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Abstract

Strengthening primary care services in Indonesia requires that community health centers, namely Pusat Kesehatan Masyarakat (Puskesmas), involve medical personnel with family medicine competence. However, the fulfillment of physicians with this competence, especially Primary Care Family Medicine Specialists or Spesialis Kedokteran Keluarga Layanan Primer (Sp.KKLP), still face significant obstacles. This qualitative research uses the integrated Easton's System Model and Buse's Policy Framework to analyze the dynamics of this policy. The findings reveal a gap between the strong legal foundation and weak implementation mechanisms on the ground. First, there is ambiguity in terminology and lack of harmonization among regulations, especially concerning the Sp.KKLP nomenclature, which creates confusion in terms of legal status and professional recognition. Second, an implementation gap (policy–practice gap) exists because the central government has not yet issued technical derivative regulations (technical guidelines, compensation mechanisms). Furthermore, the decentralization of authority and limited regional budgets impede the equitable placement of the Sp.KKLP. The success of the policy relies heavily on the synergy among the Ministry of Health, Health Council, Family Medicine Collegium, educational institutions such as Program Pendidikan Dokter Spesialis (PPDS) and Recognition of Prior Learning (RPL), and professional organizations such as Pengurus Besar Ikatan Dokter Indonesia (PB IDI). Recommendations include the development of technical implementation regulations, clarification of the Sp.KKLP definition, and establishment of inclusive pathways for competence enhancement such as PPDS and RPL.

References

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Bahasa Abstract

Penguatan pelayanan kesehatan primer di Indonesia menuntut Pusat Kesehatan Masyarakat (Puskesmas) untuk melibatkan tenaga medis dengan kompetensi kedokteran keluarga. Namun, pemenuhan dokter dengan kompetensi tersebut, terutama Spesialis Kedokteran Keluarga Layanan Primer (Sp.KKLP), masih menghadapi kendala serius. Penelitian kualitatif ini menggunakan pendekatan terintegrasi antara Model Sistem Easton dan Kerangka Kebijakan Buse untuk menganalisis dinamika kebijakan tersebut. Temuan menunjukkan adanya kesenjangan antara landasan hukum yang kuat dan mekanisme pelaksanaan yang lemah di lapangan. Pertama, terdapat ambiguitas terminologi dan kurangnya harmonisasi antarregulasi, terutama terkait nomenklatur Sp.KKLP, yang menimbulkan kebingungan mengenai status hukum dan pengakuan profesi. Kedua, terdapat gap implementasi (policy–practice gap) karena pemerintah pusat belum menerbitkan regulasi turunan teknis seperti petunjuk pelaksanaan maupun mekanisme kompensasi. Selain itu, desentralisasi kewenangan serta keterbatasan anggaran daerah turut menghambat pemerataan penempatan Sp.KKLP. Keberhasilan kebijakan ini sangat bergantung pada sinergi antara Kementerian Kesehatan, Konsil Kesehatan Indonesia, Kolegium Kedokteran Keluarga, institusi pendidikan seperti Program Pendidikan Dokter Spesialis (PPDS) dan Recognition of Prior Learning (RPL), serta organisasi profesi seperti Pengurus Besar Ikatan Dokter Indonesia (PB IDI). Rekomendasi kebijakan meliputi penyusunan regulasi teknis implementasi, penegasan definisi Sp.KKLP, dan pengembangan jalur pemenuhan kompetensi yang lebih inklusif seperti PPDS dan RPL.

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