Medicalnews – Ketua Dewan Pembina Indonesia Health Development Center (IHDC), Nila F Moeloek, menyampaikan hasil kajian terbaru di Jakarta.
Kajian tersebut menunjukkan partisipasi kesehatan di Indonesia masih belum inklusif.
Perempuan, masyarakat miskin, penyandang disabilitas, dan pasien penyakit kronis masih menghadapi hambatan.
Warga di wilayah terpencil juga sulit terlibat dalam sistem kesehatan secara bermakna.
Menurut Nila, hambatan ini bersifat struktural dan berlangsung lama.
Kondisi tersebut membatasi keterlibatan masyarakat dalam pengambilan keputusan kesehatan.
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IHDC sebelumnya menyusun kajian ilmiah bertajuk Partisipasi Kesehatan sebagai Ideologi Kesehatan Bangsa.
Kajian ini menyoroti lemahnya partisipasi publik dalam sistem kesehatan nasional.
IHDC menilai masalah kesehatan tidak hanya soal pembiayaan.
Perencanaan, pelaksanaan, dan evaluasi kebijakan juga minim keterlibatan warga.
Kondisi ini melemahkan efektivitas program kesehatan di lapangan.
Akibatnya, banyak kebijakan tidak sesuai kebutuhan masyarakat.
Cakupan JKN Tinggi, Namun Keadilan Akses Belum Merata
Indonesia telah mencapai cakupan Jaminan Kesehatan Nasional lebih dari 95 persen.
Namun, capaian ini belum sejalan dengan kualitas layanan.
Nila menilai keadilan akses layanan masih timpang.
Ketimpangan muncul antar wilayah, gender, dan status sosial ekonomi.
Penyandang disabilitas dan pasien penyakit tertentu juga menghadapi hambatan layanan.
Kepercayaan publik terhadap sistem kesehatan ikut terpengaruh.
Dampak Nyata Lemahnya Partisipasi Masyarakat
Rendahnya partisipasi memicu penundaan pengobatan di masyarakat.
Banyak pasien juga tidak patuh pada terapi.
Perilaku promotif dan preventif masih rendah.
Beban pengobatan kuratif dan pembiayaan kesehatan terus meningkat.
Kepercayaan publik menurun dan mendorong praktik berobat ke luar negeri.
Fenomena ini menunjukkan masalah sistemik yang perlu perhatian serius.
Perempuan dan Kelompok Rentan Masih Terpinggirkan
Direktur Eksekutif IHDC, Ray Wagiu Basrowi, menyoroti rendahnya keterlibatan perempuan.
Perempuan mengambil lebih dari 70 persen keputusan kesehatan keluarga.
Namun, perempuan jarang terlibat dalam perencanaan pembangunan kesehatan.
Keterlibatan mereka dalam forum resmi masih sangat terbatas.
Kelompok miskin dan marjinal juga menghadapi kendala serupa.
Tingkat partisipasi mereka di forum kesehatan berada di bawah 40 persen.
Penyandang disabilitas menghadapi kondisi lebih berat.
Kurang dari 20 persen pernah terlibat dalam forum layanan publik.
Stigma dan Ketimpangan Wilayah Perparah Masalah
Stigma terhadap HIV, TBC, dan kesehatan jiwa menghambat layanan.
Dan Stigma ini menurunkan minat tes dan kepatuhan terapi.
Ketimpangan wilayah juga masih tinggi.
Partisipasi kesehatan di daerah tertinggal hanya sekitar 30 hingga 35 persen.
Warga harus menempuh perjalanan 2 hingga 4 jam ke layanan rujukan.
Kondisi ini mengurangi akses dan partisipasi masyarakat.
Rekomendasi 9 Pilar dan 5 Instrumen Penguatan
IHDC merekomendasikan sembilan pilar penguatan partisipasi kesehatan.
Pilar ini mencakup pendekatan gotong royong dan pengalaman hidup masyarakat.
IHDC juga mendorong pemantauan berbasis komunitas dan penguatan kepercayaan publik.
Pendekatan desa dan keluarga menjadi fokus utama strategi ini.
Selain itu, IHDC mengusulkan lima instrumen pendukung.
Instrumen tersebut mencakup agen komunitas, indeks partisipasi, dan perlindungan dari stigma.
Partisipasi Bermakna Jadi Fondasi Sistem Kesehatan
IHDC menegaskan partisipasi bermakna sebagai fondasi sistem kesehatan berkelanjutan.
Cakupan layanan luas harus diiringi keterlibatan aktif masyarakat.
Ray menilai sistem tanpa partisipasi akan rapuh secara sosial.
Dengan partisipasi kuat, sistem kesehatan dapat membangun kepercayaan publik.
Pendekatan ini diharapkan memperkuat ketahanan kesehatan nasional.
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