sdm kesehatan & kebijakan
DESCRIPTION
Health Human Resource and PolicyTRANSCRIPT
SDM KESEHATAN & KEBIJAKAN
Yosri Azwar
KEBIJAKAN (Kesehatan)
UU No.8 thn 1961 tentang wajib sarjana – lulusan FK, FKG dan Farmasi wajib kerja sebagai PNS selama sekurang-kurangnya 3 tahun
UU No.6 thn 1963 tentang wewenang Depkes untuk mengatur, mengarahkan dan mengawasi pegawai kesehatan dalam melaksanakan tugasnya.
PP 37 thn 1964 yang menyatakan bahwa semua lulusan pendidikan kesehatan, dokter, dokter gigi dan apoteker harus mendaftar ke Depkes.
PP 32 thn 1996 tentang Tenaga Kesehatan disebutkan bahwa jenis tenaga kesehatan yaitu: tenaga medis, keperawatan, kefarmasian, kesehatan masyarakat, gizi, keterapian fisik dan keteknisan medis.
Keppres No. 5 thn 2004 tentang tunjangan jabatan fungsional dokter1, dokter gigi2, apoteker3, asisten apoteker4, pranata laboratorium kesehatan5, epidemiologi kesehatan6, entomologi kesehatan7, sanitarian8, administrator kesehatan9, penyuluh kesehatan masyarakat10, perawat gigi11, nutrisionis12, bidan13, perawat14, radiografer15, perekam medis16 dan teknisi elektromedis17.
KepMenkes No.679/Menkes/SK/V/2003 tentang kartu registrasi dan izin kerja asisten apoteker.
KepMenkes No.1076/Menkes/SK/VII/2003 tentang penyelenggaraan pengobatan tradisional
KepMenkes No.1277/Menkes/SK/VII/2003 tentang tenaga akupuntur.
KEBIJAKAN (Kesehatan)
KepMenkes No.725/Menkes/SK/V/2003 Pedoman Penyelenggaraan Pelatihan di Bidang Kesehatan.
KepMenkes No.788/Menkes/SK/VI/2003 tentang Pedoman Penyelenggaraan Seleksi Penerimaan Siswa/Mahasiswa Baru Pendidikan Tenaga Kesehatan (SIPENSIMARU DIKNAKES)
KepMenkes No. 81/Menkes/SK/I/2004 tentang Pedoman Penyusunan Perencanaan SDM Kesehatan di Tingkat Provinsi, Kab./Kota serta Rumah Sakit.
KEBIJAKAN (Kesehatan)
UU No. 8 Tahun 1974 tentang Pokok-Pokok Kepegawaian.
UU No. 43 Tahun 1999 tentang Perubahan atas UU No. 8 Tahun 1974 Tentang Pokok-Pokok Kepegawaian.
PP No. 16 Tahun 1994 tentang Jabatan Fungsional Pegawai Negeri Sipil.
Keppres No. 87 tahun 1999 tentang Rumpun Jabatan Fungsional Pegawai Negeri Sipil.
KEBIJAKAN (Umum)
PP No. 97 tahun 2000 tentang Formasi PNS.
PP No. 98 tahun 2000 tentang Pengadaan PNS.
PP No. 99 tahun 2000 tentang Kenaikan Pangkat PNS.
PP No. 100 tahun 2000 tentang Pengangkatan PNS dalam Jabatan Struktural.
PP No. 8 tahun 2003 tentang Pedoman Organisasi Perangkat Daerah.
PP No. 9 tahun 2003 tentang Wewenang Pengangkatan, Pemindahan dan Pemberhentian PNS.
Keputusan Kepala Badan Kepegawaian Negara Nomor 43/KEP/2001 tentang Standar Kompetensi Jabatan Struktural Pegawai Negeri Sipil.
KEBIJAKAN (Umum)
PP No. 97 tahun 2000 tentang Formasi PNS.
Pasal 4
(1) Formasi masing-masing satuan organisasi Negara disusun berdasarkan analisis kebutuhan dan penyediaan pegawai sesuai dengan jabatan yang tersedia dengan memperhatikan norma, standar, dan prosedur yang ditetapkan oleh Pemerintah.
(2) Analisis kebutuhan sebagaimana dimaksud dalam ayat (1) dilakukan berdasarkan:a. jenis pekerjaan;
b. sifat pekerjaan;
c. analisis beban kerja dan perkiraan kapasitas seorang pegawai negeri sipil dalam jangka waktu tertentu.
d. prinsip pelaksanaan pekerjaan; dan
e. peralatan yang tersedia.
KEBIJAKAN (Umum)
Effective health service delivery requires the efficient use of the skills of a well-motivated health sector workforce. The health sector is labour-intensive. The delivery of care by its very nature involves personal interaction and effective teamwork.
The health sector workforce is complex, with several health-specific professional groups with distinct roles and their own educational and regulatory structures: doctors, nurses, dentists, pharmacists, etc. It is important also to mention that health occupations tend to have a strong distinctive culture and identity, which can complicates some changes, such as promoting teamwork or reviewing hierarchical structures.
HRH & HEALTH SERVICES
Context Policies
Overall environment• Political• Socioeconomic• Demographic• Epidemiologic• New Technology
Human resources development policy formulation: A framework for analysis
Support system
Government programme• Macroeconomic and financial
policies• Change in priorities: productive and
social sectors
Information• Assessment tools• Nat’l health mgt info system• HRH database and payroll• Performance monitoring
MAJOR REFORMS• Civil service• Decentralization• Privatization• Institutional reorganization
MAJOR PLAYERS• Government• Civil society• Prof. assoc & trade unions• Private sector• Donors
HEALTH POLICY• Health sector reforms• Changes in priorities and strategies
HRD POLICY & PLANNING• Content• Formulation process
HUMAN RESOURCES• National capacities, including
institutional strengthening• Technical assistance
FINANCIAL RESOURCES• Mechanism for allocation• Management system & payment• Incentives
Functions the system performs
Goals/ objectives of the system
Stewardship (leadership, oversight)
Creating resources (investment & training)
Financing (collecting, pooling and purchasing)
Delivering services (provision)
HEALTH
Responsiveness (to people’s non-medical
expectation)
Fair (financial)
contribution
Intermediate Final
SDM-KES & SISTEM KESEHATAN
SDM-KES & SISTEM KESEHATAN
Functions the system performs
Goals/ objectives of the system
Stewardship & Financing
Delivering services
Intermediate Final
HRH Generation
HRH Provision
Labour market
HEALTHResponsiveness
Financial Fairness
Conceptual Framework
Non-health
Health• Financing• Stewardship/ Health planning
• Provision• Resources generation
Stakeholders
Structural factors
Dynamic factors
Management Organization
• Health needs• Utilization of health care
• Individual factors• Educational/training• Labour participation• Barriers to entry• Migration
• Financial/ Physical/ Knowledge
PoliciesHealth care
system
Health labourdemand
• Shortage• Equilibrium• Oversupply
Health laboursupply
Resources
Glo
baliz
atio
nNational/
Sub-national
Forces driving the workforce
Health needsDemographics
Disease burdenEpidemics
Health systemFinancing
TechnologyConsumer preference
ContextLabour and education
Disease burdenEpidemics
NumbersShortage/excess
Skill mixHealth team balance
DistributionInternal (urban/rural)
International migration
Working conditionsCompensation
Non-financial incentivesWorkplace safety
Driving forces Workforce challenges
Working lifespan strategies
Entry:Preparing the workforce
PlanningEducation
Recruitment
Exit:Managing attrition
MigrationCarrier choice
Health and safetyRetirement
Workforce:Enhance worker performance
SupervisionCompensationSystem supportLifelong learning
AvailabilityCompetence
ResponsivenessProductivity
Workforceperformance
Health workers in all sectors
Health serviceproviders
Sector
Occupation
Health sector All other sectors
Health mgt and support workers
Health serviceproviders
All others
• Professionals• doctor, nurse
• Associate• lab technician
• Community• traditional
practitioner
• Professionals• hosp. account
• Associate• administrative
• Support staff• clerical
• Craft & trade workers
• Professionals• physician
employed in mining company
A Framework for analyzing future trends in HRH
Demographic transition
Technological innovation
Global tradeInstitutional
change
Organizational reform
Work force
Work content Work place
Work outcomes
Getting the mix right: challenge to health workforce production
Drivers influencingWorkforce composition
Health needs- Demographic- Disease burden- Epidemic
Limited shortages - Increase class size- Shorten training time
NumbersWidespread shortages - Develop new institution
- Increase regional cooperation
Maldistribution - Select from underserved area- Locate training in
underserved areaDiversityHomogenity - Outreach for minorities to apply
- Retention efforts during trainingMissing - New institutions, cadres
- Regional, international networksCompetencies
Ineffective - Evaluation and certification- Accreditation, licensure
Health system- Financing- Technology- Consumer
preference
Context- Labour & education- Public sector reform- Globalization
Challenges Possible actions
Appropriatenumbers
Enhanceddiversity
Competenciesensure
Desired impact onworkforce production
Relationship of education, labour and health services markets with human resources
Education market Labour marketHealth services
market
Training institutions Health organizations Service unitsInstalled capacity
ProgrammeCurriculum
prices
Individual practicePositionSalaries
ProtocolsInfrastructureTechnology
InputsPrices
Educationdemand
Labourdemand
Laboursupply
Demand for services
Applicants Graduates Unemployed Linked Opportunities Resources Users
Transformation process Linking process Production process
Students Resources Workers
Intellectual capacitySkills
Capacity
CompetenciesExperiencesExpectations
PerformanceAbilities
Substitutions
Dimensions of health workforce performance
Dimension DescriptionAvailability Availability in terms of space and time: encompasses distribution and
attendance of existing workers
Competence Encompasses he combination of technical knowledge, skill and behaviours
Responsiveness People are treated decently, regardless of whether or not their health improves or who they are
Productivity Producing the maximum effective health services and health outcomes possible given the existing stock of health workers; reducing waste of staff time or skills.
Indicators to assess health workforce performance
Dimension Possible indicatorsAvailability • Staff ratios
• Absence rate• Waiting time
Competence • Individual: prescribing practices• Institutional: readmission rate; live births; cross-infections
Responsiveness • Patient satisfaction• Assessment of responsiveness
Productivity • Occupied bed• Outpatient visits• Interventions delivered per worker or facility
Levers to influence the four dimensions of health workforce performance
Job relatedJob descriptions
Norm and codes of conductSkill matched with tasks
Supervision
Support system relatedRemuneration
Information & communicationInfrastructures & supplies
Enabling work environmentLifelong learning
Team managementResponsibility with accountability
Availability
Competence
Responsiveness
Productivity
Levers Health workforce performance
An aid to thinking through potential effect of levers on health workforce performance
LeversDimension of health workforce performance
Availability Competence Responsiveness Productivity
1. Job description + + + +
2. Norm and code of conduct ++ + ++ +/++
3. Match skill to task + + + +++
4. Supportive supervision + +++ ++ ++
5a. Salary level +++ + + ++
5b. Payment mechanisms ++/- - +/- +/- +++/- - -
6. Information & communication 0 ++ + ++
7. Infrastructure and supplies ++ 0 + ++
8. Lifelong learning + +++ + +
9. Teamwork and management + + ++ +++
10. Responsibility with accountability ++ + ++ +++
+ : positive effect; - : negative effect+ : some effect; ++ : significant effect; +++ : substantial effectPayment mechanisms: the effects will depend on the mechanism used
Managing for Performance
Health outcomesHealth system performance
Workforce objectives
Human resource action
Coverage:Social and physical
Motivation:System and
support
Competence:Training and
learning
Equitable access
Quality and responsiveness
Efficiency and
effectiveness
Health of the
population
• Numeric adequacy• Skill mix• Social outreach
• Satisfactory remuneration
• Work environment• Systems support
• Appropriate skills• Training and learning
• Leadership and entrepreneurship
“Terobosan yang paling menggairahkan pada abad ke 21 yang akan terjadi bukan karena tekhnologi, melainkan munculnya konsep yang luas dari apa artinya menjadi MANUSIA” (John Naisbitt).
Pengelolaan SDM Kesehatan khususnya perencanaan kebutuhan selama ini masih bersifat: administratif kepegawaian, belum dikelola secara profesional;
masih bersifat top-down, belum bottom-up;
belum sesuai dengan kebutuhan organisasi dan kebutuhan nyata di lapangan, serta;
belum berorientasi jangka panjang.
Perencanaan SDM Kesehatan(KEPMENKES No. 81/MENKES/SK/I/2004)
Tujuan pedoman adalah untuk membantu daerah dalam mewujudkan rencana penyediaan dan kebutuhan SDM Kesehatan.
Pedoman meliputi: Pedoman penyusunan rencana penyediaan dan kebutuhan SDM di
institusi pelayanan kesehatan (rumah sakit, puskesmas).
Pedoman penyusunan rencana penyediaan dan kebutuhan SDM kesehatan di wilayah (provinsi, kabupaten/kota).
Pedoman penyusunan rencana kebutuhan SDM kesehatan untuk Bencana.
Perencanaan SDM Kesehatan(KEPMENKES No. 81/MENKES/SK/I/2004)