JAKARTA, KOMPAS – The state’s health burden, mostly resulting from communicable and noncommunicable diseases and mental disorder, remains high. In the long run, this will erode the national productivity level and economy. Efforts to promote a healthy lifestyle and disease prevention must be more serious.
Health Ministry primary healthcare director Saraswati said in Jakarta on Thursday that public healthcare campaign efforts in community health centers (Puskesmas) were not optimal. A majority of these Puskesmas still apply the old paradigm of prioritizing curative health efforts. Nowadays, preventive efforts through public outreach campaigns must be prioritized.
A majority of diseases, disabilities and deaths from illnesses can be prevented through promotive and preventive measures. However, public health campaigns at the level of primary healthcare services are not yet optimal. “Less than 50 percent of heads of Puskesmas truly understand how public health campaigns must be carried out,” Saraswati said.
Poor health and disease prevention promotion efforts have resulted in high morbidity and mortality rates. In the fourth quarter in 2017, 3,597 mothers died from childbirth and 22,377 babies died. The prevalence of children suffering from stunted growth, severe malnutrition or malnutrition is at 27.6 percent, 3.4 percent and 14.4 percent, respectively.
Moreover, in the past year, diphtheria, which is preventable by vaccination, exploded into a health emergency in 170 regencies and cities. The prevalence of tuberculosis remained at 618 out of every 100,000 people in 2016.
Meanwhile, heart and cardiovascular diseases remain the leading cause of death. This is linked to a number of preventable risks, including hypertension, the prevalence of which remains at 30.9 percent.
Patient visits
In line with the implementation of the National Health Insurance-Indonesia Health Card (JKN-KIS) program, patient visits to Puskesmas are increasing. Kompas monitoring in a number of regions showed that there are lines of JKN-KIS patients at Puskesmas.
Puskesma Sobo head Hanipan in Banyuwangi, East Java, said 56,389 patients visited Puskesmas throughout the year, or 160 patients per day, in 2012. The number has increased to 60,522 patients in a year, or 173 per day. Most patients come to Puskesmas to check on their blood pressure, blood sugar level, cholesterol level and uric acid.
In Puskesmas in Kenjeran, Surabaya, between 100 and 150 patients come every day to seek treatment. Before the JKN-KIS program was implemented, fewer than 100 patients came in every day. Most patients sought treatment for acute respiratory tract infection (ISPA), muscle pain, diarrhea and hypertension.
Without good preventative measures in place, a number of risk factors may lead to illness and will therefore increase the number of visits to Puskesmas. However, only a handful of Puskesmas are actively reaching out to the public for health promotion and preventive campaigns.
In Central Kalimantan, Madan, 48, a resident in Mentaren, Pulang Pisau regency, said there had never been any health campaigns on hypertension in his village. Local nurses and midwives only check on nutritional levels in pregnant women and toddlers.
Meanwhile, in the mountainous region of Seram Island, especially in Inamosol district, Western Seram regency, Maluku, locals need to visit Puskesmas Kairatu, located dozens of kilometers from their home. Puskesmas Inamosol cannot function effectively as a primary healthcare facility.
On Monday, there were no healthcare officers manning the Puskesmas. Locals said the officers were enjoying leisure time in the city and that this was a common occurrence.
Outreach
Amid the high prevalence of Puskesmas still trapped in the old paradigm of waiting for patients to arrive, some Puskesmas are actively reaching out to locals.
West Java health agency head Dodo Suherman said healthcare officers in 300 of the 1,058 Puskesmas in the province had received training on mapping locals’ health condition. “It is time for us to be active in coming to the people and monitoring their health. If one area has many people suffering from hypertension, we need to intensify our socialization efforts on the disease. If it is not monitored, hypertension can lead to stroke,” he said.
In Banyuwangi, apart from serving as a place for medical treatment, local Puskesmas are designed to provide health consultations. Banyuwangi Regent Abdullah Azwar Anas said he hoped a healthy lifestyle movement could be carried out without having to wait for people to get sick. Therefore, the regency administration expresses appreciation for the Puskesmas that provide the most health consultation sessions.
Village and district heads are asked to give time to healthcare officers from Puskesmas to provide training when said villages or trainings are holding events where locals are gathered.
In Surabaya, public outreach is implemented by Puskesmas through 2,800 integrated health service posts (Posyandu) and 1,900 integrated health guidance posts.
(ADH/IDO/FRN/GER/BKY/TAM/SYA)
