Now More Than Ever

Christian University of Krida Wacana

Azarya Sihite​1 ​, Shindie​2 ​, Alega Greacia​3

Abstract
To ensure public health, especially for mothers and children, the Government of Indonesia has
sought it through Puskesmas as the first institution closest to the community which is the
spearhead for preventive and promotive programs. Limited health costs are also not a problem
because the Government has even provided a health insurance called BPJS.
Key Word : Vaccinated, Primary Health Care

Introduce
Indonesia is the largest archipelago country in the world, and the fourth most populated
country. It comprises more than 17 000 islands, the largest being Java, Sumatera,
Kalimantan/Borneo, Sulawesi/Celebes, and Papua. Indonesia has 255 461 million inhabitants
linked by one official language, Bahasa Indonesia, while there are more than 700 local
languages. Administratively, the country has 34 provinces, 514 districts, more than 7000
subdistricts, and more than 80 000 villages. Though it has a stable life expectancy, Indonesia is
still challenged by poverty, and 11% of the population is living below the poverty line.​1
Indonesia is facing a triple burden of health care problems due to (a)re-emerging
diseases such as polio and diphtheria, due to challenges in the distribution and scope of child
immunization. (b) the ineffective control of infectious diseases such as tuberculosis, malaria,
dengue fever and other infections (c) the rise of chronic diseases into the list of top five
catastrophic disorders in the country, leading to increased risk of metabolic disorders, such as
diabetes mellitus, hypertension, dyslipidaemia, and cancers, in addition to cardiovascular
problems, trauma and injuries.​1
Quality of life dan equal are basic of human right. In Indonesia accordance with Article
34 of the Nation Constitution of 1945 and Nation Health Act No. 36 of 2009 truly support the
health movement as a human right that is in accordance with the ideals of the Indonesian nation
and the state making it a priority and national development must also consider increasing the
degree of public health.​1
Outline Problems
In Indonesia immunization is adjusted to the age of the child. For complete basic
immunization, infants under 24 hours are given Hepatitis B immunization (HB-0), age 1 month
is given (BCG and Polio 1), age 2 months is given (DPT-HB-Hib 1 and Polio 2), age 3 month is
given (DPT-HB-Hib 2 and Polio 3), age 4 months is given (DPT-HB-Hib 3, Polio 4 and IPV or
injectable Polio), and age 9 months is given (Measles or MR).
Since vaccination decision affect not only mother and their kids, but also the
community, these decisions cannot be treated as individual ones. At the point where individual
decision might harm the community. Because there are two points of problem that come from
internal or because of external problems. Mother can be influence by other people stories such
as their children are still sick even though they have been immunized or other information that
has not been proven truth, hesitant about the benefits, disbelief in the health agency or external
problem such access to health.
Vaccination has strongly developing into modern medicine and shows positive impact.
Vaccines can be given to children and adults, depending on the health conditions needed. The
function of vaccines is also to protect from the risk of disability and death where the provision
of vaccines is believed to protect against the risk of disability and death. That means the more
vaccinated people there are, the harder it is for a disease to spread. It means we protect
individual health, but also protect the whole community against potential outbreaks. ​In this
paper we want the obstacles to rejection of vaccines to disappear by reminding the importance
of providing education and health facilities such as Puskesmas and Posyandu.

Solution
Primary Health Care (PHC) was introduced by the World Health Organization (WHO)
around the 1970s, with the aim of increasing public access to quality health services. In
Indonesia, Primary Health Care has 3 (three) main strategies, namely multisectoral
cooperation, community participation and the application of technology that is in accordance
with the implementation in the community. According to the Declaration of Alma Ata (1978),
"PHC is the first contact of individuals, families, or communities with a service system". This
understanding is in accordance with the definition of the National Health System (SKN) in 2009
which stated that, "Primary Health Efforts are basic health efforts where the first contact of
individuals or communities occurs with health services." 2​
In Indonesia, the implementation of Primary Health Care (PHC) is carried out in
Puskesmas and community-based networks and community participation, namely Posyandu
which is in every district and subdistric. According to the national health system Puskesmas
(Community Health Center) is the first fondation health care facility that is responsible for
organizing individual health efforts and community health efforts.
The purpose of establishing a Puskesmas is for national health development, increasing
awareness, willingness and ability to live healthy for everyone who lives in the working area of
​Puskesmas. The function of Puskesmas is 3 (three), center for mobilizing health-minded
development, the center for community empowerment, and the first fondation health service
center. The first health service in the Puskesmas includes promotive, preventive, curative and
rehabilitative services.​2
The Puskesmas is responsible for organizing individual health efforts and public health
efforts, both of which are viewed from the national health system as a first level health service.
The health efforts are grouped into 2 (two), namely compulsory health efforts and development
health efforts.​2
1. Mandatory Health Efforts
The mandatory health efforts of the Puskesmas are efforts that are determined based on
national, regional and global commitments and that have a high leverage to improve public
health. This mandatory health effort must be carried out in every Puskesmas in the territory of
Indonesia. The mandatory health efforts are health promotion effort, environmental health
efforts, maternal and child health efforts and family planning, efforts to improve community
nutrition, efforts to prevent and eradicate infectious diseases, treatment efforts
2. Development Health Efforts
Health efforts to develop Puskesmas are efforts that are determined based on health
problems found in the community as well as those adapted to the capabilities of the Puskesmas.
Development health efforts are selected from the list of existing primary health center efforts,
namely school health efforts, sports health efforts, public health care efforts, occupational
health efforts, dental and oral health efforts, mental health efforts, eye health efforts, elderly
health efforts, efforts to foster traditional medicine.​3
In addition to the existence of Puskesmas, there are also other health businesses called
Posyandu (Integrated Service Posts). Posyandu is one form of Community based Health Efforts
(UKBM) carried out by, from and with the community, to empower and provide facilities for
the community to obtain health for mothers, babies and children under five. There are various
types of activities carried out by Posyandu such maternal health of children, family planning,
immunization, improved nutrition, overcoming diarrhea, basic sanitation, provision of essential
medicines.​4 ​Posyandu is one form of Community Based Health Efforts (UKBM) managed and
held from, by, for, and with the community in managing ​health development to empower the
community and provide convenienceto the community in obtaining basic basic / social health
services for ​accelerate the decline in Maternal and Infant Mortality. Thus Posyandu is a basic
health activity organized by​ ​community and for communities assisted by health workers.​4

Conclusion
Therefore, the Government has made primary health efforts, namely Puskesmas in each
district and subdistrict, community based networks and community participation, namely
Posyandu that serves child immunization. As hope, there is the closest contact between
individuals or communities to get health services. To solve external and internal problems that
have been explained, Puskesmas have mandatory health principles, that is efforts to promote
health, environmental health efforts, maternal and child health efforts, efforts to improve
community nutrition, efforts to prevent and eradicate infectious diseases and treatment efforts.
Because the main principle of Puskesmas is developed promotion and preventive efforts, so if
the program is well implemented by the Puskesmas internal and external problems can be
solved because with good education built good health. And also for the cost problem the
Government has established BPJS a health social security agency to help and guarantee that the
community can access Puskesmas and other health services for free.

Recommendation
Problems that Posyandu might face are lack of community and qualified cadre. Cadres
are expected to bridge between health officers or experts with the community as well help the
community identify and face or answer health needs themselves. In this case the Posyandu
Cadre as a motor for driving public health must be a reliable communicator in disseminating
information on health to the community. Through Posyandu, this cadre must communicate the
maternal and child health information appropriately. Thus, community participation in
managing and utilizing Posyandu programs can be seen from active community participation in
Posyandu activities every month such as utilizing free immunizations, weighing toddlers,
controlling health.

References
1. ​World Health Organization, 2017, ​Primary health care systems (PRIMASYS): case
study from Indonesia​, cited: April 5, 2019.
<​https://www.who.int/alliance-hpsr/projects/alliancehpsr_indonesiaabridgedprimasys.
pdf?ua=1
2. ​Departemen Kesehatan Indonesia, 2011, ​Implementasi Primary Healt Care di Indonesia​,
cited April 5, 2019 <http://www.depkes.go.id/pdf.php?id=1558
3. ​KEPMENKES, 2004, cited: April 4, 2019.
<https://peraturan.bkpm.go.id/jdih/userfiles/batang/KEPMENKES_128_2004.pdf
4. Saepudin E, Rizal E, Rusman A, 2017, ‘​Posyandu Roles as Mothers and Children Health
Information Center​ ` , Record and Library Jurnal ,​Vol 3, No. 2.