Monitoring pelaksanaan kebijakan Bantuan Operasional Kesehatan di daerah terpencil, perbatasan dan kepulauan
Date
2014
Authors
Journal Title
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Publisher
Pusat Kebijakan dan Manajemen Kesehatan, Universitas Gadjah Mada, Yogyakarta, ID
Abstract
Background: Currently, health development efforts are
focused on achieving the MDG targets through several priority
programs such as health insurance expansion; equitable
access to health services in Remote Areas, Borders, and
Islands (DTPK Areas); increase of promotion – preventive
measures, and response to diseases. One of the strategic
steps taken by the government to achieve that goal is by issuing
Health Operational Assistance Policy (BOK). In recent years,
increase in budget for health has occurred at the central level.
Although on one hand the increment has not reached 5 % of
total the state budget, on the other hand the budget absorption
is low, i.e. not reaching 100 %. Most budget absorption takes
place within the last quarter of the fiscal year. This indicates
that there are serious problems in the implementation of the
health system, one of which is inefficiencies. This phenomenon
also occurs in the implementation of BOK policy. The proportion
of BOK funds has increased in recent years, but the amount
absorption does not reach 100 %. This of course would
cumulatively affect the achievement of health system
performance.
Objective: This study aimed to explore the implementation of
BOK policy at the primary health care level, identifying the
factors that contribute to inefficiencies in the implementation
of BOK policy, and assess the effectiveness of BOK policy in
achieving the target of minimum services standard of health
(SPM).
Methods: This study was a descriptive study using a case
study research strategy. The location was in Sabu Raijua
Regency, East Nusa Tenggara Province while the research
period was from June to August 2013.
Results and Discussion: BOK Fund is the only source of
funds to finance the implementation of preventive and
promotion programs at health center level. There is no fund
allocated by local government (APBD) due to its limited amount
and high allocation to finance other sectors. The study identified
several factors contributing to inefficiency in the use of BOK
funds in the DTPK area, including the limited number and quality
of human resources in health centers to run the programs.
The result are dual task that implies a high workload (service/
care and administrative); delay of Technical Guide issuance
and its subsequent socialization by the central government
and district health offices to primary health centers; poor
management capacity of health authorities in the implementation
of the BOK fund due to varied understanding of the allocation
of BOK fund; lack of data or evidence use in developing activity
plans, and delays in disbursement of funds which resulted in
the accumulation of funds to be disbursed in the 4th quarter of
a fiscal year. Other findings also show that there was no significant change in the coverage of services and programs
at the health center level when compared to the national target
of SPM.
Conclusions: The implementation of BOK policy has yet to
show significant impact on the improvement of health system
performance in the sub national level. At the central level, an
in-depth and systematic evaluation is required for the allocation
of BOK funds. At the local level, it requires significant
improvement on the input side and on the process of planning
and oversight mechanisms for community health centers and
health authorities – which is integrated in nature - so that the
BOK’s policy implementation could pose significant impacts on
the improvement of the local health system performance.
Description
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Journal Article (peer-reviewed)
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Text
Keywords
HEALTH FINANCING, HEALTH INSURANCE, GEOGRAPHICAL DISTRIBUTION, BUDGETARY POLICY, GOVERNMENT ROLE, HEALTH ADMINISTRATION, PERFORMANCE STANDARDS, CORRUPTION, RESOURCE ALLOCATION, ACCOUNTABILITY, HEALTH-CARE DELIVERY, LOCAL GOVERNMENT
Citation
Ovidius Dodo, D. (2014). Monitoring pelaksanaan kebijakan Bantuan Operasional Kesehatan di daerah terpencil, perbatasan dan kepulauan. Jurnal Kebijakan Kesehatan Indonesia, 3(2): 82-96.