Abstract

Di Indonesia, desentralisasi sektor kesehatan tidak selalu berdampak baik pada upaya penurunan angka kematian ibu, bayi dan anak balita. Desentralisasi tidak hanya memberi kewenangan pengembangan kebijakan lokal spesifik yang tepat, tetapi juga kebijakan yang tidak mendukung kebijakan nasional sehingga berdampak pencapaian yang rendah. Penelitian ini bertujuan mengetahui efektivitas desentralisasi kesehatan dalam mendorong pemerintah daerah menurunkan angka kematian ibu dan bayi. Penelitian ini menggunakan metode kualitatif wawancara semi terstruktur, observasi, dan diskusi kelompok terarah pada informan kunci yang terlibat dalam penyusunan dan pelaksanaan kebijakan daerah. Tiga kabupaten dipilih secara purposif berdasarkan expert judgement meliputi Kabupaten Pasuruan, Kabupaten Takalar dan Kabupaten Kupang. Kebijakan desentralisasi ditemukan bukan saja memberikan kewenang pelayanan kesehatan, tetapi juga menuntut kreativitas penyusunan kebijakan kesehatan. Tiga kabupaten tersebut ternyata mampu membuat kebijakan kesehatan yang menurunkan angka kematian ibu dan bayi. Di setiap daerah, ditemukan inovasi kebijakan yang mengarah pada perbaikan sistem pelayanan kesehatan ibu dan bayi. Pemerintah pusat perlu mendorong pemerintah daerah untuk berinovasi mengembangkan kebijakan kesehatan sehingga target MDGs bidang kesehatan pada tahun 2015 dapat tercapai.

In Indonesia, health sector desentralization does not always show good effect reduction measure of infant, maternal and under five children mortality. Local government can make appropriate local spesific health policy, but not always appropriate to national policy, that effect on low coverage. The objective of this study is to analyzes the rule of local policies in reducing maternal and infant mortality rate in Indonesia. The approach used is qualitative research with semi-structured interviews to key informants involved in the preparation and implementation of local policies, making direct observation and Focus Group Discussion (FGD). Three districts were selected purposively based on expert judgment are Pasuruan District, Takalar District and Kupang District. The results showed that decentralization gives local governments the authority to conduct health services and local government demanded creativity in formulating health policy. The three districts were able to make health policy related to reducing maternal and infant mortality. This policy is effective to a decrease in maternal and infant mortality rates in the three districts. Although found in every area of innovation policy but its direction is towards the improvement of the health care system for mothers and babies. Therefore, the central government needs to encourage local governments to undertake innovative health policies mainly to decrease maternal and infant mortality rates in order to achieve the MDGs health targets to be achieved by 2015.

References

1. Adair T. Child mortality in Indonesia’s mega urban regions: measurement, analysis of differentials, and policy implications. 12th Biennial Conference of the Australian Population Association, 2004 Sept 15-17; Canberra, Australia. Canberra: Australian Population Association; 2009.

2. Frankenberg E, Suriastini W, and Thomas D. Can xpanding Access to Basic Healthcare Improve Children’s Health Status? Lessons from Indonesia’s Midwife in the Village’ Programme, Population Studies. 2005; 59 (1): 5-19.

3. Swaminathan S, Matsumoto T, Nugent JB. Midwives and maternal mortality: how effective has Indonesia’s village midwife program been? UCSD Conference. Tokyo: University of Tokyo and Western Economic Association; 2008.

4. World Bank. Indonesia health sector review: accelerating improvementent maternal health: why reform is needed. Policy and discussion notes. Jakarta: World Bank; 2010.

5. Kementerian Kesehatan Republik Indonesia. Laporan nasional: riset kesehatan dasar (Riskesdas) 2010. Jakarta: Kementerian Kesehatan Republik Indonesia; 2011.

6. The United Nations of Children’s Fund. Maternal and child health [online]. Unicef Indonesia, Issue Briefs, October 2012 [cited 2013 Jan 10]. Available from: www.unicef.org/indonesia/A5_E_Issue _Brief_Maternal_REV.pdf.

7. Simatupang R, Rentanida. Evaluation of decentralization outcomes in Indonesia: analysis of health and education sectors. [Dissertation]. Atlanta: Department of Economics Georgia State University; 2009.

8. Lieberman S, Capuno JJ, Minh HV. Decentralizing health: lessons from Indonesia, the Philippines, and Vietnam. Chapter in Books: East Asia Decentralizes. Washinton DC: World Bank; 2010.

9. Pranata S, Pratiwi LP, Rahanto S. Pemberdayaan masyarakat di bidang kesehatan, gambaran peranan kader posyandu dalam upaya penurunan angka kematian ibu dan bayi di Kota Manado dan Palangkaraya. Bulletin Penelitian Sistem Kesehatan. 2011; 14 (2).

10. Chevalier A, O’Sullivan V. Mother’s education and birth weight. Discussion Paper No. 2640 February 2007. Forschungsinstitut zur Zukunft der Arbeit Institute for the Study of Labor; 2007.

11. Akmam W. Women’s education and fertility rate in developing countries, with special reference to Bangladesh. Eubios Journal of Asian and International Bioethics. 2002; 12: 138-43.

12. McAlister C, Baskett TF. Female education and maternal mortality: a worldwide survey. Journal Obstetrics Gynaecology of Canada. 2006; 28: 983-90.

Download

Share

COinS