International Journal of Science and Healthcare Research Vol.4; Issue: 1; Jan.-March 2019 Website: www.ijshr.com Original Research Article ISSN: 2455-7587

Determinant Factors in Remote Regional Health Services in the Wondiboy Health Center in Teluk Wondama District (Case Study in Sendrawoi District Health Center)

Aning Melalolin1, A.L. Rantetampang2, Yermia Msen3, Anwar Mallongi4

1Magister Program of Public Health, Faculty of Public Health, Cenderawasih University, Jayapura. 2,3Lecturer of Master Program in Public Health. Faculty of Public Health, Cenderawasih University, Jayapura 4Environmental Health Department, Faculty of Public Health, Hasanuddin University, Makassar

Corresponding Author: Anwar Mallongi ______

ABSTRACT disappoints people who eventually have to travel far and difficult. This situation is Background; Health Centre or Puskesmas as strengthening the interest of the community not the primary service provider that is the mainstay to go to the puskesmas. Therefore, it is of service for the community, has not been able necessary to complete medical devices and to provide services to remote areas, border areas consumables that support health services, and islands. The working area of the Puskesmas especially for cases of diseases that occur in is quite extensive, geographically it is difficult many auxiliary health centers. Funds in Health to reach, a small population, scattered in small Services in Remote Areas Wondiboi Health groups far apart. The transportation is very Center, Teluk Wondama (Case Study limited with expensive fees both land, sea and in Sendrawoi District Health Center) is available air. Public health status and health service but not sufficient to carry out health services in coverage in remote border areas are still low. all remote areas and tourism in Wondama Bay Methods: The purpose of this study is to in general. identify the factors that influence the affordability of Wondiboy health center services Keywords: Energy, facilities, health problems, (Case Study in Sendrawoi Pustu) which are community access included in remote areas of Wondama Bay Regency. This study uses a descriptive method 1. INTRODUCTION with a qualitative research approach. Starting The direction of health development from some of the opinions of the experts above, goals is to increase the reach and equal the type of this research is descriptive in the distribution of quality health services for the form of qualitative research methods, namely community border and island remote areas obtaining an overview of energy, facilities, health problems, community access in especially in DTP national priority health Puskesmas services, service factors, traditional centers. In order to increase reach and even factors, community behavior factors is a distribution of services health, an action determinant that influences the affordability of plan and development plan have been health services in remote areas in Sendrawoi prepared. There are 6 (six) strategies Pustu, Wondama Bay Regency. determined by the Indonesian Ministry of Results: There is insufficient coverage Health., 2010 namely:1) Mobilizing and according to existing needs because more empowering the community in DTPK, 2) personnel are employed in cities than in remote Increasing DTPK community access to areas, the security of officers is not guaranteed health services quality,3) Increase financing live in pustu. Means for Health Services in for health services in DTPK 4) Increasing Remote Areas in Wondiboi Health Center Teluk Wondama Regency (Case Study in Sendrawoi the empowerment of Health Human District Health Center), lack of health Resources in DTPK, 5) Increasing the equipment and health support facilities availability of drugs and supplies and (laboratories) in the puskesmas often strategies 6) Improve management of

International Journal of Science and Healthcare Research (www.ijshr.com) 163 Vol.4; Issue: 1; January-March 2019 Aning Melalolin et.al. Determinant Factors in Remote Regional Health Services in the Wondiboy Health Center in Teluk Wondama District (Case Study in Sendrawoi District Health Center)

Puskesmas in DTPK, including surveillance based on health centers, namely as technical systems, monitoring and evaluation, as well implementers of the District / City Health as a Health Information System. Office which are responsible for organizing The Indonesian Ministry of Health health development in their working areas, develops an action plan and operational because Puskesmas are always in the development plan for implementation in the District area or in rural areas. Some related field including community empowerment in policies that regulate basic health services, the form of Desa Siaga, Poskesdes, including: Kepmenkes number. 128 of Posyandu, improving Maternal and Child 2004, concerning the Basic Policy of Health (MCH), Nutrition, Prevention of Puskesmas, Kepmenkes number 949 and Infectious Diseases, Flying Doctors, 1239 in 2007 and health service guidelines Doctors Plus, Houses Moving Pain, for remote and very remote health centers in increased health financing in the form of disadvantaged areas, which in principle play Special Allocation Funds (DAK), Co- a role in organizing health efforts to Administration (TP), deconcentration funds, increase awareness, willingness and ability Social Assistance Programs, Community to live healthy for each resident to obtain Health Insurance(Jamkesmas), Health optimal health degree. Operational Assistance (BOK), Childbirth Everyone has the right to an Assurance (Jampersal), HR improvement adequate standard of living for the health especially Health Human Resources in the and well-being of himself and his family. As form of Non-Permanent Employees (PTT), a human right, human rights are inherent in Special Assignments, Study Tasks, a person not because of a person or state, improvement of medication and health and therefore certainly cannot be revoked equipment, improved health management and violated by anyone. The condition of (including management training Puskesmas, the people across the border, coastal areas surveillance program); the development of and rural areas has conditions that have Basic Essential Neonatal Obstetric Services socio-economic conditions that are not (PONED) at the Puskesmas and the different from those in . But the Maternal and Infants' Babies Hospital fact that it is clear is that health services in (RSSIB) and Comprehensive Obstetric general have not been evenly distributed in Neonatal Services (PONEK) at the Hospital; all remote border areas and islands with improving the appearance and performance people living in urban areas. The priority of Puskesmas in border areas between situation is the emergence of health countries; and the development of Flying problems that are not yet clear standard Health Care; and Support for inter-island health services provided by health providers transport with Water-Around Health Centers along the border and inland areas. While the (RI Ministry of Health, 2010). right of the Puskesmas which is the There are three target groups, spearhead of access to health services is namely infants, toddlers and pregnant / very instrumental in health services in postpartum / breastfeeding mothers. The remote areas. public problem or issue that arises is that the Puskesmas as the primary service border area is a country window, in addition provider that is the mainstay of service for to remote areas, borders and islands the community, has not been able to provide (DTPK) has extreme topography. Therefore services to remote areas, border areas and the role of infrastructure is one of the islands. The working area of the Puskesmas important physical components of the is quite extensive, geographically it is border region because of systematic difficult to reach, a small population, infrastructure development, scattered in small groups far apart. The In its implementation, health transportation is very limited with expensive services in remote and very remote areas are fees both land, sea and air. Public health

International Journal of Science and Healthcare Research (www.ijshr.com) 164 Vol.4; Issue: 1; January-March 2019 Aning Melalolin et.al. Determinant Factors in Remote Regional Health Services in the Wondiboy Health Center in Teluk Wondama District (Case Study in Sendrawoi District Health Center) status and health service coverage in remote (P2KTP) or Save Papua was carried out, in border areas are still low. The community in 2009 - 2010, when the results were not general does not yet have the knowledge maximized. Then in the following years, and behavior of healthy living and this kind of service, packaged in Flying unfavorable environmental conditions. The Doctor Health Care (FDHC) or Community use of Puskesmas in remote areas is Based Health Services with APBN and influenced by, among others, access to APBD funding sources. The research services that are not only caused by distance question is how is the health center of the problems, but there are two determinants, Puskesmas and how is the service pattern of namely determinants of supply, which are puskesmas and its networks in remote service factors, and determinants of demand border areas? which are user factors (Timyan Judith, et al. Based on the research questions 1997). Determinants of provision consist of above, the purpose of this study is to service organizations and physical identify the factors that influence the infrastructure, service locations, availability, affordability of Wondiboy health center utilization and distribution of officers, services (Case Study in Sendrawoi Pustu) service costs and service quality. While the which are included in remote areas of determinant of demand which is a user Wondama Bay Regency. This research is factor includes the low level of education focused on 2 (two) supply determinants and the socio-cultural conditions of the which are service factors, and demand community and the level of income of the determinants which are user factors. The low or poor people. The primary need to results of the research can be used as input obtain effective service access is the for the program and policy makers so that availability of facilities and officers, the efforts of health center implementers in affordable and financial distance and social remote areas, borders can be reached and cultural issues that can be accepted by the reach the public. user. The constraints are the distance of the residence of the user from the service area, 2. MATERIALS AND METHODS the lack of tools and supplies of the service 2.1 Type of Research area, lack of funds for transportation costs, This study uses a descriptive method and lack of funds for transportation costs, with a qualitative research approach. lack of funds for medical expenses. In Starting from some of the opinions of the addition to transportation facilities and experts above, the type of this research is infrastructure factors, there are still many descriptive in the form of qualitative other factors that have not been revealed research methods, namely obtaining an clearly related to the affordability of overview of energy, facilities, health services that can help resolve the problem. problems, community access in puskesmas Health services carried out in West services, service factors, traditional factors, Papua Province and Districts in the West community behavior factors is a Papua region are with Puskesmas services determinant that influences the affordability inside buildings and outside buildings. of health services in remote areas in Three-quarters of the number of Puskesmas Sendrawoi Pustu, Wondama Bay Regency. in Province are located or have 2.2. Location and Time of Research working areas in remote areas. Of course the This research was conducted at Wondiboi characteristics of such areas are not enough Health Center and in Sendrawoi Pustu, to rely on the static services of the Wondama Bay Regency as one of the far- Puskesmas and / or the services of the reaching Sub-District Health Centers from Mobile Puskesmas (Pusling). Even though the city of Rasiei, the capital of Teluk for several years the Acceleration of Health Wondama Regency, which was held from Development program in Tanah Papua October to November 2018.

International Journal of Science and Healthcare Research (www.ijshr.com) 165 Vol.4; Issue: 1; January-March 2019 Aning Melalolin et.al. Determinant Factors in Remote Regional Health Services in the Wondiboy Health Center in Teluk Wondama District (Case Study in Sendrawoi District Health Center)

2.3. Informant and How to Determine it provide true data / information - the truth According to Moleong (2007; 90) about other people or their environment, Informants are people who are used to while respondents are people who are able provide information about the situation and to provide true data / information - truth background conditions of the study. about themselves (motivation, ideas, Whereas Rusidi (2006; 28), suggests that sentiments, attitudes, activities / real work - informants are people who are able to really).

Table1. Respondents Characteristics No Informant Age Occupation Position Education Notes 1. Informant 1 54 year PNS Chief S1 Informant Key 2. Informant 2 52 year PNS chief deptS1 Health staff 3. Informant 3 39 year PNS chief central Doctor 4. Informant 4 34 year PNS Staffs D3 Seaman 5. Informant 5 50 year PNS HeadS1 District Wondiboi

By looking at table 1 above, an matter of consideration to be an evaluation illustration of age is obtained informants for us. " ranging from 34 years to 54 years. Of the 5 Informant 3: "Health workers do informants, all were male. They are ASN, exist, but they are not sufficient because we including 2 people working at the Wondama have difficulty managing our employees. Bay District Health Office. Each of them This is due to employees who have their SK held the position of Head of the Health placed in rural areas always wanting to Office, Head of Health Services, 1 Head of move to the city, on the grounds that they Community Health Center, 1 Person of follow their husbands. Some say they don't Pustu Sendrawoi Officer, 1 person Head of feel at home, there is no attention from the Wondiboi District. government. The sanction that we give to employees - employees, who are lazy, is to 2. Profound Interview Results give a reprimand letter and even some a. Power Variable: employees are detained. On the other hand, Informant 1: "In general, the number with limited energy, resulting in multiple of staff in Wondama Bay District has not tasks, so that sometimes other tasks are been able to fulfill health services ignored. considering the number of Puskesmas is Informant 4: The limited energy in quite extensive and is an area that is difficult the Wondiboi Community Health Center to reach, partly by sea, land which is quite made us fail in doing services, so some steep. So in general our labor is still lacking. activities were reduced by the number of Health workers are there, but still lacking. visits that should be once a month for 3 Therefore we remain with all our might months. If the main puskesmas has a personnel so that health services must still meeting or minilok activity, it means that be carried out. One effort is to provide PTT the pustu is not open. So if there is an doctors and contract workers" emergency patient, it must be rushed to the Informant 2: Personnel scattered in main Puskesmas. The officer also said that several Puskesmas have not been evenly he was not comfortable because of the lack distributed so that the number of available of security factor in this area, some officers staff has not maximally carried out essential who had served were not at home, one of services including activities outside the which was inadequate housing, lighting was building. The main obstacle is that the not good either” facilities of the Pustu located near the Informant 5: "The pustu officer village often have no officers in the place. arrived at the pustu, the clerk was at least The officers mostly live in the city rather two weeks before he arrived, and even once than having to be in the village. This is a a month came all the health centers around

International Journal of Science and Healthcare Research (www.ijshr.com) 166 Vol.4; Issue: 1; January-March 2019 Aning Melalolin et.al. Determinant Factors in Remote Regional Health Services in the Wondiboy Health Center in Teluk Wondama District (Case Study in Sendrawoi District Health Center) the road for drugs. The officers are still infrastructure that is the complaint of the lacking, so there are more in the city. This is officers. The addition of cars and two- what we still use as an apparatus to continue wheeled operational motors must be to expect attention from the government in prepared. It's no longer a secret that service providing nurses and paramedics in our in remote areas is always complained about. area" " From the results of interviews with 5 Informant 2: "The vehicle facilities informants, the results were obtained: When used for parking are actually already viewed from existing resources, the number inadequate so they cannot be used to go to of health workers needed, both those distant villages with steep terrain. In my engaged in promotive, preventive, curative opinion, one of the factors that makes the and rehabilitative fields there are still many obstacle for Puskesmas do a lot of work in the city. All informants said the number c. Fund Variable of personnel in the Puskesmas was there but Informant 1: "Existing funds are the distribution was not evenly distributed. available to service all puskesmas services The number of nurses and midwives for so that the even distribution of services is medical services inside and outside the still minimal. With the complex problems in building is still lacking. Similar to the remote health services, the APBD-P budget condition of doctors, there are still many is more focused on remote areas like services in the building. The distribution of Sendrawoi. Informant 2: "Funds available to local health personnel must be optimized, carry out services are sourced from Non- especially to remote areas. Optimizing Physical DAK funds, which are used by health workers is one of the efforts to Puskesmas services, the available funds are increase the availability, equity and quality not fully sufficient for Health services". of health workers, especially in remote, Informant 3: "Health financing support such disadvantaged, border and island areas as Jamkesmas, Health Operational (DTPK). The safety factor is also Assistance (BOK), Special Allocation inadequate where the officers and lighting Funds (DAK), Jampersal, and social are still using makeshift tools. Feeling assistance; POA Existing funds are certainly uncomfortable with the environment around not enough to fulfill all puskesmas services. the house. d. Variable Health Problems b. Means variable: Informant 1: "Health issues that are a Informant 1: "The main building of priority in Wondiboi District are prevention, the Wondiboi Community Health Center is and prevention of diseases such as malaria, quite extensive, there is a doctor's house, a Ispa, and diarrhea and other diseases in house for paramedics. There are also 6 society or diseases that are classical and Pustu buildings, but only 4 are active, the mushrooming in the lives of many people vehicles owned by the Wondiboi Health who are still far from healthy living Center only have 1 unit, but not all people behaviors, such as still littering, not yet use ambulances to operate services in aware of using latrines in homes that are remote areas. Facilities to support health available. services are also still limited, for example Informant 2: "In the top 10 diseases the equipment owned by the health center is it is clear that the biggest diseases are still minimal, equipment for blood tests? Malaria, Ispa, Diarrhea, and what stands out Mini laboratories are still constrained by also from the problem of clean and healthy energy and equipment. The lack of health behavior, they are still not aware of services cannot be entirely blamed on field maintaining environmental hygiene, still officers, because to get maximum service, it throwing garbage carelessly, and not fully is necessary to support the performance of using toilet for defecation." medical personnel, the condition of the

International Journal of Science and Healthcare Research (www.ijshr.com) 167 Vol.4; Issue: 1; January-March 2019 Aning Melalolin et.al. Determinant Factors in Remote Regional Health Services in the Wondiboy Health Center in Teluk Wondama District (Case Study in Sendrawoi District Health Center)

Informant 3: "The most problems in field, but at the same time had to provide the service we encountered were classic services at the puskesmas that were of an problems, Malaria, Ispa, diarrhea, still emergency nature or could not be delayed. littering, the surrounding environment that For example, there are patients who have still looked dirty, still defecating carelessly time to give birth. In addition, there is a lack even though there were latrines in every of adequate transportation, as explained house." above. Posyandu activities are also not a. Variables of Community Distance in maximal in Sendrawoi Sub-District because Using Puskesmas Services the community is encouraged to go to Informant 1: "It is admitted that the Posyandu because of the provision of distance between the residents' residence to supplementary food in the form of MP ASI the Pustu is rather far away, the community ”.Informant 2: "The service factor also still must cross the riveron foot. Not to mention lacks the availability of medicines at if heavy rain means it cannot cross the river. Sendrawoi Health Center and equipment, Not to mention transportation that is we are still continuing to improve, in order difficult to add plus a lack of economic to further improve services. Both in terms of community. Sekurang - the lack of people energy, equipment and even more maximal only relied on traditional medicine before service. We also do not fully service the interpreting health services. Moreover, officers who are not in place, this issue people are happier or more prioritizing to go should be communicated with the to gardening later in the afternoon, then stakeholders in this area. " come home new if there is someone who is sick, looking for a health worker.” 4. CONCLUSION Informant 2: "The distance between a. Personnel in the Determinants of Health the residence of the residents to the Pustu is Services in Remote Areas In Wondiboi very far they must come by foot and the Health Center, Teluk Wondama Regency most worrying must pass through Kalii. If (Case Study in Sendrawoi District Health it's not raining, it means you can pass it, if Center) there is insufficient coverage it's raining, you have to be patient. The according to existing needs because more opposite is also true for our officers to pick personnel are employed in cities than in up emergency patients. remote areas, the security of officers is not Informant 3: Most of the residents' guaranteed live in pustu. houses are very far from the pustu they have b. Means for Health Services in Remote to walk, if good weather means they can be Areas in Wondiboi Health Center Teluk reached. The trip can be up to 1-2 KM ... Wondama Regency (Case Study in That is our obstacle in terms of service so Sendrawoi District Health Center) The lack that it cannot be denied that the low number of health equipment and health support of people visiting to the pustu is low. But facilities (laboratories) in the puskesmas that does not mean that the community does often disappoints people who eventually not use health services at all. They are have to travel far and difficult. This looking for health cadres who have indeed situation is strengthening the interest of the been provided with makeshift drugs such as community not to go to the puskesmas. paracetamol and antalgin. Therefore, it is necessary to complete b. Service Factor Variables medical devices and consumables that Informant 1: ‘’ The problem support health services, especially for cases experienced by the Sendrawoi Community of diseases that occur in many auxiliary Health Center is that in serving the health of health centers. the community in buildings and outside c. Funds in Health Services in Remote buildings, there is a lack of energy. This was Areas Wondiboi Health Center, Teluk felt when the officers had to get off the Wondama Regency (Case Study in

International Journal of Science and Healthcare Research (www.ijshr.com) 168 Vol.4; Issue: 1; January-March 2019 Aning Melalolin et.al. Determinant Factors in Remote Regional Health Services in the Wondiboy Health Center in Teluk Wondama District (Case Study in Sendrawoi District Health Center)

Sendrawoi District Health Center) is  Eka Setyaning Suci, A. L. Rantetampang, available but not sufficient to carry out Bernard Sandjaja, Anwar Mallongi. 2018. health services in all remote areas and Influential Factors against Exclusive Breast tourism in Wondama Bay in general. Feeding In Working Area of Wania District d. Health Problems in Health Services in Health Center of Mimika Regency. Remote Areas Wondiboi Health Center, International Journal of Science and Healthcare Research 3 (2), 206-211 Teluk Wondama Regency (Case Study in  Handayani L, Evie S, Siswanto, dkk. 2006. Sendrawoi District Health Center) is UpayaRevitalisasi Pelayanan Malaria, ARI, Diarrhea, because there is  KesehatanPuskesmasdanjaringannyadalamr still low public awareness to maintain angkaPeningkatanKualitasPelayananKeseha cleanliness. tan. Surabaya: Pusat Penelitiandan e. Distance from Community Houses to Pengembangan Sistemdan Kebijakan Puskesmas in Remote Regional Health Kesehatan. LaporanA khir Penelitian Services at Wondiboi Health Center,  Kepmenkes RI Nomor 128, 2004. Wondama Bay District. (Case Study in Kebijakan Dasar Puskesmas. JakartaNomor Sendrawoi Pustu) is far away and must be 949 dan 1239, 2007. Pedoman Pelayanan traveled by foot about 1-2 hours, if it is Kesehatan Puskesmas Terpencil. Jakarta raining and extreme weather cannot cross  Lefaan Margareta M.K, Rantetampang A.L, times to go to Pustu. Sandjaja B, Anwar Mallongi., 2018. Factors f. Service Factors in Remote Regional Affecting of Pregnancy Women to K4 Visits in Timika Public Health Center, District of Health Services in Wondiboi Health Center, Mimika, Papua. International Journal of Wondama Bay District. (Case Study in Science and Healthcare Research 3 (2), 212- Sendrawoi Sub-district) From the 220 interviews, according to all the informants,  Notoatmojo, S. 2007. Prinsip – Prinsip the officers had done the maximum service Dasar Ilmu Kesehatan Masyarakat. Rineka possible, turned back to the role of Cipta. Jakarta infrastructure and transportation as one of  Noor, J. 2011, MetodologiPenelitian: the important physical components for Skripsi, Tesis, DisertasidanKaryaIlmiah, remote areas. And if you find an emergency CetakanPertama, Kencana, Jakarta. case that needs immediate help, the pustu is  PongtikuArry,dkk, 2016. closed. MetodePenelitianKualitatifSaja.Jayapura.  Profi l PuskesmasWondiboitahun 2016. REFERENCES DinkesKabupatenTelukWondama  Adisasmito, W. 2012. Sistem Kesehatan.  Stefanus Supriyanto dan Nyoman Anita PT. Raja Grafindo Persada. Jakarta Damayanti, 2007. Perencanaan dan  Algifari, 1997. Statistika Induktif untuk Evaluasi. 2007. Surabaya Ekonomi dan Bisnis. Cetakan Pertama.  SumiarniEndang, dkk, 2018, Yogyakarta. EksitensiHukumAdat Serta Nilai –  Arikunto, 2004 Prosedur Penelitian Suatu NilaiKearifanLokalsebagaiPenunjang Pendekatan Praktek. RinekaCipta.Jakarta. Pembangunan Suku – Suku di  Bertha Kamo, Yermia Msen, A.L. KabupatenTelukWondamaProvinsi Papua Rantetampang, Anwar Mallongi, 2018, The Barat.. Factors affecting with Four Visited at Public  Suharmiati,dkk, 2012 Faktor – faktor yang Health Centre Sub Province Mimika Papuan mempengaruhiKeterjangkauanpelayananKe Province. International Journal of Science sehatan di Puskesmas Daerah and Healthcare Research, Vol.3; Issue: 2; Terpencilperbatasan di kabupaten Sambas, April-June 2018 Kalimantan  Dinkes Kabupaten Teluk Wondama, 2016.  Wahab, 1997. Analisis Kebijaksanaan dari Rekapitulasi Laporan Tahunan. Wasior. Formulasi ke Implementasi Kebijaksanaan  Dunn Wiliam, 2003, Analisis Kebijakan Negara. Edisi 2. Bumi Akasara. Jakarta. Publik, edisiKedua, Jakarta

International Journal of Science and Healthcare Research (www.ijshr.com) 169 Vol.4; Issue: 1; January-March 2019 Aning Melalolin et.al. Determinant Factors in Remote Regional Health Services in the Wondiboy Health Center in Teluk Wondama District (Case Study in Sendrawoi District Health Center)

 2010. Analisis Kebijaksanaan dari International Journal of Science and Formulasi ke Implementasi Kebijaksanaan Healthcare Research 3 (2), 195-205 Negara. Edisi 2. Bumi Akasara. Jakarta.  Wirman Syafri, H. 2010. Implementasi How to cite this article: Melalolin A, Kebijakan Publik dan Etika Profesi Pamong Rantetampang AL, Msen Y et.al. Determinant Praja. Edisi 2. Alqa Prisma Interdelta. factors in remote regional health services in the Jatinangor Wondiboy health center in teluk Wondama  Yuliarta Mararu, Bernard Sandjaja, A. L. district (case study in Sendrawoi district health Rantetampang, Anwar Mallongi, 2018. center). International Journal of Science & Determinant Factors Affecting Malaria Healthcare Research. 2019; 4(1): 163-170. Occurrence among Pregnant Woman in the Wania Puskesmas, District of Mimika.

******

International Journal of Science and Healthcare Research (www.ijshr.com) 170 Vol.4; Issue: 1; January-March 2019