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"Penyakit TB masih merupakan masalah kesehatan di Indonesia, walaupun upaya pengendalian sudah dilakukan sejak jaman penjajahan. Evaluasi yang dilakukan selama ini masih merupakan evaluasi proses, maka kali ini peneliti menawarkan suatu evaluasi yang menyeluruh yaitu adanya cara pengukuran baru berupa variabel laten ( lingkungan, sarana prasarana, proses, target dan output) dengan tujuan hasil evaluasi ini untuk memberi masukan pada penentu kebijakan pengendalian TB di masa yang akan datang.Penelitian di lakukan dengan memakai gabungan data Rifaskes 2011 dan P2PL 2011.Metode yang dipakai adalah analisa data sekunder, serta penambahan data kualitatif dengan memakai penelitian sistem, serta metode pemodelan variabel dengan menggunakan analisa Struktural Equation Modeling. Hasil yang didapat adalah di perolehnya 4 model hasil evaluasi program pengendalian TB: Model nasional, model wilayah Sumatra, model Jawa Bali, model wilayah lainnya. Secara garis besar ada beberapa perbedaan kontribusi setiap hubungan variabel laten; pada model nasional kontribusi terbesar (1.sarana prasarana ke proses, 2. Target 1 dan CDR 3. proses ke target 2) pada hasil evaluasi Sumatra (1. sarana prasarana ke proses; 2. target 1 dan CDR 2. target 1 dengan CNR 3.lingkungan dan sarana prasarana) hasil evaluasi Jawa Bali (1.target 1 dan CNR 2.target 1 dengan CDR 3. Target 2 dan CR ) dan hasil evaluasi wilayah lainnya (1. target 1 dengan CNR 2. lingkung dan sarana prasarana 3. sarana prasarana ke proses).

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TB disease remains a health problem in Indonesia, despite the control measures already carried out since the colonial era. Evaluations were conducted for this is still an evaluation process, so this time offers researchers a comprehensive evaluation that is the way of new measures in the form of latent variables (environment, infrastructure, processes, targets and output) with the purpose of this evaluation to provide input on policy makers TB control in the future.

The experiment was conducted using a combination of data P2PL Rifaskes 2011 and 2011. The method used is the analysis of secondary data, as well as additional qualitative data using systems research, as well as variable modeling methods using Structural Equation Modeling analysis. The result is a model of evaluation results oBTAin it 4 TB control program: The national model, a model region of Sumatra, Java and Bali models, models of other regions. Broadly speaking, there are some differences in the contribution of each relationship latent variables; the largest contribution to the national model (1. infrastructure to process, targets 1 and CDR 3.target 1 to process) on evaluation of Sumatra (1. infrastructure to process; 2. target 1 and CDR 2. target of 1 to CNR. 3.the environment and infrastructure) on the evaluation of Java Bali (1.target 1 and CNR 2.target 1 with CDR 3. Target 2 and CR) and the results of evaluation of other areas (1.targets 1 with CNR 2. infrastructure with the environment and 3.infrastructure to process)."

"ABSTRACTBehavioral factor is considered to be one of the affecting factors in individual or community health status. The mother's behavior in dental health can affect her child's oral health state since children under five years of age their oral health measure still depends on their parents and they usually rely very much on their mothers.World health Organization stated that the prevalence of gingivitis for eight and fourteen year old children should be one of the oral health indicate! s, according to the last survey conducted by the Ministry of Health in 1991. The prevalence of gingivitis in Indonesia for eight year old children: was approximately 60 % and 90 % for fourteen year old children. This condition was due to the poor oral hygiene and child's dental health behavior.Gingivitis process starts in children under five years old and its prevalence will increase as the children grow. This condition will reach its peak in puberty, then decrease gradually. No one can be gingivitis free (Garrariza, 1984).Preliminary studies show that dental plaque is the main causative factor of gingivitis.Mature dental plaque produces bacterial products that can countinuously produce stimuli in gingival crevice. Gingivitis then occurs with the existence of stimuli, tow tissue endurance and high virulency of Streptococcus strains.Dental plaque is easily formed within four hours after tooth brushing; however, it can be easily removed by conducting a proper tooth brushing technique. Dental plaque can be detected by using a colouring substance called disclosing solution or by using a pocket probe.Health behavior can be determined as covert and overt behavior. Covert behavior concerns the knowledge and attitude toward health, and overt behavior concerns the health practice including tooth brushing.Maternal behavior toward dental health affects the mother and her child's oral health status. In this study a concept is constructed based on previous studies to investigate the relationship among the influencing variables. The next steps are testing the hypothesis and defining the variables into operational forms that are measureable.Questionnaires as a measurement tool to collect data are tested for their validity and reliability. The data to be collected are the behavior of the mothers using the questionnaires. Data about the children's dental plaque and gingivitis status are collected by using a clinical examination.Objectives being observed are four year old children and their mothers in Jakarta. The sampling method is multistage cluster random sampling. The sample size is 374 and it is multiplied by two to avoid design effect. However, the sample size with inclusive criteria is only 680. Univariate, bivariate and multivariate data analysis are used by SPSS computerized statistical program.The result of the study are described as follows. In this study, a phenomenon of the main causative factor of gingivitis of four year old children is their mothers behavioral revealed. The reason is because a four year old child's oral health measure still depends on the mother.Generally the mothers of four year old children in Jakarta have good knowledge, attitude and practice toward oral health; however, only 0.9 % of the children are plaque free. In fact their mother's knowledge, attitude and practice toward dental health are not properly applied to maintain their children's oral health.Two point four percents of the mothers have low education or only have completed primary school education. Eighty four point five percents have completed high school and only 13.1 % have University or college education. The mother's good education, class society which is mostly distributed in the middle and high level could enhance the implementation of a dental health education program because those mother's get information better than those with low level of education.The mother's age ranges from 20 to 41 years old. The variability is limited because of inclusive criteria of the mothers having four year old children. In this study, the mothers who have a high level of formal education are younger than their who have lower education.Ten point one percents of the samples are mothers with very low economic status; 22.4 % are in !ow category; 15.3 % are in fair category; 7.9 % are in high category and 24.3 % are in very high category_ A family economic status describes the family welfare and ability in supporting the family health financially.The family size of 40.4 % samples are mothers with one to two children; 47 8 % with 3 children and 11.8 % with 4-5 children. Respondents with 3 children or less are 88.2 %. This condition indicates the success of family health planning program conducted by the government.The children's gingivitis statusThe prevalence of gingivitis in Jakarta during 1993-1994.The prevalence of gingivitis was 46.2 % and 53.8 % was gingivitis free. This figure was lower than the previous studies conducted in Jakarta (59 %) and in Pengalengan, West Java, (61.6 %), but was higher than the survey conducted in Bandung (32.9 %). The National data about the gingivitis state of four year old children were not available; therefore, we could not make comparisson.The level of severity of gingivitis in Jakarta are as follows : 70.7 % of four year old children in Jakarta are with mild gingivitis; 25.4 % with moderate gingivitis and 3.82 % with severe gingivitis. These figures are lower than the previous studies conducted in 1993 (92 %), and the study in Bandung (96 %) in 1992. However, the figure for moderate level of gingivitis is higher than the previous studies in Jakarta (8 °/c) and in Bandung (4 %). The prevalence of severe gingivitis in the previous studies of Bandung & Pengalengan, West Java, are not found.Dental plaque status of the children.Zero point nine percents of the children are free from dental plaque. Twenty percents of the children have a small amount of plaque, 44.7 % have a fair category of plaque and 34.4 % are considered to have a large amount of dental plaque.Mother's knowledge.Generally, the mother's have good knowledge about dental health. Four point one percents is categorized to have a low level of knowledge, 70.1 % has a good knowledge about dental health. A good knowledge about dental health is an important basis for a good behavior in dental health. Therefore, a recommendation of this study is important to increase the knowledge, attitude and practice or behavior of dental health.Mother's attitude.Generally, the mother's attitude toward dental health is good; 9.3 % is categorized as low; 28.6 % was fair and 52.1 % good. However, mothers with good knowledge about dental health do not always have good attitude toward dental health.Mother's behaviorGenerally, mothers have good behavior. Five point three percents of the mothers are categorized as low; 27.5 % fair and 67.2% good.Dental health service utilization.Generally the mothers have utilized dental health services. 2.5% of the respondents are categorized low in utilizing dental health services, 28.4 % fair and 69.1 % good. The 69.1 % of the respondents who are categorized as good utilize the dental health services mostly for curative treatment. Therefore it requires a good promotive and preventive strategies to support the quality of services.Dental Health EducationDental health education for mothers is generally considered insufficient; 40.3 % is categorized having very little knowledge and 38.4 % is fair. Only 21.3 % is considered to have a good knowledge about dental health.Each independent variable contribution to gingivitis.Mother's behavior contribution to the gingivitis in children is 73.2 %. It shows that the mother's behavior is one of the most influencing factors. One unit increase of mother's behavior will decrease the gingivitis index to 0.86 unit.Dental plaque contribution to gingivitis is 46.7 %. Dental plaque is the main etiological cause of gingivitis. For four year old children, the presence of dental plaque is due to the mother's behavior in dental health. Other causative factor is because the mothers do not utilize the dental health service available in the community in order to maintain their children's oral health, such as gingival health and plaque control. In this study, the condition of children with a small amount of dental plaque category causes gingivitis, however children with fair category of dental plaque existence do not entirely suffer from gingivitis. Other possible factors are the quality of microorganisms in the oral cavity, the activity and quality of saliva and the gingival tissue endurance.The mother's education level has a strong influence contributes 73.2 % to their behavior, and the higher the level of education makes it easier the mother receive information on dental health.The mother's age seems to be a weak influence to their behavior (12.6 %). A group of mothers with high level of education has better dental health behavior than the older group.The family size contributes 25.8 % to the mothers behavior. Fewer children their give them a chance to consentrate on her children's welfare including the their oral health.The mother's behavior contributes 73.4% to the children's dental plaque formation. The influence is considered fair. The formation of dental plaque is caused by mother's less attantion in maintaning their children's oral health, since four year old children still depend on their mothers.The family economic status seems to be a weak influence to the mother's behavior, which is 22.3 %. The family economic status is one of the influencing factors of the mother's behavior towards the family dental health. The higher economic status the family has, the more the family could afford and utilize the dental health services.The influence of the utilization of dental health services to the mother's behavior is 67 %. Dental health facilities in Jakarta are considered reachable because of the good public transportation system.Dental health education recieved by the mothers constributes 27.2 % to their behavior. The dental health education should increase the knowledge, attitude and behavior toward dental health.Contribution of all the independent variables to the mother's behavior.The independent variables of mother's education level, family economic status, family size, dental health service utilization and dental health education the mother received toward mother's behavior contributed are as follows:1. The mother's education level contribution to the mother's behavior is 3.3 %.2. The family economic status contribution to the mother's behavior is 0.7 %3. The family size contribution to the mother's behavior is 0.7 %.4. The dental health education that the mother has received contributes 2.1 % to the mother's behavior. The reasons why dental health education contributes low influence to the mother's behavior are :a. The dental health education material on gingiva health is very little and does not vary very much.b. The method of dental health education used to explain the material did not vary very much.c. Dental health educators do not have enough skills.Contribution of all independent variables to the children's gingival status. The independent variables of mother's behavior, dental plaque, formal education level of the mother, family economic status, dental health service utilization and dental health education to the children's gingivitis status are as follows _1. The mother's behavior contribution to the children's gingivitis status.a. Direct impact of the mother's behavior to the children's gingivitis is as much as 6.8%b. Total impact of the mother's behavior to the children's gingivitis (direct impact plus indirect impact) is as much as 22.8 %.2. Dental plaque contribution to the children's gingivitis status is 8.3%.3. The mother's education level contribution to the children's gingivitis status is 2 %.4. The family economic status contribution to the children's gingivits status is 4.2 %.5. The dental health facilities utilization, contributing to the children's gingivitis status is 4.8 °/o.6. The dental health education the mother recieved contributing to the children's gingivitis status is 2.1 %."

"ABSTRAKFaktor risiko, menurut Last (1983), adalah suatu terminologi yang dihasilkan oleh suatu penelitian epidemiologi yang mempunyai beberapa arti yang antara lain:1) suatu atribut atau pemajanan yang dapat dihubungkan dengan peningkatan probabilitas terjadinya suatu outcome seperti terjadinya suatu penyakit; yang tidak selalu merupakan faktor kausal. Ini sering disebut sebagai risk marker2) suatu atribut atau pemajanan yang meningkatkan probabilitas terjadinya suatu penyakit atau suatu outcome tertentu lainnya. Ini sering disebut penentu (determinant) atau faktor yang menentukan3) suatu penentu yang dapat dimodifikasi dengan intervensi sehingga dapat mengurangi probabilitas teijadinya penyakit atau suatu outcome tertentu. Ini Bering juga disebut sebagai faktor risiko yang dapat dimodifikasi.Dalam penelitian ini yang dimaksud dengan faktor risiko dari pneumonia pada bayi dan anak balita tercakup dalam tiga pengertian di atas.Pneumonia adalah penyakit dengan gejala batuk pilek disertai napas sesak atau napas cepat. Definisi pneumonia di atas adalah definisi kasus yang baru diperkenalkan oleh WHO pada tahun 1989 dan dipakai oleh Departemen Kesehatan Republik Indonesia dalam program penanggulangan Infeksi Saluran Pernapasan Akut (ISPA) secara nasional pada tahun 1991. Sebelumnya, istilah yang dipakai untuk kasus ini adalah ISPA. ISPA biasanya mengandung arti yang lebih luas karena di dalam ISPA juga termasuk saluran pernapasan atas, telinga, hidung, dan tenggorok, sedangkan pada pneumonia yang dimaksud adalah infeksi saluran pernapasan bawah yang akut dan penyakit ini mempunyai tingkat kematian yang tinggi. Sebenarnya, program penanggulangan ISPA yang mempunyai tujuan menurunkan mortalitas pada bayi dan anak balita ditujukan pada pneumonia ini. Oleh karena itu, sejak tahun 1989, WHO menggunakan istilah pneumonia dalam case managementnya sebagai pengganti ISPA dan hal ini pun dilaksanakan oleh Departemen Kesehatan RI sejak tahun 1991. Dalam telaah kepustakaan pun baru pada tahun-tahun terakhir ini lebih banyak muncul istilah pneumonia; sebelumnya cukup banyak dipergunakan istilah ISPA. Biasanya, yang dimaksud pneumonia sekarang adalah istilah yang dulunya dikategorikan sebagai "ISPA sedang" dan "ISPA berat"."

"ABSTRAKBerbagai studi tentang Keselamatan Pasien (KP) menyatakan bahwa untuk memperbaiki upaya-upaya KP di RS perlu diketahui kondisi budaya/iklim KP di RS tersebut pada tahap awal, sebagai salah satu alat untuk memprediksi perhatian RS terhadap KP. Untuk itu, studi ini bertujuan mengembangkan model pengukuran Iklim KP (Patient Safety Climate) di RS Muhammadiyah-?Aisyiyah (RSMA) dengan nilai psikometrik yang baik. Disain studi ini adalah cross sectional, dan analisis model pengukuran dan struktural menggunakan Confirmatory Factor Analysis (CFA) dan Structural Equation Model (SEM) 2nd level, dengan program LISREL 8.50. Kuesioner disebarkan secara proporsional di 5 RSMA di lima provinsi di P. Jawa, selama bulan Januari-Juni 2011, dengan tingkat respon:1198 (79.8%), dan total kuesioner yang bersih (no-missing data): 936 (62.40%). Wawancara mendalam dilakukan dengan Direksi RSMA untuk konfirmasi hasil penelitian. Model pengukuran menghasilkan 3 variabel laten eksogen yang saling berhubungan yaitu Kepemimpinan Transformasional, Kesadaran Individual, dan Kerjasama Tim. Ketiganya berpengaruh langsung secara bermakna terhadap variabel laten endogen Iklim KP (α=0.05). Model pengukuran terbukti valid (t>1,96 SLF>0,70); reliabel (CR > 0.70, dan VE > 0.50), serta close fit (RMSEA= 0.047 < 0.08). Penelitian menunjukkan model pengukuran mempunyai nilai psikometrik yang baik dan dapat menggambarkan kondisi iklim KP RSMA. Kepemimpinan transformasional terbukti berpengaruh langsung terbesar (SLF=0,56) terhadap iklim KP. Penelitian ini merekomendasikan agar model yang diperoleh dapat digunakan di seluruh RSMA atau RS sejenisnya dan dapat menjadi salah satu dasar pengembangan model untuk jenis RS lainnya (pemerintah atau swasta lainnya).

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ABSTRACTThe recent studies of patient safety have witnessed a growing concern over the issues of patient safety culture/climate as the first step to improve patient safety efforts, and also becoming an assessment tool in predicting hospital commitment to patient safety. This study is aimed to develop a measurement model of patient safety climate in RS Muhammadiyah-?Aisyiyah (RSMA) with good psychometric scores. The study is using cross sectional design. The Confirmatory Factor Analysis (CFA) and Structural Equation Models (SEM) 2nd level with LISREL 8.50 version are carried out to analyse the measurement and structural model. The questionnaire distributed proportionally to all employees in the 5 RS Muhammadiyah-?Aisyiyah from five provinces in Java, during the months of January-June, 2011. The response rate is 1198 (79.8%) with the total number of no-missing data is 936 (62.40%). In-depth interviews with Directors of RSMA were also conducted to confirm the results. The measurement model consist of 3 latent exogen variables: Transformational Leadership; Individually Consciousness, Teamwork, which are significantly related each other and have significant impact to Patient Safety Climate. It is valid and reliable (α=0.05: t>1,96, SLF>0,70; CR=0.90>0.70, and VE>0.50), and also a close fit model (RMSEA = 0.047 <0,08). This research shows that the measurement model has good psychometric scores and describes well the patient safety climate condition in each RSMA. It is also proved that Transformational Leadership had a greater positive impact (SLF=0,56) directly to the Patient Safety Climate than other variables. This research recommends the developed model to be implemented in all RSMA hospitals and could be used as a reference to develop similar model for other kind of hospital (government or other private hospital)"

"Implementasi manajemen mutu menjadi sangat penting khususnya bagi organisasi rumah sakit guna meningkatkan proses, memecahkan masalah, mengurangi variasi dan kesalahan dalam pelayanan. Penelitian ini bertujuan mengembangkan model manajemen mutu rumah sakit yang terintegrasi dari TQM dan Six Sigma sebagai ?Model Aliansi Manajemen Mutu (QMA)? meliputi enam konstruk: Praktek Manajemen (MP); Praktek Infrastruktur TQM (IPTQM); Praktek Inti TQM (CPTQM); Praktek Infrastruktur Six Sigma (IPSS); Praktek Inti Six Sigma (CPSS); dan Kinerja Rumah Sakit (KRS).Desain studi adalah cross sectional dengan sampel sebanyak 863 responden yaitu karyawan dari delapan rumah sakit di provinsi Jambi yang diambil secara acak proporsional. Pengumpulan data melalui survei menggunakan kuesioner yang diisi sendiri oleh responden dan dianalisis menggunakan Structural Equation Model (SEM).Penelitian ini membuktikan bahwa model QMA layak dan dapat diterapkan untuk mengukur implementasi manajemen mutu rumah sakit di Provinsi Jambi, dengan model pengukuran fit, dan variabel serta indikator yang valid dan reliabel. Hasil analisis model struktural, diperoleh sebelas kerangka hubungan yang signifikan yaitu MP terhadap IPTQM (t=11,17); IPTQM terhadap CPTQM (t=2,10); IPTQM terhadap KRS (t=4,23); CPTQM terhadap KRS (t=3,36); MP terhadap IPSS (t=20,94); IPSS terhadap CPSS (t=11,77); CPSS terhadap KRS (t=7,27); IPTQM terhadap CPSS (t=15,90); IPSS terhadap IPTQM (t=10,03); IPSS terhadap CPTQM (t=2,41); CPSS terhadap CPTQM (t=3,77), sedangkan kerangka hubungan yang tidak signifikan adalah CPSS terhadap KRS (t=0,29).Studi ini merekomendasikan kepada manajemen rumah sakit untuk dapat menerapkan Model QMA secara optimal guna meningkatkan kinerja, dan memanfaatkannya sebagai instrumen evaluasi (self assessment) pelaksanaan manajemen mutu untuk membangun budaya mutu dan membantu memenuhi standar akreditasi rumah sakit.

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Implementation of quality management is particularly important for hospital organizations to improve processes, solve problems, reduce variations and errors in service. This research aims to develop a hospital quality management model is an integrated of TQM and Six Sigma as "Model Alliance Quality Management (QMA)" includes six constructs: Practice Management (MP); Infrastructure Practice TQM (IPTQM); Core Practice TQM (CPTQM); Infrastructure Practice Six Sigma (IPSS); Core Practice Six Sigma (CPSS); Hospital Performance (KRS).

The study design was cross-sectional with a sample of 863 respondents are employees of eight hospitals in Jambi Province are taken random proportionally. Data collection through survey using questionnaires filled out by the respondents and analyzed using Structural Equation Model (SEM).

This study proves that the model QMA feasible and can be applied to measure hospital quality management implementation in Jambi Province with the measurement model fit, and the variables and indicators are valid and reliable. The results of the structural model analysis, found eleven significant relationship framework that MP to IPTQM (t=11.17); IPTQM to CPTQM (t=2.10); IPTQM to KRS (t=4.23); CPTQM to KRS (t=3.36); MP to the IPSS (t=20.94); IPSS to CPSS (t=11.77); CPSS to KRS (t=7.27); IPTQM to CPSS (t=15.90); IPSS to IPTQM (t=10.03); IPSS to CPTQM (t=2.41); CPSS to CPTQM (t=3.77), whereas no significant relationship framework is CPSS to KRS (t=0.29).

The study recommends to the hospital management to implement the model QMA optimally to improve performance, and using it as an instrument of self-assessment for implementation of quality management to build a quality culture and to meet accreditation standard hospital."

"Tuberkulosis masih merupakan masalah kesehatan masyarakat yang utama di dunia, termasuk di Indonesia. Menemukan dan menyembuhkan pasien merupakan cara terbaik dalam upaya pencegahan penularan TB, dengan menerapkan strategi DOTS. Sejalan dengan kebijakan pembangunan nasional, pelaksanaan strategi pengendalian TB nasional diprioritaskan pada daerah terpencil, perbatasan dan kepulauan terutama yang belum memenuhi target penemuan kasus dan keberhasilan pengobatan. Terdapat lima provinsi dengan TB paru tertinggi dan dua tertinggi yaitu Provinsi Jawa Barat (0.7%), Papua (0.6%). Akses pelayanan kesehatan pasien TB menunjukan ketidakmerataan, dimana hanya ada di wilayah perkotaan dan berada pada ekonomi tinggi. Permasalahan dalam penelitian ini adalah masih ditemukan pasien TB yang tidak mendapatkan akses pelayanan kesehatan. Keterbatasan akses pelayanan kesehatan pasien TB dapat disebabkan oleh kondisi individu yang berbeda-beda serta adanya perbedaan kondisi fisik (geografis). Tujuan penelitian ini adalah mendapatkan model spasial akses pelayanan kesehatan di provinsi Jawa Barat dan Papua.Penelitian ini menggunakan desain potong lintang dan menggunakan data yang berasal dari Riset Kesehatan Dasar 2013. Lokasi penelitian di 2 provinsi yaitu di provinsi Jawa Barat dan provinsi Papua. Analisis penelitian dengan menggunakan regresi logistik untuk melihat pengaruh karakteristik individu terhadap akses pelayanan kesehatan dan analisis spasial statistik menggunakan Geographically Weighted Regression (GWR) untuk melihat spasial akses pelayanan kesehatan. Akses pelayanan kesehatan adalah pasien TB yang melakukan pemeriksaan dahak, foto rontgen dan mendapatkan obat anti TB.Akses pelayanan kesehatan pasien TB di provinsi Papua masih rendah. Karakteristik individu yang mempengaruhi akses pelayanan kesehatan adalah asuransi kesehatan, pekerjaan, menikah, mengetahui ketersediaan fasilitas kesehatan. Model spasial akses pelayanan kesehatan menghasilkan dua jenis variabel pembentuknya, yaitu adanya variabel lokal dan variabel global. Variabel lokal adalah variabel yang mempunyai pengaruh unsur kewilayahannya terhadap akses pelayanan kesehatan, sedangkan variabel global merupakan variabel yang berpengaruh di tingkat provinsi.Masih rendahnya pasien TB yang melakukan akses pelayanan dapat disebabkan oleh sulitnya pasien TB dalam mencapai fasilitas kesehatan, terutama di wilayah dengan perbedaan geografis. Sehingga perlunya ada kebijakan dalam menyiapkan sarana dan prasarana kesehatan pasien TB, yaitu dengan mulai memasukan tenaga kesehatan terlatih di bidang tuberkulosis pada seluruh fasilitas pelayanan kesehatan.

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Tuberculosis is a major public health problem in the world, including in Indonesia. Finding and curing the patients are the best way of preventing transmission of TB by implementing the DOTS strategy. Implementation of the national TB control strategy prioritized in remote, border and island especially TB patients who do not meet the target case detection and treatment success. There are two of provinces with the highest and second highest TB namely west Java province (0.7%) and Papua (0.6%). Accessibility to health services of TB patients showed inequality, which only exist in urban areas and at high economic status. The problem in this research is find the of TB patients who do not get accessibility to health services. Limited accessibility to health services of TB patients could be caused by conditions different individuals as well as differences in physical conditions (geographic). The purpose of this study is to setup a spatial model of accessibility to health services in the province of West Java and Papua.

This study used a cross-sectional design and data derived from the Basic Health Research in 2013 (RISKESDAS). Research sites in the provinces of West Java and Papua. Research analysis applied logistic regression to determine the effect of individual characteristics of accessibility to health services and statistical spatial analysis using the Geographically Weighted Regression (GWR) for a model of spatial accessibility to health services.

Accessibility to health care is the patient of TB sputum examination, x-rays and getting anti-TB. Accessibility to health services of TB patients in the province of Papua remains low. Individual characteristics that affect accessibility to health care are health insurance, employment, marriage, the availability of health facilities. Spatial models of accessibility to health services generate two types of constituent variables, the local variables and global variables. Local variables are variables that influence the spatial element of accessibility to health services, while global variables are variables that influence at the provincial level.

The low TB patients who do accessibility services may be caused by the difficulty in the of TB patients to health facilities, especially in the areas with geographical differences. Thus the need for a policy in preparing health facilities TB patients, i.e. to start entering trained health personnel in the field of tuberculosis in the entire health care facility."

"ABSTRAK1. PendahuluanPada saat ini organisasi pelayanan kesehatan menghadapi dua tekanan secara simultan. Pertama, tekanan atau tuntutan masyarakat untuk mendapatkan pelayanan kesehatan yang bermutu dengan harga terjangkau. Kedua, sulitnya mendapatkan sumber daya yang semakin terbatas untuk memberikan pelayanan kesehatan yang bermutu tersebut. Tekanan-tekanan tersebut membuat pimpinan organisasi terpecah konsentrasinya kepada dua pilihan yang secara bersamaan hares dikerjakan. Pada kondisi seperti ini kualitas pemimpin organisasi kesehatan sangat menentukan terhadap tingkat kinerja organisasi pelayanan kesehatan itu sendiri.Pada negara maju, umumnya dokter tidak pemah secara formal menjadi bagian organisasi kesehatan. Sebagai profesional, mereka memandang organisasi hanya sebagai tempat kerja atau laboratorium untuk menampilkan keahlian mereka. Organisasi kesehatan lebih merupakan media atau sarana untuk praktik profesi ilmu kedokteran mereka. Mayoritas dokter tidak merasa bertanggung jawab terhadap kinerja organisasi kesehatan.Pada negara berkembang fungsi dokter berbeda, terutama yang bekerja di pusat pelayanan kesehatan masyarakat. Mereka mempunyai fungsi ganda yaitu fungsi administratif dan teknis medis. Mereka diharapkan mempunyai kinerja yang baik dalam kedua fungsi tesebut untuk mencapai tujuan organisasi kesehatan dengan sumber daya yang. terbatas. Tentu ini bukan.tugas dan kewajiban yang mudah untuk dicapai sekaligus.2. PermasalahanPenempatan dokter sebagai pegawai tidak tetap (PTT) diharapkan dapat berperan sebagai agen pembangunan kesehatan di wilayah kerja puskesmas. Masalahnya apakah dokter PTT dapat memenuhi harapan pemerintah dan masyarakat untuk memberikan pelayanan kesehatan yang bermutu dapat dipenuhi. Melihat besarnya beban yang dipikul oleh dokter PTT, sedangkan imbalan relatif kecil, dengan status pegawai tidak tetap, banyak yang menyangsikan dan mempertanyakan tentang kinerja mereka di puskesmas.Pentingnya kajian tentang kinerja profesional kesehatan sebagai pemimpin puskesmas sangatlah dirasakan. Adanya kebijakan dokter PTT yang diperkerjakan di puskesmas merupakan kasus yang menarik untuk dikaji lebih dalam. Berdasarkan pertimbangan pentingnya pecan dokter di puskesmas sebagai pemimpin pembangunan kesehatan rakyat maka penelitian dengan tajuk, Determinan Kinerja Dokter Puskesmas Kasus : Dokter Pegawai Tidak Tetap ini dilaksanakan.3. MetodologiRancangan penelitian ini adalah studi penampang. Lokasi penelitian mencakup 12 provinsi, 20 kabupaten, dan 405 kecamatan. Pada kelompok 6 provinsi pertama pengambilan data dilakukan melalui surat. Akan halnya, pada kelompok 6 provinsi kedua pengambilan data dilakukan dengan tatap muka. Pada kedua kelompok provinsi digunakan instrumen kuesioner yang diisi sendiri oleh responden (self administered questionaire).Pengelompokan provinsi dan terbatasnya sumber daya membawa konsekuensi berbedanya Cara pengambilan sampel. Pada provinsi kelompok pertama dilakukan total sampling. Adapun kelompok provinsi kedua dilakukan cluster sampling dan pengambilan data dilakukan secara tatap muka Penelitian ini mendapatkan jumlah sampel 405 responden. Penggunaan teknik cluster sampling maka pada analisis data dilakukan pembobotan (Ma) agar titik estimasi sampel penelitian tidal bias. Pengukuran kinerja pada penelitian ini dilakukan dengan teknik penilaian sendiri (self assesment) dengan menggunakan skala Likert.Analisis data dilakukan secara bertahap. Pertama, dilakukan penggabungan kedua berkas data mailing dan non-mailing. Tahap kedua, dilakukan pemeriksaan konsistensi internal dari vaniabel kinerja. Tahap ketiga, dilakukan analisis faktor untuk setiap variabel komposit. Dengan diketahuinya faktor muatan, dapat dihitung skor setiap variabel komposit dengan formula nilai observasi dikalikan dengan faktor muatan setiap sub-variabel. Berdasarkan formula ini didapatkan skor variabel komposit yang standardized.Tahap keempat, dilakukan analisis univariat dan bivariat. Tahap akhir, dilakukan analisis multivariat. Sabelum dilakukan analisis multivariat dilakukan beberapa pemeriksaan terhadap data penelitian yaitu 1) pemeriksaan konsistensi penilaian kinerja, 2) pemeriksaan multi-kolinieritas dan 3) pemeriksaan interaksi diantara variabel bebas.

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ABSTRACT

1. Introduction

Concern toward better management of human resources has increased since last decade. Presently, almost all leaders realize that personnel are the most important component of organization. The effectiveness of the other resources is relied on how effective the organization manages the human resources.

The performance of health personnel is one of the important aspects that should be analyzed to maintain and to increase the health development. The literature review leads us to understand determinants of the personnel performance, which can be categorized into 3 groups. Those are individual characteristic, psychological, and organizational variables.

The individual characteristic variables consist of competency, skill, and demographic variables. The psychological variables contain of perceptions, attitudes, personality, learning, and motivation. The organizational variables include resources, leadership, reward, structure, and work design.

2. Problem

The policy for contracted doctors was set by the Ministry of Health, with a high expectation that they could take a role as an agent of the health sector development in a sub-district area. With relatively low rewards and' temporary personnel status, many people believe that the expectation seems remain as a dream. Issues are raised whether programs and services offered meet the performance standard. Such issues were never been sufficiently answered Therefore it is imperative to conduct analysis on the performance of contracted doctors who work in health centers.

3. Objectives

The objectives of this study were to explore the doctor performance in health centers and to establish whether this performance was associated to individual characteristics, sociodemography, and organizational factors.

4. Methodology

Mail surveys followed by interviews were conducted to 405 contracted doctors in twelve provinces. Those provinces were divided into two categories based on the geographic area. In West Kalimantan, East Timor, Southeast Sulawesi, Maluku, Bali, and Irian Jaya provinces, all eligible doctors were included in the survey. In the remaining provinces (East Java, Jambi, South Kalimantan, East Nusa Tenggara, South Sulawesi, and Aceh) a cluster sampling was applied."