DPR Sahkan UU Kesehatan, Negara Tak Tanggung Lagi Biaya, Pelayanan Terancam Kacau Balau
JAKARTA - Dewan Perwakilan Rakyat (DPR) RI menyetujui untuk mengesahkan Rancangan Undang-Undang (RUU) Kesehatan menjadi undang-undang dalam Rapat Paripurna DPR RI ke-29 Masa Persidangan V Tahun Sidang 2022-2023.
Pengesahan itu melalui pengambilan keputusan tingkat II yang dipimpin langsung oleh Ketua DPR RI Puan Maharani di Kompleks Parlemen, Senayan, Jakarta, Selasa 11 Juli 2023.
Pengesahan tersebut mendapat penolakan dari Persatuan Perawat Nasional Indonesia ( PPNI ) menurut Ketua PPNI, Harif Fadhillah PPNI dan organisasi profesi menganggap RUU Kesehatan dibuat secara sembunyi-sembunyi. Sebab hingga hari ini pihaknya tidak mendapatkan draf resmi dari RUU Kesehatan Omnibus Law itu.
“Sampai hari ini kami tidak mendapatkan akses terhadap draf yang dibahas. Kami tenaga kesehatan, khususnya perawat yang (jumlahnya) 60 persen dari seluruh jumlah nakes adalah stakeholder yang akan menjalankan UU itu bila sudah jadi,” kata Harif.
Harif merasa bahwa ia dan jajarannya adalah pihak yang penting dalam RUU ini sehingga harus diberi kesempatan untuk berpartisipasi di dalam pembuatannya.
“Kami ingin ada partisipasi dan dalam berbagai kesempatan. ami melakukan lobi, advokasi, audiensi, dan sebagainya terhadap aspirasi kami. Tapi belum ada yang diterima aspirasi kami itu," ujarnya.
Berikutnya adalah isu menghilangkan mandatory spending atau anggaran belanja yang sebelumnya sudah diatur UU. Mandatory spending semula 5 persen dari anggaran pendapatan dan belanja negara (APBN) dan 10 persen anggaran pendapatan belanja daerah (APBD).
"Apa yang terjadi kalau dihilangkan? Hari ini tenaga perawat itu lebih dari 80 ribu orang bertatus honor dan sukarelawan. Yang di daerah bahkan negara tidak mampu memberikan kompensasi untuk kerja mereka di daerah terpencil," paparnya.
Menurutnya, jika mandatory spending dihilangkan situasi akan semakin parah. "Tidak mendapat kejelasan bagaimana mereka dibayar, sementara mereka sudah mengabdi puluhan tahun, belasan tahun kepada faskes milik pemerintah,” tambah Harif.
Menghilangkan mandatory spending dapat membuat para tenaga honor diberhentikan. Sementara di daerah-daerah jumlah PNS-nya lebih sedikit.
Hal ini dapat berpengaruh pada pelayanan kesehatan bagi masyarakat, ujar Harif. Ketiga, menurutnya, mengesahkan RUU Kesehatan sama dengan mencabut UU No 38 Tahun 2014.
UU ini tentang sistem keperawatan yang menyakut pengembangan kapasitas perawat Indonesia yang sudah dikembangkan sejak lama. Secara umum, UU ini berisi perkembangan kompetensi, menjaga mutu dan praktik perawat.
"Jika dicabut tanpa ada pasal pengganti yang spesifik bagi perawat, maka dampaknya adalah pada pengaturan delegasi blanko nanti. Kita tidak tahu aturan seperti apa yang akan dibuat oleh pemerintah nanti," tutupnya.
Ketua DPR RI Puan Maharani memastikan seluruh hak-hak bagi tenaga kesehatan (nakes) tidak akan hilang dalam UU Kesehatan yang telah disahkan DPR.
"Hak-hak bagi Nakes yang sebelumnya telah dicantumkan dalam UU Kesehatan tidak akan hilang dalam UU ini. Justru hak-hak bagi nakes akan ditingkatkan dalam hal pemberian kesejahteraan demi kelangsungan hidup yang lebih baik lagi," kata Puan.
Mantan Menko PMK ini menyebut, UU Kesehatan juga memperhatikan perlindungan hukum bagi pelaku pelayanan kesehatan.
Menurut Puan, hal itu didasari karena banyaknya tindakan hukum yang diterima oleh Nakes namun tidak ada payung hukum yang melindunginya.
"Saya mengapresiasi Nakes yang merupakan mitra strategis dalam memenuhi hak dasar masyarakat dalam memperoleh pelayanan kesehatan. Untuk itu, nakes perlu mendapatkan perlindungan hukum yang layak," ujarnya.
UU inisiatif DPR yang didukung oleh pemerintah itu juga mengusung sejumlah manfaat. Beleid ini disebut akan membentuk masa depan yang lebih baik bagi seluruh masyarakat Indonesia.
"UU Kesehatan ini bertujuan memperkuat sistem kesehatan negara dan meningkatkan kualitas kesehatan serta kesejahteraan masyarakat," ucap Puan.
DPR dipastikan berkomitmen untuk mengawal diterapkannya Omnibus Law UU Kesehatan secara adil. Puan merinci, mulai dari perlindungan hukum bagi nakes maupun pasien, sampai pada hal peningkatan kualitas pelayanan sistem kesehatan.
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"Kami di DPR akan mengawal implementasi setiap peraturan yang ada dalam UU Kesehatan. Ini semua demi meningkatkan kualitas kesehatan nasional, melindungi masyarakat dan mensejahterakan para petugas kesehatan," ucapnya.
Lebih lanjut DPR menyadari UU Kesehatan menimbulkan pro dan kontra. Meski begitu, Puan menyebut pembahasan UU Kesehatan telah memenuhi unsur keterbukaan, serta dibahas secara intensif dengan prinsip kehati-hatian.
Puan juga memastikan pembahasan UU Kesehatan telah melibatkan partisipasi publik, termasuk dari kalangan dunia kesehatan dan medis. Hal ini demi memastikan agar UU dibuat secara komprehensif.
“Dalam pembahasan UU Kesehatan, DPR telah melibatkan seluruh pemangku kepentingan, termasuk dari masyarakat secara umum, sebagai bentuk keikutsertaan publik di penyusunan UU ini. Tentunya partisipasi publik telah memperkaya wawasan untuk penyempurnaan konsepsi UU Kesehatan,” katanya.
Dia menyebut, konsultasi publik telah dilakukan DPR dengan melibatkan berbagai organisasi masyarakat, organisasi profesi, akademisi, asosiasi penyedia layanan kesehatan, lembaga keagamaan dan lembaga think tank.
Puan menyebut, UU Kesehatan juga telah melalui tahap sosialisasi dan konsultasi publik yang dilakukan oleh Pemerintah.
“DPR RI bersama Pemerintah sangat mempertimbangkan pelibatan masyarakat dan pemangku kepentingan demi menjaga keterbukaan dan partisipasi bermakna (meaningfull participation) dari masyarakat, yaitu hak untuk didengar, hak untuk dipertimbangkan, dan hak untuk diberikan penjelasan,” ucapnya.
“Masukan-masukan dari berbagai elemen masyarakat tersebut tentunya telah diakomodasi dan dipertimbangkan secara seksama di dalam UU tentang Kesehatan ini,” pungkas Puan Maharani.
Kebutuhan Dokter
Terpisah, seusai meresmikan Tol Cisumdawu, Presiden Joko Widodo ( Jokowi ) berharap Rancangan Undang-Undang (RUU) tentang Kesehatan nantinya dapat memperbaiki reformasi bidang pelayanan kesehatan di Tanah Air.
“Undang-Undang Kesehatan kita harapkan setelah dievaluasi dan dikoreksi di DPR saya kira akan memperbaiki reformasi di bidang pelayanan kesehatan kita,” ujar Jokowi.
Selain itu, Kepala Negara juga berharap dengan adanya Undang-Undang Kesehatan tersebut akan dapat mendorong pemenuhan kebutuhan tenaga kesehatan yang masih kurang di dalam negeri.
“Kita harapkan kekurangan dokter bisa lebih dipercepat, kekurangan spesialis bisa dipercepat, saya kira arahnya ke sana,” ucapnya.
Sementara itu, terkait RUU tentang Desa yang juga masih dalam proses pembahasan di DPR, Presiden Jokowi menyebut bahwa pemerintah akan memberikan pandangan pada saatnya nanti.
“Karena masih dibahas di DPR untuk Undang-Undang Desa, jadi pertimbangan dan pandangan dari pemerintah nanti ada saatnya akan kita berikan,” kata Presiden.
Senada dengan Presiden, Kepala Surveilans Epidemiologi dan Imunisasi Dinas Kesehatan Provinsi DKI Jakarta, dr Ngabila Salama MKM, menyebut keberadaan RUU Kesehatan bisa melahirkan banyak dokter spesialis karena adanya hospital based.
"Selain yang selama ini berbasis universitas dan AHS yang akan terus ada. Hospital based ini akan gratis, sekolah spesialis, peserta tetap dibayar selama sekolah karena mengabdi di RS pendidikan, dan mencegah bullying," papar Ngabila.
Ditambah lagi lanjut Ngabila perlindungan hukum terhadap tenaga kesehatan bakal terjamin. Tidak hanya itu selama pendidikan, tenaga kesehatan bisa menghentikan pelayanan ke pasien jika ada ancaman verbal.
"Dan penyelesaian sengketa diutamakan mediasi atau di luar pengadilan, narasi kesembuhan sudah dihapuskan, menambah perlindungan hukum untuk tenaga kesehatan," ujar Ngabila.
Berikutnya kesejahteraan tenaga kesehatan bakal ditambahkan. Diantaranya berupa insentif, infrastruktur, beasiswa, pemerataan mutu layanan kesehatan, dan sebagainya.
"Kesehatan masyarakat diutamakan dengan pilar pertama yaitu transformasi layanan primer," ujarnya.
Tidak hanya itu kelebihan adanya UU Kesehatan yang sudah disahkan terkait surat tanda registrasi (STR) berlaku seumur hidup tanpa perlu perpanjangan lagi. Izin praktik tenaga kesehatan juga gratis lima tahun sekali tanpa membayar apa pun.
"Termasuk iuran keanggotaan organisasi profesi menggunakan aplikasi transparan oleh Kementerian Kesehatan RI," ujar Ngabila.
Terakhir, organisasi profesi akan independen dan tidak diatur pemerintah (tidak dibunyikan) dalam RUU ini.
Serta akan mandiri menjadi mitra pemerintah dalam hal kesehatan.
"Namun tetap bisa menjaga marwah dan kebaikan-kebaikan untuk tiap anggotanya," kata Ngabila.
Politikus Partai Demokrat yang juga anggota Badan Legislatif, Santoso menyebutkan bahwa RUU Kesehatan menghapus perjuangan SBY dalam mandatory spending atau pengeluaran belanja negara dalam kesehatan.
"Dalam RUU Kesehatan Omnibus ini, mandatory spending yang sejak awal diperjuangkan Partai Demokrat di era Pak SBY saat ini dihapus. Maka rakyat tidak akan mampu lagi berobat dengan biaya negara. Apakah kita setuju jika anggaran itu tidak dispending-kan 10 persen," kata Santoso.
Menurutnya hal itu menjadi dasar pihaknya menolak RUU Kesehatan karena tidak memberikan jaminan kepada rakyat. "Itulah salah satu kita menolak ini. Karena tidak memberi jaminan kepada rakyat untuk sehat dengan jaminan dari pemerintah," tegasnya.
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Menurutnya Indonesia sebagai negara berkembang sangat butuh mandatory spending untuk pembiayaan kesehatan.
"Amerika saja sebagai negara maju, pemerintahnya masih memberikan program untuk kesehatan bagi rakyatnya. Apalagi kita sebagai negara yang masih berkembang ini. Undang-Undang ini kita tolak karena kita punya dasar," jelasnya.
Kemudian Santoso juga menyinggung soal sudah tidak adanya lagi Undang-Undang keperawatan, kebidanan, di RUU Kesehatan.
"Bahwa setiap profesi dilindungi oleh Undang-Undang. Ada Undang-Undang keperawatan, kebidanan, di RUU ini Undang-Undang ini ditiadakan. Berarti semua tenaga kesehatan tidak dilindungi oleh negara. Itu harus kita tolak karena suadara (Tenaga Kesehatan) garda terdepan untuk kesehatan masyarakat," jelasnya.
Menurutnya jika Undang-Undang dimana profesi kesehatan ditiadakan, maka profesi tersebut tidak dihargai oleh negara.
"Dan posisi saudara akan sulit juga bekerja untuk rakyat. Berikutnya, Undang-Undang ini, atau RUU ini, tampaknya lebih pro kepada oligarki, pengusaha-pengusaha asing, untuk bangun kesehatan di negeri kita," ujarnya.
Santoso juga mendukung rencana organisasi profesi tenaga kesehatan (nakes) bakal mengajukan gugatan judicial review RUU Omnibus Law Kesehatan ke Mahkamah Konstitusi (MK).
"Karena Demokrat bersikap menolak, jika ini disahkan, maka cara konstitusinya adalah melalui judicial review. Maka kami akan mendukungnya," kata Santoso.
Selain itu, Santoso juga merespons soal rencana sejumlah organisasi profesi nakes yang bakal mogok kerja, jika RUU Kesehatan disahkan DPR.
"Jika itu menjadi jalan terbaik agar para nakes terlindungi, terproteksi dengan adanya UU. Tidak seperti UU saat ini, menurut saya menjadi hak mereka juga untuk melakukan itu," ucap Santoso.
"Karena existing yang ada ini kan ada UU keperawatan, tentang bidan, ini ditiadakan di UU ini tak hanya pasal penyebutan saja," sambungnya.
Meski demikian, Santoso mengatakan, sebelum mogok kerja nakes dilakukan. Pemerintah harus berpikir bahwa profesi kesehatan harus diakomodir juga.
"Jadi jangan atas nama kekuasaan, atas nama rakyat keseluruhan, tapi mengorbankan orang yang bekerja untuk kesehatan, untuk rakyat," kata Santoso.
"Mereka sebagai warga negara memiliki hak juga untuk dilindungi, untuk diakomodir profesinya," sambungnya.
DPR Passes Law on Health, State No Longer Responsible for Costs, Services Threatened to Chaos
JAKARTA - The Republic of Indonesia's House of Representatives (DPR) agreed to ratify the Health Bill (RUU) to become law at the 29th DPR RI Plenary Session Session Period V Session Year 2022-2023.
The ratification was made through a level II decision which was led directly by the Chairperson of the Republic of Indonesia DPR Puan Maharani at the Parliament Complex, Senayan, Jakarta, Tuesday 11 July 2023.
The ratification was rejected by the Indonesian National Nurses Association ( PPNI ) according to the Chairman of the PPNI, Harif Fadhillah PPNI and professional organizations thought the billion health was drafted clandestinely. Because until today his party has not received an official draft from the Health Omnibus Law Bill.
"Until today we did not get access to the draft discussed. We health workers, especially nurses, who (number) make up 60 percent of the total number of health workers, are stakeholders who will implement the law when it is made," said Harif.
Harif feels that he and his staff are important parties in this bill, so they must be given the opportunity to participate in its drafting.
“We want participation and on various occasions. we lobby, advocate, hear, and so on for our aspirations. But none of our aspirations have been accepted," he said.
Next is the issue of eliminating mandatory spending or spending budgets that have previously been regulated by law. Mandatory spending was originally 5 percent of the state revenue and expenditure budget (APBN) and 10 percent of regional expenditure revenue budget (APBD).
"What happens if they are eliminated? Today there are more than 80,000 nurses with the status of honorarium and volunteers. Even in the regions, the state is unable to provide compensation for their work in remote areas," he explained.
According to him, if mandatory spending is eliminated the situation will get worse. "It is not clear how they are paid, while they have served tens of years, dozens of years for government-owned health facilities," added Harif.
Eliminating mandatory spending can result in termination of contract workers. While in the regions the number of civil servants is less.
This can affect health services for the community, said Harif. Third, according to him, passing the Health Bill is the same as revoking Law No. 38 of 2014.
This law is about the nursing system which concerns the capacity building of Indonesian nurses which has been developed for a long time. In general, this law contains competence development, maintaining the quality and practice of nurses.
"If it is repealed without a specific replacement article for nurses, then the impact will be on the arrangement of blank delegations later. We don't know what kind of rules the government will make later," he concluded.
The chairman of the Republic of Indonesia DPR Puan Maharani ensures that all rights for health workers will not be lost in the Health Law that has been passed by the DPR.
"The rights for health workers that were previously included in the Health Law will not be lost in this law. In fact, the rights for health workers will be increased in terms of providing welfare for a better survival," said Puan.
The former Coordinating Minister for PMK said that the Health Law also pays attention to legal protection for health service providers.
According to Puan, this was based on the many legal actions received by Health Workers but there was no legal umbrella to protect them.
"I appreciate Health Workers who are strategic partners in fulfilling people's basic rights to obtain health services. For this reason, Health Workers need to get proper legal protection," he said.
The DPR's initiative law, which is supported by the government, also brings a number of benefits. This regulation is said to shape a better future for all Indonesian people.
"The Health Law aims to strengthen the country's health system and improve the quality of public health and welfare," said Puan.
The DPR is certain to be committed to overseeing the fair implementation of the Omnibus Law on the Health Law. Puan detailed, starting from legal protection for health workers and patients, to improving the quality of health system services.
"We at the DPR will oversee the implementation of every regulation contained in the Health Law. This is all for the sake of improving the quality of national health, protecting the public and the welfare of health workers," he said.
Furthermore, the DPR is aware that the Health Law raises pros and cons. Even so, Puan said the discussion of the Health Law had met the elements of openness, and was discussed intensively with the precautionary principle.
Puan also ensured that the discussion on the Health Law involved public participation, including those from the health and medical world. This is to ensure that the law is made comprehensively.
"In deliberating the Health Law, the DPR has involved all stakeholders, including the public in general, as a form of public participation in drafting this law. Of course, public participation has enriched insights to improve the conception of the Health Law," he said.
He said public consultations had been carried out by the DPR involving various community organizations, professional organizations, academics, associations of health service providers, religious institutions and think tanks.
Puan said the Health Law had also gone through the socialization and public consultation stages conducted by the Government.
"The DPR RI together with the Government seriously consider involving the community and stakeholders in order to maintain transparency and meaningful participation (meaningfull participation) from the community, namely the right to be heard, the right to be considered, and the right to be given an explanation," he said.
"Inputs from various elements of society have of course been accommodated and considered carefully in this Law on Health," concluded Puan Maharani.
Doctor's Needs
Separately, after inaugurating the Cisumdawu Toll Road, President Joko Widodo (Jokowi) hopes that the Draft Law (RUU) on Health will be able to improve reforms in the health service sector in the country.
"We hope that after it has been evaluated and corrected in the DPR, I think it will improve reforms in our health service sector," said Jokowi.
In addition, the Head of State also hopes that the existence of the Health Law will be able to encourage the fulfillment of the need for health workers who are still lacking in the country.
"We hope the shortage of doctors can be accelerated, the shortage of specialists can be accelerated, I think the direction is in that direction," he said.
Meanwhile, regarding the Bill on Villages which is also still in the process of being discussed in the DPR, President Jokowi said that the government will provide its views at a later time.
"Because it is still being discussed in the DPR for the Village Law, we will give considerations and views from the government later," said the President.
In line with the President, the Head of Epidemiology Surveillance and Immunization at the DKI Jakarta Provincial Health Office, Dr. Ngabila Salama MKM, said that the existence of the Draft Health Bill can give birth to many specialist doctors because it is hospital based.
"Apart from those currently based on universities and AHS which will continue to exist. Hospital based will be free, specialist schools, participants will still be paid during school because they serve in educational hospitals, and prevent bullying," said Ngabila.
In addition, continued Ngabila, legal protection for health workers will be guaranteed. Not only that during education, health workers can stop services to patients if there is a verbal threat.
"And dispute resolution is prioritized through mediation or out of court, the healing narrative has been abolished, increasing legal protection for health workers," said Ngabila.
Next, the welfare of health workers will be added. Among them are in the form of incentives, infrastructure, scholarships, equity in the quality of health services, and so on.
"Public health is prioritized with the first pillar, namely the transformation of primary services," he said.
Not only that, the advantage is that the Health Law which has been passed regarding the registration certificate (STR) is valid for life without the need for further extension. Health worker practice permits are also free every five years without paying anything.
"Including membership fees for professional organizations using a transparent application by the Indonesian Ministry of Health," said Ngabila.
Finally, professional organizations will be independent and not regulated by the government (unspoken) in this bill.
As well as being independent as a government partner in terms of health.
"But still able to maintain the dignity and kindness of each member," said Ngabila.
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Democrat Party politician who is also a member of the Legislative Body, Santoso said that the Draft Health Bill erased SBY's struggle for mandatory spending or state spending on health.
"In this Omnibus Health Bill, the mandatory spending that the Democrat Party has been fighting for since the start during Pak SBY's era is currently being removed. So the people will no longer be able to afford treatment at state expense. Do we agree if the budget is not allocated 10 percent," said Santoso .
According to him, this became the basis for his party rejecting the Health Bill because it did not provide guarantees to the people. "That is one of us rejecting this. Because it does not guarantee the people to be healthy with guarantees from the government," he said.
According to him, Indonesia as a developing country really needs mandatory spending for health financing.
"Even America as a developed country, the government still provides programs for health for its people. Moreover, we as a developing country. We reject this law because we have a basis," he explained.
Then Santoso also alluded to the fact that there are no more laws on nursing, midwifery, in the Health Bill.
"That every profession is protected by law. There are laws on nursing, midwifery, in this bill this law is abolished. It means that all health workers are not protected by the state. We must reject it because the nurses (health workers) are at the forefront of public health," he explained.
According to him, if the law where the health profession is abolished, then the profession will not be respected by the state.
"And it will be difficult for you to work for the people. Next, this law, or this bill, seems to be more pro towards oligarchs, foreign entrepreneurs, to build health in our country," he said.
Santoso also supports the plan of the health worker professional organization (Nakes) to file a lawsuit for a judicial review of the Health Omnibus Law Bill to the Constitutional Court (MK).
"Because the Democrats are refusing, if this is passed, then the constitutional way is through a judicial review. So we will support it," said Santoso.
Apart from that, Santoso also responded to the plans of a number of professional health workers' organizations to go on strike if the DPR passed the Health Bill.
"If that is the best way for health workers to be protected, protected by the law. Unlike the current law, in my opinion it is also their right to do that," said Santoso.
"Because there is an existing nursing law regarding midwives, this law has been omitted in this law, not only the article mentioning it," he continued.
However, Santoso said, before the strike, the health workers were carried out. The government must think that the health profession must be accommodated as well.
"So don't be in the name of power, in the name of the whole people, but sacrifice people who work for health, for the people," said Santoso.
"They as citizens also have the right to be protected, to be accommodated by their profession," he continued.