SDM KESEHATAN & KEBIJAKAN

25
SDM KESEHATAN & KEBIJAKAN Yosri Azwar

description

Health Human Resource and Policy

Transcript of SDM KESEHATAN & KEBIJAKAN

Page 1: SDM KESEHATAN & KEBIJAKAN

SDM KESEHATAN & KEBIJAKAN

Yosri Azwar

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KEBIJAKAN (Kesehatan)

UU No.8 thn 1961 tentang wajib sarjana – lulusan FK, FKG dan Farmasi wajib kerja sebagai PNS selama sekurang-kurangnya 3 tahun

UU No.6 thn 1963 tentang wewenang Depkes untuk mengatur, mengarahkan dan mengawasi pegawai kesehatan dalam melaksanakan tugasnya.

PP 37 thn 1964 yang menyatakan bahwa semua lulusan pendidikan kesehatan, dokter, dokter gigi dan apoteker harus mendaftar ke Depkes.

PP 32 thn 1996 tentang Tenaga Kesehatan disebutkan bahwa jenis tenaga kesehatan yaitu: tenaga medis, keperawatan, kefarmasian, kesehatan masyarakat, gizi, keterapian fisik dan keteknisan medis.

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Keppres No. 5 thn 2004 tentang tunjangan jabatan fungsional dokter1, dokter gigi2, apoteker3, asisten apoteker4, pranata laboratorium kesehatan5, epidemiologi kesehatan6, entomologi kesehatan7, sanitarian8, administrator kesehatan9, penyuluh kesehatan masyarakat10, perawat gigi11, nutrisionis12, bidan13, perawat14, radiografer15, perekam medis16 dan teknisi elektromedis17.

KepMenkes No.679/Menkes/SK/V/2003 tentang kartu registrasi dan izin kerja asisten apoteker.

KepMenkes No.1076/Menkes/SK/VII/2003 tentang penyelenggaraan pengobatan tradisional

KepMenkes No.1277/Menkes/SK/VII/2003 tentang tenaga akupuntur.

KEBIJAKAN (Kesehatan)

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KepMenkes No.725/Menkes/SK/V/2003 Pedoman Penyelenggaraan Pelatihan di Bidang Kesehatan.

KepMenkes No.788/Menkes/SK/VI/2003 tentang Pedoman Penyelenggaraan Seleksi Penerimaan Siswa/Mahasiswa Baru Pendidikan Tenaga Kesehatan (SIPENSIMARU DIKNAKES)

KepMenkes No. 81/Menkes/SK/I/2004 tentang Pedoman Penyusunan Perencanaan SDM Kesehatan di Tingkat Provinsi, Kab./Kota serta Rumah Sakit.

KEBIJAKAN (Kesehatan)

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UU No. 8 Tahun 1974 tentang Pokok-Pokok Kepegawaian.

UU No. 43 Tahun 1999 tentang Perubahan atas UU No. 8 Tahun 1974 Tentang Pokok-Pokok Kepegawaian.

PP No. 16 Tahun 1994 tentang Jabatan Fungsional Pegawai Negeri Sipil.

Keppres No. 87 tahun 1999 tentang Rumpun Jabatan Fungsional Pegawai Negeri Sipil.

KEBIJAKAN (Umum)

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PP No. 97 tahun 2000 tentang Formasi PNS.

PP No. 98 tahun 2000 tentang Pengadaan PNS.

PP No. 99 tahun 2000 tentang Kenaikan Pangkat PNS.

PP No. 100 tahun 2000 tentang Pengangkatan PNS dalam Jabatan Struktural.

PP No. 8 tahun 2003 tentang Pedoman Organisasi Perangkat Daerah.

PP No. 9 tahun 2003 tentang Wewenang Pengangkatan, Pemindahan dan Pemberhentian PNS.

Keputusan Kepala Badan Kepegawaian Negara Nomor 43/KEP/2001 tentang Standar Kompetensi Jabatan Struktural Pegawai Negeri Sipil.

KEBIJAKAN (Umum)

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PP No. 97 tahun 2000 tentang Formasi PNS.

Pasal 4

(1) Formasi masing-masing satuan organisasi Negara disusun berdasarkan analisis kebutuhan dan penyediaan pegawai sesuai dengan jabatan yang tersedia dengan memperhatikan norma, standar, dan prosedur yang ditetapkan oleh Pemerintah.

(2) Analisis kebutuhan sebagaimana dimaksud dalam ayat (1) dilakukan berdasarkan:a. jenis pekerjaan;

b. sifat pekerjaan;

c. analisis beban kerja dan perkiraan kapasitas seorang pegawai negeri sipil dalam jangka waktu tertentu.

d. prinsip pelaksanaan pekerjaan; dan

e. peralatan yang tersedia.

KEBIJAKAN (Umum)

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Effective health service delivery requires the efficient use of the skills of a well-motivated health sector workforce. The health sector is labour-intensive. The delivery of care by its very nature involves personal interaction and effective teamwork.

The health sector workforce is complex, with several health-specific professional groups with distinct roles and their own educational and regulatory structures: doctors, nurses, dentists, pharmacists, etc. It is important also to mention that health occupations tend to have a strong distinctive culture and identity, which can complicates some changes, such as promoting teamwork or reviewing hierarchical structures.

HRH & HEALTH SERVICES

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Context Policies

Overall environment• Political• Socioeconomic• Demographic• Epidemiologic• New Technology

Human resources development policy formulation: A framework for analysis

Support system

Government programme• Macroeconomic and financial

policies• Change in priorities: productive and

social sectors

Information• Assessment tools• Nat’l health mgt info system• HRH database and payroll• Performance monitoring

MAJOR REFORMS• Civil service• Decentralization• Privatization• Institutional reorganization

MAJOR PLAYERS• Government• Civil society• Prof. assoc & trade unions• Private sector• Donors

HEALTH POLICY• Health sector reforms• Changes in priorities and strategies

HRD POLICY & PLANNING• Content• Formulation process

HUMAN RESOURCES• National capacities, including

institutional strengthening• Technical assistance

FINANCIAL RESOURCES• Mechanism for allocation• Management system & payment• Incentives

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Functions the system performs

Goals/ objectives of the system

Stewardship (leadership, oversight)

Creating resources (investment & training)

Financing (collecting, pooling and purchasing)

Delivering services (provision)

HEALTH

Responsiveness (to people’s non-medical

expectation)

Fair (financial)

contribution

Intermediate Final

SDM-KES & SISTEM KESEHATAN

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SDM-KES & SISTEM KESEHATAN

Functions the system performs

Goals/ objectives of the system

Stewardship & Financing

Delivering services

Intermediate Final

HRH Generation

HRH Provision

Labour market

HEALTHResponsiveness

Financial Fairness

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Conceptual Framework

Non-health

Health• Financing• Stewardship/ Health planning

• Provision• Resources generation

Stakeholders

Structural factors

Dynamic factors

Management Organization

• Health needs• Utilization of health care

• Individual factors• Educational/training• Labour participation• Barriers to entry• Migration

• Financial/ Physical/ Knowledge

PoliciesHealth care

system

Health labourdemand

• Shortage• Equilibrium• Oversupply

Health laboursupply

Resources

Glo

baliz

atio

nNational/

Sub-national

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Forces driving the workforce

Health needsDemographics

Disease burdenEpidemics

Health systemFinancing

TechnologyConsumer preference

ContextLabour and education

Disease burdenEpidemics

NumbersShortage/excess

Skill mixHealth team balance

DistributionInternal (urban/rural)

International migration

Working conditionsCompensation

Non-financial incentivesWorkplace safety

Driving forces Workforce challenges

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Working lifespan strategies

Entry:Preparing the workforce

PlanningEducation

Recruitment

Exit:Managing attrition

MigrationCarrier choice

Health and safetyRetirement

Workforce:Enhance worker performance

SupervisionCompensationSystem supportLifelong learning

AvailabilityCompetence

ResponsivenessProductivity

Workforceperformance

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Health workers in all sectors

Health serviceproviders

Sector

Occupation

Health sector All other sectors

Health mgt and support workers

Health serviceproviders

All others

• Professionals• doctor, nurse

• Associate• lab technician

• Community• traditional

practitioner

• Professionals• hosp. account

• Associate• administrative

• Support staff• clerical

• Craft & trade workers

• Professionals• physician

employed in mining company

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A Framework for analyzing future trends in HRH

Demographic transition

Technological innovation

Global tradeInstitutional

change

Organizational reform

Work force

Work content Work place

Work outcomes

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Getting the mix right: challenge to health workforce production

Drivers influencingWorkforce composition

Health needs- Demographic- Disease burden- Epidemic

Limited shortages - Increase class size- Shorten training time

NumbersWidespread shortages - Develop new institution

- Increase regional cooperation

Maldistribution - Select from underserved area- Locate training in

underserved areaDiversityHomogenity - Outreach for minorities to apply

- Retention efforts during trainingMissing - New institutions, cadres

- Regional, international networksCompetencies

Ineffective - Evaluation and certification- Accreditation, licensure

Health system- Financing- Technology- Consumer

preference

Context- Labour & education- Public sector reform- Globalization

Challenges Possible actions

Appropriatenumbers

Enhanceddiversity

Competenciesensure

Desired impact onworkforce production

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Relationship of education, labour and health services markets with human resources

Education market Labour marketHealth services

market

Training institutions Health organizations Service unitsInstalled capacity

ProgrammeCurriculum

prices

Individual practicePositionSalaries

ProtocolsInfrastructureTechnology

InputsPrices

Educationdemand

Labourdemand

Laboursupply

Demand for services

Applicants Graduates Unemployed Linked Opportunities Resources Users

Transformation process Linking process Production process

Students Resources Workers

Intellectual capacitySkills

Capacity

CompetenciesExperiencesExpectations

PerformanceAbilities

Substitutions

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Dimensions of health workforce performance

Dimension DescriptionAvailability Availability in terms of space and time: encompasses distribution and

attendance of existing workers

Competence Encompasses he combination of technical knowledge, skill and behaviours

Responsiveness People are treated decently, regardless of whether or not their health improves or who they are

Productivity Producing the maximum effective health services and health outcomes possible given the existing stock of health workers; reducing waste of staff time or skills.

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Indicators to assess health workforce performance

Dimension Possible indicatorsAvailability • Staff ratios

• Absence rate• Waiting time

Competence • Individual: prescribing practices• Institutional: readmission rate; live births; cross-infections

Responsiveness • Patient satisfaction• Assessment of responsiveness

Productivity • Occupied bed• Outpatient visits• Interventions delivered per worker or facility

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Levers to influence the four dimensions of health workforce performance

Job relatedJob descriptions

Norm and codes of conductSkill matched with tasks

Supervision

Support system relatedRemuneration

Information & communicationInfrastructures & supplies

Enabling work environmentLifelong learning

Team managementResponsibility with accountability

Availability

Competence

Responsiveness

Productivity

Levers Health workforce performance

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An aid to thinking through potential effect of levers on health workforce performance

LeversDimension of health workforce performance

Availability Competence Responsiveness Productivity

1. Job description + + + +

2. Norm and code of conduct ++ + ++ +/++

3. Match skill to task + + + +++

4. Supportive supervision + +++ ++ ++

5a. Salary level +++ + + ++

5b. Payment mechanisms ++/- - +/- +/- +++/- - -

6. Information & communication 0 ++ + ++

7. Infrastructure and supplies ++ 0 + ++

8. Lifelong learning + +++ + +

9. Teamwork and management + + ++ +++

10. Responsibility with accountability ++ + ++ +++

+ : positive effect; - : negative effect+ : some effect; ++ : significant effect; +++ : substantial effectPayment mechanisms: the effects will depend on the mechanism used

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Managing for Performance

Health outcomesHealth system performance

Workforce objectives

Human resource action

Coverage:Social and physical

Motivation:System and

support

Competence:Training and

learning

Equitable access

Quality and responsiveness

Efficiency and

effectiveness

Health of the

population

• Numeric adequacy• Skill mix• Social outreach

• Satisfactory remuneration

• Work environment• Systems support

• Appropriate skills• Training and learning

• Leadership and entrepreneurship

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“Terobosan yang paling menggairahkan pada abad ke 21 yang akan terjadi bukan karena tekhnologi, melainkan munculnya konsep yang luas dari apa artinya menjadi MANUSIA” (John Naisbitt).

Pengelolaan SDM Kesehatan khususnya perencanaan kebutuhan selama ini masih bersifat: administratif kepegawaian, belum dikelola secara profesional;

masih bersifat top-down, belum bottom-up;

belum sesuai dengan kebutuhan organisasi dan kebutuhan nyata di lapangan, serta;

belum berorientasi jangka panjang.

Perencanaan SDM Kesehatan(KEPMENKES No. 81/MENKES/SK/I/2004)

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Tujuan pedoman adalah untuk membantu daerah dalam mewujudkan rencana penyediaan dan kebutuhan SDM Kesehatan.

Pedoman meliputi: Pedoman penyusunan rencana penyediaan dan kebutuhan SDM di

institusi pelayanan kesehatan (rumah sakit, puskesmas).

Pedoman penyusunan rencana penyediaan dan kebutuhan SDM kesehatan di wilayah (provinsi, kabupaten/kota).

Pedoman penyusunan rencana kebutuhan SDM kesehatan untuk Bencana.

Perencanaan SDM Kesehatan(KEPMENKES No. 81/MENKES/SK/I/2004)