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Eduvest �
Journal of Universal Studies Volume 3 Number 2, February, 2023 p- ISSN 2775-3735- e-ISSN 2775-3727 |
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IMPLEMENTATION OF SPECIAL AUTONOMY POLICY IN THE HEALTH SECTOR IN WONDAMA
BAY REGENCY WEST PAPUA PROVINCE |
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Eduard Nunaki,
Murtir Jeddawi, Djo Hermansyah, Hyroni Misrowa Institut Pemerintahan
Dalam Negeri Jakarta, Indonesia |
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ABSTRACT |
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The
degree of public health and health services has not shown results that are in
line with the objectives of the special autonomy policy. The data shows that
the infant mortality rate (IMR) is still high and the maternal mortality rate
is still high. The aim of the research is to analyze and explain the
implementation of the autonomy policy, especially in the health sector, the
influencing factors and to formulate a new model regarding the implementation
of the special autonomy policy in the health sector in Wondama Bay Regency,
West Papua Province. This research uses implementation policy theory put
forward by Grindle which consists of content policy and implementation
context policy. The research approach used in this research is a qualitative
approach with a descriptive research type. Data collection techniques were
carried out by interviews, observation and documentation. Data analysis
techniques used were data reduction and conclusion. The results of the study
show that the implementation of the special autonomy policy in the health
sector is not optimal, thus it needs to involve many components (authority,
affairs, finance, resources, attitude of implementers, community
participation and so on). The "NUNAKI" Policy Implementation Model
is a construction of research results consisting of three elements, namely:
commitment, communication and collaboration. The implementation of the
"NUNAKI" model requires five basic prerequisites, namely: regional
authority, regional institutions, state finances, local government politics
and the effectiveness of coordination, guidance and supervision. |
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KEYWORDS |
policy
implementation, special autonomy, health |
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This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International |
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INTRODUCTION
The essence of the government's presence is to provide protection, promote
general welfare and educate the nation's life and maintain world order, lasting
peace and social justice for citizens,
as mandated by the Constitution of the Republic of Indonesia at the Preamble to
the 1945 Constitution. Based on the mandate of the constitution, the state is
obliged and responsible for organizing a quality public service system in
various aspects of national and state life, especially providing quality public
services to the people who are citizens. Quality public service to the people
will give birth to the satisfaction and trust of the people in the country (Fanggidae &
Yuanjaya, 2016).
To realize the responsibilities and obligations of the state in the public
service system and by considering that the territory of the Republic of
Indonesia is very broad, the mandate of Article 18 of the 1945 Constitution
after being amended in 2001:
(1)
The Unitary State of
the Republic of Indonesia is divided into provincial areas and the provincial
areas are divided into regencies and cities, each of which has a local
government, which is regulated in law.
(2)
Provincial, district,
and municipal governments regulate and manage their own government affairs
according to the principle of autonomy and auxiliary duties.
(3)
Provincial, district,
and municipal governments have a Regional House of Representatives whose
members are elected through general elections.
(4)
Governors, Regents,
and Mayors as heads of provincial, district, and municipal governments are
democratically elected, respectively.
(5)
Local governments
exercise the widest possible autonomy, except for government affairs which by
law are determined to be the affairs of the Central Government.
(6)
Local governments
have the right to enact local regulations and other regulations to carry out
autonomy and auxiliary duties.
(7)
The composition and
procedures for the implementation of the regions are regulated in the law.
Furthermore, it is explained that because the Indonesian state is an eenheidstaat, Indonesia will not have an
area within its environment that is staat
as well. The explanation in the aforementioned constitution, reinforced by
Koswara (2015: 1) that the Indonesian region is divided into provincial areas
and the provincial areas are also divided into smaller areas.
Observed from the historical aspect, in fact, in the practice of
implementing the Indonesian government with the principle of decentralization,
it has gone through state consistusion, namely Article 18 of the 1945
Constitution. This is affirmed by (Jeddawi & Rahman,
2018) by stating that the application of the principle of decentralization in the
process of administering government in the history of local government has
actually been accommodated in article 18 of the 1945 Constitution.� The consequence of applying the principle of
decentralization is with state political policy, namely the state handing over
part of the authority to the regions to become autonomous regions to regulate (regeling) and manage (besstuur) the affairs of
self-government and the interests of regional communities in the system of the
Unitary State of the Republic of Indonesia. Furthermore, according to (Wasistiono, 2019) states �that the argument that underlies the implementation of the principle �of decentralization, is that Indonesia as the largest archipelagic state in the world, with tens of
thousands of islands and islands and with hundreds of ethnic groups inhabiting
it, then decentralization is a condition
sine qua non.
In line with the principle of decentralization, special autonomy is a form
of good �will and political will of
the government in �bringing government services closer to the
community in order to realize the welfare of the community in areas that have
special characteristics, as well as focusing development on certain areas that
are basic needs. Health is the basic need �of the people and is one of the indicators of the quality of human development in
a country (Sukmalalana et al.,
2020). Therefore, it is the government's obligation to fulfill it through quality
services.� The quality of government
services will greatly help the community to achieve prosperity, but poverty is
still a severe challenge for the Indonesian nation, as shown in the following
table:
Table 1
Number of Poor People in Eastern Indonesia
|
PROVINCE |
SUM |
||||
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2017 |
2018 |
2019 |
2020 |
2021 |
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|
East Nusa Tenggara |
1160.53 |
1150.08 |
1134.74 |
1134.11 |
1146.32 |
|
Maluku |
327.78 |
331.79 |
320.42 |
317.84 |
317.69 |
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North Maluku |
72.65 |
76.40 |
78.28 |
81.93 |
84.60 |
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West Papua |
225.54 |
223.60 |
212.86 |
213.67 |
211.50 |
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Papua |
898.21 |
914.87 |
910.42 |
915.22 |
926.36 |
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Indonesian |
28513.57 |
27764.32 |
26582.99 |
25674.58 |
25144.72 |
Source: BPS RI 2022
Based on the data mentioned above, it illustrates that the number of poor
people in eastern Indonesia is still very large, especially the two provinces
on the island of Papua which still have millions of poor people who urgently
need quality services. With such an understanding, the presence and existence
of government for the community is a necessity as well as a solution to various
problems that accompany people's daily lives and at the same time, quality
government services are a need, longing and hope of the community. In this
context, Government Science analysts come to the conclusion that modern
government is essentially a service to society (Thalib & SH,
2018); (Sule, Trisnawati
Ernie dan Saefullah, 2007) and service is an essential function of a government (Taliziduhu, 2003).
To bring government services closer to the community, one form of almost
acceptable in interpreting government services is through a special autonomy
policy. The policy of special autonomy is a political space that provides a
pattern of government relations between the central and regional governments
and between local governments and their people, egalitarianly, democratically
and responsibly. Through this political policy, the essential duties and
functions of government, namely government service to the community, are
proclaimed and give meaning to the community. That the policy of special
autonomy is a manifestation of the political
will �of a nation-state in carrying out
the division �of power (divisioan of power) with the regions.
Through this division of power, it gives birth to autonomous regions that
have broad rights and authorities and great responsibilities, to carry out
services to the community, differences and regional development efficiently,
effectively, democratically, transparently and accountably in realizing social
order, justice, independence and community welfare in the regions. The purpose
of autonomy has become very clear to support equitable distribution of
development and health services, considering the high maternal mortality rate
as one of the indicators of the quality of health services in Indonesia. The
gaps that appear in health care can be seen in the following Table:
Table 2
Maternal Mortality Rate in Indonesia by Island
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�Island (Join) |
Maternal Mortality Rate By Island |
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2021 |
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Sumatra |
344 |
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Java - Bali |
247 |
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Kalimantan |
466 |
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Sulawesi |
282 |
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Nusa Tenggara, Maluku, Papua |
489 |
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Indonesian |
305 |
Source: BPS RI 2022
The data above shows the inequality of health services, especially services
for parturients which shows that eastern Indonesia still faces very complex
health problems. This can mean that the policy of decentralization and regional
autonomy, is not an objective but it is an instrument or a good momentum for
local governments in manifesting the essential function of government, namely
quality government services to the community, including health services so that
through this momentum, government service activities or health services take
place as well as the role of local governments or local government
bureaucracies in organizing the ministry in question.
Interpreted in depth, the policy of special autonomy is born from the
political policy of the state on decentralization and regional autonomy within
a country. In that context, if examined from a historical perspective, then the
policy of decentralization and regional autonomy in Indonesia, is not a new
policy but it has existed in the history of the long journey of central and
regional government relations, starting from the colonial rule of the Dutch
East Indies called Wethousdende
Decentralisatie van het Bestuur in Nederlandsch Indie or known as Decentralisatiewet �1903 i.e. decentralization tentag
law (Koswara, 2016).
The central government's attention to the politics of decentralization and
regional autonomy continued through various policies such as Law Number 1 of
1945 after Indonesia became independent, Law Number 22 of 1948, Law of the
State of Eastern Indonesia Number 44 of 1950, Law Number 1 of 1957,
Presidential Instruction Number 6 of 1959, Presidential Instruction Number 5 of
1960, Law Number 18 of 1965,� Law Number
5 of 1974, Law Number 22 of 1999, Law Number 32 of 2004 and Law Number 12 of
2008 and Law number 23 of 2014 concerning Regional Government. This policy of
decentralization and regional autonomy through various laws and regulations is
intended to realize the acceleration of development and welfare of the
Indonesian people in the regions.
In the context of the implementation of government in Papua, theethics of
an independent Indonesia on August 17, 1945, Papua was included in the
territory of the Republic of Indonesia and was one of the residencies within
the Maluku province (Koentjaraningrat,
1994). Furthermore, Indonesia returned West Irian to the lap of Mother Earth with
the birth of West Irian Province. Subsequently, there was a change and the
formation of West Irian Province whose territory included the entire Nieuw
Guinea residentie with the capital in Hollandia which was still in Dutch
territory (Djopari, 1993). The journey of autonomous regional government as the jurisdiction of
Indonesia was stated that the legal basis for the administration of government
in West Irian includes:
1.
Law Number 15 of 1956
concerning the establishment of an autonomous region of West Irian Province;
2.
Law Number 23 of 1958
concerning the Establishment of Emergency Law Number 20 of 1957 concerning the
addition of the Law on the establishment of Level I self-sufficient areas of
West Irian as a law;
3.
Law Number 20 of 1957
concerning Amendments to the Law on the Establishment of the Autonomous Region
of West Irian Province;
4.
Law Number 12 of 1969
concerning the establishment of the West Irian Autonomous Province and
Autonomous Districts in West Irian Province;
5.
Law Number 16 of 1969
concerning the composition and position of the People's Consultative Assembly,
the House of Representatives, the Regional People's Representative Council for
West Irian Province;
6.
Presidential Decree
No. 1 of 1962 concerning the establishment of a new form of West Irian
Province;
7.
Determination of
Precedent No. 1 of 1963, concerning the formation of government immediately
after it was handed over to the Republic of Indonesia;
8.
Presidential Decree
No. 14 of 1963 concerning the policy of West Irian Province Development;
Responding to the various demands of the Papuan people regarding
development inequality, and the demands for secession or independence delivered
by the Delegation of the Papuan community component of 100 people on February
26, 1999 Bpak BJ. Habibie the President of the Republic of Indonesia at the
State Palace Jakarta, (Tunggal, 2008), so to accelerate the development process in Irian Jaya Province, the
government enacted Law Number 45 of 1999 concerning the expansion of Irian Jaya
Province into Central Irian Jaya Province, West Irian Jaya Province, Paniai
Regency, Mimika Regency, Puncak Jaya Regency and Sorong City. However, it was
rejected, because of the improper momentum, "because it was considered
non-aspirational and was in the interest of the Central Government in an effort
to suppress or divide the Free Papua movement"(Lipi Political Journal Vol
3 No.1 of 2006, p. 29). In line with the demands for the legality of special
autonomy for West Papua Province, Law Number 1 of 2008 concerning the
establishment of Perpu Number 1 of 2008 concerning amendments to Law Number 21
of 2001, law Number 35 of 2008 was born in the framework of the Revision of Law
No. 21 of 2001 concerning Special Autonomy for the Provinces of Papua and West
Papua.
On the other hand, to answer the demands that tend to lead to the
disintegration of the nation in 1998 as a result of human rights violations, (Djohan, n.d.) stated that "Papua is part of the Unitary State of the Republic of
Indonesia, as well as to answer the armed resistance carried out by the Free
Papua Organization (OPM), to answer these demands the Government gave birth to
a policy of asymmetric decentralization or special autonomy through Law Number
21 of 2001� on Special Autonomy for Papua
Province".�� This political policy
of asymmetric decentralization or special autonomy is a public policy issued by
the state and is an extraordinary policy with consideration of the problems
faced by the Papuan people such as "various policies for centralized
governance and development, unfulfilled sense of justice, not yet achieved the
welfare of the people, the realization of law enforcement and it seems that
respect for human rights and� the
occurrence of problems in almost all sectors of life, especially in the fields
of education, health, economy, culture and socio-politics as well as government
bureaucracy at various levels", (Sumaryadi, 2006: 208).
The special autonomy policy for the Provinces of Papua and West Papua is a
form of cultural recognition that the Papuan people are people with Melanesian
families.� The policy of special autonomy
is a manifestation of the good will and political will of the state to create a
prosperous, independent, cultured and dignified Papuan society. The country's
commitment, accompanied by special autonomy funds for the Provinces of Papua
and West Papua. Although the special autonomy policy has been implemented since
2001, the facts show that the implementation of special autonomy for the
Provinces of Papua and West Papua has not provided the greatest benefit to the
welfare of the people in Papua and West Papua Provinces.
The results of research conducted by Mardyanto and Yusuf from the
Indonesian Institute of Sciences (2018: 176) show that "the amount of
special autonomy funds that increase every year is not enough to make a
significant contribution to improving the welfare of the people of West Papua.
The level of welfare of the people of West Papua is still inadequate. In
addition, the level of education and health is also still very low". Data
from the West Papua Human Development Index (HDI) in 2016 shows that there is a
decrease in the number of poor people, but the number is insignificant and
tends to stagnate.� So
it can be seen that large special autonomy funds do not have a significant
impact on improving welfare.
The comparison between the amount of special autonomy funds provided and
the improvement of community welfare can be described in Table 3, The amount of
special autonomy funds and the number of poor people in West Papua:
Table 3
Number of Special Autonomy Funds and Number of Poor People
In West Papua Province
|
Year |
Special Autonomy Fund (IDR) |
Number of Poor People (%) |
|
2017 |
1.353.196.948.950,00 |
28,53 |
|
2018 |
1.642.886.635.000,00 |
27,04 |
|
2019 |
1.866.835.735.000,00 |
27,14 |
|
2020 |
2.047.315.954.000,00 |
26,26 |
|
2021 |
2.117.327.091.000,00 |
25,73 |
Source : Ministry of Finance and BPS, data processed in 2022
The amount of transfer funds is actually considered
unable to improve the welfare of the people of West Papua, which until 2021
still has a poor population of 211 thousand people. In addition, theenactment of Special Autonomy in West Papua Province in 2007 has not been
able to improve the welfare of the poor even though the gini ratio tends to
increase, even west Papua's gini ratio is above the national gini ratio. This
is illustrated in the following chart:
Graph 1
Comparison of Gini Ratio of West Papua and Indonesia
The results of LIPI's research show that in 2011 the gini ratio was above
the national gini ratio and in 2015 West Papua Province was one of the
provinces that had the highest gini ratio rate in Indonesia. This shows that
income inequality between rich and poor in West Papua Province is increasing
after the enactment of special autonomy.�
On the other hand, in general, the life expectancy in each region has
always progressed and in 20 1 5, the life expectancy of West
Papua Province reaches 65.1 9 years, meaning that the average population of West Pap ua Province can live for 65 years. The highest life
expectancy is d i Sorong City of 69.0 4 years �d a n the lowest life expectancy in �Teluk Wondama Regency of 58.36 years. This
means that the residents of �Teluk Wondama District can live
for 58.66 years.
Table 4 on the Human Development Index, describes Wondama Bay District at
the lowest order, as it is influenced by various factors, including the health
field.
Table 4
HDI Data for West Papua Province by District/City
|
Districts/Cities |
HDI |
Rank |
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2019 |
2020 |
2021 |
2019 |
2020 |
2021 |
|
|
(1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
|
F a k-F ak |
64,29 |
64,73 |
64,92 |
3 |
3 |
3 |
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K aim a na |
60,36 |
61,07 |
61,33 |
6 |
5 |
5 |
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Teluk Wond a ma |
55,65 |
56,27 |
56,64 |
9 |
9 |
9 |
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Teluk Bi n tuni |
59,79 |
60,40 |
61,09 |
7 |
7 |
7 |
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Manokwari |
68,81 |
69,35 |
69,91 |
2 |
2 |
2 |
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Sorong Selatan |
57,73 |
58,24 |
58,60 |
8 |
8 |
8 |
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Stretch out |
60,86 |
61,23 |
61,86 |
4 |
4 |
4 |
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Raja Ampat |
60,36 |
60,86 |
61,23 |
5 |
6 |
6 |
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Tambrauw |
48,69 |
49,40 |
49,77 |
13 |
13 |
13 |
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Maybart |
54,93 |
55,36 |
55,78 |
11 |
10 |
11 |
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South Manokwari |
54,95 |
55,32 |
56,59 |
10 |
11 |
10 |
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Arfak Mountains |
53,36 |
53,69 |
53,73 |
12 |
12 |
12 |
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Sorong City |
76,96 |
75,78 |
75,91 |
1 |
1 |
1 |
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West Papua |
60,91 |
61,28 |
61,73 |
33 |
33 |
33 |
Source: BPS West Papua Province.
Departing from the problems as stated, in government services in the health
sector, it is necessary to take it seriously as a responsibility in the welfare
of the people. Data from the last 3 years from 2019 to 2021 in Teluk Wondama
Regency, shows that health services have not received serious attention, it is
evident from the allocation of special autonomy funds in the health sector
which is very low compared to 4 (four) other development areas, this can be
seen in the following table:
Table 5
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Special Autonomy
Fund Allocation 2017 - 2021 Per Field |
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Teluk Wondama
District Government |
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Year of Angga- Ran |
Fund Ceiling |
Field Division |
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Education |
Health |
Infra-Structure |
Perekono-Mian Rakyat |
Affirmative Action |
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2017 |
� 65.000.000.000 |
19.516.288.000 |
9.766.294.000 |
25.855.194.000 |
4.734.098.000 |
5.128.126.000 |
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2018 |
68.780.186.020 |
33.962.656.116 |
7.019.142.400 |
9.250.000.000 |
9.748.387.504 |
8.800.000.000 |
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2019 |
81.639.568.856 |
37.227.585.339 |
5.682.624.493 |
5.895.045.792 |
6.479.667.643 |
6.354.645.589 |
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2020 |
92.629.466.000 |
25.445.928.030 |
9.206.499.677 |
23.445.844.942 |
9.091.898.701 |
25.439.294.650 |
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2021 |
93.039.830.440 |
24.743.783.395 |
9.206.960.900 |
19.302.790.000 |
37.007.371.145 |
2.778.925.000 |
Source : Regional Development Planning,
Control and Development Agency of Teluk Wondama Regency
Baer based on this data, with the allocation of the special autonomy fund
budget as the government's policy in bringing government services closer to
health services.
Departing from this problem, the central theme of this dissertation is the
implementation of a special autonomy policy in the health sector, with settings and fields, health services in Teluk Wondama Regency. The argument that
underlies the choice of this theme, that the essence of the presence and
existence of government in a country is service to the community, because
service is the main function of a government,
for that there is no government without service and there is no society in
a country whose presence and existence is without the establishment of
government services. On the other hand, Rasyid (2007) said that government is the
only formal institution that gains political legitimacy and social
acceptability from society, to serve the people in a country, because the
government is not formed to serve itself nor is it formed to engineer a system
for the perpetuation of power, but it is formed to serve the community,� With the main purpose of forming a government
is to realize a system of order, justice, independence and public welfare
through quality services, in various fields of development.
One of the areas that is a problem with the implementation of special
autonomy for the Provinces of Papua and West Papua is the health sector. Health
is a basic need of society and has become a concern for the global community
and it is the duty and responsibility of governments to fulfill them. Public
health becomes very important because it is related to the quality of human
resources within a State. The progress and decline of a country depends largely on the quality of its people because the
quality of society gives birth to a quality government. Quality government will
provide quality government services to the people. Such is the cycle that
illustrates how strategic health development is for the community.
The importance of health for the community, placing
health as one of the measures of meaningfulness or meaninglessness of the
presence and existence of government for the people in a State. Therefore, UNDP
(United Nations Development Programme) gave
birth� to the Human Development Index in a country and
chose health as one of the indicators, in addition to education and the
economy.
Normatively, Law Number 36 of 2009 concerning Health
emphasizes the importance of health for the community. Health, according to
this law is one of the elements of general welfare that must be realized in
accordance with the ideals of the Indonesian nation. It is also emphasized that
health development is directed to heighten the degree of health that is large
for the development and development of human resources. In the context of this
embodiment, namely the optimal degree of health for the community, health
service efforts are organized with an approach of maintenance, health
improvement (promotive), disease
prevention (preventive), disease
treatment (curative) and health recovery (rehabilitative)
which is carried out thoroughly, integrated and sustainable.
Because of health as a basic need of society and as one
of the indicators of human development in a State, the government is obliged
and responsible to serve by performing well, in the context of providing, distributing
and fulfilling it preferentially to the people, when the people need it or
before the people ask. The good performance of health services from the
government is a necessity, longing and hope and a must. People as citizens
deserve quality health services.
Teluk Wondama Regency as one of the regencies in West
Papua Province, has implemented a special autonomy policy since 2009. One of
the areas of special concern in the administration of government in Teluk
Wondama Regency is the health sector. However, public health and health
services have not shown results that are in line with the objectives of the
special autonomy policy. Data shows that the infant mortality rate (AKB) is
still high and the maternal mortality rate is also still high. This condition
shows that health services in Teluk Wondama Regency are still far from people's
expectations. Data shows that in 2013, the infant mortality rate was 224 babies
per thousand live births. Meanwhile, the number of deaths of pregnant women in
2013 was 62 people (Wondama In Figures, 2015). Data
from the Teluk Wondama District Health Office report in 2014, showed that
diarrhea in 2013 was 120 cases, 8 people died. In 2014, Diarrhea was 115 cases
and 7 people died. Furthermore, malnutrition, in 2013 as many as 966 people. In
2014 there were 870 people. Furthermore, malaria sufferers spread in 6 (six)
health centers. Data in 2013 malaria sufferers were 350 people, in 2014 there
were 245 people. In addition, people with HIV / AIDS disease also spread in
Teluk Wondama Regency. Demmy Antoh (2008: 36) argues that deadly diseases such
as HIV / AIDS thrive in Papua because weak prevention efforts and other
preventive actions are still not optimal implementation.� In terms of health facilities and
infrastructure, it is still limited. The data shows that the number of
Puskesmas in Teluk Wondama is 6 puskesmas from 13 districts and 75 villages.
Likewise, the number of health workers is still lacking. The number of doctors
is 8 people and nurses are 156 people (Wondama In Numbers,
2015).
The condition of public health as stated above, shows
that the problem of people's basic needs in the health sector is still a
problem of people's lives. At the same time, people are still complaining about
the behavior of government officials, including; doctors, medical personnel and
employees in providing health services, such as less friendly, less sympathetic
and empathetic, untimely in providing services, rigid and convoluted, less
serious and sometimes often leave the place of duty for days and lack of health
socialization for the community. In addition, there is a lack of availability
of health facilities and infrastructure in districts and villages, both
Puskesmas and Pustu as well as medicines and other medical devices. In
addition, there are still limited numbers of health workers. The community's
complaints are the same as the author's initial observations when starting
research at Wondama Regional Hospital as well as several Puskesmas and Pustu.
Associated with the meaning of the presence of government
for the people, government science answers that the local government
bureaucracy, as an institution that carries out daily state political policies
through service to the community, has not been able to carry out its role
properly. In fact, quality service to the community is one of the indicators of
assessing government behavior in front of the people or an indicator of the
meaningfulness or meaninglessness of the presence of government for the people.
In other words, the meaning of the presence and existence of the government
before the people, lies in the extent to which the bureaucratic apparatus in
producing, distributing and allocating quickly, precisely, fairly and can be
reached from an economic aspect and is available when the people need it or
before the people ask.
Theoretically, it is understood that one of the
institutions that is the personification of the government and has a very
strategic role for the achievement of the goals, tasks and functions of
government is the government bureaucracy.�
It is the government bureaucracy that translates policies of an
operational nature and implements them at the empirical level. In other words,
the effectiveness of government political policies will be meaningful or
achieve goals, if the government bureaucracy carries out its duties and
functions in a professional, sensitive, responsive, empathetic, committed and
consistent and responsible manner. With the role of the government bureaucracy,
Palmer (1989: 259) argues that the government bureaucracy plays the role of
implementing the decisions formulated by political leaders. Furthermore, Rasyid
(1999: 4) strengthened Palmer's opinion by arguing that the government
bureaucracy is the most active party in the daily management of State power. In
the context of the effective implementation of regional autonomy, Rondinelli
and Cheema (1983: 299) argue that regional autonomy can be effective, in which
agencies and actors at the provincial and local levels, have developed their
ability to effectively implement the planning, policy making and management
functions left to them.
One of the bodies or perpetrators as stated in the
constatation above, is the government bureaucracy.� The government bureaucracy has a very
important role in realizing the policy objectives of asymmetric
decentralization or special autonomy. It is the Government Bureaucracy that
carries out the various autonomy authorities that have been handed over by the
Government, to carry out services, empowerment and regional development in
order to proclaim and realize justice, independence and welfare of the people.
That is the role of the government bureaucracy in the atmosphere of regional
autonomy in providing quality services to the community, including health
services.
In
general, referring to the formulation of research questions that have been
described above, the purpose of the study is to analyze and explain the
implementation of the special autonomy policy in the health sector in Teluk Wondama Regency, West Papua
Regency.
Through
the study of the implementation of special autonomy policies in the health
sector, theoretically this research can develop policy implementation theories,
especially from the aspects of content of policy and context of implementation,
in the practice of public services in government administration in Indonesia.
The findings of this study will complement the conceptualization of government
policy implementation methods in encouraging better governance.
RESEARCH
METHOD
The research design in this study is research using a qualitative approach.
According to (Bogdan, 2018), in a qualitative approach, researchers
observe and capture reality and examine the behavior of individuals, groups and
their daily experiences. In line with the above opinion, (Ndraha, 2013), argues that qualitative approaches are used for introspection, retrospect,
describing as it is, experiencing and discovering verstehen, deep-seated uniqueness, researching a symptom, observing empirical qualities, forming theories and
data.
The emphasis on a qualitative approach in this study is based on the
consideration that the focus of this study reveals the process and discovers
the meaning of health services provided by the government bureaucratic
apparatus as well as those experienced by everyday society, Disclosure of
processes and interplay of meaning in a study, qualitative approaches are more
relevant (Smith et al., 2014); (Creswell & Creswell, 2017): (Maxwell & Frankenberger, 2022)
An approach that primarily uses a knowledge paradigm
based on constructivist views (individual experiences or advocacy views. There
are three strategies used in this approach, namely: first, entomography
research is a form of research that focuses on sociological meaning through
closed field observation of sociocultural phenomena (Emzir,
2007: 143). Second, grounded
theory research is a general theory of the scientific method that deals with
the generalization, elaboration, and validation of social science theory (Rantung, 2018). Third, action research is an
informal, qualitative, formative, subjective, interpretive, reflective research
and an experiential research model, in which all individuals are likened to
studies as participants who know and support.
This research uses a qualitative approach, namely research that produces
significant research according to data and information in the field. According
to Sugiyono (2012: 32) that in qualitative research, data collection is not guided by theory, but
guided by facts found while in the field.�
Meanwhile, theory only serves to help researchers to create various
research questions, not to guide how to collect data and analyze data. While
the qualitative research method according to Bogdan and Taylor �in (Moleong, 2002: 3) is a research procedure that produces descriptive data in the form of
written or spoken words from people and observable behaviors. Qualitative
research carried out in a particular social setting is not intended to
represent or represent a particular setting. This is due to the highly
contextual nature of qualitative research and seeks to examine social phenomena
at the micro level, and does not intend to make generalizations (Bungin, 2010: 45).
Newman in (Sugiyono, 2012) stated that qualitative research forms events in social reality that are
meaningful to events in society or in organizational institutions by focusing
on interactive processes and events that prioritize authenticity and assess
explicitly using theory, facts and data in the field depending on the situation
/ event on the subject, using thematic analysis involving researchers� immediately.
Furthermore, according to (Moleong, 2002) that the �use of qualitative methods is based
on 3 (three) main considerations, namely: 1) it is easier to adjust to reality
that is dual or dealing with reality that is complex, 2) the ability to present
the nature of the relationship between researchers and informants and
respondents, 3) be more sensitive and adaptive to value patterns, meaning that
it can adjust to many influences and patterns of value faced.
Data collection techniques in this study, refer to the
opinion of Creswell (1994: 149) that in qualitative research, there are 4 (four) basic types in data
collection, namely observation,
interviews, documents and visual
imagess. Based on this opinion, it can be explained as follows:
1.
Interview
Interviews are conducted with the aim of obtaining adequate data on the
object of study. In this context, researchers use indepth interview techniques, with interview guidelines.
2.
Observation or
Observation
Using participatory observation techniques, which place researchers as an
integral part of the society receiving government services in the health
sector. Make observations. �Observations are made
of phenomena related to the object of study, which are observed directly at the
site of the researcher, with the guidance of observation design. Through
participatory observation techniques, researchers are placed as an integral
part of the community receiving government services in the health sector. The
phenomenon observed is the ongoing health service process and in or service
actions carried out by health workers both by Doctors, Nurses, Midwives,
employees and other health workers in service centers such as in General
Hospitals, Puskesmas, Pustu and Polindes. Furthermore, it observes the health
service process such as service procedures, punctuality of service, length of
service, service costs, service center environment and supporting
infrastructure. The manner or action of health services by officers includes
speed of service, accuracy, responsiveness, politeness, friendliness, empathy,
communication, intensity of counseling and discipline in addition, researchers
also, observe people's habits in daily life, the living environment and the
intensity of visits to health service centers. Data obtained through observation,
systematically recorded or recorded.
3.
Documentation
Documentation is carried out on
various literature on the behavior of government bureaucracies and public
services. In addition, it examines various legal documents and products
relevant to the object of researchn
RESULT
AND DISCUSSION
Teluk Wondama District was part of Manokwari District in
the beginning. In 2003, Teluk Wondama Regency was officially established,
separating itself from its parent district based on Law Number 26 of 2002.
Teluk Wondama Regency is located on the neck of the
island bird's head and is part of West Papua Province. The territory of this
regency is partly on the mainland of Papua Island, and the islands and part of
the other are water areas. Teluk Wondama Regency which has a land and ocean
area of 1,272,833 ha, more than 50% of its area is in the form of ocean, which
is around 777,711 ha which is Cendrawasih Bay National Park.
Geographically, the county is located between 132�35' -
134�45' BT and 0�15' - 3�25' LS. The geographical location of Teluk Wondama
Regency can be seen in Figure 1. next:
Figure 1 Geographical location of Teluk Wondama Regency
Source: BPS Teluk
Wondama Regency D a l a m Angk a Tahun 2021
In 2021, the Teluk Wondama Regency Administrative Region
consists of 13 districts which are completely divided into 75 villages and 1
kelurahan. Wasior District is the district that has the highest number of
villages/kelurahan compared to other districts in Teluk Wondama Regency. In
2021, the Wasior District area is completely divided into 9 villages and 1
village is also the only area that has a village in Wondama Bay. Rumberpon
District then became the district with the second highest number of villages,
namely 7 villages. The area of the district is indeed recorded as the most
extensive among other districts in Teluk Wondama Regency.
Demographic Condition
of Teluk Wondama Regency
The demographic condition of an area in general is reflected through the
number of population, population growth rate,
population structure, population distribution and employment. Based on BPS data
in the latest statistical indicators of Teluk Wondama Regency in 2021, the
total population of Teluk Wondama Regency in 2021 reached 42,609 people with a
growth rate of 2.32 percent.
Table 6
Total Population of Teluk Wondama Regency Tahun 2018-2021
|
No |
youareaian |
Wondama Bay District |
|||
|
2018 |
2019 |
2020 |
2021 |
||
|
1 |
Juml a h Penduduk (jiwa) |
31.769 |
32.521 |
41.644 |
42.609 |
|
2 |
L aj u P ert u mb u ha n Pend uduk (%)
|
2,20 |
2,34 |
4,54 |
2,32 |
|
3 |
Topa d a t a n Penduduk
(jiwa/km) |
1,92 |
2,17 |
2,78 |
2,50 |
Source: Wondama Bay District In Figures
2019-2021
Wondama Bay in 2021 by sex can be said to be relatively balanced. Based on
the results of the Interim Projection carried out by the Central Statistics
Agency, of the 42,609 residents of Teluk Wondama Regency, 22,541 people are
male residents. This value covers 52.90 percent of the total population of
Teluk Wondama Regency as a whole in 2020. Meanwhile, the female population
reached 20,068 people in 2020, or around 47.10 percent.
The condition of development in
the health sector in the RPJMD, among others, aims to obtain health services
easily, cheaply and evenly. Through these efforts, it is hoped that a better
degree of health will be achieved. Based on data obtained by the Posyandu to
the number of toddlers in 2021 of 0.014, this figure shows that the formation
of posyandu in Teluk Wondama Regency has been achieved and has been above the
ideal where 1 posyandu serves 100 toddlers or 0.01, the spread of posyandu
formation should not be too close to puskesmas so that health services are more
achieved. The existence of Posyandu plays a role in supporting the reduction of
infant mortality rate (AKB), maternal mortality rate (pregnant women,
childbirth and puerperium), cultivating the Norms of Happy and Sejatera Small
Families (NKKBS), increasing community participation and community ability to
develop health and family planning activities as a vehicle for the reproductive
movement of prosperous families.
Table 7
Number of Posyandu and Toddlers in Teluk Wondama Regency
Year 2019-2021
|
No |
youareaian |
2018 |
2019 |
2020 |
2021 |
|
1. |
Number of Posyandu |
61 |
61 |
61 |
64 |
|
2. |
Number of Toddlers |
4.804 |
5.104 |
4.033 |
4.440 |
|
3. |
Ratio |
0,012 |
0,011 |
0,015 |
0,014 |
S umber: BPS Wondama Bay District D a l a m Angk a Tahun 2019-2 0 21
It has previously been stated
that health is an influential factor in human development. A good degree of
public health will result in good development performance in the community.
Therefore, the existence of health facilities plays an important role in improving
the degree of public health, the easier it is for people to reach available
health facilities, the less the level of pain will be.
Table 8
Number of Puskesmas in Teluk Wondama Regency in 2018-2021
|
No |
youareaian |
2018 |
2019 |
2020 |
2021 |
|
1. |
Number of Puskesmas |
9 |
13 |
13 |
13 |
|
2. |
Population |
31.769 |
32.521 |
41.644 |
42.609 |
|
3. |
Ratio |
0,0002 |
0,0003 |
0,0003 |
0,0003 |
S umber: B��� PS
Wondama Bay District D a l a m Angk a Tahun 2019-2 0 21
Realizing sustainable health
development with a fast reach, in 2021 Teluk Wondama Regency has a total of 13
Puskesmas with a population of 42,609 people, then the ratio of the number of
Puskesmas to the population is 0.0003, it should be 1 Puskesmas approximately
10,000 people or as many as 28 people per day, this describes health services
according to the quantity of the community.
Table 9
Number of Doctors in Teluk Wondama Regency in 2018-2021
|
No |
youareaian |
2018 |
2019 |
2020 |
2021 |
|
1. |
Number of Doctors |
9 |
11 |
14 |
15 |
|
2. |
Population |
31.769 |
32.521 |
41.644 |
42.609 |
|
3. |
Ratio |
0,000283 |
0,000338 |
0,000336 |
0,000352 |
Source: Wondama Bay District In Figures 2019-2021
In accordance with the data obtained by the indicator of the ratio of
doctors per population shows the level of services that can be provided by
doctors compared to the number of existing population,
the ratio of doctors in Teluk Wondama Regency in 2021 is 0.000352 which means that 1 doctor serves 2,840
residents, where ideally 1 doctor serves 2,500 residents, looking at this data,
Teluk Wondama Regency means that the community has not all been served by
doctors.
Based on the real conditions that are the implementers
of health development in Teluk Wondama Regency, it can be seen based on the
ratio of health workers to the population union. Health workforce ratio of the
union of the population, as below :
Table 10
Number of Health Workers in Teluk Wondama Regency in
2018-2021
|
No |
youareaian |
2018 |
2019 |
2020 |
2021 |
|
1. |
Number of Health
Workers� |
214 |
296 |
245 |
284 |
|
2. |
Population |
31.769 |
32.521 |
41.644 |
42.609 |
|
3. |
Ratio |
0,0067 |
0,0091 |
0,0058 |
0,0066 |
Source: Wondama Bay District In Figures
2019-2021
The ratio of health workers as described above, shows that a health worker
must serve as many as 150 people per year, this shows that the number of health
workers in Teluk Wondama District has met the ideal ratio.
Results of Research and Discussion
Implementation of
Special Autonomy Policy for Health in Teluk Wondama Regency
Government public policy should be inherent in what is being or will be
developed in future governments, Decentralization is a model of governance in
Indonesia as a solution in ensuring services received by the community.
The Special Autonomy Policy for Health in Wondama Bay is understood as the
central government's attention to the provinces of Papua and West Papua,
especially health problems, which allows for increased development in the
health sector.
This special autonomy in the health sector is also understood as the
allocation of considerable funds from the central government for health
development for the Papuan people through the Regency and Provincial
Governments. With Special Autonomy, it is also possible for health development
in Teluk Wondama Regency to be adapted to the needs of the community according
to culture and geographical circumstances.
The special autonomy policy is supported by a balance fund, as are other regions
in Indonesia, which consist of a revenue sharing fund, a general allocation
fund, and a special allocation fund, plus an adjustment fund. In order to
implement special autonomy, the Government has allocated funds in the State
Budget (APBN) since 2002 for the implementation of special autonomy. Since
fiscal year 2006, the Government has also allocated additional funds as
proposed by the Province for activities primarily
aimed at financing infrastructure development. Based on Law Number 21 of 2001
and its amendments, namely Law Number 35 of 2008, the policy of dividing funds
in the context of special autonomy is as follows:
1.
A special autonomy
fund equivalent to 2% of the DAUNational ceiling, which is primarily aimed at
financing education and health;
2.
Additional
infrastructure funds in the context of implementing special autonomy, the
amount of which is determined based on the proposal of the Province.
These funds are primarily intended for financing infrastructure development.
The fund is intended so that in at least 25 years all provincial cities,
regencies/cities, districts or other population centers are connected to
quality land, sea or air transportation, so that Papua Province can carry out
its economic activities properly and profitably as part of the national and
global economic system.
CONCLUSION
Based on the description of the discussion on the
Implementation of the Special Autonomy Policy for Health Sector in Teluk Wondama Regency, West Papua
Province, which is the object of specific research that has been stated in
Chapter IV, the author can draw conclusions, as follows:
The implementation of the Special Autonomy Policy in Teluk Wondama Regency, West Papua
Province has not been optimal, this can be seen from:
The content of the policy shows that interest affected
also has an important role in policy implementation through coordination
efforts in order to mobilize related interest groups in an organized manner,
especially the community. The benefits felt by the people of Teluk Wondama
Regency as a result of the implementation of special autonomy are quite
significant, this can be seen from the achievements, targets or targets that
have been sufficiently met although there must still be improvements or
improvements adapted to the situation and conditions in the field. The degree
of expected change in the health sector has not been fully achieved because the
level of public awareness of health needs and behaviors still requires
motivation, encouragement or support from the government, meaning that people
have not been independent in behaving clean and healthy despite an increase in
the achievement of the human development index in the health sector. The Teluk
Wondama Regency Government is quite responsive, especially in accommodating the
wants or needs of the community, where the Regent of Teluk Wondama as the main
actor of policy makers and program initiators immediately makes policies/decisions
in accordance with relevant laws and regulations. The implementor of the
program is quite supportive in the implementation of the special autonomy
policy of Teluk Wondama Regency where the performance or performance and
attitude of the implementers who have sufficient motivation and commitment to
the programs implemented in order to improve services to the community. The
existing resources have not fully supported the implementation of the special
autonomy policy in Teluk Wondama Regency, especially in terms of human
resources (HR), namely an adequate apparatus both in terms of number and
competence, limited budget, besides that facilities and infrastructure have not
fully supported the implementation of the special autonomy policy in Teluk
Wondama Regency because before the construction of community
infrastructure,� The Teluk Wondama
Regency government is still improving the internal facilities and
infrastructure of the government itself even though there are plans in
fulfilling infrastructure development for the community that is adjusted to the
financial capabilities of the region.
The context of policy implementation shows that the
power, interests and strategies of actors involved face various obstacles
caused by limited power, authority, funds, and across administrative areas as
well as many differences in interests of the actors involved and the weaknesses
of various strategies implemented by policy actors (stakeholders). The
characteristics of institutions and governments (institution and regime characteristics)
have not been fully supported by the characteristics of ideal institutions and
rulers, where the use of authority from the character of the broader ruling
institutions takes time and bureaucratic procedures are long enough (the West
Papua Provincial government and the Central Government) so that the
implementation of these policies is not optimal. This difference in capacity
and competence is one of the aspects that makes the implementation of this
policy not optimal, another aspect that affects the compliance and
responsiveness of the implementer is the lack of reward for implementers who
have performed their duties beyond what the organization or implementers expect
such as the provision of income improvement allowances adjusted to the workload
of the implementors where this can�
stimulate the achievement of better tasks for the outstanding executor
and his colleagues, and ultimately can improve the capabilities of the
organization or SKPD.
There are determinants of the Implementation of the Special
Autonomy Policy for Health in Teluk Wondama Regency, West Papua Province:
The commitment to service quality is carried out in the
form shown through the provision of service facilities that provide convenience
for service recipients, but this is not optimal.
The quality of human resources of government officials
and communities in Teluk Wondama
Regency is still largely unaware of the process of implementing special
autonomy policies in the health sector, thus affecting the participatory
overall service process.
Well-built public communication must have various
dimensions, not only the communicator's ability to convey public service
messages, but more than that is how all elements or factors in public service
communication can be best utilized.
Culture, talking about the local wisdom of the Papuan
people, especially those in Teluk Wondama
Regency, which utilizes the existing potential to support development
efficiently which is inseparable from the basic rights of Papuans.
Socio-political conditions, the massive expansion process
can be said to violate article 76 of Law no. 21 of 2001 by eliminating the role
of the Papuan People's Assembly and the Papuan People's Representative Council
(Suryawan, 2010). This picture shows that the problem
of democratization is still not well implemented in this era of special
autonomy.
Geographical conditions and environmental sanitation, the
area of Teluk Wondama
Regency is partly on the large plains of Papua Island, partly islands and
partly waters (Cenderawasih Bay). Most of the area is
still covered in forests; Merbau, Matoa, beautiful
wood, rattan, agarwood, masoi, bamboo, lawang wood, sago, etc.
The
"NUNAKI" Policy Implementation Model is a construction of research
results consisting of three elements, namely: commitment, communication and
collaboration. The implementation of the "NUNAKI" model requires five
basic prerequisites, namely: regional authority, regional institutions, state
finance, local government politics and the effectiveness of coordination,
guidance and supervision.
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