Law Enforcement of Health Protocols in Controlling The 2019 Corona Virus

The Coronavirus disease 2019 (COVID-19) is spreading rapidly and has become a worldwide pandemic labeled a public health emergency of international concern. Prevention efforts are carried out, among others, by limiting community activities and implementing health protocols both in public spaces and in the household domain. This study aims to determine the implementation of Deli Serdang Regent's Regulation Number 77 of 2020 concerning discipline and law enforcement of health protocols to control Corona Virus Disease 2019. This study implemented a cross-sectional design by collecting data using a questionnaire and documentation as the secondary data. The number of respondents was 156 people in Sunggal and Hamparan Perak sub-districts, which were taken using a simple random sampling method. The data were analyzed descriptively with George Edwards III's policy implementation approach. Based on the analysis results, it was found that the implementation of Deli Serdang Regent Regulation number 77 of 2020 was carried out in the form of implementing health protocols with a good category by 73.1% of respondents. The health protocol that is most often carried out masks. Factors related to the Deli Serdang Regent's Regulation implementation include policy communication, availability of resource support in the form of cross-sectoral coordination and budgeting, strong cross-sectoral commitment, and a clear bureaucratic structure at each implementation stage of the policies.


INTRODUCTION
The novel coronavirus was first discovered in Wuhan at the end of 2019 and has become a worldwide pandemic that has caused the disease currently known as coronavirus disease 19 (COVID-19) and has been designated an international health problem (World Health Organization, 2020).Since the first confirmed positive cases were found in Indonesia, the government has provided quick responses in dealing with this pandemic.
In the efforts to prevent and control the transmission of COVID-19, the Indonesian government has made various efforts to prevent the transmission of COVID-19.Prevention Several studies have shown that COVID-19 has had an impact on changes in people's lives, including changes in the provision of basic health and maternal health services (Saputri et al., 2020;Wijayanti et al., 2021).Other studies have also found changes in fertility planning in various countries in the Americas, Europe, and Australia during the COVID-19 pandemic (Kahn et al., 2021;Micelli et al., 2020;Qu, 2021).The most fundamental change that occurs in society is the obligation to practice efforts to prevent the transmission of COVID-19 by implementing health protocols (prokes) following the appeal of the world health agency which was later regulated by the Minister of Health of the Republic of Indonesia and followed by regional regulations.The implementation of health protocols includes the correct use of masks, proper practice of hand washing, physical distancing, as well as various provisions governing community movement and organizing activities in public spaces.
The rapid transmission of the disease during the COVID-19 pandemic caused anxiety and concern for both vulnerable groups (including pregnant women and the elderly) and the general public (Dewi et al., 2020;Media & Afriyani, 2020;Safitri et al., 2021).For example, a literature review indicates that during the COVID-19 pandemic, pregnant women experience concerns about the health of mothers and their children, which include concerns about whether or not prenatal care is being met, as well as feelings of isolation due to restrictions on activities outside the home (Purwaningsih, 2020).
Various research results related to the COVID-19 pandemic that has been carried out in Indonesia show that COVID-19 is associated with changes in the provision of health services (Saputri et al., 2020;Tristanti & Kulsum, 2020).In addition, the implementation of social distancing is considered a useful step in protecting vulnerable groups such as pregnant women, children, and the elderly (Pradana et al., 2020).Meanwhile, studies on policy analysis indicate that there is a delay in the government in providing policy responses in handling COVID-19 accompanied by people who are less concerned with the government's appeal (Agustino, 2020).Another study indicated an imbalance between anxiety and the behavior of the community in implementing COVID-19 prevention, hence suggesting that anxiety is not followed by the application of health protocols (Aritonang et al., 2020).Furthermore, research shows an insignificant relationship between that attitude toward COVID-19 and the preventive behavior (Dewi et al., 2020).
Based on the results of the Indonesian COVID-19 Data Analysis updated as of October 25, 2020, there were 62,649 confirmed COVID-19 cases in Indonesia, and 12,562 cases in North Sumatra Province, of which 1.3828 cases came from Deli Serdang Regency (Satuan Tugas Penganganan COVID-19, 2020a).Meanwhile, the results of research on efforts to prevent COVID-19 still show varied results, with research in Yogyakarta showing only 43% of people have good COVID-19 prevention behavior (Mujiburrahman et al., 2020).
To Given the importance of implementing health protocols as an effort to prevent disease transmission during a pandemic, it is necessary to conduct research on the implementation of the Deli Serdang Regent's Regulation through the application of health protocols during the COVID-19 pandemic, including through the application of health protocols, as well as the efforts undertaken in the implementation of the Regent's Regulation.

Research design
This study used a cross-sectional design using secondary data from the pregnancy during the COVID-19 pandemic survey conducted by the National Population and Family Planning Board (BKKBN) Representative of North Sumatra in November 2020.Data collection of the pregnancy during the COVID-19 pandemic was performed through interviews using a questionnaire in Sunggal Subdistrict and Hamparan Perak Subdistrict, Deli Serdang Regency, North Sumatra Province.Secondary data on law enforcement was collected through documentation studies (official reports and news from the website of the Deli Serdang Regency Government).

Participant Characteristics
The population of this study is 156 respondents of pregnancy during the COVID-19 pandemic survey.The total data of 156 pregnant respondents were obtained with permission from the BKKBN Representative of North Sumatra.

Data analysis
The variable analyzed in this study is the behavior of implementing health protocols under Deli Serdang Regent Regulation Number 77 of 2020 concerning the Implementation of Discipline and Law Enforcement of Health Protocols as an Effort to Control Corona Virus Disease 2019.The behavior of implementing health protocols studied consisted of implementation of health protocols for individuals (use of personal protective equipment in the form of masks; behavior of washing hands with soap with running water; behavior of limiting physical interaction (physical distancing) and avoiding crowds; and clean and healthy living behavior (PHBS).
Sociodemographic characteristics of respondents and implementation of health protocols are presented using descriptive statistics.(Putra & Khaidir, 2019).

RESULTS AND DISCUSSION
Table 1 shows the characteristics of respondents based on socio-demographic background.Of the 156 respondents, 62.1 percent of respondents are educated in upper secondary and almost 68 percent have health insurance.One in five respondent are working and only 20 percent of respondents have a monthly family income equivalent to the regional minimum wage.All respondents performed activities outside the home using personal vehicles.Table 2 shows the proportion of behavior in implementing health protocols during the COVID-19 pandemic.The table shows that the use of masks is the health protocol that is most often carried out with 77 percent of respondents always wearing masks when leaving the house.Meanwhile, hand washing is the most often neglected protocol, with around 10 percent of respondents claiming to have never washed their hands with soap and running water.Based on the behavior of implementing health protocols, there is 73.1 percent of respondents who implement the Deli Serdang Regent's regulation in an adequate category, while 23.7 percent of respondents implement the health protocol procedure in the moderate category, and there is still 3.2 percent of respondents who have not implemented all the health programs regulated in the Deli Regent's Regulation.Serdang No. 77 of 2020.This means that out of 4 respondents, there is one person who has not implemented health protocols properly.The proportion of respondents in implementing this health protocol is higher than in previous research which showed that only about 43.2 percent of respondents carried out good health procedures (Mujiburrahman et al., 2020).
The results showed that the most well-implemented health protocol by respondents was wearing a face-masks.This is in accordance with the results of a study conducted in Denpasar where the use of masks when doing activities outside the home is the thing that is most obeyed by pregnant women (Purnamayanti & Astiti, 2021).Previous studies have shown that the use of masks during a pandemic is an effective step in preventing the transmission of infectious diseases, including preventing the transmission of coronavirus infections (Y.Wang et al., 2021).The use of masks as an effort to prevent COVID-19 of course must be supported by the application of other health protocols including maintaining distance, avoiding crowds, and maintaining hand hygiene (J.Wang et al., 2020).
Implementation of Deli Serdang Regent Regulation.Based on the theory of policy implementation by George Edwards III (Mubarok et al., 2020), the implementation of a policy is influenced by several factors, including communication, resources, disposition and bureaucratic structure.
Communication.Based on the theory of policy implementation, the first factor that affects the effectiveness of a policy is determined with communication.
Communication is an effort to convey a message to be received by other parties with the aim that the content of the message is understood equally by both parties (Mubarok et al., 2020).Based on the results of the policy analysis study, the context of communication in the effort to implement COVID-19 prevention can be seen in the form of clear and consistent coordination between actors (Agustino, 2020).
In terms of communication, the implementation of Deli Serdang Regent Regulation number 77 of 2022 has been carried out adequately.This can be seen from the socialization activities of the regent's regulations carried out in various sub-districts which were carried out in coordination between the actors involved as mandated in the regulations.
Based on Deli Serdang Regent Regulation No. 77 of 2020, communication activities are carried out with communication forums for regional leaders and involve the participation of various elements of the community, religious leaders, traditional leaders, and the community.The results of the document search show that the implementation of the socialization activities for the Deli Serdang Regent's Regulation has been carried out in coordination with various related sectors, including involving elements of the Health Service, Koramil, Polresta, Transportation Service, and various elements of the community, accompanied directly by the sub-district leader (Dinas Komunikasi dan Informatika Deli Serdang, 2020c, 2020a).The coordination activities were carried out in various regions on various occasions, which means that the elements of communication and message are delivered accordingly.
Resources.Resources are an important element in supporting the achievement of goals.Therefore, in order for the objectives of a policy to be achieved effectively and efficiently, resource support must be balanced with appropriate materials, facilities and approach methods.According to the Van Metter Horn model, human resources are the most decisive resource in addition to other resources such as finance and time (Sutmasa, 2021).This means that in carrying out a policy implementation, resources must focus on the capacity and competence of the implementer in accordance with the authority of each actor so that the implementation of functions and roles can be carried out properly (Agustino, 2020).
Deli Serdang Regent Regulation No. 77 of 2020 has regulated that the necessary financing is charged to the Regional Revenue and Expenditure Budget.As is known, the implementation of a policy must be supported by the financing (Putra & Khaidir, 2019).The resource structure that is adapted to its capacity can increase the effectiveness of the use of available information and facilities (Sutmasa, 2021).In addition to financial support, there is also support for personnel as implementers who come from various elements of society as described in the communication element.
Disposition.Disposition relates to the characteristics of the implementor in carrying out a policy (Putra & Khaidir, 2019).In addition, the disposition of appropriate policies is also influenced by the bureaucracy (personnel and institutions) and the incentives obtained.Disposition concerns the attitude of the implementer which must be parallel and accepting of the public policy itself (Sutmasa, 2021).In terms of disposition, the implementation of Deli Serdang Regent Regulation no.77 of 2020 can be grouped by the presence of two elements supporting the enforcement of discipline.In terms of disposition, the implementation of the regulation is an urgent matter, the implementation of which is focused and carried out simultaneously in various regions.Based on the placement of dispositions, the enforcement of discipline based on the Deli Serdang Perbup No. 77 of 2020 is carried out with a context-appropriate approach, with incentives in the form of sanctions imposed when the health protocols regulated in Deli Serdang Regulation No. 77 of 2020 are not implemented.
In implementing the regent's regulations, judicial operations are carried out as a form of sanctions for people who do not comply with health protocols.In accordance with the activity report on the Deli Serdang Regency government website, socialization activities for Perbup No. 77 in various crowded areas on a sub-district basis, including markets and major intersections, and health protocol disciplinary operations were carried out as a monitoring effort.For example, on June 23, 2020, the COVID-19 Task Force Team conducted a health protocol socialization activity at the Ujung Purba Village Office, Bangun Purba sub-district, which was accompanied by a simulation of the disciplinary enforcement (Dinas Komunikasi dan Informatika Deli Serdang, 2020b).As another example, the implementation of Perbub 77 was carried out in the form of a judicial operation in Delitua District on September 26, 2020, there were still residents who did not comply with the health protocol, and therefore as many as 48 residents consisting of street vendors and community members who were caught were given written sanctions (Dinas Komunikasi dan Informatika Deli Serdang, 2020c).
The imposition of strict sanctions and the attitude of the implementers in enforcing the rules are fundamental, especially in situations that are important and urgent.In accordance with public policy theory, to realize the objectives of an action plan, the implementation of a policy program must be escorted by everyone involved.Furthermore, it is necessary to evaluate the implementation of a policy, because the policy without being accompanied by an evaluation with rewards will cause public policy to be limited to an appeal (Sutmasa, 2021).
Bureaucratic Structure.The bureaucratic structure is an important component in implementing a policy.A long bureaucratic structure will create a long command process, while a centralized bureaucratic structure can make it easier to command, especially on things that are important and urgent (Agustino, 2020).The performance of the bureaucratic/organizational structure needs to be directed towards the existence of SOP (standard operating procedure) and fragmentation of authority.By Deli Serdang Regent Regulation No. 77 of 2020, bureaucratic arrangements have been made under clear authorities and responsibilities.This is under the theory of policy implementation which states that fragmentation of authority needs to be carried out by spreading the responsibility for the activities or activities of each implementing unit among several work units (Sutmasa, 2021).
Deli Serdang Regent Regulation No. 77 of 2020 and Implementation of Prokes Enforcement.Based on behavioral determinants, knowledge is generally a driving factor for someone to take an action (Pakpahan et al., 2021).The study in Yogyakarta showed a significant relationship between knowledge and efforts to prevent COVID-19 (Mujiburrahman et al., 2020).This is in line with the results of research conducted in Semarang which showed that there was a strong and unidirectional relationship between knowledge and efforts to prevent COVID-19, which means that the better the level of public knowledge, the better the prevention efforts (Suryaningrum et al., 2021).The same indication was also found in North Luwu Regency where studies showed that there was an effect of knowledge on pregnant women's adherence to the COVID-19 health protocol at the Bone-Bone Health Center (Sarah et al., 2021).
The level of knowledge is influenced by the level of education, information received, and access to information.The relationship between knowledge and the application of health care is very likely to be influenced by perceptions and attitudes about the disease, as well as perceptions and attitudes regarding the need for the application of health care in disease prevention.Research on pregnant women in Denpasar shows that attitudes have a positive significant correlation with maternal compliance with masks (Purnamayanti & Astiti, 2021).With outreach activities regarding the importance of enforcing health protocols, supported by simulations of enforcement of health protocol disciplines, the public will be more exposed to information.
In addition, the character of the community still shows the need for sanctions to be imposed if a disciplinary violation is committed because people are still ignorant of the rules.This is following the results of the study of the relevance of legal sanctions where it was found that based on legal norms there is still a void in the legal regulations related to COVID-19 violations because the existing regulations do not specifically regulate the obligation to implement the COVID-19 health protocol, as well as legal sanctions regulated in the regulations.currently in force is still an administrative sanction (Sari et al., 2022).Therefore, it is necessary to give sanctions that provide a deterrent effect (Doly, 2021).However, administrative sanctions do not always affect the implementation of regulations.For example, the implementation of social sanctions for violations of health protocols in Sukabumi City has shown an effect in decreasing the number of violations (Diskominfo Kota Sukabumi, 2020).

LIMITATION OF THE STUDY
The study was limited to the availability of the data on law enforcement and health protocols monitoring which was published and documented by the COVID-19 task force (Gugus tugas penanganan COVID-19).Therefore, further research and documentation are needed for a better evaluation.

CONCLUSIONS AND SUGGESTIONS
The study found that the implementation of Deli Serdang Regent Regulation no.77 of 2020 was performed adequately by 73.1% of respondents, while around three percent of respondents have not implemented the health protocol.The health protocol that is most often carried out is wearing face masks.Factors related to the implementation of Deli Serdang Regent Regulation no.77 of 2020 include policy communication, availability of resource support in the form of cross-sectoral coordination, strong cross-sectoral commitment, and a clear bureaucratic structure in each stage of implementing the established policies.
The results of this study can be used as evaluation material regarding the implementation of public policies and legal products produced in an effort to control Corona Virus Disease 2019.So that some recommendations can be derived from this research; 1. Supervise and control the public in the implementation of public policies and legal products others that regulate the community to continue to comply with health protocols.
2. Conducting socialization and education as well as communication-related to policies in providing correct understanding to the public.
3. Strengthening resources by conducting cross-sectoral coordination and cooperation that also involves the community so as to realize the effectiveness of the implementation and enforcement of regulations and policies.
In addition, the results of this study can also be used as documentation for further planning and policy making.
efforts are carried out, among others, through Government Regulation number 21 of 2020 on March 31, 2020 (Peraturan Pemerintah Nomor 21 Tahun 2020 Tentang Pembatasan Sosial Berskala Besar Dalam Rangka Percepatan Penanganan Corona Virus Disease 2019/COVID-19, 2020) which regulates various efforts to limit activities both in public and at work.Furthermore, on April 13, 2020, the Government also issued Government Regulation Number 12 of 2020 concerning the Designation of Non-Natural Disasters that Cause Corona Virus Disease 2019 (COVID-19) as a National Disasters (Keputusan Presiden Republik Indonesia Nomor 12 Tahun 2020 Tentang Penetapan Bencana Nonalam Penyebaran Corona Virus Disease 2019 (Covid-19) Sebagai Bencana Nasional, 2020), which was followed up by the Decree of the Minister of Health of the Republic of Indonesia Number Hk.01.07/Menkes/328/2020 concerning Guidelines for Prevention and Control of Corona Virus Disease 2019 (Covid-19) in the Workplace Offices and Industry in Supporting Business Continuity In Situation Pandemic (KEPUTUSAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR HK.01.07/MENKES/328/2020TENTANG PANDUAN PENCEGAHAN DAN PENGENDALIAN CORONA VIRUS DISEASE 2019 (COVID-19) DI TEMPAT KERJA PERKANTORAN DAN INDUSTRI DALAM MENDUKUNG KEBERLANGSUNGAN USAHA PADA SITUASI PAND, 2020).All of the above prevention efforts are carried out with the aim that the implementation of the Health protocol can be carried out by the entire community.
implement Presidential Instruction Number 6 of 2020 and Instruction of the Minister of Home Affairs Number 4 of 2020, the Regent of Deli is setting a Regent Regulation on the Implementation of Discipline and Law Enforcement of Health Protocols as an Effort to Control Corona Virus Disease 2019 on August 13, 2020, through Deli Serdang Regent Regulation number 77 of 2020 (PERATURAN BUPATI DELI SERDANG NOMOR 77 TAHUN 2020 TENTANG PENERAPAN DISIPLIN DAN PENEGAKAN HUKUM PROTOKOL KESEHATAN SEBAGAI UPAYA PENGENDALIAN CORONA VIRUS DISEASE 2019, 2020).Data on the monitoring report for the health protocol compliance of Deli Serdang Regency on August 5 -August 11 2020 shows around 29% of people wear no masks, and there are 33.6% of people do not keep their distance (remain in crowds) (Satuan Tugas Penganganan COVID-19, 2020b).