Advances in Health Science Research, volume 6 2nd Sari Mulia International Conference on Health and Sciences (SMICHS 2017) The Analysis Of Implementation Program Of Adolescent Reproductive Health Service In North Barito , Center Of

Adriana Palimbo1* 1Department of Midwifery STIKES Sari Mulia Banjarmasin, Indonesia *[email protected]

Sukamto2 2The Health Office of Banjarmasin Province, Banjarmasin, Indonesia [email protected]

Erna Susanti1 1Department of Midwifery STIKES Sari Mulia Banjarmasin, Indonesia [email protected]

ABSTRACT

Objective: Knowing the implementation of Youth Reproduction Health (KRR) program in North Barito District. It is seen from four aspects of Health Services System which include aspects of input, process, output, and impact. This study also specifically aims to obtain information on the implementation of promotional and preventive strategic efforts needed through Adolescent Reproductive Health (KRR), and specifically to serve Youth Care Program (PKPR). The reason for this problem is based on the increasing cases of HIV-infected adolescents in Barito Utara District, , Indonesia since 2013. Method: The research design used was qualitative approach with sampling technique of Purposive Sampling which consisted of 19 people consist of 4 main informants and 15 informants triangulation in four working area of Public Health Center at North Barito Health Office. Data collection techniques were conducted with in-depth interviews. Result: The result of the research shows that information on health care service of the adolescent program by four Puskesmas have not all been going well, there is some research indicating that not yet maximal, among others Peer Counselor Training, Human Resources, Funding, and Infrastructure Facility. Conclusion: Fulfillment of Human Resources, Facilities and Infrastructure as well as 6 aspects The process of implementation of Reproductive Health of Adolescents especially on Health Care Services Youth at the level of Puskesmas the maximum and quality play an important role in realizing healthy teenagers and is expected to reduce health problems in adolescents.

Keywords: Adolescent Care Health Services, Adolescent Reproductive Health, Health Services System, Program Implementation

I. INTRODUCTION geographically located in the central part of Indonesia. Based on the description of North Barito regency is a region in Topography, the area of North Barito Regency Central Kalimantan Province which is is 8,300 km with the population of 159.402

Copyright © 2017, the Authors. Published by Atlantis Press. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). 1 Advances in Health Science Research, volume 6 people (in 2015) with population density 19,21 behavior, among others, the abuse of drugs soul / km2. North Barito District has 9 (Narcotics, Psychotropic and other addictive subdistricts, consisting of 10 villages and 93 substances), free sex, abortion, early marriage villages. The North Barito region is in the at risk of exposure HIV / AIDS infection, hinterland of the Barito River area at an Sexually Transmitted Infections (STIs) plus altitude of 201,730 m above sea level [1]. Nutrition problems (anemia, chronic energy Achievement of health development deficiency (KEK), obesity / overweight). outcomes The Human Development Index These health problems are not only the value of North Barito Regency in 2013 is 76%. responsibility of cross-health programs but This data increases compared to 2012 by 76%. also the cooperation of all elements of society HDI Kab. Barut occupies the second highest and inter-related sectors [5]. ranking of 14 districts/cities in Central Based on the projected population of Kalimantan [2]. 2015, the number of adolescents aged 10-24 Youth as a young generation is prepared years in Indonesia reaches more than 66 to be qualified and independent human million or 25% of the Indonesian Population resources so it needs strategic efforts that are 255 million (Bapenas, BPS, UNFPA 2013), promotive and preventive [3]. meaning that one in four Indonesians are Teenage is a vulnerable age because it Adolescents. The large number is coupled with has a high curiosity and want to try new an increase in the number of teenage births things, coupled with the rapid technological (15-19 years old) and TRIAD KRR (Sexuality, advances make teenagers can fall into the free Drugs, HIV / AIDS) [10]. association because of its daring to try without Marriage among teens aged 15-19 the thought of a mature [4][5]. pregnant and first childbirth rose from 8% to These issues and policies are 9% (IDHS 2007 - 2012). Teenage drug users reinforced by Michelle J Hindin on Youth reached 3.6 million people in 2012 and then monitoring and reproductive health who argue increased to 3.8 million in 2013 [11][12]. that 2016 is a critical year for adolescent Profile of Central Kalimantan Provincial sexual and reproductive health, when two Health Office in 2015, data of 2014 number of major global health strategies Agenda 2030 for 18 teenagers aged 15-24 years infected with Sustainable Development and the United HIV, seven people suffering from AIDS and States Global Strategy for Women's Health, two people died from AIDS. Data from 2013 Children and Adolescents begin to take effect to 2015 in North Barito District, adolescents [6][7]. So that if not given information / infected with HIV aged 21-30 years as many services teenagers correct and correct, then as three people by 2013, as many as three adolescent behavior often leads to risky

2 Advances in Health Science Research, volume 6 people in 2014 and as many as 16 people by Resources, Facilities, and Funding. Second, an 2015 [13]. in-depth interview on what and how resources To overcome this problem of teenagers, and services are run. Aspects of the process various prevention and improvement efforts under study include Information have been done through cross-program and Communication and Education, Clinical cross-sectoral. BKKBN conducts and responds Medical, Counseling, Healthy Living Skills to adolescent problems through the efforts of Education, Referral and Peer Counselor population control and family development Training. And thirdly, interviews on the (Law number 52 the year 2009 article 54), that Aspects of Output and Impact Aspects [16] is through family development policy[2][14]. [17]. Similarly, the development of the Adolescent The research focuses on four PKPR Health Program in Indonesia uses the Care of Community Health Centers in North Barito Youth Care (PKPR) approach since 2003[10]. District, Kandui Health Center, Ketapang Preliminary study conducted by researchers at Public Health Center, Muara Teweh Health Health Service District of North Barito, four Center and Lanjas Community Health Center Puskesmas have run PKPR service activities (Puskesmas Lanjas). In determining the [15]. subject of research, sampling technique used is The purpose of this study is to determine Purposive Sampling. The use of this theory is the implementation of adolescent reproductive based on the problems faced by PKPR health services special services Health Care Puskesmas in North Barito Regency related to Care Youth in four areas Health Centers in several aspects of Input such as untrained Kab. North Barito. PKPR Resources, no PKPR team, less funding

and no allocation for PKPR, inadequate II. RESEARCH METHOD infrastructure and not yet maximal

In this study used a qualitative approach, implementation of aspects the process of with in-depth interviews with 19 informants which are six activities of minimum PKPR. consisting of four main informants and 15 informants triangulation. The research design III. RESULTS is intended to obtain in-depth information about the implementation of PKPR program Input: based on Input, Process and Output aspects. Human Resources First, the researcher conducted in-depth There are three PKPR formed from four interviews on how the readiness and potential Puskesmas. The division of service tasks is not aspects of Input consisting of Human scheduled. Officers have been trained but in

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the implementation of socialization is still Medical Clinical Services integrated with other programs. Teenagers are served according to Funding standardized service procedures. Teenage Existing funding sources come from cases with special problems are kept BOK, APBDes, and BKBPP. Utilization of confidential. But what has not been fulfilled is funds exist but not yet equipped with activity the availability of Special Medical Records for PoA and adolescents are given free according teenagers, from four Puskesmas only one to school card. For the availability of funds Puskesmas already available but still and the adequacy of funds not all available inadequate because it has not had its own because they have to share with other storage. programs. Counseling Infrastructure Three Puskesmas have been carried out The availability of space and equipment counseling according to the standard services is limited to only one building that is procedure but there is no fixed schedule and used in an integrated manner. served in KIA / Nutrition room because not yet Table 1. Availability List of Infrastructure Facilities of have its own space. PKPR Program Implementation in Four Puskesmas N Facilities Teweh Healthy Living Skills Education Ketapan o available Kandui Tenga Lanjas g h Three Puskesmas have not been Separate service 1 x x x implemented this activity has no technical room  The room is clean 2     manual and 10 materials of Psychosocial and comfortable Available trash  Competence. Peer Counselor Training 3 cans and hand v v v wash Peer Counselor Training is In the room there  4 are tables and v v only carried out by one Puskesmas by training chairs v The plot of PKPR 10 junior high school students and 10 high Services is 5 displayed, which  x x x school students from the average of 300 anyone can see / read students. Unscheduled activity. Since 2013, it KIE & Counseling x x x 6  Tool (complete) has only been held one time constrained

Process: funding as well as the time of the students Communication, Information, Education themselves. (IEC) Referral Service IEC activities, coaching, and counseling Four PKPR Puskesmas only established have been carried out according to the criteria vertical and horizontal Medical Referral of PKPR at least twice a year in two target Cooperation, no social and legal referrals have schools, a group of religious organizations and been handled in case of an adolescent. three groups of adolescent parents.

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Output: comprehensively through promotive, From the results of research on the preventive, curative and rehabilitative efforts number of Schools built has been implemented in all places of PKPR. Adolescents want according to PKPR criteria. The frequency of privacy, are recognized, respected and school counseling, there are only two involved in planning, implementation, and Puskesmas that have been implemented 1-2 evaluation of activities [10][17]. times coaching, two other Puskesmas only This is accompanied by the formation of held every month. For funding has not been a team of PKPR accompanied by a Decree of optimally utilized and the time provided by the the Head of the Puskesmas including the school has not been according to the needs of division of tasks between the Teams such as students. Drugs on Drugs, Drugs in charge of Doctors, Impact: Pharmacists or Nurses, while reproductive The result of four Puskesmas, adolescents health materials are provided by midwives. aged 10-19 years only visited when they were Two of the three Puskesmas already have a sick and asked for treatment, they have not schedule of task distribution between teams. received the package of PKPR services There is already good coordination with the including promotive, preventive, curative and school so that activities can be scheduled on rehabilitative services which must be given the date arranged by the school. This is in line comprehensively in all places of PKPR with Russell P. Harris's research that evidence service. One Puskesmas there is a positive of good and fair quality must have clear and impact of increased knowledge, changes in uninterrupted regulation of primary care and adolescent behavior and to decrease adolescent prevention and maintenance services [25]. health problems. While in three other This research is supported by Ni Luh Puskesmas cannot be seen because the impact Kadek et al. (2013) it is said that the program of activity has not been active and optimal and cannot be completed by the program holder recording reporting has not been routinely alone, it is necessary to divide the task not done. And there is a decrease in school girls' only among health workers but also between pregnancy cases. health workers with school and related sectors [18]. The results of this study in accordance IV. DISCUSSION with the National Standard Guidelines PKPR Human Resources 2014, stated that the health personnel trained Based on the results of research on PKPR is health workers Puskesmas as Human Resources aspects, it is found that members of the team who have received teenagers have not been served PKPR training conducted by the Provincial

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Health Office or District / City including the of the program holder, the proposed work plan related institutions and institutions or is not proposed, the lack of internal orientation to increase insight PKPR with socialization and the attitude of the Puskesmas reference to "PKPR Training Manual for tend to ignore the PKPR Program because it is Health Workers" conducted internally by not the Puskesmas Mandatory Program and the Puskesmas. It can be concluded that the number of programs that must be run. improvement of PKPR's insight through PKPR Infrastructure orientation activities can be done internally at Health infrastructure deals with all basic the level of Puskesmas with reference to equipment that indirectly supports the PKPR Training Guidelines. implementation of health services such as Furthermore, internal socialization is rooms, buildings and buildings, parking lots needed as a form of orientation for all and laboratories, tables, chairs, beds, PLN and Puskesmas officers by the Head of Puskesmas PDAM installations. together with PKPR program managers with From the research results obtained the the aim to gain common understanding, availability of special space PKPR is still agreement on the implementation of PKPR incorporated with other service program space. and increase the sensitivity of all Puskesmas This is supported by Permenkes number 75 of officers to be able to be friendly teen [17]. 2014 that concerning the Puskesmas space, the External socialization is an effort by number and type of space are determined Puskesmas to change or influence public through the analysis of space needs based on policy through various forms of persuasive the services held and the availability of communication to all stakeholders to gain resources. Nevertheless requires the commitment and support to PKPR program. management of the space in such a way that in Stakeholders at the Puskesmas level include accordance with the concept of PKPR, Camat, District Health Offices, Schools, maintaining privacy, according to the tastes of Community Leaders, Communities, Private adolescents and youth-friendly [19]. Companies, Youth Concerns NGOs, Parents, Related to other supporting facilities Youth Groups, Karang Taruna [17] [18]. such as phantom props, leaflets, flipcharts, Funding game tools, LCD and teenage visit flow owned The results of the study revealed that by Puskesmas are not enough in three funding and program limitations were not Puskemas. accompanied by Planning of Action (POA) as Communication, Information, Education well as no special allocation but only (IEC) extension fees during the health screening to From the results of the research, IEC schools. Constraints lie in the lack of advocacy services have been implemented and at the

6 Advances in Health Science Research, volume 6 same time, the guidance and discussion of the room) and separated from other visiting information and education that is covered records at the Polyclinic [24]. include adolescent growth, reproductive Counseling health, adolescent nutrition, HIV / AIDS, drug, Results of three Puskesmas research, smoking hazard, and unwanted pregnancy. Counseling has been implemented but there is This is in accordance with the guidelines and no fixed schedule and served in the room KIA standards of Puskesmas criteria are able to or Nutrition because it has no separate space. carry out the PKPR, among others, is to This is not in accordance with the criteria of conduct IEC activities in the target schools at PKPR standard, which each activity must also least two times a year [10]. have a Counseling Manual. Adolescent health Associated with the competence of counseling is counseling given to a teenage officers to adolescents obtained the result that client or adolescent group who needs a they are satisfied in terms of delivery, mastery companion to recognize and solve the problem of material, appearance and methods of which in its implementation requires delivering the material. But there are some documents or books on which it is based, suggestions for the future that they want a guidance and guidance) for health workers to clearer and more concise way of deliberation carry out the counseling process [10]. that is easier to understand, more examples Healthy Living Skills Education with pictures, multiplied game methods, The results of three Puskesmas research games, and movie screenings. have not been done yet because they have no Medical Clinical Services Technical Instruction Book and the subject Based on the results of research, Medical matter about PKHS. Clinical Services in four Puskesmas obtained Related to giving 10 materials by adolescents served according to the Psychosocial Competence in PKHS give standard procedure of handling each disease. impact to adolescent behavior development Teenage cases with special problems are kept that is: self-awareness, empathy, decision confidential. But what has not been fulfilled is making, problem-solving, critical thinking, the availability of Medical Records. creative thinking, effective communication, PKPR National Standard 2014 mentions interpersonal relationship, emotional control that Puskesmas should have a safe (locked) and coping stress [10]. storage area and sufficient for medical records Peer Counselor Training including counseling records so that the right From the result of the research, there are of privacy and confidentiality of adolescent three Puskesmas that have not been done Peer clients is guaranteed. Storage of a separate Counselor Training. This is due to constrained juvenile counseling file (stored in the PKPR cost because there are so many other programs

7 Advances in Health Science Research, volume 6 that must be financed, the constraints of the counselors as much as 10% of the total officers have not been all trained PKPR, but students in the target schools [10]. only the orientation is still lacking so that the Furthermore, the frequency of coaching confusion officers in preparing Peer Counselor to schools, which must be implemented twice Training as well as constraints Puskesmas do a year, with consideration of the importance of not have the Manual on Peer Counseling adolescents get a lot of material according to Training. the guidance of the book PKPR and the high Referral Service health problems of adolescents in the work From the results of four Puskesmas area. research, only medical cooperation is Low-cost constraints and the time that established either vertically (to higher medical can be provided by the school for students services, such as hospitals) and horizontal cause counselor training peer at four health (from one part in one unit of Puskesmas, for centers PKPR not run as PKPR criteria [16]. example from PKPR clinic to Dental Impact Polyclinic or STI Clinic). This is not in Impact is the result of the output of the system accordance with the criteria standards of in the form of the overriding health problems PKPR Guidelines. Although there is no case with the consequent increase in the degree of referral system, a legal and social referral public health [16]. system should be established and prepared Based on Law Number 23 of 2002 with other institutions[20][21]. Referral Service regarding Child Protection, the target of PKPR is conducting case referral to higher medical service users is a group of adolescents aged 10 services. Social referrals are also required in - 18 years. However, given the age limit of the PKPR, for example channeling to work WHO according to WHO is 10 - 19 years, skill institutions for adolescents post-drug hence Ministry of Health set the target of abuse[10]. service user of PKPR covers adolescent aged Output 10 until 19 years, regardless of marital status.. Output is an element generated from the From the results of research in four ongoing process in the system including health Puskesmas PKPR stated that positive impacts services generated by health program units occur both to increase knowledge, changes in [16]. adolescent behavior and to decrease adolescent The outcome is seen from three criteria health problems. As for the negative impact of Puskesmas capable of implementation of can be seen from the evaluation of activities PKPR that has at least 1 school assisted, at that have not been active and the maximum least 2 times a year doing coaching / giving and recording reporting has not been routinely KIE to the target schools and train peer done [24].

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The impact on School Health Program continuously improved both the quality and managers states that there is a decrease in the number of Puskesmas PKPR, given the pregnancy among schoolgirls. This indicates complex health problems of adolescents. It is that there needs to be increased cooperation expected that with the implementation of a between the school and health officials related consistent, continuous and qualified PKPR to the reporting system of cases or health program, it can improve the health of youth as problems of adolescents as well as train and the nation's successor. enable the function of peer counselors in V. CONCLUSION schools that allow all problems teenagers can Overall, the result of this research is be known earlier [24]. concluded that PKPR activities have not run Recommendation: Improvement of Adolescent optimally in compliance with the standard of Reproductive Health Services and Adolescent procedure of Guidelines of Implementation Care Health Services recommended to the and Technical Guidance of PKPR. District Health Office of North Barito Regency Where, Aspect of the Process has not yet is a) Use of space at the Puskesmas, b) been supported by adequate resources both in Conduct orientation and training of PKPR for terms of competence of health workers who health providers, c) Procurement manual, Peer have not held adolescent-friendly principles, as Counseling Training, socialization and well as poor governance and health partnership with sector and external management systems in terms of monitoring stakeholders, and d) Provide information and and evaluation and the slowness of follow-up education to adolescents through social media, plans. Other issues are also not supported by banners at school, interactive videos on the commitment of stakeholders at the cross- advertising services on local television. The program and cross-cutting leadership levels to discussion was also reinforced by the make breakthroughs and strategies to address conclusion of Joy Sotolongo, et al, on the adolescent issues by focusing on preventive services of a teenage reproductive health and promotive efforts. strategy called Teen Wellness Center (TWC) [22]. REFERENCES

And then another strategy model of the Bronx [1]. Profil Kabupaten Barito Utara Tahun Youth Clinical Model Model in adolescents is 2014. Barito Utara, 2015 [2]. Kementerian Kesehatan RI.. Profil also presented by Deborah J. O'Uhuru, 2016 Kesehatan Tahun 2011. Jakarta, 2012. that adolescents are served on quality sexual [3]. Kementerian Kesehatan RI.. Profil Kesehatan Tahun 2012. Jakarta, 2013. and reproductive health services [23]. [4]. Izzatun Nurul Rohmah & Tauran, S.Sos., Therefore, the expectations expressed by M.Soc., Sc. Implementation of Youth Care Health Program (PKPR) at Health all informants for PKPR activities must be

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