Puskesmas are the most strategic health service units because they play an important role in ensuring equitable services sevices to the population. Their roles are also crucial in reducing disparity between areas and in reducing the escalation of health cists. Futhermore, the outputs of their activities are the priority indicators for health sector at the national level, namely Minimum Service Standards (MSS) and program Indonesia Sehat denga Pendekatan keluarga (Healthy Indonesia program Through Family Approach/ PIS-PK), as well at the indicators related to Sustainable Development Goals at the global level.
However, since decentralization and during the JKN era, the perfomance results of Puskesmas have tended to prioriteze curative efforts rather than promotive and preventive efforts. We can see this from the output or performance impact of the Puskesmas, such s the maternal mortality rate, infant mortality rate, cases of communicable diseases, non-communicable diseases, and contraceptives use, which are worse than expected. 1 This condition is compoundedn by the corona virus-19 pandemic affectig all aspects of life. Health service programs both in health facilities and in the community are hampered, such as immunization, services for pregnant/childbirth/ postpartum mothers, family planning services, infectious diseases, and non-communicable services.
The challenges faced by Puskesmas in achieving its intended outcomes are multifaceted, from access, geography, available resources, and quality of services. The barriers related to resources include amongst others the availability of competence health workers, drugs and medical devices. Infrastructure constraint such as limited internet network can also become a challenge. Additionally, limited capacity of Puskesmas staffs as well as district health official such as in preparing drug needs plans and applying e-catalogs can hamper the performance of Puskesmas for this reason, a strategy to strengthen basic health services in Puskesmas for this reason, a strategy to strengthen basic health services in Puskesmas is needed, such as strengthening the institutions, strengthening human resources, managing drug and medical equitment logistics, ensuring financing effectiveness, improving management and quality of Puskesmas services, improving accountability as well as implementing affimative polices to provide more support for Puskesmas in remote areas