Day 6: Primary Health Care in Indonesia

Alright… Before this, I’ve mention about Primary Health Care (PHC) in general and about Declaration of Alma-Ata. So, I’ve decided that we should recognize the PHC around ourselves, in this case Indonesia.

Actually, prior to Declaration of Alma-Ata in 1978 regarding PHC, Indonesia has already developed various forms of PHC in some regions. Based on research in 1976, it is noted that 200 community-based health activities (CBHA) have been implemented and carried out within the community. Along that time, PHC has developed rapidly in various forms of CBHA and one of it as Posyandu (Integrated Service Post), which activities covers 5 major programs: family planning, maternal and child health, nutrition improvement, immunization and diarrhea prevention. Besides Posyandu, there is village maternity home (VMH) which is managed by village midwife as a way to make maternal and child health services close to the community. However, in 1997, the CBHA went into a decline during monetary crisis which resulted in multi-dimension crises.

Various services provided by Posyandu

Indonesia experienced a political reform following the 1997 monetary crisis. One form of the change in health sector was the issuance of Health Minister Decree number 128/Menkes/SK/II/2004 regarding the basic policy of health care.

There are 3 functions of PHC:

• Center for health development
• Center of community empowerment
• Center of health service at primary level which divided into:
• Individual health service
• Public health service

Earlier on, I’ve mention a little bit about community-based health activities (CBHA) as form of PHC. What is CBHA actually provide to the community?

CBHA is a form of community institution or movement which come from, manage by and also for the community themselves. Usually the community chooses health volunteers and the health care provides training for them. CBHA for different community groups are different (for under-five, for elderly people and etc.).

[Different group of people need different type of medical attention...]

 Activities of CBHA varied. Some of them are:

1. Posyandu (integrated service post/ISP) is managed by health volunteers and spread out in all villagers. Usually, one posyandu serves 100 under-five years old children.
2. Polindes (village maternity home/VMH) is managed by midwife. It is expected that every village has one VMH but so far not all villages have it.
3. Poskesdes (village health post/VHP) is managed by midwife and health volunteers. It is a community institution beyond VMH, to cover other public health services. Each VMH will be improved to be VHP.
4. Posyandu for elderly people (integrated service post for elderly people) is managed by health volunteers and usually exist in sub-district level. It is a form of health empowerment for elderly people in addressing common diseases for elderly people, especially degenerative diseases.
5. Posyandu for non-communicable disease (NCD post) is managed by health volunteers and it is a form of health empowerment for non-communicable disease risk factor identification such as smoking, sedentary life-style, obesity that can manifest as hypertension, cardio-vascular diseases, diabetes mellitus, etc.
6. Village medicine post is managed by health volunteers. Its main role is to help in detecting malaria disease and curing it.
7. Islamic school health post is managed by Islamic school student. The main role is to improve healthy behaviours for Islamic school students.
8. Occupational health post is managed by health volunteers who are appointed from the informal workers.
9. Saka Bhakti Husada (Health Scout) is managed by health volunteers and is developed in the scout organization. This organization activity covers various aspects such as nutrition, environment health, maternal and child health, disease prevention and narcotics and drugs.

As has been describe, there are many activities of CBHA. Among this, Posyandu (ISP) is the most familiar and popular form of CBHA in Indonesia. Posyandu is run by health volunteers, open once a month and provides: mother and child health (MCH), family planning (FP), nutrition, immunization and diarrhoea disease control. The posyandus’ performances varies, from unstable posyandu to self-reliant posyandu (regular activities and high coverage of all programmes). 

The posyandu is categorized into 4 level of development:

1. Pratama or first level posyandu. It’s the unstable posyandu and the activities depend on the presence of health personnel.
2. Madya or second level posyandu. It has regular activities, but the program coverage is still <50%. 
3. Purnama or third level posyandu. The activities has run regularly, the programme coverage is high (>50%), but has not yet supported by community health fund.
4. Mandiri or self-reliant posyandu. It has regular activity, high programme coverage and supported by community health fund.

Other activities of CBHA can be read from the one and only reference shown below… ;)

Thank you for your attentiion! ^_^

REFERENCE:

1. REVITALIZING PRIMARY HEALTH CARE; COUNTRY EXPERIENCE: INDONESIA