1

TABLE OF CONTENTS

TABLE OF CONTENTS ........................................................................................................ 2

TABLE OF TABLES............................................................................................................... 3
TABLES OF FIGURES .......................................................................................................... 4
1. Background ...................................................................................................................... 5
2. Aims................................................................................................................................... 6
3. Participants ....................................................................................................................... 6
4. Facilitator Team ............................................................................................................... 8
5. Method .............................................................................................................................. 8
6. Date, Time and Place ....................................................................................................... 8
7. Workshop Schedule ......................................................................................................... 8
8. Workshop Activity ......................................................................................................... 10
8.1. Day One ...............................................................................................................................10
8.1.1. Opening and Briefing: The development of Indonesian NQPS final document .........10
8.1.2. Workshop methods briefing ........................................................................................10
8.1.3. A Situational Analysis of Health Care Quality in Indonesia .......................................10
8.1.4. FGD NQPS Draft: Vision, mission and aim of NQPS, definition and dimension of
health care quality in Indonesia. ...................................................................................................11
8.1.5 Presentation of FGD result...............................................................................................13
8.1.6 FGD NQPS Draft: The main role of stakeholders within NQPS.....................................18
8.2 Day Two ..............................................................................................................................18
8.2.1 Review and building consensus from the discussion results on day one .........................18
8.2.2 FGD NQPS Draft: National Health Care Quality Indicators ...........................................20
8.2.3 A Discussion on National Health Care Quality Indicators ..............................................20
Table 10. FGD result: National Health Care Quality Indicators...................................................20
8.2.4 Closing .............................................................................................................................22
9 Workshop Result Dissemination on Website .............................................................. 22
Annex 1. List of Participants on Day One ........................................................................... 23
Annex 2. List of Participants on Day Two ........................................................................... 24
Annex 3. NQPS Draft ............................................................................................................ 25

2
 TABLE OF TABLES

Table 1. List of Participants of Workshop of Vision, Mission, and Target on Health Care
Quality in Indonesia, 22-23 May 2018 .............................................................................. 7
Table 2. The Schedule................................................................................................................ 8
Table 3. The groups ................................................................................................................. 12
Table 4. FGD result: Vision of The Indonesian NQPS ........................................................... 13
Table 5. FGD result: Mission of The Indonesian NQPS ......................................................... 14
Table 6. FGD result: Aims of The Indonesian NQPS ............................................................. 15
Table 7. FGD result: Definition of Indonesia’s Health Care Quality ...................................... 16
Table 8. FGD result: Dimensions of Indonesia’s Health Care Quality ................................... 17
Table 9. Discussion Result for The NQPS Drafting Team Consideration .............................. 19
Table 10. FGD result: National Health Care Quality Indicators ............................................. 20

3
 TABLES OF FIGURES

Figure 1. A Conceptual Framework of The Development of Indonesian National Quality

Policy ................................................................................................................................. 6
Figure 2. Opening by Director of Healthcare Quality and Accreditation ................................ 10
Figure 3. Group 1 ..................................................................................................................... 11
Figure 4. Group 2 ..................................................................................................................... 11
Figure 5. Group 3 ..................................................................................................................... 12
Figure 6. Presentation by each group ....................................................................................... 13
Figure 7. Proposed health care quality concept by group 3 ..................................................... 18
Figure 8. Quality dimensions of Indonesia’s health care ......................................................... 20
Figure 9. The partcipants and the facilitators took a picture after the workshop ..................... 22

4
 Development of The Indonesian National Quality Policy and Strategy: Workshop of
Vision, Mission, and Target on Health Care Quality Improvement in Indonesia

Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing
UGM, in collaboration with The Directorate of Healthcare Quality and Accreditation,
Ministry of Health, Republic of Indonesia, supported by WHO Indonesia
Jakarta, 22-23 May 2018

1. Background
Health care quality has been a national and global issue. Global quality improvement
in health care has a long history started in the 1900s whereas Indonesia has started its journey
since more than 30 years ago. The issue on health care quality continues to be strategic in
achieving Universal Health Coverage (UHC), an important component in the Sustainable
Development Goals (SDGs). As stated, SDGs has a specific target for UHC, i.e. “Achieving
UHC, including financial risk protection, access to quality essential health service and access
to safe, effective, quality, and affordable medications and vaccines for all” (WHO, 2015).
Considering the needs for improving health care quality to achieve UHC and SDGs,
efforts to improve quality in the entire health system should be supported by a National Quality
Policy and Strategy (NQPS). WHO has launched the NQPS handbook which will be used to
guide countries in developing the national quality policy and strategy appropriate to their
national health policies and planning (WHO, 2017). With the establishment of The Directorate
of Healthcare Quality and Accreditation in the Ministry of Health Republic of Indonesia in
2016, there is an urgent need and a golden opportunity to document various quality policies
and strategies in each component of NQPS.
In 2017, Center for Health Policy and Management, Faculty of Medicine, Public Health
and Nursing UGM worked in collaboration with Ministry of Health and WHO Indonesia to
develop a situational analysis for all eight elements of WHO NQPS process based on the
existing documents, discussion and consultations with stakeholders and policy makers.
In 2018, NQPS development continued to determine all of Indonesian NQPS
components (figure 1) through discussions and building consensus with broader stakeholders
and policy makers.

5
 Figure 1. A Conceptual Framework of The Development of Indonesian National Quality Policy
and Strategy

2. Aims
This workshop aims to:

1. Present a situational analysis of health care quality in Indonesia to broader stakeholders

and policy makers.
2. Determine vision, mission and target on health care quality improvement by building
consensus on:
a. Vision, mission, and aim of The Indonesian NQPS
b. Definition of health care quality in Indonesia
c. Dimension of health care quality in Indonesia
d. Role and responsibility of relevant stakeholders
e. National health care quality indicators based on defined quality dimensions.

3. Participants
Guest participants were the stakeholders in the discipline of health which were from
thirteen institutions. There were two government institutions functioned as regulators (Ministry
of Health and and Health Office), commission of health facility accreditation, health insurance
as purchaser (Healthcare and Social Security Agency/Badan Penyelenggara Jaminan Sosial
Kesehatan-BPJS Kesehatan), four health facility associations as representative health care
service provider (Indonesian Hospital Association/PERSI, Indonesian Private Hospital
Associations/ARSSI, Local Hospital Association/ARSADA and Indonesian Association of
Clinics and Primary Health Facilities/PKFI), two professional organizations (Indonesian
6
Dentist Associations/PDGI and Indonesian Midwifes Associations/IBI), two health NGOs
(Share To Care Community and Caring Parents Foundation/YOP) and one donor agency which
was WHO Indonesia. All participants came from DKI Jakarta. This is the list of the participant:

Table 1. List of Participants of Workshop of Vision, Mission, and Target on Health Care Quality in
Indonesia, 22-23 May 2018

Institution Name of Participant

WHO Indonesia 1. dr.Tini Setiawan, M.Kes
Directorate of Health Care Quality and Accreditation, 2. dr.Eka Viora, Sp.KJ
Ministry of Health 3. B. Eka A. Wahjoeni
4. Ardjuna Sakti
5. Sari Wijiyastuti
6. Nurhayati
Directorate of Primary Healthcare, Ministry of Health 7. Irni Dwi A.
8. Enita Pardede

Directorate of Referral Healthcare, Ministry of Health 9. dr.Yout Savitri

10. dr.Ira Melati
Provincial Health Office of DKI Jakarta 11. drg.Pratiwi, MM
Healthcare and Social Security Agency (BPJS 12. dr.Kamelia
Kesehatan) 13. Heni Riswanti
14. Tedo Arya T.
15. Irfan Qadarusanan
16. Adiwan Qodar
Commission of Primary Health Facilities Accreditation 17. dr. K.M. Taufik, MMR
Health Facility Associations
- Indonesian Hospital Association (PERSI) 18. dr.Widaningsih
- Local Hospital Association (ARSADA) 19. dr. Yudi A., Sp.U
- Indonesian Private Hospital Associations
(ARSSI) 20. Anastina Tahjoo
- Indonesian Association of Clinics and Primary
Health Facilities (PKFI) 21. dr.Fazilet S, MPH
Proffesional Organizations
- Indonesian Midwifes Association (IBI) 22. Fitriani
- Indonesian Dentist Association (PDGI) 23. drg. Endang Jeniati,
MARS
Health NGOs
- Share To Care Community 24. Aisyah Adenita
25. Tjut Sriyana
- Caring Parents Foundation (YOP) 26. Putri Suhendro

7
4. Facilitator Team
1. Prof. dr. Adi Utarini MSc, MPH, PhD
2. dr. Hanevi Djasri, MARS
3. dr. Novika Handayani

5. Method
The participants discussed about vision, mission and aim of The Indonesian NQPS,
and also the definition and dimensions of health care quality. The facilitator team prepared
The Indonesian NQPS draft and shared to the participants for discussion material. Then,
we discussed their results and chosen the best vision and mission of NQPS, definition and
dimensions of health care quality, to be the NQPS drafting team’s consideration.
Participants also discussed about the main role of each stakeholders in NQPS and national
indicators for health care quality based on the chosen quality dimensions.

6. Date, Time and Place

Day/Date : Tuesday-Wednesday, 22-23 May 2018

Time : 09:00-14:30
Place : Meeting Room 503, Adhyatma Building, Ministry of Health, Jakarta

7. Workshop Schedule
Table 2. The Schedule

Time Activity Facilitators/Speakers

Day I
09:15-09:30 Opening and Briefing: The Development of Eka Viora
Indonesian NQPS Final Document
09:30-10:00 Workshop methods briefing Hanevi Djasri
10:00-10:30 A situational Analysis of Health Care Quality Novika Handayani
in Indonesia
10:30-10:45 Discussion
10:45-12.00 FGD NQPS Draft: Vision, Mission and Aim Team
of NQPS, Definition and Dimension of Health
Care Quality in Indonesia

8
12.00-12.30 Break
12.30-13.00 FGD NQPS Draft: Vision, Mission, Aim, Team
Definition and Dimension of Health Care
Quality in Indonesia
13.00-13:15 Discussion result presentation by group 1 Group representative
13:15-13.30 Discussion result presentation by group 2 Group representative
13.30-13.45 Discussion result presentation by group 3 Group representative
13.45-14.00 Discussion Team
14.00-14.30 FGD NQPS Draft: The main role of Team
stakeholders in NQPS
Day II
09:15-10.45 Review and building consensus from Hanevi Djasri
discussion results on day one (Vision, Mission
and Aim of NQPS, Definition and Dimension
of Health Care Quality in Indonesia)
10.45-12.00 FGD NQPS Draft: National Health Care Team
Quality Indicators
12:00-12:30 Break Hanevi Djasri
12:30-12:45 Discussion result presentation by group 1 Group representative
12:45-13.00 Discussion result presentation by group 2 Group representative
13.00-13.15 Discussion result presentation by group 3 Group representative
13.15-14.15 Discussion Team
14.15-14.30 Closing Hanevi Djasri

9
8. Workshop Activity
8.1. Day One
8.1.1. Opening and Briefing: The development of Indonesian NQPS final document
Dr.Eka Viora, as a Director of Healthcare Quality and Accreditation, Ministry of
Health, opened the workshop officially. Dr.Eka also explained the background and the
process of The Indonesian NQPS development that has started since 2017.

Figure 2. Opening by Director of Healthcare Quality and Accreditation

8.1.2. Workshop methods briefing

Dr. Hanevi Djasri gave explanation about the aims of this workshop and the NQPS
draft that has developed by the facilitator team for discussion material. Participants
were divided into focused group discussion(FGD). From the discussion results, we
chose one of their results on vision and mission of NQPS, also the definition and
dimensions of health care quality to be The NQPS drafting team’s consideration.

8.1.3. A Situational Analysis of Health Care Quality in Indonesia

We presented the result of situational analysis of health care quality in Indonesia

that was developed in 2017. These findings are going to be the references for
developing the next steps of NQPS process. The participants, especially whose not
joined the NQPS workshop last year, got the current situation of health care quality and

10
the SWOT (Strength, Weakness, Opportunity dan Threats) of quality improvement in
Indonesia.

8.1.4. FGD NQPS Draft: Vision, mission and aim of NQPS, definition and dimension
of health care quality in Indonesia.

There were three focused group discussions (FGD). The facilitators gave The
Indonesian NQPS draft to the participants for their discussion material.

Figure 3. Group 1

Figure 4. Group 2

11
 Figure 5. Group 3

Table 3. The groups

Group Institutions
1 WHO Indonesia
Healthcare and Social Security Agency
Provincial health office of DKI Jakarta
Indonesian Midwifes Association (IBI)
Persatuan Seluruh Rumah Sakit Indonesia (PERSI)
2 Directorate of Health Care Quality and Accreditation, Ministry of
Health
Local Hospital Association ARSADA)
Indonesian Dentist Association (PDGI)
Caring Parents Foundation (YOP)
Share To Care Community
3 Directorate of Health Care Quality and Accreditation, Ministry of
Health
Directorate of Referral Healthcare, Ministry of Health
Directorate of Primary Healthcare, Ministry of Health
Commission of Primary Health Facilities Accreditation
Indonesian Association of Clinics and Primary Health Facilities
Indonesian Private Hospital Association (ARSSI)
Healthcare and Social Security Agency

12
8.1.5 Presentation of FGD result

All participants enthusiastically gave their aspirations in the discussions. Each

group presented their discussion results.WHO Indonesia representative also gave
feedback to their results. Here are the FGD results:

Figure 6. Presentation by each group

Table 4. FGD result: Vision of The Indonesian NQPS

NQPS Draft Group 1 and 3 Group 2

Achieve quality health The realization of quality The realization of quality

care for all Indonesian health care for all Indonesian health care in all health
people people institutions that addressed
to all Indonesian people

13

NQPS draft
❖ Integrating various systems and
efforts to improve health care
quality that have been running or
will be developed further
❖ Increasing the participation of the
community and all stakeholders in
improving the health care quality
in Indonesia
❖ Building a sustainable culture of
quality of health care throughout
health institutions
Table 5. FGD result: Mission of The Indonesian NQPS
Group 1 & 3
❖ Integrating various systems and efforts to
improve health care quality that have been
running or will be developed further
❖ Increasing the participation of the
community and all stakeholders in
improving the health care quality in
Indonesia
❖ Building a sustainable culture of health care
quality for all stakeholders
Group 2
❖ Integrating various systems and efforts to
improve health care quality within all relevant
stakeholders
❖ Establishing health care system that is oriented to
the culture of quality and patient safety
❖ Increasing the active role of patients, families
and communities in monitoring the quality of
services received
❖ Building a sustainable culture of health care
quality and patient safety
❖ Increasing the active role of the community and
all relevant stakeholders in improving the quality
of health care
14
 Table 6. FGD result: Aims of The Indonesian NQPS

NQPS draft Group 1 Group 2

❖ Provide guidance and technical guidance on
the implementation of quality improvement
efforts
❖ Provide advocacy and information to
stakeholders on their respective roles and
responsibilities in quality improvement
efforts
❖ Improving coordination between various
efforts to improve the quality of health care
❖ Provide guidance and technical guidance on
the implementation of quality improvement
efforts
❖ Provide advocacy to stakeholders on their
respective roles and responsibilities in order to
improve the quality of health care
❖ Providing information to the public about
their participation in quality improvement
efforts
❖ Improve coordination among stakeholders in
efforts to improve the quality of health care
❖ Improve coordination between various
efforts managers to improve the quality of
health care
❖ Provide guidance and technical guidance
on the implementation of quality
improvement efforts
❖ Provide advocacy, education and
information to stakeholders about their
respective roles and responsibilities in
order to improve the quality of health care
❖ Active role of the community .............

15
 Table 7. FGD result: Definition of Indonesia’s Health Care Quality

NQPS Draft Group 1 Group 2 & 3

The level of quality of health services in
accordance with the standards of service and
current professional knowledge, based on human
rights and involving patients and families, thus
providing desired health outcomes by individuals
and communities
The degree of conformity with the service standards, Same as the draft
current professional knowledge, and the effort of
quality and cost control, by considering human
rights and involving patients and families in order to
give optimal health outcomes

16
 Table 8. FGD result: Dimensions of Indonesia’s Health Care Quality

NQPS draft Group 1 Group 2 Group 3

Effective Effective Same as the Safe

draft
Eficient Eficient Effective

Access Access People-centred

Patient-centred People-centred Timely

Equity Equity Efficient

Safe Safe Equity

Integrated Integrated

17
 Besides discussing about those mentioned above, Group 3 also proposed
healthcare quality concept.

Figure 7. Proposed health care quality concept by group 3

8.1.6 FGD NQPS Draft: The main role of stakeholders within NQPS
Before closing, the groups were asked to discuss about the main role of all
relevant stakeholders in NQPS draft (results were captured in NQPS draft, see annex 3
on table 2).

8.2 Day Two

8.2.1 Review and building consensus from the discussion results on day one
Workshop day two was held on the next day, Wednesday 23 May 2018 at the
same place. In the beginning, Dr.Hanevi reviewed all discussion results on day one.
After discussion, participants and facilitators agreed that a consensus will be held by
the NQPS drafting team by considering the results that proposed in this session. Here
are the results:

18
 Table 9. Discussion Result for The NQPS Drafting Team Consideration

Subject Discussion Result for The NQPS

Drafting Team Consideration
Vision of NQPS The realization of quality health care for all Indonesian
people
Mission of NQPS 1. Integrating various systems and efforts to improve
health care quality that have been running or will be
developed further
2. Increasing the participation of all stakeholders in
improving health care quality in Indonesia
3. Increasing the active role of patients, families and
communities throughout health care quality
improvement process
4. Building a sustainable culture of health care quality
for all stakeholders
Aims of NQPS There are several different sentences that proposed by the
groups and those will be discussed further by the NQPS
drafting team
Definition of The degree of conformity with the service standards, current
Indonesia’s Health professional knowledge, and the effort of quality and cost
Care Quality control, by considering human rights and involving patients
and families in order to give optimal health outcomes
Dimensions of In accordance with the quality dimensions in WHO Global
Indonesia’s Health Strategy on Integrated and People-Centred Health Services
Care Quality 2016: safe, effective, people-centred, eficient, timely,
equity, integrated, and supported by good access

If illustrated, here is the proposed dimensions of Indonesia’s health care quality

that adapts from the quality dimensions in WHO Global Strategy on Integrated and
People-Centred Health Services 2016:

19
 Figure 8. Quality dimensions of Indonesia’s health care

8.2.2 FGD NQPS Draft: National Health Care Quality Indicators

In this session, the participants were divided into two groups. They were asked
to propose quality indicators adjusted to the chosen quality dimensions. National health
care quality indicators are expected to be general so that those can be a guideline for
developing quality indicators in population level, primary health facilities level and
referral health facilities level.

8.2.3 A Discussion on National Health Care Quality Indicators

Table 10. FGD result: National Health Care Quality Indicators

Dimension Indicator
• Percentage of compliance to the Clinical Practice Guidelines
(draft)
Effective • Basic immunization coverage (draft)
• Percentage of compliance to Standard Operating Procedure
(proposed by the groups)
• Percentage of prescription writing according to national
formulary (draft)
• Outpatient waiting time (draft)
Efficient • Health care financing conformity with clinical pathway
(proposed by the groups)
• Health care financing conformity with Diagnosis and Therapy
in non-specialist cases (proposed by the groups)
• Eligibility of the number and the competency of health care
workers (draft)
• Bed occupancy rates (draft)
Access • Percentage of sick people who are able to access health
facilities (proposed by the groups)
• Number of people who are covered by health insurance
(proposed by the groups)

20
 • Patient and family satisfaction in receiving health services
People-centred (draft)
• Speed of response to patient complaints (draft)
• Eligibility of sanitation and water (draft)
• Percentage of customer complaints (proposed by the groups)
• Percentage of customer complaints resolution (proposed by
the groups)
Equity
• Sufficiency of Health Resources (as per Law 36 Year 2009)
on health service provision (proposed by the groups)
• Availability of health services for special needs (proposed by
the groups)
• Compliance of correct handwashing compliance by medical
personnel (draft)
• Occurrence of nosocomial infection in health facility (draft)
Safe • Compliance of Personal Protective Equipment usage by
health personnel (proposed by the groups)
• Waste governance (proposed by the groups)

• Outpatient waiting time (proposed by the groups)

• Emergency Room time response <5 minutes (proposed by
Timely the groups)
• Punctuality of a health worker’s practice licence
administration (proposed by the groups)
• Competency-based referral system (proposed by the groups)
• Medical record completeness (proposed by the groups)
Integrated • Cross-sectoral involvement in the provision of health
services (proposed by the groups)

From the results of each group’s presentation, the Director of Healthcare

Quality and Accreditation gave some comments regarding national quality indicators
in NQPS. The indicators should be general for each quality dimension and there will
be an example of indicators for health facilities (hospital, primary health facility,
laboratory) in appendix section of the future document. Understanding of each
dimension of quality also needs to be equated (referring to the meaning of each
dimension by WHO). In addition, the indicators will be discussed further by the NQPS
drafting team and will not be much different from the existing indicators. So, the
existing indicators are being our references but those will be adjusted for each setting.

21
 8.2.4 Closing
A closing by Dr.Eka was followed by taking pictures together.

Figure 9. The partcipants and the facilitators took a picture after the workshop

9 Workshop Result Dissemination on Website

Presentation material and a workshop report can be accessed at
http://www.mutupelayanankesehatan.net/14-agenda/2807-penyusunan-kebijakan-dan-
strategi-nasional-mutu-pelayanan-kesehatan-indonesia-workshop-penetapan-visi-misi

22
Annex

Annex 1. List of Participants on Day One

Institution Name of Participant

WHO Indonesia 27. dr.Tini Setiawan, M.Kes
Directorate of Health Care Quality and Accreditation, 28. dr.Eka Viora, Sp.KJ
Ministry of Health 29. B. Eka A. Wahjoeni
30. Ardjuna Sakti
31. Sari Wijiyastuti
32. Nurhayati
Directorate of Primary Healthcare, Ministry of Health 33. Irni Dwi A.
34. Enita Pardede

Directorate of Referral Healthcare, Ministry of Health 35. dr.Yout Savitri

36. dr.Ira Melati
Provincial Health Office of DKI Jakarta 37. drg.Pratiwi, MM
Healthcare and Social Security Agency (BPJS 38. dr.Kamelia
Kesehatan) 39. Heni Riswanti
40. Tedo Arya T.
41. Irfan Qadarusanan
42. Adiwan Qodar
Commission of Primary Health Facilities Accreditation 43. dr. K.M. Taufik, MMR
Health Facility Associations
- Indonesian Hospital Association (PERSI) 44. dr.Widaningsih
- Local Hospital Association (ARSADA) 45. dr. Yudi A., Sp.U
- Indonesian Private Hospital Associations
(ARSSI) 46. Anastina Tahjoo
- Indonesian Association of Clinics and Primary
Health Facilities (PKFI) 47. dr.Fazilet S, MPH
Professional Organizations
- Indonesian Midwifes Association (IBI) 48. Fitriani
- Indonesian Dentist Association (PDGI) 49. drg. Endang Jeniati,
MARS
Health NGOs
- Share To Care Community 50. Aisyah Adenita
51. Tjut Sriyana
- Caring Parents Foundation (YOP) 52. Putri Suhendro

23
Annex 2. List of Participants on Day Two

Lembaga Nama Peserta

WHO Indonesia 1. dr.Tini Setiawan, M.Kes
Directorate of Health Care Quality and Accreditation, 2. dr.Eka Viora, Sp.KJ
Ministry of Health 3. Ardjuna Sakti
4. Sari Wijiyastuti
5. Nurhayati
Directorate of Primary Healthcare, Ministry of Health 6. Irni Dwi A.
7. Enita Pardede

Provincial Health Office of DKI Jakarta 8. drg.Pratiwi, MM

Healthcare and Social Security Agency (BPJS 9. Irfan Qadarusanan
Kesehatan) 10. Adiwan Qodar
Commission of Primary Health Facilities Accreditation 11. dr. K.M. Taufik, MMR
Health Facility Associations
- Indonesian Hospital Association (PERSI) 12. dr.Widaningsih
- Local Hospital Association (ARSADA) 13. dr. Yudi A., Sp.U
- Indonesian Private Hospital Associations 14. Anastina Tahjoo
(ARSSI)
- Indonesian Association of Clinics and Primary 15. dr.Fazilet S, MPH
Health Facilities (PKFI)
Professional Organizations
- Indonesian Midwifes Association (IBI) 16. Fitriani

Health NGOs
- Share To Care Community 17. Aisyah Adenita
18. Tjut Sriyana
- Caring Parents Foundation (YOP) 19. Putri Suhendro

24
Annex 3. NQPS Draft

Kebijakan dan Strategi Nasional Mutu Pelayanan Kesehatan Indonesia

(Draft)
Kementerian Kesehatan RI bekerjasama dengan Pusat Kebijakan dan Manajemen Kesehatan
FKKMK UGM, didukung oleh WHO Indonesia

I. LATAR BELAKANG
Prioritas kesehatan nasional tertuang dalam Nawacita, Rencana Jangka Panjang
Nasional (RPJPN 2005-2025), Rencana Jangka Menengah Nasional (RJPMN 2015-2019) dan
Rencana Strategis Kementerian Kesehatan. Akses dan mutu pelayanan kesehatan menjadi
salah satu sasaran pada RPJMN 2015-2019 dan Rencana Strategis Kementerian Kesehatan.
Walaupun secara umum status kesehatan Indonesia telah meningkat secara signifikan dalam
beberapa dekade terakhir, masih ada beberapa indikator seperti angka kematian ibu serta status
gizi ibu hamil dan anak-anak yang tetap menjadi tantangan. Demikian juga dengan penyakit
menular dan penyakit tidak menular yang masih menjadi beban penyakit di Indonesia.

Indonesia memiliki perjalanan panjang dalam upaya peningkatan mutu pelayanan

kesehatan dan tetap berkomitmen untuk terus berupaya hingga saat ini. Untuk
mengintegrasikan inisiatif peningkatan mutu yang lebih baik, Indonesia mengikuti
rekomendasi dari WHO untuk mengembangkan Kebijakan dan Strategi Nasional Mutu
Pelayanan Kesehatan Indonesia, yang didasari pada analisis situasi dan konsultasi kepada
pembuat kebijakan serta pemangku kepentingan. Indonesia memiliki banyak kekuatan dan
kesempatan untuk terus meningkatkan mutu pelayanan kesehatan. Berbagai regulasi mengenai
kesehatan telah dikaji dan ditemukan terdapat 258 dokumen regulasi yang relevan dengan mutu
pelayanan. Namun, hasil kajian menunjukkan bahwa definisi dan dimensi mutu belum
dinyatakan secara eksplisit dan belum ada regulasi yang secara spesifik dibuat untuk mutu
pelayanan kesehatan di Indonesia.

Upaya peningkatan mutu layanan kesehatan didukung oleh sangat banyak pemangku
kepentingan baik dari sektor publik maupun swasta dari tingkat nasional hingga fasilitas
kesehatan, termasuk komunitas pemerhati layanan kesehatan beserta pasien dan keluarganya.
Pada tahun 2016, Kementerian Kesehatan Indonesia telah mengambil langkah besar dengan
membentuk Direktorat Mutu dan Akreditasi Pelayanan Kesehatan. Oleh karena itu, Direktorat
Mutu dan Akreditasi Pelayanan Kesehatan, sebagai aktor kunci dalam mutu pelayanan

25
kesehatan harus memberikan kepemimpinan strategis salah satunya dengan memperjelas
struktur dan tata kelola organisasi untuk peningkatan mutu pelayanan kesehatan karena hingga
saat ini peranan dan tanggung jawab tiap pemangku kepentingan untuk peningkatan mutu
masih belum jelas. Dengan adanya penetapan tersebut, diharapkan adanya jalur koordinasi
yang lebih baik.
Indonesia telah menerapkan berbagai intervensi peningkatan mutu sejak kurang lebih
30 tahun yang lalu seperti Quality Assurance, Total Quality Management, sertifikasi ISO,
keselamatan pasien, akreditasi fasilitas kesehatan dan lain-lain. Saat ini, akreditasi rumah sakit
dan akreditasi pelayanan tingkat primer menjadi suatu program yang paling banyak mendapat
perhatian oleh pemangku kepentingan. Hal ini diperkuat juga oleh sistem JKN yang
menjadikan akreditasi fasilitas pelayanan kesehatan adalah syarat untuk perpanjangan ijin
operasional ataupun syarat fasilitas kesehatan menjadi provider BPJS. Meskipun akreditasi
telah memberi manfaat dengan terlaksananya pelayanan yang terstandar oleh fasilitas
kesehatan, tetapi efektifitas akreditasi dalam terciptanya budaya mutu yang berkelanjutan
masih menjadi tantangan secara global. Tantangan lainnya adalah pemantauan dan evaluasi
berbagai program peningkatan mutu pelayanan kesehatan masih belum dilakukan secara
konsisten. Berbagai data yang tersedia juga belum digunakan untuk melakukan evaluasi secara
optimal. Saat ini pengukuran mutu banyak dilakukan dengan survei kepuasan pasien dan
indikator mutu. Tetapi, indikator mutu dibuat oleh beberapa kementerian dan beberapa institusi
lainnya sehingga masih bervariasi dan disesuaikan dengan kepentingan masing-masing
institusi yang membuatnya.

Di dalam era JKN seperti saat ini, kesenjangan terkait akses layanan kesehatan masih
belum teratasi. Jumlah layanan primer, rumah sakit dan juga tenaga kesehatan menunjukkan
peningkatan, tetapi kesenjangan dalam distribusi dokter spesialis dan fasilitas kesehatan masih
tampak jelas di Indonesia bagian Timur. Untuk mengatasi masalah ini, Kementerian Kesehatan
telah melakukan berbagai upaya untuk meningkatkan akses dan kesetaraan. Hal ini juga
menunjukkan bahwa berbagai intervensi yang berbeda, menyesuaikan kondisi dan kapasitas
masing-masing daerah, diperlukan untuk mengatasi hambatan masing-masing daerah dalam
memberikan pelayanan yang bermutu.
Dengan disusunnya dokumen Kebijakan dan Strategi Nasional Mutu Pelayanan
Kesehatan Indonesia, kebijakan dan strategi mutu pelayanan kesehatan di Indonesia akan
terintegrasi dan lebih terarah. Kebijakan dan Strategi Nasional Mutu Pelayanan Kesehatan

26
Indonesia akan berfungsi sebagai pedoman nasional dalam upaya peningkatan mutu pelayanan
kesehatan.

II. VISI, MISI DAN TUJUAN

Kebijakan dan Strategi Nasional Mutu Pelayanan Kesehatan Indonesia memiliki visi,
misi dan tujuan sebagai berikut:
Visi: Mewujudkan pelayanan kesehatan yang bermutu bagi seluruh masyarakat
Indonesia
Misi:
1. Mengintegrasikan berbagai sistem dan upaya peningkatan mutu pelayanan
kesehatan yang telah berjalan maupun yang akan dikembangkan lebih lanjut
2. Meningkatkan peran serta masyarakat dan seluruh pemangku kepentingan dalam
meningkatkan mutu pelayanan kesehatan di Indonseia
3. Membangun budaya mutu pelayanan kesehatan berkelanjutan diseluruh institusi
kesehatan

Tujuan:
1. Memberikan pedoman dan petunjuk teknis pelaksanaan upaya peningkatan mutu
pelayanan kesehatan
2. Memberikan advokasi dan informasi kepada para pemangku kepentingan mengenai
peran dan tanggung jawab mereka masing-masing dalam upaya peningkatan mutu
3. Meningkatkan koordinasi antara berbagai pengelola upaya peningkatan mutu
pelayanan kesehatan

III. STRATEGI DAN PROGRAM MUTU PELAYANAN KESEHATAN INDONESIA

1. Kerangka Konsep Mutu Pelayanan Kesehatan di Indonesia

Sesuai dengan kerangka konsep mutu yang dikenalkan oleh Donabedian, maka
Kebijakan dan Strategi Nasional Mutu Pelayanan Kesehatan Indonesia menggunakan
pendekatan input, proses dan output. Output yang diharapkan adalah mutu pelayanan kesehatan
yang baik. Output ini dapat tercapai apabila input dan proses juga tersedia dengan baik.

27
 Gambar 1. Kerangka konsep Mutu Pelayanan Kesehatan Indonesia

Input yang diperlukan adalah tersedianya komponen dari sistem kesehatan “Six
building blocks” WHO, terdiri dari: 1) Pelayanan Kesehatan; 2) Tenaga Kesehatan; 3)
Informasi; 4) Obat, alat kesehatan dan teknologi; 5) Pembiayaan; dan 6) Kepemimpinan dan
Tatakelola. Sedangkan proses pelayanan kesehatan menggunakan dasar continuity of care
yang mencakup aspek pencegahan, promosi, kuratif, rehabilitatif hingga paliatif.

2. Definisi dan Dimensi Mutu Pelayanan Kesehatan

Kebijakan dan Strategi Nasional Mutu Pelayanan Kesehatan Indonesia memberikan
definisi mutu pelayanan kesehatan sebagai: tingkat mutu pelayanan kesehatan yang sesuai
dengan standar pelayanan dan perkembangan ilmu pengetahuan terkini, berlandaskan
hak asasi manusia serta melibatkan pasien dan keluarga, sehingga memberikan hasil
kesehatan yang diinginkan oleh individu maupun masyarakat (mengadaptasi dari Institute
of Medicine dan hasil diskusi pada workshop tahun 2017).
Kebijakan dan Strategi Nasional Mutu Pelayanan Kesehatan Indonesia mengadopsi
enam dimensi mutu pelayanan kesehatan dari WHO, yaitu: efektif, efisien, mudah diakses,
fokus kepada pasien, adil dan aman. Berikut ini adalah jabaran dari masing-masing dimensi:
• Efektif: memberikan pelayanan kesehatan yang berbasis pada bukti dan memberi hasil
kesehatan yang lebih baik bagi individu dan masyarakat sesuai dengan kebutuhannya.

28
 • Efisien: memberikan pelayanan kesehatan dengan memaksimalkan penggunaan
sumber daya yang tersedia dan menghindari pemborosan
• Mudah diakses: memberikan pelayanan kesehatan yang tepat waktu, terjangkau,
dalam setting dimana sumber daya dan kompetensi tenaga kesehatan sesuai dengan
kebutuhan pasien
• Fokus kepada pasien: memberikan pelayanan kesehatan dengan mempertimbangkan
preferensi dan aspirasi pasien serta keluarganya, dan mempertimbangkan budaya yang
berlaku
• Adil: memberikan mutu pelayanan kesehatan yang setara tanpa membedakan berbagai
karakteristik seperti jenis kelamin, ras, etnis, lokasi geografis, atau status sosial
ekonomi
• Aman: memberikan pelayanan kesehatan yang meminimalkan risiko dan bahaya
terhadap pasien

Pengertian dimensi mutu bagi pasien dan sarana layanan kesehatan

(dimodifikasi dari “Quality Matters: Realizing Excellent Care for All”, Ontario, Canada)

arti bagi sarana layanan

Dimensi arti bagi pasien
kesehatan
Layanan yang diberikan
Saya akan mendapat penanganan
berdasarkan bukti terbaik dan
Efektif yang tepat untuk kondisi saya,
memberikan hasil kesehatan yang
sehingga kesehatan saya membaik
diinginkan
Layanan yang saya terima dari Saya memberikan layanan
tenaga kesehatan terkoordinasi kepada pasien menggunakan
Efisien
dengan baik dengan upaya yang berbagai sumber daya manusia
tidak berlebihan dan biaya secara efisien
Saya dapat menjangkau layanan Layanan kesehatan mudah
Mudah diakses kesehatan dengan mudah dan tepat dicapai dari segi lokasi, waktu
waktu dan cara menjangkaunya
Keputusan bagi pasien saya
Pilihan dan tujuan saya
Fokus kepada mempertimbangkan tujuan dan
dipertimbangkan, saya dan keluarga
pasien pilihan dari pasien dan
ditangani dengan rasa hormat
keluarganya.
Setiap individu dapat mengakses
Tidak peduli siapa saya atau
layanan yang mereka butuhkan,
dimana saya tinggal, saya dapat
Adil tanpa membedakan tempat
diberi layanan yang memberi
tinggal, usia, jenis kelamin, dan
manfaat bagi kesehatan saya
status sosial ekonomi mereka.

29
 Layanan yang diterima oleh
Saya tidak akan mendapat kerugian
pasien saya tidak akan
Aman dari pelayanan kesehatan yang
menyebabkan kerugian/bahaya
diberikan kepada saya
bagi mereka

3. Peran dan Tanggung Jawab Pemangku Kepentingan Terkait

Berdasarkan sistem kesehatan “Six building blocks” WHO maka dalam Kebijakan dan
Strategi Nasional Mutu Pelayanan Kesehatan Indonesia terdapat banyak pemangku
kepentingan, yaitu:
1. Pelayanan Kesehatan
a. Kementerian Kesehatan: Diretorat Jenderal Pelayanan Kesehatan
b. Organisasi sarana pelayanan kesehatan: PERSI, Perhimpunan Klinik dan
Fasilitas Pelayanan Kesehatan Primer Indonesia (PKFI)
c. Lembaga akreditasi sarana pelayanan kesehatan: KARS, KAFKTP, KALK
d. Komite/Badan/Tim: KNKP-RS, BPRS, TKMKB, Tim HTA, Tim Anti Fraud,
Dewan Pertimbangan Klinis (DPK), Dewan Pertimbangan Medis (DPM)
e. Lembaga pemantau mutu pelayanan kesehatan independen: Badan Mutu,
Perguruan Tinggi
f. LSM bidang pelayanan kesehatan
g. BPJS Kesehatan: Direktorat Jaminan Pelayanan Kesehatan
2. Tenaga Kesehatan
a. Kementerian Kesehatan: BPPSDM
b. Organisasi profesi: IDI, PPNI, IBI
c. Konsil/Majelis: KKI, MTKI
d. Institusi pendidikan tenaga kesehatan: AIPKI,
e. Kemenristekdikti
3. Informasi
a. Kementerian Kesehatan: Pusdatin
b. BPJS: Direktorat Teknologi dan Infromasi
4. Obat dan Alkes
a. Kementerian Kesehatan: Direktorat Jenderal Kefarmasian dan Alkes
b. BPOM
c. Komite Farmasi
5. Pembiayaan
a. Kementerian Kesehatan: P2JK
b. BPJS Kesehatan: Direktorat Perencanaan, Pengembangan dan Manajemen
Risiko
c. Kementerian PPN/Bappenas
d. Kementerian Keuangan
6. Kepemimpinan dan Tatakelola
a. Kementerian Dalam Negeri
b. Kementerian PAN
c. Pemerintah daerah (gubernur, bupati/walikota)
d. Dinas Kesehatan
30
 e. Lembaga Donor: WHO, AUSAID, USAID, World Bank, UNICEF, UNFPA,
Global Fund dan GIZ.

Dalam NQPS Indonesia, para pemangku kepentingan memiliki peran dan tanggung jawab
utama sebagai berikut:
Pemangku Kepentingan Peran Utama dalam NQPS
1. BPJS Kesehatan: Direktorat Jaminan Mendorong peningkatan mutu
Pelayanan Kesehatan, BPJS Kesehatan: melalui mekanisme finansial
Direktorat Perencanaan, Pengembangan
dan Manajemen Risiko, BPJS: Direktorat Hasil FGD:
Teknologi dan Informasi Memastikan peningkatan mutu
layanan melalui mekanismes
finansial
Menjamin masyarakat mendapatkan
manfaat pelayanan kesehatan sesuai
standar melalui program JKN
2. BPOM Regulator penggunaan dan
pengawasan obat

Hasil FGD:
Memastikan peningkatan mutu
yankes melalui mekanisme
pembinaan dan pengawasan obat
dan makanan
3. Dinas Kesehatan Melakukan pengawasan dan
pembinaan pemenuhan berbagai
standar pelayanan kesehatan

Hasil FGD:
Memastikan peningkatan mutu
pelayanan kesehatan melalui:
Tersedianya sumber daya sesuai
dengan standar
Pembinaan dan pengawasan
Merumuskan kebijakan teknis
pelaksanaan, pengendalian,
pembinaan dan perijinan di bidang
kesehatan
4. Institusi pendidikan tenaga kesehatan: Hasil FGD:
AIPKI, Memastikan peningkatan mutu
yankes melalui pemenuhan SDM
kesehatan yang berkualitas sesuai
kebutuhan
Melaksanakan pembinaan kepada
institusi pendidikan tenaga
kesehatan dalam mencapai standar
pendidikan tenaga kesehatan
5. Kemenristekdikti Memastikan mutu institusi
pendidikan tinggi bidang kesehatan
31
 Hasil FGD:
Memastikan peningkatan mutu
yankes melalui penetapan regulasi
(NSPK)
Pembinaan dan pengawasan
Regulator penyelenggaraan
pendidikan tinggi bidang kesehatan
6. Kementerian Dalam Negeri Hasil FGD:
Memastikan peningkatan mutu
yankes melalui
penetapan regulasi dalam
implementasi pelayanan kesehatan
yang berkualitas
Pembinaan dan pengawasan
Regulator tata kelola system
pelayanan kesehatan ditingkat
kabupaten kota
7. Kementerian Kesehatan: BPPSDM, Regulator pelayanan kesehatan
Direktorat Jenderal Kefarmasian dan Alkes,
Diretorat Jenderal Pelayanan Kesehatan, Hasil FGD:
P2JK, Pusdatin Memastikan peningkatan mutu
pelayanan kesehatan melalui:
Tersedianya sumber daya sesuai
dengan standard, Pembinaan dan
pengawasan
Regulator sistem pelayanan
kesehatan secara nasional
8. Kementerian Keuangan Hasil FGD:
Memastikan peningkatan mutu
pelayanan kesehatan melalui:
Pemenuhan kebutuhan pembiayaan
bidang kesehatan
9. Kementerian PAN Hasil FGD:
Memastikan peningkatan mutu
pelayanan kesehatan melalui
Pembinaan dan pengawasan
10. Kementerian PPN/Bappenas
11. Komite Farmasi
12. Komite/Badan/Tim: KNKP-RS, BPRS,
TKMKB, Tim HTA, Tim Anti Fraud, Dewan
Pertimbangan Klinis (DPK), Dewan
Pertimbangan Medis (DPM)
13. Konsil/Majelis: KKI, MTKI
14. Lembaga akreditasi sarana pelayanan Menyusun, menilai dan
kesehatan: KARS, KAFKTP, KALK memberikan sertifikasi standar
akreditasi

32
 15. Lembaga Donor: WHO, AUSAID, USAID,
World Bank, UNICEF, UNFPA, Global
Fund dan GIZ.
16. Lembaga pemantau mutu pelayanan
kesehatan independen: Badan Mutu,
Perguruan Tinggi
17. LSM bidang pelayanan kesehatan
18. Organisasi profesi: IDI, PPNI, IBI
19. Organisasi sarana pelayanan kesehatan:
PERSI, Perhimpunan Klinik dan Fasilitas
Pelayanan Kesehatan Primer Indonesia
(PKFI)
20. Pemerintah daerah (gubernur,
bupati/walikota)
Menilai pemenuhan standar mutu
secara independen baik atas inisiatif
mandiri maupun atas permintaan
ataukerjasama dengan stakeholeder
lainnya
Mendorong masyarakat untuk
berperan serta dalam upaya
peningkatan mutu pelayanan
kesehatan
Menyusun, mensosilisasi dan
mengevaluasi kepatuhan standar
profesi
Terlibat dalam penyusunan standar
mutu bagi masing-masing sarana
pelayanan kesehatan dan
memfasilitasi pemenuhan standar
tersebut bagi para anggotanya
Menetapkan kebijakan mutu bagi
daerah masing-masing

4. Indikator Mutu Pelayanan Kesehatan Nasional

Indikator mutu pelayanan kesehatan nasional perlu ditetapkan untuk menjadi
landasan bagi indikator yang telah atau yang akan dikembangkan, sesuai dengan enam
dimensi mutu. Indikator mutu dalam Kebijakan dan Strategi Nasional Mutu Pelayanan
Kesehatan Indonesia ini bersifat general, yang dimaksudkan untuk dapat menjadi pedoman
penyusunan indikator di tingkat populasi, pelayanan kesehatan tingkat primer, dan
pelayanan kesehatan tingkat lanjut.
Indikator Mutu Nasional untuk masing-masing dimensi sebagai berikut (usulan
sementara) :

Dimensi Indikator
• Prosentase kepatuhan terhadap Panduan Praktik Klinis
Efektif (PPK)
• Cakupan imunisasi dasar
• Prosentase penulisan resep sesuai formularium nasional
Efisien
• Waktu tunggu rawat jalan
• Jumlah dan kompetensi tenaga pelayanan kesehatan
Mudah diakses memenuhi syarat
• Bed occupancy rates
• Kepuasan pasien dan keluarga di unit rawat jalan
Fokus kepada pasien
• Kecepatan respon terhadap komplain pasien
• Kebersihan air dan sanitasi memenuhi syarat
Adil
•
• Prosentase kepatuhan cuci tangan yang benar oleh tenaga
Aman
medis
33
 • Prosentase kejadian infeksi nosokomial di fasilitas
kesehatan

5. Metode dan Intervensi Peningkatan Mutu Pelayanan Kesehatan

Akan dibahas pada workshop selanjutnya
6. Tatakelola dan Struktur Organisasi Peningkatan Mutu Pelayanan Kesehatan
Akan dibahas pada workshop selanjutnya
7. Sistem Informasi Manajemen Mutu Pelayanan Kesehatan
Akan dibahas pada workshop selanjutnya

BAB IV. PENUTUP

Akan dibahas pada workshop selanjutnya

34