Pengesahan Undang-Undang Nomor 17 Tahun 2023 tentang Kesehatan memicu transformasi fundamental dalam tata kelola (governance) pembinaan dan pengawasan tenaga kesehatan di Indonesia. Regulasi ini menandai pergeseran paradigma dari model self-regulation yang didominasi oleh otonomi profesi menuju state regulatory governance yang terpusat pada otoritas negara. Penelitian ini bertujuan untuk menganalisis perubahan tata kelola kewenangan regulatif, rekonfigurasi relasi kelembagaan antara Kementerian Kesehatan RI, Konsil Kesehatan Indonesia (KKI), Kolegium, dan Organisasi Profesi (IDI, IBI, dan PPNI), serta implikasinya terhadap kepastian hukum, akuntabilitas negara, dan perlindungan publik. Penelitian kualitatif ini menggunakan pendekatan sosio-legal yang memadukan analisis normatif (law in books) dan empiris (law in action). Pengumpulan data dilakukan melalui triangulasi studi dokumen dan wawancara mendalam dengan informan kunci di tingkat pusat. Hasil penelitian menunjukkan bahwa negara telah mengatribusi kembali kewenangan strategis, mengintegrasikan Kolegium ke dalam struktur KKI, serta menghapus instrumen rekomendasi Organisasi Profesi (OP) dalam pengurusan izin praktik. Reformasi ini terbukti berhasil menyederhanakan birokrasi perizinan dan mempertegas kepastian hukum secara administratif. Namun pada tataran operasional, sentralisasi ini memicu beban kapasitas (overload capacity) di tingkat pusat dan melahirkan "area abu-abu" (governance grey areas) berupa dualisme Kolegium sebagai bentuk resistensi pasif. Direduksinya peran OP di tingkat daerah melumpuhkan sistem peringatan dini (early warning system) melalui pengawasan antarsejawat (micro-surveillance), yang berisiko menciptakan perlindungan yang kurang efektif (pseudo-protection) bagi masyarakat. Penelitian ini menyimpulkan bahwa model state regulatory governance yang terlampau sentralistis kurang adaptif dalam menyangga kompleksitas ekosistem kesehatan. Oleh karena itu, direkomendasikan transisi lanjutan menuju Collaborative Regulated Governance, yakni tata kelola yang menyinergikan ketegasan otoritas hukum negara dalam administrasi publik dengan pendelegasian wewenang pengawasan teknis lapangan kepada Organisasi Profesi guna menjamin keselamatan pasien yang optimal.

The enactment of Law Number 17 of 2023 concerning Health has triggered a fundamental transformation in the governance of the development and supervision of health workers in Indonesia. This regulation marks a paradigm shift from a self-regulation model dominated by professional autonomy towards a state regulatory governance model centralized under state authority. This study aims to analyze the changes in regulatory authority governance, the institutional reconfiguration among the Ministry of Health, the Indonesian Health Council (KKI), Collegiums, and Professional Organizations (IDI, IBI, and PPNI), as well as their implications for legal certainty, state accountability, and public protection. This qualitative research employs a socio-legal approach combining normative (law in books) and empirical (law in action) analyses. Data collection was conducted through document studies and in-depth interviews with key informants at the central level. The results indicate that the state has reclaimed strategic authority, integrated Collegiums into the KKI structure, and eliminated the recommendatory instrument of Professional Organizations (OP) in processing practice licenses. This reform has proven successful in simplifying administrative bureaucracy and affirming formal legal certainty. However, at the operational level, this centralization has triggered overload capacity at the center and created governance grey areas, such as the dualism of Collegiums as a form of passive resistance. The reduction of OP's role at the regional level disables the early warning system via peer monitoring (micro-surveillance), which risks creating pseudo-protection for the public. This study concludes that an overly centralized state regulatory governance model is less adaptive in sustaining the complexity of the health ecosystem. Therefore, a further transition towards Collaborative Regulated Governance is recommended a model that synergizes the assertive authority of state law in public administration with the delegation of field technical supervision to Professional Organizations to ensure optimal patient safety.

Program Makan Bergizi Gratis (MBG) merupakan program prioritas nasional yang dilaksanakan melalui Badan Gizi Nasional (BGN) dan Satuan Pelayanan Pemenuhan Gizi (SPPG). Di sisi lain, pemerintah daerah memiliki kewenangan dalam pembinaan kesehatan masyarakat, higiene sanitasi pangan, keamanan pangan, surveilans, dan pengendalian risiko kesehatan. Penelitian ini bertujuan menganalisis tata kelola pembinaan, pengawasan, dan pengendalian SPPG dalam Program MBG di Provinsi DKI Jakarta serta merumuskan model penguatan tata kelola antara BGN dan pemerintah daerah. Penelitian menggunakan pendekatan kualitatif dengan desain studi kasus melalui wawancara mendalam, diskusi kelompok terarah, telaah regulasi, dan analisis dokumen. Analisis menggunakan kerangka agenda setting, policy transfer, formulasi kebijakan, dan governance. Hasil penelitian menunjukkan bahwa permasalahan utama bukan semata keterbatasan kapasitas, tetapi governance gap yang ditandai oleh ketidakjelasan kewenangan, fragmentasi koordinasi, belum terintegrasinya data, belum adanya SOP lintas sektor, serta belum kuatnya mekanisme akuntabilitas, transparansi, dan mitigasi penyimpangan. Capacity gap berupa keterbatasan SDM, anggaran, waktu, dan variasi wilayah menjadi faktor sekunder yang memperkuat masalah tata kelola. Penelitian ini merekomendasikan model tata kelola binwasdal terpadu berbasis risiko, dengan BGN sebagai regulator, penyusun standar, pengelola dashboard nasional, dan evaluator; sedangkan pemerintah daerah menjalankan pembinaan, inspeksi, surveilans, investigasi kejadian, dan tindak lanjut lapangan melalui perangkat yang sudah tersedia. Penguatan binwasdal tidak harus melalui pembentukan unit baru, melainkan melalui koordinasi formal, SOP lintas sektor, dashboard bersama, audit trail, dan optimalisasi kelembagaan yang lebih efisien.

The Free Nutritious Meals Program (MBG) is a national priority program  implemented through the National Nutrition Agency (BGN) and Nutrition  Fulfillment Service Units (SPPG). At the same time, local government retains  authority over public health guidance, food hygiene and sanitation, food safety,  surveillance, and health risk control. This study aims to analyze the governance of  guidance, supervision, and control of SPPG in the MBG Program in DKI Jakarta  Province and to formulate a governance strengthening model between BGN and  local government. This qualitative case study used in-depth interviews, focus group  discussions, regulatory review, and document analysis. The analysis was guided by  agenda setting, policy transfer, policy formulation, and governance frameworks.  The findings show that the main problem is not merely limited capacity, but a  governance gap characterized by unclear authority, fragmented coordination, nonintegrated data systems, the absence of cross-sector standard operating procedures,  and weak accountability, transparency, and deviation-mitigation mechanisms.  Capacity gaps, including limited human resources, budget, time, and regional  variation, act as secondary factors that intensify governance problems. This study  recommends an integrated, risk-based governance model for guidance, supervision,  and control, positioning BGN as regulator, standard-setter, national dashboard  manager, and evaluator, while local government conducts coaching, inspection,  surveillance, incident investigation, and field follow-up through existing  institutional resources. Strengthening governance does not require establishing a  new unit; instead, it should be pursued through formal coordination, cross-sector  SOPs, shared dashboards, audit trails, and more efficient optimization of existing  institutions.

Perundungan terhadap peserta didik Program Pendidikan Dokter Spesialis (PPDS) merupakan permasalahan sistemik dalam pendidikan kedokteran di Indonesia yang berdampak pada kesehatan mental peserta didik, kualitas pendidikan klinis, keselamatan pasien, dan mutu pelayanan kesehatan. Sebagai respons terhadap berbagai kasus yang terjadi, Kementerian Kesehatan menerbitkan Instruksi Menteri Kesehatan Nomor 589 Tahun 2025 tentang Pencegahan dan Penanganan Perundungan terhadap Peserta Didik pada Rumah Sakit Pendidikan di Lingkungan Kementerian Kesehatan. Penelitian ini bertujuan menganalisis implementasi kebijakan tersebut pada Rumah Sakit Pendidikan di lingkungan Kementerian Kesehatan. Penelitian ini menggunakan pendekatan kualitatif dengan desain studi kasus. Data diperoleh melalui wawancara mendalam terhadap pembuat kebijakan, pimpinan Rumah Sakit Pendidikan, pengelola Program Pendidikan Dokter Spesialis, dan peserta didik PPDS, serta didukung telaah dokumen kebijakan. Analisis dilakukan menggunakan model implementasi kebijakan Van Meter dan Van Horn yang meliputi standar dan sasaran kebijakan, sumber daya, komunikasi dan aktivitas penegakan, karakteristik agen pelaksana, kondisi ekonomi, sosial, dan politik, serta disposisi pelaksana. Hasil penelitian menunjukkan bahwa implementasi Instruksi Menteri Kesehatan Nomor 589 Tahun 2025 telah berjalan melalui pembentukan Tim Pencegahan dan Penanganan Perundungan, penyusunan regulasi internal, serta mekanisme pelaporan dan penanganan kasus, namun implementasinya belum optimal. Standar kebijakan dinilai telah memberikan definisi dan mekanisme yang jelas, tetapi masih menyisakan area abu-abu dalam membedakan pembinaan klinis dengan perundungan. Sasaran kebijakan dipahami tidak hanya untuk melindungi peserta didik, tetapi juga mendukung keselamatan pasien, meskipun target zero bullying dinilai belum realistis. Implementasi juga dipengaruhi oleh keterbatasan sumber daya, belum optimalnya komunikasi dan koordinasi lintas institusi, kompleksitas hubungan antar pelaksana, budaya hierarkis, hidden curriculum, fear of retaliation, serta budaya pendidikan kedokteran. Penelitian ini menyimpulkan bahwa implementasi Instruksi Menteri Kesehatan Nomor 589 Tahun 2025 telah memperkuat sistem pencegahan dan penanganan perundungan di Rumah Sakit Pendidikan, namun belum sepenuhnya efektif dalam mengatasi faktor-faktor struktural yang melatarbelakangi perundungan. Penguatan implementasi memerlukan harmonisasi kebijakan lintas sektor, penguatan kelembagaan dan sistem pelaporan, penyusunan pedoman operasional yang lebih spesifik, peningkatan kapasitas pelaksana, penguatan perlindungan peserta didik, serta pengembangan mekanisme deteksi dini dan integrasi indikator budaya anti-perundungan ke dalam sistem monitoring dan akreditasi Rumah Sakit Pendidikan.

Bullying among residents in Specialist Medical Education Programs (Program Pendidikan Dokter Spesialis/PPDS) has become a systemic issue in medical education in Indonesia, adversely affecting residents' mental health, the quality of clinical education, patient safety, and healthcare service quality. In response to a series of reported cases, the Ministry of Health issued Minister of Health Instruction Number 589 of 2025 concerning the Prevention and Management of Bullying against Medical Trainees in Teaching Hospitals under the Ministry of Health. This study aimed to analyze the implementation of this policy in teaching hospitals under the Ministry of Health. This study employed a qualitative approach with a case study design. Data were collected through in-depth interviews with policymakers, teaching hospital leaders, residency program administrators, and medical residents, complemented by a review of relevant policy documents. Data were analyzed using the Van Meter and Van Horn model for policy implementation, which comprises policy standards and objectives, resources, communication and enforcement activities, characteristics of implementing agencies, economic, social, and political conditions, and implementers' disposition. The findings indicate that the implementation of the Minister of Health Instruction Number 589 of 2025 has progressed through the establishment of Bullying Prevention and Management Teams, the development of institutional regulations, and the implementation of reporting and case management mechanisms. However, implementation has not yet been fully optimal. Although policy standards provide clear definitions and procedures, ambiguities remain in distinguishing legitimate clinical supervision from bullying. Policy objectives are widely understood as extending beyond the protection of residents to include patient safety, although achieving zero bullying is considered unrealistic in the short term. Policy implementation is further constrained by limited resources, suboptimal communication and inter-institutional coordination, complex relationships among implementing actors, hierarchical culture, the hidden curriculum, fear of retaliation, and resistance to cultural change within medical education. This study concludes that the implementation of Ministry of Health instruction No. 589 of 2025 has strengthened the system for preventing and managing bullying in teaching hospitals. However, its implementation has not yet been fully effective in addressing the structural factors underlying bullying. Strengthening policy implementation requires cross-sectoral policy harmonization, institutional strengthening, and improvements to the reporting system; the development of more specific operational guidelines; capacity building for implementers; enhanced protection for medical residents; as well as the development of early detection mechanisms and the integration of anti-bullying culture indicators into the monitoring and accreditation systems of teaching hospitals.

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.