"Sejalan dengan gencarnya isu reformasi, desentralisasi dalam bcntuk otouomi
daerah menj adi tuntutan banyak pihak_ Pada akhirnya, pemberlakuan otonomi daerah ini
akan membawa dampak hagi bidang kesehatan, yang sa\ah satunya adalah Puskesmas.
Maka dari itu, mengantisipasi kemungkinan timbulnya masalah yang lebih besar,
Puskesmas diarahkan menj adi unit swadana daerah.
Berkaitan dengan hal di atas, penelitian ini bertujuan untuk mengidentiiikasi
transformasi Puskesmas Swadana, dengan fokus kajian pada proses perencanaan dan
pengeiolaan penerimaan fungsionnl pada Puskcsmas Swadana di DK] Jakarta, tepatnya
di Puskesmas Kecamatan Tebet dan Jatinegam. Proses perencanaan dan pengclolaan
pcnerimaan fungsional ini akan dibandingkan secara vertikal dan horisontal
Penelitian ini merupakan studi kasus dengan menggmmakan pendekatan
kualitatif Data diperoleh melalui observasi, penelusuran data sekunder, dan wawanoara
mendalam dengan 10 [nforman di Puskesmas Kecamatan Tebet dan 6 informan di
Puskesmas Kecamatan Jatinegnra. Informan ini adalah orang-orang yang berkepentingan
dan memahami proses pembahan yang texjadi di kedua Puskesmas ini ketika menjadi
Puskesmas Swadana - meskipun dalam SK Gubemur No. 39 Tahun 2000 masih disebut
sebagai uji coba unit swadana daerah.
Hasil penelitian menunjukkan bahwa secara persamaan antara sebelum
dan sesudah swadana adalah proses perencanaan mengikuti tahapan-tahapan mulai dad
analisis situasi sampai pada penyusmman rencana operasional dan sumber peneximaan fungsional berasal dan reuibusi pasien. Sementara ing perbedaan antara sebelum dan
sesudah menjadi Puskesmas Swadana antara lain bahwa setelah menjadi Puskesmas
Swadana terdapat kemandirian dalam proses percncanaan (bottom up planning;
integrated planning with budgetting dan target-based budgettfng), pengelolaan 100%
penerimaan fimgsional, berlaku reward system, kapasitas sumber daya manusia
diperhatikan, dan perubahan struktur organisasi yang lebih disesuaikan dengan
kebutuhan, dibandingkan bila sebelum swadana, tidak ada kemandirian dalam proses
perencanaan (top dawn planning, _fragmented planning with budgetting dan budget-
based activities), tidak memiliki wewenang dalam xnengelola penerimaan fmmgsional
(l00% disetor kc kas daerah), tidak berlaku reward system secara jelas, pautisipasi staf
rendah dan struktur organisasi sama dengan struktur organisasi Puskesmas lainnya di
Indonesia.
Hasil penelitian juga menunjukkan bahwa di antara kedua Puskcsmas swadana
jugs mcmiliki persamaan mendasar, antara lain kemandirian proses perencanaan
(bottom up planning, integrated planning with budgetting target-tiased activities),
pengelolaan pcnerimaau imgsional (sistem sam pintu, transparan, ada kriteria
pexnbagian insentif), proses dimulainya keswadanaan (1 April 2000), legal aspect (SK.
Gubernur No. 39 Tahun 2000) dan tahapan-tahapan yang dilalui untuk mcnjadi
Puskesmas Swadana (tahap intemal dan ekstemal). Sementara itu, perbedaannya terletak
pada optimalisasi partisipasi staf pada proses permcanaan (tinggi vs. cukup tinggi,
teamwork solid vs. kurang solid, dukungan tinggi vs. rendah, manajemen partisipatif vs.
representative), pola dalam pengelolaan pcnedmaan fungsional (sentralistik vs_
desentralistik), kedisiplinan staf (ketat vs. longgar, sistem amano vs. absen tertulis),
teknik pencatatan keuangan (komputerisasi vs manual), proses keswadanaan (sudah slap
sebelumnya vs. bclum begitu siap sebelumnya), perubahan (segmental vs. mcnyeluruh),
serta pola pembagian insentif Pada dasamya, Puskesmas Swadana membawa banyak
manfaat, - texutama bagi peningkatan kemandirian dan mutu pelayanan -, sehingga dapat
dikembangkan lcbih lanjut pada masa mendatang.
Abstract Reformation issues has pointed desentralization willing in an district
autonomous type being larger. At last, this district autonomous will bring some impacts
to health sector, like public health centre. Therefore, to anticipate the bigger problems,
public health centre is directed to self financed organization.
This research aims at identifying self financed public health centre
transformation, focused at planning and revenue management process. This reaserch is
located at self financed public health centre in Jakarta, those are Tebet and Jatinegara.
Both of process will be compared lvertically and horizontally.
This research is case study with qualitative approach It used observation,
secondary data collection, and indepth interview to collect data. Indepth interview was
conducted with ten informants in Tebet Public Health Centre and six informants in
Iatinegara Public Health Centre. They were chosen because they had been considered
lmow well about the process explored. For information, these Public Health Centres is
called self iinanced, although the Decree of District Government is still in the process.
The results show that generally, there are the some processes that similar before
and afier become self financed public health centre, they are 1). Planning process
follows the same steps from situational analysis to plan of action arrangement and 2).
The revenue is gotten hom patients retribution. The diierences are that alter become an
self financed organization their planning process use bottom up planning approach more,
integrated planning with budgetting and target-based budgetting, 100% of their revenue is managed by themselves, reward system, care of human resources capability, and the
change of organizational structure is suitable with the needs. Before become a self
financed organization, their planning are dominated by top down planning approach,
fiagmented planning with hudgetting and budget-based activities, have no authority to
managed their own revenue (I00% is given to the district government), there are no
clear reward system, lower staffs participation and the same of organizational structure
with another public health centre in Indonesia.
Beside that, the result also shows that between them have the basic same,
comprises of planning process (bottom up planning, integrated planning with budgetting,
target based activities, revenue management (a door, more transparant, using incentive
criterions), the beginning of self financed process (1 ? of April 2000), legal aspect
(District Govemment No. 39/2000) and the stage (intern and extern stage). The
diEerencess between them are optirnalization of staifs participation in planning process
(higher vs. lower, solid teamwork vs. not, higher support vs. lower, participative vs.
representative management), revenue management form (sentralized vs. decentralized),
staH`s discipline (higher vs. lower, amano va manual), financial recording and reporting
system (computerized vs. manually), self Hnanced process (ready vs. not ready),
gradation of change (segmental- vs comprehensive) and reward system formula.
Basically, the change being self financed public health centre is very useiiill., - mainly to
increase their autonomy and quality of care - , so that can be developed more in the
future."
