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PUSKESMAS:

THE PRIMARY HEALTH CARE SYSTEM


IN INDONESIA

Introduction

Why do you have to know about


PUSKESMAS as the primary health
care system in Indonesia in relation
to the Public health and community
nutrition systems course?

References

Pedoman Kerja Puskesmas, Depkes


RI
Sistim Kesehatan Nasional
Renstra Depkes 2005-2009
Standar Pelayanan Minimal Bidang
Kesehatan

What is PUSKESMAS?

Functional health organization unit


Public health development center
Building community participation
Provide comprehensive and
integrated services to the community
under its coverage in the forms of
principal activities

PUSKESMAS coverage

Part of or the whole sub-district


(kecamatan), depending on:

Population density (~30,000)


Areas (~district head office)
Geographic (extended to have
supporting-Puskesmas/Puskesmas
Pembantu or Puskesmas Keliling)
Infrastructure (personnel and facilities)

PUSKESMAS coverage

Especially for big cities (population


1 million) = Puskesmas Pembina:

Coverage: sub-district
Population: 150,000
Referral and Coordinating several
Puskesmas Kelurahan (village-level)

Comprehensive health service


Promotion
Prevention
Cure/treatment
Rehabilitation
for all gender and age from conception
to those dying

Integrated health services

All principal health service activities:

Policlinic
Maternal and child clinic
Hygiene and sanitation program
Communicable diseases program
And others

implemented together under one


coordination and leader

Functions and roles of PUSKESMAS


in the public health system

Functions:

Public health development center


Building community participation to
promote healthy life behaviors
Provide comprehensive and integrated
health care services

Functions and roles of PUSKESMAS


in the public health system

Activities:

Stimulating the community to do self-help


activities
Informing the community to search and use the
locally available resources effectively and
efficiently
Technically assisting the community for medical
content, medical and health referral without
rising any dependency
Providing direct health services to the
community
Collaborating with other related sectors in
implementing the health programs

Functions and roles of PUSKESMAS


in the public health system

Roles:

As a technical implemental institution, it


shall have a managerial capabilities and
long-term vision to improve the quality
of health services
In planning, managing and evaluating
Using and updating related information
techniques to improve the
comprehensive and integrated health
services

Functions and roles of PUSKESMAS


in the public health system

Status:

Administration, as a technical unit of


district government office via the district
health office
Hierarchical health service, as a primary
health service facility (*)

Organization of PUSKESMAS
HEAD OF
PUSKESMAS

HEAD OF
ADMINISTRATION
UNIT

TECHNICAL UNIT
I-III

SUPPORTING
UNIT

TECHNICAL UNIT
IV-VII

Organization of PUSKESMAS
PERSONNEL

JOB DESCRIPTION

Head of
Puskesmas

Leading, supervising and


coordinating Puskesmas
activities (structural and
functionally)
Staffing, finance, facility,
recording and reporting

Head of
Administration
unit

Organization of PUSKESMAS
PERSONNEL

JOB DESCRIPTION

Unit I

Maternal and child health,


family planning and
nutrition program activities

Unit II

Prevention and treatment of


communicable diseases
(immunization,
environmental health and
laboratory)

Organization of PUSKESMAS
PERSONNEL

JOB DESCRIPTION

Unit III

Dental and oral health,


occupational health and
elderly

Unit IV

Public health nursing, school


and sport health, mental
health, eyes health and
other specific healths

Organization of PUSKESMAS
PERSONNEL

JOB DESCRIPTION

Unit V

Building and developing


community health activities
and public health promotion

Unit VI

Out-patient and in-patient


treatment services
Pharmacy

Unit VII

Organization of PUSKESMAS
SUPPORTING
UNIT
Supporting
Puskesmas

JOB DESCRIPTION

Mobile
Puskesmas
Village midwife

Implementing Puskesmas
programs to remote areas
Provide maternal and child
health service to 3,000
population

Implementing Puskesmas
programs to 2,500 10,000
population

Primary Programs of PUSKESMAS


1. Maternal and child health
2. Family Planning
3. Nutrition Improvement
4. Environmental health
5. Communicable diseases eradication
6. Treatment, including emergency condition
7. Public health education/promotion
8. School health program
9. Sport health
10.Public health nursing

Primary Programs of PUSKESMAS


11. Occupational health
12. Dental and oral health
13. Mental health
14. Eyes health
15. Laboratory
16. Reporting and recording of health
information system
17. Elderly
18. Controlling traditional healer
19. And others

Referral system
Hierarchy

Health service component

Households

Individual or family members

Community

Households of ten, Posyandu

Primary
health service
facility
Primary
referral unit
Advanced
referral unit

Puskesmas and its supporting


units, private practices, etc
District hospital, laboratory,
private practices, etc
Provincial hospitals, special
health facilities, etc

Referral system

Type of referral system:

Medical referral (diagnostic and treatment):


patient consultation, sending specimens and
inviting special health personnel
Health referral (promotion and prevention):
epidemiological survey and eradication of
outbreaks, food aids, investigation of food
poisoning, special aids during disaster and
displaced population/refugee, clean water
technology and laboratory

Conclusion

Why do you have to know about


PUSKESMAS as the primary health
care system in Indonesia in relation
to the Public health and community
nutrition systems course?