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"ABSTRAKThe accreditation of health centers is an endeavor by the Ministry of Health to improve the quality and performance of health centers regulated by Permenkes No. 4/2015. Of the 38 health centers in Brebes, only 10 has been accredited. We wish to discover how prepared are the health centers to be accredited based on the resources available and pre-accreditation survey. Data was obtained through in-depth interviews and documentary research. Results indicated that there was sufficient funds, facilities and equipment for the accreditation. However, the assessment scores for human resources sufficiency and documentary completeness was low.ABSTRAKAkreditasi Puskesmas merupakan upaya peningkatan mutu dan kinerja pelayanan puskesmas yang diatur oleh Permenkes Nomor 46 Tahun 2015. Dari 38 puskesmas di Kabupaten Brebes, hanya 10 puskesmas yang sudah terakreditasi. Penelitian ini bertujuan untuk mengetahui seberapa siapkah Puskesmas di Kabupaten Brebes untuk menghadapi akreditasi berdasarkan variabel sumber daya dan tahapan kesiapan survei pra-akreditasi. Data dikumpulkan melalui wawancara mendalam dan telaah dokumen. Hasil penelitian menunjukkan bahwa ketersediaan dana, sarana dan prasarana dinilai cukup siap untuk mendukung penilaian akreditasi puskesmas, namun hasil skoring assessment pada keterpemenuhan kompetensi SDM dan kelengkapan dokumen masih rendah."

"Akreditasi Puskesmas merupakan upaya peningkatan mutu dan kinerja pelayanan Puskesmas sebagaimana tercantum dalam Permenkes Nomor 46 Tahun 2015. Dari 38 puskesmas di Kabupaten Brebes baru 10 puskesmas yang terakreditasi. Dasar pengajuan roadmap akreditasi puskesmas di Kabupaten Brebes hanya berdasarkan penunjukkan langsung, tanpa mengukur kesiapan puskesmas baik dari segi kelengkapan dokumen, penilaian assessment, serta ketersediaan sumber daya meliputi SDM, dana dan fasilitas sarana prasarana sesuai standar instrumen akreditasi puskesmas. Tujuan penelitian ini adalah mengetahui kesiapan akreditasi puskesmas di Kabupaten Brebes ditinjau dari sisi input, proses dan output berdasarkan variabel sumber daya dan tahapan kesiapan prasurvei akreditasi. Penelitian kualitatif ini proses pengumpulan datanya dilakukan dengan wawancara mendalam dan telaah dokumen. Hasil penelitian menunjukkan bahwa ketersediaan dana, sarana dan prasarana dinilai cukup siap untuk mendukung penilaian akreditasi puskesmas, namun hasil skoring assessment pada keterpemenuhan kompetensi SDM dan kelengkapan dokumen masih rendah. Rekomendasi yang diajukan adalah memenuhi syarat pengembangan kompetensi SDM, dan melengkapi dokumen serta melakukan self assessment secara rutin dan terjadwal.

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Accreditation of public health centers is an effort and performance enhancement public health centers services as listed in the Permenkes 46/2015. From 38 public health centers in Brebes District, just 10 public health centers are accredited. The basis of the filing of a roadmap of accreditation of public health centers in Brebes District only upon appointment directly, without measuring the readiness of public health centers both in terms of completeness, valuation assessment documents, as well as the availability of resources includes human resources, funds and facilities infrastructure standard instrument of accreditation of public health centers.

The purpose of this research is to know accreditation readiness of public health centers in Brebes District reviewed the input, process and output based on variable phase and readiness resources preaccreditation survey. Qualitative research is the process of collecting data using in-depth interviews conducted with the review document.

The results showed that the availability of funds and infrastructure are rated quite ready to support, but the public health centers accreditation assessment skoring assessment results on the fulfillment of human resource competency and the completeness of the documents is still low. A proposed recommendation is a qualified human resource competencies, and complete paperwork and do a self assessment regularly and scheduled."

"Latar belakang: Puskesmas adalah salah satu bentuk fasilitas pelayanan primer yang memberikan pelayanan kesehatan kepada masyarakat dan perseorangan. Penguatan pelayanan kesehatan primer menjadi fokus utama yang dikembangkan di dunia oleh WHO, dimana negara-negara berkembang didorong untuk melakukan reformasi dalam rangka penguatan pelayanan kesehatan primer. Sesuai dengan Peraturan yang ada puskesmas menjalankan fungsinya dengan lebih mengutamakan upaya promotif dan preventif, untuk mencapai derajat kesehatan yang setinggi-tingginya. Dalam rangka peningkatan mutu pelayanan, puskesmas wajib di akreditasi secara berkala paling sedikit 3 (tiga) tahun sekali. Tujuan akreditasi adalah untuk meningkatkan kinerja dalam memberikan pelayanan kesehatan perorangan dan masyarakat. Tujuan : Penelitian ini bertujuan untuk mengetahui kesiapan puskesmas untuk penilaian akreditasi dengan tujuan khusus adalah mengetahui kesiapan puskesmas dari segi administrasi manajemen, kualitas pelayanan UKM dan UKP, kesiapan dari segi ketersediaan SDM kesehatan dan diketahuinya kesiapan puskesmas dari segi pembiayaan kesehatan. Metode : Metode penelitian ini menggunakan metode kualitatif dengan pendekatan studi kasus. Hasil : Hasil penelitian menunjukkan bahwa kesiapan administrasi manajemen, ketersediaan sarana dan prasarana dan SDM kesehatan serta pembiayaan cukup siap untuk mendukung penilaian puskesmas agar mendapat kategori terakreditasi. Kesimpulan : Puskesmas yang diusulkan untuk penilaian akreditasi telah siap untuk dilakukan survei oleh tim survior. Saran : Puskesmas masih harus terus mempertahankan dan meningkatkan kesiapan dengan melakukan penyegaran dan penguatan komitmen serta melakukan kaji banding ke puskesmas yng talah terkareditasi.

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Background: Puskesmas is one form of primary care facilities that provide health services to communities and individuals. Strengthening primary health care becomes the main focus being developed in the world by the WHO, where developing countries are encouraged to implement reforms in order to strengthen primary health care. In accordance with Rule existing health centers to function more priority promotive and preventive efforts, goals to health level as high. In order to improve the quality of services, community health centers regularly accreditation mandatory in at least 3 (three) years. The purpose of accreditation is to improve performance in providing individual and community health services.

Objective: This study aimed determine the readiness of health centers for accreditation with the specific aim was to determine the readiness of puskesmas terms of administrative management, quality of service UKM and UKP, readiness in terms of availability of health human resources and health centers in terms of knowing the readiness of health financing.

Method: This study used a qualitative method with case study approach.

Results: The results showed that the administration's readiness management, availability of infrastructure and health human resources and finance are quite prepared to support the assessment of health centers in order to get accredited category.

Conclusion: The proposed health center for the accreditation assessment has been prepared for a survey conducted by a team survior.

Suggestion: Puskesmas must continue to maintain and enhance the readiness to conduct refresher and strengthening the commitment and conduct a review of an appeal to the clinic accredited."

"Akreditasi merupakan salah satu kebijakan pemerintah meningkatkan pelayanan kesehatan puskesmas yang bermutu dan berkesinambungan. Malcolm Baldrige sebagai kerangka kerja ekselen untuk evaluasi sistem pelayanan kesehatan dengan menilai diri dan memperbaiki mutu organisasi. Penelitian ini menggunakan kuesioner Malcolm Baldrige dan bab 7 tujuh akreditasi Permenkes yaitu layanan klinis berorientasi pasien untuk mengetahui gambaran mutu layanan layanan klinis rawat jalan puskesmas akreditasi dan non akreditasi dan mengetahui hubungan kepemimpinan, strategi, fokus pasien, manajemen pengetahuan dan informasi, fokus staf dan proses kerja dengan hasil. Penelitian kuantitatif dengan skoring Malcolm Baldrige, sampel penelitian sebanyak 126 responden dengan teknik purposive sampling. Hasil skor Malcolm Baldrigediperoleh skor rata-rata A-D-L-I approach-deployment-learning-integration dan Le-TC-I level-trend-comparison-integration < 30. Kedua jenis puskesmas berada pada level kinerja poor. Puskesmas akreditasi berada pada kriteria early result dan non akreditasi dengan kriteria early development. Kepemimpinan, strategi, fokus pasien,informasi dan analisis, fokus staf, dan proses mempunyai hubungan signifikan dengan hasil layanan klinis rawat jalan. Puskesmas belum banyak dokumentasi layanan klinis rawat jalan, pendekatan belum optimal, perbaikan bila ada masalah dan belum terintegrasi antar unit layanan. Puskesmas akreditasi dan non akreditasi perlu meningkatkan mutu layanan klinis rawat jalan dan mengevaluasi diri dengan kerangka kerja ekselen Malcolm Baldrige.

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Accreditation is one of the government policies to improve health services of Public Health Centers PHC either to improve its quality or sustainability. This study used the Baldrige questionnaire and chapter 7 of Indonesian Ministry of health accreditation regulation, namely patient oriented clinical service, in order to know the description of the quality clinical services outpatient in PHC accreditation non accreditation, as well as to know the relationship of leadership, strategy, costumer focus, information, staff focus, work processes with result. Quantitative research is conducted by scoring Baldrige 126 samples by using purposive sampling technique. Baldrige score result shows that the average score of A-D-L-I and Le-TC-I is less that 30 . Both types of PHC are at the level of poor performance. PHC accreditation is classified as the early result criteria and non accreditation is classified as the early development criteria.Leadership, strategy, patient and staff focus, information, process, have a significant relationship with outpatient clinical outcome results. PHC has less documentation of out patient clinic services, not optimal approach, not well improvement if there is a problem, not yet integrated among service units. Therefor, PHC - accreditation non accreditation need to improve their quality of outpatient clinical services, conduct self assessment by using the excellent framework of Baldrige."

"The National Health Insurance (NHI) Program was implemented in Indonesia on January 1st 2014. This program definitely brings some changes into managerialaspect in public health center (PHC). This study aimed to determine an impact of NHI policy in the implementation of health promotion programs at PHCin South Tangerang City, Indonesia. This study was conducted using qualitative method during February and March 2016. The impact of NHI is seen on policy,budget, equipment, human resource and implementation of health promotion program. With purposive sampling method, six policy makers, eight serviceproviders and eight service users were selected for in-depth interview. 17 documents were analyzed. Observation was conducted at four selected PHC’s.Data analysis used thematic content analysis. There was no difference of PHC’s functions before and after NHI period. Budget expended for health promotionprograms increased after NHI was implemented which could represent an opportunity for PHC to innovate, procure materials and implement better healthpromotion programs. Capitation budget which could be used for executing health promotion program and some recently implemented health promotion programsin the NHI era evidences that NHI policy has a positive impact on the implementation of health promotion programs at PHC.Jaminan Kesehatan Nasional (JKN) telah diimplementasikan di Indonesia pada 1 Januari 2014. Hal tersebut membawa beberapa perubahan pada aspekmanajerial pada pusat kesehatan masyarakat (puskesmas). Penelitian ini bertujuan untuk mengidentifikasi dampak dari kebijakan JKN terhadap implementasiprogram promosi kesehatan di puskesmas di Kota Tangerang Selatan, Indonesia. Penelitian menggunakan metode kualitatif. Data dikumpulkan padaFebruari – Maret 2016. Dampak program dilihat dalam hal kebijakan, pendanaan, fasilitas, sumber daya manusia dan pelaksanaan program promosi kesehatan.Dengan menggunakan metode purposive sampling, enam pengambil kebijakan, delapan pemberi layanan dan delapan penerima layanan diambil sebagaiinforman dalam penelitian ini. Pada analisis dokumen, 17 dokumen telah dianalisis. Observasi dilakukan dengan melihat kegiatan yang dilakukan diempat puskesmas. Analisis data menggunakan analisis konten tematik. Tidak terdapat perbedaan dari fungsi puskesmas sebelum dan setelah adanya JKN.Dana yang digunakan untuk kegiatan promosi kesehatan telah mengalami peningkatan setelah implementasi kebijakan JKN dimana dana tersebut dapat digunakanuntuk berinovasi, memberi peralatan dan melakukan promosi kesehatan dengan lebih baik. Dana kapitasi yang dapat digunakan untuk melaksanakanprogram promosi kesehatan dan beberapa kegiatan promosi kesehatan yang baru dilaksanakan pada saat era JKN menjadi bukti bahwa kebijakan JKN memilikidampak positif terhadap pelaksanaan program promosi kesehatan di puskesmas"

"There are many challenges women face to be able to give birth in health facilities in many parts ofIndonesia. This study explores the roles and observations of close-to-community maternal health providers and othercommunity members on potential barriers faced by women to deliver in health facilities in two districts within TheArchipelago. Methods: Employing an explorative qualitative approach, 110 semi-structured interviews and 7 focusgroup discussions were conducted in 8 villages in Southwest Sumba, in the East Nusa Tenggara province, and in 8 villagesin Cianjur, in the West Java province. The participants included village midwives, Posyandu volunteer (village healthvolunteers), traditional birth attendants (TBAs), mothers, men, village heads and district health officials. Results: Themain findings were mostly similar in the two study areas. However, there were some key differences. Preference forTBA care, traditional beliefs, a lack of responsiveness of health providers to local traditions, distance, cost of travel andindirect costs of accompanying family members were all barriers to patients attending health facilities for the birth oftheir child. TBAs were the preferred health providers in most cases due to their close proximity at the time of childbirthand their adherence to traditional practices during pregnancy and delivery. Conclusions: Improving collaborationsbetween midwives and TBAs, and responsiveness to traditional practices within health facilities and effective healthpromotion campaigns about the benefits of giving birth in health facilities may increase the use of health facilities inboth study areas."