The evaluation of Nusantara Sehat program using Nusantara Sehat Public Health Index

Abstract

Latar Belakang: Faktor geografi Indonesia yang berupa daratan, lautan, pegunungan, dan pulau-pulau yang tersebar menyebabkan distribusi tenaga kesehatan dan akses pelayanan kesehatan yang tidak optimal. Berdasarkan Peraturan menteri kesehatan yang telah ditetapkan, pemerintah berupaya mendayagunakan secara khusus sumber daya manusia kesehatan dalam kurun waktu tertentu dengan jumlah dan jenis tertentu, agar meningkatkan akses dan mutu pelayanan kesehatan pada fasilitas pelayanan kesehatan khususnya di wilayah Daerah Tertinggal, Perbatasan, dan Kepulauan (DTPK) dan Daerah Bermasalah Kesehatan (DBK) melalui Program Nusantara Sehat (NS).
 Metode: Tahun 2015 telah ditugaskan Tim NS Batch 1 dan 2 pada 120 Puskesmas di DTPK dan DBK selama 2 tahun. Kemudian pada tahun 2017 setelah masa tugas berakhir, diadakan evaluasi program yang bertujuan untuk mengetahui dampak program NS terhadap indeks kesehatan masyarakat dengan menggunakan desain Pre and Post-Test Intervention with Control. Evaluasi dilakukan di 15 provinsi, 27 kabupaten, dan 60 Puskesmas pada bulan Februari - Desember 2017.
 Hasil: Hasil evaluasi program menunjukkan bahwa pada tahun 2017 terjadi perubahan rata-rata indeks kesehatan masyarakat dibandingkan dengan tahun 2015, baik pada Puskesmas intervensi maupun kontrol (p=0,000). Kemudian hasil uji independen t-test terhadap delta perubahan indeks menunjukkan bahwa peningkatan indeks kesehatan masyarakat pada Puskesmas intervensi lebih besar dibandingkan dengan Puskesmas kontrol (p=0,046).
 Kesimpulan: penugasan Tim NS pada Puskesmas telah membawa perbaikan indeks kesehatan masyarakat yang lebih baik. Diperlukan pengamatan lebih jauh terkait sustainabilitas Program NS dan analisis biaya manfaat (cost benefit analysis) terhadap Program NS. 
 Kata Kunci: Evaluasi program, Nusantara Sehat, Indeks Kesehatan Masyarakat, Indonesia.
 
 Abstract
 Backgrounds: Indonesia’s geographical factors in the form of land, oceans, mountains, and scattered islands have caused the distribution of health workforce and access to health services are not optimal. Based on the Minister of Health regulation, the government seeks to utilize health human resources specifically for a certain period, with certain number and types, in order to improve access and quality of health service to health service facilities, especially in remote area through the Nusantara Sehat Program (Health Indonesia Program-NS).
 Methods: In 2015, NS Team Batch 1 and 2 were assigned to 120 primary health care center (Puskesmas) in remote areas for 2 years. Then in 2017 after the term ends, NS program evaluation were conducted in 15 provinces, 27 districts, and 60 Puskesmas from Feb to Dec 2017.
 Results: This evaluation aims to analyze the impact of NS program on public health index using Pre and Post Test Intervention with Control Design. The results of program evaluation showed that in 2017 there was a change in the average public health index compared to 2015, both in intervention and control Puskesmas (p = 0,000). The independent t-test result on the delta of index change indicated that public health index improvement at intervention Puskesmas is greater than the control (p = 0,046).
 Conclusion: The assignment of NS Team at the Puskesmas has brought improvement of public health index. Further observations are needed regarding the sustainability and the cost benefit analysis of NS Program. 
 Keywords: Program evaluation, Nusantara Sehat, Public Health Index, Indonesia.

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