COMPARATIVE VACCINATION SERVICE MANAGEMENT OF COVID-19 IN CENTRAL SULAWESI

Background: Based on the initial observations of the study, it was obtained that the management of the COVID-19 vaccination service doses 1 and 2 in Sigi Regency and Palu City experienced different achievement targets. This can be seen from the achievement of vaccination in the district. Sigi at the 1st dose reached 74.08% and the second still reached 49.94%. Meanwhile, the vaccination achievement of Palu City at dose 1 had reached 92.37% and at dose 2 it was 71.39%. This is because there are still many people in Sigi Regency who are reluctant to get vaccinated, some of the Sigi people who live on the border mostly carry out vaccinations in Palu City, data entry is late, and there are still many isolated areas that are difficult to reach. Meanwhile in Palu, the management of vaccine services has been running well and according to the predetermined targets. Aim: This research plan aims to compare the management of the first and second dose of COVID-19 vaccination services in middle Sulawesi. Method: A qualitative approach with a descriptive design is the research methodology adopted. A comparison study is the kind of descriptive research technique utilized. Findings: Based on the results of the study, it was found that the management of the COVID-19 vaccination service doses 1 and 2 in Sigi Regency was less than optimal, while Palu City was running well. directing, coordinating, supervision © The author(s). This work is distributed under the terms of the Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0)


INTRODUCTION
In Indonesia, March 2020, transmission of the 2019-COVID (Corona Virus Disease) occurred, the number of cases of the COVID outbreak increased day by day until the government finally imposed restrictions on activities due to Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) or better known as the Corona virus (Husain, 2020).
Various efforts in the form of policies continue to be made to the policy of vaccination which is an injection to increase a person's immunity to a disease. The objectives of the pandemic vaccination carried out include: reducing the transmission/transmission of COVID-19, reducing morbidity and mortality due to COVID-19, achieving herd immunity/immunity, and protecting the public so that they remain productive (4 Benefits of the COVID-19 Vaccine You Must Know, t.t.).
The Sinovac vaccine is the most widely used COVID vaccine in Indonesia. Sinovac vaccine is given to people aged 18-59 years without a history of disease (healthy) as much as 2 injections. The first injection and the second injection are at least 14 days apart, with the use of a dose of 0.5 ml per injection which is given to the public free of charge from the government (Dewi, 2021).
Technical guidelines for vaccination services in the context of dealing with a pandemic are regulated in the decision of the Director General of disease prevention and control number HK.02.02/4/1/2021. It was explained that corona virus disease is a type of virus that is contagious so that it requires appropriate and fast handling so that the central government together with the provincial government and district/city regional governments to carry out guidance and supervision of COVID-19 vaccination services so that their implementation can be in accordance with applicable regulations. (Technical Instructions for the Implementation of Vaccination in the Context of Combating the Corona Virus Disease 2019 (COVID-19), 2021).
In Indonesia, the vaccination program began on January 13, 2021, followed by several provinces including Central Sulawesi. Previous research related to the implementation of the COVID-19 vaccination policy was carried out well, one of which was the Jakarta area which had the highest vaccination achievement in Indonesia (Fikri & Amal Chalik Sjaaf, 2022). Subsequent research by (Shadiq et al., 2021) examined several strategies carried out by the Sumenep district health office so that vaccination coverage in the area was also quite high. The two studies show that the coverage of COVID-19 vaccination is high and good.
Therefore, the novelty in this study is related to vaccination services at the first and second doses, in two areas, namely Sigi Regency and Palu City. Vaccination coverage in Palu City is also already high. However, vaccination coverage in Sigi district is still low because it is constrained by vaccine distribution, several areas in Sigi are isolated, causing delays in the vaccination process and data entry, and several Sigi people living on the border are vaccinated in Palu City. On this basis, the purpose of this study is to find out how the management of the Sigi district government compares with the Palu City government in the COVID-19 vaccination service. In addition, the researchers also would like to discover the inhibiting factors and the efforts made by the Sigi Regency Government and the Palu City Government in the implementation of vaccination.

METHOD
This study used a qualitative approach with a descriptive design. The type of descriptive research method used is a comparative study. The aim is to understand the phenomena that occur related to the management of vaccination services, especially in Palu as an administrative city and Sigi Regency which is one of the Level II Regions in the province of Middle Sulawesi. Informants in this study were determined purposively. Comparative management of COVID-19 vaccination services at the first and second doses is seen from Hanry Fayol's management functions: planning, organizing, directing, coordinating, and controlling in Middle Sulawesi with case studies at Sigi Regency Government and Palu City Government.

RESULTS AND DISCUSSION COVID-19 Vaccination Services
Since the COVID-19 pandemic and became a global virus which later received serious attention, various efforts were made by the government to stop the spread of the virus. The government's efforts can be seen from the various policies made by the government ranging from Large-Scale Social Restrictions, Indonesian called PSBB to finally deciding to issue a vaccination policy. In this policy, around 70 to 80 percent of the Indonesian population must receive vaccinations to achieve herd immunity from the spread of the corona virus (Department of Health, 2021). The COVID-19 vaccination program since January 13, 2021 is carried out in 2 (two) stages. The first phase begins in April 2021 with a target of 1.3 million health workers, public officers (17.4 million), and the elderly (21.5 million). Furthermore, in the second stage, it prioritizes a number of vulnerable people (63.9 million), as well as the general public with a total of 77.4 million people (COVID-19 Handling Task Force, 2021).

Source: Ministry of Health Republic of Indonesia
The target of the COVID-19 vaccination in Middle Sulawesi is 2,452,517 people, which also targets health workers, public officers, the elderly, vulnerable communities and the general public, aged 12-17 years, and ages 6-11 years. The total vaccination dose 1 reached 77.59% (1,902,814) people, of the total achievement there were still 549,703 people who had not been vaccinated. Furthermore, the total vaccination dose 2 reached 52.63% (1,290,868) so that the target for vaccination in the second phase is still 1,161,649 people who are not vaccinated (Ministry of Health, 2022a).
Based on this target, the realization of the program in several regions in Middle Sulawesi until September 15,2022, that there are areas that have high vaccination coverage and some are still low. Palu City is an area with high vaccination coverage, namely the 1 st dose of 280,534 people or (93.40%) and the second dose of 71. 42% (216,844). Sigi is still low with coverage at dose 1 (74.11%) 157,482 people and at dose 2 (49.96%) 106,168 people (Kemenkes, 2022b). The Central Sulawesi Vaccination Update until September 15, 2022 can be seen in the image below.  The location of the process of providing vaccination services has been determined in various places that have met the requirements, whether they are owned by the government, the public or the private sector. In addition to the locations prepared, the government has also determined the flow of the COVID-19 vaccination service which has been simplified from 4 to 2 tables provided. Initially, the four seats were intended for registration in seat 1, screening in seat 2, the vaccination process in seat 3, and the fourth was recording and reporting on receiving vaccines. Meanwhile, the 2 table simplification flow is only intended for screening and vaccination process at the first table, and the second table is for recording and observing vaccination participants. This simplification is carried out so that the vaccination process takes place effectively and efficiently. Simplification of vaccination services is also taking place in Kab. Sigi and Palu City. The comparison of the Sigi Regency Government's COVID-19 vaccination service management with the Palu City Government can be seen from the management function of Henry Fayol. In this management function, there are 5 very important aspects to consider in the service delivery process, including planning, organizing, directing, coordinating, and control.

Management of COVID-19 Vaccination Services for Sigi Regency Government
The aspects of service that Henry Fayol put forward can be described in the results of interviews with several sources or who became informants who have been determined using purposive techniques, as follows.

Planning
In achieving goals, it must begin with good planning so that the desired results are in line with expectations. Planning is a very important initial process to achieve the goals of an organization. Vaccination targets for the first time were carried out in several places targeting elements of government leadership and several officials. Furthermore, it is directed to medical personnel who will be at the forefront of the vaccination service process. Only after that it is given to the general public according to the priority targets that have been previously planned.
In planning the implementation, the district government. Sigi requires 28,607 doses of stock vaccine. This aims to achieve the national target in order to form communal immunity in the community. Government expectations. Until the end of December 2021, COVID-19 vaccination can reach the 70% target. However, based on data from the local government. Sigi that the available vaccines have only reached more than 11,000, while the vaccination has only reached 60% of the dose (Hajiji, 2021a). COVID-19 vaccination in the district. Sigi was first conducted on February 3, 2021, which was given to Mohamad Irwan as Sigi Regent. Subsequent gifts were given to several regional officials, namely the Regional Secretary of Sigi Regency, Head of the Sigi Regency Ministry of Religion, Sigi Police Chief, Head of the Donggala District Court, Chair of the Sigi Regency Indonesian Doctors Association, Commander of the East Palu Division of the Salvation Army, and Tadulako University Chancellor. After the first vaccine was administered at the Sigi Regent's office, vaccination was gradually administered to as many as 1,120 health workers throughout the Sigi Regency area. A total of 2,240 doses of Sinovac vaccine were provided in the district (Hajiji, 2021b).

Organizing
The management of vaccination services in Kab. Sigi begins by registering on the BPJS Health Primary Care (P-Care) application that has been provided. The next step is for health workers to carry out a physical examination or amnesic screening to determine the health condition of the patient who will be receiving treatment vaccinated. If the condition is in good health, then vaccination is carried out. After the patient receives the injection, the next step will be to get an early stage vaccination card.

Directing
Various efforts have been made by the government to prevent the spread of the corona virus which has claimed many lives. Suggestions for the community to continue to comply with health protocols (maintaining distance, washing hands, and wearing masks), as well as appeals for the public to be aware that they want to be vaccinated are always conveyed by the government. The result, Kab. Sigi is at 70% in the acceleration of vaccination until 2021. However, from the figures obtained, there are still sub-districts whose vaccination achievement is still low, namely Kinovaro District. Therefore, the strategy for accelerating vaccination is to carry out systematic data collection starting from the village to the RT level. In this case, the village community empowerment office in the district. Sigi and the district health office. Sigi cooperated with each other, and provided information through the RT and RW heads who would later receive a reward from the government if they had achieved the vaccination target.
In addition to the strategy above, the Sigi Regent also ordered all sub-districts in 16 subdistricts to continue to directly oversee the implementation of the COVID vaccination. This escort is intended for each village to target vaccination of 100 people per day (Hajiji, 2021a).

Coordination
District government. Sigi in this case Mohamad Irwan as Regent always coordinates related to the acceleration of vaccination. The purpose of this coordination is to quickly achieve the vaccination target as expected, so that Herd Immunity can be realized. Regarding the coordination, according to the Head of PMK, the Health Office, dr. Marannu C. Sambo also confirmed the government's coordination in accelerating the vaccination process. According to him, not only elements from the health department, but various parties are collaborating and supporting the government to suppress the surge in COVID-19 cases.

Control
In management, control or supervision is the last phase. Control is carried out to ensure that all running processes are in accordance with procedures or not. Through this phase, it is also at the same time evaluating if processes or things are found that are not suitable, so that improvements can be made. In supervising the COVID vaccination service in Sigi district, in this case the Sigi Regent who is also the head of the task force, directly monitors the management of the vaccination service.
The Regent does not work alone, but the government is fully responsible for the assistance of the Health Service and the TNI/POLRI to oversee the implementation of the vaccination to completion. In addition, in the process of accelerating vaccination, representatives of the Financial and Development Supervisory Agency (BPKP) of Middle Sulawesi Province are an important part. BPKP is a strategic partner of the Sigi Regency Government. The results of monitoring by BPKP Representatives, that Kab. Sigi in the achievement of vaccination ranks second lowest in the province of Middle Sulawesi. Based on the report, various strategic efforts were taken to accelerate vaccination. These efforts include: 1). Efforts are made to have a schedule that targets per UPT Puskesmas, per village per day and per week, 2). There is direct monitoring of the Regent, 3). Priority areas are densely populated and have easy-to-reach access, including ASN and schools, 4). Good stock management, including stock requests to the Provincial Health Office (Kominfo BPKP Central Sulawesi, 2010).

Management of COVID-19 Vaccination Services for Palu City Government Planning
The Palu city government received 11 thousand doses of vaccine from PT Bio Farma which was sent directly from Jakarta and arrived at Mutiara Sis Al-Jufri Airport Palu on January 5, 2021. The first priority to receive vaccinations were health workers, which totaled 22,116 people throughout Middle Sulawesi. While 70 percent is targeted from the existing population (Susanto, 2021). Furthermore, on January 19, 2022, the COVID-19 vaccination for children aged 6-11 years was simultaneously carried out by the Palu City Government in 14 working areas of the Puskesmas in Palu City (Reza, 2022). According to Mrs. Nirmawita (40) as the Head of the Surveillance and Immunization Division of the Palu City Health Office said that: "Initially, the vaccination given by the center did not match the target given to the conditions in the field, so that data collection from below was started. Therefore, the center reshuffled the initial target of vaccination, up to 265,462. Our stages are divided into 3 stages, namely the first stage for health workers, the second stage for public servants such as the TNI/POLRI and the elderly such as the elderly, then for the general public which is divided into several groups namely adults, teenagers and finally children over 12 year." (Interview on 11 July 2022, 14:00-15:30 WITA) Based on the fact that there was a change in the target for vaccination, the government responded quickly through the health service, which then re-entered the data. The government has also carried out planning related to the flow and mapping of vaccination targets that prioritize health workers first (Ridwan, 2022).
As of September 13, 2022, data on the coverage of dose 1 vaccination has reached 280,463 people or (92.37%). The second dose of vaccination reached 216,745 people (71.39%) (Ministry of Health, 2022b).

Organizing
In the vaccination service, the mayor of Palu acts as the head of the task force. The secretariat and its secretary are at the BPBD (Regional Disaster Management Agency) Palu City. The synergy of various parties in the implementation of vaccinations is carried out starting from the Health side carrying out logistics and vaccination. The TNI/POLRI are working with the village heads and sub-district heads in each region to invite the public to accept the COVID-19 vaccine. The government has also opened a large number of vaccine outlets accompanied by reliable medical personnel. According to Mrs. Nirmawita explained that: "In vaccination services, all cross-sectors are involved, starting from health workers who prepare logistics and vaccinators. TNI/POLRI as mass mobilizers usually work closely with the sub-district head, village head, and OPD in each region. The age limit for vaccine recipients is currently based on regulations from the central government, namely from the age of 12 years and over to the elderly. (Interview on 11 July 2022, 14:00-15:30 WITA) In order to prevent the spread of the corona virus, in addition to giving vaccinations, socialization regarding Health protocols, making policies related to procedures for carrying out activities during the pandemic (urging people to reduce mobility) outside the home are still being carried out. Further information from Mr. Gayus Novanto Pakan (37) as Head of the Disaster Prevention Section of BPBD Palu said that: "When the city of Palu was confirmed to have COVID-19, the government moved very quickly. The first thing was to form a task force unit which was chaired directly by the mayor of Palu, where the secretariat and secretary were at the Palu City BPBD (Regional Disaster Management Agency), carried out socialization on Health protocols, formed several new policies regarding activities during the pandemic such as urging the public to reduce mobility outside the home, carry out guarding at every border in Palu City, prohibit people from doing activities that invite a lot of people". (Interview on 12 July 2022, 10:00-11:45 WITA)

Directing
Leadership is very necessary to achieve a goal. In this COVID-19 vaccination service, the Palu City Government has instructed starting from his subordinates to the general public about vaccination recommendations so that they can be carried out in accordance with applicable regulations. The government also provides socialization related to vaccination to the public. This policy is expected to reduce the level of transmission of the corona virus so that normal life can return to normal.
Mrs. Nirmawita (40) as Head of the Surveillance and Immunization Division of the Palu City Health Office stated that: "We are working with communication and information technology to promote vaccines and spread this information faster and more evenly. After this socialization, if there are still people who do not want to be vaccinated, especially ASN, it is emphasized that they will not be able to receive salaries without vaccination and will be forced to do so under pressure. So people end up wanting to be vaccinated." (Interview on 11 July 2022, 14:00-15:30 WITA) Based on the results of interviews and facts in the field, the government educates the public to understand so they want to be vaccinated. Efforts are made through education and outreach to the public, as for residents who object to being vaccinated, then the government will act decisively by applying pressure. This is done to prevent the spread of the virus from increasing.
The direction by the government was justified by Mrs. Maryam (49) who is a housewife, according to her: "The information dissemination is very good. The Palu City Government through the apparatus in each village conveyed information about the vaccine itself. At first there was fear, so they received education and then they dared to be vaccinated." (Interview on 12 July 2022, 16:00-17:00 WITA) From the results of interviews and facts in the field, that people respond to government actions related to the importance of vaccination which not only benefits themselves but can also protect others from the spread of the virus.

Coordinating
In the management function, coordination is very important in order to know which stage the expected goals have reached. In addition, to find out the obstacles faced so that the institution or organizer immediately takes action as a solution so that the goals can be achieved effectively and efficiently. In the process of vaccination services, the Palu city government as the head of the task force for the acceleration of handling COVID-19 coordinated directly with various agencies or related partners that handle vaccination services. The agencies or partners consist of the Health Service, the TNI/POLRI, the vaccination center/hospital, the Regional Apparatus Organization (OPD), and several volunteers.
The form of coordination of the COVID-19 vaccination service can be seen from the results of a joint interview with Mrs. Nirmawita (40) Head of the Surveillance and Immunization Division of the City Health Office that: "Many parties are involved in the implementation of vaccination services, starting from the health office as the organizer, supervisor and logistics. Several Health Centers, Hospitals, both regional and private hospitals, Clinics, Health Polytechnics and Vaccine Mutual Cooperation Prodia and Kinara, Prodia and Kinara have also advocated, and so far there has been no fatal vaccine failure. There is one resident who is swollen in the area that has been vaccinated, that's because he has a history of allergies, but has been treated medically." (Interview on 11 July 2022, 14:00-15:30 WITA) Based on the results of these interviews and facts on the ground that show the synergy between agencies starting from the health department including health centers, hospitals, clinics, and prodia. In addition, health polytechnics are also involved in vaccination services. Meanwhile, the National Police/TNI helped in bringing order and security to the people who were waiting for the vaccination service process.
The Head of the MIddle Sulawesi Financial and Development Supervisory Agency (BPKP) and the deputy Mayor of Palu directly monitored the implementation of the COVID-19 Vaccination carried out by Kodim 1306/Donggala Palu City (Arsa & Naufal, 2021). Seeing the government's readiness in coordination so that the vaccinations that have been carried out in Palu City are running as expected.

Controlling
The last aspect in the management function is supervision, this is important as a form of achieving the management function. Supervision helps ensure that activities are carried out according to pre-established rules and procedures. In this case, to find out the management process for the COVID-19 vaccination service carried out by the Palu City Government. According to Mrs. Nirmawita, there is a government policy that requires citizens to be vaccinated. For those who refuse, there is an appeal from the government to the community that they cannot get assistance at the same time that those who are workers will not get a salary. This is done as an effort by the government to get people to accept vaccines in order to keep this virus under control. Furthermore, supervision is also carried out by the health office which forms a special team to oversee vaccination services. This special team works starting from inputting data on the number of vaccines used per day to the number of people who have been vaccinated. The data is then sent to the center through an application that has been provided by the government.
Until now, as long as vaccination services continue to run, the government also continues to encourage people to continue to adhere to health protocols (maintaining distance, wearing masks, washing hands). In addition, the government appeals not to believe in hoaxes that often develop in the community. Another way that the government does so that people want to be vaccinated is by requiring them to show a vaccine letter in their activities.

Government Inhibiting Factors in the Implementation of COVID-19 Vaccination
After various policies and efforts that have been taken by the government starting from PSBB, PPKM, to the implementation of the new normal in order to suppress the rate of spread of the corona virus. The government then took a strategy to prevent the spread of COVID-19 by implementing a policy of injecting the Corona-19 vaccine to all citizens. Of course, the decision to give gifts by the government received a response from the community, ranging from the pros and cons of the decision.
There are various reasons given by people who do not want to be vaccinated, which then become obstacles to the vaccination service process, namely Residents still have doubts regarding the effectiveness of vaccination, people who still believe in hoaxes that arise after vaccination, public distrust of the government on the recommendation of vaccination, the availability of vaccines that are not in accordance with the vaccination target, limited medical personnel and facilities provided, and there is still a lack of socialization of the benefits of vaccines to the community, especially those in villages.
Specifically for the district. Sigi, that there are still many villages in the Sigi area which are located very far away and even remote so that it is difficult for the government to reach. In addition, that most of the people who live directly adjacent to Palu City (Tingge Village, Kalukubula, and Mpanau) most of them have been vaccinated in Palu City. This will affect the data and input process to a system that is connected directly to the center in this case is the ministry of health.

Government Efforts in Implementing COVID-19 Vaccination
The various obstacles and obstacles that have been described above must be faced by the government, but these obstacles must be overcome by looking for various solutions or efforts. This is done so that the implementation of the COVID-19 vaccination continues according to the policies that have been previously determined. The efforts carried out by the government of Sigi and Palu City, including The government continuously provides socialization to the public regarding the use of the COVID-19 vaccine, the government and partners intensively provide education regarding the purpose of providing vaccines, the government provides COVID-19 vaccination booths to make it easier for the public, the Sigi Regency Government prepares door prizes for its citizens who will be vaccinated, the government urges the village heads to RT/RW to escort their citizens in the vaccination process, and door to door or visiting people's homes directly so they want to be vaccinated. Some of these efforts are steps taken by the government in collaboration with several relevant agencies so that the implementation of vaccination can achieve the target.

CONCLUSION
The management of the 1 st and 2 nd doses of the COVID-19 vaccination service for the Sigi Regency and Palu City governments has differences. This is based on 5 (five) aspects in Henry Fayol's theory. From the planning aspect, the Palu City government carried out vaccination earlier and obtained the highest vaccination coverage compared to Kab. Sigi. In terms of organization, the Palu City Government until the time of the implementation of the vaccination service went smoothly. While the district government. Sigi is constrained by limited facilities and infrastructure in reaching isolated areas, delays in inputting data for participants who have been vaccinated, and limited resources. From the aspect of direction, coordination, and control are carried out optimally by the two regions. Through this study, it is recommended to the government to continue to strive to improve the management of vaccination services, as well as pay attention to the data input process so that input errors do not occur. Increasing resources and providing facilities and infrastructure, especially for isolated areas in order to obtain COVID-19 vaccination services.