Pemenuhan sembilan jenis tenaga kesehatan strategis di Puskesmas merupakan pilar utama pelayanan kesehatan primer. Kabupaten Sukabumi, sebagai wilayah terluas di Jawa Barat, menghadapi tantangan besar dalam pemenuhan standar ketenagaan minimal akibat kendala geografis dan fiskal daerah. Penelitian ini bertujuan mengevaluasi implementasi dan dampak kebijakan pemenuhan tenaga kesehatan di Kabupaten Sukabumi. Penelitian ini merupakan penelitian kualitatif dengan menggunakan pendekatan evaluasi kebijakan Model George C. Edward III (komunikasi, sumber daya, struktur birokrasi, disposisi) dan Teori William N. Dunn (kecukupan dan pemerataan). Pengumpulan data dilakukan melalui wawancara mendalam dan telaah dokumen di Dinas Kesehatan serta 3 Puskesmas sampel. Selain itu dilakukan analisis spasial sederhana sebagai visualisasi distribusi nakes menggunakan Geographic Information System (GIS). Hasil evaluasi menunjukkan proses komunikasi berjalan baik, namun terdapat inkonsistensi target nasional (sembilan nakes) dengan regulasi terbaru (tiga belas nakes) serta penutupan aplikasi rencana kebutuhan (Renbut). Hambatan kritis bersumber dari alokasi anggaran daerah (financial resources) yang terikat batas belanja pegawai APBD 30% berdasarkan Undang-Undang Hubungan Keuangan antara Pemerintah Pusat dan Pemerintahan Daerah (UU HKPD). Struktur birokrasi belum memiliki SOP mikro daerah untuk redistribusi nakes lokal, sementara aspek disposisi menunjukkan komitmen pelaksana yang tinggi namun terhambat skala prioritas formasi pemerintah daerah. Ditinjau dari aspek dampak, tingkat kecukupan sangat rendah, di mana hanya 12,07% Puskesmas memenuhi standar, dengan kekosongan kritis pada posisi Dokter Gigi dan Tenaga Gizi. Dari aspek pemerataan, terjadi ketimpangan distribusi nakes yang tajam antara wilayah perkotaan dan pelosok akibat hambatan geografis dan ketiadaan regulasi retensi. Penelitian ini disimpulkan implementasi kebijakan belum optimal dalam menjamin kecukupan dan pemerataan nakes. Disarankan kepada pemerintah daerah untuk menerbitkan Peraturan Bupati terkait redistribusi, mengoptimalkan program inovasi regional, dan membuka kuota formasi CASN berbasis pemetaan geolokalitas terpencil.

The provision of nine strategic health workers in Community Health Centers (Puskesmas) is a key pillar of primary health care. Sukabumi Regency, as the largest region in West Java, faces significant challenges in meeting minimum staffing standards due to regional geographic and fiscal constraints. This study aims to evaluate the implementation and impact of health worker provision policies in Sukabumi Regency. This study is a qualitative study using the George C. Edward III Model of policy evaluation (communication, resources, bureaucratic structure, disposition) and William N. Dunn's Theory (sufficiency and equity). Data collection was conducted through in-depth interviews and document reviews at the Health Office and three sample Community Health Centers. A simple spatial analysis was also conducted to visualize the distribution of health workers using a Geographic Information System (GIS). The evaluation results showed that the communication process was running well, but there were inconsistencies between the national target (nine health workers) and the latest regulation (thirteen health workers) and the closure of the needs plan (Renbut) application. Critical obstacles stem from regional budget allocations (financial resources) that are bound by a 30% APBD employee spending limit based on the Law on Financial Relations between the Central Government and Regional Governments (HKPD Law). The bureaucratic structure does not yet have a regional micro SOP for the redistribution of local health workers, while the disposition aspect shows a high commitment of implementers but is hampered by the priority scale of local government formations. In terms of impact, the adequacy level is very low, where only 12.07% of Community Health Centers meet the standards, with critical vacancies in the positions of Dentists and Nutritionists. From the aspect of equity, there is a sharp imbalance in the distribution of health workers between urban and remote areas due to geographical barriers and the absence of retention regulations. This study concludes that policy implementation is not optimal in ensuring the adequacy and equity of health workers. It is recommended that local governments issue a Regent Regulation regarding redistribution, optimize regional innovation programs, and open CASN formation quotas based on remote geolocality mapping.

Kebijakan Pendayagunaan Dokter Spesialis (PGDS) berdasarkan Peraturan Presiden Nomor 31 Tahun 2019 Tentang Pendayagunaan Dokter Spesialis yang bertujuan untuk memenuhi kebutuhan dan pemerataan dokter spesialis di Indonesia perlu dievaluasi. Implementasi Pelaksanaan program PGDS mencakup beberapa tahapan yang meliputi perencanaan, pengadaaan, penempatan, monitoring, evaluasi, pembinaan dan pengawasan dan pendanaan. Namun, masih terdapat beberapa permasalahan dalam pelaksanaannya, salah satunya terkait dengan penempatan tenaga dokter spesialis di daerah tertentu, minimnya motivasi dan minat dokter spesialis untuk menetap di daerah, dokter spesialis lebih memilih untuk menetap di kota-kota besar atau daerah yang lebih berkembang. Penelitian ini menggunakan metode penelitian kualitatif dengan Pendekatan teori Donabedian, Six Building Blocks of a Health System, Edward III, Van Meter Van Horn, Teori Minat Poerwadar dan Perpres 31 tahun 2019. Lokasi penelitian di Sumatera Selatan, Jawa Barat, Nusa Tenggara Timur, Sulawesi Tenggara, Maluku Utara, dan Papua Barat. Penelitian didahului dengan survei kepada 249 Dokter Spesialis Peserta PGDS, kemudian dilakukan wawancara medalam kepada 6 peserta PGDS, Ditjen Tenaga Kesehatan, Sekretaris POGI, Wakil Fakultas Kedokteran Undana, 6 orang Kasie SDK Dinkes Provinsi dan 6 orang Kasie SDK Dinkes Kabupaten, dan telaah dokumen. Temuan penelitian ini mengungkapkan adanya kesenjangan dalam tahap perencanaan, pengadaan, dan penempatan dokter spesialis di Indonesia. Distribusi Dokter spesialis belum merata, peserta PGDS tidak dapat langsung ditempatkan kembali di tempat penugasan awal, dari kebijakan PGDS yang bersifat sukarela dinilai lebih humanis, sarana prasarana dan alat penunjang medis di rumah sakit masih kurang. Kebijakan PGDS dianggap efektif terhadap peningkatan signifikan dalam jumlah kunjungan pasien. Kebijakan PGDS tidak efektif karena terdapat daerah yang masih kekurangan dokter spesialis dan waktu penempatan 1 tahun tidak efektif dan belum ada indikator keberhasilan Program Pendayagunaan Dokter Spesialis. Diharapkan adanya revisi kebijakan Peraturan Presiden nomor 31 Tahun 2019 terkait waktu penempatan dokter spesialis, dengan waktu penugasan minimal diatas 2 tahun dan membuat indikator efektivitas kebijakan PGDS untuk mengidentifikasi keberhasilan dan tantangan. Kata kunci: Efektivitas Kebijakan, pendayagunaan, dokter spesialis

The Policy of Specialist Doctor Utilization (PGDS) based on Presidential Regulation Number 31 of 2019 on Specialist Doctor Utilization, aimed at meeting the needs and equal distribution of specialist doctors in Indonesia, needs to be evaluated. The implementation of the PGDS program involves several stages, including planning, procurement, placement, monitoring, evaluation, development and supervision, and funding. However, there are still several issues in its implementation, such as the placement of specialist doctors in certain regions, lack of motivation and interest among specialist doctors to work in remote areas, as they prefer to settle in big cities or more developed regions. This research adopts a qualitative research method with the Donabedian Theory, Six Building Blocks of a Health System, Edward III, Van Meter Van Horn Theory, Poerwadarminto's Theory of Interest, and Presidential Regulation Number 31 of 2019 as the theoretical framework. The study was conducted in South Sumatra, West Java, East Nusa Tenggara, Southeast Sulawesi, North Maluku, and West Papua. It began with a survey of 249 Specialist Doctor participants in the PGDS program, followed by in-depth interviews with 6 PGDS participants, the Directorate General of Health Human Resources, the Secretary of the Indonesian Society of Obstetrics and Gynecology, the Deputy Dean of the Faculty of Medicine Undana, 6 Head of Subdivision of Human Resources Development from Provincial Health Office, and 6 Head of Subdivision of Human Resources Development from District Health Office, and document review. The findings of this research reveal gaps in the planning, procurement, and placement stages of specialist doctors in Indonesia. The distribution of specialist doctors is still uneven, and PGDS participants are not directly placed back in their initial deployment locations. The voluntary nature of the PGDS policy is considered more humane. However, there are still insufficient infrastructure and medical support facilities in hospitals. The PGDS policy is considered effective in significantly increasing the number of patient visits. However, it is deemed ineffective in areas that still lack specialist doctors, and the one-year placement period is not effective without indicators of the PGDS program's success. It is recommended to revise Presidential Regulation Number 31 of 2019 regarding the placement period of specialist doctors, with a minimum deployment period of over 2 years and to establish indicators for the effectiveness of the PGDS policy to identify its success and challenges. Keywords: Policy effectiveness, utilization, specialist doctors.

Transformasi pelayanan kesehatan primer merupakan Pilar Pertama dalam Transformasi Kesehatan. Pendampingan Integrasi Pelayanan Kesehatan Primer di Puskesmas (ILP) untuk mewujudkan fokus transformasi pelayanan kesehatan primer dilaksanakan pada bulan Juli sampai Oktober 2022. Penelitian bertujuan melakukan analisis kebijakan ILP di lokasi intervensi awal, mewakili karakteristik wilayah Puskesmas. Lokasi penelitian adalah Puskesmas Kebonsari, Kota Surabaya, Puskesmas Jereweh, Kabupaten Sumbawa Barat, Puskesmas Banjarwangi, Kabupaten Garut, dan Puskesmas Niki-Niki, Kabupaten Timor Tengah Selatan. Penelitian menggunakan metode penelitian kualitatif dengan desain studi kasus eksploratif. Dalam penelitian ini digunakan pendekatan realist evaluation dengan empat tahap yaitu pengembangan teori program, pengumpulan data, pengujian teori program serta interpretasi dan perbaikan. Data primer diperoleh dari wawancara mendalam, FGD, telaah dokumen dan observasi. Informan penelitian ini sejumlah 73 orang mulai dari tingkat Pusat dan daerah (Dinas Kesehatan Provinsi, Kabupaten/Kota, Puskesmas dan Desa). Di seluruh lokasi, durasi pelayanan bertambah akibat skrining antara lain disebabkan kurangnya dokter. Di perkotaan, terdapat sistem pendaftaran online dan batasan durasi pelayanan yang berpengaruh. Posyandu Prima dan Posyandu mewujudkan tersedianya akses di tingkat desa melalui pemenuhan sumber daya termasuk bidan, perawat dan kader. Belum semua lokasi melaksanakan Posyandu dusun terintegrasi satu waktu. Pelaksanaan Posyandu integrasi perlu memperhatikan jumlah sasaran dan SDMK yang bertugas. Sosialisasi dengan pendekatan sesuai karakter masyarakat dapat meningkatkan utilisasi layanan dalam ILP. Dashboard untuk mewujudkan Pemantauan Wilayah Setempat masih belum optimal. Koordinasi kasus antar Puskesmas sampai desa dilakukan manual via telepon maupun kartu kontrol. Tingginya komitmen ditunjukkan oleh para aktor tingkat Pusat, Daerah dan Desa dibuktikan secara verbal, regulasi pendukung maupun alokasi anggaran termasuk insentif kader. Daerah siap mereplikasi ILP namun menyampaikan kebutuhan kejelasan regulasi. Penelitian ini menghasilkan teori program pelaksanaan ILP mengacu pada tiga fokus transformasi pelayanan primer serta regulasi, integrasi kebijakan dan dukungan stakeholders. Dalam konteks berbeda, pendekatan ILP akan mengalami mekanisme berbeda dalam menghasilkan outcome peningkatan utilisasi layanan. Diperlukan percepatan kebijakan untuk mendukung pendekatan ILP serta harmonisasi kebijakan pendukung untuk konsistensi dukungan daerah dalam replikasi ILP.

Transformation of primary health services is the first pillar of Health Transformation. Pilot of Integrated Primary Health Care in Puskesmas (ILP) to implement the focus of the transformation of primary health services carried out from July to October 2022. This research aims to conduct a policy analysis of ILP at the initial intervention location, representing the characteristics of the Puskesmas. Research locations were in Puskesmas Kebonsari in Surabaya, Puskesmas Jereweh in Sumbawa Barat, Puskesmas Banjarwangi in Garut, and Puskesmas Niki-Niki in Timor Tengah Selatan. This research used qualitative method with an exploratory case study design. The study was conducted using a realist evaluation approach in four stages: development of program theory; data collection; testing the program theory; interpretation and refinement. Primary data were obtained from in-depth interviews, FGDs, document reviews, and observations. The informants for this study were 73 people from the central and regional levels (Provincial, District/City Health Offices, Puskesmas, and Villages). In all locations, the duration of service increased as a result of screening, in part because of a lack of doctors. In urban areas, there is an online registration system, and service duration limits that matter. Posyandu Prima and Posyandu provide access at the village level through the fulfillment of resources including midwives, nurses, and cadres. Not all locations performed integrated Posyandu at one time. The implementation of integrated Posyandu needs to pay attention to the number of targets and the health staff involved. Socialization with an approach depending on community character can increase service utilization od ILP. The dashboard for accomplish Local Area Monitoring is still not optimal. Coordination of cases between Puskesmas and villages was done manually via telephone or control card. Actors at the Central, Regional, and Village levels showed a high level of commitment as evidenced verbally, supporting regulations and budget allocations including cadre incentives. Several regions are ready to replicate the ILP, but convey the need for regulatory clarification. This research create program theories of ILP referring to the three focuses of primary service transformation as well as regulation, policy integration, and stakeholders support. In different contexts, the ILP approach will experience different mechanisms in producing service utilization improvement outcomes. Policy acceleration is needed to support the ILP approach and harmonize supporting policies for consistent local government support in ILP replication.

Rasio kebutuhan dokter di Indonesia masih dibawah standar WHO. Sesuai dengan amanat Undang-undang, Kementerian Kesehatan berkomitmen memenuhi kebutuhan dokter spesialis di seluruh wilayah Indonesia melalui Kebijakan bantuan biaya Pendidikan dokter spesialis-dokter gigi spesialis. Penelitian ini bertujuan menganalisis implementasi kebijakan yang sudah dilaksanakan yaitu kebijakan bantuan biaya Pendidikan dokter spesialis-dokter gigi spesialis. Penelitian ini merupakan penelitian kualitatif dengan desain penelitian Rapid Assesment Procedure. Penelitian ini menggabungkan model implementasi kebijakan Edward III dan Van Meter Van Horn dengan menggunakan 6 variabel yaitu ukuran dan tujuan kebijakan, komunikasi, sumber daya, disposisi, karakteristik organisasi pelaksana, serta lingkungan politik, sosial dan ekonomi. Pengambilan data dilakukan melalui wawancara mendalam, telaah dokumen dan observasi. Informan Penelitian terdiri dari ketua dan anggota tim kerja penyelenggaraan beasiswa PPDS-PPDGS, dinas Kesehatan provinsi Riau, Nusa Tenggara Timur, Maluku dan Sulawesi Selatan. Penelitian dilakukan mulai bulan Mei- Juni 2023. Hasil Penelitian menunjukkan bahwa implementasi kebijakan sudah berjalan dengan baik. Pada variable ukuran dan tujuan Kebijakan bantuan biaya PDS-DGS telah jelas dan dapat diukur dan tertuang kedalam indikator kinerja kegiatan Direktorat Penyediaan Tenaga Kesehatan yang terdapat dalam Rencana Strategis Kementerian Kesehatan. Komunikasi kebijakan antar organisasi berjalan baik antara Direktorat penyediaan Tenaga Kesehatan, Dinas Kesehatan Provinsi dan stakeholder lainnya melalui sosialisasi dan koordinasi secara rutin. Sumber daya dalam implementasi kebijakan bantuan biaya PDS-DGS baik sumber daya manusia, anggaran, dan kewenangan telah dioptimalkan dengan baik oleh Direktorat Penyediaan Tenaga Kesehatan, namun untuk sumber daya fasilitas yaitu system informasi masih diperlukan pengembangan agar dapat digunakan secara optimal. Karakteristik organisasi pelaksana didukung dengan ketersediaan SOP penyelenggaraan beasiswa PPDS-PPDS yang sudah lengkap dan pembagian wewenang antar organisasi yang sudah jelas. Pada variable disposisi, komitmen pimpinan dan tim kerja dalam implementasi kebijakan bantuan biaya PDS-DGS dengan melaksanakan tugas sesuai peran dan tanggung jawab masing-masing. Variabel lingkungan ekonomi, sosial dan politik menunjukkan besarnya dukungan stakeholder terkait dalam implementasi kebijakan bantuan biaya PDS-DGS 

---

The ratio of the need for doctors in Indonesia is still below the WHO standard. In accordance with the mandate of the Law, the Ministry of Health is committed to meeting the needs of specialist doctors in all regions of Indonesia through a policy of assistance with the cost of education for specialist dentists. This study aims to analyze the implementation of policies that have been implemented, namely the policy of educational assistance for specialist dentists. This research is a qualitative research with a Rapid Assessment Procedure research design. This study combines the policy implementation model of Edward III and Van Meter Van Horn by using 6 variables, namely policy size and objectives, communication, resources, dispositions, characteristics of implementing organizations, as well as the political, social and economic environment. Data collection was carried out through in-depth interviews, document review and observation. The research informants consisted of the heads and members of the PPDS-PPDGS working team members, the Riau, East Nusa Tenggara, Maluku and South Sulawesi provincial health offices. The research was conducted from May to June 2023. The research results show that policy implementation has been going well. The size and objective of the PDS-DGS cost assistance policy are clear and measurable and are contained in the performance indicators for the Directorate of Provision of Health Personnel activities contained in the Strategic Plan of the Ministry of Health. Inter-organizational policy communication runs well between the Directorate for the provision of health workers, the Provincial Health Office and other stakeholders through regular outreach and coordination. Resources in the implementation of the PDS-DGS financial assistance policy, both human resources, budget, and authority, have been well optimized by the Directorate for Provision of Health Personnel, but for facility resources, namely the information system, development is still needed so that it can be used optimally. The characteristics of implementing organizations are supported by the availability of complete PPDS-PPDS scholarship implementation SOPs and a clear division of authority between organizations. In the disposition variable, the commitment of the leadership and work team in implementing the PDS-DGS financial assistance policy by carrying out tasks according to their respective roles and responsibilities. The economic, social and political environment variables show the magnitude of the support of relevant stakeholders in the implementation of the PDS-DGS financial aid policy