| 4. In which ways is the initiative creative and innovative?
The hospital been established as leading refractive center under the Decree of Head of Eye Specialized Hospital on June 2013.
This initiative owns a superior service, namely Lasik surgery, which is only US$450 up to US#977 for one and two eyes, a low cost is earned by cutting-off Return Of Investment system’s. Those strategies then affect this hospital as the only hospital which provides the cheapest LASIK surgery in Indonesia. thus it may indirectly block the loss of state foreign, the fact shows the much Indonesian people are going aboard to perform eye surgery.
Then this initiative also has a big role in overcoming the mass vision disorder in South Sumatera namely by eye camp program using wheel radius system, to reach a public requires healthcare throughout South Sumatera, focusses it’s service at healthcare center and cooperates with the public health center (Puskesmas) at the remote areas, where this Puskesmas will capture patient then it’s will be held a surgery at the nearest Puskesmas. This coordination also reduced the patient numbers significantly and create the specialist personnel due to they will work in highly volume as for the impact it will create the skillful and expertise’s increase for those specialist.
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
South Sumatera’s Governor has stipulated the Establishment for South Sumatera Province’s Blindness Disorder Overcoming Committee in 2012 through Governor Decree No 813/KPTS/DINKES/2012. Concerning with the said Governor Decree, the eye specialized hospital becomes the reference throughout South Sumatera in case of South Sumatera Province’s blindness overcome.
This initiative is done by South Sumatera Province’s eye-specialized hospital by involving all civil servants as their duties and functions also related elements, particularly within implementation of initiative elements such as the one stop solution – completed service by affordable cost, the similar treatment for poor with easy and clear financing service’s procedure also optimizing organization’s roles like Indonesian Ophthalmologists Association/ Persatuan Dokter Mata Indonesia (Perdami) of South Sumatera as the provider institution of medical personal assistance for in-building and out-building activities, which are motorized by Hospital.
There are positive impacts of this initiative, namely,
Based upon the medical record data indicates that patient visit from 2013until 2015 averagely raises about 1.4-2% annually, for the latest 2 years, 2014 and 2015 are having a visit increase about 2.3 %, this data indicates this hospital (SILAM-SAT) becomes a public target to gain eye healthcare facilities.
Regarding Eye camps are held evenly in South Sumatera Province’s Regencies in 2014 – 2015 occurs the decrease of surgery realization is about 33% by the surgery quantity to 1,260 patients by 2014 and 680 patients by 2015 (Eye Camp report data). It means the Eye camp program is significantly reducing backlog (cataract patient’s accumulation) in South Sumatera.
| 6. How was the strategy implemented and what resources were mobilized?
This initiative’s core constitutes routine activities of all civil servants are namely, providing primary service to public without any difference such initiative shall be facilitative to all publics wish to gain the integrated and comprehensive eye healthcare, which are easy and low-cost even free.
To sustain the service fluency on this initiative program shall be done at several stages:
1. Performance review
Its function as the unit reporting of each activity whether may be held in synergy, well-coordinated, appropriate with the available funds, and according to the field condition and situation.
For compiling the planning shall be done through activities:
1) Technical coordination meeting comprises of management and planning division
2) The making of Capacity building plan for human resources gradually
3) It is held an expert meeting with the discussed topics.
It is done a role sharing amongst related units to achieve the stipulated objectives.
1) Implementation is conducted by all units are appropriate with respective duties (in-building)
2) The fund allocation making for eye camp program, sets a target and realization of the backlog reduce (cataract patient’s accumulation)
It is done monitoring and evaluation to supervise the healthcare activities.
Resources are used in this initiative namely,
1. Human Resources : The main motor is all Eye-Specialized Hospital’s employees, appropriate with organization structure and respective duties and functions, namely a Head assisted by 1 person of Administration Sub Division Head, 2 persons of Division Head who synergize with functional groups like medical personal, nursery paramedic and non-nursery also administration personnel.
The latest data in December 2016, total employees are 168 persons comprises of 54 males and 114 females, particularly for specialist personnel from totally are 12 persons, 8 persons of them are females and the rest are males, the employment equity aspects of this initiative shall be applied and female aspect to this initiative has a bigger roles as the initiative main motor.
SILAM-SAT’s healthcare basically constitutes the provider for public service’s means and facilities, therefore since it has been optimized a SILAM-SAT services (one stop-eye healthcare system /Sistem Pelayanan Kesehatan Mata Satu Atap), inter unit human resources’ role shall be better with supported by hospital management that makes SILAM-SAT as process for more increasing the public health quality.
2. Financial Resources : this initiative operation is mostly tuned into :
1. Budget business plan (RBA)-BLUD (Public Service Agency) South Sumatera Province’s eye-specialized hospital are following routine goods/service procurement process to meet technical-operational requirements of SILAM-SAT and The budget from Public Service Agency also used for payroll of Non Civil Servant’s human resources at eye-specialized hospital.
2. National Budget and Local Budget’s subsidization,
3. Utilizing Corporate Social Responsibility (CSR), which constitutes the Company accountability to the public social-economic environment. Such as the free glasses distribution for students, social services, etc.
The above funds management shall be done transparently and orderly by continuously facilitation by Finance and Development Supervisory Agency (BPKP) of South Sumatera Province.
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
In the beginning for making the low-rate tariff is the idea of South Sumatra Province’s Governor of which in accordance with the visions of South Sumatra Province’s are namely, SOUTH SUMATERA IS MORE ADVANCE, AND INTERNATIONALLY COMPETITION”. Then the said idea is elaborated by the hospital management by proposing the unit cost calculation.
The SILAM-SAT’s initiator is South Sumatera Province’s eye-specialized hospital. Those are main motors;
• South Sumatra Province’s Governor (related agencies)
• Management (Hospital Head, Administration Sub Division Head, Medical Service Section Head and Medical and Nursery Supporting Section Head)
• Hospital’s human resources (medical, non-medical and administration personnel)
• National Health Security (NHS)
• Third Parties, NGO, Organization, Private, State-owned enterprise, education Parties. As cooperated within Cooperation Agreement.
The shareholder’s involvements are namely as follow:
1. Governor serves as stakeholder being the policy director through South Sumatra Province’s Local Secretary and Local Financial and Asset Management Agency has implemented the laws mandate is namely forming South Sumatera Province’s eye-specialized hospital being Financial Management Pattern for Local Public Service Agencies (PPK BLUD).
2. Governor serves as regulator (Jamsoskes regulation, Tariff Local Regulation, Organization Structure)
Task Force’s Involvements:
1. Department of Health, as supervision and referral Technical Implementation Unit.
2. Local Financial and Asset Management Agency (BPKAD), budget allocation making support and asset management for Local Public Service Agency (BLUD)
3. Financial and Development Monitoring Agency (BPKP), serves as facilitator for BLUD’s financial management.
Organization and the related technical Parties’ involvements:
1. Perdami, serves as partner that jointly assists the South Sumatra Province region’s blindness overcome program.
2. Education firms, human resources supply of medical personnel.
3. State-owned enterprise, local-owned enterprise, have roles through corporate social responsibility to assist finance in overcoming the eye health disorder.
4. NHS, serves as facilitator for financing the service user public.
| 8. What were the most successful outputs and why was the initiative effective?
Some outputs of this initiative;
1. The high of public satisfaction serves as the comprehensive eye healthcare user ( one stop solution )
2. Affordable/low-tariff pattern
3. Poor gains a health insurance facilities beyond JKN (NHS)
4. Reduces a backlog numbers (cataract patient’s accumulation) with routine eye camp throughout areas of South Sumatera.
Such outputs provide effectively achievement as follow;
Based upon the public satisfaction index (IKM)’s survey result as conducted by this initiative from 2013 until 2015, it ranges about 62.51 – 81.25 that means a good category, public satisfies with the integrated eye healthcare facility (one stop service) because it insures public to gain the easiness of eye healthcare with preventable and curable, also rehabilitative comprehensively in one stop solution.
In order the eye healthcare at SILAM-SAT may reach all public levels, South Sumatera local government provides means and infrastructures and the eye-specialized hospital only provides operational activities without counting unit cost of means purchasing therefore the given healthcare tariff shall be affordable/cheap to the public.
Health Social Security South Sumatera (HSS - Jamsoskes) Sumsel Semesta program is designated only for public have no other health insurance, particularly for poor, because the health issues is basic service shall be fulfilled by the government.
The eye amp activities, which conducted routinely each year may reduce the blindness and other eye disorder’s rate by shortening a time realization target, instead of just waiting the patient visits to healthcare center due to such activities have been spread over entire region of South Sumatera’s regencies / cities.
| 9. What were the main obstacles encountered and how were they overcome?
1. National Health Security system’s application of current healthcare center is more complex caused by the Indonesia health security will be more structured and centralized (Universal Coverage), which enable all Local Health Security must joint with NHS not later than 2019, which the obligation serves as the Laws mandate. Here the problems arise by the swelling of provincial budget if the integration with NHS caused by the paid premium difference will be bigger. Public’s assumption is regarding NHS also remaining much constraints such as inpatient cases by the limited time and so many procedural chains shall be carried out by the public and it is quite different with HSS-Jamsoskes by sufficiently attaching their citizen identity card/family card to the hospitals can have provided a public service. The solution is the Governor shall direct the related Parties remains carrying out HSS-Jamsoskes program as the NHS facilitator until the integration of NHS participants has gradually completed entirely.
2. In case of institution, this hospital still constitutes Agency Technical Executor Unit (UPTD) of South Sumatera Province Health Agency, recalling all matters shall be coordinated to the agency, the complicated bureaucracy flows shall be initially submitted to the agency, although there are many sciences and technologies located in the eye specialized hospital makes it becomes science intensive, technology intensive and capital intensive’s organization. The much types of functional personnel with their varied expertise and competencies make the hospital happens work intensive then it will finally happen an interest intensive, problem intensive and conflict intensive. As for the solution, it has been done any effort to improve the status from Agency Technical Executor Unit (UPTD) becomes Central unit agency (SKPD) itself is more independently, by making the academic script and other terms for the intended status improvement.