KURNIA PURUHITA SARI

EFFECT OF MANAGEMENT SUPPORT ON DRUG PLANNING IN
DATU BERU DISTRICT HOSPITAL CENTRAL ACEH 2010
SUMMARY
By :
KURNIA PURUHITA SARI
09/293466/PKU/10977
GRADUATE PROGRAM
FACULTY OF MEDICINE
GADJAH MADA UNIVERSITY
YOGYAKARTA
2011

EFFECT OF MANAGEMENT SUPPORT ON DRUG PLANNING IN
DATU BERU DISTRICT HOSPITAL CENTRAL ACEH 2010
SUMMARY
By :
KURNIA PURUHITA SARI
09/293466/PKU/10977
Has Been Approved By The Supervisors Lecture
Main supervisor
Assistant
Dra. Nunung Priyatni, Apt, M. Biomed
Tanggal ………..…….
Dra. Endang Sulistiyani, Apt, M.Kes
Tanggal ………..…….

SUMMARY
Introduction
Drug management is a serial of complex activities which is an
interrelating cycle that normally consists of four basic functions including
selection and planning, procurement, distribution and utilization (Quick et al,
1997). Planning of drug needs is one of important and determining aspects in
drug management since planning will affect the procurement, distribution and
utilization of drugs in health service units (BPOM, 2001). Poor drug drug
planning will lead to chaos in overall drug management cycle.
According to Quick et al (2007), the process of proses drug
management can be well carried out if supported with good management
support including organization, budget, information management system drug
management and human resources. Obstacles commonly found in drug
management in hospital were (1) Limitation of human resources both in
number and quality. (2) Limitation of budget source, where only small portion
of the budget was fulfilled by the local authority. (3) Limitation of facilities in
drug management, and this affected the quality of drugs procured
(Kepmenkes RI and JICA, 2010).
In Datu Beru district hospital, human resources were lacking,
information system used was still manual, and sometimes drug budget was
not not in concordance with needs and there were also still prescribing
outside the formulary. This lead to non optimal service of pharmaceutical
functions.
Methods
The research was a nonexperimental one, with case-study analytic
descriptive design. Data collected were primary in the form of in-depth
1

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interview, and secondary data which took form of document observation in
the year 2010.
This research was conducted in Datu Beru district hospital.
Respondents of the research were Director of Datu Beru district hospital,
Chief of Hospital Installation of Pharmacy, Chief of Division Chief of Division
of medical supports, Chief of Division of Program planning, Chief of Division
of Administration, Chief of Division of Education, Training, Research, and
Development and computer operator in hospital installation of Pharmacy.
Results and Discussions
1. Management Support
a. Organization
Arrangement of organization and working rules in Installation
of Pharmacy Datu Beru district hospital was led by a pharmacist
which was assigned as the chief of Installation of Pharmacy. In
carrying out his/her duties, the chief was directly responsible to the
vice director of Medical Services. However, in real application, the
vice director did not control the staffs under his authority. This implied
the lack of cooperation and communication between managers in
conducting duties.
There is no drug planning team in Pharmacy Installation. In
the implementation of drug planning, it is only conducted by a
pharmacist as the Head of Pharmacy Installation and assisted by one
of pharmacist assistants who has the duty to see the existing drug
stock in the warehouse and make the Report of Jamkesmas Drug
Expenses (LPO) every month and every year. So that in the drug
planning the Head of Pharmacy Installation has the very massive role
and all duties become overlapping. The working program in
Pharmacy Installation has been arranged, but it has not been able to

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be applied in Pharmacy Installation. The obstacle are (1) The bad
management in Pharmacy Installation of Datu Beru RSUD because it
cannot function each part in accordance with the job description
which has been applied, this is because of the lack of socialization to
the staff, (2) the lack of direction and socialization to the staf toward
the working program which has been arranged so that it has not been
applied maximally in the Pharmacy Installation (3) the human
resource quality which has not been professional yet so that it needs
to be done the HRD performance for every three month, because all
this time it has been done yet by Pharmacy Installation of Datu Beru
RSUD.
b. Human resources
The number of workers available in the adequate number will
facilitate the organization to reach the purpose. The pharmacists in
the Pharmacy Installation are 15 people, consisted of 2 people of
Pharmacists that is 1 people of civil servant and 1 people of non-civil
servant, 1 people of Society Health Bachelor, 8 people of pharmacy
analysts that are 6 people of civil servant and 2 people of non-civil
servant and 4 people of pharmacist assistants. Each staf has job
description in accordance with the education and the type of the job.
According to the Depkes RI (2004), the ideal is that there is 1
pharmacist available for 30 bed (for the whole pharmacy services). In
RSUD of Datu Beru, the number of beds are 216 pieces and the
number of pharmacists are 2 people. So, the number of pharmacists
in Pharmacy Installation of Datu Beru RSUD is still lack of 5 people
pharmacists. However, the policy from Depkes RI (2004) cannot be
used as the guidance in Datu Beru RSUD, because Datu Beru RSUD
Installation should serve Jamkesmas pasient. From the data, it is
obtained that approximately the Jamkesmas patient in the year of

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2010 for the outpatients per day are 58 people and the inpatients are
15 people. In the in-depth interview there are several opinion
differences about the number of human resources in Pharmacy
Installation, it is caused by the lack of good communication and the
evaluation of employee need is never conducted in Pharmacy
Installation.
c. Information management system
Information management system in Datu Beru district
hospital was still using manual system which was conducted by filling
the drug expenditure report (Laporan Pengeluaran Obat) of
Jamkesmas. There were obstacles in filling this LPO since most
stock cards that had been provided was never been filled by staffs in
the Installation of Pharmacy, so the drug traffic could not be carefully
detected. Datu Beru district hospital had two units of computer that
were used to save encode for processing from LPO Jamkesmas.
However, the manin function of this computer was to make reports in
claiming for Jamkesmas drugs. This led to conclusion that
information management system in Datu Beru district hospital was
not yet maximum.
d. Budget
Budget for drug procurement in Datu Beru district hospital
was sourced from local authority and claim from Jamkesmas. The
amount of Jamkesmas drug budget in the year 2010 was
Rp.1.726.250.000,-. Percentage of drug budget from all health
budget in Datu Beru district hospital was 18.59%. From this data,
according to the director and the chief of Installation of Pharmacy,
the budget was not yet sufficient for completing the drug need in the
year 2010.

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e. Policy
Policy and regulations regarding drug planning in Datu Beru
district hospital consisted of:
1) Policy regarding the manual of DOEN utilization in drug planning in
Datu Beru district hospital which was contained in SOP of
Installation of Pharmacy
2) Decree from Director of Datu Beru district hospital No. I/D/RSUD-
DB/VI/08, Standard Operational Procedure (SOP) Installation of
Pharmacy, about Pharmaceutical Supply Planning
3) Decree of Director of Datu Beru district hospital Takengon No.
445/529/Kep/RSUD-DB/2009 regarding activities of
pharmaceutical service in Datu Beru district hospital Takengon
Policy regarding manual of Jamkesmas formulary utilization
in drug planning had not existed. However in its implementation in
Datu Beru district hospital, Jamkesmas Formulary had been
employed as guidance in dalam drug planning.
2. Process of drug planning
The drug planning in Pharmacy Installation of Datu Beru RSUD is
done by Head of Pharmacy Installation assisted by a pharmacist
assistant in doing the task. The process of drug planning in RSUD of
Datu Beru whether it is sourced from Pemda, and the claim of
Jamkesmas through the stage of selection and using compilation.
However, in the stage of need calculation, it is only done for the drug
budget sourced from Pemda, while for the drug budget sourced from
Jamkesmas claim is not through the stage of need calculation.
Planning for determining drug needs involved stages as follows:
a. Drug choosing
In this stage, the Installation of Pharmacy in Datu Beru
district hospital in drug choosing had not yet consider the number nor

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patients/visit and pattern of diseases. Drug choosing was based on
drug utilization in previous year and available stock in the
warehouse. Drug choosing was based on DOEN and Jamkesmas
formulary.
Based on the result of in depth interview, the process of drug
choosing was started with basics of drug need which consisted of:
1) Ways of drug choosing that were too many which was done by
considering the drug distribution, which consisted of 2: fast
moving and slow moving.
2) In avoiding and minimizing utilization, combination had not yet
been able to be carried out since activities of clinical pharmacy
and comittee of pharmacy and therapy had not been formed yet.
3) Considering ways of drug choosing that were too many, drug
choosing could be based on drug of choice by reviewing
patients’ Medical Record where DM and hypertension had the
highest number of patients, so procurement should include drugs
required for these diseases.
b. Compilation of utilization
This stage had been applied in the Installation of Pharmacy
Datu Beru, which was conducted by the making of Jamkesmas drug
expenditure report (Laporan Pengeluaran Obat, LPO) every month
and recap was conducted annually. Utilization and distribution of
drugs, all were conducted in the Installation of Pharmacy.
c. Calculation of drug needs
At this stage, of the drug budget sourced from Pemda used
the consumption method in which the calculation was based on drug
use in previous year. The Decree of Indonesian Ministry of Health
and and JICA (2010) stated that the calculation of drug need
according to consumption method was by using this formula (12x

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average monthly utilization + safety stock (10-20%) + Lead time
(waiting time) 3 months) – year-end ready stock.
Result of calculation using consumption method showed that
11% of drug item had been in concordance with drug need in the
year 2010. While 28% drug item was still lacking and 61% drug items
were excessive as compared to drug need in the year 2010. From
the result of in depth interview with Chief of Installation of Pharmacy,
it was stated that approach for planning for drug need was done by
consumption method. However, calculation above showed that drug
need in Datu Beru district hospital in the year 2010 was not in
concordance with the calculation result of consumption method.
The purchase of drug need sourced from Jamkesmas claim is
done by seeing the existing drug stock in the warehouse, if there is
the drug which runs out, and then it is immediately ordered to PBF.
This drug spending can be done more than one time in once year,
accordance with the drug need in the hospital of RSUD Datu Beru.
The benefit from drug purchase itself, if it is compared to the use of
consumption method, it can minimize the occurrence of expired drug,
the exceeded drug stock and empty stock of drug, it is caused by the
drug spending is not used for the long term (1 year).
d. Evaluation of planning
Techniques/Methods of evaluation could be conducted as
follows which was by conducting ABC value analysis for evaluation of
economical aspects, consideration/criteria of VEN for evaluation of
medical/therapetic aspects, combination of ABC and VEN, revision of
list of pharmaceutical supply. At this stage, the Installation of
Pharmacy Datu Beru had not yet been able to be applied due to the
limited human resources no training had been conducted regarding

8
evaluation of planning, and this led to poor understanding of human
resources about the benefits of evaluation of planning.
3. Effectivity of drug need
a. Concordance of available items with DOEN
Percentage of concordance of available drug items DOEN
was 59%. Based on interview with Chief of Installation of Pharmacy, it
was stated that utilization manual had not yet played significant role
due to its disconcordance with DOEN, and also because PFT had not
been formed so hospital formulary was not yet formed also.
Therefore, no control was exerted by authorities regarding DOEN
utilization as guidance in drug planning. This demonstrated the lack of
full management support in DOEN utilization as guidance for drug
planning, and this was also affected by (1) The drug planning team
has not been established yet (2) sistem informasi yang mendukung
dalam perencanaan obat masih manual sehingga untuk mengontrol
penggunaan obat sesuai dengan DOEN belum maksimal, (3)
information system supporting drug planning was still conducted
manually so control on concordance of utilization with DOEN had not
yet maximal (4) budget in Datu Beru district hospital was still limited
so utilization manual made by referring to DOEN should be better
obeyed (5) hospital policy regarding drug utilization manual to DOEN
had been available, but in practice the utilization manual DOEN
hadn’t played adequate role yet (6) increased drug promotion from
drug distributors. This might lead to increased tendency of prescribing
drugs outside the formulary.
b. Concordance of drug items with Jamkesmas Formulary
According to Kepmenkes of RI and JICA (2010), it states that
the drug selection in the hospital refers to the formularium of Health
Guarantee for Soceity (Jamkesmas). In RSUD of Datu Beru there is no

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policy about the guideline of using of Jamkesmas Formularium in the
drug planning but in the implementation the Datu Beru RSUD has used
the Jamkesmas formularium as the guideline in the drug planning. The
percentage of drug item with the Jamkesmas formularium in the year
2008 is 82%. Based on the interview with the Head of Pharmacy
Installation, he stated that the high of percentage of drug planning
guideline toward the Jamkesmas formularium is compared to DOEN
because in Pharmacy Installation, it only serves Jamkesmas patient,
so that in the drug planning tends to guided on the Jamkesmas
formularium, in addition the doctors both who are in the polyclinic and
in the room guided to the Jamkesmas formularium in giving the drug
receipt. It is also affected by the policy or SK of Health Minister
No.686/Menkes/SK/VI/2010 about the Guideline of Jamkesmas
Implementation, stating that to fulfill the drug need in the Hospital of
Pharmacy Installation/Hospital Pharmacy is responsible to provide all
drugs to serve the health of poor people needed. In order that there is
efficiency of drug service, it is done by referring to the Jamkesmas
formularium.
There is 18% of drug excluded the Jamkesmas formularium, it
is caused by (1) influence of DOEN using that is still low, because the
Jamkesmas formularium refers to DOEN (2) management support
which has not supported fully that is drug planning team has not
established yet, the supporting information system in the drug planning
is still manual so that to control the drug using in accordance with the
Jamkesmas formularium has not been maximal, the budget in Datu
Beru RSUD is limited so that it is expected the guideline of drug using
is in accordance with the Jamkesmas formularium and should be
maximized (3) the drug planning process especially in the stage of
selection has not run maximally.

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Conclusions and Suggestions
Conclusion
Based on results and discussion, conclusions could be drawn as
follows:
1. Management support in drug planning in Datu Beru district hospital had
not yet fully supportive, this could be viewed from:
a. Organizational structure in the Installation of Pharmacy had been
formed but activities within it was not yet active in which not all parts
could function to conduct the job description as regulated.
b. The human resource working quality in Pharmacy Installation is still
less professional in the implementation of the task, because the staff
in the Pharmacy Installation does not quite understand about the job
description that has been determined and never participated the
trainings supporting in the process of drug planning. In the Pharmacy
Installation, it needs to be done the evaluation of employee necessity
so that it can be recognized surely the number of human resource
needed.
c. Information system in the Installation of Pharmacy used manual
system which was condicted by filling the drug expenditure report
(Laporan Pengeluaran Obat) of Jamkesmas drugs which was
conducted monthly and recapped annually.
d. Drug budget in Datu Beru district hospital was sourced from local
authority and claim of Jamkesmas. Percentage of drug budget from
total health budget was 18.5% (Rp 1.726.250.000,-). With limited
budget, drug procurement prioritized drugs that were needed the
most.
e. Letter of decree or director policy regarding drug planning was Letter
of Decree No. I/D/RSUD-DB/VI/08, Standard Operational Procedure
(SOP) of Installation of Pharmacy concerning planning of

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pharmaceutical supply, policy regarding utilization of DOEN in drug
planning was written in SOP of Installation of Pharmacy, Policy
regarding utilization of Jamkesmas formulary in drug planning was
not yet available. However, in practice, drug planning had been
conducted in concordance with Jamkesmas formulary, and Letter of
Decree No. 445/529/Kep/RSUD-DB/2009 regarding activities of
pharmaceutical services in Datu Beru district hospital.
2. The drug planning in Pharmacy Installation of Datu Beru RSUD is done
by Head of Pharmacy Installation assisted by a pharmacist assistant in
doing the task. The process of drug planning in RSUD of Datu Beru
whether it is sourced from Pemda, and the claim of Jamkesmas through
the stage of selection and using compilation. However, in the stage of
need calculation, it is only done for the drug budget sourced from Pemda,
while for the drug budget sourced from Jamkesmas claim is not through
the stage of need calculation.
The process of drug planning in RSUD of Datu Beru whether it is sourced
from Pemda and Jamkesmas claim has not been suitable to the
Kepmenkes of RI and JICA (2010) that is in the stage of need calculation
has not been in accordance with the consumption method and the
absence of planning evaluation. Meanwhile the stage which is
accordance with the Kepmenkes of RI and JICA (2010) is the stage f
selection and using compilation.
3. Effectivity of drug need in Datu Beru district hospital which had been in
concordance with DOEN was 59% and concordance with Jamkesmas
formulary was 82%.
Suggestions
The Installation of Pharmacy Datu Beru district hospital should
improve the management support for drug planning which consisted of:
1. Organization

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a. Organizational structure in the Installation of Pharmacy Datu Beru
district hospital that was already formed should be encouraged to put
all parts into function, implementing the jobs provided in the job
description, and to improve the quality of work, evaluation should be
carried out in order to improve the management in the organization.
b. The program for pharmaceutical activities that had been arranged
should be implemented as planned and continous evaluation on
activities should also be carried out every three months.
c. Letter of Decree or policy regarding the drug planning team should
be provided by the Director.
d. Forming Committe of Pharmacy and Therapy (Komite Farmasi dan
Terapi, KFT) in Datu Beru district hospital so good relationship
between pharmacists, doctors and other health workers could be well
maintained.
2. Human resources
a. Need analysis on human resources should be carried out in the
Installation of Pharmacy Datu Beru district hospital in order to obtain
the exact number of human resources.
b. Educations and trainings should be provided as part of developing
and improving human resources and for the next step, evaluation for
working performance of personnels should be conducted in the
Installation of Pharmacy Datu Beru especially regarding drug
management which consisted of drug planning, procurement,
distribution and utilization.
3. Information management system (SIM)
a. In early stage, computer unit equipped with specialized software for
drug management should be added and developed as part of
integrated hospiyal information management system.

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b. Routine filling of stock card should be conducted in order to control
and observe the drugs in pharmacy warehouse.
4. Advocating for increase in budget from the source of specific allocation
budget (Dana Alokasi Khusus, DAK) which equipped with accurate
supporting data in order to provide all drugs needed. Installation of
Pharmacy in Datu Beru district hospital was also expected to provide
service for patients of Askes and JKA (Jaminan Kesehatan Aceh).
5. Standard of Medical Service should be made in the Installation of
Pharmacy Datu Beru district hospital.
6. The implementation of utilization of DOEN maximally in drug need
planning in the Installation of Pharmacy Datu Beru district hospital.
7. For other researcher, it was suggested to conduct research regarding the
effect of management support on drug management which consisted of
drug procurement, distribution and utilization.