Ketersediaan Obat Esensial pada Sarana Kesehatan di Kabupaten Bangka Barat

https://doi.org/10.22146/jkki.v1i3.36017

Achmad Nursyandi(1*), Mustofa Mustofa(2), Mubasysyir Hasanbasri(3)

(1) Dinas Kesehatan Kabupaten Bangka Barat, Provinsi Bangka Belitung
(2) Farmakologi, Fakultas Kedokteran, Universitas Gadjah Mada, Yogyakarta
(3) Program Studi Ilmu Kesehatan Masyarakat, Fakultas Kedokteran, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author

Abstract


Background: The effectiveness of treatment at government health facilities is largely determined by the availability of the drug. In addition to essential drugs, doctors and the public can choose medications that are considered more suitable for medical needs. Bureaucratic rigidity and lack of funds the government plans to make the supply of medicines in health centers to be minimalist in terms of number and variety of drugs. Such inflexibility encourage minimalist prescribing behavior among primary care physicians and health workers. Objective: This study want to learn management practices that deal with drug supply and its distribution in government owned primary health care facilities. It specifically tried to identify strategies at health center level that allow the provision of more drugs in accordance with the medical needs and rational drug use practices. Method: Data were collected by observation report drug use and demand for health facilities in January-June 2010 and in- depth interview of chief health official, the head of pharmacy department, 7 of pharmacy main health centers and 11 midwives/nurses extending health center, village health clinic and village health post. Results: This case illustrates a successful story about making drugs available at primary health care facilities. Five main health centers, four extending health centers, and ten village health clinic and village health posts are classified as “safe” based on MOH standard. This success reflects human resource capacity and decentralized management of drug supply. Pharmacists and pharmacy assistants throughout the Bangka Barat Regency has already trained in drug supply management. The study also found that the procurement of drugs has been based on bottom-up planning. Although under the coordination of district level pharmacy unit, health care centers has broader authority to determine their drug needs. They also have their own drug procurement budget that are part of district budget that can be used for unexpected situations. Conclusion: This study attempted to show effort to change local government health sector bureaucracy in decentralization era. This case study shows the involvement and bigger participation of primary care facilities in the planning and implementation of drug supply. Health centers have a greater authority in managing the medication needs to circumstances beyond expectations. Communication, information and education to doctors about the drug delivery mechanism will allow doctors to prescribe drugs according to the medical needs of patients and drug development, and because it makes health care facilities into place an effective treatment.

 

Latar Belakang: Efektivitas pengobatan di fasilitas kesehatan pemerintah sangat ditentukan oleh ketersediaan obat. Di samping obat esensial, dokter dan masyarakat dapat memilih obat-obat yang dipandang lebih cocok untuk kebutuhan medik. Kekakuan birokrasi perencanaan dan keterbatasan dana pemerintah membuat penyediaan obat di puskesmas menjadi minimalis dari sisi jumlah dan variasi obat. Kekakuan seperti itu mendorong praktik peresepan minimalis yang diragukan manfaat terapetiknya. Tujuan: Penelitian ini mempelajari manajemen penyediaan obat dan distribusinya di fasilitas kesehatan dasar. Ia secara khusus berusaha menemukan strategi-strategi di tingkat puskesmas yang membuat penyediaan obat lebih sesuai dengan kebutuhan lapangan dan pengobatan rasional. Metode: Data dikumpulkan dengan observasi laporan pemakaian dan permintaan obat sarana kesehatan bulan Januari-Juni 2010 dan wawancara mendalam terhadap kepala dinas kesehatan, kepala instalasi farmasi, 7 pengelola obat puskesmas dan 11 bidan/perawat pustu, polindes serta poskesdes. Hasil: Penelitian ini menunjukkan bahwa lima puskesmas, empat puskesmas pembantu, dan sepuluh polindes dan poskesdes berhasil merencanakan dan menyediakan obat hingga pada tingkat yang “aman”. Keberhasilan ini merupakan bukti dari kapasitas tenaga yang memadai. Apoteker dan seluruh pengelola obat puskesmas Kabupaten Bangka Barat sudah memiliki mengikuti pelatihan manajemen pengelolaan obat. Penelitian juga menemukan bahwa pengadaan obat telah berbasis desentralisasi dan mencerminkan perencanaan bottom up. Meski di bawah koordinasi instalasi farmasi kabupaten, puskesmas memiliki kewenangan menentukan kebutuhan. Mereka juga memiliki fleksibilitas pengadaan obat sendiri untuk situasi di luar dugaan. Kesimpulan: Penelitian ini berusaha memperlihatkan upaya perubahan birokrasi di bidang kesehatan dalam era desentralisasi. Studi kasus dalam penyediaan obat esensial di Kabupaten Bangka Barat menunjukkan keterlibatan dan partisipasi puskesmas yang lebih besar dalam perencanaan dan implementasinya. Puskesmas juga memiliki kewenangan lebih besar dalam mengelola kebutuhan obat untuk situasi di luar dugaan. Komunikasi, informasi dan edukasi kepada dokter tentang mekanisme penyediaan obat akan memudahkan dokter meresepkan obat sesuai dengan kebutuhan medik pasien dan perkembangan obat, dan karena itu membuat fasilitas kesehatan menjadi tempat pengobatan yang efektif.


Keywords


: Essential drugs; Drug availability; Drug management; Obat esensial; Ketersediaan obat; Pengelolaan obat

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References

Departemen Kesehatan Republik Indonesia, Daftar Obat Esensial Nasional, Jakarta, 2008.

Quick JD, Hogerzeil HV, Velasquez G, Rago L, Twenty-five Years of Essential Medicines, Bul- letin of the WHO 80, 2002.

Babar ZU, Ibrahim MIM, Singh H, Bukahri N, Creese A, Evaluating Drug Prices, Availability, Affordability and Price Components: Implication for Acces to Drugs in Malaysia. Plos Med, 2007;4(3):82e.

Putri AE, Siahaan S, Tjahyono L, Budiharto M, Sundari S, Angkasawati T, Helmi R, Ariningrum R, The Prices People Have to Pay for Medicine in Indonesia. Center for Health Service and Tech- nology Research National Institute of Health Research and Development, Ministry of Health Indonesia in Collaboration with WHO, Health Action International, Jakarta, 2007.

Departemen Kesehatan Republik Indonesia, Roadmap Reformasi Kesehatan Masyarakat, Jakarta, 2010.

Quick JD, Hume ML, Rankin IR, Laing RO, O’Connor, Managing Drug Supply, Second Edition Revised and Expanded, Kumarian Press, West Harford, 1997.

Dong HJ, Bogg L, Rehnberg C, Diwan V, Drug Policy in China: Pharmaceutical Distribution in Rural Areas, Social Science and Medicine, 1999;48:777-786.

Departemen Kesehatan Republik Indonesia, Petunjuk Pelaksanaan Pemantauan/ Pengendalian Ketersediaan Obat Terpadu Daerah Tingkat II, Jakarta, 1998.

Jitta J, Whyte SR, Nshakira N, The Availability of Drug: What Does It Mean in Ugandan Pri- mary Care. Elsevier Science-Health Policy, 2003;65:167-179.

Siddiqi S, Masud TI, Nishtar S, Peters DH, Sabri B, Bile KM, Jama MA, (2009) Framework for Assessing Governance of the Health System in Developing Countries: Gateway to Good Gov- ernance. Health Policy, 2009;90:13-25.

Syhakhang L, Sengaloundeth S, Paphassarang C, Freudenthal S, Wahlstrom R, Availability of Essential Drugs and Sustainability of Village Revolving Drug Funds in Remote Areas of Lao PDR. Drugs, 2008:519-543.

Garraoui A, Feuvre PL, Ledoux M, Introducing Management Principles Into the Supply and Distribution of Medicines in Tunisia. Bulletin of the WHO, 1999;77(6).

World Health Organization, Equitable Access to Essential Medicines: A Framework for Col- lective Action, Geneva, 2004.

Gerald MC, National Drug Policy and Rational Drug Use: A Model Curriculum for Developing Countries. J Clin epidemiology, 1991;44(l,II): 95s-99s.

Hogerzeil HV, The Concept of Essential Medi- cines: Lessons for Rich Countries, BMJ, 2004;329.

Jeppsson A, Okuonzi SA, Vertical or Holistic Decentralization of the Health Sector? Experi- ences from Zambia and Uganda. International Journal of Health Planning and Management, 2000;15:273-289.

Osborne D, Gaebler T, Reinventing Government: How the Enterpreneurial Spirit is Transforming the Public Sector, Addision-Wesley Publishing Company, New York, 1992.

Oyaya CO, Rifkin SB, Health Sector Reforms in Kenya: An Examination of District Level Plan- ning. Health Policy, 2003;64:113-127.

Handayani S, Ilmu Politik dalam Kebijakan Kesehatan. Ed. pertama, Gosyen Publishing, Yogyakarta, 2010.

Brinkerhoff D, Accountability and Health Sys- tems: Overview, Framework and Strategies. Technical Report No. 018. Bethesda, MD: The Partners for Health Reformplus Project, Abt Associates Inc, 2003.

Nikfar S, Kebriaeezadeh A, Majdzadeh R, Abdollahi M, Monitoring of National Drug Policy and Its Standardized Indicators; Conformity to Decisions of the National Drug Selecting Committee in Iran. BMC International Health and Human Rights, 2005;5:5.

Barnett P, Tenbensel T, Cumming J, Clayden C, Ashton T, Pledger M, Burnette M, Implement- ing New Modes of Governance in the New Zealand Health System: An Empirical Study. Health Policy, 2009;93:118-127.

Feletto E, Wilson LK, Roberts AS, Benrimoj SI, Flexibility in Community Pharmacy: A Qualita- tive Study of Business Models and Cognitive Services, Pharm World Sci, 2010;32:130-138.

Lufesi NN, Andrew M, Aursnes I, Deficient Sup- plies of Drugs for Life Threatening Diseases in an Africa Community. BMC Health Services Research, 2007;7:86.

World Health Organization, Good Distribution Practices for Pharmaceutical Products. WHO Technical Report Series, 2006;937.

Yu X, Li C, Shi Y, Yu M, Pharmaceutical Supply Chain in China: Current Issues and Implications for Health System Reform. Health Policy, 2010:2481.

Gifford, Pinchot E, The End of Bureaucracy and The Rise of The Intelligent Organization.: Barret- Koehler Publishers, San Fransisco, 1993.

Lockhart M, Babar ZU, Garg S, Evaluation of Policies to Support Drug Development in New Zealand. Health Policy, 2010;96:108-117.

Badan Perencanaan dan Pembangunan Nasional, Kajian Kebijakan Perencanaan Tenaga Kesehatan, Direktorat Kesehatan dan Gizi Masyarakat. Deputi Bidang Sumber Daya Manusia dan Kebudayaan, BAPPENAS, Jakarta, 2005.

World Health Organization, How to Develop and Implement a National Drug Policy, Geneva, 2001.

Saide MAO, Stewart DE, Decentralization and Human Resource Management in the Health Sector: A Case Study (1996 ± 1998) from Nampula Province, Mozambique. International Journal of Health Planning and Management, 2001;16:155-168.

Kingma M, Human Resources for Health Eco- nomic Incentive in Community Nursing: Attrac- tion, Rejection or Indifference?. BMC Human Resources for Health, 2003;12:1-12.



DOI: https://doi.org/10.22146/jkki.v1i3.36017

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