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"Health problems in districts can be caused by political dynamics in a decentralized era. This study analyzes the political dimension in health policy making in districts in East Java. Phenomenological qualitative approach is used with case study design. The results showed that political interests affect planning-budgeting, selection of executive officers, and procurement of goods and services in the health sector. Head of the health district office and director of the district hospital act as the agent whereas the district mayor and the legislature act as the principles. Not only principle-agent relationship is influenced by relationship between institutions and interpersonal relationship, it is also inflenced by personal values of the political elite and actor concerning health issue. Those three factors influence and intervene the decision space in health policy making. Non-political elites such as business people and invisible hand also influence the decision space. Political skill, a term which has no relation whatsoever in practical politics behavior that refers to a package of specific strategies and skills which in this case assists health policy actor in achieving public health main goals, directs policy making in accordance with health normative goal. Political skill should be adopted as a prerequisite competence for district-level structural officials in health sector.

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Masalah kesehatan kabupaten/kota dapat disebabkan oleh dinamika politik di era desentralisasi. Penelitian ini menganalisis dimensi politik dalam penentuan kebijakan kesehatan kabupaten/kota di Jawa Timur. Pendekatan kualitatif fenomenologi digunakan dengan rancangan studi kasus. Hasil penelitian menunjukkan kepentingan politik mewarnai perencanaan-penganggaran, penentuan pejabat dan pengadaan barang-jasa di sektor kesehatan. Kepala dinas kesehatan dan direktur RSUD merupakan agen sedangkan kepala daerah dan DPRD adalah prinsipal. Selain dipengaruhi oleh hubungan antarkelembagaan dan hubungan interpersonal, pola hubungan prinsipal-agen yang ada juga dipengaruhi oleh personal values elit dan aktor politik tentang kesehatan. Ketiga hal tersebut secara bersama dapat memengaruhi dan mengganggu decision space pada proses penentuan kebijakan kesehatan. Kehadiran elit nonpolitik yaitu pelaku bisnis dan the invisible hand juga mempengaruhi decision space tersebut. Political skill sebagai sebuah paket strategi dan ketrampilan yang dimiliki oleh pelaku kebijakan kesehatan demi tercapainya tujuan utama kesehatan masyarakat dan tidak berkaitan sama sekali dengan perilaku politik praktis yang dimiliki oleh pelaku kebijakan kesehatan mengarahkan penentuan kebijakan sesuai tujuan normatif kesehatan. Parameter political skill hendaknya diadopsi sebagai syarat kompetensi bagi pejabat struktural di kabupaten/kota, khususnya di sektor kesehatan."

"Ketersediaan obat baru di Indonesia masih didominasi oleh produk impor dan terbatasnya industri farmasi yang menghasilkan obat berbasis riset walaupun pemerintah telah melakukan intervensi regulasi. Industri farmasi lebih banyak melakukan formulasi dan/atau pengemasan obat dibandingkan memproduksi obat berbasis riset. Produksi obat berbasis riset dibutuhkan untuk menjamin keberlangsungan ketersediaan obat. Penelitian ini bertujuan membangun model kebijakan yang mampu memprediksi dampak pengembangan obat berbasis riset di Indonesia. Penelitian dengan pendekatan kros seksional ini menggunakan metode kuantitatif dengan melakukan survei terhadap industri farmasi dan penentu kebijakan pengembangan obat di Indonesia; dan metode kualitatif dengan melakukan kajian masalah dari dokumen kebijakan dan wawancara terstruktur. Model kebijakan ditetapkan berdasarkan analisis pengaruh variabel kapabilitas industri farmasi dengan variabel mekanisme insentif dari pemerintah terhadap konteks fisibilitas politik yang mempengaruhi pengembangan obat berbasis riset, dengan pengukuran yang dilakukan terhadap indikator-indikator yang merefleksikan variabel tersebut. Model kebijakan diuji menggunakan structural equation modeling. Identifikasi kesenjangan (gap analysis) dilakukan sebagai upaya untuk meminimalkan perbedaan pandangan antara industri farmasi dan pemerintah terhadap kapabilitas industri farmasi dan mekanisme insentif dari pemerintah. Analisis determinan kebijakan dan dampak dilakukan untuk memprediksi keberhasilan model tersebut dalam memberikan dampak.Hasil penelitian membuktikan bahwa kapabilitas industri farmasi, konteks fisibilitas politik, dan mekanisme insentif inovasi yang spesifik untuk kapabilitas industri farmasi, merupakan variabel yang berpengaruh kuat untuk memberikan dampak pengembangan obat berbasis riset, dengan indikator yang paling kuat memberikan pengaruh adalah peluang pasar, faktor penarik inovasi, sumber daya pemerintah dan program nasional. Walaupun hasil penelitian juga membuktikan bahwa regulasi, kapasitas industri farmasi, karakteristik obat, peluang pasar, faktor pendorong inovasi, faktor penarik inovasi, faktor penarik regulasi, aktor kebijakan, nilai kebijakan, sumber daya pemerintah dan program nasional merupakan indikator yang memberikan pengaruh dalam pengembangan obat berbasis riset, namun indikator-indikator ini belum mampu menjadi pengungkit dan memberikan dampak terhadap pengembangan obat berbasis riset di Indonesia. Prioritas kebijakan dan perbaikan harus segera dilakukan pada regulasi, peluang pasar, dan mekanisme insentif inovasi sehingga pengembangan obat yang diharapkan dapat terjadi.

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Indonesia`s supply of new drugs currently relies on imported drugs. Pharmaceutical companies appear to be hesitant to transform from being an inventor to being an innovator, and instead continue the process of formulation and packaging. Government regulation intervention has not led to any significant changes. Drug development involves the creation of an innovative drug that is not yet available in the country. Domestic development is needed to ensure sustainability of the access to research-based drug and to reduce the price of that drug that is currently imported. This study aims to develop a policy model that is strategically able to predict an outcome of investment in research-based drug development. Several factors that could trigger domestic research-based drug development were explored and incorporated into a predictive model of an innovation policy. A data collection in this cross-sectional study used a quantitative and qualitative method to explore the policy making process. Data was collected using a structured questionnaire to pharmaceutical companies and policy makers, and also a document review and indepth interview. The process of modeling the policy was established based on the functional relationships between factors related to the capability of pharmaceutical companies in the development of research-based drug and government incentives to political feasibility to predict a drug development, validated using a set of techniques pertaining to the calculation of structural equations. Gap analysis was an effort for examining the similarities and differences in perceptions of capability of pharmaceutical companies and incentive mechanism to accelerate research-based drug development. The findings provided empirical insights on the gaps that can arise from inconsistent perceptions of potential and current situations between pharmaceutical companies and policy makers. The alignment between policy recommendations and intended outcomes was then analyzed using analysis of determinants of policy impact.

The study proves that pharmaceutical company capabilities, political feasibility and innovation incentives correlated to pharmaceutical company capabilities are major catalysts that encourage pharmaceutical companies to invest more in drug development, majorly explained by market opportunities, pull factors, government resources and national program. Although the study proves that regulation, pharmaceutical company capacities, drug characteristics, market, push-pull-regulatory pull factors, actors, values, government resources and national program are strong indicators relating to drug development, the study reveals that those indicators are not yet able to become leverage and make impact to drug development. Special attention on policy priorities and improvements have to be put on regulation, market opportunities, and push-pull-regulatory pull factors to make impact on drug development in Indonesia."

"Pendahuluan: Keselamatan pasien merupakan suatu sistem yang menjamin pasien aman dari insiden. Perawat sebagai bagian dari sistem pelayanan kesehatan wajib menerapkan sasaran keselamatan pasien (SKP). Dibutuhkan instrumen yang bersifat proaktif mencegah insiden. Penelitian ini bertujuan untuk mengembangkan instrumen faktor prediktor kepatuhan perawat dalam melaksanakan SKP di rumah sakit. Metode: Tahap 1 merupakan pengembangan item instrumen dengan 3 fase: wawancara, expert judgement, dan uji keterbacaan. Tahap 2 yakni uji validitas dan reliabilitas instrumen dengan pendekatan cross sectional menggunakan dua analisis data, yakni Confirmatory Factor Analysis (CFA) dan regresi linier berganda. Partisipan dalam fase wawancara menggunakan perawat pelaksana dan perawat manajer. Uji validitas dan reliabilitas instrumen melibatkan perawat pelaksana dengan jumlah sampel 100 responden. Variabel dependen yakni kepatuhan perawat dalam melaksanakan SKP di rumah sakit. Hasil: Sebanyak 16 faktor dan 63 item dihasilkan dari tahap 1 penelitian. Uji CFA menyebutkan bahwa seluruh faktor, termasuk variabel kepatuhan perawat dalam melaksanakan SKP dinyatakan valid dan reliabel dengan model yang dinyatakan dalam rentang good fit hingga perfect fit. Hasil analisis regresi linier pada uji t menyimpulkan bahwa hanya delapan faktor yang memiliki pengaruh terhadap kepatuhan, antara lain: sarana prasarana, kesadaran diri, niat, professional habit, komitmen, imbalan, kepemimpinan, serta tuntutan dan reputasi rumah sakit. Pada uji f menyimpulkan bahwa semua faktor tersebut menghasilkan 51,1% potensial memengaruhi kepatuhan perawat. Saran: Manajer keperawatan rumah sakit direkomendasikan untuk menggunakan instrumen ini untuk memperkuat sistem pencegahan insiden oleh perawat pelaksana.

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Introduction: Patient safety is a system that ensures patients are safe from incidents. Nurses, as part of the health service system, are obliged to implement patient safety targets (SKP). We need instruments that are proactive in preventing incidents. This research aims to develop an instrument for predicting factors of nurse compliance when implementing SKP in hospitals. Method: Stage 1 is the development of instrument items with 3 phases: interview, expert judgment, and readability test. Stage 2 is testing the validity and reliability of the instrument with a cross-sectional approach using two data analyses, namely confirmatory factor analysis (CFA) and multiple linear regression. Participants in the interview phase were nurse practitioners and nurse managers. Testing the validity and reliability of the instrument involved implementing nurses with a sample size of 100 respondents. The dependent variable is nurses' compliance with implementing SKP in hospitals. Results: A total of 16 factors and 63 items were generated from phase 1 of the research. The CFA test states that all factors, including the nurse compliance variable in implementing SKP, are declared valid and reliable with the model stated in the range of good fit to perfect fit. The results of the linear regression analysis on the t test concluded that only eight factors had an influence on compliance, including: infrastructure, self-awareness, intention, professional habit, commitment, rewards, leadership, as well as hospital demands and reputation. The f test concluded that all these factors produced 51.1% of the potential to influence nurse compliance. Suggestion: Hospital nursing managers are recommended to use this instrument to strengthen the incident prevention system by implementing nurses."