A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Nurse’s License and Midwife’ License (now Registration Identity Letter / STR) previously was issued by Health Agency of East Java Province through complex bureaucracy and requirement which need relative longer time, while the health worker must be immediately work in facility of health or independent. The requirement of STR issuance for Nurse and Midwife, among others are Photocopy of legalized diploma and transcript, passport photograph, health notice letter from government, oath pronunciation, stamp duty application letter, etc, where Applicant sometimes forget, lost, lack of 1 requirement, so that applicant must return to his/her original region which relatively far from Surabaya. Head of Health Agency with its high activity as Government’s Officer, is often be not in place, so that could not sign the license and at one side, signature is unable to be delegated, so that requires a long time. Too many applications (until tens of thousands) and not well recorded, and the license which has been signed is not taken, causes archives are disorganized, so that many licenses are lost and difficult to find. There is no online system, so that many people who do not acknowledge whether his/her license is completed or not, at the time he/she desires to take it, health worker go home with empty hands. As for officers in Health agency of Province are not able to immediately issue Registration Identity Letter (STR). Averagely more than 3 months STR can be issued with many editorial errors on the STR to be revised. Whereas, competence test is keep on continued, so that may who wait for the STR issuance and many are unemployed. At one side, demand of health service facility (Puskesmas/Public health center and State Hospital and private Hospital) so that health workers must have STR is greater, so that if there are health workers who just graduated have no STR it means that they will not be able to work, and this can be a problem of employment and social.

B. Strategic Approach

 2. What was the solution?
In 2008, to ensure health worker’s quality, East Java Province established Health Worker Forum of Province (MTKP) of East Java which one of its functions is to carry out competence test for health worker (especially: Nurse and Midwife) to obtain competence certificate as requirement to issue registration identity letter / license. MTKP of East Java, Health Agency of Province and Profession Organization as well as Non-Governmental Organization field of Health carry out competence test to approximately 25.000 Nurses/Midwives one in 3 months. For Nurse and Midwife who jus has graduated the competence test will be granted competence certificate as the requirement if the issuance of Registration Identity Letter or License. Health Worker Forum of Province (MTKP) of East Java, profession organizations (PPNI and IBI) and Users (RS and Dinkes) urge Province Government to complete this licensing, and by delivering letter to Governor of East Java c/q. Head of Health Agency of East Java Province so that STR issuance problem is carried out as soon as possible. MTKP of East Java is also performs dialogue with Health Workers who has conducted demonstration at the Health Agency to requires the settlement of this STR problem. Considering, PP 38/2007 regarding Governmental Affairs Division, which stated that registration and certification of health workers can be carried out by Province Local Government, which is finally decided that issuance of Health Worker’s License I issued by Integrated License Service (P2T). With the agreement on STR issuance for heath worker by Integrated License Service (P2T) , averagely 200 STR are completed / day = approximately 4000 STR/month, so the STR issuance problem is gradually settled.

 3. How did the initiative solve the problem and improve people’s lives?
Health Workers (especially Nurse and Midwife) who has graduated the competence test receives competence test certificate from MTKP of East Java (graduation announcement to the acceptance of competence certificate is maximum 1 week). Subsequently, it is scheduled in accordance with order number of competence test everyday approximately 200 new graduations (added by 50 who perform license extension) served by P2T is directly obtain license or registration identity letter (waiting time is approximately 1 hour). With P2T who takes over issuance of health worker’s STR by simple mechanism and requirement and “helps” applicant, STR is promptly can be received by health worker to be used to work. As comparison of STR management in Health Agency before it is implemented in P2T, STR issuance requires time 3 – 6 months to be completed, yet the Applicant can several time comes to Health Agency, so it requires quite much time, cost and energy.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Based on the regulation of Governor of East Java number 71 of 2010 and Number 77 of 2010, Technical Implement Unit (UPT) of Integrated License Service (P2T) performs operational technical duty of integrated licensing including in it is Registration Identity Letter (STR) of health worker on principal of coordination, integration, synchronization and simplification (KISS) namely: - First, to manifest licensing service especially STR into the form of One Window/roof Integrated Service (PTSP). - Second, integration of licensing service is placed in one place so that easy and no need arrangement in several places. - Third, KISS principal is concreted in form of simplification of licensing arrangement so that able to reduce licensing arrangement time as few as possible and STR service is continue to be developed by utilizing information system on web basis and can be accessed by community of license applicant by online.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
For the issuing of License or Registration Identity Letter for Health Worker, who involved and often to be involved by Integrated License Service (P2T) are: Health Agency of Province, Province Panel of Health Worker (MTKP) of East Java, Health NGO and Profession Organization of Health Worker. Health Agency of Province is continue in performing socialization to Health Agency of Regency / City that STR issued by Integrated License Service (P2T) has legal power as requirement of the issuance of working license and practice license of health worker. MTKP of East Java continues to carry out competence teat to health worker so that health worker’s quality is continued to improve, and institution of health education will also improve its graduation quality. Health NGO participates to help on supervising health worker’s practice who has STR, and at the other side, profession organization also participates to coach its health worker by performing education and training of competence improving.
 6. How was the strategy implemented and what resources were mobilized?
Service of STR licensing in Technical Implement Unit of Integrated Licensing Service of Investment Capital Agency of East Java Province by exempting all of arrangement costs and all of cost burdens of service is financed by fund of Regional Expenditure Revenue Budget of Investment Capital Agency of East Java Agency. Licensing service in the Technical Implement Unit of Integrated Licensing Service of Investment Capital Agency of East Java Agency is supported by service officer with the number of personnel as many as 72 persons and in addition, it is supported by Quick Response Unit (URC) which is on charge to help acceleration of licensing issuance.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Service of Health Worker’s STR issuance of approximately 25.000 old (renewal) and new health workers fast and accurately with very cheap operational cost. Averagely STR issuance for health worker in Integrated License Service (P2T) is of 200 STR per day, so that Health Worker who has just graduated will promptly obtain efficiently. By promptly issuance of Health Worker’s STR, the Health Worker will be able to immediately work in health service facility and or work independently. It is expected that Health Worker who has STR will work more professional in providing health service to community and both health workers and community will be legally protected. The East Java population approximately as 38,3 millions, the number of Government Hospital = 57, Private Hospital = 205, number of TNI/POLRI/State Owned Enterprise Hospital = 38, Puskesmas/public heath centre = 948, they require minimum 70.000 nurses and minimum 35.000 midwives in East Java whereas health worker distribution in East Java is not unevenly. In remote and very remote regions are still lacking of health workers both in quantity and quality. By International Hospital accreditation and to welcome National Health Security, then Government and Private hospitals will receive man health workers who have STR and qualified. With STR fast issuance from Integrated License Service (P2T), so waiting time which was approximately 6 months in the previous period automatically will reduce health worker’s unemployment within the period of 1 year or more.

 8. What were the most successful outputs and why was the initiative effective?
1. Accept suggestion and critics directly by Health Worker open, by providing a suggestion box complete with paper and other writing equipment. 2. Invite stakeholders periodically on trimester basis to discuss and to evaluate performance. 3. Open website and comment online. 4. Customer Satisfaction Survey which is carried out periodically, and to be evaluated and being presented at the point 2 above.

 9. What were the main obstacles encountered and how were they overcome?
1. Service provided to Health worker who comes from far region, so that the worker must first overstay to obtain queue on the next day (requires high cost), the solution is application can be delegated to his/her family or original education institution. The granted STR will be able to be used as acceptance requirement as employee in health service institution. 2. The lacking of the requirement issuance, can be facilitated by Integrated License Service (P2T), by providing of photocopy machine, binder, stamp duty, etc. 3. Currently, province which has carried out competence test and STR issuance except East Java are Central Java, Yogyakarta and West Java. Other provinces are yet. So that other province will feel “happy” if receive health worker who has STR issued by Integrated License Service (P2T), due to the health worker must be competence tested and obtained legalization.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
1. Health workers will be easily obtains service of license issuance fast, accurately and cheap. There is an image for health worker to obtain service which is fast, cheap and easy, so that will inspire in providing health service to community well too. 2. Certain health worker who duty as implement or health service provider is authorized by education competence he/she obtained, so that it is closely related to his/her right and obligation. The competence and authority indicates basic professional ability and constitutes profession standard for the health worker. Fast issuance of Health Worker’s will give impact of this kind. 3. In its implementation, it is actually that Health Worker as the supporter of health effort in performing his/her duty must always be guided and supervised. Guiding is carried out to maintain and improve his/her ability, so that always be responsive to health problem which is be his/her responsibility. While supervising is conducted to his/her activity so that the health worker can carry out his/her duty in accordance with legislation policy and system stipulated. Each distortion in duty implementation by health worker causes consequence in form of sanction, especially administrative sanction. STR issued by Integrated License Service (P2T) is an administration legal product which is revocable if the Health Worker gets sanction.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
1. MTKP of East Java has accepted comparison study for mechanism of health worker’s STR issuance service from other province, such as: Aceh, West Sumatera, Central Kalimantan, etc. 2. In several regions in East Java, such as: Regencies of Jember, Banyuwangi, Madiun, Malang, Bojonegoro, Ngawi have replicated service held by Integrated License Service (P2T) make closer for several regions with service regionalization system in the area of Governor’s Helper.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
1. The demands for qualified health service is greater. The service forming which is implemented by Integrated License Service (P2T) is as East Java Government’s effort to improve health service quality for individual and community. it is expected to be able to minimize the gap between community’s expectation and received service. 2. Provide guidance, supervision and control to education institution in East Java so that its graduation quality to be more qualified. 3. For Health Workers who obtained fast and easy service from Integrated License Service (P2T) will give positive impact to the original education institution, working partner, and its profession organization to be more improves health worker quality in East Java. 4. For Integrated License Service (P2T) side, provides certain letter fast and easy for community which considers very important for his/her fate, will give a good image of public service.

Contact Information

Institution Type:   Government Agency  
Contact Person:   Ahmad Basofi
Title:   Head Section of License Service  
Telephone/ Fax:   +62313577691/+62313577692/
Institution's / Project's Website:  
Address:   Jl. Pahlawan No. 116
Postal Code:   60174
City:   Surabaya
State/Province:   East Java

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