puskesmas & posyandu - website staff...

PUSKESMAS & PUSKESMAS & POSYANDUPOSYANDUSaptawati BardosonoSaptawati Bardosono

PUSKESMASPUSKESMAS

Pusat Kesehatan Masyarakat or primary health Pusat Kesehatan Masyarakat or primary health care centercare center

Functional organization that provides health Functional organization that provides health services:services: ComprehensiveComprehensive IntegratedIntegrated For all agesFor all ages AcceptableAcceptable Affordable Affordable and supported by community participation and supported by community participation

PUSKESMAS - PolicyPUSKESMAS - Policy

Puskesmas is an operational unit that has to perform Puskesmas is an operational unit that has to perform health development operational task in sub-district level health development operational task in sub-district level

Vision: To achieve healthy community at sub-district Vision: To achieve healthy community at sub-district level to be able to reach Healthy Indonesia 2010level to be able to reach Healthy Indonesia 2010

Mission: Mission: Encourage people to practice clean and healthy lifestyleEncourage people to practice clean and healthy lifestyle Increase intersectoral cooperation in health aspectsIncrease intersectoral cooperation in health aspects Increase working disciplinary and health staffs performanceIncrease working disciplinary and health staffs performance Sustain and increase the health service standard Sustain and increase the health service standard

PUSKESMAS - PolicyPUSKESMAS - Policy

Puskesmas is an operational unit that has to perform Puskesmas is an operational unit that has to perform health development operational task in sub-district level health development operational task in sub-district level

Vision: To achieve healthy community at sub-district Vision: To achieve healthy community at sub-district level to be able to reach Healthy Indonesia 2010level to be able to reach Healthy Indonesia 2010

Mission: Mission: Encourage people to practice clean and healthy lifestyleEncourage people to practice clean and healthy lifestyle Increase intersectoral cooperation in health aspectsIncrease intersectoral cooperation in health aspects Increase working disciplinary and health staffs performanceIncrease working disciplinary and health staffs performance Sustain and increase the health service standard Sustain and increase the health service standard

Puskesmas coverage:

Based on sub-district area or number of population? Why?

PUSKESMAS - FunctionsPUSKESMAS - Functions

1.1. Center for development program for Center for development program for health, health,

2.2. Center for community and family Center for community and family empowerment in health program and empowerment in health program and

3.3. Center for primary health servicesCenter for primary health services


1.1. Center for development program for Center for development program for health, health,

2.2. Center for community and family Center for community and family empowerment in health program and empowerment in health program and

3.3. Center for primary health servicesCenter for primary health services

Puskesmas functions:

How to manage the activities to meet all of its functions? Manpower needed?


Function for medical techniquesFunction for medical techniques Function for human resource skills that could Function for human resource skills that could

organize community social modality:organize community social modality: Finding the social modality provided, Finding the social modality provided, Determine problems, Determine problems, Formulate alternative solutions Formulate alternative solutions Build social institution which are democratic, Build social institution which are democratic,

based on community aspiration, needs, strength based on community aspiration, needs, strength and potencyand potency


Function for medical techniquesFunction for medical techniques Function for human resource skills that could Function for human resource skills that could

organize community social modality:organize community social modality: Finding the social modality provided, Finding the social modality provided, Determine problems, Determine problems, Formulate alternative solutions Formulate alternative solutions Build social institution which are democratic, Build social institution which are democratic,

based on community aspiration, needs, strength based on community aspiration, needs, strength and potencyand potency

How to overcome nutrition problems among under-five children?

PUSKESMAS - StaffsPUSKESMAS - Staffs

Medical doctorMedical doctor DentistDentist MidwifeMidwife NurseNurse SanitarianSanitarian Administration staffAdministration staff Volunteer Volunteer

Sufficient manpower as institution

(organization) and do its functions?

PUSKESMAS - ProgramPUSKESMAS - Program

Health promotionHealth promotion Maternal and child Maternal and child

healthhealth PoliclinicPoliclinic Dental health clinicDental health clinic Nutrition counselingNutrition counseling ImmunizationImmunization Puberty and elderly Puberty and elderly

counselingcounseling

School health School health programprogram

Disease prevention Disease prevention and elimination and elimination programprogram

Environment healthEnvironment health Mental healthMental health LaboratoryLaboratory Eye clinicEye clinic Hearing clinic Hearing clinic

PUSKESMAS - ProgramPUSKESMAS - Program

Health promotionHealth promotion Maternal and child Maternal and child

healthhealth PoliclinicPoliclinic Dental health clinicDental health clinic Nutrition counselingNutrition counseling ImmunizationImmunization Puberty and elderly Puberty and elderly

counselingcounseling

School health School health programprogram

Disease prevention Disease prevention and elimination and elimination programprogram

Environment healthEnvironment health Mental healthMental health LaboratoryLaboratory Eye clinicEye clinic Hearing clinic Hearing clinic

Puskesmas program:

What are the minimal activities to meet its functions?

PUSKESMAS – Referral PUSKESMAS – Referral systemsystem Sick individual to PuskesmasSick individual to Puskesmas Being examined and treated optimallyBeing examined and treated optimally Need further examination and/or therapy, Need further examination and/or therapy,

will be referred to local hospitalwill be referred to local hospital The referred patient should be referred The referred patient should be referred

back to the Puskesmas for further back to the Puskesmas for further evaluation for its diseaseevaluation for its disease

PUSKESMAS – Referral PUSKESMAS – Referral systemsystem Sick individual to PuskesmasSick individual to Puskesmas Being examined and treated optimallyBeing examined and treated optimally Need further examination and/or therapy, Need further examination and/or therapy,

will be referred to local hospitalwill be referred to local hospital The referred patient should be referred The referred patient should be referred

back to the Puskesmas for further back to the Puskesmas for further evaluation for its diseaseevaluation for its disease

Puskesmas referral system:

Is it needed?

PUSKESMAS - ProblemsPUSKESMAS - Problems

Not optimally usedNot optimally used Limitation on:Limitation on:

FacilityFacility Man-powerMan-power Capability to run the programCapability to run the program

Other personal problem:Other personal problem: Time consuming for registration and Time consuming for registration and

examination examination Unfriendly medical staffsUnfriendly medical staffs

PUSKESMAS - ProblemsPUSKESMAS - Problems

Not optimally usedNot optimally used Limitation on:Limitation on:

FacilityFacility Man-powerMan-power Capability to run the programCapability to run the program

Other personal problem:Other personal problem: Time consuming for registration and Time consuming for registration and

examination examination Unfriendly medical staffsUnfriendly medical staffs

Puskesmas problems:

How to overcome these problems?

Summary:Summary:

What is Puskesmas?What is Puskesmas? Puskesmas coverage?Puskesmas coverage? Puskesmas functions and activities?Puskesmas functions and activities? Puskesmas staffs and its limitations?Puskesmas staffs and its limitations?

POSYANDUPOSYANDU

Pos pelayanan terpadu or integrated health Pos pelayanan terpadu or integrated health care postcare post

Starting as an organization of services aimed Starting as an organization of services aimed to prevent diseases and family planning for to prevent diseases and family planning for reproductive mothers and underfive childrenreproductive mothers and underfive children

It is expected that Posyandu could be existed It is expected that Posyandu could be existed and developed based on community and developed based on community awareness and effort or social participation of awareness and effort or social participation of each community in village or kelurahan leveleach community in village or kelurahan level

POSYANDU - POLICYPOSYANDU - POLICY

1. Increase intersectoral cooperation to conducting 1. Increase intersectoral cooperation to conducting Posyandu in the scope of LKMD (village community Posyandu in the scope of LKMD (village community security organization) and PKK (family welfare security organization) and PKK (family welfare organization) organization)

2. Develop community participation to increase Posyandu 2. Develop community participation to increase Posyandu function and increase community participation in function and increase community participation in village community development programs village community development programs

3. Increase the functions and roles of LKMD and PKK, 3. Increase the functions and roles of LKMD and PKK, prioritizing in the role of development of caderprioritizing in the role of development of cader

4. Implementing the formation of Posyandu in each village 4. Implementing the formation of Posyandu in each village to conduct integrated health and family planning to conduct integrated health and family planning servicesservices

5. Dana sehat (health fund) is a way to manage 5. Dana sehat (health fund) is a way to manage integrated health maintenanceintegrated health maintenance

POSYANDU - COMMITTEEPOSYANDU - COMMITTEE

1.1. Responsible person: Head of LKMD Responsible person: Head of LKMD (village head) (village head)

2.2. Responsible for its operation: Vice Responsible for its operation: Vice head-1 of LKMD (Key person) head-1 of LKMD (Key person)

3.3. Executive leader: Vice head-2 of Executive leader: Vice head-2 of LKMD /section 10 of LKMD (Leader of LKMD /section 10 of LKMD (Leader of PKK) PKK)

4.4. Secretary: Head of section 7 of LKMD Secretary: Head of section 7 of LKMD 5.5. Executive staffs: PKK cader, assisted Executive staffs: PKK cader, assisted

by national working group at local levelby national working group at local level


National working group for Posyandu at National working group for Posyandu at sub-district level:sub-district level:

Puskesmas, Puskesmas, Family planning field supervisor Family planning field supervisor Development sectionDevelopment section Village development caderVillage development cader


Tasks of National working group for Posyandu at Tasks of National working group for Posyandu at sub-district level:sub-district level:

• • Preparing data and target group, and program Preparing data and target group, and program coveragecoverage

• • Cader preparationCader preparation• • Problem analisis and determine alternatives for Problem analisis and determine alternatives for

problem solvingproblem solving• • Proposal formulation Proposal formulation • • Monitoring and supervising Monitoring and supervising • • Inform any problems to related institutionsInform any problems to related institutions• • Report the activities to LKMD. Report the activities to LKMD.

POSYANDU - POSYANDU - DEVELOPMENTDEVELOPMENT

1)1) Inter program and inter sectoral meeting at Inter program and inter sectoral meeting at subdistrict level subdistrict level

2)2) Self-evaluation survey by PKK cader under Self-evaluation survey by PKK cader under supervision of health and family planning supervision of health and family planning technical staffs technical staffs

3)3) Community meeting at village level to discuss Community meeting at village level to discuss the survey results, facilities and fundingthe survey results, facilities and funding

4)4) Selection of Posyandu cader Selection of Posyandu cader 5)5) Training of Posyandu cader Training of Posyandu cader 6)6) Supervision Supervision

POSYANDU – POSYANDU – DEVELOPMENT CRITERIADEVELOPMENT CRITERIA

1)1) Not too close to Puskesmas Not too close to Puskesmas 2)2) One Posyandu can serve 100 One Posyandu can serve 100

underfives underfives

POSYANDU – CADER POSYANDU – CADER CRITERIACRITERIA

1) Can read and write 1) Can read and write 2) Social and willing to volunteer 2) Social and willing to volunteer 3) Understand culture and habits of the 3) Understand culture and habits of the

local community local community 4) Can provide time 4) Can provide time 5) Living around the Posyandu location 5) Living around the Posyandu location 6) Friendly and sympathetic6) Friendly and sympathetic7) Accepted by the local community 7) Accepted by the local community

POSYANDU - OBJECTIVESPOSYANDU - OBJECTIVES

1.1. Decrease infant mortality rate (IMR), maternal Decrease infant mortality rate (IMR), maternal mortality rate (MMR) – pregnant women, delivery and mortality rate (MMR) – pregnant women, delivery and post-partumpost-partum

2.2. Develop NKKBS, norma keluarga kecil bahagia Develop NKKBS, norma keluarga kecil bahagia sejahtera (small happy and wealthy family norm) sejahtera (small happy and wealthy family norm)

3.3. Increase community participation and capability to Increase community participation and capability to develop health and family planning activities, and develop health and family planning activities, and other activities supporting the attainment of healthy other activities supporting the attainment of healthy and wealthy community and wealthy community

4.4. Function as reproductive movement vehicle to Function as reproductive movement vehicle to achieve wealthy family, family security, and achieve wealthy family, family security, and economically wealthy familyeconomically wealthy family

POSYANDU - PROGRAMPOSYANDU - PROGRAM

For children, early detection of any For children, early detection of any disorder of growth and developmentdisorder of growth and development

For mothers (pregnant and nursing), For mothers (pregnant and nursing), counseling, weight monitoring, iron pill counseling, weight monitoring, iron pill distribution, and preparation for save distribution, and preparation for save delivery caredelivery care

POSYANDU - ACTIVITIESPOSYANDU - ACTIVITIES

1.1. Maternal and child health (MCH)Maternal and child health (MCH)2.2. Family planning Family planning 3.3. lmmunisationlmmunisation4.4. Nutrition Nutrition 5.5. Tackling diarrhea Tackling diarrhea

POSYANDU – POSYANDU – IMPLEMENTATIONIMPLEMENTATION

Running once a month by LKMD, cader, PKK and Running once a month by LKMD, cader, PKK and health and family planning staffs at village levelhealth and family planning staffs at village level

Providing service known as “5 table system”:Providing service known as “5 table system”: Table I : Registration Table I : Registration Table II : Weighing Table II : Weighing Table III: KMS recordingTable III: KMS recording Table IV: Individual conseling based on KMS Table IV: Individual conseling based on KMS Table V : Health and family planning services Table V : Health and family planning services

ImmunizationImmunization High dose vitamin A distribution given orally every February and High dose vitamin A distribution given orally every February and

AugustAugust Providing pill or condomProviding pill or condom Simple medicationSimple medication Health, nutrition and family planning counseling Health, nutrition and family planning counseling

POSYANDU – INDICATORSPOSYANDU – INDICATORS

Evaluated using SKDN-coverage: Evaluated using SKDN-coverage: S : Semua, all underfive children in Posyandu S : Semua, all underfive children in Posyandu

coveragecoverage K : KMS, all underfive children owned KMSK : KMS, all underfive children owned KMS D : Datang, all underfive children weighed this D : Datang, all underfive children weighed this

month month N : Naik, all weighed underfive children who N : Naik, all weighed underfive children who

increased their body weightincreased their body weight Interpretation: Interpretation:

D/S, presenting the quality of community D/S, presenting the quality of community participation participation

N/D, presenting the posyandu’s achievementN/D, presenting the posyandu’s achievement


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٢٠

٤٠

٦٠

٨٠

١٠٠

Rose Yasmin Orchid

SKDN


Indicators to determine strata/level Indicators to determine strata/level Posyandu: Posyandu:

1.1. Number of open-day per-yearNumber of open-day per-year2.2. Number of active caderNumber of active cader3.3. Program coverageProgram coverage4.4. Additional programAdditional program5.5. Availability of Dana sehatAvailability of Dana sehat

POSYANDU – FUNDINGPOSYANDU – FUNDING

Source of funding: Source of funding: community self-supporting through community self-supporting through

mutual cooperation, e.g. contributing mutual cooperation, e.g. contributing small amount of rice (jimpitan) or other small amount of rice (jimpitan) or other local potential product and other local potential product and other funding from donators to be funding from donators to be accumulated as health fund (Dana accumulated as health fund (Dana Sehat) Sehat)

POSYANDU – LEVELPOSYANDU – LEVEL

Posyandu Pratama (red) : Posyandu Pratama (red) : • • Not steady yet Not steady yet • • No routine activities No routine activities • • Limited numbers of cader Limited numbers of cader

Posyandu Madya (yellow): Posyandu Madya (yellow): • • More routine activities More routine activities • • Number of cader 5 Number of cader 5

Posyandu Purnama Posyandu Purnama (green): (green):

• • Routine activities Routine activities • • Good program coverageGood program coverage• • Number of cader 5 Number of cader 5 • • Having additional program Having additional program

Posyandu Mandiri (Blue): Posyandu Mandiri (Blue): • • Routine activities and Routine activities and

steady steady • • Good program coverage Good program coverage • • Having steady Dana SehatHaving steady Dana Sehat

POSYANDU - PROBLEMSPOSYANDU - PROBLEMS

Not all village has PosyanduNot all village has Posyandu There is a Posyandu physically but not really There is a Posyandu physically but not really

runningrunning Only providing nutrition activities (monthly Only providing nutrition activities (monthly

weighing, weight monitoring using KMS/weight weighing, weight monitoring using KMS/weight monitoring card, and supplementary feeding)monitoring card, and supplementary feeding)

Being used as place for curative service by the Being used as place for curative service by the paramedic’s private practice paramedic’s private practice

Inactive cader and member of PKKInactive cader and member of PKK

POSYANDU - ISSUESPOSYANDU - ISSUES

Participation, otoriter, not democrative in Participation, otoriter, not democrative in developing posyandudeveloping posyandu

Gender biasGender bias Who is responsibleWho is responsible Poor understandingPoor understanding Only related to health aspect Only related to health aspect

Summary:Summary:

What is Posyandu?What is Posyandu? Posyandu policy?Posyandu policy? Posyandu program, activities and its Posyandu program, activities and its

implementations?implementations? Evaluate Posyandu?Evaluate Posyandu? Problems and issues?Problems and issues?

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