Referral System for Individual Health Services states that health services are conducted in stages according to medical needs, starting from basic, second, and then third level health . The BPJS standard on the referral ratio limitation from health center to hospital is 15%. A total of 22 out of 32 health centers (69%) in Depok have referral ratios above 15%. This study was to identify factors infl uencing high referral ratios at health centers in Depok..This study was implemented from March to October 2017 by cross sectional design. The population was 32 health centers in Depok. Samples were health centers in Depok registered by BPJS as FKTP. There were 12 health centers, each 6 with high and low referrals. The sample of health workers were providers such as: doctors and dentist, heads of health centers and health offi ces. The results showed that the most referenced disease was a refraction disorder, unspecifi ed. Most primary health care with a high referral ratio (> 15%) did not have the required compulsory services at the primary health care, especially emergency and laboratory services (66.7%). The type of health personnel was less than that at Permenkes 75 of 2014 (83.3%). Facilities and infrastructure in health center were out of standards. Less drugs supplies also affected to referral. Suggestion: The government needs to provide more types of services, numbers of health workers and infrastructure in order to support the capacity of the health centre as well as better services . Abstrak Sistem Rujukan Pelayanan Kesehatan Perorangan menyebutkan bahwa pelayanan kesehatan dilaksanakan secara berjenjang sesuai kebutuhan medis, dimulai dari pelayanan dasar ke pelayanan kesehatan tingkat kedua berlanjut ke tingkat ketiga. Standar BPJS mengenai batasan rasio rujukan puskesmas ke pelayanan kesehatan tingkat lanjut maksimal 15%. Sebanyak 22 puskesmas (69%) dari 32 puskesmas di Kota Depok yang memiliki rasio rujukan diatas 15%. Penelitian ini bertujuan untuk memberikan gambaran faktor yang mempengaruhi rasio rujukan tinggi di puskesmas Kota Depok. Penelitian dilaksanakan pada bulan Maret sampai Oktober 2017. Metode yang digunakan adalah cross sectional (potong lintang). Populasi penelitian sebanyak 32 puskesmas di Kota Depok. Sampel yang diambil adalah puskesmas Kota Depok yang telah terdaftar pada BPJS sebagai FKTP sebanyak 12 puskesmas, 6 puskesmas dengan rujukan tinggi dan 6 puskesmas dengan rujukan rendah. Sampel tenaga kesehatan yang diwawancara meliputi pemberi pelayanan (dokter dan dokter gigi), kepala puskesmas dan Kepala Bidang Yankes Dinas Kesehatan. Hasil penelitian menunjukkan bahwa penyakit yang paling banyak dirujuk adalah disorder of refraction, unspecifi ed (kelainan refraksi mata). Sebagian besar puskesmas dengan rasio rujukannya tinggi (>15%) tidak memiliki kelengkapan pelayanan yang wajib ada di puskesmas terutama pelayanan gawat darurat dan laboratorium (66,7%). Jenis tenaga kesehatan kurang dari jumlah yang ada berdasarkan Permenkes 75 tahun 2014 (83,3%). Sarana dan prasarana belum sesuai dengan standar yang harus ada di puskesmas. Obat-obatan yang tidak tersedia di puskesmas menjadi salah satu alasan melakukan rujukan. Saran: Pemerintah harus selalu berupaya melengkapi jenis pelayanan, tenaga kesehatan dan sarana prasarana di puskesmas, agar kemampuan puskesmas dalam memberikan pelayanan menjadi lebih baik lagi.  

Abstrak Setiap puskesmas harus menyelenggarakan Upaya Kesehatan Masyarakat (UKM) esensial tanpa melihat kriteria puskesmas. UKM esensial meliputi 5 jenis pelayanan, yaitu promosi kesehatan; kesehatan lingkungan; kesehatan ibu, anak, dan keluarga berencana; pelayanan gizi; dan pencegahan dan pengendalian penyakit. Tujuan dari penelitian ini dilakukan untuk memberikan gambaran pelaksanaan UKM esensial di puskesmas terpencil dan sangat terpencil di wilayah Indonesia. Data diperoleh dari hasil survei lokasi calon penempatan tim Nusantara Sehat Tahun 2016 sebanyak 131 unit puskesmas terdiri dari 74 puskesmas terpencil dan 57 puskesmas sangat terpencil. Hasil penelitian menunjukkan terdapat 87,0 persen puskesmas melaksanakan 5 jenis pelayanan esensial dan masih terdapat puskesmas yang hanya melaksanakan 3 jenis pelayanan yaitu sebesar 1,5 persen. Pelayanan kesehatan lingkungan merupakan jenis UKM esensial yang paling banyak tidak dapat diselenggarakan oleh puskesmas. Belum semua jenis tenaga kesehatan ada di puskesmas terpencil dan sangat terpencil. Terkait dengan pelaksanaan UKM esensial jenis tenaga yang masih kurang di daerah terpencil dan sangat terpencil yaitu dokter, tenaga kesling, tenaga pelaksana gizi dan tenaga kesehatan masyarakat. Peningkatkan kemampuan Puskesmas untuk menyelenggarakan UKM esensial secara menyeluruh baik di puskesmas terpencil maupun puskesmas sangat terpencil, perlu didukung dengan tenaga yang memiliki kompetensi sesuai dengan jenis UKM esensial. Abstract Every health center must organized an essential public health effort (essential UKM’s), without looking at the health center’s criteria. Essential UKM’s are consist of five programs, namely health promotion; environmental health; health of maternal, child, and family planning; nutrition services; and prevention and control of diseases. The purpose of this study is to get an overview of the implementation of the essential UKM’s in remote areas and very remote health centers. Data obtained from the survey of Healthy Archipelago team based placement in 2016, as many as 131 units of health centers, consisting of 74 remote area health centers and 57 very remote area health centers. Result of this study showed that 87,0 percent health centers organize a complete 5 programs of essential UKM’s, but there are 1,5 percent of health center that only organize three programs of essential UKM’s. Environmental health was an essential program that most would be un-organized by health center. Not all types of health workers are in remote and very remote health clinics. Associated with the implementation of essential UKM’s, personnels that are still lacking in remote and very remote areas is doctor, environmental health, nutritionist and public health. To improve the ability of the health center organized a complete essential UKM’s throughly both health center in remote areas and very remote areas, need to be supported by of human resources for health who have appropriate competence with essential UKM’s.

Abstrak Bidan sebagai tenaga kesehatan strategis yang berperan dalam pelayanan kesehatan ibu dan anak dituntut memiliki kompetensi tinggi untuk dapat menjalankan fungsinya dengan baik. Kompetensi yang tinggi dapat tercapai bila penyelenggara pendidikan profesi bidan memenuhi standar penyelenggaraan pendidikan. Berdasarkan data Majelis Tenaga Kesehatan Indonesia (MTKI) tahun 2016, nilai rata-rata uji kompetensi DIII kebidanan hanya 41,08. Peserta uji kompetensi yang belum lulus sebanyak 46,5%. Hasil yang masih jauh dari harapan juga ditunjukkan dari rerata try out uji kompetensi tenaga kesehatan tahun 2012 hingga tahun 2015 yang cenderung menurun. Kajian ini bertujuan untuk mendapatkan informasi identifikasi kompetensi bidan berdasarkan Kepmenkes 369/MENKES/SK/III/2007 tentang standar profesi bidan pada hasil Risdiknakes tahun 2017. Kajian dilakukan menggunakan observasi, wawancara mendalam dan literatur review. Informan adalah bidan di puskesmas dan pakar kebidanan. Hasil kajian menunjukkan bahwa kompetensi bidan di fasilitas pelayanan kesehatan masih belum sesuai standar. Beberapa faktor dalam penyelenggaraan pendidikan kebidanan turut membentuk kompetensi bidan yang dihasilkan. Proses rekrutmen calon peserta didik, kualitas dosen, dan proses penyelenggaraan pendidikan kebidanan secara keseluruhan merupakan komponen yang harus menjadi fokus untuk menghasilkan bidan yang sesuai dengan standar kompetensi seperti tercantum dalam Kepmenkes Nomor 369/MENKES/SK/III/2007. Kata kunci: kompetensi bidan, kajian kebidanan, pendidikan bidan, kurikulum kebidanan Abstract Midwives are strategic health workers who play an important role in maternal and child health services. They are required to have well competencies to run their tasks properly. Well, competencies can be achieved if the midwife's professional education providers meet the standards. Based on the Indonesian Health Workers' Assembly (MTKI) data in 2016, the average value of the DIII midwifery-competency test was only 41.08. Participants who failed the competency test were as much as 46.5%. It is still far from the expectation as the average value of health workers’ competency tests try out between 2012 to 2015 tends to decline. This study aims to identify midwife competencies based on Minister of Health's decree No. 369/MENKES/SK/III/2007 on midwives' profession standards and the results of the 2017 Research on Health Workers’ Education (Risdiknakes). The study was conducted using observation, in-depth interviews, and literature review. Informants are midwives at primary health care and midwifery experts. The results of the study indicate that midwife competencies in health care facilities are still not up to standard. Several factors in the administration of midwifery education also shape the competence of the midwives produced. The process of recruiting prospective students, the quality of lecturers, and the process of conducting midwifery education as a whole are components that must be the focus to produce midwives that comply with the competency standards in Minister of Health's decree No. 369/MENKES/SK/III/ 2007. Keywords: midwife competencies, midwifery studies, midwife education

Chikungunya is a viral disease through the bite of Aedes aegypti mosquito or Aedes albopictus acts as an intermediary or vector carrying chikungunya virus in its body. It is common in the tropics and often causes endemics, densely populated areas, high population mobility, and many water reservoirs, natural habitats (e.g. bamboo cuts, coconut shells and leaf busts). Chikungunya fever is often confused with dengue fever because the symptoms are almost the same, but the symptoms of joint pain are an important symptom of chikungunya fever. Data collection in outbreak area at Selemadeg Barat Public Health Center, Tabanan Regency through direct interview with patient or local resident who know of chikungunya disease. The results of data collection found 98 cases in Mundeh Kauh village, 28 cases in Lumbung Kauh village and 37 cases in Mundeh village. The first case of Jembrana Regency where the case of Chikungunya outbreak has developed before the incident in the Region of West Selemadeg Puskesmas this. Based on interviews most patients are adults who used to go to the Garden, so it can be suspected the source of transmission is a mosquito as a vector Chikungunya which is widely found in the garden of the population. The spread of cases is the area of the affected villages in the West Selemadeg Puskesmas area is a forest and plantation area that allows the development of mosquitoes as a vector of infectious diseases. On the Side the conditions on the ground indicate that many breeding places allow mosquitoes to breed such as coconut shells, brown skin, banana leaves and water filled trees.

Midwifery education graduates ideally work as midwives. This study explored the relationship between characteristics and suitability the field of work graduates of DIII midwifery study program in 2019. This study applied a cross-sectional design with a quantitative approach. The population was graduates in 4 DIII midwifery study programs in West Java and the sample whose access the google form as many as 442 respondents. Google forms distributed by email, Facebook, and WhatsApp group graduates within one month. The dependent variable was the suitability the field of work graduate. In contrast, the independent variables were characteristics of graduate (the status of the study program, age, marital status, year of graduation, the value of IPK, and additional education after graduation). Analysis of data used chi-square. The results showed 10.2% of midwifery study program graduates worked not as midwives, 37.8% of them said that salary was the reason they did outside the midwife profession and another 15.6% expressed no interest as midwives. The results of the bivariate analysis showed that marital status and IPK at graduation had a significant relationship with the suitability of the graduate work field (p <0.005). The commitment of graduates as midwives is the main focus to enhance midwifery professionalism. The existence of graduates whose work outside the midwife profession along with their reasons provided information on the need for strengthening midwife salary standards based on labour regulations.  Abstrak Lulusan pendidikan kebidanan idealnya bekerja sebagai bidan. Penelitian ini dilakukan pada tahun 2019 untuk menilai hubungan antara karakteristik dengan kesesuaian bidang kerja lulusan prodi DIII kebidanan. Penelitian menggunakan desain penelitian potong lintang dengan pendekatan kuantitatif. Populasi adalah lulusan di 4 prodi DIII kebidanan di Jawa Barat dan sampel adalah yang mengakses google form. Total sampel sebanyak sebanyak 442 responden. Google form yang disebarkan melalui email, facebook, dan whatsapp group lulusan dalam jangka waktu 1 bulan. Sebagai variabel terikat adalah kesesuaian bidang kerja lulusan, variabel bebas adalah karakteristik lulusan (status program studi, umur, status pernikahan, tahun lulus, nilai IPK, dan pendidikan tambahan setelah lulus). Data dianalisis menggunakan chi-square. Hasil penelitian menunjukkan 10,2% lulusan prodi DIII kebidanan bekerja bukan sebagai bidan, 37,8% diantaranya menyampaikan bahwa gaji merupakan alasan mereka bekerja di luar profesi bidan dan 15,6% lainnya menyatakan tidak berminat sebagai bidan. Hasil analisis bivariat memperlihatkan status pernikahan dan IPK saat lulus memiliki hubungan yang bermakna dengan kesesuaian bidang kerja lulusan (p<0,005). Komitmen lulusan sebagai bidan merupakan fokus utama untuk meningkatkan profesionalisme bidan. Keberadaan lulusan yang bekerja di luar profesi bidan beserta alasannya memberikan informasi perlunya penetapan standar gaji bidan dengan berpedoman pada aturan ketenagakerjaan.