Untuk mewujudkan "Indonesia Sehat Tahun 2010", dimana salah satu tujuannya adalah meningkatan mutu pelayanan puskesmas, untuk menjamin tersedianya pelayanan kesehatan yang bermutu melalui jaminan mutu. Jaminan mutu yang mulai dikembangkan pada tahun 1998, pada tiga program dasar yaitu Ante Natal Care (ANC), Infeksi Saluran Pernapasan Akut (ISPA) dan imunisasi, namun hasilnya belum seperti yang diharapkan dilihat dari rendah cakupan pnemonia pada balita. Walaupun pada awal kegiatan telah dilakukan strategi yaitu membangun kesepakatan, membangun kapasitas dengan pelatihan dan pelembagaan yaitu membuat mutu pelayanan menjadi budaya kerja. Berdasarkan itu peneliti berasumsi penggerakannya tidak berjalan. Penelitian ini bertujuan untuk mendapatkan informasi tentang faktor-faktor yang melatarbelakangi penggerakan jaminan mutu di Kota Bandar Lampung. Penelitian ini dilakukan dengan menggunakan metode kualitatif pada unit analisis Kepala Dinas Kesehatan Kota Bandar Lampung, Pimpinan Struktural, Pimpinan Puskesmas dan Petugas jaminan mutu di Puskesmas yang keseluruhan berjumlah 20 orang. Pengumpulan data dilakukan dengan wawancara mendalam, diskusi kelompok terarah, dan telaah dokumen. Dari hasil penelitian terlihat bahwa penggerakan program jaminan mutu ISPA di Dinkes Kota Bandar Lampung tidak berjalan maksimal, walupun Kepala Dinas Kesehatan menetapkan mutu pelayanan menjadi prioritas utama, namun kegiatan masih bersifat jangka panjang yaitu peningkatan kualitas SDK; peningkatan sarana dan prasarana puskesmas dan puskesmas unit swadana. Pimpinan di tingkat bawahnya yaitu Kepala Subdin P2M pun tidak mempunyai kebijakan untuk program jaminan mutu ISPA. Penggerakan yang dilakukan oleh kepala dinas adalah dengan memotivasi namun tidak maksimal hanya bersifat pujian, tidak pernah mengkomunikasikan program jaminan mutu ISPA, tidak menunjuk koordinator untuk program tersebut. Kepala Subdin P2M pun tidak melaksanakan penggerakan karena tidak ada dukungan dari atasan, walaupun sudah mencoba mengalokasikan dana untuk kegiatan jaminan mutu ISPA, namun tidak terealisasi. Begitu juga di puskesmas pemahaman pimpinan puskesmas tentang penggerakan hanya terbatas bagaimana memotivasi staf. Puskesmas Simpur penggerakannya lebih baik jika dibandingkan dengan puskesmas Kota Karang, dimana pimpinan mempunyai kebijakan untuk program jaminan mutu ISPA, komunikasi dan koordinasi berjalan dan ada usaha dari pimpinan untuk mencapai keberhasilan program jaminan mutu ISPA. Hasil penelitian ini menyarankan kepada Kepala Dinas Kesehatan Provinsi untuk menumbuhkan komitmen Kepala Dinas Kesehatan KabupatenlKota dengan melaksanakan Lokakarya tentang jaminan mutu ISPA dengan tujuan membangun kesepakatan dan melakukan pelatihan Training of Trainer (TOT) Jaminan Mutu, serta memberikan stimulan untuk mengatasi hambatan seperti juklak, datar tilik, dan sarana. Bagi Dinas Kesehatan Kota Bandar Lampung disarankan untuk melaksanakan lokakarya mutu di Dinkes Kota Bandar Lampung dalam rangka meningkatkan budaya kerja yang berwawasan mutu. Begitu juga di Puskesmas Kota Karang dan Simpur diharapkan pimpinan menerapkan budaya kerja berwawasan mutu dan tanggap akan perubahan serta meningkatkan kemampuan untuk memotivasi staf, berkomunikasi dan mengkoordinasikan program jaminan mutu ISPA melalui forum lokakarya mini bulanan. Pimpinan puskesmas meningkatkan kemampuan petugas dalam penggunaan obat rasional serta menghadapi hambatan ketenagaan dan dana dengan memanfaatkan tenaga yang ada sebaik mungkin dan mengalokasikan dana dari ristribusi puskesmas untuk jaminan mutu ISPA. Daftar Pustaka ; 50 (1982 - 2002)

Qualitative Analysis Quality Assurance Actuating System of Acute Respiratory Tract Infection at Simpur and Kota Karang Community Health Centre, Bandar Lampung, 2003One of the ways to achieve "Healthy Indonesia 2010" is by increasing quality of health care services at Community Health Care through Quality Assurance. Quality Assurance System has been developed since 1998 in 3 (three) basic programs i.e. Antenatal Care, Acute Respiratory Tract Infection and Immunization. But, from the low coverage of Pneumonia in children below 5 year, it can be said that the result is far beyond what has been expected though some strategies has been carried out from the beginning, such as commitment and capacity building by training and institution alisation also making service quality becoming a custom in working environment. Based on this fact, researcher assumes that Quality Assurance movement did not run well. The purpose of this research was to gather information about the background of Quality Assurance Actuating in Bandar Lampung. Method used in this research was qualitative method with analysis unit were the Head of Bandar Lampung Health Office and his subordinates, head of Community Health Centers and their staffs who are responsible for quality assurance program; it accounted for 20 person all together. Data collection was done by interviewing, discussion and document analysis. The result showed us that Quality Assurance Actuating of Acute Respiratory Tract Infection in Bandar Lampung Municipality did not run well. Though the Head of Bandar Lampung Health Office determined service quality as priority, nevertheless they still conducted long-term activity such as Human Resources Development, superstructure and infrastructure building at Community Health Centers and "Unit swadana" His subordinate, the chief of P2M (Prevention and Eradication Contagious Diseases) Division did also not have policy related to Quality Assurance Program of Acute Respiratory Tract Infection. The only thing the Head of Municipality Health Office did, was giving motivation by praising them. He has never communicated this program and asked someone to become programme coordinator. The Chief of P2M (Prevention and Eradication Contagious Disease) Division did not do any activity related to this. Though she said that she already tried to allocate some funds for this, but because there was no support from her boss, nothing she can do about this. The same thing happened at community health centers. Their understanding about this movement, only limited on how to motivate staff. Compare with Kota Karang, Simpur Community Health Centre had better action on this movement. It can be seen from the policy she made, better communication and coordination, and hard efforts to achieve good result on this movement. It is recommended that the Head of Province Health Office gather commitment from District I Municipality Health Office by holding Acute Respiratory Tract Infection Quality Assurance Program Workshop with the objective is to build commitment and conduct quality assurance training for TOT (training of trainer), besides give stimulant to solve problems. In addition, it is also suggested to carry out on the job training about quality to enhance quality awareness in the work environment. Kota Karang and Simpur Community Health Office should apply work environment based on quality and aware of changes, also improve capability to motivate staff, communicate and coordinate Acute Respiratory Tract Infection Quality Assurance Program through monthly "Mini Workshop ". It is hoped that Community Health Centre' Chief improve staff ability in using drug 1 medicine rationally and solving staff and fund burden by utilizing staff optimally and allocating fund from community health centres fee for Acute Respiratory Tract Infection Quality Assurance Program. Bibliography ; 50 (1980 - 2002)

Latar Belakang: Tuberkulosis (TB) masih menjadi tantangan kesehatan masyarakat global, dengan Indonesia menempati peringkat kedua beban TB tertinggi di dunia. Terapi Pencegahan Tuberkulosis (TPT) adalah strategi kunci untuk menekan progresi infeksi laten menjadi TB aktif, namun cakupan TPT di Kota Bekasi masih sangat rendah, yakni hanya mencapai 14,11%. Tujuan: Penelitian ini bertujuan menganalisis mutu pelaksanaan program TPT di Puskesmas Kota Bekasi berdasarkan kerangka Donabedian (struktur, proses, dan hasil) serta mengidentifikasi adanya kesenjangan persepsi layanan (Gap 1) antara tenaga kesehatan dan pasien. Metode: Penelitian kualitatif dengan desain studi kasus, dilakukan di empat puskesmas terpilih berdasarkan capaian TPT. Data dikumpulkan melalui wawancara mendalam, observasi, dan telaah dokumen, kemudian dianalisis secara tematik. Hasil: Dari aspek struktur, program menghadapi keterbatasan sumber daya manusia (SDM), sarana diagnostik (foto thoraks), dan perbedaan kemandirian anggaran antar-puskesmas. Dalam proses, ditemukan suboptimalitas pada investigasi kontak, edukasi yang terbatas, pemantauan yang tidak berkesinambungan, serta pemanfaatan Sistem Informasi Tuberkulosis (SITB) yang belum maksimal . Analisis Gap 1 menemukan adanya kesesuaian persepsi pada layanan individual, tetapi terdapat potensi kesenjangan pada aspek non-klinis karena pasien mengharapkan edukasi yang lebih luas pada tingkat komunitas untuk mengurangi stigma. Kesimpulan: Mutu program TPT di Puskesmas Kota Bekasi sudah berjalan, tetapi masih menghadapi hambatan struktural, proses, dan potensi kesenjangan persepsi. Diperlukan penguatan kapasitas tenaga kesehatan, pemenuhan logistik dan sarana diagnostik, optimalisasi SITB, serta peningkatan edukasi berbasis komunitas untuk memperbaiki mutu program dan meningkatkan cakupan TPT di masa mendatang. Kata Kunci: Tuberkulosis, Terapi Pencegahan Tuberkulosis, Mutu Layanan, Donabedian, Puskesmas.

Background: Tuberculosis (TB) remains a global public health challenge, with Indonesia ranking second in the world for the highest TB burden. Tuberculosis Preventive Therapy (TPT) is a key strategy to suppress the progression of latent infection to active TB, but TPT coverage in Bekasi City is still very low, reaching only 14.11%. Objective: This study aims to analyze the quality of TPT program implementation in Bekasi City Puskesmas based on the Donabedian framework (structure, process, and outcome) and to identify the presence of a service perception gap (Gap 1) between health workers and patients. Method: A qualitative study with a case study design was conducted in four selected Puskesmas based on their TPT achievement. Data were collected through in-depth interviews, observation, and document review, and then analyzed thematically. Results: Regarding the structure aspect, the program faces limitations in human resources (HR), diagnostic facilities (chest X-ray), and differences in budget independence among Puskesmas. In the process, suboptimal performance was found in contact investigation, limited education, inconsistent monitoring, and underutilization of the Tuberculosis Information System (SITB). The Gap 1 analysis found a correspondence of perception in individual services, but a potential gap exists in non-clinical aspects, as patients expect broader community-level education to reduce stigma. Conclusion: The quality of the TPT program in Bekasi City Puskesmas is running, but still faces structural and process barriers, as well as a potential perception gap. Strengthening health worker capacity, fulfilling logistics and diagnostic facilities, optimizing SITB, and increasing community-based education are needed to improve program quality and increase TPT coverage in the future.  Keywords: Tuberculosis, Tuberculosis Preventive Therapy, Service Quality, Donabedian, Puskesmas.