under-utilization of community health centers

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UNDER-UTILIZATION

OF COMMUNITYHEALTH CENTERS

IN PURWOREJO

REGENCY, CENTRAL

JAVA

Atik Triratnawati

Department Of Anthropology, Faculty Of Cultural Science

Gadjah Mada University,Yogyakarta 55281, Indonesia

Makara, Kesehatan, Vol. 10, No. 1, June 2006


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Average number of consults per week is

6 in Barualte and 0-1 in Imelda

Underutilization of health centers in

Cluster 10

To identify factors that affect

underutilization of health centers

To develop plans that aim to maximizeutilization of health care services in

rural areas


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Health systems of Kenya, Ghana,Zaire, Pakistan, Indonesia andBangladesh

Nation wide networks but with weaksupportive structures and underutilizedhealth services

Lack of implementation of plans

Declining share in the national budget Most hospitals and medical schools in

Indonesia are private


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Indonesia Health Vision by 2010 Providing PHC by the government

Hospital-doctor oriented care tocommunity-based PHC

Health paradigm, decentralization,professionalism and manage care

215 million in more than 13,600 islands

Variety concerning race, ethnic, religion,social strata, education and language

Total health cost Rp. 5.1 billion 30% government (2.5% of total annual

government budget)

70% private sectors


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Community health centers or

Puskesmas

Health status of the Indonesians

increased gradually

After the economic crisis in 1997,

many people could not afford to

fulfill basic needs Most Indonesian health care

centers are under-utilized


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United Nations report (1979)


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Purworejo Regency, Central Java

utility of PHCs seemed to bedecreasing

Purworejo has 25 PHCs, 63 sub-PHCs, 81 physicians, 26 dentists,and 233 paramedics

comprised of 16 sub-districts and

494 villages Infectious and nutritional

deficiencies of women and children


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PURWOREJO SAN JUAN

25 PHCs 42 Barangays

81 physicians MHOs

DFCM residents

Pedia residents

Medical Interns

1 physician/puskesmas 2-3 medical interns

1 Midwife : 1 puskesmas 1 Midwife: 2-3 BHC

10 Healthpersonnel/puskesmas

5-6 BHW/health center(Cluster 10)

30, 000 people/puskesmas 1556 (Barualte)

905 (Imelda)


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To investigate the utilization of

PHC units through health sociology

approach, focusing on the

bureaucratic, administrative aspect

of health care management,

health seeking behavior, medical

pluralism and labeling ofcommunity health centers


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Puskesmasin Purworejo District, CentralJava

Qualitative method using in-depthinterview, observation and Focus Group

Discussion In-depth interviewof 3 health personnel

and 3 persons

FGDamong 8 types of groups: paramedic,non paramedic , laboratory staff,

bureaucrats, mothers who have children

under-utilization of community health centers

Documents