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1. Funding Need
The organization of health program needs the development of funding system that originates from the government and society including the private that can produce ready
to use and adequate fund. Experience so far has shown the emergence of efficiency in the utilization of governmental and private budget. Hence in the future will be striven for the
more efficient use of fund that can be reached through the compilation of funding system that puts attention to equality, efficiency, and continuity and that can assure the
availability of qualified services. The use of governmental fund hitherto is still directed more to health service efforts that
are curative and rehabilitative at the basic and referral health service levels. Therefore mentioned funding system can hopefully be shifted to the promotive and preventive
services by observing the continuity of the existing available services especially those to the poor people. With the imminent decentralization process, the funding sources of
central and regional governments will be developed optimally and proportionately, either between health programs, regions or sectors.
Public direct spending to get health service is the biggest portion of national health expenditure which will be directed to become pre payment system JPKM, so as to make
it more efficient. So far JPKM has not run well and hence will be improved by preparing professional field workers and creating conducive climate for its development. The
development of this system will take long enough time in order to cover most of the people.
On the other side, the state economy at present is not yet bright and various other crises are not sure yet when they will resolve, that makes calculation on fund requirement hard
to be done. The fact that health sector is one of the sectors that receives great attention during crisis, beside education and social, is an opportunity that should be used optimally
to increase health sector’s budget portion in the future. The macro picture of governmental budgetary need for health sector is hoped to rise from
only 2.5 to 5 in the future, it is followed by reallocation of budget to various programs
that are ‘cost-effective’. On the other side, in the short run we still have to take into consideration funding need for arranging the social safety net in health sector which is
estimated to continue several years to come. This situation is very much dependent on mobilization effort of public resources in the form of development of JPKM system and
its equipment. 2.
Fund Raising
Resource for the implementation of health development originates from the government and public private funds. Since the economic crisis, there is a great dependence on off
shore fund. It is estimated that the off shore fund will decline in the coming several years so exploration of the p
ublic’s funding source become an attempt that should be started and implemented in the coming years.
It should be observed that in the future the role of regions become prominent in health development funding as a logic consequence of decentralization process.
3.
Funding Management
Management of fund is directed to achieve the highest efficiency level, either in allocation efficiency or in technical efficiency at program, area or institutional levels. Ability of the
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region’s health office in advocation to the regional government about the importance of regional health development will be increased continually. Beside that good governance
is a precondition for the creation of good system of funding. Management of public fund that is striven through the mechanism of the third party
JPKM is hoped to become more efficient. This situation can be realized soon if supported by JPKM managerial manpower that is professional and the availability of
supporting rules and regulation.
General
Implementation of national health developmental activities needs a broad and careful management in various levels of administration of the government and the society itself.
Aside from that, the dynamics and rapid change in domestic situation and abroad should also be watched. Beside that attention should also be given to the challenge from global
competition, the execution of regional autonomy, economic balance between central and the regions, public participation, equity and justice, and potential and diversity of each
region. Going in line with health developmental strategy in order to realize Healthy Indonesia
2010, it should be underlined that health development can not just rely on health sector’s activity alone, but also on the developmental activities that are done synchronously and
efficiently from various related sectors. It has been realized since long that cross-sectoral and cross program co-operations is one of the main keys of developmental success, that
has in fact so far received inadequate attention. Activating the execution of various health programs is meant to make the health service
providers, consumers and other sides acting as supporters and supervisors can implement the various health programs as perfect as possible.
The progress so far shows that the inter-dependence among human being is increasingly felt. For the success of a program, communication and cooperation are needed between
various groups or working units. Beside that a high motivation and renewal in value orientation which needs support from awareness on the importance of preparation and
utilization of data and information dissemination also needs to be grown. Actuation of program implementation includes organizing, work force filling, public
motivating and task in order to increase public participation, intra and inter-sectoral co- operation and cultivation.
Organizing
In order to support health developmental implementation, health efforts need to be implemented through organizational structural pattern. The main task of the Ministry of
Health is to organize a part of the governmental general task and developmental task in health sector. Hence, a health program principle is always being adjusted to efforts
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including the general governance implementation, either with routine activities or developmental effort activities that are restricted in time and target. The routine and
developmental activities of a program principle is very much influencing the magnitude of an organizational unit, hence an organizational structure will always change.
What should be considered in the implementation actuation is the already ratified act number 22 1999 about Regional Government and the act number 25 on Economic
Balance of the Central and Regional Governments. The organizational picture that will be described below has as far as possible absorbed various aspirations that have
developed in the discussion on the elaboration of both acts. 1.
Health Organization at Rural Level
a. Rural Society Tenacity Institution LKMD
In the governance at rural level, health developmental efforts of rural society is an integral part of the development of rural society, it is implemented by the Health and Family
Planning Section of the LKMD that is responsible to the Rural Head and Rural Representative Body.
b. Helper Puskesmas Pustu
Pustu is an integral part of puskesmas and it does the function of puskesmas at the rural level. At certain regions, in accordance to need, pustu and puskesmas encourage the
formation of health posts by the society which is coordinated by the rural governance. 2.
Health Organizations at Subdistrict Level
a. Puskesmas
Puskesmas is an operational unit of health office at the district municipality and is responsible to health office of district municipality.
Puskesmas has the task to implement the health efforts at sub-district area, whose matters have been delegated to the autonomous region and the assisting task.
b. Technical Executing Unit UPT
An UPT is formed when needed and its task is to arrange one of the health efforts separately.
c. Organization of Private Health Effort
The organization of private health effort is a society organization including the private that organizes health effort according to the rules and regulations as well as professional
standards and other regulations as determined by the government together with the professional organization.
3.
District Municipal Regional Health Organization
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a. District Municipal Regional Health Office
District Municipal Regional Health Office is an operational unit of district municipal regional government under and being responsible to the district municipal regional chief,
its task is to implement part of the household affairs of the region in health sector. Health apparatus at district municipal level, i.e. district municipal health office holds the
broad decentralization authority in health sector and assisting task. It means that all health efforts that are not yet fully executable by the society become the task of district
municipal health apparatus to implement it, by holding on the policy standards and rules already determined by the Ministry of Health. The district municipal health office also
implements various assisting tasks in health sector such as outbreak management and surveillance of contagious diseases.
So, district municipal regional government can form various types of UPT in health sector, so far as the primary coverage of the working area is the relevant district
municipality. The UPT can be for example the puskesmas, district municipal hospitals, pharmaceutical warehouses, health laboratories, etc.
b. Hospitals
The regional general hospital is an organic unit of regional government that has the task to implement health services, especially the curing of patients and rehabilitating disabilities
of body and mi nd. Service at the hospital is prioritized on referral service. Hospital’s
organizational structure is based on the type and class of service being offered by the respective hospital.
c. Technical Executing Unit UPT
This unit is formed according to need in order to implement one field of task in the support of the principle task of its chief. The organizational structure of an UPT is
adjusted to organize pattern of UPT as determined by governmental regulation. One example of UPT at the district level is the district municipal pharmaceutical warehouse
that is located in the circle of district municipal health office.
d. Private Health Enterprise
Health effort of the society private at district municipal level can be in the form of hospital or other service unit. The organizational structure and work order of the private
health enterprise is arranged according to the prevailing regulation. Private hospital can also be a network of foreign hospitals that has met the conditions for operation in
Indonesia. 4.
Provincial Regional Health Organization
According to the act number 22 1999 about Regional Government, the health developmental implementation at the provincial level is the Provincial health Office that
holds two kinds of authority or task i.e.: 1 limited decentralization authority or task, and
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2 broad de-concentration authority or task. What is meant by the limited decentralization authority or task is the implementation of health effort that can not be
handled by the society that is cross district municipal or still unable to be handled by district municipal government or that is more effective and efficient if handled by the
provincial government. 5.
Central Level Health Organization
In order to improve the organization at the central level is always based on development in health effort and function that should be done. Development in the form of expansion
or retrenchment can occur in the main operating element such as at the level of Directorate General, since the work volume and load of developmental task in health
sector is increasing or conversely decreasing due to merger. Development can also occur at the element of assistant chief according to the addition of functions and efforts that
have to be done especially in the managerial fields. The act number 22 1992 about health stipulates that health development is done by
government and society. The society should be turned into the prime actor of health development, while government only acts as the companion. This means that only health
efforts that are still unhandleable by the society requires settlement by the government. For efforts already manageable by society the government only acts as the cultivator,
supervisor and facilitator. The cultivating task is done through determination of national policy standardization and regulation. Supervising task is done through licensing,
accreditation and safeguarding. While facilitative task is done through guidance and control.
According to the decentralization strategy, the task of implementation of health efforts that can not be tackled by the society will be done by regional government, i.e. either by
the district municipal regional government or the provincial government. While for effectiveness and efficiency except regarding the management of several types of
pharmaceutical inventories such as medicines, and the task of facilitating will be done by the provincial regional government.
Abiding to the principle, then it can be decided that at the central level the main task of the Ministry of Health is to cultivate supervision and facilitation of health development
through determination of national policy in health sector, standardization, and regulation as well as coordination of licensing, accreditation, cultivation and control.
Actuation of Implementation
1. Government
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