Desentralisasi dan Pengambilan Keputusan Kebijakan Peningkatan Gizi Balita di Kota Depok dan Kota Bogor Propinsi Jawa Barat

https://doi.org/10.22146/jkki.36378

Candra Dewi Purnamasari(1*), Dumilah Ayuningtyas(2), Riastuti Kusumawhardani(3)

(1) Fakultas Kesehatan Masyarakat, Universitas Indonesia, Jakarta
(2) Fakultas Kesehatan Masyarakat, Universitas Indonesia, Jakarta
(3) Universitas Islam Negeri Ciputat, Tangerang, Jawa Barat
(*) Corresponding Author

Abstract


Background: Heywood and Choi ( 2010) found that there is only a slight increase of health system performance post decentralization. Low performance in decentralization of the health sector can be inferred from the high incidence of poor nutrition for U5 (under five) in the city of Bogor in West Java. However the city of Depok has a different situation in which they have successfully reduced poor U5 nutrient to 0% . Performance in a decentralized health system is affected by policy decisions that are influenced by decison space, institutional capacity and accountability of local government . Objective: This study aims to describe the decision-making processes for U5 nutrition based on decision space, capacity and accountability of local government institutions in the city of Depok and city of Bogor in West Java Province . Methods: This study is a qualitative case study design . In- depth understanding of the decision-making on health policy in the era of decentralization will be traced by means of in-depth interviews . Informants in this study include the Head of Department , Mayor , Chief Health Center and Head of Nutrition at the Provincial Health Office , Head of Bappeda. Results: Post Decentralization, nutrition policy decision-making process at the level of the city of Bogor and Depok conducted by larger decision space, the accountability of policy decisions in both regions showed an increase , but the capacity of public institutions and the level of participation of non- government actors as well as the institutional capacity is higher in the city of Depok than in the city of Bogor . Conclusion: Decentralization increases the decision space and accountability in health policy decision-making process. Increased institutional capacity, especially the capacity of human resources and increased levels of participation and non-government actors are needed to produce a more responsive policy decisions.

 

Latar Belakang: Heywood dan Choi (2010) dalam studinya menemukan bahwa secara umum hanya terjadi sedikit pening- katan kinerja sistem kesehatan pasca desentralisasi. Rendahnyakinerja desentralisasi pada sektor kesehatan dapat dilihat dari masih tingginya kasus gizi balita buruk diKotaBogor Propinsi Jawa Barat.Kondisi yang berbeda terjadi di Kota Depok yang telah berhasil menekan gizi Balita buruk menjadi 0% . Kinerja sistem kesehatan dalam era desentralisasi dipengaruhi oleh pengambilan keputusan kebijakan yang dipengaruhi oleh decison space kapasitas institusional dan akuntabilitas pemerintah daerah. Tujuan: Penelitian ini bertujuan menggambarkan proses pengambilan keputusan kebijakan Gizi Balita berdasarkan decision space, kapasitas institusidan akuntabilitas pemerintah daerah diKota Depok dan Kota Bogor Propinsi jawa Barat. Metode: Penelitian ini merupakan penelitian kualitatif dengan rancangan studi kasus. Pemahaman secara mendalam menge- nai pengambilan keputusan pada penyusunan kebijakan kese- hatan pada era desentralisasi akan ditelusuri dengan cara melakukan wawancara mendalam (indepth interview). Informan dalam penelitian ini meliputi Kepala Dinas, WaliKota, Kepala Puskesmas dan Kepala Bagian Gizi di Dinas Kesehatan Propinsi, kepala Bappeda. Hasil: Setelah Desentralisasi, proses pengambilan keputusan kebijakan Gizi di tingkat Kota Bogor dan Kota Depok dilaksana- kan dengan Decision spaceyang lebih besar, akuntabilitas pengambilan keputusan kebijakan pada kedua daerah menun- jukkan adanya peningkatan, namun kapasitas institusi dan tingkat partisipasi masyarakat maupun aktor diluar pemerintah Kota Depok lebih tinggi dibanding Kapasitas Institusi di Kota Bogor. Kesimpulan: Desentralisasi meningkatkan decision space dan akuntabilitas pada proses pengambilan keputusan kebi- jakan kesehatan. Peningkatankapasitas institusi terutama kapa- sitas sumberdaya manusia dan peningkatan tingkat partisipasi masyarakat dan aktor diluar pemerintah sangat dibutuhkan untuk menghasilkan keputusan kebijakan yang lebih responsive.


Keywords


Decentralization; Decision space; Accountability; Human Resource Capacity; Desentralisasi, Decision Space, Akuntabilitas, Kapasitas SDM

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DOI: https://doi.org/10.22146/jkki.36378

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