Peningkatan Manajemen dengan Penyediaan Tenaga Spesialis

Penyusunan project ini saya lakukan bersama dengan teman - teman SIMKES UGM 2008 di Wisma UGM tepatnya di lereng gunung Merapi Kaliurang. Sambil menikmati keindahan alam dan pemandangan di sana yang masih begitu sangat asri, saya dan teman-teman Simkes lainnya tetap melaksanakan tugas yang diberikan oleh dr. Mubasyirir Hasan Basri, MA untuk sesegera mungkin menyusun project pengembangan terhadap "Peningkatan Manajemen dengan Penyediaan Tenaga Spesialis untuk Memininimalisir Angka Kematian Ibu di Propinsi Y". Mohon maaf sekali, saya tidak dapat menyebutkan nama propinsi dan kabupaten pada project ini, oleh karena itu saya samarkan dengan menggunakan huruf X dan Y.

Lebih praktisnya, akan saya kupas sedikit mengenai project yang telah saya laksanakan bersama dengan temen-teman lainnya yang satu kelompok dengan saya yaitu :

1. dr. Muhamad Albar Gani (Dinkes Kabupaten Barito Kuala)

2. Anton Ferri, SKM (Dinkes Kabupaten Karimun)

3. Syamsu Ihsan, S.Kom, SKM (Batam)

4. Novita Veranita, SKM (Dinkes Provinsi NTB)

Nah berikut inilah sedikit ulasan mengenai project pengembangannnya :

Executive Summary :

Situasi :

1. Tenaga spesialis tidak bersedia ditempatkan di daerah terpencil karena tidak memiliki fasilitas yang mencukupi.
2. Tekanan dari tabel dan angka-angka
3. Hanya menggunakan tenaga seadanya, seperti dukun desa untuk membantu pasien dalam melahirkan sehingga memiliki high risk terhadap kematian.

Rencana perubahan :

Kegiatan berupa :

• Mampu melayani pasien melahirkan dengan konsekuansi penambahan gaji plus tunjangan.
• Mampu melayani pasien melahirkan dengan konsekuensi penambahan gaji dan tunjangan plus bonus dari daerah
• Tenaga spesialis tertarik dengan tawaran tersebut sehingga mereka bersedia ditempatkan di daerah terpencil untuk menangani pasien yang membutuhkan pertolongan dalam persalinan sehingga akan menekan angka kematian.
• Biaya yang dibutuhkan diambil dari anggaran pemerintah daerah dengan menambah proporsi dalam bidang kesehatan.

Beberapa pertimbangan yang mendukung :

1. Betapa pentingnya tenaga spesialis dalam menagani proses kelahiran, sehingga akan dapat menurunkan dan meminimalisir angka kematian ibu dan dapat meningkatkan derajat kesehatan.
2. Pertolongan dalam proses kelahiran di Kabupaten X harus membutuhkan penanganan yang serius agar mampu melahirkan bayi – bayi yang sehat sehingga akan menjadi generasi - generasi penerus dalam membangun daerah demi mempertahankan negara kesatuan Republik Indonesia.

Tenaga Spesialis Tidak Bersedia Bekerja di Kabupaten X

Cara yang salah	Cara yang lain 1	Cara yang lain 2
Planning	Perekrutan tenaga yang sembarangan/ PNS/ KKN.	Perekrutan sesuai dengan perjanjian sebelumnya/ kontrak kerja.	Perjanjian beasiswa dengan putra daerah.
Organizing	Lemahnya dan tidak berjalannya sistem organisasi di dalamnya karena penempatan posisi tidak sesuai dengan skill	Penempatan sesuai dengan bidangnya / skill.	Peningakatan SDM
Actuating	Gajinya standar PNS Pusat	Gaji daerah + tunjangan dari daerah	Gaji daerah +tunjangan+ bonus
Controling	Lemahnya bahkan tidak adanya pengawasan sama sekali	Pengawas dari pihak pemerintah	Tersedianya pengawas yang jujur dari pihak ketiga / lembaga swasta
Evaluation	Evaluasi ada, dievaluasi oleh pihak yang tidak berkompeten, reportnya direkayasa	Dievaluasi oleh pemerintah yang berkompeten di bidangnya dilakukan setiap semester.	Evaluasi setiap CAWU

Narasi :

1. Betapa pentingnya tenaga spesialis dalam menagani proses kelahiran, sehingga akan dapat menurunkan dan meminimalisir angka kematian ibu serta dapat meningkatkan derajat kesehatan. Kurangnya tenaga tenaga spesialis dan bidan terampil sehingga menyebabkan angka kematian menjadi meningkat karena persalinan hanya dibantu dan ditangani oleh dukun tradisional. Banyak tenaga spesialis yang tidak bersedia untuk ditempatkan didaerah terpencil tersebut karena terbatasnya fasilitas-fasilitas yang ada di daerah tersebut.

2. Jika tenaga spesialis tetap ditugaskan di tempat terpencil maka akan memunculkan permasalahan baru, karena diperkotaan akan menjadi kekurangan tenaga spesialis. Seperti diketahui, bahwa penduduk di perkotaan lebih banyak dari pada penduduk di desa atau daerah terpencil, sehingga hal tersebut dianggap kurang efektif. Jika kita melihat dari perbandingan jumlah penduduk yang berdomisili, maka penduduk diperkotaan itulah yang lebih membutuhkan tenaga spesialis untuk menangani proses melahirkan.

3. Untuk mengatasi permasalahan kurang tenaga kesehatan, harus ada suatu tindak lanjut dengan menyediakan tenaga spesialis yang bermutu dan berkualitas, seperti menyewa tenaga spesialis dari pihak swasta sehingga akan mampu menangani seluruh pasien yang ada di daerah terpencil. Pada kenyataannya tenaga spesialis yang ada masih kurang dan tidak ingin ditempatkan di daerah terpencil.

Untuk tahap selanjutnya, maka dilakukan suatu perancangan project dengan menggunakan bantuan software Micrasoft Project Office. Untuk lebih jelasnya bisa diperhatikan pada gambar di bawah ini :

Update : Mohon maaf, untuk gambar perancangan project dengan menggunakan Microsoft Project Office telah saya hapus karena space hosting saya yang sangat terbatas.

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Implementation of regional health information system in terms of aspects of data management and information technology

Since the establishment of healthy Indonesia 2010 as a vision of health, Indonesia has established the policy reforms in health development, namely health paradigm is the core principle emphasizes the importance of health as human rights, health as an investment and the health of the nation as a central point of national development. To support the success of development policy reform has been drawn up the National Health System which is capable of answering new and respond to the challenges of health development for present and future. Organization of the health system are stated in various health programs through a cycle of planning, implementation, monitoring and control and accountability in a systematic, tiered and sustainable. In connection with this health system, the region needs to establish health systems as a sub system of local government system which operate according to the aspirations, potential, and local requirements with respect to health development priorities of each (Depkes, 2004).

Head of Data Center for Information, Communication and Telecommunication Department of the Interior Mr. Fauzie Rafei in his paper that's titled "The Role of Institutional Communication and Information in the Region" in 2004 wrote that the current state of Indonesia recognizes that reform in the life of the nation today is intended to reach state the realization of a democratic system of government a better and responsible (good governance) in which the targets will be achieved through good governance is to get a strong bureaucracy, professional, efficient, productive and able to provide a quality service to the community. Realizing how important the sense to realize good governance, then the entire state apparatus needed to improve performance. One effort to realize good governance and answer the demands of society, need to develop management information systems and the acceleration of work processes within the government (central and local) by modernizing the administration through electronic data management, automation in government offices, the modernization of administrative services to the community, as realization of e-government that electronic-based government (information technology).

In order to control health care system that aims to monitor and evaluate the success of the implementation in stages and sustainable use measures or indicators of health development, national or regional level. In this connection it is necessary to develop national health information system and an integrated regional health care that can generate data / information is accurate, timely and complete, so as to be a major part of decision-making. Although the needs of data / information increasingly accurate, but it turns out that the information system is currently still not able to produce data accurate, complete and timely. Various problems were encountered in the implementation of health information systems, among others is the absence of the same perception among health providers, especially providers of health information systems. Organization of health information system itself still has not done efficiently. "Redundant" of data, duplication of activities, inefficient use of resources is still happening. This is because of the "overlapping" in the collection activities, data processing, each work unit both at the central and regional levels. Data management activities / information are not yet integrated and well coordinated (Depkes, 2004).

Implementation of health sector decentralization has been underway since early 2001 where after walking for 8 years was necessary to review the implementation of health information systems that are in the level of districts that experienced various obstacles and run less smoothly so it will be input as a source of information in decision-making and advocacy. National Health Information System was developed by combining the Regional Health Information System and other system related information, including data from public health facilities, health efforts, health financing, health human resources, medicines and medical equipment. Has identified various weaknesses in the implementation of Health Information Systems such as the data is less precise and accurate, less according to the needs, delivery of health centers and hospitals are not on time, the data collected is still so much that gives weight to the officers. In addition to the quantity and quality that's executive power is still weak, as well as data processing and utilization of various administrative levels is not ideal. Feedback were identified too rarely done, and inadequate computer equipment and funds to manage health information system very limited and not able to accommodate data from other related sectors.

Regional Health Information System (or better known as SIKDA) is a system that was implemented in the province and in an area where this SIKDA under the auspices of the National Health Information System (NHIS) or better known as SIKNAS. Regional Health Information System is usually held by the Provincial Health Office to implement the system can handle all information related to existing health coverage under the District Health Office City Health Center even to the district level though. Provincial Health Office is a very important role on the operation SIKDA for this institution, which will control and control and take a decision regarding health information systems available in the area.

In the implementation of regional health information system that lasted for this is to not release the use of data management from any existing institution and the central area. Data management related to all areas of health focused on provincial health office (Provincial of Health Office) and then will proceed to the centers in this case is the Data and Information Center (Pusdatin). Poor data management will lead to difficulties in uniting the Pusdatin all the data available in each provincial health office in the Republic of Indonesia.

Republic of Indonesia Department of Health (Depkes RI) is below a Department of Data and Information Center (Pusdatin) based in Jakarta rather overwhelmed in combining various kinds of data received from each provincial health office because they have different formats - different, not to mention every Department of Health that there is no data to send it in a timely Pusdatin so it will be very difficult for the parties Pusdatin in processing the data, analyze it and prepared a report which will be accountable to the Depkes. This is a problem that desperately need attention because it will affect how quickly the decision of the Depkes and would hinder the plans and future programs for the existing Public Health Service in each province.

The Head of Pusdatin Department of Health Republic of Indonesia Mr. Bambang Hartono in his presentation at the workshop that the theme of "One Day Seminar on Implementation of Computerized Sosioteknis Health Center and Public Health" held on February 14, 2009 and then held at Faculty of Medicine Gadjah Mada University PSIK Ismangoen House Building said that of the many existing health office in the country Indonesia, only a few Public Health Service are always routinely send data to the Pusdatin about developments in the region, although the data is sent in the form of diskettes. The majority of the Provincial Health Office is always late in sending data to the Pusdatin though the Depkes RI has provided Siknas Online can be accessed at any time. Mr Bambang Hartono also added that for several months ahead, the application will be Siknas Online temporarily offline as it is in the process of change the new provider.

Puskesmas as the holder of power of the health problems that occurred the district level to provide data as accurate as possible and timely to the District Health Office who will then proceed to the Provincial Health Office. The problem of data management is still a problem at the health center is located on the human, technology and organization. This is because human beings in it have not been able to use existing information technologies within the organization as a tool to simplify and streamline the data management at health center level. Need for training - training for health workers on duty in order to improve the ability in the use of information technology. Mastery of information technology such as the use of computers for data entry and use of Internet access for sending data to the District Health Office needs more attention because this is an important aspect of how to convey some information about health to the next level in order to take important decisions in handling health problems that occur work area.

In fact the field, health center located remote areas is always late can not even send its data at all the District Health Office for its natural geographic conditions that do not allow that would be very difficult for the District Health Office in combining existing data in any existing health center work area. Perhaps to overcome this, the health center may have to use a device like a modem to access the Internet so that data can be sent via E-Mail to the Public Health Service in a timely manner. The problem is not just to be here, but how to use the internet modem if there is no mobile telecommunications network to the remote areas. Therefore, the installation provider of telecommunication towers in remote areas is needed to facilitate the use of the internet modem.

Granted, the Minister of Health and Minister of Communication and Telecommunication negotiate to reach a conclusion and to take immediate steps to quickly and decisively in handling these problems so that all regions in Indonesia can be reached by communications and telecommunications networks so that all communities are able to optimum use within their their needs particularly for the benefit of their information systems and health data management.

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