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All Stakeholders agreed that health facilities in Lampung Province still need to improve their health service quality. With decentralization, services must be brought closer to the community, and the district/city government is required to provide a better quality health services. A model of accountability for health system would be developed to improve health service quality that is more customer-oriented.
In connection with quality, the role of stakeholders, i.e., the Provincial Health office is to be responsible for handling cross-regional problems, or problems that are beyond the regional government’s capability to solve. The District Health Office is responsible for the planning, advocacy, monitoring, and evaluation on all health facilites in their own region. Health facilites themself should is responsible for the monitoring and improvement of health service quality given to the community/patients. Professional Organization plays its role in building its members’ capacity, for example through sustainable membership and capacity building, technical assistance and advocacy. Meanwhile, Non Government Organization acts as mediator, partner, or actor.
An observational study based on a qualitative method was conducted to find facts in the field, and then from these facts the study proposed a recommendation for a public-accountability model having been adjusted to the real condition in the field. In addition to taking the Provincial dan District Health Office as its samples, the study also took other samples, namely hospitals, Primary Health Care Centres, Association of Indonesian Doctors (IDI), and Non Government Organizations. For the analysis in hospital unit, the study conducted interviews with respondents from medical service and medical record sections, customer relation unit or other units of similar function as well as the patients. For primary health care centre analysis, the respondents consisted of medical record responsible person (in-patient primary health care centre), the head, and patients. For Provincial and District Health Offices, the respondents were represented by sub-sections of health service.
The system for taking and solving complaints in health service system should be based on the principles of easy access and procedure, speedy and transparent process, fairness for all -patients and medical staffs as well-, and beneficial to health service quality improvement. By adopting these principles, health facility is expected to deal with complaints directly in the front line. However, if this ideal is difficult to achieve, the role of a Patient Support Manager (PSM) is needed to help deal with complaints as promptly as possible and in a transparent, non-defensive, and mediating manner. A PSM must have personal access to the top leader of health facility and to medical record, in addition to having high motivation to do his tasks of mediation to offer win-win solution to both conflicting parties. Whenever it fulfils the requirement and gets approval from the two parties, an unresolved complaint in health facility level can be handled by the Health Office, which acts as mediator by doing an independent review. The system of taking and solving complaints must be integrated into service quality improvement measures.
In connection with service quality improvement and malpractice prevention, everyone in the health system of Lampung Province must build a quality framework, and taking into account non-medical indicator. The current indicator together with the one to be developed must be extended periodically, and must include dimensions of health status, clinical effectiveness, medical error/safety, efficiency and incentive, as well as fairness. Meanwhile, the steps to be taken for quality improvement in order to prevent malpractice are as follows: first, to decide an effort to maintain retrospective quality for example through technical standardization, periodical licensing, and certification and prospective quality for example through record review to diagnosis and medication and satisfaction survey to be conducted by health facility, and also to decide who to carry them out; and second, to give feed back to health facility and the Office of heath Offices in city/district level as for periodical and continuous advocacy. These steps can be implemented first in health facilities with autonomous management, under an assumption that they can make a decision more quickly.
In the implementation of health service performance evaluation, the Provincial and District Health Office and health facilities need to include responsiveness with its all dimensions as one of the important performances in the health service system, which relates to non medical aspects and patient’s rights. The mechanism can be introduced through survey on responsiveness at the household and health facility levels.
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