Gambaran Indikator Evaluasi Pengelolaan dan Pembiayaan Obat di 20 Puskesmas Sumatera Barat

Drug financing is the biggest cost component of health care which is relatively easy to be intervened, especially at the government sector. If key outcome indicators have been determined at the beginning of an intervention measuring whether the objectives of the intervention have been met through changes in these indicators makes it possible to assess the impact of an intervention. The objective of the study is essential regarding the recent decentralization policy. Guidelines on Drug Management and Financing at Puskesmas with indicators adopted from WHO-PAHO “Manual of Rapid Assessment Pharmaceutical Management, 1995” as well as indicators recently developed from a study in Pekalongan District in 1999/2000, i.e. cost recovery, actual cost and ability to pay, is intended to increase efficiency, to assess the system and to broaden the knowledge of drug managing staff at District Health Office (Dinkes Kabupaten/Kota), District Pharmaceutical Warehouse (GFK) and Primary Health Care (Puskesmas). This cross-sectional retrospective study was designed to characterize drug use practices in each locality for a sample of at least 20 health facilities, with a minimum of 30 encounters being recorded in each facility. Studying 20 Puskesmas from 4 districts, i.e. Pesisir Selatan, Sawahlunto Sijunjung, Padang Pariaman and Payakumbuh through their medical records (600 from each district) will increase the reliability and generalizability of the indicators. The results of this study shows that in all district, drug budget per capita was too high during 1998-2001 for drug cost per encounter had been determined up to 218% higher than the actual drug cost per encounter and patients’ ability to pay was higher than the actual treatment cost for certain diseases. On the other hand, the cost recovery was declining for all districts. More intensive socialization of rational prescribing for Puskesmas physician to achieve efficiency in drug financing and implementation of this guidelines is necessary, regional authority should better return all Puskesmas retribution entirely.