What does Donald Trump think about drugs?

Luis Gómez Romero, University of Wollongong

In recent years, many countries – with the conspicuous exception of Indonesia and the Philippines – have been rethinking the international war on drugs. The world, it seems, has grown tired of mass incarceration, militarised law enforcement and endless interdiction of drug shipments that nonetheless keep arriving at borders.

Even the United States, the key enforcer of this relentless and violent obsession with narcotics, started to ease up during the Barack Obama administration.

Will Donald Trump continue his predecessor’s reform path? Or will he reheat the 40-year drug war, domestically and abroad?

A hemisphere behind bars

These questions are not abstract in the Americas.

In the US, eight states have legalised marijuana, in conflict with federal law. This reform movement is partly rooted in the country’s outrageous incarceration rates.

Human Rights Watch has dubbed the US a “nation behind bars”, because it locks up more of its citizens than any other country in the world. A disproportionate number of them are black.

Long jail sentences for drug offenders, even for low-level crimes such as possession, which represents 80% of drug arrests, are the greatest contributor to the country’s massive federal prison population.

President Barack Obama’s compassionate approach to non-violent drug offenders has helped incarceration rates drop by 13% since 2012, back to 1998 levels. But one decade of reform is insufficient to undo a half century of harsh policy; drug offenders still represent 46.4% of federal inmates.

Stakes are just as high in Latin America, where the war on drugs has fueled record levels of violence, corruption, criminality, and social inequality.

Cabinet of drug warriors

So what is Trump’s stance on drugs and drug policy? As with many matters, he has proven inconsistent in this realm. In 1990 in a lunch with the Miami Herald newspaper, Trump deemed the drug war a “joke” and called for the legalisation of all drugs.

By his 2016 presidential campaign, however, he seemed to have changed his mind. In a February interview with Fox News, Trump called Colorado’s legal marijuana industry a “real problem” (though he said that he’s “100%” for medical cannabis). A few months later, he declared that he would “leave [marijuana legalisation] up to the states.”

The administration’s likely approach to drugs becomes clearer when considering that his cabinet will be crammed with unwavering drug warriors, including vice president-elect Mike Pence.

Trump’s attorney general pick, Jeff Sessions, said in an April senate hearing that “good people don’t smoke marijuana” and incorrectly linked cannabis use to cocaine and heroin consumption.

During his recent confirmation hearing, Sessions also opened the door to government intervention in states with legal cannabis.

Trump has tapped John Kelly as Secretary of Homeland Security. As the former head of the US Southern Command, which plays a prominent role in curbing the flow of illicit substances from Latin America into the US, Kelly argued for “destroying” drugs, not legalising them.

Kelly also opposed US marijuana legalisation, claiming it would prevent Latin American countries from staying “shoulder to shoulder” with the US “in the drug fight in their part of the world.”

The war on drugs has imposed a huge economic burden on the region. Colombia, for example, spends $US8 billion each year just to keep up in America’s fight.

Kelly admitted during his confirmation hearing that a border wall with Mexico would not prevent the flow of drugs into the US. In his view, “the defence of the Southwest border starts 1,500 miles to the south, with Peru.”

This sounds suspiciously like Kelly plans to enlist all countries from Peru to the US in preventing drugs from reaching American consumers.

The war that has not been won

Latin America may prove unwilling to continue guarding America’s borders.

In December 2016, Colombian president Juan Manuel Santos accepted his Nobel Peace prize. He was awarded the honour for his efforts in negotiating a peace agreement with the Revolutionary Armed Forces of Colombia.

In his acceptance speech, Santos called on the international community to “rethink” the war on drugs, a conflict “where Colombia has been the country that has paid the highest cost in deaths and sacrifices.”

According to the National Centre of Historical Memory, Colombia’s civil war has claimed at least 220,000 lives since 1958.

Add in the 150,000 casualties from Mexico’s decade-long drug war, plus the unceasing flow of drugs into the US, and Santos’ blunt assessment is essentially uncontroversial: “The war on drugs has not been won, and is not being won”.

Might does not make right

Things are changing in much of the world. But based on Trump’s cabinet and law-and-order rhetoric, the incoming American administration seems poised to look backwards to a time when violence reigned and countless Latin American lives were thrown away for the pipe dream of a “drug-free world”.

If the Trump administration fails to pursue President Barack Obama’s reform track, which followed years of activism by a growing global reform movement, it will be incumbent on the people of all the Americas to promote change from the grassroots level.

The first step consists of acknowledging that drug consumption is a personal choice and a health issue rather than a criminal or military problem.

Latin Americans have been pioneers in reforming drug laws that fuelled organised crime and undermined democracy in the region. The Contadora Group, which contributed significantly to terminating the military conflicts in Central America in the 1980s, is one such pioneer.

Launched jointly by Colombia, Mexico, Panama and Venezuela to pressure the US to soften its militaristic stance in the region, Contadora ultimately failed to end American unilateral action. But when it concluded in 1986, the effort had opened the possibility of negotiating shared and peaceful solutions to regional Latin American conflicts.

Today, the Atitude Programme in Pernambuco, Brazil, shows how local leaders can stop fighting the drug war on their turf.

The five-year-old programme, which emerged from the government’s realisation that it couldn’t arrest its way out of its crack problem, combines street intervention, mental health care and provisional housing for drug users. A 2016 study shows that Atitude has not only helped drug users’ well-being, it has reduced drug-related violence in the state.

If the Trump administration seeks to draw the Americas back into a violent drug war, resisting may be a civic duty – on both sides of the border.

Luis Gómez Romero, Senior Lecturer in Human Rights, Constitutional Law and Legal Theory, University of Wollongong

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Diseminasi Hasil Penelitian, ACeHAP dan CISDI Sepakati Joint Research

Sebagai tindak lanjut penelitian tahun 2018 tentang collaborative leadership skills pada gerakan sosial berbasis tim di Indonesia, ACeHAP diwakili oleh Nuzulul Kusuma Putri, initiative leader ACeHAPuntuk healthcare leadership issue, mendiseminasikan hasil penelitiannya (4/4/2019) kepada Center for Indonesia’s Strategic Development Initiatives (CISDI).

CISDI merupakan organisasi yang mencetuskan inovasi gerakan Pencerah Nusantara. Hingga April 2019, CISDI setidaknya telah mengelola enam angkatan Pencerah Nusantara yang telah tersebar di Daerah Terpencil Perbatasan dan Kepulauan yang ada di Indonesia.

Tenaga kesehatan dalam gerakan ini bekerja dalam tim lintas profesi. Dalam kajian cross-professional team working, tim sangat rentan memiliki perbedaan pendapat antar anggota. Self-leadership dibutuhkan agar setiap individu dalam tim dapat menyesuaikan diri berkinerja sesuai dengan budaya tim. Sudah menjadi rahasia umum juga bahwa pengelolaan tenaga kesehatan di DTPK selalu dihantui oleh turnover rate tenaga kesehatan yang cukup tinggi. Oleh karena itu, konsep gerakan sosial untuk penataan sumber daya kesehatan di DTPK seperti Pencerah Nusantara ini mulai banyak direplikasi, salah satunya oleh Nusantara Sehat yang dibesut Kementerian Kesehatan.

ACeHAP menggandeng CISDI untuk melakukan analisis menjawab tantangan tersebut. Setidaknya 80% dari tenaga kesehatan yang tergabung dalam Pencerah Nusantara angkatan 5 berpartisipasi dalam penelitian yang telah dilakukan di tahun 2018.

Hasil penelitian menunjukkan bahwa Pencerah Nusantara telah mampu menyediakan sistem kerja yang menjamin  kepuasan kerja tenaga kesehatan. Hampir 75% dari tenaga kesehatan yang saat ini bertugas menyatakan keinginannya untuk kembali bergabung dalam gerakan sosial ini. Penelitian yang dilakukan oleh Nuzulul Kusuma Putri dan Ilham Akhsanu Ridlo ini juga menemukan bahwa kemampuan komunikasi interpersonal merupakan penentu utama keberhasilan kolaborasi lintas profesi. Sementara ada kualitas personal khusus yang ternyata secara signifikan menentukan kemampuan komunikasi ini.

Diseminasi ini dihadiri oleh tim koordinator Pencerah Nusantara dari berbagai divisi. Di akhir diskusi, ACeHAP dan CISDI sepakat untuk melanjutkan kerjasama penelitian menjawab bagaimana membuat komposisi tim yang paling pas untuk menghasilkan outcome yang maksimal. Jalinan kerjasama ini juga direncanakan terus berlanjut dengan kesempatan magang yang diberikan oleh CISDI bagi para research assistants di ACeHAP untuk lebih mengenal pengelolaan Pencerah Nusantara.

Kajian lengkap mengenai penelitian ini dapat disimak dalam publikasi kami selanjutnya. Instrumen dan laporan penelitian dapat diakses melalui permintaan kepada ACeHAP.

Gambaran Prevalensi Balita Stunting dan Faktor yang Berkaitan di Indonesia: Analisis Lanjut Profil Kesehatan Indonesia Tahun 2017


Hasil Riskesdas tahun 2007, 2013 dan 2018 menunjukan angka stunting pada balita masih di atas 30%. Sementara kemiskinan dibuktikan seringkali hadir bersamaan dengan terjadinya stunting pada balita. Gizi yang adekuat pada masa hamil dan pengawasan kesehatan ibu hamil melalui pelayanan antenatal care dinilai merupakan salah satu upaya sensitif dalam penanggulangan stunting. Studi ini ditujukan untuk menjawab apakah faktor kemiskinan dan ketersediaan layanan kesehatan berhubungan dengan prevalensi balita stunting di provinsi di Indonesia. Penelitian ini merupakan analisis lanjut data sekunder “Data dan Informasi: Profil Kesehatan Indonesia tahun 2017”. Data dianalisis secara deskriptif dengan tabulasi silang. Hasil penelitian menunjukkan bahwa pada kategori persentase penduduk miskin yang tinggi (> 14,43%) didominasi oleh prevalensi balita stunting yang tinggi (22,51%-30,0%). Pada kategori rasio Puskesmas per 100 ribu penduduk tinggi (≥ 4) terlihat didominasi oleh prevalensi balita stunting pada kategori tinggi (22,51%-30,0%). Pada kategori rasio tenaga gizi per 100 ribu penduduk tinggi (> 12) justru terlihat didominasi oleh prevalensi balita stunting kategori tinggi (22,51%-30,0%). Pada kategori rasio tenaga bidan per 100 ribu penduduk tinggi (> 97) didominasi oleh prevalensi balita stunting kategori tinggi (22,51%-30,0%). Disimpulkan bahwa persentase penduduk miskin berhubungan secara positif dengan prevalensi balita stunting. Sementara faktor input pelayanan kesehatan (Puskesmas, tenaga gizi, dan tenaga bidan) tidak berhubungan dengan prevalensi balita stunting. Disarankan pemerintah lebih memfokuskan sasaran kebijakan pada masyarakat miskin.

Kata Kunci: balita, stunting, profil kesehatan, kemiskinan


Laksono, Agung & Kusrini, Ina. (2019). Gambaran Prevalensi Balita Stunting dan Faktor yang Berkaitan di Indonesia: Analisis Lanjut Profil Kesehatan Indonesia Tahun 2017. 10.13140/RG.2.2.35448.70401. 

#CondomEmoji: Are urban Indonesians receptive to a social media-based campaign for safer sex?

Abstract Purpose
The purpose of this paper is to explore participants’ attitudes and receptivity to a #CondomEmoji campaign insofar as investigating whether attitudes and receptivity were important predictors for brand impression and intention to buy. Design/methodology/approach – This study involved 206 research participants who live in Jakarta and Surabaya and who answered online questionnaires to measure attitudes, receptivity to #CondomEmoji advertising, brand impression and intention to buy condoms. Questionnaires were circulated on several social media platforms and instant messaging apps. The participants were asked to watch the #CondomEmoji advertising video before proceeding to fill out the questionnaires. Findings – Research findings suggested that participants mostly held negative attitudes and receptivity to the campaign. Non-sexually active participants were more likely to perceive the advertising as offensive. Attitudes and receptivity were good predictors for brand impression, yet attitude was not significantly attributed to intention to buy condoms. The result was stronger in sexually active participants. Research limitations/implications – Non-sexually active young people need to be more informed about healthy sexual behavior so that they would not feel embarrassed to discuss and ask about sexual behavior. A socially acceptable condom-use advertising campaign needs to be conducted to lessen the resistance of conservative audiences.
This paper offers an insight into how conservative audiences may respond to social-media-based campaign of safer sex.
Keywords: Social marketing, Attitudes, Health media
Paper type: Research paper

The Changing Nature of CampusHealth Insurance: Testing Portability Issues of National Health Insurance

Before National Health Insurance was implemented, the majority of leading universities in Indonesia already covered their studentswith a health insurance scheme. They managed their own campus health insurance independently. Both National Health Insurance in 2014 and single tuition policy in 2015 brought huge change to campus health insurance. This study aims to analyse students’ needsin health insurance after implementation of these policies. This is an exploratory study with cross-sectional design. The sample was taken by voluntary sample through online questionnaire. There were 83 students across different academic degree participated in this study. Most of the students (65.1%) came from various districts outside the campus district and chose to reside in boarder houses around the campus. There were only 52.9% of the students already listed as National Health Insurance participants. Out-of-pocket risk belongs to 35.5% students who were not covered by health insurance at all. Almost all of the students who already participated in National Health Insurance (93.3%) were registered in the primary healthcare in their hometown. The students are already paying for single tuition which does not accommodate health insurance. A real changing need of migrant students for health insurance coverage exists in the National Health Insurance era. 1INTRODUCTIONUniversal Health Coverage swept many countries in the last decade, including Indonesia. Even though Indonesia is the biggest archipelago country with a widely dispersed territory, National Health Insurance is chosen as the health insurance mechanism ratherthan region-based insurance. This decision has consequences in the portability challenges of the preferred health insurance scheme. Previous region-based health insurance mechanisms already implemented by local government should be merged into a national scheme. It should enable not only raising the poolinglevel in local government, but also maintaining the cross-regional participation transfer (Pan et al., 2016).Previously, the majority of universities in Indonesia had institutionally managed health services for their students before the enactment of the National Health Insurance. The provision of this health service is funded through a student health insurance scheme that is managed independently by the university and which is limited only for students in the university. Student health insurance is regulated through the policy of each rector. Generally, this fund pooling is collected through a semi-annual contribution in addition to the tuition fee. These funds are managed to finance the health of students during their education. However, in accordance with the mandate of the Ministry of Education, universities are not permitted to collect additional fees outside the national rate. However, the calculation of this national rate does not accommodatestudent healthcare insurance. The National Health Insurance that was launched one year previously also makes this situation more complicated. The availability of parental health insurance can have significant effects on the probability that a young individual enrols as a full-time student in university (Jung et al., 2013). Unfortunately, there is no individual student membership in National Health Insurance. To be able to be covered by National HealthInsurance, students should be registered with all of their family members. The huge variations of health insurance mechanisms bring many obstacles to the citizens who wish to temporarily move to another region for some years. In Indonesia, young adults from rural regions who have just graduated from senior high

Putri, N. and Ernawaty, .The Changing Nature of Campus Health Insurance: Testing Portability Issues of National Health Insurance.InProceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 14-19ISBN: 978-989-758-335-3Copyright©2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved Mark as interesting Comment Delete highlight
(1) (PDF) The Changing Nature of Campus Health Insurance: Testing Portability Issues of National Health Insurance. Available from: https://www.researchgate.net/publication/329217279_The_Changing_Nature_of_Campus_Health_Insurance_Testing_Portability_Issues_of_National_Health_Insurance [accessed Mar 30 2019].

Protecting those who care: The characteristics of occupational Tuberculosis risk in health care workers

Nosocomial TB infection remains an urgent public health problem that requires relentless efforts to overcome. In general, health care workers (HCWs) have a significantly higher risk of suffering from active and latent TB owing to their daily occupational TB risk exposure. The risk is indeed more severe in high TB burden countries, such as Indonesia. In this research, we aimed to: (1) investigate the underlying factor structure of risk characteristics, specifically the risk of nosocomial TB transmission in health care facilities; (2) estimate the effects of work-related determinants and risk characteristics on risk perception; and (3) compare occupational risk perception of contracting TB with expert risk assessment. A paper-based questionnaire was administered to 179 HCWs working for ten public health centres and two hospitals in Surabaya, Indonesia. An exploratory factor analysis of nine risk characteristics revealed a two-factor solution (knowledge-evoked dread and controllability of damage). Structural equation modelling indicated a piece of suggestive evidence that controllability of damage positively affected risk perception, while knowledge-evoked dread did not. Perceived safety conditions yielded a positive and moderate association to controllability of damage, implying that safety infrastructure could be perceived as ‘a cue’ to the presence of a dangerous hazard. The intensity of exposure to TB patients was negatively correlated with the controllability of damage. This indicates that more experience in handling TB patients could lead to underestimation of risk. Our research showed that HCWs tended to accurately estimate the risk of contracting TB based on their specific profession/duties, yet overestimated the risk of contracting TB when it was aggregated to the health care facility level. Although further research is necessary, to include the prevalence of latent/active TB as a part of risk assessments, our research highlights the importance of addressing risk perception, especially encouraging HCWs to become more active in advocating for the required allocation resources for their workplaces or even aiding in raising communities’ awareness of TB transmission.

Urban and rural disparities in hospital utilization among Indonesian adults

Equal access to healthcare facilities, patient’s satisfaction, and respect for the desire of the patient were recognized as the basic principles of each of the health care system. Each person must be given the opportunity to access health services in accordance with the requirements of their health. We aimed to prove the existence of disparities hospital utilization based on the category of urban-rural areas. Methods: The research used the 2013 Indonesian Basic Health Survey (RKD) as analysis material, that was de-signed a cross-sectional survey. With the multi-stage cluster random sampling method, 722,329 respondents were obtained. Data were analyzed using Multinomial Logistic Regression tests. Results: The results showed adults living in urban were likely to use hospital outpatient facilities 1.246 times higher than adults living in rural areas (OR 1.246; 95% CI 1.026 – 1.030). The likelihood of utilizing at the same time outpatient and inpatient facilities at 1.134 times higher in adults living in urban than those in rural areas (OR 1.134; 95% CI 1.025 – 1.255). While for the category of hospital inpatient utilization, there was no significant difference. Conclusion: There was a disparity in hospital utilization between urban-rural areas. Urban show better utilization than rural areas in outpatient and at the same time the use of inpatient care.

Do Justice and Trust Affect Acceptability of Indonesian Social Health Insurance Policy? A cross-sectional survey of laypeople and health care workers

After two bills passed in 2004 and 2011, a nation-wide social insurance in Indonesia has formally established. Aiming at a universal health coverage in 2019, the Jaminan Kesehatan Nasional (JKN) will cover almost 260 million Indonesians and be one of the biggest single payer national health insurance scheme in the world. Our research attempted to investigate whether justice, trust to health care services, confidence level of health system, political party support and evaluation of health care services post-JKN affected policy acceptability in our health workers (N=95) and laypeople (N=308) sample. A-two level multilevel modelling in our health worker sample revealed that justice negatively correlated to policy acceptability, while confidence to health system and institutions as well as evaluation of health care service post-JKN yielded positive correlation. In our laypeople sample, trust to health care service and evaluation of health care service post-JKN were positively affected policy acceptability. In this paper, we discussed why justice matters to a positive policy acceptability for health workers, but not for laypeople. We also discussed the possibility of laypeople’s pragmatic motives of joining JKN scheme.

Indonesia Darurat Kesehatan Mental?

Kasus kematian akibat bunuh diri 17 Maret di Jagakarsa, Jakarta Selatan sejatinya membuka mata kita tentang kondisi kesehatan mental masyarakat Indonesia. Tidak jauh dari pemberitaan tentang itu, kita kembali dibuat terkaget-kaget saat beberapa hari yang lalu koran ini menyajikan berita pendalaman kasus pornografi anak (child pornography) oleh subdit cyber crimeDitreskrimsus Polda Metro Jaya yang menambah jumlah korban dan pelaku yang menggunakan media Facebook sebagai jejaringnya. Saat ini kasus tersebut masih menjadi sumber ketakutan bagai mayoritas orangtua. Dua kasus tersebut dapat dimaknai sebagai fenomena iceberg yang memungkinkan kejadian serupa lebih besar jumlahnya di bawah permukaan pengungkapan media.

Secara global, kesehatan mental merupakan isu sentral pembangunan kesehatan. WHO menegaskan bahwa definisi sehat merupakan definisi yang sifatnya integral; artinya tidak bukan sekedar bebas dari penyakit, namun kondisi dimana seseorang mencapai kesejahteraan paripurna secara fisik, mental dan sosial. Melihat tren global, kesehatan mental tidak lagi dipandang sebagai isu perifer dalam pembangunan kesehatan, mengingat betapa seriusnya dampak yang diakibatkan oleh lemahnya kondisi kesehatan mental. Apabila kita mencermati estimasi WHO mengenai disability-life adjusted years(DALY) pada tahun 2012 menempatkan Unipolar Depressive Disorders pada peringkat 9 dari 20 penyakit utama, apabila dibandingkan dengan penyakit menular (communicable diseases) atau penyakit tidak menular (noxn-communicable diseases) lainnya. Artinya, meskipun gangguan mental belum terlalu dipandang sebagai problem epidemiologis, nyatanya memiliki dampak yang cukup signifikan dalam membuat jutaan orang hidup dalam disabilitas.

Gangguan kesehatan mental membutuhkan fokus penuh dari para pengambil kebijakan, mengingat gangguan kesehatan mental mulai dianggap sebagai ancaman serius yang membutuhkan respon cepat dari penyedia layanan kesehatan. Survei yang dilakukan di Amerika Serikat menyatakan bahwa nilai kerugian dalam domain sumberdaya manusia yang harus ditanggung pemberi kerja mencapai US$36 juta setiap tahunnya akibat major depressive disorder(MDD) yang diderita para pekerjanya. Lebih lanjut, 10 negara partisipan survei WMH melaporkan adanya rata-rata kerugian produktivitas sampai dengan 22 hari/pekerja. Sayangnya sampai dengan saat ini, gangguan kesehatan mental masih tergolong low priority issue di mayoritas negara berkembang. Hal ini menunjukkan kurangnya komitmen para pengambil kebijakan untuk serius menangani masalah kesehatan mental, meskipun data-data epidemiologis menunjukkan bahwa problem ini tak lagi bisa dianggap remeh.

Sampai Dimana Kita?

Riset  Kesehatan Dasar (Riskesdas) tahun 2013 yang lalu memang menunjukkan adanya penurunan prevalensi gangguan mental emosional, apabila dibandingkan dengan Riskesdas tahun 2007. Namun, penurunan prevalensi kejadian kesehatan mental merupakan sebuah anomali, bahkan sesungguhnya bertentangan dengan kenyataan di lapangan. Hal ini semakin menegaskan bahwa pemerintah kekurangan data epidemiologis yang berkualitas untuk menyusun kebijakan kesehatan mental. Perangkat kebijakan yang menaungi upaya peningkatan kualitas kesehatan mental di Indonesia adalah Undang-Undang Nomor 18 tahun 2014 mengenai Kesehatan Jiwa.

Upaya membentuk payung legislasi atas kebijakan kesehatan mental adalah usaha yang patut diapresiasi, meskipun pemerintah cenderung lambat dalam menjabarkannya dalam peraturan teknis. Selain itu, arah kebijakan kesehatan mental di Indonesia masih berkutat di area kuratif, belum memberikan porsi yang sama pada tahap preventif, promotif maupun rehabilitatif. Upaya tersebut dipengaruhi oleh komitmen pemerintah Indonesia dalam pembangunan kesehatan di Indonesia dengan alokasi belanja kesehatan yang hanya diberi slot 5% dari APBN 2016, sedangkan anggaran untuk kesehatan mental hanya rata-rata 1% dari total anggaran kesehatan. Selain isu mengenai data epidemiologis, proses legislasi dan health budgeting, isu lainnya yang menjadi sentral dalam perbincangan mengenai kesehatan mental di Indonesia adalah problem mengenai kesenjangan perawatan (treatment gap) serta stigma dan diskriminasi yang dialami oleh orang dengan gangguan mental (ODGM).

Masalah kesehatan mental tak lagi dapat dianggap sebagai isu perifer dalam perancangan kebijakan kesehatan. Faktanya, gangguan kesehatan mental adalah ancaman global yang juga harus dihadapi oleh masyarakat Indonesia. Kebijakan kesehatan mental yang evidence-based tentunya tak mungkin dapat disusun apabila data epidemiologis yang berkualitas tidak tersedia, sehingga langkah pertama yang harus diambil oleh pemerintah adalah berupaya untuk memotret kondisi kesehatan mental masyarakat melalui riset yang komperhensif. Dengan data yang komperhensif, perancangan program kunci dan alokasi anggaran tentunya akan dapat diatur secara proporsional. Selanjutnya komitmen politik yang progresif menjadi faktor pendorong mengatasi kesenjangan perawatan. Pemerintah harus merevitalisasi upaya dukungan kesehatan mental yang berkualitas berbasis keluarga dan komunitas, yang saat ini linier dengan sistem kesehatan nasional kita.

Artikel diatas adalah teks asli, sebelum masuk ke meja redaksi.
Dimuat di Rubrik Opini, Jawa Pos tanggal 27 Maret 2017.

Mendorong Komitmen Politik bagi Kesehatan Mental

Peringatan Hari Kesehatan sedunia 7 April kemarin membawa tajuk ‘Depression: Let’s talk,’ memfokuskan perhatian masyarakat dunia pada masalah kesehatan mental, khususnya Depresi. Depresi menjadi sorotan karena menimbulkan beban penyakit yang cukup. Berdasarkan riset Global Health Estimates yang dilakukan oleh World Health Organization (WHO) menyebutkan bahwa Disability Adjusted Life Years (DALY), yakni beban penyakit (burden of disease) kelak pada tahun 2020 menempatkan Depresi di peringkat kedua dunia dan diprediksikan naik ke peringkat 1 pada tahun 2030.
Depresi berbeda dengan stres, berbeda dengan pemahaman awam pada umumnya. Depresi merupakan bentuk yang ekstrim dan patologis dari stres. Depresi merupakan salah satu penyebab utama disabilitas, sangat mempengaruhi kondisi fisik, dan secara langsung sebagai penyumbang kejadian kematian akibat bunuh diri. Pada periode pasca persalinan, Depresi merupakan masalah yang berisiko dialami oleh ibu (post-partum depression) dan mempengaruhi pertumbuhan dan perkembangan bayi.
Angka yang dirilis oleh WHO tentang Depresi menempatkan Indonesia diperingkat ke-4 dunia setelah India, India dan Amerika Serikat dengan prevalensi Depresi tertinggi. Meskipun ada pengaruh besarnya populasi penduduk, namun hal ini dapat dimaknai bahwa Depresi merupakan konsekuensi dari overpopulasi. Oleh tenaga kesehatan mental, Depresi sering disebut sebagai “Black Dog” dimana resikonya tidak bisa sepenuhnya dihilangkan, namun tetap dapat dikendalikan.

Kesenjangan Perawatan dan Health Budgeting

Permasalahan treatment gap tidak hanya terjadi di Indonesia, melainkan di seluruh dunia. Di seluruh dunia, tercatat sekitar 32.2% penderita Skizofrenia yang tidak mendapatkan akses ke layanan kesehatan. Sedangkan di Indonesia, seperti yang dicatat Kementerian Kesehatan, angkanya jauh lebih mencengangkan 96.5% penderita skizofrenia tidak mendapatkan perawatan medis yang memadai. Artinya, kurang dari 10% penderita skizofrenia mendapatkan pelayanan di fasilitas kesehatan.

Selama ini, layanan kesehatan mental banyak berpusat di rumah sakit jiwa milik pemerintah dan swasta yang jumlahnya ‘hanya’ 48 dan hanya ada di 26 propinsi di Indonesia. Lebih lanjut, jumlah tempat tidur yang dialokasikan untuk pasien psikiatrik hanya ada 7500 tempat tidur di seluruh Indonesia. Keterbatasan sumberdaya yang dimiliki rumah sakit jiwa tentunya memaksa pemerintah untuk mengubah orientasinya dari pelayanan kesehatan mental berbasis rujukan (pasien gangguan mental dirujuk ke rumah sakit jiwa) menjadi kesehatan mental komunitas dasar (pasien dirawat di layanan kesehatan primer) serta dengan memperkuat pendekatan keluarga.

Namun sejak integrasi layanan kesehatan mental ke Puskesmas pertama kali diperkenalkan pada tahun 2000, hanya 30% dari 9000 Puskesmas di seluruh Indonesia yang berhasil menyediakan layanan kesehatan mental. Indonesia juga masih kekurangan tenaga kesehatan mental yang siap melayani pasien di layanan kesehatan primer (Puskesmas), tenaga kesehatan di Puskesmas juga kurang terlatih untuk menangani kasus kesehatan mental, bahkan harus menangani kasus diluar kompetensinya.

Kesenjangan perawatan dan penanggulangan kesehatan mental dari hulu ke hilir sangat bergantung pada aspek proporsi anggaran di bidang kesehatan. Peningkatan anggaran dalam penanganan masalah kesehatan mental sangat diperlukan. Investasi terhadap kesehatan mental akan berdampak langsung pada peningkatan kinerja ekonomi sebuah negara.

WHO menyebutkan bahwa setiap investasi US$1 kepada penanganan kesehatan mental akan berdampak pada peningkatan kesehatan yang lebih baik dan kemampuan produktivitas sebesar US$4. Keengganan berpihak dalam aspek pembiayaan kesehatan mental akan menimbulkan kerugian ekonomi. Keluarga akan langsung dirugikan karena tidak mampu bekerja lebih baik, produktivitas angkatan kerja menurun, sebagai konsekuensinya. Pertumbuhan ekonomi sebuah negara akan sulit ditingkatkan, karena beban masalah kesehatan mental.

Perlu Dukungan Politik

Proses perbaikan anggaran kesehatan di Indonesia khususnya untuk kesehatan mental memerlukan dukungan policymaker. Beragam upaya dari para mental health expert tidak lengkap tanpa dukungan politik. Membekali para politisi dengan pengetahuan komprehensif mengenai isu kesehatan mental adalah salah satu langkah tepat bagi para penyusun kebijakan kesehatan mental agar proses politik anggaran berjalan lancar. Sekarang saatnya untuk menjadikan isu kesehatan mental menjadi salah satu isu prioritas, tidak lagi menempatkannya pada posisi yang subordinat. Policymaker tidak bisa ‘berjalan’ sendiri tanpa dukungan dari para mental health expert. Riset-riset epidemiologis harus digencarkan untuk mengakomodasi evidence-based policy. Usaha untuk menjembatani expert dengan policymaker harus mulai diinisiasi.

Pada akhirnya, kita sudah selayaknya tidak menyerah untuk mewujudkan Indonesia yang sehat mental. Oleh karenanya, kita harus mendorong agar kesehatan mental menjadi isu prioritas, sekaligus mendukung upaya pembangunan kesehatan Indonesia. Dialog panjang atas proses politik harus ditinggalkan untuk mencapai kepentingan jangka panjang. Proses politik tentunya harus diarahkan pada penyusunan conceptual framework yang operasional dan relevan dalam mewujudkan masyarakat Indonesia yang lebih sehat dan sejahtera.