Sejalan dengan gencarnya isu reformasi, desentralisasi dalam bcntuk otouomidaerah menj adi tuntutan banyak pihak_ Pada akhirnya, pemberlakuan otonomi daerah iniakan membawa dampak hagi bidang kesehatan, yang sa\ah satunya adalah Puskesmas.Maka dari itu, mengantisipasi kemungkinan timbulnya masalah yang lebih besar,Puskesmas diarahkan menj adi unit swadana daerah.Berkaitan dengan hal di atas, penelitian ini bertujuan untuk mengidentiiikasitransformasi Puskesmas Swadana, dengan fokus kajian pada proses perencanaan danpengeiolaan penerimaan fungsionnl pada Puskcsmas Swadana di DK] Jakarta, tepatnyadi Puskesmas Kecamatan Tebet dan Jatinegam. Proses perencanaan dan pengclolaanpcnerimaan fungsional ini akan dibandingkan secara vertikal dan horisontalPenelitian ini merupakan studi kasus dengan menggmmakan pendekatankualitatif Data diperoleh melalui observasi, penelusuran data sekunder, dan wawanoaramendalam dengan 10 [nforman di Puskesmas Kecamatan Tebet dan 6 informan diPuskesmas Kecamatan Jatinegnra. Informan ini adalah orang-orang yang berkepentingandan memahami proses pembahan yang texjadi di kedua Puskesmas ini ketika menjadiPuskesmas Swadana - meskipun dalam SK Gubemur No. 39 Tahun 2000 masih disebutsebagai uji coba unit swadana daerah.Hasil penelitian menunjukkan bahwa secara persamaan antara sebelumdan sesudah swadana adalah proses perencanaan mengikuti tahapan-tahapan mulai dadanalisis situasi sampai pada penyusmman rencana operasional dan sumber peneximaan fungsional berasal dan reuibusi pasien. Sementara ing perbedaan antara sebelum dansesudah menjadi Puskesmas Swadana antara lain bahwa setelah menjadi PuskesmasSwadana terdapat kemandirian dalam proses percncanaan (bottom up planning;integrated planning with budgetting dan target-based budgettfng), pengelolaan 100%penerimaan fimgsional, berlaku reward system, kapasitas sumber daya manusiadiperhatikan, dan perubahan struktur organisasi yang lebih disesuaikan dengankebutuhan, dibandingkan bila sebelum swadana, tidak ada kemandirian dalam prosesperencanaan (top dawn planning, _fragmented planning with budgetting dan budget-based activities), tidak memiliki wewenang dalam xnengelola penerimaan fmmgsional(l00% disetor kc kas daerah), tidak berlaku reward system secara jelas, pautisipasi stafrendah dan struktur organisasi sama dengan struktur organisasi Puskesmas lainnya diIndonesia.Hasil penelitian juga menunjukkan bahwa di antara kedua Puskcsmas swadanajugs mcmiliki persamaan mendasar, antara lain kemandirian proses perencanaan(bottom up planning, integrated planning with budgetting target-tiased activities),pengelolaan pcnerimaau imgsional (sistem sam pintu, transparan, ada kriteriapexnbagian insentif), proses dimulainya keswadanaan (1 April 2000), legal aspect (SK.Gubernur No. 39 Tahun 2000) dan tahapan-tahapan yang dilalui untuk mcnjadiPuskesmas Swadana (tahap intemal dan ekstemal). Sementara itu, perbedaannya terletakpada optimalisasi partisipasi staf pada proses permcanaan (tinggi vs. cukup tinggi,teamwork solid vs. kurang solid, dukungan tinggi vs. rendah, manajemen partisipatif vs.representative), pola dalam pengelolaan pcnedmaan fungsional (sentralistik vs_desentralistik), kedisiplinan staf (ketat vs. longgar, sistem amano vs. absen tertulis),teknik pencatatan keuangan (komputerisasi vs manual), proses keswadanaan (sudah slapsebelumnya vs. bclum begitu siap sebelumnya), perubahan (segmental vs. mcnyeluruh),serta pola pembagian insentif Pada dasamya, Puskesmas Swadana membawa banyakmanfaat, - texutama bagi peningkatan kemandirian dan mutu pelayanan -, sehingga dapatdikembangkan lcbih lanjut pada masa mendatang.
Abstract
Reformation issues has pointed desentralization willing in an districtautonomous type being larger. At last, this district autonomous will bring some impactsto health sector, like public health centre. Therefore, to anticipate the bigger problems,public health centre is directed to self financed organization.This research aims at identifying self financed public health centretransformation, focused at planning and revenue management process. This reaserch islocated at self financed public health centre in Jakarta, those are Tebet and Jatinegara.Both of process will be compared lvertically and horizontally.This research is case study with qualitative approach It used observation,secondary data collection, and indepth interview to collect data. Indepth interview wasconducted with ten informants in Tebet Public Health Centre and six informants inIatinegara Public Health Centre. They were chosen because they had been consideredlmow well about the process explored. For information, these Public Health Centres iscalled self iinanced, although the Decree of District Government is still in the process.The results show that generally, there are the some processes that similar beforeand afier become self financed public health centre, they are 1). Planning processfollows the same steps from situational analysis to plan of action arrangement and 2).The revenue is gotten hom patients retribution. The diierences are that alter become anself financed organization their planning process use bottom up planning approach more,integrated planning with budgetting and target-based budgetting, 100% of their revenue is managed by themselves, reward system, care of human resources capability, and thechange of organizational structure is suitable with the needs. Before become a selffinanced organization, their planning are dominated by top down planning approach,fiagmented planning with hudgetting and budget-based activities, have no authority tomanaged their own revenue (I00% is given to the district government), there are noclear reward system, lower staffs participation and the same of organizational structurewith another public health centre in Indonesia.Beside that, the result also shows that between them have the basic same,comprises of planning process (bottom up planning, integrated planning with budgetting,target based activities, revenue management (a door, more transparant, using incentivecriterions), the beginning of self financed process (1 ? of April 2000), legal aspect(District Govemment No. 39/2000) and the stage (intern and extern stage). ThediEerencess between them are optirnalization of staifs participation in planning process(higher vs. lower, solid teamwork vs. not, higher support vs. lower, participative vs.representative management), revenue management form (sentralized vs. decentralized),staH`s discipline (higher vs. lower, amano va manual), financial recording and reportingsystem (computerized vs. manually), self Hnanced process (ready vs. not ready),gradation of change (segmental- vs comprehensive) and reward system formula.Basically, the change being self financed public health centre is very useiiill., - mainly toincrease their autonomy and quality of care - , so that can be developed more in thefuture. |
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