Community health center (Puskesmas) as the front line in health services must improved their quality continuously. Therefore, Puskesmas need strong tools to measure their quality. The tool must be used both by the Puskesmas itself and by the health agency. This study aims to develop a reliable quality measurement tool in the form of Health Service Quality Index (HSQI). This study is a cross-sectional and observational. Data collection was conducted in June–October 2017 in. 200 community centers selected by convenience sampling, by assessing the completeness of regulations and documents; observations, simulations, and interviews. The questionnaire consisted of 344 scoring elements (SE) derived from the results of the content vaidity test and the feasibility of answers to questions 776 of the SE accreditation instruments. Data analysis in this study used Structural Equation Modelling (SEM) and multinomial logistic regression analysis. The results of validity and reliability test for construct variables based on Malcolm Baldrige concept of 344 SE showed 179 valid SE with alpha cronbach > 0.8 and r > 0.75. Next to the 179 SE, an SEM is conducted to obtain the first alternative Health Services Quality Index (HSQI) consisting of 88 SE. For these 88 SE the content validity and suitability of the references tests were conducted to obtain a second alternative of HSQI consisting of 18 SE. Finally, multinomial logistic regression was carried out which resulted in 85.4% conformity for the first alternative (88 SE) and 76.7% for the second alternative (18 SE) on the results of the accreditation assessment (basic, intermediate, primary, and plenary). The HSQI can describe the quality of services with a predictive power of over 76% on the result of Puskesmas accreditation, so that the index can be used by community health center to assess the quality of their services more quickly and more easily. Abstrak Pusat Kesehatan Masyarakat (Puskesmas) sebagai barisan terdepan dalam pelayanan kesehatan harus meningkatkan mutunya terus menerus. Oleh karena itu, puskesmas membutuhkan alat yang kuat untuk mengukur kualitasnya. Alat tersebut harus dapat digunakan baik oleh puskesmas sendiri maupun oleh Dinas Kesehatan. Studi ini bertujuan untuk mengembangkan alat ukur mutu yang reliabel dalam bentuk Indeks Mutu Pelayanan Kesehatan (IMPK). Penelitian ini merupakan penelitian observasional secara potong lintang. Pengumpulan data dilakukan pada bulan Juni–Oktober 2017 pada 200 puskesmas penelitian yang dipilih secara convenience sampling, dengan cara menilai kelengkapan regulasi, kelengkapan dokumen, pengamatan, simulasi, dan wawancara. Kuesioner terdiri atas 344 elemen penilaian (EP) yang berasal dari hasil uji validitas isi dan visibilitas jawaban dari pertanyaan 776 EP instrumen akreditasi. Analisis data penelitian ini menggunakan Structural Equation Modeling (SEM) dan analisis regresi secara multinomial logistik. Hasil dari uji validitas dan reliabilitas terhadap variabel konstruk berdasarkan konsep Malcolm Baldrige terhadap 344 EP, menunjukkan 179 EP yang valid dengan alpha cronbach > 0,8 dan r > 0,75. Selanjutnya terhadap 179 EP ini dilakukan analisis SEM sehingga didapatkan IMPK alternatif pertama terdiri dari 88 EP. Terhadap 88 EP ini dilakukan uji validitas isi dan kesesuaiannya dengan referensi sehingga didapatkan IMPK alternatif kedua terdiri dari 18 EP. Akhirnya, dilakukan analisis regresi multinomial logistik yang menghasilkan kesesuaian 85,4% untuk alternatif pertama (88 EP) dan 76,7% untuk alternatif kedua (18 EP) terhadap hasil penilaian akreditasi (dasar, madya, utama, dan paripurna). IMPK ini dapat menggambarkan mutu layanan dengan kekuatan prediksi di atas 76% terhadap hasil akreditasi puskesmas, sehingga indeks tersebut bisa digunakan oleh puskesmas untuk menilai mutu layanannya dengan lebih cepat dan lebih mudah.

Abstract One of the government’s efforts to reduce MMR, which is still high, is the implementation of the Antenatal Care (ANC) program at the primary health center (PHC). Besides, the government also accredits PHC to improve the quality of health services starting in 2015, so it is hoped that ANC achievements will increase. This study aims to determine the relationship between accreditation status and ANC achievements in PHC. The study design was cross-sectional with a sample of 103 accredited PHC. The distribution of PHC samples is seen based on the 2013 Public Health Development Index (IPKM) categorized as low, medium, and high. Analysis of the relationship between accreditation status and the K4 achievement program used the chi-square test. The results of this study indicate that the majority of the PHC in the sample are distributed in areas with a high and medium IPKM areas. The relationship between accreditation status and K4 achievement showed a value of p = 0.034. The logistic regression results showed that when compared with primary - complete accredited PHC, basic PHC had OR = 0.224 (95% CI: 0.064 - 0.786) with p = 0.020 to the proportion of K4 achievements. Meanwhile, the middle PHC had OR = 0.517 (95% CI: 0.146 - 1.828) with a p-value = 0.306. This study concludes that the accreditation status of PHC is related to the proportion of K4 achievements. The proportion of K4 achievements increases with the increase in the level of PHC accreditation. A basic accredited PHC has a chance to achieve K4 by 0.224, lower than a primary – complete accredited PHC. There was no significant difference between middle accredited PHC with primary - complete PHC for the proportion of K4 achievement Abstrak Salah satu upaya pemerintah menurunkan AKI yang masih tinggi adalah dengan pelaksanaan program Antenatal Care (ANC) di puskesmas. Selain itu, pemerintah juga melakukan akreditasi puskesmas untuk meningkatkan mutu pelayanan kesehatan yang dimulai tahun 2015, sehingga diharapkan capaian ANC meningkat. Penelitian ini bertujuan untuk mengetahui hubungan status akreditasi terhadap capaian ANC di puskesmas. Desain penelitian ini adalah crosssectional dengan sampel penelitian sebanyak 103 puskesmas terakreditasi. Sebaran sampel puskesmas dilihat berdasarkan Indeks Pembangunan Kesehatan Masyarakat (IPKM) tahun 2013 dengan dikategorikan sebagai IPKM rendah, sedang, dan tinggi. Analisis hubungan status akreditasi dengan program capaian K4 digunakan uji chi-square. Hasil dari penelitian ini menunjukkan mayoritas puskesmas yang menjadi sampel terdistribusi pada wilayah dengan IPKM tinggi dan sedang. Hasil analisis chi-square hubungan antara status akreditasi dengan ketercapaian K4 menunjukkan nilai p=0,034. Hasil regresi logistik menunjukkan bahwa jika dibandingkan dengan puskesmas terakreditasi utama-paripurna, puskesmas terkareditasi dasar mempunyai OR = 0,224 (95%CI: 0,064 - 0,786) dengan nilai p = 0,020 terhadap proporsi capaian K4. Sedangkan puskesmas terkareditasi madya mempunyai OR = 0,517 (95% CI: 0,146 - 1,828) dengan nilai p = 0,306. Kesimpulan penelitian ini adalah status akreditasi puskesmas berhubungan dengan proporsi capaian K4. Proporsi capaian K4 meningkat seiring meningkatnya satus akreditasi puskesmas. Puskesmas terakreditasi dasar mempunyai peluang untuk tercapaianya K4 sebesar 0,224 lebih rendah dibandingkan puskesmas terakreditasi utama - paripurna. Tidak ada perbedaan yang signifikan antara puskesmas terakreditasi madya dengan puskesmas terakreditasi utama-paripurna terhadap proporsi capaian K4.

The decree of the minister of health number 46 year 2015 regarding Primary Health Center (PHC) Accreditation marked a new era in enhancing the performance of PHC in Indonesia. The accreditation is also expected to boost the client satisfaction level in every aspect of its service. This point of view in this particular situation has never been visited especially in a large scale. This study aims to identify satisfaction level in 200 accredited and unaccredited PHC. This is a cross-sectional and observational study. The data were collected in June-October 2017. There were 200 PHC assessed using satisfaction questionnaire based on SERVQUAL scale. Ten clients divided into community health service clients and clinical health service clients from each PHC answered the questionnaire. The data was then descriptively analyzed with PHC as the unit of analysis. The data suggested that most of SERVQUAL dimensions was consistent with the level of PHC accreditation regarding community health service. In this category, only the dimension of tangible and reliability were slightly off from the assumed order. Whereas, in the clinical health service category, the tangible category was only the consistent one. Many conditions could lead to these results. However, the current health insurance policy in Indonesia might be the most prominent one. The community health service is arguably better than clinical health service based on the satisfaction level of PHC in Indonesia. Further research regarding the quality of the PHC amid the accreditation period in Indonesia needs to be done to ensure that this process is worthwhile.

Abstrak Diperkirakan 40–70% alat-alat medis di negara-negara miskin dan berkembang mengalami kerusakan, tidak dapat digunakan atau tidak digunakan sesuai tujuannya dan akan memengaruhi kualitas pelayanan kesehatan. Beberapa penelitian menunjukkan masih kurangnya kualitas peralatan di Puskesmas. Tujuan penelitian ini adalah untuk menilai faktor-faktor yang memengaruhi jaminan kualitas alat-alat medis dan nonmedis yang ada di Puskesmas. Penelitian ini merupakan analisis lanjut dari penelitian “Pengembangan Indeks Mutu Pelayanan Kesehatan Puskesmas” pada tahun 2017. Penelitian ini menggunakan desain potong lintang dengan 200 puskesmas terpilih sebagai sampel penelitian. Analisis univariat dilakukan untuk menilai karakteristik responden. Analisis bivariat dilakukan menggunakan uji Chi-square untuk menilai faktor-faktor yang berhubungan dengan jaminan kualitas terhadap peralatan di tempat pelayanan. Variabel yang dianalisis yaitu dilakukan monitoring terhadap pemeliharaan peralatan medis dan nonmedis (p209); ada tempat penyimpanan/gudang sarana dan peralatan yang memenuhi persyaratan (p255); dilakukan kalibrasi atau validasi instrumen/alat ukur tepat waktu dan oleh pihak yang kompeten sesuai prosedur (p820); terdapat bukti dokumentasi dilakukannya kalibrasi atau validasi, dan masih berlaku (p821); ditetapkan kebijakan dan prosedur untuk memisahkan alat yang bersih dan alat yang kotor, alat yang memerlukan sterilisasi, alat yang membutuhkan perawatan lebih lanjut (tidak siap pakai), serta alat-alat yang membutuhkan persyaratan khusus untuk peletakannya (p868) terbukti mempunyai hubungan secara bermakna dan variabel “dilakukan kalibrasi atau validasi instrumen/alat ukur tepat waktu dan oleh pihak yang kompeten sesuai prosedur” berpeluang sebesar 27,681 kali mempunyai jaminan kualitas yang baik terhadap peralatan di tempat pelayanan dibandingkan dengan Puskesmas yang tidak melakukannya. Kata Kunci : Alat kesehatan, sterilisasi, kalibrasi Abstract An estimated 40–70% of medical equipment in poor and developing countries are damaged, unusable or unused under its purpose and will affect the quality of health services. Several studies have shown that there is still a lack of equipment quality in Puskesmas. The purpose of this study is to assess the factors that affect the quality assurance of medical and non-medical devices in Puskesmas. This study is an in-depth analysis of the “The Development of Puskesmas Health Service Quality Index” in 2017. A cross-sectional design is used with 200 Puskesmas as the research sample. Univariate analysis and Chi-square test were conducted to assess the characteristics of the respondents and the factors associated with quality assurance of equipment at the service center. The analyzed variables are monitoring of medical and non-medical equipment maintenance (p209); storage area/warehouse that meets the requirements (p255); instruments / measuring instruments calibration or validation is carried out on time by competent parties according to procedures (p820); there is still valid documentary evidence of calibration or validation (p821); there is established policies and procedures to use clean and dirty tools, tools requiring sterilization, further treatment and special requirements for their placement (p868) proved to be significant. instruments / measuring instruments calibration or validation is carried out on time by competent parties according to procedures had a 27,681 times chance of having a good quality assurance of equipment in the service place compared to Puskesmas that did not do so. Keywords: health devices, sterilization, calibration

Abstrak Saat ini pelayanan kesehatan tradisional semakin berkembang maju. Griya sehat merupakan fasilitas pelayanan kesehatan tradisional (fasyankestrad) komplementer. Di Indonesia, saat ini banyak terdapat fasilitas pelayanan kesehatan tradisional griya sehat, namun tidak semua griya sehat yang ada di masyarakat sesuai dengan persyaratan yang ditetapkan oleh Kementerian Kesehatan Republik Indonesia. Tujuan penelitian ini adalah untuk memperoleh gambaran penyelenggaraan fasilitas pelayanan kesehatan tradisional griya sehat yang ada di Indonesia. Disain penelitian ini adalah potong lintang. Sampel penelitian ini adalah fasilitas pelayanan kesehatan tradisional griya sehat yang memenuhi kriteria inklusi dan eksklusi penelitian. Data penelitian diperoleh melalui wawancara dan observasi terhadap 21 griya sehat yang dikunjungi. Hasil penelitian menunjukkan bahwa menurut kepemilikan griya sehat terdapat 7 milik pemerintah dan 14 milik swasta. Menurut perizinan, terdiri dari 3 UPT pusat, 4 UPT daerah, 10 rekomendasi dinas kesehatan, dan 4 griya sehat belum memiliki perizinan. Ada beberapa jenis pelayanan kesehatan tradisional yang diberikan di setiap griya sehat, terdiri dari 16 herbal, 15 akupunktur, 15 akupresur/pijat, 16 lainnya seperti spa, bekam, totok, fisioterapi. Tenaga yang melakukan pelayanan terdiri dari 16 tenaga kesehatan, 11 tenaga kesehatan tradisional. Pengelola dan penanggung jawab pelayanan fasyankestrad terdiri dari 4 tenaga kesehatan tradisional dan 17 tenaga kesehatan dan lainnya. Pendekatan pelayanan terdiri dari 14 promotif, 18 preventif, 21 kuratif, 16 rehabilitatif, dan 2 paliatif. Penyelenggaraan fasyankestrad komplementer griya sehat masih harus dilengkapi, khususnya terkait perizinan, standar sarana prasarana, standar operasional pelayanan, sistem pelaporan dan pengawasan oleh dinas kesehatan kabupaten/kota. Perlu dilakukan sosialisasi ketentuan standar fasilitas griya sehat kepada penyelenggara sesuai pedoman kementrian kesehatan, termasuk tentang kebutuhan pendidikan dan pelatihan bagi tenaga kesehatan tradisional. Kata kunci: pelayanan kesehatan, tradisional, griya sehat Abstract In recent years, traditional health services are growing forward. Griya Sehat is a complementary traditional health service facility. In Indonesia, there are many traditional health care facilities as griya sehat, but not all are in accordance with the requirements set by the Ministry of Health of the Republic of Indonesia. The purpose of this study was to describe the implementation of traditional health care facilities as griya sehat in Indonesia. The design of this study is cross-sectional. The sample of this study is a traditional health care facility that meets inclusion and exclusion criteria. The quantitative data was collected through interviews and observation of the infrastructure in 21 visited griya sehat. The results showed that according to ownership there were 7 government-owned and 14 private (individual)-owned. The license was 3 from the central government, 4 from the district government, 10 from the health office, and 4 did not have a license. There are several types of traditional health services provided in griya sehat, consisting of 16 herbs, 15 acupuncture, 15 acupressure/massage, 16 others such as spa, cupping, full-blooded, physiotherapy. The managers and the people in charge were 4 traditional health workers, and 17 were other health workers. The service approach consists of 14 promotive, 18 preventive, 21 curative, 16 rehabilitative, and 2 palliatives. The implementation of a complementary traditional health service facility must still be completed, particularly in relation to the license, infrastructure facilities, standard operating procedures, reporting systems, and supervision by district/city health office. It is necessary to socialize the provisions on the standard for griya sehat facilities to the providers in accordance with the ministry of health guidelines, including the need for education and training for traditional health workers. Keywords: health service, traditional, griya sehat