CHAPTER I

INTRODUCTION

1.1 Background
The Community Medicine and Public Health Block is the twenty-second
block in semester VII of the Medical Education Competency Based
Curriculum in the Faculty of Medicine, Muhammadiyah University,
Palembang. On this occasion a case study of scenario A was presented
Boba, a Puskesmas doctor at Dusun Lintas, before carrying out medication
to the patient, he always gathers his patient on puskesmas waiting rooms to
perform health promotion and education regarding defecatig in toilets. The
given matery was in correlation with health problem that was listed in
Puskesmas “Rencana Usulan Kegiatan”.
The most common found infection disease at Dusun Lintas Puskesmas
working area was gastroenteritis. Prevention of infectious disease attempt
(P2M) of Dusun Lintas Puskesmas was low, hencofort doctor Boba
organizing a training about health promotion technique for P2M and
Posyandu Cadre.

1.2 Purpose and Objectives

The purpose and objective of this case study tutorial report are:
1. As a tutorial group tasl report that is part of the KBK learning
system at the Faculty of Medicine, University of Muhammadiyah
Palembang.
2. Can resolve the case given in the scenario with the method of
analysis and learning of group sicussion.
3. The achievment of the objectives of the tutorial learning method.

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 CHAPTER II
DISCUSSION

2.1 Tutorial Data

Tutor : dr. Ernes Putra Gunawan
Moderator : Nazla Fakhirah
Desk Secretary : Novi Putri Dwi Iriani
Board Secretary : Dita Azzahra Maso
Time : Tuesday, 22 Oktober 2019
Thursday, 24 Oktober 2019
Rule Tutorial : 1. Gadget should be nonactive or in silent mode.
2. Everyone in the group should express their
opinion.
3. Ask for permission if want to go outside.
4. Eating and drinking are not allowed in the room.

2.2 Case Scenario

“ The Boba’s Promotion “
Boba, a Puskesmas doctor at Dusun Lintas, before carrying out medication
to the patient, he always gathers his patient on puskesmas waiting rooms to
perform health promotion and education regarding defecatig in toilets. The
given matery was in correlation with health problem that was listed in
Puskesmas “Rencana Usulan Kegiatan”.
The most common found infection disease at Dusun Lintas Puskesmas
working area was gastroenteritis. Prevention of infectious disease attempt
(P2M) of Dusun Lintas Puskesmas was low, hencofort doctor Boba
organizing a training about health promotion technique for P2M and
Posyandu Cadre.

2
2.3 Term Clarification
No Term Clarification
.

1. Helath Efforts to improve the ability of the community

Promotion through learning from and by and with the
community so that they can help themselves.

2. Puskesmas The technical implementation unit of the service

(UPTD) is a health service facility that organizes
public health efforts and first-level individual
health efforts by prioritizing promotive and
preventive efforts to achieve the highest degree of
public health in the working area.

3. Health Learning efforts for the community so that the

Education community will take actions to maintain and
improve their health.

4. Posyandu Cadre Local residents who are selected and reviewed by

the community and can work voluntarily to
manage the posyandu.
5. Rencana Usulan A work plan regarding health efforts.
Kegiatan

6. Gastroenteritis An inflamation of gaster and intestine

7. P2M Preventive infectious diseases

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 2.4 Problem Identification
1. Boba, a Puskesmas doctor at Dusun Lintas, before carrying out
medication to the patient, he always gathers his patient on puskesmas
waiting rooms to perform health promotion and education regarding
defecatig in toilets. The given matery was in correlation with health
problem that was listed in Puskesmas “Rencana Usulan Kegiatan”.
2. The most common found infection disease at Dusun Lintas Puskesmas
working area was gastroenteritis. Prevention of infectious disease
attempt (P2M) of Dusun Lintas Puskesmas was low, hencofort doctor
Boba organizing a training about health promotion technique for P2M
and Posyandu Cadre.

2.5 Problem Analysis

1. Boba, a Puskesmas doctor at Dusun Lintas, before carrying out
medication to the patient, he always gathers his patient on
puskesmas waiting rooms to perform health promotion and
education regarding defecatig in toilets. The given matery was in
correlation with health problem that was listed in Puskesmas
“Rencana Usulan Kegiatan”.
a. What is the definition of Puskesmas based on Permenkes?
Answer:
According to Ministry of Health Regulation No. 75 of 2014
the Public Health Center, hereinafter referred to as Puskesmas, is
a health service facility that organizes public health efforts and
first-level individual health efforts, prioritizing promotive and
preventive efforts, to achieve the highest degree of public health
in the region it works (Ministry of Health, 2014).
Puskesmas is a functional health organization which is a
center of community health development that also fosters
community participation in addition to providing comprehensive

4
 and integrated services to the community in its working area in
the form of main activities. The role of the puskesmas and its
network as institutions that provide health services at the first
level that is directly involved with the community is very
important. The puskesmas is responsible for organizing health
development in its working area (Kemenkes RI, 2016).

b. What are the function of Puskesmas?

Answer:
In carrying out their duties, the Puskesmas carries out the
function of conducting the first-level Individual Health Efforts
(UKP) in its working area. In carrying out its functions, the
Puskesmas is authorized to:
1) Carry out a plan based on an analysis of public health
problems and an analysis of the service needs needed.
2) Carry out advocacy and health policy socialization.
3) Carry out communication, information, education, and
community empowerment in the health sector.
4) Mobilizing the community to identify and solve health
problems at every level of community development in
collaboration with other related sectors.
5) Carry out technical guidance for the network of services
and community-based health efforts.
6) Implementing an increase in the competency of the
Puskesmas human resources.
7) Monitor the implementation of development so as to be
health-minded.
8) Carrying out the recording, reporting, and evaluation of
access, quality, and coverage of Health Services.
9) Provide recommendations related to public health issues,
including support for early alert systems and disease
response responses (Kemenkes, 2014).

5
c. What is the purpose of Puskesmas?
Answer:
1) Health development held in Puskesmas aims to realize
communities that:
a) Have healthy behaviors which include awareness, will
and will ability to live healthy.
b) Able to reach quality health services.
c) Live in a healthy environment; and
d) Have optimal health degrees, both individuals,
families, group and society.

2) Health development carried out in the Puskesmas as

referred to in paragraph (1) supports the realization of a
healthy sub-district (Permenkes RI, 2014).

d. How is the structure of Puskesmas?

Answer:
The organizational structure pattern of the Puskesmas that
can be used as a reference for Puskesmas in the Remote and Very
Remote areas is as follows:
1) Head of Puskesmas; with the criteria that health workers
with a minimum diploma level of education three if there
are no health workers with a bachelor's degree, have
public health management competencies, have a
minimum of 2 (two) years of work in the Puskesmas, and
have attended Puskesmas management training.
2) Head of Administration sub-division, which is
responsible for assisting the head of the Puskesmas in
managing the Puskesmas, staffing, and household
Information System. The treasurer is included in the
Administration section.
3) Responsible for Essential UKM, UKM Development and
Public Health Nursing.

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 4) Responsible for UKP, pharmacy and laboratory
5) Responsible for the Puskesmas service network and
health service facility network, which oversees:
a) Supporting Puskesmas
b) Mobile Health Centers
c) Village Midwife
d) Network of health service facilities (Permenkes
No.75 2014).

e. What is the Puskesmas right dan responsibility?

Answer:
A. Puskesmas Responsibility

According to Permenkes RI No. 75 / MenKes / 2014 in Chapter II

- Article 4

Puskesmas have the task of implementing health policies to

achieve the goals of health development in their work area in
order to support the realization of healthy sub-districts.

- Article 5

In carrying out the tasks referred to in Article 4, the

Puskesmas shall carry out the functions of:

a) Organizing first-level SMEs in the working area.

b) Organizing the first level UKP in the working area.

B. Puskesmas Rights

Puskesmas rights According to Permenkes RI No. 75 /

MenKes / 2014 in Chapter II

- Article 6 I

Carrying out the functions referred to in Article 5 letter a, the

Puskesmas is authorized to:

a) Carry out planning based on the analysis of public

health problems and analysis of service needs needed.
b) Carry out health policy advocacy and dissemination.

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 c) Implement communication, information, education, and
community empowerment in the health sector.
d) Mobilize the community to identify and solve health
problems at every level of community development in
collaboration with other related sectors.
e) Carrying out technical guidance to the network of
services and community-based health efforts.
f) Implement an increase in the competency of the
Puskesmas human resources.
g) Monitor the implementation of development so as to be
health-minded.
h) Recording, reporting and evaluating the access, quality
and scope of health services.
i) Provide recommendations related to public health
issues, including support for early alert systems and
disease response responses.

- Article 7

In carrying out the functions referred to in Article 5 letter b,

the Puskesmas is authorized to:

a) Organizing basic health services in a comprehensive,

sustainable and quality manner.
b) Organizing health services that prioritize promotive and
preventive efforts.
c) Organizing Health Services oriented to individuals,
families, groups and the community.
d) Organizing health services that prioritize the safety and
safety of patients, officers and visitors.
e) Organizing Health Services with the principle of
coordinative and inter-professional cooperation.
f) Carry out medical records.
g) Record, report and evaluate the quality and access of
Health Services;
h) Implement competency improvement in Health Energy;
i) Coordinate and implement first-rate health service
facility development in the working area; and
j) Conduct referral screening in accordance with medical
indications and referral systems.

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f. What is the difference between health promotion and
education?
Answer:
Health promotion was born out of health education. The
reasons included include: First, so that extension workers / public
health educators become more aware of the need for a positive
approach in health education more than just prevention of disease.
Second, it is becoming increasingly apparent that health education
will be more empowered if supported by a set of efforts (such as
legal, environmental and regulatory).
Why aren't health education efforts enough? Health
education which aims to change the behavior of individuals,
groups and communities, is apparently not enough to improve
health status, because beyond that there are still many factors or
determinants that affect health and are outside the health area.
Health determinants cannot be intervened with health education,
but must pass regulations and legislation, through mediation and
advocacy efforts. These advocacy, social support and
empowerment efforts are the main mission and strategy in health
promotion (Susilowati, 2016).

g. What is the purpose of health promotion?

Answer:
The purpose of implementing health promotion is basically a
vision of health promotion itself, which is to create / create a
community that:
1) Willing (willingness) to maintain and improve health.
2) Ability (ability) to maintain and improve health.
3) Maintaining health, means willing and able to prevent
disease.
4) Protect yourself from health problems.

9
 5) Improve health, means willing and able to improve their
health. Health needs to be improved because the degree of
health of individuals, groups or communities is dynamic
not static.

The purpose of health promotion can be seen from several

things, namely:
1) The purpose of Health Promotion according to WHO
a) General purpose
Change the behavior of individuals / communities in
the field of Health
b) Special purpose
 Making health as something of value to the
community.
 Helping individuals to be able to
independently / in groups carry out activities
to achieve healthy living goals.
 Encourage the development and proper use
of facilities existing health services.
2) Operational Objectives:
a) So that people have a better understanding of the
existence and changes of the system in health care
and how to use it efficiently & effectively.
b) So that the client / community has greater
responsibility for health (himself), environmental
safety and the community.
c) In order for people to take positive steps in
preventing the occurrence of illness, preventing the
development of the disease becoming more severe
and preventing the state of dependency through
rehabilitation of disabilities due to disease.

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 d) So that people learn what they can do themselves
and how, without always asking for help from the
normal health service system.

Meanwhile, according to Green, the goal of health promotion

consists of 3 levels of goals, that is:
1) Program Objectives
Is a statement of what will be achieved in a certain period of
time related to health status.
2) Educational Objectives
Is a description of the behavior to be achieved to overcome
existing health problems.
3) Behavioral Objectives
Is an education or learning that must be achieved (desired
behavior). Therefore, the purpose of behavior is related to
knowledge and attitude.
4) Purpose of Behavioral Interventions in health promotion
a) Reducing negative behavior for health.
For example: reducing smoking
b) Prevent increased negative behavior for health
For example: prevent the increase in 'free sex'
behavior
c) Promotes positive behavior for health
For example: encourage sports habits
d) Prevents the decline in positive behavior for health
For example: prevent decreased fiber-rich eating
behavior (Susiolowati, 2016).

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h. Who is the target for the health promotion?
Answer:
Based on the Ministry of Health No. 1114, 2005. In the
implementation of health promotion there are 3 (three) types of
targets, namely:

1) Primary targets (primary) efforts to promote health are

actually patients, healthy individuals and families
(households) as a component of society. They are expected
to change their unclean and unhealthy life behaviors into
clean and healthy living behaviors (PHBS).
2) Secondary targets are community leaders, both informal
leaders (such as traditional leaders, religious leaders, etc.)
and formal leaders (such as health workers, government
officials and others), community organizations and the
mass media. They are expected to be able to participate in
efforts to improve PHBS of patients, healthy individuals
and families (households) by: Serving as role models in
practicing PHBS. Also disseminating information about
PHBS and creating a conducive atmosphere for PHBS.
Serves as a pressure group to accelerate the formation of
PHBS.
3) Tertiary targets are public policy makers in the form of
legislation in the health sector and other related fields as
well as those who can facilitate or provide resources. They
are expected to participate in efforts to increase PHBS of
patients, healthy individuals and families (households).

i. How is the steps of health promotion?

Answer:
Steps in Promoting Health in the Community:
1) Introduction to regional conditions
2) Identification of health problems
3) Introspective survey
4) Village or kelurahan deliberations
5) Participatory planning
6) Implementation of activities
7) Sustainability development (Kemenkes, 2011).

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j. What is the vision and mision of health promotion?
Answer:
Based on the National Health Promotion Policy. Decree of the
Minister of Health of the Republic of Indonesia Number: 1193 /
MENKES / SK / X / 2004:
A. Vision of Health Promotion

1) Prevent the emergence of diseases and other health

problems.
2) Tackling diseases and other health problems, in improving
health status.
3) Utilizing health services, as well.
4) Develop and strive for community-based health.

B. Health Promotion Missions

To realize the vision mentioned above. the National Health
Promotion Mission is:
1) Empowering individuals, families and groups in society,
both through individual and family approaches, and
through community organizing and mobilization.
2) Fostering an atmosphere or environment that is conducive
to the creation of clean and healthy behavior in the
community such as the use of clean latrines inside the
house.
3) Advocating for decision makers and policy makers as well
as other interested parties (stakeholders) in order to:
 Encouraging the adoption of health-oriented policies
and legislation.
 Integrating health promotion, especially community
empowerment, in health programs, so that the
community is aware of defecation in the toilet.

13
  Enhancing synergistic partnerships between the central
government and regional governments, as well as
between the government and the community (including
NGOs) and the business world.
 Increase investment in the health promotion sector in
particular and the health sector in general.

k. How is the effort of health in Puskesmas?

Answer:
According to the Minister of Health Decree No. 128 of 2004
concerning Basic Policies for Community Health Centers:

1) Mandatory Health Efforts

Puskesmas mandatory health efforts are efforts
determined based on national, regional and global
commitments and those that have high leverage to
improve community health status. This mandatory health
effort must be carried out by every puskesmas in
Indonesia.
The mandatory health efforts are:
a) Health Promotion Efforts
b) Environmental Health Efforts
c) Health Efforts for Mother and Child and Family
Planning
d) Nutrition Improvement Efforts
e) Efforts to Prevent and Eradicate Communicable
Diseases
f) Treatment efforts

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2) Health Development Efforts
Puskesmas development health efforts are efforts
determined based on health problems found in the
community as well as those that are tailored to the
capabilities of the puskesmas. The development health
effort was chosen from the list of existing primary health
center health efforts, namely:
a) School Health Efforts
b) Sports Health Efforts
c) Community Health Care Efforts
d) Occupational Health Efforts
e) Dental and Oral Health Efforts
f) Mental Health Efforts
g) Eye Health Efforts
h) Elderly Health Efforts
i) Efforts to Foster Traditional Medicine

The efforts of medical laboratories and public health

laboratories as well as recording and reporting efforts are
not included as a choice because these three efforts are
supporting services for each mandatory effort and
puskesmas development effort.

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l. How is the strategy of health promotion?
Answer:
1) Society Empowerment
Society empowerment is the provision of information and
assistance in preventing and overcoming health problems, in
order to help individuals, families or community groups go
through stages of knowing, wanting and being able to practice
PHBS.

2) Community Development
An effort to create a social environment that encourages
individual members of the community to want to do the
behavior that is introduced. Someone will be encouraged to
want to do something if the social environment wherever he is
(family at home, student / student organizations, trade unions /
employees, people who become role models / idols, arisan
groups, religious assemblies and others, and even the general
public) approves or supports this behavior. Therefore, to
strengthen the empowerment process, especially in an effort to
improve individuals from the tofu phase to the willing phase, it
is necessary to develop atmosphere. There are three categories
of atmosphere development processes;
a. Individual atmosphere development
b. Group atmosphere development
c. Public atmosphere development.

3) Advocacy
Advocacy is strategic or planned effort or process to get
commitment and support from relevant parties (stakeholders).
These related parties are community leaders (formal and
informal) who generally act as resource persons (opinion
leaders), or policy makers (norms) or funders. Also in the form
of groups in society and mass media that can play a role in
creating a conducive atmosphere, public opinion and
encouragement (pressure) for the creation of community
PHBS.

4) Partnerships
Must be promoted both in the context of empowerment as well
as fostering atmosphere and advocacy in order to build
cooperation and get support. Thus, partnerships need to be
organized between individuals, families, officials or

16
 government agencies related to health affairs (across sectors),
community leaders or figures, mass media and others.
Partnerships must be based on three basic principles, there are;
a. Equality
b. Openness
c. Mutual benefit (Kemenkes RI, 2011).

m. What is the purpose of health education?

Answer:
Achieving changes in individual behavior, and society in
maintaining healthy behavior and playing an active role in
realizing optimal health status (Notoatmodjo, Soekidjo, 2012).

n. How is the prosses of health education?

Answer:
A well-known approach to planning, implementing and
evaluating health education programs is the Precede-Proceed
model proposed by Green & Kreuter in 2005. The Precede section
of the model (phases 1-4) focuses on program planning and the
proceed (phases 5-8) focus on implementation and evaluation.
The eight phases of the planning guidance model in creating a
health promotion program, begin with an output more general and
change to more specific outputs. On finally, the process of leading
to programmaking, delivering program and evaluating program
(Fertman, 2010).

Phase 1: Social Diagnosis

In this phase, the program determines how specific the
quality of life of the community is. To find out the
problem, social indicators of health in a specific
population are often used (for example, degrees of
poverty, average crime, absenteeism, or low levels of
education) that have an effect to health and quality of
life.

17
Phase 2: Epidemiologic diagnosis
Social problems in the first phase in terms of health are
things that can affect the quality of people's lives. In this
second phase the program identifies health factors or
other factors that play a role in deteriorating quality of
life.
Phase 3: Educational and Ecological Assessment
The focus in phase 3 alternates into a mediating factor
that can encourage or avoid a positive environment or
positive behavior. These factors are grouped into three
categories: predisposing factors, enabling factors and
reinforcing factors (Green & Kreuter, 2005).
Phase 4: Policy Administration & Assessment & Intervention
Alignment
In this phase, efforts to improve health status can be
supported or hampered by existing regulations and
policies. So it can be seen that the main focus in the
administration and assessment of policies and the
alignment of interventions in the fourth phase is the
assurance of reality, to ensure that this is in the rules
(school, workplace, health service organization, or
community) all possible support, funding, personality ,
facilities, policies and other resources will be displayed
to develop and implement the program.
Phase 5: Implementation or Implementation
Submission of the program occurs during phase 5. Also,
the evaluation process (phase 6), which in the first
evaluation phase, occurs in consultation with the
implementation of the program.
Phase 6: Evaluation Process

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 The evaluation process is a formative evaluation,
something that arises during the implementation of the
program.
Phase 7: Effect of Evaluation
The focus in this phase is summative evaluation, which
is measured after the program is completed, to find out
the influence of interference in behavior or the
environment.
Phase 8: Evaluation Results or Output
The focus of the last evaluation phase is the same as the
focus when all processes are running - evaluation
indicators on quality of life and health status (Fertman,
2010).

o. What is the scope of health education?

Answer:
The scope of health education can be seen from 3 dimensions
according to Fitriani (2011), namely:
a) The dimensions of the target
1) Individual health education with the target is
individuals.
2) Group health education with the target is certain
community groups.
3) Public health education with the target is the wider
community.
b) Dimensions of the place of implementation
1) Health education in hospitals targeting patients and
families.
2) Health education in schools with the target is
students.
3) Health education in the community or workplace
with the target is the community or workers.

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 c) Dimensions of the level of health service
1) Health education for health promotion, for
example: improvement of nutrition, improvement
of environmental sanitation, lifestyle and so on.
2) Health education for special protection, for
example: immunization.
3) Health education for early diagnosis and proper
treatment, for example: with proper and perfect
treatment can avoid the risk of disability.
4) Health education for rehabilitation, for example:
by restoring the condition of disability through
certain exercises.

p. How to make “Rencana Usulan Kegiatan”?

Answer:
Preparation of Proposed Action Plan This activity consists
of 2 (two) steps, namely Problem Analysis and Preparation of
Proposed Activity Activities (Health Office of Bantul Regency
No 440, 2016).
1) Analysis of Problems
Problem Analysis can be done through group agreement of
the Drafting Team for Puskesmas Level Planning and
Health Forum through stages:
a) Identification of the problem
The problem is the gap between hope and reality.
Problem identification is carried out by making a list
of the problems obtained, grouped by type of
program, scope, quality, availability of resources.
b) Establishing Priority Order Problems
Each criterion is assigned a value of 1–5. The value
is greater if the level of urgency is very urgent, or
the level of development and the level of seriousness

20
 are more alarming if not addressed. Then multiply
the level of urgency (U) by the level of development
(G) and the level of seriousness (S).
c) Formulating the Problem
Gastroenteritis outbreaks in Dusun Lintas due to
people not defecating in latrines and the low effort
to prevent infectious diseases (P2M)
d) Finding the Root Cause of the Problem
Finding the root of the problem can be done using
the method:
 Cause and effect diagrams of Ishikawa, or
so-called fishbone diagrams.
 Problem trees.
e) Determine How to Solve Problems
Establishing ways of solving the problem can be
done by agreement between team members. If there
is no agreement, matrix criteria can be used. For this
reason alternative solutions must be sought.

2) Preparation of Proposed Activity Plans (RUK)

Preparation of the Proposed Activity Plan includes essential
health efforts, health development efforts and supporting
health efforts, which include:
a) Future activities (including routine activities,
facilities / infrastructure, operations and program
results of problem analysis). For example healthy
toilet facilities / infrastructure.
b) Resource requirements based on the availability of
available resources in the current year, such as
health promotion technical training for posyandu
cadres and P2M puskesmas.

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 c) Recapitulation of Proposed Activity Plans and
required resources into the RUK Puskesmas format.

The Proposed Activity Plan is arranged in a matrix form by

considering various applicable policies, both global, national,
and regional agreements in accordance with existing problems
as a result of data and information studies available at the
Puskesmas (Bantul District Health Office No 440, 2016).

q. What is the benefit of “Rencana Usulan Kegiatan”?

Answer:
Benefits of Integrated Puskesmas Level Planning
(Perencanaan Tingkat Puskesmas/PTP)
The benefits of Integrated Puskesmas Level Planning are as
follows:
a) Planning can provide instructions for organizing health
efforts
b) Effectively and efficiently in order to achieve the goals
set.
c) Planning facilitates supervision and accountability.
d) Planning can consider obstacles, support and potential that
exists.
At the district level, documentation of the results of
integrated PTP is used as a tool for monitoring the use of funds
and implementing activities at the Puskesmas level, as well as to
identify Puskesmas needs that need to be supported by districts
and provinces (KOMPAK, 2015).

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2. The most common found infection disease at Dusun Lintas
Puskesmas working area was gastroenteritis. Prevention of
infectious disease attempt (P2M) of Dusun Lintas Puskesmas
was low, hencofort doctor Boba organizing a training about
health promotion technique for P2M and Posyandu Cadre.
a. What is the meaning the most common found infection
disease at Dusun Lintas Puskesmas working area was
gastroenteritis?
Answer:
The meaning the most commoon found infection diseases at
dusun lintas puskesmas working area was gastroenteritis that it
hasn't hit yet of “Kejadian Luar Biasa” and “Wabah”.

b. How is the epidemiology of gastroenteritis?

Answer:
This disease is more common in children. Children in
developing countries are more at risk both in terms of morbidity
and mortality. This disease affects 3-5 billion children each year
and causes around 1.5-2.5 million deaths per year or constitutes
12% of all causes of death in children. children under the age of
5 years (Chow et al., 2010).
In adults, an estimated 179 million cases of acute
gastroenteritis occur each year, with an inpatient rate of 500,000
and more than 5000 dying (Al-Thani et al., 2013).
In general, developing countries have higher rates of
hospitalization compared to developed countries. This is
possible based on the fact that children in developed countries
have better nutritional status and primary health services (Chow
et al., 2010).
In Indonesia in 2010 diarrhea and gastroenteritis caused by
certain infections still ranked first in the largest number of
inpatients in Indonesia, as many as 96,278 cases with a mortality
rate (Case Fatality Rate / CFR) of 1.92% (Kemenkes, 2012).

23
c. What are the factors that influence the epidemiology of
disease in a region?
Answer:

• Host (host): age, gender, race, religion, ancestry, personality,

behavior and nutrition.
• Agent: An agent can be a biological agent (vector, biology, and
virus); chemical agents (insecticides); physical (climate); and
food (stale food and fatty foods).
• Environment (environment): physical environment, biology,
climate, politics and customs.

d. How is the effort to organize P2M?

Answer:
Pasal 7
(1) The Government in organizing the communicable disease
control program can form a work unit / technical implementing
unit that has the duties and functions to include:
a) preparing preparations and recommendations for types
of infectious diseases that require quarantine;
b) Ministry of Health focal points in the regions; and
c) investigation of the place or location suspected as a
source of spread of infectious diseases. (Permenkes no
82 tahun 2014)

24
e. What is the definition of “Kejadian Luar Biasa” and
“Wabah”?
Asnwer:
Definitions of outbreaks and epidemics (Permenkes No.1501,
2010)
An outbreak is an outbreak of an infectious disease in a
society where the number of sufferers increases significantly
more than in the normal circumstances at certain times and
regions and can cause havoc. Specific types of infectious
diseases that can cause epidemics are as follows: a. Cholera b.
Pes c. Dengue Hemorrhagic Fever d. Measles e. Polio f.
Diphtheria g. Pertussis h. Rabies i. Malaria j. Avian Influenza
H5N1 k. Anthrax l. Leptospirosis m. Hepatitis n. New influenza
A (H1N1) / Pandemic 2009 o. Meningitis p. Yellow Fever q.
Chikungunya
Extraordinary Events (KLB) are the emergence or increase in
the incidence of morbidity and / or death that is
epidemiologically significant in an area within a certain period
of time and is a condition that can lead to an outbreak.

f. How to determine that an area occurred "Kejadian Luar

Biasa" and "Wabah"?
Answer:
An area can be determined in an KLB, if it meets one of the
following criteria:

25
 a) The emergence of a certain infectious disease as referred
to in Article 4 which previously did not exist or was not
known in an area.
b) The increase in the incidence of pain continuously for 3
(three) time periods in hours, days or weeks in a row
according to the type of disease.
c) Increased incidence of morbidity twice or more compared
to the previous period in the period of hours, days or
weeks according to the type of disease.
d) The number of new sufferers in a period of 1 (one) month
shows an increase of twice or more compared to the
average number per month in the previous year.
e) The average number of morbid events per month for 1
(one) year shows an increase of two or more times
compared to the average number of morbid events per
month in the previous year.
f) The case fatality rate (Case Fatality Rate) within 1 (one)
certain period of time shows an increase of 50% (fifty
percent) or more compared to the case fatality rate for a
previous period in the same period.
g) Proportional rate of new sufferers in one period shows an
increase of two or more times compared to one previous
period in the same period.

The determination of an area in an outbreak situation is carried

out if the outbreak situation develops or increases and has the
potential to cause disaster, with the following considerations:
a) Epidemiologically, disease data show an increase in
morbidity and / or mortality.

26
 b) Disruption of community conditions based on socio-
cultural, economic, and security considerations.

g. What is the purpose of Posyandu?

Answer:
In general, the objectives of holding a Posyandu are as follows
(Depkes RI, 2006):
a) Accelerating the reduction in Infant Mortality Rate
(IMR), children under five and birth rates.
b) Accelerate the decrease in MMR (maternal mortality
rate), pregnant women and childbirth.
c) Accelerating the acceptance of Norms of Happy and
Prosperous Small Families (NHPSF).
d) Increase the ability of the community to develop health
activities and other supporting activities as needed.
e) Increase the reach of health services.

h. What are the role of Posyandu Cadre?

Answer:
1) Before the Posyandu Open Day
a) Prepare for the organization of Posyandu activities
regarding gastroenteritis.
b) Disseminate information about Posyandu opening days
through local community meetings or circular letters.
c) Carry out the division of tasks between cadres, including
registration, weighing, recording, counseling, providing
additional food, and services that can be carried out by
cadres.
d) Coordinate with health workers and other officers
regarding the type of service to be held. This type of
activity is a follow-up to the previous Posyandu activity
or a predetermined activity plan.

27
 e) Prepare extension materials and supplementary feeding.
Counseling materials according to the problems faced by
parents and adapted to the counseling method, for
example: preparing food ingredients if you want to do a
cooking demonstration, turning sheets for counseling
activities, tapes or CDs, KMS, KIA books, tools for
stimulation of infants.
f) Prepare notebooks for Posyandu activities
2) When Open Posyandu Day
a) Registering, including registering toddlers, pregnant
women, post-partum mothers, nursing mothers, and other
targets.
b) Maternal and child health services. For child health
services at Posyandu, weighing, measuring height,
measuring head circumference of children, monitoring
children's activities, monitoring children's immunization
status, monitoring parental actions regarding parenting
performed on children, monitoring about toddler
problems, and so forth.
c) Guiding parents to take notes on various measurement
results and monitoring the condition of children under
five.
d) Conduct counseling about parenting toddlers. In this
activity, cadres can provide consulting services,
counseling, group discussions and demonstrations with
parents / families of toddlers such as prohibiting children
from playing or bathing in the river which is also used by
local residents to defecate.
e) Motivating toddlers' parents to continue to take good
care of their children by prohibiting their children from
bathing or playing in the river as well as maintaining

28
 cleanliness to prevent gastroenteritis, by applying the
principles of nurture-care.
f) Give appreciation to parents who have come to
Posyandu and ask them to return on the next Posyandu
day.
g) Convey information to parents to contact the cadre if
there are problems related to their toddlers.
h) Record activities that have been carried out on the
opening day of the Posyandu.
3) After the Day Open Posyandu
a) Conducting home visits for toddlers who are absent on
the opening day of Posyandu, malnourished children, or
children who suffer from outpatient malnutrition, and
others.
b) Motivate the community, for example to use the yard in
order to improve family nutrition, plant family medicinal
plants, create a safe and comfortable children's
playground. In addition, providing counseling about
Perilaku Hidup Bersih dan Sehat (PHBS) such as the use
of clean latrines.
c) Conduct meetings with community leaders, regional
leaders to convey the results of Posyandu activities and
propose support so that the Posyandu continues to run
well.
d) Organize meetings, discussions with the community, to
discuss Posyandu activities. Proposals from the
community are used as material for developing follow-
up plans for subsequent activities.
e) Study the Posyandu Information System (SIP). SIP is a
system of recording data or information about services
provided at Posyandu. The benefits of SIP are as a guide
for cadres to understand the problems that exist, so they

29
 can develop the right type of activity and in accordance
with the needs of the target.
f) SIP format includes;
 Records of pregnant women, births, infant deaths,
maternal deaths, childbirth, childbirth;
 Records of infants and toddlers in the Posyandu
working area; the right type of activity and in
accordance with the needs of the target.
 Notes on vitamin A administration, administration of
ORS, administration of blood-added tablets to
pregnant women, date and status of immunization;
 Records of women of childbearing age, couples of
childbearing age, number of households, number of
pregnant women, gestational age, immunization of
pregnant women, risk of pregnancy, birth support
plans, tabulin, village ambulances, prospective blood
donors in the Posyandu working area (Kemenkes,
2012).

i. What are the criteria for Posyandu Cadre?

Answer:
Posyandu cadres are selected by Posyandu administrators
from community members who are willing, able and have time
to organize Posyandu activities. Posyandu cadres organize
voluntary posyandu activities. Posyandu cadre criteria include
the following (MOH, 2006):

30
 a) Preferably come from members of the local community.
b) Can read and write Latin letters.
c) Has a pioneering spirit, a reformer and community
mobilizer.
d) Willing to work voluntarily, have the ability and free
time.

j. How is Posyandu implementation?

Answer:
According to Kemenkes (2006) posyandu is usually
implemented once in a month of activity, both on the Posyandu's
open day and outside the Posyandu's open day. Posyandu open
days at least one day a month. The day and time chosen,
according to the cadre agreement. If it needed, Posyandu can
open more than once a month.

The venue for Posyandu activities should be in a location

that is easily accessible to the community. The venue can be in
one of the houses of the residents, the yard, the village / village
hall, the RW / RT / hamlet, one of the stalls in the market, one
of the office spaces, or a place built by the community that can
be called by the name "Wisma Posyandu" and etc. (Depkes RI).

k. What are the technique of health promotion?

Answer:
Based on Communication Techniques
1) Direct counseling.
In this case the instructors directly face to face or face to
face with the target. These include: home visits, discussion

31
 meetings (FGD), meetings at village halls, meetings at
Posyandu, etc.
2) Indirect.
In this case the instructors do not directly face to face with
the target, but he conveys his message with intermediaries
(the media). For example publications in the form of print
media, through film shows, etc. (Notoatmojo, Soekidjo,
2012).

l. What are the media of health promotion?

Answer:
1) Visual viewing aids
This tool is useful in helping to stimulate the senses of the
eye (vision) at the time of the educational process. This
tool has 2 forms:
• Projected devices, for example: slides, films,
filmstrips, etc.
• Unprojected device:
- Two dimensions, map image, chart
- Three dimensions, globe, dolls. Etc.
2) Hearing aids (Audio Aids)
Is a tool that can help stimulate the sense of hearing,
during the process of delivering educational / teaching
material, such as vinyl records, radio, sound panels, etc.
3) Hearing aids such as television and video cassettes.
Props can also be divided into two types according to their
manufacture and use:
a) Complicated visual aids, such as films, filmstrips,
slides, which require electricity and a projector.
b) Simple props, which are easily made by yourself
with local materials that are easily obtained:

32
 bamboo, cardboard, used tins, newsprint, etc.
Some examples of teaching aids that can be used
in various places:
• In households such as leaflets, picture book
models, and tangible objects.
• In offices and schools such as blackboards,
flipcarts, posters, story books, dolls.
• In the community, poste, banner, leaflet,
flanelgraph.

According to the form of extension media are divided into:

a) Visual media: media that can be seen (slides,
transparencies).
b) Audio media: media that can be heard (radio).
c) Audiovisual media: media that can be heard and
seen (television, film).
d) Media to display (blackboard, stickboard, OHP,
planel board).
e) Real experience media or artificial media
(simulation, real objects).
f) Printed media (reading books, leaflets, folders,
posters, brochures) (Fitriani, 2011).

m. What are the methods of health promotion?

Answer:
Health promotion methods are classified into three, namely:
(Maryam S, 2014)

1) Individual (Individual) Education Methods

33
 Individual health promotion methods are used to foster new
behaviors or foster someone who is starting to be attracted
to a change in behavior or innovation. This method
includes:
a) Guidance or counseling, this method contains
information related to education, work, personal and
social problems presented in the form of lessons. This
method makes contact between individuals and health
workers more intensive. Every problem faced by an
individual can be investigated and can be helped to
resolve so that the individual voluntarily, based on
awareness and understanding will accept the behavior
(change behavior).
b) Interview (interview) aims to dig up information why he
did not or has not received change, whether the behavior
that has been or will be adopted that has a strong
understanding and awareness basis.
2) Group Education Methods
In choosing a group education method, you must keep in
mind the size of the target group and the level of formal
education of the target. For large groups the method will be
different from small groups. Effectiveness of a method will
depend on the size of the educational target, a large group is
the participant or the target is more than 25 people. The
following are included in the group health promotion
method:
a) Lecture, is a speech delivered by a speaker conducted in
front of a group of listeners. The advantages of this
method are that it can be used by adults, spends time
well, is used in large groups, can be used to repeat or
introduce members to lessons or activities. The weakness
of this method is that it prevents the response of the

34
 listener, only a few teachers can be good speakers, the
speaker must master all the subjects, is less interesting,
limited memory and difficult to use in children.
b) Seminar, is a presentation of one or several experts on a
topic that is considered important and is usually
considered warm in the community. This method is only
suitable for large groups with higher education.
c) Group discussion, is a conversation planned or prepared
between three or more people about a particular topic
and one of them leads the discussion. The strength of this
method is that it allows for sharing opinions, broadening
views, and helping develop leadership. The disadvantage
of this method is that it cannot be used in large groups,
participants obtain limited information and need skilled
leaders.
d) Brainstorming is the solution of problems when each
member proposes quickly so that the problem solving is
discussed. The advantage of this method is that it
generates new opinions resulting in chain reactions in
opinions and does not take up much time. The weakness
of this method is that it is easily out of control and may
make it difficult for participants to understand that all
opinions are acceptable.

3) Mass Education Methods

This method is suitable for communicating health messages
addressed to the public. Therefore, the objective of this
method is general, in the sense that it does not distinguish
between age groups, sex, occupation, socioeconomic status,

35
 education level and so on. This method is divided into
public lectures and speeches.

3. Islamic Value
Answer:
There is a small percentage of Muslims who believe that epidemics
or infectious diseases do not exist. This they based on the hadiths:

From Abu Hurairah said: The Messenger of Allah said "There are no
infectious diseases and thiyarah (feeling unlucky with birds and the
like) and I like good words".

This certainly seems contrary to the fact that we see a lot of

outbreaks and infectious diseases, this epidemic can even take the
lives of a group of people quickly. But there are also other
propositions which show that Islam also recognizes the plague of
infectious diseases.

From Abu Hurairah from the Prophet Muhammad SAW said:

ِ ‫الَ يُوْ ِر ُد ُم ْم ِرضٌ َعلَى ُم‬
ٍّ‫صح‬

“Don't be healthy camels mixed with sick camels”.

This second hadiths, gives the view that even though an infectious
disease is due to the will of Allah, we still have to maintain or strive
to prevent the infectious disease.

2.6 Conclution
dr. Boba, a puskesmas doctor at Dusun Lintas, performed health education
and promotion for P2M and Posyandu cadre because of P2M at Dusun
Lintas Puskesmas was low.

2.7 Conceptual Framework

Highest case of
P2M was low gastroenteritis

Health problem
36 listed in
RUK
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