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Background : In order to support the global commitment in addressing the burden of non-communicable diseases, the government through the Ministry of Health set the one of the targets of the National Development Strategy Plan is the promotion and preventive service through the availability of health promotion personnel at the Puskesmas. To meet these needs the government issued a policy that is the Regulation of the Minister of Health No. 82 of 2015 on Technical Guidance Special Allocation Fund for Health Operational Support where one of financing is for promotive and preventive activities directed to finance one (1) contract health promotion workers. Aims : To analyze the implementation of the policy of Non-Physical Special Allocation Fund of 2016 to recruit Health Promotion Contract Workers for Puskesmas in Sumbawa and Sleman districts. Methods : A single case study study was established using Implementation Research carried out at the Health Office in Sumbawa and Sleman districts. Informants were interviewed using the Consolidated for Implementation Research (CFIR) framework as a guide in collecting and analyzing qualitative data. Result : The most dominant factor of CFIRs affecting the implementation of contract labor policies is the internal communication network, particularly the involvement of the management. Organizational needs are the reasons for implementing a policy, but this is not a major factor in the implementation of a policy. Meeting the needs of the organization is influenced by the involvement factor of the leader of the organization in this case the leadership commitment to the vision of the organization, the implementation is also influenced by the external communication network organization that is: advocacy, coordination and cooperation with cross-related sector. Conclusion : The policy of recruitment of contract workers in Sleman district was successfully implemented because the policy makers and implementers played a good role, while Sumbawa regency did not implement this policy because of the difference perception about the need of health promotion personnel between Puskesmas as implementer of policy and health department as policy maker which supervises the Puskesmas. Keyword : Implementation, outcome, DAK non-Physical policy, Contract force health promotion, Consolidated Framework for Implementation Research ABSTRAK Latar belakang: Isu global tentang beban penyakit tidak menular menjadi salah satu dasar kebijakan nasional di bidang kesehatan. Penyakit tidak menular adalah penyebab 68% kematian di dunia dan sebagian terjadi pada negara berpenghasilan menengah ke bawah. Dalam rangka mendukung komitmen global pemerintah melalui Kementerian Kesehatan menetapkan salah satu sasaran Rencana Strategi Pembangunan Nasional (RPJMN) adalah upaya pelayanan promotif dan preventif dalam rangka menurunkan kejadian penyakit tidak menular yang dalam beberapa tahun terakhir berkembang pesat. Untuk memenuhi kebutuhan tersebut pemerintah melalui Kementerian Kesehatan mengeluarkan kebijakan yaitu Peraturan Menteri Kesehatan Nomor 82 Tahun 2015 tentang Juknis Dana Alokasi Khusus sebagai Bantuan Operasional Kesehatan dimana salah satu pembiayaannya adalah untuk kegiatan promotif dan preventif yang diarahkan untuk membiayai satu (1) orang tenaga kontrak promosi kesehatan. Tujuan untuk menganalisis pelaksanaan kebijakan Dana Alokasi Khusus Non Fisik Tahun 2016 untuk merekrut Tenaga Kontrak Promosi Kesehatan di Kabupaten Sumbawa dan Kabupaten Sleman Metode: Penelitian studi kasus tunggal terjalin dengan strategi pendekatan menggunakan Riset Implementasi ini dilakukan di Dinas Kesehatan di Kabupaten Sumbawa yang belum melaksanakan kebijakan Tenaga Kontrak Promosi Kesehatan dan Kabupaten Sleman yang telah melaksanakanya. Informan diwawancarai dengan menggunakan kerangka kerja The Consolidated for Implementation Research ( CFIR ) sebagai panduan dalam pengumpulan dan analisis data kualitatif. Partisipasi aktif pembuat keputusan kebijakan baik di Pusat maupun di Daerah ikut dilibatkan selama proses penelitian berlangsung, mulai dari penentuan topik, pertanyaan penelitian sampai pada pelaksanaan penelitian. Kata kunci : Implementasi, outcome, kebijakan DAK non Fisik, Tenaga Kontrak promosi kesehatan, Consolidated Framework for Implementation Research

Background: The operation of mobile health center activitiesis currently unable to increase the coverage and provide equaldistribution of basic health service for people in isolated areas.The cost for mobile health center activities is relativelyhigh; it needs lots of staff and the service hours are limited. Asthe budget for mobile health center operation is limited, thefrequency of mobile health center activities is relatively low.Further consequence is that the implementation of survaillanceand priority program is constrained. To improve health servicefor people living in isolated areas of Meratus Mountain theDistrict Government of Hulu Sungai Tengah in 2002 issued apolicy on Non Permanent Staff Nurses. This policy is aimed toprovide continuous and accessible basic health service forthe community whenever they need it.Method: This was a descriptive qualitative study that used acase study design and was carried out at 4 villages that gotallocation of non permanent staff nurses with as many as 14informants. Primary data were obtained from indepth interviewwhereas secondary data were obtained from documentsearch particularly documents at Hulu Sungai Tengah districthealth office and health centers. Observation was also madeto get information not covered in indepth interview.Result: The result shows improvement in availability of basicservices to the community. On the other hand limited facilitiesare made available to the non permanent staff nurses, alongwith inadequate equipment, supplies, and vehicle to do theirwork. Also there is lack of additional incentive and regularmonitoring to support them.Conclusion: Basic health service was available more continuouslyand more accessible for people at isolated areas.However, findings also suggest that the policy of non permanentstaff nurses for isolated areas of Meratus Mountain, Districtof Hulu Sungai Tengah had not been fully supported bynecessary facilities, equipment, additional incentives and monitoring.Keywords: policy evalution, non permanent staff nurses, isolatedareas

Background: One of the important things forchange is a sequentialcharacteristic or the phase of time for a change. Suchas the change stipulated by BLUD (Publis Service Agency)policy of the State Regional Hospital (RSUD) to become BLUD.The implementation of BLUD in the regional public hospital(RSUD) of Undata is generally based on the regulation of TheDepartement of Internal Affairs No 61 year 2007. The newparadigm as BLUD must be balancedof both the “Enterprisingthe Goverment” and the “Public Service Oriented”. The backgroundof Undata Hospital before becoming BLUD were theproblem of health care cost was getting expensive whilst thetariffs imposed had to be competitive, and the demand of goodquality of services to care for the patients. All of this could beachieved if Undata hospital applies the financial managementsystem of the regional public service agency (PPK-BLUD).Method Of Research:Thisresearch uses a descriptive analysiswith the case study design. The samplings conducted inthis research are purposive sampling. Method of data colectionobtained through in depth interview, observation, utilization ofdocuments.Research Result: The implentation of regional public serviceagency (BLUD) based on the result of evaluation study inUndata hospital and in the health departement of CentralSulawesi Province shows that: The implementation based onthe standard, namely governance, business strategy plan,and the report of financial management has been implementedwell. Whereas the implementation which is not in accordanceyet with the BLUD criteria is the minimum service standardrelated to indicator and criteria of SPM. Also the role of healthdepartement as the supervisory board has yet to be implementedbecause there is no supervisory board.Conclusion: It shows the governance, business strategyplan and financial report are already in accordance with standard,set while the minimum service standard and the supervisoryboard have not run optimally within the standard andcriteria set.Key words: PPK-BLUD, implementation of BLUD, Hospital,Stakeholders

Background: Strengthening referral system is a method toaccelerate decrease of maternal mortality rate. The main factorsaffecting referral system are facilities, staff, team work, andbudget that need seroius attention from all stakeholdersinvolved in the program of maternal health. By strengtheningthe system of maternal health the problem and the challenge ofhealth center to support of maternal referral can be addressed.Objective: The study aimed to evaluate referral system ofmaternal health at District of Karimun Province of KepulauanRiau.Method: This was a qualitative case study undertaken atKarimun Hospital and 2 health centers with high maternal andinfant mortality rate, i.e. Meral and Moro Health Center thatwere located at both urban and rural areas. Data were obtainedthrough in-depth interview, focus group discussion,observation, checklist and document study.Result: The result of the study showed there was limitation ofresources at primary health service such as facilities andequipments and hospital limited ability to provide comprehensiveemergency neonatal and obstetric management despite beingoperated 24 hours. There were lack of team coordicationacross referral levels involving district health office, hospitaland health centers, incomplete standard operating procedures,weak information system and bypassing referral procedure.Community participation in referral system was very highthough some labor was assisted by traditional childbirthattendants. This condition was mainly due to cultural factors/reasons.Conclusion: There are some problems and challenges in bothprimary health service and hospitals to support maternalreferral system in Karimun District. Some policies are requiredas a first step toward better referral system in Karimun District,for instance accelerating a functioning CMOC hospital,strengthening the teamwork across referral system, andestablishing SOP for maternal cases including its referralprocedures.Keywords: Problem, Challenge, Maternal referral system,Health Center, Distric Goverment Hospital.

Background: NTB Mental Hospital as the only major referralcenter for mental health services in NTB was required to servethe community, to develop and be self-sufficient, while at thesame time must be able to compete in providing quality andaffordable services to the community. In order to fulfill thesedemands, since January 29, 2011 NTB Mental Hospital hasreceived full endorsement as a Mental Hospital with FinancialManagement Patterns of Local Public Service Agency (PPKBLUD).Therefore, indepth review of the implementation ofPPK-BLUD policy in NTB Provincial Mental Hospital (RSJP) isrequired.Objectives: To explore the transformation process andimplementation of PPK-BLUD policy in RSJP.Methods: The design of this study is a qualitative researchcase study to describe the dynamics of the change processand implementation of PPK-BLUD policy in RSJP.Results and Discussion: The phase of transformationprocess was not running as expected. The implementation ofPPK-BLUD policy is not optimal because some flexibility as ahospital privileges with BLUD financial pattern have not beenimplemented yet. The f inance manager was hesitant toimplement the flexible financial management and still followingthe local government financial management mechanisms. Forexternal stakeholders, the implementation of PPK-BLUD policyimplementation in RSJP did not harm local fiscal policy becausethe revenue of RSJP was still counted as revenue for localgovernment, as opposed to independent PPK-BLUD. A surveywas conducted, consisting of community satisfaction towardsthe services in RSJP, data of revenue and budgettingmanagement and distribution of fee services to employees inRSJP. The survey result described that the implementation ofPPK-BLUD policy in RSJP gives positive impacts on financial,services and benefits performances to RSJP. The positiveimpacts were an increase in the number of income, increasedof service indicators measurement and increased incentive toall employees.Conclusion: Management changes in the transformationprocess were not running optimal so that the PPK-BLUD policyin RSJP is not fully implemented, although there were someperceived positive results.Keywords: Local Public Service Agency, policy, changemanagement.

Background: Health financing provided by the governmentgreatly helps the implementation of health system in the decentralizedera. General Allocation Fund and Local Revenueand Expenditure Budget are apparently inadequate to financehealth service. Some efforts have been made to finance healthservice such as Community Health Insurance (Jamkesmas),Childbirth Insurance (Jampersal), and Health Operational Fund(Bantuan Operasional Kesehatan/BOK). These are meant toachieve Millennium Development Goals in 2015. The practiceof coordination from planning to implementation and stakeholders’commitment can affect the process of maternal and childhealth service. Coordination is definitely needed to run theprogram policy and prevent the overlapping financing in orderthat the objective of the program can be achieved.Objective: To evaluate coordination of planning, implementationand stakeholders’ commitment in relation to maternal andchild health (MCH) service in Lombok Tengah District.Method: This was a descriptive-analytical study with a qualitativeapproach and a case-study design. Samples were takenpurposively. The data were obtained through in-depth interview,observation and documentation analysis.Result: The planning coordination of MCH health financinghad not been optimal, even despite the involvement of crosssector and program. However, the organizations of healthprofessionals were not involved in program planning. The coordinationof health financing implementation had not been optimalas well. Even though there was no overlapping financingfrom some different sources, in the policy implementation therewas cost sharing for referral and drugs. Private sectors werenot involved in the implementation of Jampersal. Stakeholders’commitment was relatively optimum as reflected from the policyand action in health development acceleration particularly MCH.The process of MCH service at both primary and secondarylevel could run well.Conclusion: Coordination of MCH financing implementation inLombok Tengah District through BOK, Jampersal, Jamkesmas,Community Empowerment National Program of Healthy andSmart Generation and Local Revenue and Expenditure Budgethad not been optimal; therefore, it needed to be improved toeliminate cost sharing. Professional organizations and privatehealth providers were not yet involved in the program planningand implementation.Keywords: coordination, stakeholders’ commitment, healthfinancing, maternal and child health, program evaluation