460 AMJ September 2016

Health Promotion Activities in Bandung Public Health Centre

(Puskesmas)

Siti Fairuz Nadya,1 Insi Farisa Desy Arya,2 Anggraini Alam3

Faculty of Medicine Universitas Padjadjaran, 2Department of Public Health Faculty of
1

Medicine Universitas Padjadjaran, 3Department of Child Health Faculty of Medicine Universitas

Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung

Abstract

Background: Health promotion is one of Public Health Centre (Pusat Kesehatan Masyarakat, Puskesmas)
essential health effort able to increase community health status. The purpose of this study was to describe
health promotion activities in Bandung Public Health Centre (Puskesmas).
Methods: This study was a cross sectional descriptive study using questionnaire as data collection
instrument. The questionnaires were distributed to 24 Puskesmas in Bandung that were selected randomly
using simple random sampling method. The process of questionnaire filling was performed by health
promotion officer after informed consent was done. The variables were basic health promotion strategies,
health promotion supports, health promotion in health facility and health promotion in community.
Results: Most of the Puskesmas showed that basic health promotion strategies, health promotion in health
facility and health promotion in community were already done. Support media that was mostly used was
printed media while lectures was the most used method. Human resources practitioner and coordinator of
health promotion were dominated by mid level health workers consists of midwife and nurse. This study
showed that the majority of health promotion coordinator had underwint training and certificate related to
health promotion. The availability of funds were possessed by 13 out of 24 sample. While, health promotion
guideline were possessed by less than half of the sample.
Conclusions: Health promotion is done in almost all sample. There is lack of health promotion support in
the form of the availability of funds and guideline of health promotion method. [AMJ.2016;3(3):460–8]

Keywords: Health promotion, health promotion support, Puskesmas

Introduction in 1983 to 15.9% in 2010 among adult men.

It is thus implicitly concluded that health
Public Health Centre (Pusat Kesehatan promotion leads to the improving of public
Masyarakat, Puskesmas) is the executive unit health status. Another example from Australia
of a municipal (city or regency) health office also demonstrates that innovations in health
which holds the primary role for providing promotion leads to fewer interventions on
health services, particularly stressing teenagers with cigarette and alcohol abuse.5
on promotive and preventive aspects. In Indonesia, the success of health
Puskesmas is responsible for both essential promotion leads to clean and healthy
and developmental health services. Health behaviors (Perilaku Hidup Bersih dan Sehat,
promotion is an example of the former group PHBS) in public. In Bandung’s 2011 health
able to contribute to increase the public level profile, 65.64% households were reported to
of health. According to WHO, health promotion practise the behavior but interestingly there
is a process of increasing an individual’s was no yearly increasing in the percentage of
capabilities to improve health.1-3 households practising such behavior. 6,7
In 1980, an innovation known as “Quit Indonesia has adopted the nationwide
Campaign” was introduced in Australia and it health insurance (JKN) per 1 January 2014.
was a nationwide campaign aiming to reduce According to Regulation of the President of
smoking-related mortality. The campaign the Republic of Indonesia number 12 year
reduced the prevalence of smoking from 40% 2013 on the nationwide health insurance,

Correspondence: Siti Fairuz Nadya, Faculty of Medicine, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang
Km.21, Jatinangor, Sumedang, Indonesia, Phone: 085316488993 Email: [email protected]

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 461

every citizen is entitled to (1) primary level self-administered by 24 officers from the
healthcare, consisting of general health aforementioned 24 Puskesmas.
care, (2) advanced level healthcare based Informed consent was collected by the
on referrals and (3) other forms of health healthcare officers prior to filling out of the
care as laid out by the Minister of Health. questionnaires. The same officers also filled
Promotive and preventive efforts form the out another informed consent form stating
bulk of primary level healthcare. Additionally, their willingness to participate in this study.
the nationwide health insurance adopts a Respondents with incomplete questionnaires
system of capitation based on the number of were later contacted. Data analysis were
applicants regarding to the type and number carried out using Microsoft Excel 2010.
of provided healthcare services. In order to
prevent medical personnels defaulting on the Results
capitation fees, health promotion becomes top
priority in an attempt to curb down costs on Data were collected from 24 Puskesmas in
curative efforts.8 Bandung. Four variables in this study and the
Therefore, this study on the degree of results for the first variable which was basic
health promotion done by various Puskesmas strategies of health promotion are presented
in Bandung in 2011 should help us to face in Table 1.
the era of nationwide health insurance with From four facets of basic strategy,
its own set of demands on health promotion, optimising the environment was practised
challenges on managing the limited capitation the least. Additionally, the questionnaires
fees and the relatively stagnant adoption of revealed that not all of the primary health
clean and healthy behavior by the people. The Centres exercised all four strategies and there
purpose of this study was to describe health were Centres practicing none.
promotion activities in Bandung Public Health Table 2 demonstrated that midwives
Centre. contributed the most in the implementation
of basic health promotional strategies while
Methods community health officers contributed the
least. The public formed the main target when
This was a cross-sectional descriptive study it came to empowerment and optimisation
which employed a simple randomized of the environment. Public organizations
sampling method by choosing 24 out of 73 were at the last of advocacy. There was not
Puskesmas in Bandung. Data collection were primary healthcare Centres picked political
carried out from September to November organizations as their targets of advocacy. In the
2014. meantime, partnerships with religious elders
This study had been approved by Health were commonly practised. Empowerment and
Research Ethics Committee of Faculty optimisation of the environment were done
of Medicine of Universitas Padjadjaran. mostly on a monthly basis.
Primary data were recorded using validated On the second variable, i.e. health
questionnaires based on the standardized promotion supportive instruments, there
protocol on health promotion in Puskesmas were 5 investigated subvariables. Table 3
published by the Ministry of Health Republic demonstrated that 6 Puskesmas utilized the
of Indonesia. The questionnaires contained guideline-directed individual, group and mass-
questions on health promotion strategies targeted approaches. Mass media also formed
in Indonesia, supportive measures of such the most widely utilized health promotion
strategies, and health promotive activites instrument.
both on healthcare centre premises and in Out of 24 Puskesmas, 13 had enough funds
the community. The questionnaires were to carry out health promotional programs

Table 1 Basic Strategies of Health Promotion

Basic Strategy Frequency
Empowerment 21
Environment Optimisation 18
Advocacy 19
Partnership 22

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Table 2 Basic Strategies of Health Promotion and Their Implementation

Basic Strategy
Environment
Empowerment Advocacy Partnership
Optimisation
(n) (n) (n)
(n)
Implementor
Community Health Personnels 2 2 2 2
Doctor 12 11 13 17
Nurse 14 13 13 15
Midwife 18 15 16 18
Sanitarian 7 8 9 11
Others 7 7 5 3
Targets
Individual 17 11 - -
Family 17 9 - -
Community 19 17 - -
State officials - - 6 -
Entrepreneurs - - 6 -
Political organizations - - 0 -
Public organizations - - 14 -
Professional groups - - - 12
Religious elders - - - 15
Independent public institutions - - - 11
Mass media - - - 4
Others - - 10 5
Frequency
Daily 8 6 - -
Weekly 12 7 - -
Monthly 16 13 - -
Others 1 3 - -

and 10 had a midwife(s) to coordinate such contributing the most.

programs. Over half of study samples had
a health promotional efforts coordinator Discussion
who had undergone training and gained
certification. As demonstrated in table 1, more than half of the
Table 4 demonstrated that health promotion participating healthcare Centres (Puskesmas)
in the inpatient wards was the least in number had performed the basic strategies of health
among all forms of health promotion within promotion. A study conducted by Rezeki
the healthcare premises. and Mulyadi10 in Puskesmas Sei Kijang,
Table 5 showed that approaches to Pelalawan Regency demonstrated a significant
individuals and families formed the bulk of association between health promotional
health promotion in the community. All types strategies, i.e. advocacy, empowerment and
of health personnels contributed to these optimisation of environment, and the adoption
approaches with doctors, nurses and midwives of clean and healthy behaviors (Perilaku

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 Siti Fairuz Nadya, Insi Farisa Desy Arya, Anggraini Alam: Health Promotion Activities in Bandung Public 463
Health Centre (Puskesmas)

Table 3 Health Promotion Supportive Instruments (1)

Supportive Instruments Number
Method
Individual approach
Health education 23
Counselling 20
Others 0
Group Approach
Lectures 20
Seminar 5
Group Discussions 15
Snow-ball 0
Buzz Group 11
Simulations 2
Role Play 2
Others 0
Mass Approach
Lectures 19
Talkshows 9
Simulation 9
Films 4
Articles in the media 3
Billboard 17
Others 1
Media
Printed 7
Booklet 21
Leaflet 12
Flyer 17
Flipchart 6
Rubric 20
Poster 18
Photos 3
Others 0
No assisting material
Electronic 7
Television 3
Radio 1
Video 13
Slides 2
Film Strip 1

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Table 3 Health Promotion Supportive Instruments (2)

Supportive Instruments Number
Others 2
No assisting material 0
Media Boards
Billboard 9
Others 3
No assisting material 0
Guideline 6
Funds 13
Human Resources Coordinators
Community health personnels 3
Doctor 2
Midwife 10
Nurse 5
Human Resources Coordinators
Sanitarian 0
Others 4
Qualitifcations
D1 2
D3 17
S1 3
Professional 2
Training 23
Certification 16

Hidup Bersih dan Sehat, PHBS). Even though working at various Puskesmas in Bandung
more than half of the participating healthcare focusing on public health. Health profile data
Centres have implemented the basic strategies in 2011 also stated that there was only one
of health promotion, the health profile of the public health officer for every 3 Puskesmas in
city of Bandung in 2011 only stated 65.64% Bandung.7
adoption rate of clean and healthy behavior by Data on table 3 shows that 23 Centres
the public and the rate was relatively stagnant have coordinators on health promotion who
for several years.7 previously has undergone training on health
This study also found that health promotion and 16 of the coordinators have a
promotional efforts are dominated by nurses certificate on health promotion. Most of these
and midwives classified as mid-level health coordinators were either midwives or nurses
workers. Such observation had also been and this observation was already in accord
confirmed by the 2011 Bandung health profile with the regulations on health promotional
data.7 Additionally, a study by Lassi et al.11 officers qualifications.9 A study by Yuniarti12
from 1973-2012 showed that there was no stated that the level of education, training,
difference in the degree of effectiveness of knowledge, skill and leadership capabilities of
health service carried out by mid-level health the officers influenced their performances.12
workers and higher level health workers.11 This study has revealed that more than half
Table 3 demonstrates that only 2 health of the participating coordinators have already
promotional officers have a degree in public fulfilled the criteria on education and training.
health. In 2011, there were only 74 people From table 3 it can be showed that on the

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 Siti Fairuz Nadya, Insi Farisa Desy Arya, Anggraini Alam: Health Promotion Activities in Bandung Public 465
Health Centre (Puskesmas)

Table 4 Health Promotion in Health Facility (1)

Health Promotion in Health Facility Number
Registration sites
Type of information
Service flow 22
Service type 18
Map of clinic 10
Problem info 16
Regulations 19
Media
Leaflet 11
Poster 20
Flyers 13
Other media 7
Polyclinic
Interview with officers 24
Models
Flipchart 19
Poster 14
Leaflet 21
Pictures 17
Polyclinic
Models
Other media 7
Information dispersal media in waiting rooms 24
Contraception and mother-child health wards
Interview with patients 24
Health information media 24
Inpatient wards
Education 2
Preventive readings 2
Group-based health promotion 1
Media in waiting rooms 2
Centre yards
Information on clean and healthy behavior 21
Family Drug Plants 16
Health promotion on the walls 24
National Health Day information 9
Health information at the canteen 5
Health information at religious sites 5

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Table 4 Health Promotion in Health Facility (2)

Health Promotion in Health Facility Number
Laboratories
Health information media 11
Drug storage rooms
Health information media 9
Cashiers
Hospitality toward patients 12
Specialist clinics
Counselling service 18

one hand, lectures are the preferred method Rahmawati15 in 2007 stated that mothers with
when approaching the groups and the masses. young children exhibited better improvements
Harsono13 lengthily explained that utilizing on knowledge and behavior after being taught
animations during lectures influenced the using audiovisual media than conventional
effectiveness of the lectures. Thus, health media (e.g., modules). Another study by
promotional officers should come up with Sweeney16 in 2012 also stated that technology
innovations on improving the dispersal of presents an ideal means for healthcare
health-related information. On the other hand, Centrees to improve public health status.
guidelines are the least favored method of Thus, healthcare officers should be familiar in
health promotion. using technology to promote health and better
The collected data demonstrate that mass disperse health information.
media dominates health promotion while Table 3 also states that the availability of
board medias are the least utilized. From 18 funds for health promotion-related activities
out of 24 participated healthcare Centres are only found in 13 Centres. Currently, there is
used electronic media. According to a study by no standard on the amount of funds allocated
Pramono14, knowledge on clean and healthy for such activities.9 A previous study stated that
behavior (is improved significantly by the universal health coverage can only be achieved
use of electronic media. Then, a study by if the government invests sufficient political

Table 5 Health Promotional Activites in the Community

Health promotion in the community Number
Performed activities
Individual approach 24
Family approach 23
Approach to public organizations 6
Activities involving the community 10
Others 4
Parties involved
Health community personnels 3
Doctor 20
Nurse 22
Midwife 22
Sanitarian 16
Others 14

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 Siti Fairuz Nadya, Insi Farisa Desy Arya, Anggraini Alam: Health Promotion Activities in Bandung Public 467
Health Centre (Puskesmas)

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