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Bagaimana Negara Berkembang Mencapai Jaminan Kesehatan Universal?

Hampir semua negara di seluruh dunia sudah sepakat untuk mencapai Jaminan Kesehatan Universal (AKU) pada 2030, sebagai bagian dari Tujuan Pengembangan Berkelanjutan PBB. Namun, beberapa negara sedang berkembang lebih pesat dibanding yang lainnya dalam menyediakan akses yang sama rata, bukan hanya untuk pelayanan kesehatan, namun juga obat-obatan dan vaksin terjangkau. Salah satu yang terdepan dalam hal ini ialah Vietnam.

Hari ini, 87,7% populasi Vietnam – yaitu 83,6 juta jiwa – telah tercakup dalam asuransi kesehatan. Menurut Laporan Pengawasan Global terakhir mengenai AKU, juga dipublikasikan bersama dengan WHO dan Bank Dunia, 97% anak-anak Vietnam telah menerima vaksin standar, dibandingkan 95% di Amerika Serikat. Sejak 1990, tingkat kematian kelahiran di Vietnam telah turun sebesar 75%.

Vietnam berhasil mencapai tonggak sejarah yang hebat jauh sebelum rencana, meski hanya memiliki pendapatan per kapita rata-rata sebesar $2.342 pada 2017. Kunci dari kesuksesan tersebut bukanlah besarnya investasi untuk pelayanan kesehatan, yang hanya dialokasikan senilai $142 untuk tiap orang tiap tahun (termasuk dari pendanaan publik maupun dari biaya pribadi), tetapi bagaimana pemerintah menggunakan sumber daya yang ada, termasuk modal intelektual negara.

Langkah strategis Vietnam dapat dilihat di skema Pengarahan Aktivitas Pelayanan Kesehatan dari Departemen Kesehatan Vietnam, yang mewajibkan fasilitas kesehatan pada level pusat dan provinsi untuk membantu membangun kapasitas fasilitas di tingkat distrik dan komunitas. Tujuan kunci dari skema ini adalah membagi beban penyediaan layanan kesehatan dari rumah sakit di level yang lebih tinggi ke pusat layanan kesehatan primer di level yang lebih rendah.

Dengan sejarah panjang perbedaan yang besar antara pelayanan kesehatan di perkotaan dan perkampungan, orang-orang Vietnam masih terus berusaha melangkahi fasilitas kesehatan lokal karena lebih menyukai rumah sakit besar di pusat kota. Hal ini menyebabkan inefisiensi di sistem kesehatan dan meningkatnya biaya pribadi yang harus dikeluarkan pasien dan keluarganya, tanpa menjamin pelayanan yang terbaik.

Jadi, selain memastikan fasilitas kesehatan komunitas dapat memberi layanan yang terjangkau dan berkualitas, ada suatu kebutuhan untuk mengubah persepsi publik. Keluarga harus percaya bahwa mereka bisa mendapatkan diagnosa tepat untuk malaria, penyakit paru obstruktif kronis, atau diabetes pada tingkat lokal, juga mendapat pengobatan dan terapi lain yang dibutuhkan.

Pada akhirnya, fasilitas kesehatan harus memperkuat hubungan mereka dengan komunitas lokal, diantaranya dengan menyediakan secara rutin level pelayanan yang memuaskan pasien. Hubungan tersebut akan membantu pengembangan hal yang memperbaiki kesehatan sekaligus mengurangi biaya: petugas kesehatan lokal harus dapat mengedukasi komunitas mereka untuk menjaga kesehatan dan mencegah penyakit. Kesuksesan usaha ini menuntut kondisi pekerjaan yang baik dan akses terhadap pelatihan yang berlangsung, serta manajemen pendukung yang sangat penting untuk kepuasan pekerja.

Pemerintah Vietnam menyadari bahwa, untuk implementasi strategi pelayanan kesehatan dengan efektif, mereka butuh bantuan. Pemerintah telah menyusun Kelompok Pekerja untuk Transformasi Pelayanan Kesehatan Primer, dipimpin oleh Kementrian Kesehatan Vietnam dan mencakup pelaku yang beragam dari sektor publik, non-profit, dan privat. Mitra pendiri kelompok tersebut termasuk Forum Ekonomi Dunia, Sekolah Medis Harvard, dan Norvatis (yang mana saya adalah ketua dewannya).

Kelompok pekerja bertujuan memperkuat proyek demonstrasi pelayanan primer yang sudah ada di tiap 30 provinsi Vietnam, serta mengaplikasikan pelajaran yang didapat untuk pengembangan solusi menyeluruh yang dapat direplikasi dan terukur. Kelompok ini juga menetapkan prioritas tinggi untuk pengukuran dan evaluasi ketat dari hasil yang ditunjukkan, mulai dari kualitas pelayanan kesehatan tingkat komunitas hingga efektivitas biaya dari pelayanan kesehatan primer.

Setiap mitra diundang untuk berkontribusi dalam hal kapabilitas, sumber daya, serta pengetahuan untuk hal ini. Sebagai contoh, Sekolah Medis Harvard memberi tenaga ahli level dunia dalam manajemen organisasi untuk tim-tim pelayanan kesehatan primer. Mitra-mitra nasional, diantaranya memberi pengertian mendalam tentang konteks lokal yang sangat penting dalam pengembangan dan implementasi solusi berkelanjutan.

Untuk bagiannya, Novartis menawarkan pengertian bagaimana cara mengimplementasikan teknologi digital dalam skala besar, melibatkan komunitas desa dalam edukasi kesehatan, dan memperluas program edukasi untuk praktisi layanan kesehatan di komunitas pedesaan. Faktanya, Novartis sudah memberi kontribusi yang mirip lewat kemitraan publik-privat lainnya yang sukses di Vietnam, bernama Cùng Sông Khòe.

Dilaksanakan dalam kemitraan bersama pemerintah Vietnam, Cùng Sông Khòe telah menyediakan sejumlah pelayanan untuk komunitas-komunitas rural tak terjangkau di Vietnam sejak 2012. Inisiatif tersebut telah mengembangkan pelayanan kesehatan, baik untuk isu kesehatan umum seperti diabetes, hipertensi, dan penyakit paru-paru, maupun edukasi kesehatan pasien serta melanjutkan edukasi medis untuk ahli kesehatan. Sejak 2012, CSK telah menyentuh lebih dari 570.000 orang, umumnya dewasa, di 16 provinsi.

Vietnam memiliki tantangan signifikan kedepannya. Negara ini harus bergulat antara faktor sikap maupun lingkungan yang mendasari buruknya kesehatan serta penyakit, terutama tingginya jumlah perokok laki-laki, tingginya konsumsi alkohol, serta polusi udara. Negara ini juga telah menjadi salah satu populasi yang menua paling cepat di dunia.

Terlebih, reformasi pelayanan kesehatan penting masih harus dilakukan untuk meningkatkan hasil. Sebagai contoh, pemerintah harus memberi insentif untuk dokter agar lebih selektif dalam merujuk pasien ke rumah sakit dengan level lebih tinggi, atau merujuk pasien lebih banyak ke pusat-pusat pelayanan kesehatan primer lokal.

Namun demikian, kemajuan Vietnam menuju AKU sudah sangat luar biasa, sebagian karena kesediaan pemerintah dalam membentuk kemitraan publik-privat. Untuk negara-negara yang sedang berjuang untuk maju, model ini – serta langkah-langkah dari beberapa negara dengan performa tinggi menuju AKU, seperti Indonesia, Rwanda, dan Thailand – mungkin dapat diterapkan.

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Tulisan diterjemahkan dari artikel yang berjudul “How Developing Countries Can Achieve Universal Health Coverage” yang ditulis oleh Jorg Reinhard, Chairman of the Board of Directors for Novartis.

 

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