Discretion in health service delivery: A case study of the Kassi-Kassi Health Community Centre in Makassar

Abstract

Objective

This study aims to describe the use of discretion at the Street Level Bureaucrat level against the dilemma in Home Care services at the Kassi-Kassi Health Centre in Makassar City.

Method

The method used in this study is descriptive qualitative. Data collection was carried out through observation, interviews, and analysis of documents relevant to this research.

Results

The results of the study on the discretion of health services in the City of Makassar (case studies on Home Care services at Kassi-Kassi Health Centre) can be seen from four indicators according to Lipsky,¹ namely service costs, service time, service information and service ethics. Based on these indicators, the Street level desires to face a dilemma in terms of service time and service information. On this basis, the discretion taken by the Dottorotta of the Kassi-Kassi health community center aims to provide maximum service and the Dottorotta team in responding to requests for Home Care services at the same time as being responsive to patients.

Conclusion

This research indicates that health workers experience dilemmas in providing health services, so they tend to do discretion to respond to the dilemmas. This study identified four principal discretions by health workers. First, the officers will no longer follow the standard operating procedures if it is considered to slow down the service process. Second, maximize the additional service response team to provide services when the number of patients increases. Third, overcome the limitations of drugs by encouraging patients to buy drugs at other public pharmacies. Finally, educating the public to use telephone services 24 hours 112 only in emergencies and not to abuse the service.