing agencies areconstrained by human resource constraints. Disposition of implementors supported, butstill found some implementers who are not orderly. Economic and political conditions aregood, but social condition are not yet supportive. Conclusion found that implementationof complete basic immunization in Depok still has constraints in each variable and needto be done process of fulfillment of less variable. The recommendation of this research isthe success of implementation will be achieved if the improvement of deficiency, bothfrom the side of standard and objective, policy resources, interorganizationalcommunication, characteristic of implementing agencies, disposition of implementors,and social, economy, political condition. Barriers to existing programs can be overcomeby optimizing the Puskesmas's authority as a regional coach.
