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.

Hipertensi merupakan faktor risiko kardiovaskular utama yang menyebabkan kecacatan di seluruh dunia dan di antaranya tidak menyadari kondisi kesehatannya sehingga sering disebut sebagai the silent killer. Angka prevalensi hipertensi di Indonesia cukup tinggi. Berdasarkan Riskesdas (2018), Provinsi Kalimantan Selatan menunjukkan prevalensi tertinggi hipertensi, namun presentase penderita hipertensi yang mendapat pelayanan kesehatan masih rendah. Kota Banjarbaru memiliki persentase terendah yakni 11,3% dari target 100%. Pelayanan kesehatan penderita hipertensi termasuk dalam Standar Pelayanan Minimal (SPM) Bidang Kesehatan yang diatur dalam peraturan perundang-undangan dan kebijakan pemerintah. Tujuan penelitian ini untuk menganalisis implementasi kebijakan SPM bidang kesehatan penderita hipertensi di Kota Banjarbaru. Penelitian kualitatif dengan desain penelitian Rapid Assessment Procedure (RAP) dilakukan pada bulan Mei hingga Juni 2023 di Kota Banjarbaru Provinsi Kalimantan Selatan. Pengambilan data dilakukan melalui wawancara mendalam, observasi dan telaah dokumen. Hasil penelitian menunjukkan bahwa implementasi kebijakan SPM hipertensi belum optimal dapat dilihat dari laporan capaian SPM bidang kesehatan Kota Banjarbaru berada di posisi terendah di antara 12 jenis pelayanan kesehatan dasar. Kesimpulannya, beberapa kendala dalam implementasi SPM hipertensi yakni pencatatan dan pelaporan penderita hipertensi, rendahnya kesadaran masyarakat untuk melakukan pemeriksaan dan berobat di puskesmas sehingga datanya tidak tercatat, tidak ada alokasi anggaran khusus SPM hipertensi di puskesmas, dan tugas rangkap dari petugas kesehatan sehingga tidak maksimal dalam mencapai suatu program. Diperlukan upaya kerjasama lintas sektor untuk keterpaduan pencatatan dan pelaporan data pasien hipertensi, pengajuan anggaran SPM hipertensi, upaya mengajak masyarakat, dan membagi tugas secara adil bagi petugas puskesmas.

Hypertension is a major cardiovascular risk factor that causes disability worldwide and many of them are not aware of their health condition, so it is often referred to as the silent killer. The prevalence rate of hypertension in Indonesia is quite high. Based on Riskesdas (2018), South Kalimantan Province shows the highest prevalence of hypertension, but the percentage of hypertensive patients who receive health services is still low. Banjarbaru City has the lowest percentage, namely 11.3% of the 100% target. Health services for people with hypertension are included in the Minimum Service Standards (SPM) in the Health Sector which are regulated in laws and regulations and government policies. The purpose of this study was to analyze the implementation of the SPM policy in the health sector for hypertension sufferers in Banjarbaru City. Qualitative research with the Rapid Assessment Procedure (RAP) research design was conducted from May to June 2023 in Banjarbaru City, South Kalimantan Province. Data collection was carried out through in-depth interviews, observation and document review. The results of the study showed that the implementation of the SPM policy for hypertension was not optimal, as can be seen from the achievement report on SPM in the health sector in Banjarbaru City which was in the lowest position among the 12 types of basic health services. In conclusion, several obstacles in the implementation of hypertension SPM are recording and reporting of hypertension sufferers, low public awareness to carry out examinations and treatment at the puskesmas so that the data is not recorded, there is no special budget allocation for hypertension SPM at the puskesmas, and multiple assignments from health workers so that they are not optimal in reach a program. Cross-sector collaboration efforts are needed to integrate the recording and reporting of hypertension patient data, hypertension SPM budget submission, efforts to invite the community, and distribute tasks fairly for health center staff.

Penelitian ini bertujuan untuk menganalisis implementasi kebijakan anggaran berbasis kinerja terhadap capaian Standar Pelayanan Minimal (SPM) HIV Dinas Kesehatan Kota Tangerang Selatan Tahun Anggaran 2024. Penelitian ini menggunakan pendekatan kualitatif dengan teknik pengumpulan data melalui wawancara mendalam, studi dokumen, dan observasi. Hasil penelitian menunjukkan bahwa meskipun proses penganggaran telah mengikuti siklus perencanaan, pengesahan, pelaksanaan, dan evaluasi, namun belum sepenuhnya mencerminkan prinsip anggaran berbasis kinerja. Kesenjangan terjadi pada penentuan target kinerja yang masih bersifat administratif dan belum berorientasi pada outcome seperti penurunan kasus HIV atau pencapaian target 95-95-95. Selain itu, belum optimalnya penggunaan sistem informasi seperti Siscobikes serta belum terintegrasinya hasil evaluasi ke dalam proses perencanaan turut memengaruhi efektivitas alokasi anggaran. Berdasarkan perhitungan kebutuhan anggaran dengan acuan Peraturan Menteri Kesehatan Nomor 6 Tahun 2024 tentang Standar Teknis Pemenuhan SPM Kesehatan, estimasi anggaran untuk menjangkau 38.588 orang sasaran adalah sebesar Rp1.610.068.963,00 namun alokasi yang tersedia masih jauh dari kebutuhan tersebut. Oleh karena itu, diperlukan penguatan dalam penyusunan anggaran yang berbasis kinerja, peningkatan kapasitas perencana, serta integrasi antarsektor dalam mendukung perencanaan dan penganggaran yang lebih berorientasi hasil guna mendukung upaya pengendalian HIV dan tercapainya ending AIDS 2030.

 

This study aims to analyze the implementation of performance-based budgeting policy in achieving the Minimum Service Standards (SPM) of HIV infection at the South Tangerang City Health Office in Fiscal Year 2024. A qualitative approach was used, with data collected through in-depth interviews, document review, and observation. The findings indicate that although the budgeting process follows the planning, approval, implementation, and evaluation cycle, it has not fully reflected the principles of performance-based budgeting. A key gap lies in the determination of performance targets, which remain administrative in nature and are not yet outcome-oriented—such as reducing HIV cases or achieving the 95-95-95 global targets. In addition, the use of integrated information systems like Siscobikes remains suboptimal, and evaluation results have not been effectively incorporated into the planning process, thereby affecting the efficiency of budget allocation. Based on budget needs calculations referring to the Minister of Health Regulation No. 6 of 2024 on Technical Standards for Fulfilling Health SPM, the estimated budget required to reach 38,588 target individuals is Rp1.610.068.963,00; however, the current allocation falls significantly short of that need. Therefore, it is necessary to strengthen performance-based budget planning, improve the capacity of planners, and promote cross-sectoral integration to support result-oriented budgeting and planning, in order to enhance HIV control efforts and achieve the 2030 AIDS elimination target.

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.