An Evaluation of Youth Care Health Program (PKPR) in Public

Health Center in Jakarta, Indonesia

Iram Barida Maisya

, Mochamad Iqbal Nurmansyah

2,3

, Mizna Sabilla

National Institute of Health Research and Development, Ministry of Health of Indonesia, Jakarta, Indonesia.

Faculty of Health Sciences, University of Muhamadiyah Prof. Dr. Hamka, Jakarta, Indonesia.

Faculty of Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indoensia.

Faculty of Public Health, University of Muhammadiyah Jakarta, Indonesia.

Keywords: Youth, Health Promotion, Health Care, Indonesia.

Abstract: Indonesia government has facilitated youth care that was implemented in the Public Health Centre (PHC)

called Youth Care Health Service (PKPR). This research aimed to evaluate the implementation of PKPR

program in the Public Health Centre in Jakarta, Indonesia. This research employed qualitative approach. The

data were collected from 10 Public Health Centre in Jakarta from August to October 2016. The informants

consisted of head of PHC, PKPR program manager, visitors, and PKPR patients. We specifically explored

the input and process of the implementation of PKPR program. Thematic content analysis was used to analyse

the data. It was revealed that all PHC have implemented the PKPR Program. In term of facilitation, a PHC

has a special room for implementing PKPR clinic, but others do not. Some PHCs did not have staffs that

specifically manage the PKPR program. However, some staffs have not been trained for giving care for youth.

Trained staffs are necessary to provide or the patients. Further, some of the PHC staffs did not use HEADSSS

assessment.

1 INTRODUCTION

Youth is a critical stage in human development.

Youths tend to develop risk-taking behaviours,

sensation-seeking, novelty-seeking and increased

focus on social status (Berenbaum, Beltz, & Corley,

2015; National Research Council, Institute of

Medicine, & Transportation Research Board, 2007).

Therefore, susceptibility to substantive abuse in that

period increases (Berenbaum et al., 2015).

Indonesia Global Student Health Survey revealed

that smoking and drinking alcohol, less fruit and

vegetable intake, mental health, and violence become

the main risk factors among Indonesian youth

(Puslitbang, 2015). Based on the report, 13.6% of

student were current smoker and 4.4% were alcohol

user (World Health Organisation, 2015). Moreover,

in dietary behaviour, Indonesia is facing double

burden of malnutrition which is marked by the

coexistence of under-nutrition along with overweight

and obesity (Hanandita & Tampubolon, 2015).

Youth health becomes an important aspect that

contributes to the national development. Investing in

the health of youth will bring high benefits and

significant progress towards achieving Sustainable

Development Goals (Sheehan et al., 2017). World

Health Organization stated that investing in

adolescent health will bring benefits for themselves,

their future lives, and their next generation (WHO,

2009).

Nevertheless, the importance of investing in

adolescence health is facing challenges, especially in

providing healthcare for adolescence in Indonesia. A

research conducted in Semarang stated that 61.5% of

youth still less participated in youth care program

(Sari, Musthofa, & Widjanarko, 2017). Research in

evaluating youth care program in Jakarta also

revealed that there were still lack of facilities,

manpower, and financial support in providing youth

care, leading to a less standardized services.

(Friskarini & Manalu, 2017).

In 2014, Ministry of Health of Indonesia

developed a set of guidelines for Public Health Centre

(PHC) to perform Youth Care Program (PKPR).

PKPR program includes activities inside and outside

Barida, I., Nurmansyah, M. and Sabilla, M.

An Evaluation of Youth Care Health Program (PKPR) in Public Health Center in Jakarta, Indonesia.

DOI: 10.5220/0008380500560060

In Proceedings of the 1st International Conference on Social Determinants of Health (ICSDH 2018), pages 56-60

ISBN: 978-989-758-362-9

PHC. The former includes disease prevention, health

counselling, and treatment for youth, while the latter

includes health screening and health education in

school, youth society, orphanage, and youth prison

(Ministry of Health Republic of Indonesia, 2014).

Ministry of Health also developed Indonesia

HEADSSS assessment, a guideline for psychosocial

assessment in youth. HEADSSS stands for Home,

Education (school), Activities/Employment, Drugs,

Suicidality, Sex and eating, and Safety

(Katzenellenbogen, 2005).

This research aimed to explore the performance

and challenges of youth health service in 10 PHCs in

Jakarta. This research is expected to enrich the

literature regarding youth care performance in Public

Health Centre, especially in using HEADSSS

assessment guidelines.

2 METHOD

This qualitative research was conducted in 10 Public

Health Centres in Jakarta. The data were collected in

December 2016. The informants were chosen using

purposive sampling method. They were involved in

the Youth Care Program of the PHCs. The informants

in each PHC were consisted of one Head of PHC, 2

staffs who managed the Youth Care Health Program,

2 staffs of PHC who were involved in PKPR

Program, and 2 adolescents attending the care centre.

Therefore, the total of number of informants in this

study was 50.

The data were collected through in-depth

interview. Semi-structured interview guidelines were

made prior to the data collection. The interview

guidelines were aimed to explore the adequacy of

PKPR implementation program from 5Ms

perspective (Manpower, Money, Material, Method,

Machine) and functions of Management (Planning,

Organizing, Actuating, Controlling and Evaluating).

In managerial elements, we assessed the readiness,

education, training, and skill adequacy of the staffs

responsible for the adequacy of funding, adequacy of

health promotion media, policy and standard

operational procedure, adequate facilities for the

program. We also assessed the managerial process of

the program, such as the planning process of the

program, organization of the program,

implementation barriers and satisfaction of the

patients, as well as monitoring and evaluating process

of the program.

Informants who agreed to involve in this study

signed the inform consent prior to the interview. No

consequence was imposed on the informants who

were unwilling to involve in this study. Six

researchers from National Institute for Health

Research and Development and Directorate of Child

and Adolescent Health, Ministry of Health of

Indonesia were assigned to do the interview for data

collection. During the interview process, the

researcher used voice recorder and notes to record the

interview contents. After collecting the data, the

researcher made an interview transcript and analysed

the data. Thematic content analysis was used to

analyse the data.

3 RESULTS AND DISCUSSIONS

Readiness for the implementation of PKPR was

assessed by identifying the condition of the facilities,

human resources, and funding of the program in PHC.

3.1 PHCs Facilities

Most of PHCs have had an adequate facility for

implementing PKPR Program. It includes a special

room, health equipment, and other facilities to

support the program. The informants also stated that

they already have PKPR guideline from the Ministry

of Health as guidelines in implementing PKPR.

Yet, some PHCs still have not provided special

room for PKPR Program, leading to the cancellation

of the program because during the service, the rooms

were used for other types of services. The

unavailability of the room was caused by several

reasons, such as small area of the PHC building. The

unavailability of the room was caused by several

reasons; one of which is the moving of the PHC to a

new area that is smaller than the previous place. It

results in the inability of the centre to provide a room

for the program. A specific room is necessary for

providing private care to the youth patients, allowing

them to discuss their problems more deliberately.

“...Because the PHC’s building is small, a room

for youth service in the other time is also used by

another program so there is a lack of room...” (Public

Health Centre Staff)

The informants also said that the infrastructure

(medical equipment and service room) was the

biggest obstacle in implementing PKPR Program. For

instance, stethoscope, thermometer and flashlight

were not in good condition.

An Evaluation of Youth Care Health Program (PKPR) in Public Health Center in Jakarta, Indonesia

3.2 Human Resources

In the context of availability and competence of

human resources, most informants stated that they

already have adequate human resources to implement

the PKPR Program. They also said that they already

have sufficiently competent staffs for the service.

They had been trained before the implementation of

the program.

Nonetheless, other informants stated that they

lacked human resources for the program, in terms of

number and competence. The less competent staffs

were unable to solve the problems faced by the youth,

such as when they experienced a kind of violence. In

terms of number, the staffs in PHC are not only

responsible for the €PKPR program, but also

responsible for other duties, leading to double their

workload. Another consequence is the less routine

service in the clinic, since the staffs are not available

every day.

“…Honestly, I feel that I still have

forthcomings, because giving service for youth needs

special skill in order to explore youth problems, for

example there was a youth that experiencing bullying

so there is a need more competence for giving youth

service…” (Public Health Centre Staff)

3.3 Implementation Of PKPR Program

All informants stated that PKPR Program has

been implemented in their PHC. There were

programs that were implemented inside and outside

of the PHC. The program that is implemented in of

the building includes health counselling for youth,

while outside includes school visiting for health

promotion and education.

3.4 Integrated Service

Previously, some PHCs integrated their service

for youth and other patients, but currently, most PHCs

have implemented youth health counselling program

in separated room from other service. In addition, the

program is available 6 days a week.

Most informants stated that they have a special

procedure for their patient (client). It is not necessary

for the youth to go the general clinic. Instead, they can

go directly to the youth care clinic. However, youth

with special cases, such as pregnancy and dental

problem , have to visit a more particular clinic before

they proceed to the youth care. All in all, some PHCs

still allow patients of all ages to enter the general

clinic.

3.5 Use Of Headsss Assessment And

Counselling Process

In terms of diagnosis procedures, some PHCs have

implemented the algorithm proposed by the Ministry

of Health. In spite of that, some other has not used it

because they were confused of it. In some cases,

sometimes they could not find the disease in the

algorithm, such as the infectious disease.

“…There is some diagnosis that not included in this

algorithm like smallpox. The algorithm is confusing

because infection diseases is not included…” (Public

Health Centre Staff)

Another reason is caused by the high number of

the clients. Therefore, to shorten the waiting time, the

staffs should do the counselling faster. They stated

that the algorithm should be made simpler to facilitate

the diagnosis process as well as clear classification.

“…If I did not use overall case for HEADSSS maybe

the service just 10 minutes. But if we use overall

HEADSSS algorithm, the service maybe reach one

hour for one patient…” (Public Health Centre Staff)

In giving the counselling, some informants found

it difficult to build good rapport with the clients.

Good relation helps the clients to be more open in

counselling about their health problem. The staffs

should work harder to make the clients trust them.

3.6 PKPR Program Outside Building

For youth program outside building, the

program was varied among PHCs. Most of PHCs

have implemented health education program in

school that scoped in their area. Most of PHCs also

have program for training peer as health counsellor.

Some of PHCs have a program for training youth to

be a volunteer in keeping environment free from

mosquito larvae.

3.7 PKPR Monitoring And Evaluation

The results revealed that there were some

kinds of monitoring and evaluation of the PKPR

Program. Evaluation was performed by the head of

ICSDH 2018 - International Conference on Social Determinants of Health

PHC and also Jakarta Subdistrict Health Office. It

was performed in every month and every 3 months.

The monthly evaluation is performed by the internal

staffs of PHC, while the 3-month evaluation involves

other sectors such as educational sector and other

governmental sectors.

4 DISCUSSIONS

All PHCs in this research have implemented

PKPR Program in their service. Not all PHCs used the

algorithm for diagnosing the patient. Most of human

resources responsible for the program are competent

in giving the service. Only some PHCs have special

room and specific procedure for giving service for the

youth.

Some staffs stated that there was no special room

for youth examination. World Health Organization

(WHO) in the Global Standards for Quality Health-

Care Services for Adolescents stated that the

examining room plays an important role in ensuring

the privacy of the patients, especially during clinical

examination and treatment (World Health

Organization, 2015). One study in Burundi revealed

that designated exam rooms, educational materials in

waiting rooms, privacy, and confidentiality are

significantly associated with adolescents’ use of

youth health service (Moise, Verity, &

Kangmennaang, 2017).

In the aspect of human resources, some

informants stated that they were not sufficiently

competent in helping the clients’ problem. Health-

care knowledge, attitude, and skills are essentials

element in quality service provision (Ambresin,

Bennett, Patton, Sanci, & Sawyer, 2013). Health

providers also need to create a comfortable

atmosphere that allows the youth to talk about their

health issues (Grant, Elliott, Di Meglio, Lane, &

Norris, 2008). Some PHCs staff stated that they have

not yet used the diagnosis procedure algorithm from

the Ministry of Health. Some informants stated the

length of the diagnosis process using the algorithm

causes them unwilling to use it. Grant in her paper

agreed that addressing psychosocial risks was time

consuming, therefore, when short on time, a strategy

is to address one or two psychosocial domains at each

visit (Grant et al., 2008).

5 CONCLUSIONS

All PHCs have implemented PKPR inside and

outside the building. There were several challenges

that were faced by the PHCs in performing PKPR:

lack of competence and number of human resources

as well as lack of facilities, such as room and medical

equipment. Adolescent is a critical period when

health/unhealthy behaviours are established and

therefore it is necessary to counsel and educate them

in order to develop healthy lifestyle early (National

Research Council and Instittue of Medicine, 2009).

In order to provide better performance in the

youth health care, training for PHC staffs is needed.

Besides, it increases their competence in performing

the counselling and treatment for youth in the PKPR

program. Nevertheless, the government should also

increase the number of the staffs in PHCs to avoid any

workload and to ensure quality service.

ACKNOWLEDGEMENTS

We would like to extend our gratitude to all of

staff in Public Health Centres in Jakarta who have

involved and assisted for data collection process of

this research.

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ICSDH 2018 - International Conference on Social Determinants of Health