Implementation of Health Care Service Program (PKPR) Puskesmas

Kecamatan Pulogadung Jakarta Timur in 2019

Sela Irawati

Department of Public Health, Faculty of Health and Sciences, Universitas Esa Unggul,

Jl. Arjuna Utara No.9, Jakarta 11510, Indonesia

Keywords: Program Implementation, Health Service, Caring for.

Abstract: Ministry of Health Republic of Indonesia in 2017, the Indonesian population aged 10-19 years amounted to

around 44 million people or around 20% of the total population. PKPR began in 2003 at the Puskesmas.

PKPR is a special health service for teenagers to deal with problems that exist in adolescents. The number

of adolescent health problems in the Pulogadung District Health Center in 2018 is still high. The purpose of

this study was to analyze the implementation of the Youth Health Care Services (PKPR) program at the

Pulogadung District Health Center. This research uses a descriptive type with a qualitative approach and

tests the validity of the data by triangulating methods, sources, and data. Data were collected using in-depth

interviews, observation and document review. The results of the study revealed that human resources did

not have permanent doctors in the PKPR program, facilities were still lacking in the absence of IEC media,

and the expansion of the PKPR program was still lacking. It is expected that the puskesmas will assign one

PKPR polyclinic doctor to facilitate patient monitoring as well as additional means to promote the PKPR

program to adolescents who still do not utilize the PKPR in the puskesmas.

1 INTRODUCTION

According to WHO, adolescents are residents in the

age range of 10-19 years. According to the Republic

of Indonesia's Minister of Health Regulation number

25 of 2014, adolescents are residents in the age

range of 10-18 years. Meanwhile, according to the

National Population and Family Planning Agency

(BKKBN), the age range of teenagers is 10-24 years

and not yet married. The different definitions

indicate that there is no universal agreement

regarding the limits of the adolescent age group.

However, adolescence is associated with the

transition from childhood to adulthood. This period

is a period of preparation for adulthood that will pass

through several important stages of development in

life. In addition to physical and sexual maturity,

adolescents also experience stages towards social

and economic independence, building identity,

acquisition of abilities (skills) for adult life and the

ability to negotiate (abstract reasoning) (WHO,

2015).

Adolescence is a transition from childhood to

adulthood. Teenagers' lives are crucial for their

future lives. Teenagers also have very complex

problems along with the transition experienced by

adolescents. Complex teen problems such as

education, friendship, love and one of them are

unhealthy lifestyles. Unhealthy lifestyles among

adolescents occur as a result of a transition period in

adolescents characterized by physical,

psychological, and social changes. This change

makes adolescents seem emotionally unstable. This

unhealthy lifestyle certainly raises various health-

related problems and the emergence of juvenile

delinquency. Adolescents experience health

problems due to the influence of environmental

factors on the incidence of risky behavior such as

information that is easily accessible, harmful

substances easily obtained and the decline in social

values. The impact caused not only health problems,

but the preparation of an immature adult such as low

education due to dropping out of school due to

premarital sex resulting in teenage pregnancy

resulting in increased unemployment due to

inadequate skills.

Based on data from the Ministry of Health of the

Republic of Indonesia in 2017, Indonesia's

population aged 10-19 years amounted to around 44

million people or around 20% of the total

266

Irawati, S.

Implementation of Health Care Service Program (PKPR) Puskesmas Kecamatan Pulogadung Jakarta Timur in 2019.

DOI: 10.5220/0009593002660271

In Proceedings of the 1st International Conference on Health (ICOH 2019), pages 266-271

ISBN: 978-989-758-454-1

population. This is in accordance with the proportion

of adolescents in the world, where the number of

adolescents is 1.2 billion or about 1/5 of the world's

population. The large population of adolescents is an

asset to the nation in the future. So they play a very

important role in the future survival of their people.

Therefore we need quality teenagers both in physical

and spiritual health to make a nation develop and

progress. Teenagers are a vulnerable age, where they

have a high sense of curiosity and want to try new

things.

The results of the 2018 Riskesdas show the

prevalence of smokers in the population aged 10-18

years which is 9.1%. About 3% of the population

aged 10 years and over have consumed alcoholic

beverages with various types of drinks, such as

whiskey, traditional drinks, mixtures, wine-wine,

beer and so forth. Meanwhile according to the 2017

IDHS the percentage of men who smoke increases

from 56% (IDHS, 2012) to 57%. About 31%

(women) and 21% (men) in adolescents, smoking

for the first time before age 13 years and half of the

men smoke more than 10 cigarettes in 24 hours. The

percentage of women who first drink alcohol at the

age of fewer than 14 years is 27% higher than men

16%. Health Demographic Survey Results in 2017

Book Teenagers about attitudes toward premarital

sexual relations, the percentage of teenage boys aged

15-19 years who agree with premarital sexual

relations is 5.4% higher compared with young

women which are 3%. The reason for premarital

sexual relations is mostly because of curiosity or

curiosity (57.5% of men), just happened (38% of

women) and forced by a partner (12.6% of women).

Among women and men who have had premarital

sexual relations, 59% (women) and 74% (men)

report having first sexual intercourse at the age of

15-19 years. The highest percentage occurred at the

age of 17 years (19%), both men and women. This

evidence reflects the lack of understanding of

adolescents about the risks of sexual relations and

the ability to reject relationships that they do not

want.

The number of deviant behavior done by

adolescents, of course, becomes a major problem in

adolescent health. For this reason, special handling

is needed for adolescents to reduce negative

behavior. The Ministry of Health of the Republic of

Indonesia has developed the Youth Health Care

Program (PKPR) since 2003 at the Puskesmas. The

PKPR program at the Puskesmas then promotes

health to schools, youth clubs, and other youth

groups. Puskesmas work closely with the UKS in

every existing school. PKPR is a health service

aimed at and reached by teenagers with a pleasant

impression, accepting teens with open arms, keeping

secrets, counseling with needs related to adolescent

health to meet those needs. With the PKPR program

being implemented at the puskesmas, adolescents

are scouted into creative teenagers without a record

of juvenile delinquency. Counseling services are a

feature of PKPR considering that adolescent

problems are not only related to physical but also

psychosocial. Outreach efforts to adolescents are

carried out through information and education

communication and counseling to schools and

adolescent groups.

Pulogadung Sub-district Health Center is one of

the Community Health Centers that has conducted

PKPR programs and works closely with schools in

East Jakarta. The PKPR program at the Pulogadung

District Health Center has run well but health

services at productive age have not reached the

target of 56.1% with the target supposed to be 100%

according to the provisions set by the puskesmas. As

a result of the program that is not going well, the

number of health problems in adolescents in the

Pulogadung District Health Center is still high.

Based on reports of visits to cases of adolescent

health services in the Pulogadung District Health

Center in 2018 namely 225 cases of obesity, 188

cases of smoking, 98 cases of pregnancy in

adolescents, 70 cases of premarital sex, 49 cases of

menstrual disorders, 39 cases of anemia, 26 cases of

childbirth, 22 cases of problems psychiatric, 19

cases of alcohol, and 2,254 other cases such as

tuberculosis, ARI, diarrhea, and others. This case

can increase because not all cases are reported to the

puskesmas.

2 METHOD

This research was conducted at the Pulogadung

District Health Center. This study used descriptive

qualitative method. The population is health workers

who carry out the PKPR program at the Pulogadung

District Health Center. Informants are selected based

on the principle of the subject who mastered the

problem, has data and is willing to provide complete

and accurate information.

There are three types of informants in this study,

namely key informants, key informants, and

supporting informants. The key informants were the

head of the puskesmas, the main informants were

health workers in the PKPR poly (program

responsible, doctors, nurses) and supporting

informants were UKS supervisors.

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Data collection techniques used by in-depth

interviews, observation and document review.

Interviews were conducted based on the interview

guidelines. Observations were made by researchers

of the activities carried out in the implementation of

adolescent health care programs carried out both

within the puskesmas and outside the puskesmas.

Data collection through document review was

carried out by researchers with documents contained

in PKPR, both planning documents, budgets,

methods, and recording PKPR activities both within

the puskesmas and outside the puskesmas.

In this research, triangulation is done, namely

method triangulation, source triangulation, and data

triangulation. Method triangulation is done by

comparing information in different ways namely

interviews, observation and document review.

The triangulation of sources is done by

examining the results of several in-depth interviews

with different informants. Data triangulation is done

by comparing primary data obtained through in-

depth interviews and observations with secondary

data obtained through the document review process

related to the PKPR program.

3 RESULTS

3.1 Overview of PKPR Input

3.1.1 Human Resources

Based on the results of research on human resources,

it was found that the human resources in charge

consisted of doctors, nurses and the person in charge

of PKPR at UKS. Health workers have also received

special training on youth as a condition of being

PKPR officers. The problem that occurs in human

resources is that the PKPR poly officers need

psychologists and permanent doctors who only serve

PKPR poly at the Pulogadung District Health

Center.

3.1.2 Infrastructure

Based on the results of research on the infrastructure

available in the Pulogadung District Health Center

on PKPR that is good enough with a room that is

already privacy with a separate room and

soundproof from the outside and is designed as

comfortable as possible for patients. However, the

room is not available for media and materials for

IEC such as posters and leaflets.

3.1.3 Method

Based on the results of the research obtained

regarding the method or guidelines used are specific

guidelines on adolescents that refer to the Ministry

of Health's PKPR National Standards and a

combination of several government regulations on

adolescents. There is a disconnect between health

workers in the PKPR policymakers regarding the

socialization and review of the method used. This is

because there are officers who are not familiar with

the reviews and outreach carried out in connection

with the PKPR program.

3.1.4 The Budget

Based on the results of research on the budget

obtained that the budget comes from the government

namely BLUD for puskesmas and BOP and BOS for

schools. There are no restrictions on the use of the

budget supported by the existence of the Work Plan

and Budget report (RKA) and the School Activity

and Budget Plan (RKAS).

3.2 Overview of the PKPR Process

3.2.1 Preparation

Based on the results of research on preparations in

PKPR Puskesmas Pulogadung District, it is done

once a year and is made one year later or planning is

running. The expansion of the PKPR program that

has been carried out by puskesmas is conducting

health promotion to schools covering the working

area of the Pulogadung District Puskesmas,

conducting IEC activities and training students to

become peer counselors.

3.2.2 Health Services

Based on the results of research related to health

services consisting of health checks, treatment,

counseling and counseling obtained from

examinations in patients aged 10-19 years with any

complaints. Then anamnesis was performed in the

form of patient data and medical record data such as

height, weight and blood pressure followed by

counseling services in the form of complaints felt by

patients. Treatment is done by treating clinically and

referring to the agency needed by the patient if the

problem cannot be handled by the health center.

Counseling is carried out by nurses with questions

asked to patients. Counseling is not done specifically

for adolescents in the health center environment but

is done through health promotion in schools.

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3.2.3 Monitoring and Evaluation

Based on the results of research on monitoring and

evaluation conducted every quarter through

meetings called minilok. The meeting was attended

by various cross-sectors in the community. The

matter discussed was in the form of achievement and

problem solving that occurred within the PKPR

program.

3.2.4 Recording and Reporting

Based on the results of the study found that the

recording is done to patients who visit by collecting

data to patients. The recording is done manually and

network systems. Enumeration was also carried out

before and after PKPR activities in the school. After

the recording will be reported to higher parties such

as schools that report to the puskesmas then proceed

to the health department.

3.3 PKPR Output Overview

Based on the results of the study it was found that

the impact of the existence of the PKPR program

both in health centers and schools provides a very

good impact on adolescents. Apart from being a

place for health examinations, PKPR is also a place

to learn about adolescent health and a place for

counseling in accordance with complaints that are

often felt by adolescents.

4 DISCUSSION

4.1 Overview of PKPR Input

4.1.1 Human Resources

Based on the results of the study that the existing

PKPR poly health human resources are quite good

with officers who already have special training for

adolescents as stipulated by PKPR officers and peer

counselors who also receive training. The absence of

permanent doctors in PKPR has led to the

monitoring of every patient who needs a little

problematic monitoring so that the high rate of

juvenile delinquency around the Pulogadung District

Health Center area.

4.1.2 Infrastructure

Based on the results of the study note that the PKPR

poly room is placed in a separate room with another

poly. But in the room, there are no restrictions

between doctors and nurses to separate the

examination and counseling services that are

conducted and IEC media that are not available.

4.1.3 Method

Based on the results of research related to the

method or guidelines, it is found that the guidelines

used to refer to the Ministry of Health's SN-PKPR

and regulations from the government. The method of

socialization was still minimal by the Pulogadung

District Health Center because there were still health

workers who did not know of the review in the

guidelines. This can cause health workers to not

understand the existing guidelines.

4.1.4 The Budget

The budget used in PKPR comes from the

government and before making a budget request a

budget planning is made to clarify the use of the

budget so that there are no problems that can

interfere with the implementation of the PKPR

program.

4.2 Overview of the PKPR Process

4.2.1 Preparation

Good preparation is done once a year at the

beginning and end of the year to determine the

setting of goals and strategies on PKPR in order to

run the program and produce good output. To

develop PKPR, puskesmas need to expand to

adolescents to increase PKPR access in the future.

4.2.2 Health Services

Based on the results of research that a clear path

makes it easier for patients to visit and be handled

quickly in patients aged 10-19 years. And if the

problem cannot be handled by the health center will

be referred to the agency required by the patient.

Patients will then be counseled about complaints that

are felt and given counseling individually in

accordance with the issues that are proposed. In

addition to individual counseling, the puskesmas

also conducts group counseling to schools that work

together with the Pulogadung District Health Center.

4.2.3 Monitoring and Evaluation

Based on the results of research that monitoring and

evaluation have been well done to monitor the

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implementation of PKPR to achieve the target or

not. But there are still officers who are not aware of

the monitoring and evaluation activities carried out.

This shows that if socialization is still not

maximized and can cause health workers not to

understand the progress and targets to be achieved

by PKPR.

4.2.4 Recording and Reporting

Based on the results of research that recording and

reporting in accordance with the existing National

Standards PKPR and run well even though there are

problems in the form of a network system that is

sometimes an error.

4.3 PKPR Output Overview

Based on the results of research that teenagers still

do not know clearly the actual PKPR program even

though they have participated in several activities

included in PKPR. The unclear information about

the use of PKPR supports why teenagers do not use

the service.

5 CONCLUSIONS

1. PKPR Poly does not have a permanent doctor

program that handles specifically PKPR Poly

and psychologists in handling counseling

issues.

2. Still lack facilities and infrastructure in PKPR

poly in the form of poly space and IEC media

location.

3. Lack of socialization on standard operating

procedures to other PKPR health workers.

4. The budget used in the PKPR program comes

from the government so that there are no

restrictions on the use of PKPR activities in

puskesmas and schools.

5. The Puskesmas has carried out planning

activities on the PKPR program to determine

targeted activities and expansion of the

programs carried out to improve PKPR access

in the future.

6. PKPR poly health services with a clear

examination flow, treatment and referral

activities, counseling services and counseling

services through health promotion in schools.

7. Monitoring and evaluation conducted by POL

PKPR through the Minilok meeting with the

aim of monitoring the achievement targets of

the PKPR program and solving problems that

occur to improve service quality in the next

period.

8. Recording every PKPR activity carried out

both inside the puskesmas and outside the

puskesmas aims to obtain data on adolescent

health in the puskesmas area and planning

interests, the results of the recording will be

reported to the higher-level agency.

9. Poly PKPR provides great benefits for

adolescents because of special services

provided to adolescents. The benefits of PKPR

include information about health and how to

look after it and a place for a consultation.

6 RECOMMENDATION

1. It is hoped that the puskesmas will establish a

special doctor program in PKPR to facilitate

the monitoring of patients who need follow-up

and add a psychologist to help solve

psychological problems in patients.

2. It is expected that the PKPR poly room is

placed in a separate place and access to the

poly does not go through other poly poles and

the addition of insulation in the room between

inspection and counseling. The addition of

IEC media such as leaflets is also very needed

for teenagers to find out information or

information about adolescent health problems

or about PKPR policymakers.

3. Good socialization is needed for all health

workers regarding the standard operating

procedures and how to review them. This is

done so that health workers can carry out

services in accordance with established

standards that will make the service have good

quality in the eyes of patients.

4. To develop poly PKPR better known by

adolescents, puskesmas are expected to expand

their activities to PKPR. This can increase

access to PKPR in the future so that more

teenagers will know and know about

polyclinics that provide adolescent health

services.

5. Puskesmas are expected to carry out special

youth counseling conducted at the puskesmas

so that adolescents will know that the PKPR

poly is not only dealing with sick patients and

reducing the number of existing adolescent

health problems.

6. It is expected that the puskesmas will conduct

socialization of every monitoring and

evaluation activity to other health workers so

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that health workers understand the progress

and targets to be achieved in the PKPR poly.

7. Enumeration conducted by the UKS is

expected to guide the UKS to monitor when

counseling has been done so as not to forget in

recording the results of counseling that will be

reported to the puskesmas.

8. It is expected that the puskesmas will conduct

socialization to adolescents and involve youth

in the implementation of PKPR to improve

and introduce that the PKPR poly is not only

dealing with sick people.

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Kesehatan RI.

Kementerian Kesehatan, 2018. Hasil Utama Riskesdas

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