Ambiguity in the Policy Implementation of the No-Smoking Area: Evidence from Indonesia

The ambiguity in the implementation of the No-Smoking Area (NOSAR) public policy is a topic of discussion among people occasionally, along with the underlying perspective of its users (smokers). This article explains the implementation of the NOSAR policy. Qualitative research methods with a phenomenological approach were used to reveal the meaning behind the facts of implementer and smoker behavior. The data collection technique is through observation at the locus where markers or writing are placed that inform about the prohibition of smoking. Apart from that, in-depth interview techniques were used with informants, both policy implementers and active smokers and passive smokers, while exploring documents regarding regulations regarding NOSAR in Bekasi City Government agencies, Indonesia. The data analysis follows an interactive model: data collection, condensation, data presentation, and verification/conclusion. The results of the research found that the implementation of the NOSAR policy in the City of Bekasi has been implemented effectively. However, there are still various obstacles found in the context of its implementation, including a lack of proportional human resources and funds for implementing regional regulations, a lack of coordination between agency leaders and employees, the implementation of trials Justice for NOSAR violators is limited to giving verbal warnings and no administrative sanctions have been given, so that violations of the rules in the NOSAR are still often found.


INTRODUCTION
Smoking is still a problem that cannot be ignored in Indonesia.Based on the 2007-2018 basic health survey, it was found that the prevalence of e-smokers aged 10-18 years had increased significantly since 2016 it was recorded from 1.2 to 10.9 percent in 2018.In 2018 the prevalence of smokers aged > 10 years was 28.1 percent of the total population in Indonesia (Kementerian Kesehatan Republik Indonesia, 2018).Apart from that, the World Health Organization (WHO, 2020) estimates that there are 1.3 billion people in the world who consume tobacco products and one of the products of tobacco products is cigarettes.
The results of the Global Youth Tobacco survey state that the prevalence of smoking among children aged >10 years is occupied by China, India, and Indonesia, where Indonesia is in third place among all countries in the world.The results of this survey are strengthened by the research results of Ayedi et al. (2022) that Tunisia is currently not in a good position.Tobacco prevalence is alarming, youth have free access to tobacco products and smoke-free regulations are only The health hazards caused by smoking do not only come from the toxic ingredients in a cigarette but also from the smoke from cigarettes that are burned and inhaled and then released by active smokers.The identification results in cigarette smoke contains more than 4,000 chemicals and more than 50 of them are known to cause cancer (WHO, 2020).This is reinforced by the research results of Farrell et al., (2022) that these findings point to one such potential category of major health difficulties, namely an increased risk of mental health problems.In the case of SHS, smoking ban policies significantly reduce major depression risk among those who have never been smokers.The findings reported in this paper indicate the marked need for further investigation of the safety profile of e-cigarette emission exposure, and whether smoking ban policies should be extended to cover e-cigarettes, particularly in environments where vulnerable populations, including children, pregnant women, and those with chronic health conditions are likely to be exposed.
Exposure to tobacco in early childhood not only creates lifelong smokers but can also contribute to stunting and stunting children's growth (WHO, 2020).The condition of children's immune system which is still weak compared to adults causes children to be easily affected by air pollution so the habit of parents smoking around their children influences the incidence of acute respiratory infections in toddlers (Jayanti, 2016).It is best if someone in the family is an active smoker to avoid smoking in front of children because children are very vulnerable to the dangers of cigarette smoke.This is reinforced by the research results of Nian et al., (2023) that these findings have important implications for informing the design of pictorial HWLs.They may address China-specific culture and challenges, better educate the public about individual and collective harms of tobacco products, and alter social norms regarding smoking in China.It is also possible they may help prevent never and former smokers from initiating cigarette use and encourage current smokers to plan to quit or think about quitting.In addition, smokers may become more concerned about smoking near family and children and more likely to comply with smoke-free laws.Smokers and non-smokers may also be less likely to gift cigarettes.
One effort to control exposure to cigarette smoke is by establishing a No-Smoking Area (NOSAR).NOSAR has been attempted a lot by various parties, government and private institutions, and the public.Still, in reality, the efforts made are far behind compared to sales, advertising/promotion, and use of cigarettes.
In reality, smoking imposes a physical and economic burden on other people as well.This burden includes the risk of other people being exposed to cigarette smoke in the surrounding environment and the costs imposed on society for health services.So that these problems and conditions can be controlled, efforts need to be made to limit the movement of smokers and safeguard against the dangers of smoking through the establishment of NOSAR which the government should carry out.
As a form of government concern for health and anticipating the negative impacts of smoking, this was realized by passing regional regulations concerning NOSAR.This regulation is expected to reduce air pollution and protect non-smokers from being exposed to cigarette smoke from other people (passive smoking).In reality, policies regarding NOSAR in various regions in Indonesia, including in the city of Bekasi as the locus of this research, at first glance do not appear to be completely effective in reducing the number of smokers, especially when seen from the following data: Diagram 1 provide an overview of the fluctuations in the number of people who smoke over the last two years.There has been a significant increase in the number of smokers in the productive age population (25-44 years).This may indicate that the NOSAR policy has not been fully implemented well in society.
The concept of policy implementation is a series of stages in the policy process (Howlett, 2019;Hupe & Hill, 2016), and is a crucial stage that determines the direction and objectives of a policy.The implementation stages need to be well prepared at the formulation or policy-making stage because mistakes in planning mean planning mistakes in implementation.Conceptually, implementation is a process of gathering resources (natural, human, and financial) followed by determining the actions that must be taken to achieve policy goals (Howlett, 2019).A series of actions is a form of transformation of the formulation decided in the policy into operational patterns that will bring about changes as mandated in the agreed policy.The essence of implementation is understanding what must be done after the policy has been decided involving all existing stakeholders.Policy implementation is not only limited to the actions or behavior of the agency responsible for implementing the program and generating compliance from the target group but extends to the network of socioeconomic and political forces that influence the behavior of all parties involved (A.R. Khan & Khandaker, 2016).Policy implementation can be seen to have both expected and unexpected impacts (Hornibrook, 2012;Guo, Xiao, and Song, 2020).This also illustrates that the implementation of a policy does not always run well, but there may be various obstacles, problems, or failures to achieve the goal (Ali, 2006;Hudson, Hunter, and Peckham, 2019;Selepe, 2023).Suppose a policy is not conditioned in such a way as mentioned above, of course.In that case, the policy can fail or be ineffective in its implementation, meaning that the policy objectives are not achieved.
The No-Smoking Area (NOSAR) policy is a policy program in the health sector to fulfill every individual's fundamental rights, which are stated globally in the Constitution of the World Health Organization.A healthy environment is the right of every individual.Every person in this world certainly longs for the environment where he lives to be healthy and comfortable.Health is an important element of human needs.Unhealthy environmental conditions can automatically affect individuals in that environment, so it is no longer surprising that recently there have been many diseases or health problems in society.
One of the factors that causes health problems is an unhealthy lifestyle or lifestyle.A healthy lifestyle greatly influences a person's physical condition.One of the unhealthy lifestyle patterns that is increasingly common is smoking.This unhealthy lifestyle touches almost all groups, from old, young, poor, and rich, and has even become a common thing, especially in big cities, where women are active smokers.Smoking has become a widespread habit in communities throughout the world, but people rarely recognize this smoking habit as a bad habit.
It is hoped that smoking activities in government agencies will no longer occur because the Bekasi City Government has issued regulations concerning NOSAR.NOSAR in the general provisions of the regulation is a place or area that is prohibited from smoking, selling, advertising, or promoting cigarettes.The local government hopes that, through the implementation of this regional regulation, it can protect non-smoking residents from being exposed to cigarette smoke from smokers, and provide residents with a healthy and comfortable space and environment directly and indirectly.
Experts (Ali, 2006;Howlett, 2019;Hudson et al., 2019;A. R. Khan & Khandaker, 2016;Selepe, 2023) agree that for policies to be implemented well, they should be designed by an appropriate frame of reference and theory, based on the existence of a correlation between the policy and its implementation, there is an organization that accommodates its implementation so that the implementation process can run well, socialization of policies that will be implemented to the lowest level implementing organizations (street level bureaucracy) is carried out, continuous monitoring is carried out and the policy and its implementation are given equal weight.This means that policy-makers assess the importance of the policy and its implementation so that the policy is equal and in its implementation, there are no gaps that make it difficult to implement.Thus, the implementation process only begins when the policy objectives have been determined.
The Bekasi City government policy contains various rules that regulate smokers not to smoke in certain places that have been designated as no-smoking areas along with sanctions imposed if they violate them.The dictum of this regulation also includes the aim of enforcing this regulation as an effort to reduce the number of cigarette consumers (smokers) in the area and to overcome air pollution in Bekasi which is currently out of control.

METHOD
This type of qualitative research with a phenomenological approach (Eberle, 2014;S. N. Khan, 2014) describes, analyzes, and explains public service policy innovations in improving people's quality of life.This phenomenological approach can provide detailed and extensive information and knowledge about public service innovation through the implementation of the No-Smoking Area (NOSAR) policy.Data, information, and knowledge were collected using observation techniques (Priya, 2017) at the research locus while conducting in-depth interviews with several selected informants (Sholokhova, Bizzari, and Fuchs, 2022), both NOSAR policy implementers and active and passive smokers.Also, collect documentation data supporting the results of observations and interviews.The data was analyzed following the stages of the interactive model (Matthew, Huberman, and Saldana, 2014), namely data collection, condensation, data presentation, and verification/conclusion.

Results
The results of this research explain the content of public policy based on the implementation of Bekasi City Government Regulation Number 15 of 2019 concerning No-Smoking Areas (NOSAR).The indicators include the interests affected, benefits, degree of change expected, location of decision-making, program implementation, and resources involved as described in the following research results.
Influenced interests.The reality at the research locus in Bekasi City is related to various interests that support and hinder policy implementation or cover the interests of the target group.This policy is contained in regional regulations concerning NOSAR.Specifically, the government agency locus contains the interests of target groups which include, among other things, protection of those who do not smoke; creating a clean and healthy environment; controlling active smokers in places where smoking is permitted, and not prohibiting smoking.This regulation aims to educate the public and straighten out the understanding that everyone has the human right to breathe clean air so smokers must be orderly and know where their cigarettes are.There are at least four target group interests that influence the implementation of these regional regulations, especially in government agencies, namely the interests of active smokers, the interests of passive smokers (consisting of employees and the community who receive services within Bekasi City government agencies, the interests of government agency leaders, and the interests of implementers NOSAR policy. A summary of the results of interviews with informants representing active smokers stated that as active smokers who received indoor services in Bekasi City government agencies, they knew the regulations regarding NOSAR in this city from the stickers affixed at the entrance to government agencies.Previously, several smokers had been reprimanded by employees for smoking indoors and then told about the smoking ban.If they do not comply with these rules then they will not be served.After receiving the warning, immediately put out your cigarette before entering the room.(Interview, April 2024).
Meanwhile, a summary of the statements of informants representing passive smokers agrees that as passive smokers who receive indoor services within the Bekasi City government agency, they strongly support the issuance of the Regulation on NOSAR, so that people who smoke (smokers) do not just practice their habit in any place.They said, neither of us nor we smoke, so of course it would be very disturbing if we inhaled cigarette smoke, especially indoors (Interview: April 2024).
Even though the target group's acceptance of the policy or rule is clear, there are also different opinions.The informant stated that initially, they did not agree with the existence of regulations regarding NOSAR in Bekasi City, especially those that prohibited smoking in the workplace.Their reason is that cigarettes are needed to remain productive, to maintain performance at work, especially after a break (lunch) so as not to feel sleepy and cigarettes can eliminate sleepiness, likewise, cigarettes are needed when working overtime and cigarettes are a loyal friend who accompanies you when you are alone (Interview: April 2024).
It is known that the regulations regarding NOSAR include the interests of target groups and foster participation from agency leaders, employees, and the people of Bekasi City.Participation means that there is a willingness of the agency leadership to prohibit the provision of smoking areas in the building, prohibit the provision of cigarettes, including selling or promoting them, and so on.
Benefit.Consistent with the interests influenced by the NOSAR policy, it is clear that this regulation is very useful and has a positive impact on creating a healthy and clean environment free of cigarette smoke.The results of interviews with several informants stated that the benefits of regional regulations regarding NOSAR are for health, both your health and the health of others; passive smokers avoid the dangers of cigarette smoke; and create a comfortable workplace environment because the air is clean from cigarette smoke pollution.(Interview: April 2024).
Based on the results of the interview, it is understood that the benefits of the NOSAR policy include, among other things, the creation of NOSAR, especially in government agencies, so that the environment in public service areas is comfortable for everyone because the air is clean from cigarette smoke pollution.Increase public awareness not to smoke in NOSAR, especially in government agencies.Thus, the implementation of regional regulations regarding NOSAR has an impact on reducing the number of smokers and improving public health.
The degree of change expected.The indicators used to measure the level of success of policies regarding NOSAR in Bekasi City government agencies are illustrated in the results of observations and interviews.Observations were made to see people smoking, special rooms for smoking, signs prohibiting smoking, the smell of cigarette smoke, the provision of ashtrays and lighters, cigarette butts in the building, as well as indications of collaboration with the tobacco industry.Meanwhile, interview indicators include knowledge of NOSAR policies, support, and implementation of regional regulations by building managers and office leaders who know that they will be subject to sanctions if they do not comply with NOSAR rules.Thus, the degree of change that was expected was proven due to reduced violations of NOSAR regulations in Bekasi City.
Location of decision making.Observation results show that the location for decisionmaking is determined by the implementer, namely the Bekasi City Government through the Health Service and the Civil Service Police Unit, involving leaders and employees of government agencies, as well as the Security Unit.The supervisory team, in this case the Civil Service Police Unit, supervises and takes action against violations.Meanwhile, the Health Service provides education/socialization about NOSAR, helping to issue no-smoking stickers which must be affixed in NOSAR areas even though these stickers are often removed by irresponsible individuals.The Health Service provides stickers for free and can be reproduced by yourself to be pasted in strategic locations in the NOSAR.This reality is to the conclusions of interviews with several informants that the Bekasi City Health Service supervises and the Civil Service Police Unit acts as a Law Enforcement Team.Meanwhile, in government agencies, Internal Supervisors or Law Enforcement Teams have been that coordinate with agency leaders based on mutual commitment.In other words, regional regulations regarding NOSAR have been implemented based on the actor's commitment (Interview: April 2024).
Program implementation.The implementation of this program is supported by the presence of competent individual and institutional actors in overseeing the policy.This has been well recorded, because the policy mentions its implementers in detail, both from government elements and community groups.
Resources involved.In reality, the resources involved in implementing the NOSAR policy in Bekasi City include the NOSAR internal supervisory team where each internal supervisory team is given training in internal supervision and NOSAR law enforcement.If it is carried out in a government agency, the training provided will be employees and security officers for internal supervision at that location, because neither the Health Service nor the Civil Service Police Unit can cover the entire NOSAR area at any time.Based on the results of interviews with several informants, it was stated that internal monitoring in this government agency had not been fully implemented, because the level of awareness of employees and the public to comply with NOSAR regulations was still low.(Interview: April 2024).
Based on the results of this research (Hafied, 2024), it is understood that to realize the enforcement of regional regulations regarding NOSAR, an Internal Supervisory Team has been formed in government agencies that previously received training in internal supervision and enforcement of NOSAR laws.The team is a security officer tasked with carrying out surveillance at the location.In reality, internal supervision in government agencies has not been fully implemented, because the level of awareness of employees and the public receiving services is still low.

Discussion
The implementation of the policy on No-Smoking Areas (NOSAR) in Bekasi City has illustrated a multi-actor and stakeholder approach, but its implementation has not been optimal.Implementing policies is not easy, because apart from being influenced by the nature of the policy, it is also very much determined by environmental factors or the policy context, as Merilee S. Grindle views.Implementation also involves many policy actors, giving rise to complexity in the implementation stage which is not only due to the many policy actors involved, but also the many variables involved in it.
Academically, the implementation model currently used in the NOSAR policy in Bekasi City is the model introduced by Merilee S. Grindle.It is known that this Grindle model has almost similar aspects to the Van Meter and Van Horn models.The same aspect is that both the Van Meter and Van Horn models and the Grindle model include environmental elements (context) of policies as factors that influence their implementation.Van Meter and Van Horn include social, political, and economic conditions as factors that influence policy implementation, while Grindle includes large variables or dimensions, namely the dimensions of the policy context or policy environment.The advantage of the Grindle model in policy environment variables is that this model focuses more on the politics of policy actors.
The first element of the environmental variable, namely power, interest, and strategies of actors involved, explains that the content of the policy is greatly influenced by the political map of the policy actors, thus the phenomenon of NOSAR policy implementation is full of various internal and external environmental factors that influence it, so it is considered "ambiguous" or has a double meaning both in terms of the perceptions of policy implementers (actors) and service recipients in Bekasi City government agencies as the locus of this research.
In this case, stakeholders or policy-determining actors try to place their interests in policies that involve their interests so that their interests can be accommodated in the content of the policy and its implementation.The second element of Grindle, namely institution and regime characteristics, and the third element, namely compliance and responsiveness, have similarities with the disposition factor (implementing attitude) from the Edwards III model (Setyawan et al., 2021).The second element (characteristics of institutions and regimes) is explained by experts and researchers (Ali, 2006;Howlett, 2019;Hudson et al., 2019;A. R. Khan & Khandaker, 2016;Selepe, 2023) that the implementation of a program can cause conflict among groups whose interests are influenced, as is the phenomenon seen in the implementation of the NOSAR policy at the research locus.
The third element of environmental variables from the Grindle model, namely compliance and responsiveness, apart from referring to disposition.The difference with the Edwards III model in this case is that Grindle focuses on the disposition of the ruler/regime/policy maker, while Edward places more emphasis on the disposition of the implementer.In fact, the implementation of NOSAR program policies, is by the views of experts and researchers (Ali, 2006;Howlett, 2019;Hudson et al., 2019;A. R. Khan & Khandaker, 2016;Selepe, 2023) that the process of selecting alternatives that satisfy implementers and target groups of policy programs is objective and subjective because it is influenced by disposition factors, as in the view of Edwards III (1980), or according to the compliance and responsiveness (Grindle, 1980) of policy formulators.Apart from the disposition aspect, compliance and responsiveness also refer to the political aspect because policies are born from the political process of public policy (Smith & Akib, 2015).
Several experts and researchers (Ali, 2006;Howlett, 2019;Hudson et al., 2019;A. R. Khan & Khandaker, 2016;Selepe, 2023) agree by stating that without sufficient responsiveness and acceptability in the implementation of program policies, implementors lose actual information and knowledge to evaluate program achievements and lose support (acceptance of program target groups) which is important as a key success factor.its implementation.
Political involvement in this element seems to still be related to the first element which mentions factors/elements of power, interests, and strategies of actors, because if an issue involves the interests and interests of policymakers and/or policy implementers, then the responsiveness of policymakers and implementers should be also higher.This theoretical assumption is real because there are also NOSAR policy actors or stakeholders who like to smoke (active smokers) and the majority of employees as public servants or people who receive services in public agencies in Bekasi City are passive smokers.Regarding the content or policy content variable, Grindle also views that policy implementation still involves political aspects -actor interests.In the first to fourth elements, namely interest affected, type of benefits, extent of change envisioned, and site of decision-making, it can be seen that the role of politics is still strong in the locus of this research.As an example of the first element, experts and researchers (Ali, 2006;Howlett, 2019;Hudson et al., 2019;A. R. Khan & Khandaker, 2016;Selepe, 2023) state that the type of public policy can have a sustainable impact on various types of political activities, such as cigarette companies sponsoring various activities in Bekasi City and various regions in Indonesia.In other words, the role of politics can still be traced to the second to fourth elements in the dimensions of the policy implementation context.
On the policy content variable, Grindle also has similar views with Edwards III as well as Van Meter and Van Horn.In the fifth element, namely program implementors, it is stated by experts and researchers (Ali, 2006;Howlett, 2019;Hudson et al., 2019;A. R. Khan & Khandaker, 2016;Selepe, 2023) that the ability of program implementers will influence the success of its implementation at a particular locus.This is to the resource factors proposed by Edwards III as well as Van Meter and Van Horn, where it is seen that various resources are involved in implementing the NOSAR policy at the research locus.It is further seen that Grindle differentiates the power source of the Edwards III as well as the Van Meter and Van Horn models.The sixth element, namely committed resources, is stated by experts and researchers (Ali, 2006;Howlett, 2019;Hudson et al., 2019;A. R. Khan & Khandaker, 2016;Selepe, 2023) as a manifestation of the availability of adequate resources in implementing policies, even though in fact in this research locus there are still obstacles and limited resources in implementing NOSAR policies.Thus, the two elements (fifth and sixth) of the Grindle model, even though they are considered the same as resource factors, as stated by Edwards III and Van Meter and Van Horn, the phenomenon at the research locus in Bekasi City is that there is a visible difference between resources in the form of resources.human resources (HR) and non-HR are equally limited in supporting the implementation of NOSAR program policies.
Based on the discourse and research results, the implementation model that is considered relevant in the analysis of NOSAR policy implementation in Bekasi City is the Grindle Model because it focuses more on the politics of policy actors.Apart from that, there is an element of compliance and responsiveness as the third element in the implementation context, because it is the research focus that analyzes the implementation of NOSAR policies in Bekasi City government agencies.Obedience means being obedient, obedient, submissive, and obedient to teachings and rules.Therefore, determinants as factors that influence people's behavior to obey according to Green (1999) are predisposing factors, supporting factors, and reinforcing factors.Meanwhile, according to Smet (1994), the factors that influence compliance are communication, knowledge, and supporting facilities.Meanwhile, factors that influence compliance according to Niven (2002) are individuals, family support, social support, and officer support.If it is related to the implementation of the NOSAR policy within Bekasi City government agencies, it can be stated that this policy is aimed at meeting the requirements in the form of responsiveness, accessibility, and acceptability of target groups, actors, and stakeholders in its implementation.
Based on the results of the policy implementation analysis, it can be seen that there is ambiguity in the views of actors, stakeholders, and experts regarding the implementation of the NOSAR policy which at the same time reflects the complexity, urgency, and significance of discussing this issue according to the content, context, and infrastructure of policy implementation, as in the view of Akib & Tarigan (2008).Here are some aspects of this ambiguity: Policy effectiveness in the long run versus the short run.Several experts state that NOSAR is effective in the short term for reducing exposure to cigarette smoke and changing smoking behavior in public places.For example, research from the American Journal of Public Health (2021) shows a significant reduction in exposure to cigarette smoke in areas that implement NOSAR.However, long-term effectiveness is still debated.A study from Health Policy (2020) states that without sustained efforts, such as public education and strong law enforcement, the positive effects of NOSAR may diminish over time.
Economic impact of policy implementation.Several studies, such as those published by researchers (DeCicca et al., 2022;Sahadewo et al., 2021), emphasize that the economic impact of NOSAR can be neutral or even positive, with reduced long-term health costs and increased work productivity due to better public health.In contrast, Donthu and Gustafsson (2020) reported that some businesses, especially in the hospitality and entertainment sectors, reported a decline in revenue as customers who smoke felt uncomfortable with these restrictions.
Enforcement and compliance of target groups for policy implementation.According to the World Health Organization (WHO, 2020), strong law enforcement and public education campaigns can ensure high compliance with NOSAR, especially in countries with strong legal systems.However, Flor et al., (2021) note that in many developing countries, weak law enforcement and corruption hinder the implementation of NOSAR, thereby reducing the effectiveness of these policies.
Social and cultural resistance in policy implementation.Some experts argue that with an inclusive and participatory approach, social and cultural resistance to NOSAR can be overcome.A case study by Flor et al., (2021) shows that collaboration between the government and local communities can increase NOSAR acceptance.However, cultural resistance remains a major challenge.Znyk, Jurewicz, and Kaleta (2021) show that in communities with a strong smoking culture, NOSAR often faces strong resistance and takes a long time to be fully accepted.
Technology implementation.The use of technology, such as reporting applications and air quality sensors, is considered to be able to improve monitoring and enforcement of NOSAR, as suggested in the Global Tobacco Surveillance System/ GTSS (Warren et al., 2009).Namun, Ellul (2021).However, Technology in Society (2021) points out that this technology is often expensive and difficult to implement in countries with limited resources, so its effectiveness is uneven.
The ambiguity in the implementation of the policy shows that although many experts agree on the potential benefits of NOSAR, its implementation is highly dependent on local context, including economic, social, cultural, and institutional factors.Successful implementation of the NOSAR policy requires an approach that is adapted to the specific conditions in each region or locus, especially because the saying is true that "another pasture is another back."

CONCLUSION
The implementation of the smoke-free area policy in Bekasi City is not enough if analyzed through a policy implementation model formulated based on the implementation model from Marilee S. Grindle which consists of policy content, implementation context, and policy results, but it is also necessary to pay attention to the factors that influence behavior.Public health includes predisposing factors, enabling factors, and reinforcing factors, as recommendations.Furthermore, it was concluded that the implementation of the NOSAR policy in Bekasi City government agencies had been implemented, but various obstacles were still found in the context of its implementation, including a lack of human resources and funds for implementing the regulation, a lack of coordination between agency leaders and employees and the implementation of judicial hearings for NOSAR violators which were only limited to given a warning, no one has been given administrative sanctions, so violations are still found in the NOSAR.