ACHIPELAGO BASED HEALTH SERVICES GOVERNANCE MODELS IN PANGKAJENE ISLANDS DISTRICT

Abstract

Pangkajene and Islands Regency (Pangkep) is an area with archipelagic geographical characteristics that presents its own challenges in health service governance. Issues of affordability of access to services, distribution of health workers, and limitations of health workers and basic infrastructure are the main obstacles in providing equitable and quality services. This study discusses the current conditions in the Pangkajene and Islands Regency that require a special approach in improving health service governance with a literature study approach and the results of field visits with a series of interviews with several key informants and strengthened through focused discussions (FGDs) to obtain more data and information to be analyzed. Data from the 2023 Performance Report of the Pangkep District Health Office shows that there are still inequalities in the achievement of key indicators, including high maternal and infant mortality rates in some island areas. In addition, the ratio of health workers per population still does not reach the recommended national target. This study analyzes governance strategies based on the New Public Service approach that emphasizes citizen participation, collaboration between stakeholders, and strengthening local capacity as a foundation for health service reform. Qualitative methods were used to review planning documents, performance reports, and data. Maternal-infant mortality, and supported by a literature analysis of the concept of democratic public service. The results show that strengthening adaptive area-based governance, adjusting the geographic-based referral system, and increasing the ratio and competence of health workers are key strategies to overcome the challenges of health services in the islands. This study recommends the formulation of extra ordinary policies specific to health services in the islands, the establishment of flexible health service units (floating clinics), increasing the role of mobile health centers, and the preparation of spatial data-based policies as part of an adaptive and equitable health governance system in the islands, involving multi-stakeholder participation to encourage awareness and shared responsibility in improving access to equitable health services.