Analysing the Healthy Public Policy’s Impact on the School Health
Program: Usaha Kesehatan Sekolah (UKS)
Muji Sulistyowati, Oedojo Soedirham
Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia
Keywords: Healthy public policy, Health promotion, School health program, UKS.
Abstract: According to WHO document, health is clearly connected to educational accomplishment, quality of life
and economic productivity. Research conducted in both developing and developed countries shows that
school health programs in each nation can concurrently decrease common health problems, increase the
efficiency of the education system, advance public health and improve education to do with social and
economic developments. Since 1950, WHO has long been an important task in promoting the health of
children through schools. In Indonesia, Usaha Kesehatan Sekolah (UKS) is one of the school health
programs coordinated by the four Ministries. Many studies showed that there has been no optimal
implementation yet of UKS. The healthy public policy concept could be a tool to analyse the possible policy
shifting and strive to incorporate the concept of health promotion in UKS. This paper describes the possible
policy changes on UKS program to be a health promoting school. Those changes needed healthy public
policy to succeed.
1 INTRODUCTION
Usaha Kesehatan Sekolah is Indonesia’s school
health promotion program, which has the potential
to overcome the public h
ealth problem. That is because the school age group
has a bigger quantity percentage than any other age
group. Most of Indonesia’s children aged 5 to 19
years of old go to school. 99.09% of children aged 7
to12 years of old go to elementary school.
Meanwhile 94.72% of teenagers aged 13 to 15 years
old participate in junior high school. 70.61% of
adolescents aged 16 to18 years old go to senior high
school (Education Officer of East Java, 2016;
Statistical Board of East Java, 2016). According to
the Health Promotion Board, of the Ministry of
Health (2011), the target range of the health
promotion program at school could be fourfold
minimally, because of the children’s ability to reach
their family population with the information.
Globally, school health programs have been
developed with a comprehensive approach to health
education and health promotion programs in school
by WHO (1997) since 1950. The approach has to be
suppressed based on the reason that school health
programs can’t be reached independently. It needs
an organised movement with a comprehensive and
holistic approach, alternatively called Health
Promoting School.
Health Promoting Schools (HPS) has been
adopted as a health promotion program documented
by the Ministry of Health (Ministry of Health,
2011). There are six elements of HPS, as a healthy
school indicator, developed by WHO-SEARO
(2003)
used by the Indonesia Health Promotion
Board. Methodologically, HPS is very strategic,
because there is Usaha Kesehatan Sekolah (UKS)
acting as the board that will be implementing it.
The implementation of the six elements of HPS
will be smooth if UKS adopts the element as well.
Unfortunately, UKS has only implemented three
elements out of the six, called TRIAS UKS, to run
their program. Table 1 shows the elements that
should be implemented in each of the school’s
health program documents.
Sulistyowati, M. and Soedirham, O.
Analysing the Healthy Public Policy’s Impact on the School Health Program: Usaha Kesehatan Sekolah (UKS).
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 5-9
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All r ights reserved
5

Table 1: The description of the elements in each of the documents for Health Promoting School
Element
WHO-SEARO (2003)
Health Promoting School document
Ministry of Health, RI (2011)
Health promotion at school
document
Ministry of Education, RI
(2012)
UKS document
1 Engages health and education
officials, students, teachers &
representative organizations, parents,
and community leaders in efforts to
p
romote health
Engages health and education
officials, students, teachers &
representative organizations,
parents, and community leaders in
efforts to promote health
Not clearly mentioned
2 Strives to provide a safe, healthy
environment
Strives to provide a safe, healthy
environment
Fostering a healthy school
environment
3 Provides school health education Provides school health education Organization of health
education
4 Provides access to health services Provides access to health services Provision of health services
5 Implements health-promoting
p
olicies and
p
ractices
Implements health-promoting
p
olicies and
p
ractices
Not clearly mentioned
6 Strives to improve the health of the
community
Strives to improve the health of the
community
Not clearly mentioned
Table 1 show that UKS document just mentioned
three elements out of six should be implemented to
be Health Promoting School. The other three
elements that are not implemented are element 1,
element 5 and element 6. All of them seem about
networking among sectors involved in UKS.
Health promotion programs in schools and UKS
should have the same goals, i.e. to increase the
student’s health status involved the whole school
community. The optimisation and effective
coordination between the two sectors will increase
the achievement of the school health program goals.
Sulistyowati and Megatsari (2015) have shown that
the Steering Committee, as a coordinator of the
school health program, do not understand about UKS
including TRIAS UKS. Other research conducted in
Indonesia also has shown the minimisation of the
UKS programs achievements’ (Sulistyowati and
Megatsari, 2015; Ministry of Education, 2012;
Permatasari, 2010; Maghfiroh, 2011; Mukminin,
2012; Mursyal, 2013; WHO, 1998).
The less optimal implementation of the UKS
program can be enhanced by implementing the other
three elements of HPS. These are all about
networking. The networking optimisation can be
reached through a public policy approach. Healthy
public policy is a strategy of health promotion that
can be used to make sure the shifting policy changes
on implementing Health Promoting School are from
UKS’s terms.
This paper aimed to analyse the possible policy
changes to do with the UKS program with a healthy
public policy concept analysis.
2 METHODS
This was a review paper with the intention of
describing the possible policy changes in the UKS
program in order to become a Health Promoting
School, using a healthy public policy concept
analysis. The analysis was taken from a few studies
on UKS in Indonesia and few HPS research studies.
Moreover, WHO documents were also used.
3 RESULT AND DISCUSSION
3.1 Usaha Kesehatan Sekolah (UKS)
UKS is a health promotion program in the school-
lead sector ran by the Ministry of Education
(Ministry of Educational, 2012). UKS has been
developed in Indonesia since 1980, consolidated by
the formation of a Steering Committee at all
government levels in 1984. Joint Decree 4 (Ministry
of Health, Ministry of Education, Ministry of Home
Affairs, and Ministry of Religious Affairs)
established in 1984, updated in 2003 and 2014,
regulating the guidance and development of the UKS
rules in pre-school, elementary school and junior
school up until senior high school. These rules
strengthen the implementation of UKS. UKS is a
mandatory program that should be implemented by
each school, according the Act of the Ministry of
Education no 39, 2008, reinforced by the Act of
Health no 36, 2009. The rules assert that the legal
basis of UKS implementation is tough.
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3.2 Public Policy
Policy is a plan of action for tackling political issues,
according to Webster’s dictionary. It is a “line of
argument rationalising the course of action of
governments”. Many experts state the definition of
policy, in which the outline covers: 1) there is a goal
that should be achieved, 2) there are processes in
place to obtain that goal, 3) the actions proposed
could be from individuals or groups, inside or
outside the government and 4) it needs input to
apply the strategy.
Public policy defined by Thomas Dye (2012) is
what the “government choose to do or not to do”.
This definition has been confirmed by George C.
Edwards III, and is a government action for goal
achievement. UKS as a program is a product of
public policy and is a form of public service.
Regional governments, presented by the four
Ministers involved in developing UKS, should be
responsible for its successful implementation. It
means that the success of UKS in becoming a Health
Promoting School needs coordination and
contributions from other sectors, not just the health
sector. The role, level of responsibility and
contributions from the four sectors minimally is
expected to make UKS become a Health Promoting
School with optimal achievements in the six listed
elements.
3.3 Health Promotion
As a fundamental human right, all people should
have access to basic resources for health (WHO,
1998). Health is defined by WHO (1998) not merely
the absence of disease or infirmity, but a complete
state of physical, social and mental wellbeing. UKS
as a school health program is compulsory in order to
achieve a whole state of wellbeing in the school
community. It is based on the WHO’s global school
health initiative which emphasizes school capacity
as a healthy place to live, learn and work (WHO,
1998).
Meanwhile, health promotion is determined by
the WHO (1998) as the process of enabling people
to increase their control over, and to improve, their
health. Health promotion represents a
comprehensive social and political process. It is not
only comprised of actions directed at strengthening
the skills and capabilities of the individuals, but also
action directed towards changing the social,
environmental and economic conditions, so as to
ease their impact on public and individual health
(WHO, 1998).
As a health promotion program in a school, the
implementation of UKS should have a positive
impact on the school community. Based on the
health promotion concept, UKS should be
implemented by coordinating all related sectors and
between other programs.
The Ottawa Charter identified three basic
strategies for health promotion. Number 1) is
advocacy (advocate) for health to increase the
essential conditions for health; the next 2) is
enabling (enable) all people to achieve their full
health potential; and 3) is mediating (mediate)
between the different interests in society in the
pursuit of health. Those strategies are supported by
five health promotion action means: 1) building
healthy public policies; 2) creating supportive
environments for health, 3) strengthening
community actions for health, 4) developing
personal skills and 5) re-orienting health services.
UKS, with the implementation of TRIAS UKS, has
not yet fully executed the aforementioned health
promotion strategies.
3.4 Healthy Public Policy
As one of the health promotion actions, the WHO
(1998) has highlighted the fact that healthy public
policy goes beyond the health care sector. It
emphasises that health should be on the policy
agenda in all sectors, and at all levels of government.
One important element in building healthy public
policy is the notion of accountability for health.
Governments are ultimately accountable to their
people for the health consequences of their policies,
or lack of policies. Health promotion policy requires
the identification of obstacles to the adoption of
healthy public policies in non-health sectors, and the
ways of removing them. The aim must be to make
the healthier choice the easier choice for policy
makers as well as for the public (WHO, 1998).
3.5 Healthy Public Policy Analysis on
UKS
The concept of health promoting schools has its
roots in Healthy public policy (HPP) that places
emphasis on participation (including inter-sector
networks), equity, and empowerment (the school
community and surrounding). Based on that concept,
HPS must fulfil the HPP criteria. It is about making
inter-sector networks and developing policies to
implement HPS (WHO, 1998). These two things are
not yet optimally implemented in UKS as a health
promotion program in schools.
Analysing the Healthy Public Policy’s Impact on the School Health Program: Usaha Kesehatan Sekolah (UKS)
7

Table 2: The analysis of strategy with HPP approach to implement the full six elements of HPS
No. HPS Element Strate
gy
to im
p
lement Possible Stakeholder involve
d
1
Engages health and education
officials, students, teachers &
representative organizations,
parents, and community leaders in
efforts to
p
romote health
- Advocacy
- Networking & collaboration
- Capacity building
- government
- school
- parents
- community surrounding
2
Strives to provide a safe, healthy
environment
- Networking & collaboration
- Resources mobilization &
allocation
- Ca
p
acit
y
buildin
g
- government
- school
- community surrounding
-
p
rivate secto
r
3 Provides school health education
- Networking & collaboration
- Resources mobilization &
allocation
- Capacity building
- government
- school
- private sector
4 Provides access to health services
- Networking & collaboration
- Resources mobilization &
allocation
- government
- school
-
p
rivate secto
r
5
Implements health-promoting
policies and practices
- Advocacy
- Networking & collaboration
- Capacity building
- Evaluation
- government
- school
- community surrounding
- parents
-
p
rivate secto
r
6
Strives to improve the health of the
community
- vision building and strategic
planning
- Capacity building
- Evaluation
- government
- school
- community surrounding
- parents
-
p
rivate secto
r
The WHO (1997) has stated strategies to
strengthen HPS implementation at local, national,
and regional/international levels. They are 1) vision
building and strategic planning, 2) advocacy, 3)
networking and collaboration, 4) resource
mobilization and allocation, 5) capacity building for
both of individual and institutions and 6) evaluation
with operational research (WHO, 1997). The
previous six strategies should be used to implement
the six elements of HPS as well. The strategies are
health promotion strategies that underline the
healthy public policy approach. Table 2 shows the
analysis of the possible strategies used to gain HPS
elements, with the potential stakeholder involved.
Table 2 reveals that the government becomes the
potential stakeholder involved in the achievement of
all HPS elements, besides school as well. The
government, including schools, must be a leader in
the context of healthy school achievements. That is
the point of the policy concept as a tool for programs
to succeed. The second most important stakeholder
is the community surroundings, including other
interconnected sectors. The role of the government,
school and community asserts that healthy schools
should be the primary policy agenda in those sectors.
They must identify all hindrances to applying
healthy school programs so that they can provide
healthier choices for school community.
4 CONCLUSIONS
Usaha Kesehatan Sekolah, as one of the health
promotion programs in schools, needs a reinforcing
factor to shift in to becoming health promoting
school, which is a comprehensive healthy school.
The government, through the implementation of
healthy public policies, will shift the UKS in to
becoming HPS, by involving schools and
community surroundings. The school committee
which is the parent’s representative should be
involved in-depth, including community’s key
person as well.
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