Each group has analyzed the problem in each country using a "problem tree" and then analyzed using the health reform cycle (Cycle of Health Reform). Definition of the problem here is the problem the result (outcome) that the level of citizen satisfaction. Problems identified performance problems of health care to the citizens satisfaction where there are three causes, namely: the demand increases the demand for health care is different, the government is not able to provide all health services and access (long waiting times, time to meet with patients is limited).
The focus of the selected root cause of the government was unable to provide all health services and access to unhealthy behavior is caused by a sedentary lifestyle, expensive health food choices and lack of health promotion incentives. Of this problem is then proposed health care reform through the 4 (four) is the financing, payment, regulatory, and organizational behavior.
The problem identified is the government not able to provide all health services. In terms of financing the proposal is a social health insurance, community insurance and partial payments. In terms of payment no analysis. In terms of insurance regulation is a new activity, good health regulations, guidelines and policies readiness. organization in terms of organizational administration by forming relationships with new models, Formatting consistent direction, organizational structure and readiness of healthcare settings. In terms of behavioral health funding is proposed division of responsibilities and education to the community.
In terms of financing by increasing the allocation of funds for rural or remote areas that be driven by the promotion of health, health care support equipment procurement and infrastructure development. Button control payments to create incentives for human resources and designing skemas health insurance for people who are in rural and remote areas.
Button control of the organization with the responsibility to local authorities for distributing vaccine (decentralization) and make a political commitment. Regulatory control buttons to make regulations regarding sanitation and housing. Control buttons diengan health promotion behaviors through family and community behavior change, for example, the spacing of pregnancy, food processing, hygiene and awareness of the importance of health.
The results of the identification problem causes high maternal mortality is immunization, access to health services, system referral, nutrition of pregnant women and infectious diseases. The root cause of the problem of the five factors are geographic factors with hills and mountainous areas, low family income, high-needs, low education, most isolated areas, lack of health promotion, access to quality services, low motivation and training and lack of resources finance.
Proposed implementation using the four buttons which starts from the financing by conducting free health care to the entire population of most of the funds from oil taxes. Button payments by providing incentives to doctors, nurses and midwives. Button mealukan organizations with improved management of human resources, training, education and providing health care equipment. Button regulations by increasing the presence of immunization programs with different policies. Button behavior in a community-based information campaigns, advocacy and media campaigns (usually using a radio capable of supporting up to the interior).
Discussion
The issue of interest is the capacity of the government on the issue of health financing and policy sectors to improve the financing of non-governmental agencies. Yu (2008) conducted a study on the case of equity in health financing across two levels in the health system, the burden of subsidy payments to the public sector and private sector users, and generates a progressive financing system. Submission is interesting about the training of midwives to midwives after graduating from the stool of education, training adapted to the place or location where the midwife will be in place.
The interesting thing is how to make the political commitment in the allocation of health funding and selection of rural or remote areas in the allocation of health funding. The selection of rural or remote based on consideration of the difficulties in terms of access to the area and saw the state of society and government, there is good governance pemeritahan but poor people or otherwise.
With more emphasis on the aspect of access to justice and where social factors that determine health status issues. The implementation of free treatment for the entire population is done by the conditions of very low incomes. Providing incentives for health workers is based on the work site, respectively, to remote areas of functional allowance of 100% of salary, the district 70% of the salary and hospitals 50% of salary.
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