IMPLEMENTASI KEBIJAKAN SUBSIDI PELAYANAN KESEHATAN DASAR TERHADAP KUALITAS PELAYANAN PUSKESMAS DI KOTA SINGKAWANG

Background: Health sector is inseparable from the decentralist system of local autonomy. Health sector is a responsibility of the local government, even though it is frequently included in the political policies of a leader. The direction of healthcare service development, particularly at the level of Health Center, has been maintained in the Mayor�s Decree of Singkawang No. 82/2009 on the subsidiary of healthcare in Kota Singkawang. Objective: To find out the quality of healthcare at the Health Centers in relation to the primary healthcare subsidy based on the perception of society, control/supervision of Local Health Office, management, service time, service capacity/type, and attitude of the health center staffs. Method: A descriptive research with case study design was conducted in three Health Centers: Singkawang Tengah, Singkawang Timur, and Singkawang Utara Health Centers. Subjects of the research were 15 health staffs and 111 patients. The data were collected using questionnaire, observation, and interviews. Results: The research found a score of 3.3 for the healthcare in Singkawang Tengah, Singkawang Timur, and Singkawang Utara Health Centers. It means that the Health Center provided relatively high quality healthcare. From the Reliability dimension, a score of 2.92 was found for Point 2 quick examination service with reference to the standard procedure and a score of 2.97 for Point 5, the timeliness of healthcare. From the Responsiveness dimension, a score of 2.77 was found for Point 3 � the patients did not wait long to get the healthcare service � and a score of 2.94 for Point 4 � the working hour of the Health Center. Qualitative analysis showed that the Local Health Office controlled/supervised the Health Centers by means of utilization/visit reports and management. It was found that service time was frequently ignored and that service type/capacity at the Health Centers was constrained by the availability of reagents and medication. The health staffs tended to ignore service quality and time and there was an indication of deviation in the utilization/visit reports sent by the Health Centers. Conclusion: The Local Health Office did not have adequate tools to control/supervise the Health Centers, as evident from the aspect of management, service time, service type/capacity, and health staff attitude. Procurement of healthcare supplies was hampered by tender process and the health staffs need continuous training and development