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Abstrak :
The World Health Report (WHR) 2000, which focused on improving health system performance, has been a lot of pro and cons. This article assesses critically the WHR 2000 for Indonesia health system. It discusses the elements of WHO evaluation model, weighting the indicators used, the variables measure, and sources of data. Of 191 countries in the world, Indonesia has attained the total rank of 106, while the level of health and distribution of health was in the rank of 103 and 156, respectively. Furthermore, the rank of health financing responsiveness and fairness was in 63-64 and 73, respectively. Meanwhile, health expenditure indicator rank was in 154 with the performance of Indonesia national health system for level of health was in 90. Overall, the rank of health system performance for Indonesia was in 92. Nevertheless, there are five critics to the WHR 2000 for Indonesia, namely, issues of obtaining the right data, method to assess responsiveness, fair financing calculation, limitation of scientific value, and further discussion on political agenda and method for assessing health system performance. Despite the limitations on methods and framework used, however, the WHR 2000 has influenced countries to prioritize the health system attainment and performance. This article recommends the necessity of comprehensive health system monitoring and evaluation with sustainable policy.

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Laporan Kesehatan Dunia (LKD) tahun 2000, yang memfokuskan pada program peningkatan kinerja sistem kesehatan, mengundang banyak pro dan kontra. Artikel ini menilai secara kritis laporan tersebut terhadap sistem kesehatan nasional Indonesia. Artikel ini membahas unsur-unsur model evaluasi WHO, pembobotan indikator yang digunakan, ukuran variabel, dan sumber data. Sebanyak 191 negara di dunia, Indonesia telah mencapai total peringkat 106, dengan tingkat kesehatan dan distribusi kesehatan masing-masing pada posisi 103 dan 156. Lebih lanjut, ketanggapan dan keadilan pembiayaan kesehatan masing-masing berada pada peringkat 63-64 dan 73. Sementara itu, indikator pengeluaran kesehatan berada pada peringkat 154 dengan kinerja Sistem Kesehatan Nasional Indonesia untuk tingkat kesehatan menduduki peringkat 90. Ssecara keseluruhan, sistem kinerja kesehatan Indonesia berada pada peringkat 92. Namun, ada 5 kritik terhadap LKD tahun 2000 untuk Indonesia yang meliputi masalah cara memperoleh data yang benar, metode menilai ketanggapan, perhitungan pembiayaan yang wajar, keterbatasan nilai ilmiah dan diskusi lebih lanjut tentang agenda politik dan metode untuk menilai kinerja sistem kesehatan. Meskipun memiliki keterbatasan metode dan kerangka yang digunakan, LKD 2000 telah mempengaruhi banyak negara untuk memprioritaskan pencapaian dan kinerja sistem kesehatan mereka. Artikel ini menyarankan perlunya pemantauan dan evaluasi sistem kesehatan yang komprehensif dengan kebijakan yang berkelanjutan.

Abstrak :
Research is a systematic search for information and new knowledge. It serves two essential and powerfull purposes in accelerating advances in health. First, basic or traditional research is necessary to generate new knowledge and technologies to deal with major unresolved health problems. Second, applied research is necessary to the process of identifying priority problems and to designing and evaluating policies and programs that will be of the greatest health benefit, using existing knowledge and available resources, both financial and human. During the past decade, concepts and research approaches to support health development have evolved rapidly. Many of these have been described by specific terms such as operations research, health services research, health manpower research, policy and economic analysis, applied research, and decision-linked research. Each of these has made crucial contributions to the development of Client-Oriented Research or Health Systems Research (HSR). HSR is ultimately concerned with improving the health of a community, however defined, by enhancing the efficiency and effectiveness of the health system as an integral part of the overall process of socioeconomic development. The aim of Client-Oriented Research or HSR is to provide health managers at all levels with the relevant information that they need to solve the problems they are facing. The participatory nature of such research is one of its major characteristics. Because HSR addresses health problems in the broad context of social, economic, and community development, research inputs from many different disciplines are required. These include demography, epidemiology, health economics, policy and management sciences, social and behavioral sciences, statistics, and some aspects of the clinical sciences. With progressive development, the uses of HSR are becoming more widely appreciated. As a result, it is being integrated into and applied in special areas of management such as quality assurance, technology assessment, and resource management.

Abstrak :
The endurance of the nation means the concept and strength of maintaining national resilience that covers its existence in the midst of civilization and strategic environmental changes, towards the dynamic conditions of national resilience for maintaining order, stability and the potential for change (the stability idea of changes). The challenges and problems of national resilience are dynamic variants that require comprehensive thinking on systems, policies and the strategy on national behavior (behavior science), which supported by patriotism and the energy of national health security towards the role of the TNI to fill the zones and accumulation of health development that illustrate the performance of national self-sufficiency and national. The struggle of the nation’s health in the perspective of structural and participatory strength starts with the ability to drive leadership, metabolic health community and agent of change that meets the reliability value of High Reliability Organization (HRO). The reliability that is formed will trigger the innovation and out of the box spirit to assemble a network (networking) for change, so that it is manifested as a performance of professional reliability that heightens the potential of the nation’s health and national resilience. Synergy of the National Health System (SKN) and the Defense Health System (Siskeshan) is a web of links to support the effort on the empowerment of the strategic value of national health.This strategy strengthens the national health network (one health) against the global health threats complexity that threaten the national resilience. The existence of Public Health Emergency global challenges in a form of outbreaks which spreads rapidly with unpredictable problematic, that triggers every nation to strengthen the nation struggle for synergizing the health development under the basis of national defense system.

Abstrak :
WHO memiliki target untuk mengeliminasi tuberkulosis pada 2035. Pembangunan dunia bebas TB tidak cukup dengan perluasan cakupan penegakkan diagnosis dan pengobatan saja, melainkan butuh sistem kesehatan yang bermutu tinggi di dalamnya. Rumah Sakit Khusus Paru Kabupaten Karawang sebagai rumah sakit rujukan TB di Kabupaten Karawang yang diharapkan dapat membantu eliminasi TB di Kabupaten Karawang. Penelitian ini bertujuan untuk melakukan optimalisasi mutu pelayanan TB dengan menggunakan kombinasi Framework High Quality Health System dan Quality of Tuberculosis Service Assessment. Penelitian ini merupakan penelitian studi kasus dengan pendekatan kualitatif untuk menganalisis mutu pelayanan TB mulai dari segi pondasi sistem pelayanan tuberkulosis, proses perawatan serta dampak mutu pelayanan tuberkulosis. Data primer didapatkan melalui wawancara mendalam dengan pemangku jabatan, penyedia pelayanan kesehatan dan pasien serta observasi lapangan. Data sekunder didapatkan dari data kunjungan, laporan serta SPO yang digunakan dalam pelayanan TB. Hasil penelitian didapatkan bahwa dari segi pondasi sistem pelayanan tuberkulosis masih memiliki kelemahan di aspek penganggaran khusus penanggulangan TB, sosialisasi kebijakan pelayanan TB serta peningkatan jejaring internal dan eksternal. Proses perawatan tuberkulosis yang berjalan masih kurang dari segi komunikasi interaksi pasien-penyedia pelayanan di Instalasi Rawat Inap serta monitoring follow up pasien sehingga mengakibatkan hambatan dalam pelayanan. Sehingga permasalahan dari segi pondasi dan proses perawatan yang bermutu kurang baik memberikan dampak berupa rendahnya angka keberhasilan pengobatan pasien TB serta adanya peningkatan pasien loss to follow up, tidak dievaluasi dan meninggal dunia. Penguatan pondasi sistem kesehatan tuberkulosis disertai implementasi proses perawatan yang berkelanjutan dan terintegrasi akan menghasilkan hasil pengobatan yang baik serta kepuasan bagi pasien. ......By 2035, the WHO aims to end TB. Expanding diagnosis and treatment options alone won't be enough to create a world free of TB, but it requires a high-quality health system within it. Karawang Lung Hospital serves as a TB referral hospital and is anticipated to aid in the eradication of TB in Karawang Regency. This study aims to optimize the quality of TB services by using a combination of the High Quality Health System Framework and the Quality of Service Tuberculosis Assessment. This study is a case study with a qualitative approach to analyze the quality of TB services starting from the foundation of the tuberculosis service system, the treatment process and the impact of the quality of tuberculosis services. Primary data were obtained through in-depth interviews with stakeholders, health service providers and patients as well as field observations. Secondary data was obtained from visit data, reports and procedurs used in TB services. The results of the study showed that in terms of the tuberculosis service system, it still has weaknesses in the aspect of special budgeting for TB control, policies on socializing TB services and increasing internal and external networks. The current tuberculosis treatment process is still lacking in terms of patient-service provider interaction in the Inpatient Unit and patient follow-up monitoring resulting in obstacles in service. So that problems in terms of treatment and care processes that are of poor quality have an impact in the form of a low success rate of treatment for TB patients as well as an increase in patient loss to follow-up, not being evaluated and death. Strengthening the foundation of the tuberculosis health system along with implementing a sustainable and integrated treatment process will result in good treatment outcomes and patient satisfaction.

Abstrak :
Penelitian ini menjelaskan mengenai dinamika kebijakan deregulasi obat yang dimulai dengan dikeluarkannya Peraturan Menteri Kesehatan RI Nomor 085/MENKES/Per/I/1989 dengan menggunakan metode penelitian sejarah. Metode penelitian sejarah terdiri dari heuristik, verifikasi, interpretasi, dan historiografi. Sejak tahun awal dari Orde Baru, harga obat di Indonesia terbilang mahal. Untuk memperbaiki situasi dan meningkatkan kesehatan masyarakat, maka Menteri Kesehatan dr. Adhyatma MPH menerapkan Peraturan Menteri Kesehatan RI Nomor 085/MENKES/Per/I/1989 tentang Obat Generik yang berguna untuk mendorong distribusi obat generik. Dengan dikeluarkannya kebijakan ini, masyarakat diharapkan dapat mengakses obat dengan mudah dan juga merasionalkan penggunaan obat. Deregulasi obat tidak hanya berusaha untuk mempermudah akses terhadap obat murah, tetapi juga sebagai langkah awal dalam perbaikan sistem kesehatan Indonesia. Penelitian ini juga membahas mengenai reaksi dari pabrik farmasi dan pengusaha apotek yang terpengaruhi dari kebijakan deregulasi obat ini. Pada akhirnya, kebijakan ini belum berhasil secara maksimal karena harga obat yang belum turun. Namun, kebijakan ini berhasil memberikan obat alternatif yang murah, meskipun baru bisa didapatkan di rumah sakit pemerintah. ......The purpose of this study was to explain the dynamics of drug deregulation policy which began with the issuance of the Minister of Health’s regulation 085/MENKES/Per/I/1989 using historical research methods. The historical research methods consist of heuristics, criticism, interpretation, and historiography. Since the start of the New Order, the price of medicine in Indonesia has been quite expensive. The Minister of Health, dr. Adhyatama MPH tried to fix the problem and improve public health by applying the Regulation of the Minister of Health of the Republic of Indonesia, numbered 085/MENKES/Per/I/1989, concerning generic drugs which is useful for encouraging the distribution of generic drugs. With the issuance of this policy, it is hoped that the public can access drugs easily and also rationalize the use of drugs. The drug deregulation was not focused only on how to make drugs cheaper, but also a start in effort to fix the health system in Indonesia. This study also discusses the reaction of pharmaceutical manufacturers, pharmacists, and pharmacies to the deregulation and its effect. In the end, this policy still cannot reduce the price of drugs in the market. Though, this policy has succeeded in providing cheaper drugs as an alternative, even if it is only in the government funded hospital.

Abstrak :
Kasus HIV dan AIDS di Indonesia terus meningkat. Sementara untuk penularan dari ibu ke bayi atau anak, jika tidak dilakukan intervensi program PPIA, kemungkinan penularannya akan lebih besar. Tujuan penelitian ini adalah untuk menjelaskan peran penentu baik bidang kesehatan dan non kesehatan dalam pelaksanaan program PPIA. Penelitian ini adalah penelitian kualitatif dengan mengambil lokasi di Kabupaten Jayawijaya. Teknik pengumpulan data menggunakan data primer yaitu melalui wawancara mendalam, observasi dan dokumentasi sedangkan data sekunder berasal dari survei fasilitas kesehatan yang dilakukan di Papua. Jumlah informan adalah 11 orang. Hasil penelitian ini menggambarkan pelaksanaan program PPIA dilihat dari peran sistem kesehatan masih kurang memadai. Mengingat luasnya wilayah dan kesulitan akses ke pelayanan kesehatan, Pemerintah Daerah perlu segera melakukan perluasan layanan PPIA yang komprehensif, pemberian Obat ARV pada ibu hamil dan kebutuhan reagen, serta dukungan psikososial pada ODHA.

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HIV and AIDS cases are increasing progressively. Especially on HIV transmission from mother to child, the possibility is greater than others if we do not apply PMTCT intervention. The objective of this research is to determine role of health system to the implementation of PMTCT. This is qualitative research located in Jayawijaya district. Primary data is collected through in depth interview, observation, and documentation, while secondary data is collected based on health facilities survey in Papua. The informant of this research is 11 people. This research is resulting insufficient PMTCT coverage due to the weak of health system. Access to health facilities is still challenging, so local government is required to provide and expand comprehensive PMTCT services, ensuring provision of HIV related commodities to people living with HIV.

Abstrak :
Sistem kesehatan merupakan salah satu isu global yang telah terjadi di banyak negara di dunia sejak lama. Berbagai upaya telah dilakukan oleh pemerintah untuk meningkatkan pelayanan kesehatan bagi warganya yang salah satunya yaitu dengan menerapkan undang-undang baru. Salah satu mekanisme yang diterapkan dari undang-undang tersebut yang digunakan oleh pemerintah adalah disebut juga sebagai sistem jaminan sosial. Skripsi ini menjelaskan penelitian mengenai perbandingan dan analisis antara Obamacare di Amerika Serikat dan Jaminan Kesehatan Nasional di Indonesia dibawah kelola skema BPJS Kesehatan. Tujuan dari penelitian skripsi ini adalah untuk membandingkan skema Obamacare di Amerika Serikat dan Jaminan Kesehatan Nasional di Indonesia. Penelitian skripsi ini menggunakan pendekatan normatif untuk mengelaborasi perbandingan dan analisis dalam hal keanggotaan, perawatan medis dan layanan yang dicakup, penyedia perusahaan asuransi, subsidi pemerintah, dan penyedia jaringan layanan kesehatan. Hasil penelitian skripsi ini menyajikan kesamaan yang signifikan dalam dasar pemikiran jaminan kesehatan dan pelayanan kesehatan dasar. Namun, terdapat juga perbedaan signifikan dalam hal skema, konsep, peratutan, dan pasar jaminan kesehatan. ...... Health system is a global issue that has occurred in many countries around the world since long time ago. Various attempts have been made by the government to improve health care for its citizens, one of which is by implementing new laws. One of prominent mechanism used by the government is called as social security system. The research elaborate the comparison and analysis between Obamacare and National Health Insurance (JKN) under Healthcare Social Security (BPJS Kesehatan) scheme. The objectives of this research are to compare the scheme of Obamacare in the United States and National Health Insurance (JKN) in Indonesia. The research use the normative approach to elaborate the comparison and analysis in respect of membership, medical treatment and services covered, insurance company providers, government subsidies, and network health providers. In conclusion, this research presents the significant similarities in the rationale of health security and basic health services. Thus, the significant differences also presented in the matters of schemes, concept, regulations, and the market of health security.

Abstrak :
The Preamble and the Directive Principles of Indias Constitution provide for state intervention for assuring every citizens health and well-being. Yet India has wide disparities and inequalities in the standard of living, with two-thirds of the people without access to tap water and a clean toilet, a third malnourished, over a million children dying before reaching the age of five, and millions dying due to communicable diseases that are treatable at an incredibly low cost. Despite insuring schemes, every year over 60 million are impoverished due to the high cost of care. This is due to abysmal spending on health, weak governance, and poor leadership. Clearly, India has failed to forge a political system founded on the principle of a social contract where ensuring universal access to fundamental public goods-clean air, safe water, sanitation, hygiene, nutritious food and basic healthcare, and security against health-expenditure shocks-is visualized as its primary obligation, not an option. In deeply stratified societies like ours where gender, caste, religion, and residence create barriers that cannot be overcome by individual effort, the negotiating presence of a strong and assertive state becomes necessary. This book discusses the evolution of Indias health policy, followed by a comprehensive discussion on financing and governance in health, and contains two stories about Indias struggle to reverse the HIV/AIDS epidemic and revitalizing the primary healthcare system in rural areas under the National Rural Health Mission (NRHM). Finally, it assesses what the future focus should be. It is based on the authors understanding of the health sector acquired over two decades of engagement in various capacities.