Why is health policy important? - Add docshare01.docshare.tips...

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KEBIJAKAN KESEHATAN

Transcript of Why is health policy important? - Add docshare01.docshare.tips...

KEBIJAKAN KESEHATAN

Mengapa Kebijakan kesehatan penting?

• Sektor kesehatan mrpkn bag.penting dari ekonomi • Bbrp melihatnya spt busa(sponge) yg menyerap

sumber daya nasional scr besar2an utk membayar nakes

• Yg lainnya melihat sbg sopir perkonomian,mll inovasi & investasi dlm teknologi biomedis atau produksi & sales farmasi, atau melalui program yg menjamin kesehatan populasi yg dpt produktif scr ekonomi.

• Karena sifat alamiah pembuatan keputusan dlm kesehatan srg melibatkan masalah hidup & mati, kesehatan memiliki tempat khusus dibandingkan masalah sosial lainnya.

Mengapa Kebijakan kesehatan penting?

• Kesehatan juga di pengaruhi oleh banyak keputusan yg tdk berhub. dg yankes

• Kemiskinan mempengaruhi kesehatan orang, dmkn juga polusi, air yg terkontaminasi atau sanitasi yg buruk.

• Kebijakan Ekonomi, spt halnya pajak pd tembakau atau alkohol dpt mempengaruhi perilaku masy.

• Penjelasan saat ini utk peningkatan obesitas dikalang. Masy. Sbg contoh, trmsk promosi bahaya makanan kalori tinggi, murahnya junk food, penjualan “soft drinks” di sekolah.

Mengapa Kebijakan kesehatan penting?

• Memahami hub. Antara kebijakan kesehatan dgn kesehatan adalah penting shg kita dpt memahami bbrp masalah kesehatan saat ini spt “rising obesity, the HIV/AIDS epidemic”, “growing drug resistance” – sbgmn kita memahami bgmn kebijakan ekonomi dan kebijakan lain berdmpk pd kesehatan.

• Kebijakan kesehatan memandu pilihan ttg teknologi kesehatan yg akan di kembangkan dan digunakan, bgmn utk mengorganisir & membiayai yankes, atau jenis obat yg tersedia bebas.

• Utk memahami hub. Ini, maka penting utk memahami apa yg dimaksud dgn kebijakan kesehatan

Apakah kebijakan itu? • Kebijakan srg diartikan sbg keputusan yg diambil oleh orang2

yg bertanggung jawab utk suatu area kebijakan yg diberikan –area trsbt dpt brp kebijakan kesehatan, lingk, pendidikan atau perdagangan.

• Orang yg membuat kebijakan disebut pembuat kebijakan • Kebijakan dpt dibuat pd bnyk level – pd pemrth pusat atau

pemda, pd suatu perusahaan multinational atau usaha lokal, di sekolah atau di RS.

• Mereka trkdng di sebut juga sbg elit politik– seklmpk khusus pembuat kebijakan yg memiliki posisi tinggi di organisasi, & srng memiliki hak istimewa ke pejabat tinggi & organisasi lainnya.

• Sbg contoh, elit kebijakan di pemerintahan dpt trmsk anggota kabinet mentri, mereka dpt menghub.pimpinan puncak perusahaan multinasional atau suatu agensi internasional, mis World Health Organisation (WHO).

Kebijakan menurut PBB

• Kebijakan menurut PBB (1975) : pedoman untuk bertindak. Pedoman itu dapat sederhana atau kompleks, umum atau khusus, luas atau sempit, kabur atau jelas, longgar atau terperinci, publik atau privat, kualitatif atau kuantitatif.

Apakah Kebijakan Publik itu?

• Kebijakan dibuat pada sektor swasta dan sektor publik

• Kebijakan Publik mengacu pd kebijakan pemerintah.

• Thomas Dye (2001): public policy adalah apapun pilihan pemerintah utk melakukan atau tdk melakukan

• Dia berargumen bahwa kegagalan utk memutuskan atau bertindak pd suatu issue juga mrpkn policy.

• For example,successive US governments have chosen not to introduce universal health care, but to rely on the market plus programmes for the very poor and those over 65 years, to meet people’s health care needs.

• When looking for examples of public policy, you should look for statements or formal positions issued by a government, or a government department

• Health policy may cover public and private policies about health

Kebijakan Kesehatan

• Kebijakan atau keputusan yang berhubungan dengan masalah kesehatan.

• Kebijakan kesehatan mencakup tindakan yang mempengaruhi institusi, organisasi, pelayanan, dan upaya pendanaan sistem kesehatan

• Program aksi yang mempengaruhi tatanan institusi, organisasi, layanan dan pembiayaan yang menyusun sistem kesehatan (Buse,dkk)

Kebijakan Kesehatan

• karena kesehatan dipengaruhi oleh banyak faktor penentu dari luar kesehatan sistem, analis kebijakan kesehatan juga dipengaruhi oleh faktor-faktor –faktor dari luar sistem kesehatan, analis kebijakan kesehatan juga tertarik dengan aksi-aksi dari organisasi diluar sistem kesehatan yang memiliki dampak terhadap kesehatan (misalnya, industri makanan, tembakau atau farmasi)

Analisis Kebijakan

• Memisahkan masalah kebijakan ke dalam unsur‐unsur pokok untuk lebih memahaminya secara keseluruhan (Buse)

• Usaha untuk mengadakan informasi dalam pembuatan kebijakan

QUIZ

• Jelaskan apa yg disebut:

• Kebijakan, kebijakan publik, kebijakan kesehatan

• Berikan contohnya utk masing-masing item

Politik & Kebijakan Kesehatan

• Politik tidak dapat dipisahkan dari kebijakan kesehatan

• Jika ada menerapkan ilmu epidemiologi, economi, biology atau profesi lain yang menerapkan pengetahuan teknis ke kehidupan sehari-hari, akan terpengaruh oleh politik

• No one is unaffected by the influence of politics.

Contoh

• Ilmuwan harus fokus pada risetnya ttg siapa yg akan mendanai, daripada mempertanyakan apa yg akan mereka eksplorasi;

• Dlm meresepkan obat, dokter hrs mempertimbangkan konflik potensial antara manajer RS, peraturan peme dan kemampuan pasien utk membayar

• Dokter srg di datangi oleh sales obat dari perusahaan farmasi yg membujuknya utk meresepkan obat ttt dgn iming2 insentif.

• Sebagian besar aktivitas adalah subyek dari arus politics.

Segitiga Kebijakan Kesehatan

The health policy triangle • Segitiga kebijakan kesehatan mrpkn pndktn yg paling sederhana

trhdp tatanan rumit dari inter-relationships, & dpt memberikan impressi bhw ke -4 faktor dpt di pisahkan.

• Pdhl tdk demikiankenyataannya • Aktor (sbg individu agau anggota organisasi) dipengaruhi konteks

dimana mereka hidup dan bekerja, konteks di pengaruhi oleh banyak faktor spt instabilitas or ideology, oleh sejarah & budaya;

• Proses pembuatan kebijakan – bgmn isu mjd agenda kebijakan, bgmn pendanaannya – dipengaruhi oleh aktor, posisinya di struktur kekuasaan, nilai & harapan mereka.

• Kontent kebijakan merefleksikan sebagian atau seluruh dimensi ini. • Segitiga kebijakan berguna utk membantu berfikir scr systematik

ttg seluruh faktor yg berbeda yg dpt berdampak pd kebijakan, • it is like a map that shows the main roads but that has yet to have

contours, rivers, forests, paths and dwellings added to it.

The Actors Who Make Policy

• Aktor mrpkn pusat dari kebijakan kesehatan (lihat gambar segitiga kebijakan)

• Aktor : individu (Nelson Mandela, the ex-President of South Africa, for example), organisasi (World Bank or multinational companies such as Shell atau pemerintah pusat.

• this is a simplification. • Individuals cannot be separated from the

organizations within which they work • any organization or group is made up of many

different people, not all of whom speak with one voice and whose values and beliefs may differ

The Actors Who Make Policy

• Sometimes many different groups get together to demonstrate strong feelings about particular issues – these are called social movements or people’s movements.

• In international relations it has been customary to talk about non-state actors (actors outside government).

• Political scientists talk about interest or pressure groups. • In the development literature these groups are usually referred to

ascivil society organizations (organizations which fall between the state and the individual or household).

• What differentiates all these actors from government or state actors is that they do not seek formal political power for themselves, although they do want to influence those with formal political power.

Tugas

• Make a list of the different actors who might be involved in health policy on HIV/AIDS in your own country.

• Put the actors into different groups.

Contextual factors that affect policy

• Context refers to systemic factors – political, economic and social, both national and international – which may have an effect on health policy.

Faktor situasi

• Situational factors are more or less transient, impermanent, or idiosyncratic conditions which can have an impact on policy (e.g. wars, droughts).

• These are sometimes called ‘focusing events’. • These may be a specific one-off occurrence, such as an

earthquake which leads to changes in hospital building regulations, or much longer diffused public recognition of a new problem.

• For example, the advent of the HIV/AIDS epidemic (which took time to be acknowledged as an epidemic on a world scale) triggered new treatment and control policies on tuberculosis because of the inter-relationship of the two diseases – people who are HIV-positive are more susceptible to diseases, and latent tuberculosis may be triggered by HIV.

Faktor struktural • Faktor struktural mrpkn elemen yg relatif tdk berubah dlm

masyarakat. • Yaitu:sistem politik; • Faktor struktural dpt trmsk jenis ekonomi & basis pekerjaan. • Cth: upah perawat rendah, sdktnya lap.pekerjaan tersedia utk

tenaga kerja terlatih, profesional krn migrasi ke negara lain. • Faktor struktural yg dpt mempengaruhi kebijakan kesehatan trmsk

demographic features or technological advance. • For example, countries with ageing populations have high hospital

and drug costs for the elderly, as their needs increase with age. • Technological change has increased the number of women giving

birth by caesarian section in many countries. • Among the reasons given are increasing professional reliance on

high technology that has led to reluctance among some doctors and midwives to take any risks, and a fear of litigation.

• And of course, a country’s national wealth will have a strong effect on which health services can be afforded

Faktor Budaya

• Dlm masy dimana hirarki formal mrpkn hal yg penting, sulit utk mempertanyakan atau menegur pejabat tinggi atau pejabat yg lebih tua.

• Posisi etnis minoritas atau perbedaan bahasa dpt memicu sekelompok org tdk terinformasi ttg hak mereka, atau tdk terpenuhinya hak mereka.

Faktor internasional atau faktor eksogenous

• International or exogenous factors which are leading to greater inter-dependence between states, and influencing sovereignty and international cooperation in health.

• Although many health problems are dealt with by national governments, some need cooperation between national, regional or multilateral organizations.

• For example, the eradication of polio has taken place in many parts of the world through national and regional action, sometimes

with the assistance from international organizations such as WHO. • even if one state manages to immunize all its children against polio,

and to sustain coverage, the polio virus can be imported by people who have not been immunized crossing the border from a neighbouring country

Proses Pembuatan Kebijakan

• Process refers to the way in which policies are initiated, developed or formulated,negotiated, communicated, implemented and evaluated. The most common approach to understanding policy processes is to use what is called the ‘stages heuristic’ (Sabatier and Jenkins-Smith 1993).

Tahapan Pembuatan Kebijakan Problem identification and issue recognition: explores how issues

get on to the policy agenda, why some issues do not even get discussed.

• Policy formulation: explores who is involved in formulating policy, how policies are arrived at, agreed upon, and how they are communicated .The role of policy making in government

• Policy implementation: this is often the most neglected phase of policy making and is sometimes seen as quite divorced from the first two stages. However, this is arguably the most important phase of policy making because if policies are not implemented, or are diverted or changed at implementation, then presumably something is going wrong – and the policy outcomes will not be those which were sought.

• Policy evaluation: identifies what happens once a policy is put into effect – how it is monitored, whether it achieves its objectives and whether it has unintended consequences. This may be the stage at which policies are changed or terminated and new policies introduced.