159 AMJ. 2020;7(3):159–4

Perspective of Cikahuripan Villagers on Traditional Health Service Provisions in Government Regulation No. 103 Year 2014

Hashfi Khairuddin,1 Rizal Chaidir,2 Deni Kurniadi Sunjaya3 1Faculty of Medicine Universitas Padjadjaran, Indonesia, 2Department of Orthopedics and Traumatology Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung, Indonesia, 3Department of Public Health Faculty of Medicine Universitas Padjadjaran, Indonesia

Abstract

Background: Traditional health service is one of the health services that is still currently used in Indonesia, especially in rural communities. The government has been regulating these services since

traditional health service providers. This study aimed to explore the perspective of the Cikahuripan 2014. Despite its long existence, there is a recent increase of potential regulation violation among Methods: Villagershealth services on Government in Cikahuripan Regulation Village. on Sixteen traditional informants health consisting services. of 8 villagers who met the inclusion criteria andThis another was a 8qualitative informants study in the using triangulation in-depth interviews negative caseand directanalysis, observations member checking, on traditional peer . Result: There were two different perspectives in the community on traditional health service provisions debriefing, and observation was involved traditional health services more responsive and safer, which would improve service quality and health in the Government Regulation. Supporters of the regulation believed that the regulation would make were too late, would make the costs for licensing expensive, and too complicated. Conclusions:benefits as well There as imposing are two effective different sanctions. public perspectives In contrast, theon theopposition regulation believed of traditional that regulations health services, which are supporting and opposing the regulation. It is expected that the local government create a derivative of the regulation by making adjustment to the community’s situation.

Keywords: Laws, perceptions, regulations, traditional health services

Introduction health services, including responsibilities, central and local government authorities, types Traditional health services have long been of traditional health services, traditional health rooted in individuals in the household, service procedures, resources, research and especially starting in the 2nd century to the development, publication and advertising, 19th community empowerment, funding, guidance, Baubau city, traditional health services have and supervision as well as an administrative 5 been century.started since In the 1986. Batupuaro In the Dayak sub-district, tribe, penalty. traditional medicine itself stands in line with The obligation to obtain permission and the Dayak tribe’s existence. Whereas the Muna intervention regulation can potentially disrupt tribe, Wakontu Village, Wadaga Subdistrict, the course of traditional health services that have been trusted by the community long medicine had existed before medical before the application of the regulation. This Westpractices. Muna1–4 Regency, said that traditional is supported by a previous study showing that The Indonesian government has issued a the Indonesian Traditional Herbal Medicine concerning the Traditional Health Services, which 6 Governmentregulates the Regulation implementation Number of 103 traditional in 2014 Association (ASPETRI)Interestingly, is not ready there inare the no implementation of Government Regulation Number 103/2014. Correspondence:

Hashfi Khairuddin, Faculty of Medicine Universitas Padjadjaran, Jalan Raya Bandung-Sumedang Km. 21, Jatinangor, Sumedang, Indonesia, Email: [email protected]. Althea Medical Journal. 2020;7(3) https://doi.org/10.15850/amj.v7n3.1912 160 AMJ September 2020 data on the total number of traditional health conducted to increase trustworthiness in this study, by interviewing the Cikahuripan have permission and opinion on this matter. villagers who had never used traditional health servicesThe community’s in West Bandung demands or West for traditional Java, who triangulation respondents were interviewed population. Thus, the implementation of servicesthoroughly as triangulationin this study respondents. until achieving Eight medicineregulation iscould about bring 20% up of different Indonesia’s opinions total saturation. in society. On one side, the government has created rules for safety and comfort in utilizing traditional health services. On the other therefore,The method the informant in this could study tell was the in-depth widest hand, this regulation is enough to restrict interviewspossible extent using about open-ended his/her experiences questions, the community’s traditional health services, and perspectives. First, they were interviewed therefore, the differences in perception can occur in the community.7 determine whether they had used traditional Previous studies have not yet analyzed the by asking their health-seeking behavior to perception of the community as a user when a short explanation about the regulations healthgoverning services. traditional Respondents health services were given PP is started. The purpose of this study was to Governmentexplore the Regulationcommunity’s Number perspectives 103/2014 in regarding these regulations were explored. Cikahuripan Village, Lembang, West Bandung, No.The researcher 103/2014, also and checked their the perspectives informants who were interviewed. Source triangulation with negative case analysis, observation, and regardinghealth services. Government Regulation Number member checking was done to increase trust 103/2014, regulations that govern traditional worthiness. Methods The researcher also had made observations to strengthen the theory that would be This research was conducted in Cikahuripan formed. The observation was carried out by going directly to one of the traditional health qualitative research design with grounded services available in Cikahuripan Village, then Villagetheory fromto explore August theto Octoberprocesses, 2019 activities, using a and events experienced by respondents. The health care methods were carried out. sampling method used in this study was a askingIn brief,and seeing the firsthandresults of how each the traditionalinterview theoretical sampling, that was not referring to were transcribed into text form. Then, data the number of samples, but the amount of data reduction and analysis were conducted to obtained from the respondents until the data select and focus on the gross data that appeared saturation had been reached and therefore aimed to create a theory.8 data encoding, i.e., breaking the data and The inclusion criteria in this study were inrearranging the field. the Furthermore, data in the form we of conducted words or phrases as representatives of the data fractions. in Cikahuripan village, had used traditional Categorization, the results of data coding, were residentshealth services, of West and Bandung agreed toRegency become who research lived grouped into homogeneous categories for the subjects. The exclusion criteria in this study process of interpretation, then the preparation were people who had limited senses such as of themes, namely by grouping categories in a blind, impaired hearing, impaired speech, and collection of categories that were considered the mentally disabled. homogeneous. Furthermore, content analysis, In determining the respondents, a purposive the process of data interpretation, in the form sampling technique was conducted by visiting of material categorization based on related topics were conducted. Thick description, the traditional health services in Cikahuripan interpretation of the data in the form of andVillage conducting and asking in-depth respondents interviews withwho one had of strong and deep descriptions and narratives used traditional health services in the village. expressed were performed and then analyzing the content analysis, analyzing the results performed to get other respondents until the from the perspective of the community.9 Next,saturation the snowballof the data sampling was reached. technique Saturation was was achieved when eight respondents who entered as inclusion criteria were interviewed quotedSeveral and referred perspectives with codes from assigned the first to thoroughly. responder (R1) to the sixteenth (R16) were Furthermore, a negative case analysis was who had used traditional health services, while them from R1 to R16. R1–R8 was respondents Althea Medical Journal. 2020;7(3) Hashfi Khairuddin et al.: Perspective of Cikahuripan Villagers on Traditional Health Service Provisions in Government 161

Regulation No. 103 Year 2014

Table Content Analysis of Public Perceptions of Traditional Health Services Regulation PRO CONS Accountability Security Increased Cost Late Enactment Quality Increase Increased Complexity Ignorance Sanctions on Violator Demand Mismatch Health Benefit Increase

not be careless at least. Our leg is important to traditional health services, and designated support life and daily activities.” R9–R16as a triangulation. was respondents This whoresearch had neverhad beenused From some opinions, it was seen that the community was very concerned about the Universitas Padjadjaran, with the registration safety of traditional health services and that approved by the Research Ethics Committee security for consumers was also guaranteed. The community also had the opinion that numberResults of 902/UN6.KEP/EC/2019 if the government prohibited traditional health services, the community would be The respondents included consisted of men and women, aged 17–65 years, education to increase the security of traditional health level were varied between elementary more careful. Regulations were considered school graduates to Diploma. The jobs of the in using traditional health services. respondents were farmers, ranchers and services,The public thereby believed increasing that publicwith regulations, confidence milking workers, students, hotel employees, traditional health services would improve the traders, market workers, construction workers, parking attendants, housewives, “Compared to the traditional health services teachers, and traditional health workers. qualitythat are of not their licensed, services. the Asprovided said by treatment R5, is Public opinions of violations in traditional better in the licensed ones.” health services according to government used traditional health services that had into two sides. There was a support for the followedR5 was government one of the respondentsregulations whoand hadfelt regulationregulation, but number there 103/2014was also an was opposition polarized to that the health services provided were indeed the regulation as shown in Table 1. better. Cikahuripan villagers assumed that With the regulation, traditional health regulations governing traditional health services were considered to provide more services were a form of accountability for traditional health services in providing health “Traditional health services is becoming official. healthCooperation benefits is alsothan maintainedbefore. R5 believed with the that, local “The regulations intend to make the traditional health department and Public Health Center services.health services Like R7 more said, accountable so that they (Pusat Kesehatan Mayarakat, Puskesmas). Even are more careful, and there is a potential threat if we use traditional medicine, we also need of being punished by the law.” drugs, antibiotics, anti-pruritic, as well as the All forms of actions taken by traditional prohibition of some foods. Compared to those who are not licensed, the healing process is faster in those who are licensed.” healthconsidered services to increase could security be justified in traditional legally. With the regulation, it was also considered Regulationhealth services in traditional in conducting health services. services This was by the public that there were sanctions for showed the community’s sense of insecurity in utilizing traditional health services at this “Now, there are sanctions for traditional birth time, so that this regulation was expected everyattendants violator (traditional of the regulation. health services), As said soby they R1, to increase the security of traditional health are no longer allowed.” This was considered reasonable by “People like us now look for traditional health the community as protection for users of services. WeR5 alsodo not said, look for the best, but we traditional health services. However, the are looking for the official ones, so they should community also considered that there was a

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accordance with the regulations, although they said, had no permit according to the regulations delay“It can in be the said enactment that the rules of this are regulation. late. Why was R2 it not enacted earlier? These services have been Discussion around for a long time, and there are already many patients using it.” There are two perceptions of Cikahuripan The community considered that the villagers on regulations governing traditional traditional health services that already existed health services. There is support for the could not be blamed because they had been regulation and there is opposition against the around for a long time and were rooted regulation, each with different reasons. The culturally in the community. existence and application of traditional health The regulation was also perceived to cause services are a necessity of the community. As traditional health services more expensive, in the Dayak community, traditional medicine contradicting the principles of traditional is currently still used in irrational diseases that never heal. In the community, traditional “If there were an obligation to use a permit, I health services are considered effective healtham afraid services, it would which be wasexpensive. low cost. It isR9 just said, not in curing various diseases and eventually fair for the poor.” become a necessity for the community. The This regulation was considered by the Dayaks believe that before or after seeing community to only make the traditional health a doctor or health worker, they must seek alternative medicine or traditional health “If we comply with the regulations, we must use services.3 servicepermits. system It is rather complicated. complicated. As saidI do notby R4, agree.” traditional health services are believed to be Whereas the formation of traditional able to increase In GayoLues the health Regency, and strengthAceh Province, of the health services was based on the needs of the community and the capabilities of traditional of the Gayo people. It also illustrates that health service providers, which would be body.traditional The benefits health servicesmatch up have the expectationsbecome the discussed next. needs of the community. The people of Lede Community needs and the ability of 10 traditional health service providers formed Province also feel better after the treatment the basis for the formation of traditional health Village,of traditional Tilabu health Regency, services. and The North service Maluku and recovery rate of traditional health services “When it comes to regulations, here we is felt far better. This makes Lede villagers services,(traditional as saidhealth by R16,services) only help, we do trust and visits traditional health services not even advertise. If anyone needs help, how more often compared to conventional health can we reject it?” services. This illustrates that traditional The regulation was considered not friendly health services are a necessity for the people to traditional health services, which were of Lede Village.11 Furthermore, the people of formed due to community needs. Due to regulations that were considered unfriendly strongly believes in traditional health services by the people of Cikahuripan village, many TelluSiattinge,to treat various Bone diseases Regency, for generations. South Sulawesi, It is people were ignoring these regulations. As this belief that makes the community seeks traditional health services so that traditional “Even though traditional health services violate health services become the community’s saidregulations, by R3, people still want to go there because needs.13 they already believe they have experienced it themselves.” In addition, researchers also made traditionalAs in West medicine Java, research is still conducted high. Traditional in rural observations of the only traditional health communitiesmedicine does shows not thatdo a public lot of confidence information in service in Cikahuripan Village, resulting in literacy in carrying out its practice. However, that this traditional health service had no permission from the government. The service traditional health services an inseparable did not put up advertisements or signposts long-standingcommunity needs. community12 In our research, trust makesit has and only served if there was a need from been proven that traditional health services the community. The type of treatment was have become the community’s needs. That rehabilitative, including massage and giving is the reason why people do not agree water accompanied by prayer for patients with with the existing traditional health service broken bones. The services provided were in regulations, due to the practice limitation of

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Regulation No. 103 Year 2014 traditional health services. This is supported services in the village of Cikahuripan. They do by several studies that prove that traditional not know anything about the rules or appeals health services have become an integral part in the use of traditional health services. The of the community and are a necessity for the community in seeking treatment. If this laws in advance so that the community can give regulation has been implemented in all regions researcherstheir perceptions must brieflyregarding explain the theregulation. related of Indonesia, it can be predicted that there will be many rejections from various groups of information was found in this study.12 people regarding this regulation. Insufficient dissemination of comprehensive The interview results of researchers on governing traditional health services showed traditional health services in the village of thatA thestudy community in West Java welcomed concerning this regulations regulation Cikahuripan have shown the unpreparedness in contrast with the previous study; our study of traditional health workers to implement has found that the people of Cikahuripan this regulation. The traditional practitioner village have two different perceptions; considers that its existence is only to meet the support and reject the regulation.12 In the needs of the people who often ask them for national health system, the government is help. This is also supported by the Indonesian responsible as a supervisor or steward of the Traditional Herbal Medicine Association public services. To carry out the stewardship function of government in traditional health regulation.6 services, they enact laws to regulate traditional (ASPETRI),From the as economicalit is not ready perspective to implement of thisthe health services. As an instrument, the permit community, traditional health services are takes the role as a guide, or to drive citizens’ preferred because they are cheaper than behavior. Licensing is also intended to provide conventional health services. These are found guidance, regulation, control, and supervision in studies conducted in various places such as of traditional health services. Permission is issued by the authorities as an instrument to inSouth Lede Sulawesi. Village, The PulauTalibu people tend Regency, to choose North be willing to follow the ways they advocate in Maluku,traditional also health in TelluSiattinge, services because Bone it Regency, is more influenceorder to achieve relations concrete with citizensgoals.14,15 in To order provide to affordable, or they never ask for wages or that function, the government enacts the fees in providing their services.11,13 In our study people show rejection of the existence traditional health services, which is expected of regulation due to economic reasons. Governmentto increase theRegulation quality Numberof traditional 103/2014 health on Traditional health services that are known services along with decreasing side effects to be cheap and never charge fees are afraid that are medically irresponsible.16 This is in to lose their economic value or become more accordance with part of the community that expensive and even set costs if they follow this supports the regulation of traditional health regulation. services, in which the regulation is believed In terms of the responsibility of traditional to improve the quality of services, health health services, research conducted in West services. This regulation is also believed to services usually claim their healing success benefits,help the accountability and security ofof traditionaltraditional health Javafrom God’s shows gift. that This most makes traditional the customer health and services. the government cannot do anything if there With the regulation, if a violation is are cases that are detrimental.12 This is in line committed by a traditional health person or with the expectations of Cikahuripan villagers a traditional health worker, then the patient with the enactment of this regulation. This can report it to the Health Service, then public regulation is expected by the community to be one of the solutions so that traditional health to the alternative medicine and directly ask services can be more responsible for what healththe therapist. office will However, conduct ita suddendoes not inspection directly they have done and get appropriate sanctions if violations occur in practice. However, responsibilities as a business actor that harms research conducted on rural communities in guaranteeconsumers. if Patientsalternative can medicine report the will violation fulfill its directly to the police if they feel they are victims of malpractice or neglect of alternative thegovernment West Java for states traditional that the medicine dissemination has healers.17 This is in accordance with the ofbeen information quite successful. from This West is Java different provincial from perception of the community that considers the perspective of the community and health that regulations governing traditional health

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AMJ September 2020 services will impose sanctions on traditional health services that violate them. 7. Badan Pusat Statistik Indonesia. This study was limited to the village of Masyarakat.Persentase penduduk2016;4(1):65–75. yang mempunyai Cikahuripan, Lembang Subdistrict, West keluhan kesehatan dan penggunaan obat

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