EVALUASI KEBIJAKAN BEROBAT GRATIS DI KABUPATEN TANJUNG JABUNG TIMUR PROPINSI JAMBI

Abstract

Background: In the decentralized era, local government has
wider authority to decide policies relevant with local needs.
For this reason the Regent of Tanjung Jabung Timur District in
2005 issued a decree on free medication at the health center
and secondary health center. However there are problems
with the sources and allocation of budget to support the decree.
Besides, there is also a problem with target of the program
funded by the government. Therefore there should be an
evaluation to find out facts for future improvement.
Objective: The study aimed to identify mechanisms of funding,
relevance of target and efficiency of the policy.
Method: This was an explanatory case study which used
quantitative and qualitative approaches. Analysis units of the
study were local government, health center and secondary
health center; and the subject were members of local
parliament, head of health office, head of local planning council,
head of health centers, staff of health centers/secondary health
centers and the community. The size of samples to measure
target relevance was determined using stratified sampling;
qualitative method was determined using purposive sampling.
Data were obtained through questionnaire, in-depth interview
and document checklist. Data were analyzed qualitatively and
quantitatively in proportion.
Result: Local government of Tanjung Jabung Timur allocated
budget in the form of operational fund of health centers, drug
allocation and incentives. The realization of budget was delayed
so that health centers used alternative financial resources,
i.e. budget of health insurance for poor community. Operational
fund did not give much support for free medication when there
was no clear cut distinction between users of health insurance
for poor communities and free medication. This caused overlap
in budgeting which might end in inefficiency. The authority did
not do monitoring and supervision appropriately. Users of free
medication were mostly non poor communities. Poor
communities utilized free medication at secondary health
centers more frequently than at health centers.
Conclusion: The local government of Tanjung Jabung Timur
District had not implemented good health insurance principles
in health financing to support free medication policies. There
was misallocation of funding because more non – poor
communities used the service. This increased the potential of
inefficiency in government budget utilization.
Keywords: free medication policy, health financing, budget
efficiency