Anemia pada ibu hamil berdampak terhadap tidak optimalnya pertumbuhan dan perkembangan janin dalam kandungan serta berpotensi menimbulkan komplikasi kehamilan dan persalinan, bahkan menyebabkan kematian ibu dan anak. Program Pemberian Tablet Tambah Darah (TTD) pada ibu hamil dimulai sejak tahun 1990 yang bertujuan untuk mencegah dan menanggulangi anemia gizi besi dimana ibu hamil diharapkan mengonsumsi TTD minimal 90 tablet selama kehamilannnya. Tujuan penelitian adalah untuk menganalisis implementasi kebijakan Suplementasi TTD pada ibu hamil di Kota Medan dengan melihat faktor yang berpengaruh yaitu komunikasi, sumberdaya, disposisi, struktur birokrasi dan lingkungan ekonomi, sosial dan politik. Penelitian ini merupakan penelitian kualitatif deskriptif dan pengumpulan data dilakukan melalui wawancara mendalam dan FGD dengan informan stakeholder terkait serta telaah dokumen. Penelitian dilakukan bulan Mei hingga Juni 2023. Hasil penelitian menunjukkan bahwa implementasi kebijakan suplementasi TTD pada ibu hamil di Kota Medan sudah terlaksana dengan cukup baik hingga saat ini. Komunikasi yang dilakukan untuk menyampaikan informasi kebijakan suplementasi TTD Ibu Hamil disampaikan kepada pelaksana kebijakan, kelompok sasaran dan pihak yang terkait secara berjenjang dari pusat, provinsi, kota, puskesmas, hingga kader dan masyarakat. SDM, anggaran dan kewenangan sudah cukup memenuhi untuk ketersediaan TTD. Pemberian TTD ini tidak memerlukan disposisi dari pimpinan, karena sudah rutin berjalan. Belum ada SOP khusus untuk TTD. Koordinasi masih terus dilakukan antar lintas sektor dan lintas program. Ibu hamil dengan tingkat ekonomi menengah keatas tidak memeriksakan kehamilannya di puskesmas, sementara pencatatan di seluruh puskesmas dan jejaringnya masih belum optimal. Keterlibatan tokoh masyarakat dan tokoh agama di Kota Medan sangat memengaruhi keberhasilan suatu program.

Anemia in pregnant women has an impact on the optimal growth and development of the fetus in the womb and has the potential to cause complications of pregnancy and childbirth, even causing death of mother and child. The Program for Giving Blood Supplement Tablets (TTD) to pregnant women began in 1990 which aims to prevent and treat iron deficiency anemia where pregnant women are expected to consume iron tablets at least 90 tablets during their pregnancy. The aim of the study was to analyze the implementation of the iron supplement supplementation policy for pregnant women in the city of Medan by looking at the influencing factors, namely communication, resources, disposition, bureaucratic structure and the economic, social and political environment. This research is a descriptive qualitative research and data collection was carried out through in-depth interviews and FGDs with relevant stakeholder informants and document review. The research was conducted from May to June 2023. The results showed that the implementation of the iron supplement supplementation policy for pregnant women in Medan City has been implemented quite well so far. Communications carried out to convey information on iron supplementation policy for pregnant women are conveyed to policy implementers, target groups and related parties in stages from the center, provinces, cities, health centers, to cadres and the community. Human resources, budget and authority are sufficient to meet the availability of TTD. Giving TTD does not require a disposition from the leadership, because it is already running routinely. There is no specific SOP for TTD yet. Coordination is still being carried out across sectors and across programs. Pregnant women with middle and upper economic levels do not have their pregnancies checked at the puskesmas, while registration at all puskesmas and their networks is still not optimal. The involvement of community leaders and religious leaders in Medan greatly influences the success of a program.

Pelayanan kesehatan usia produktif sebagai salah satu jenis pelayanan dasar dalam Standar Pelayanan Minimal (SPM) merupakan pelayanan yang diberikan kepada penduduk usia produktif (15-59 tahun) dalam bentuk edukasi dan skrining kesehatan. Berdasarkan target dan indikator kinerja pencapaian SPM Bidang Kesehatan yang tertera dalam Peraturan Wali Kota Bekasi Nomor 16 Tahun 2022, diketahui bahwa target penerima layanan dasar dari pelayanan kesehatan usia produktif setiap tahunnya yaitu sebesar 100%. Namun, persentase pelayanan kesehatan usia produktif di Kota Bekasi belum mencapai target 100% tersebut. Pada tahun 2022, Puskesmas dengan persentase Pelayanan Kesehatan Usia Produktif tertinggi  di tahun 2023 yaitu Puskesmas Rawa Tembaga dengan persentase sebesar 79,41%, kemudian Puskesmas dengan persentase Pelayanan Kesehatan Usia Produktif terendah yaitu Puskesmas Mustika Jaya dengan persentase sebesar 3,36%. Hasil penelitian menunjukkan bahwa persentase penduduk usia produktif di Kota Bekasi masih belum mencapai target capaian sebesar 100%. Oleh karena itu, beberapa hal yang dilakukan khususnya di Puskesmas Mustika Jaya dan Puskesmas Rawa Tembaga adalah bagi TPCB Dinas Kesehatan untuk memberikan pembinaan dan pengawasan khususnya kepada kedua Puskesmas tersebut untuk mengoptimalkan SDMK, pembiayaan, serta edukasi dan skrining kesehatan sebagai bagian dari Pelayanan Kesehatan Usia Produktif. 

Productive Age Healthcare Services, as a part of Minimum Service Standards (SPM) and are provided to the productive age population (15-59 years) through health education and health screening. According to the targets and performance indicators of SPM achievement in the health sector, outlined in Bekasi Mayor Regulation No. 16 of 2022, it is mentioned that the annual target for beneficiaries of productive age healthcare services is set at 100%. However, the percentage of productive age healthcare services in Bekasi City has not yet reached this 100% target. In 2022, the Puskesmas with the highest percentage of productive age healthcare services in 2023 was Puskesmas Rawa Tembaga, at 79.41%, while the lowest was Puskesmas Mustika Jaya, at 3.36%. The results of this research indicate that the percentage of the productive age population in Bekasi City receiving these services still falls short of the 100% target. Consequently, actions taken by the Bekasi Health Department’s Coaching Team for Assisted Clusters, especially targeting Mustika Jaya Community Health Centre and Rawa Tembaga Community Health Center, include providing guidance and oversight to optimize human resources, funding, as well as education and health screenings as part of the Productive Age Healthcare Services.

Filariasis limfatik masih menjadi tantangan kesehatan masyarakat di Indonesia, khususnya di wilayah endemis seperti Kecamatan Membalong, Kabupaten Belitung, yang telah memperoleh sertifikat eliminasi namun, angka mikrofilaria rate di beberapa wilayahnya tetap berada di atas ambang batas nasional. Penelitian ini bertujuan untuk menganalisis implementasi Pemberian Obat Pencegahan Massal (POPM) filariasis tahun 2023 di Kecamatan Membalong dengan menggunakan pendekatan kualitatif dan desain studi kasus. Data dikumpulkan melalui wawancara mendalam, dan telaah dokumen terhadap pelaksana program di dua Puskesmas serta Dinas Kesehatan. Analisis menggunakan model Donabedian diperkuat dengan pendekatan Indeks Kualitas Kebijakan (IKK) dari LAN, dan model Van Meter dan Van Horn untuk mengevaluasi aspek structure, process, serta output dan outcome berupa dampak. Hasil penelitian pada aspek structure menunjukkan bahwa kebijakan POPM filariasis di Kecamatan Membalong tergolong efektif sebagai dasar pelaksanaan program dan telah memenuhi indikator kualitas kebijakan menurut pendekatan IKK. Strategi pelaksanaan dinilai adaptif, ditunjukkan melalui penyesuaian waktu, pelaksanaan, sweeping serta pelibatan lintas sektor. Namun, terdapat kendala keterbatasan jumlah sumber daya manusia dan pencatatan logistik yang masih manual sehingga menimbulkan potensi risiko. Sarana prasarana dinilai memadai, dan dana kegiatan juga mencukupi kebutuhan, meskipun terdapat perbedaan dalam sistem penganggaran antar Puskesmas. Pada aspek process, Komunikasi dan koordinasi antar pemangku kepentingan sudah berjalan, namun perlu ditingkatkan sebab penting dalam dimensi process IKK yang turut menentukan kualitas implementasi kebijakan pelaksanaan POPM. Pendataan sasaran telah dilakukan secara detail, namun akurasinya masih dipengaruhi oleh mobilitas penduduk. Sosialisasi telah dilaksanakan, namun belum sepenuhnya menjangkau seluruh lapisan masyarakat. Pemberian obat telah mengikuti petunjuk teknis, namun belum seluruh sasaran hadir dan mengonsumsi obat di pos pelayanan. Sweeping efektif meningkatkan cakupan, namun keterbatasan SDM dan waktu membuat pelaksanaannya belum optimal. Fleksibilitas sweeping menjadi indikator penting dalam proses IKK untuk menilai efektivitas kebijakan. Kejadian ikutan pasca POPM umumnya bersifat ringan dan telah tertangani, tetapi pelaporan dan pemantauan masih bersifat pasif. Monitoring dan evaluasi POPM sudah terstruktur, namun masih terkendala kepatuhan, pelaporan manual, dan kurangnya integrasi. Hal ini menunjukkan perlunya penguatan indikator IKK, terutama dalam aspek efektivitas, efisiensi, dan umpan balik pelaksanaan kebijakan. Dari aspek Output, Cakupan obat di Kecamatan Membalong tinggi, namun prevalensi mikrofilaria masih >1% di beberapa wilayah. Dalam IKK, keberhasilan dinilai dari konsumsi obat yang valid serta dampaknya, bukan hanya capaian angka. Jumlah obat yang digunakan telah sesuai dengan sasaran, tetapi ditemukan selisih antara obat yang didistribusikan dengan yang benar-benar dikonsumsi oleh masyarakat. Hasil survei darah jari menunjukkan angka MF rate di wilayah Puskesmas Simpang Rusa masih di atas 1%. Pada aspek Outcome menunjukkan bahwa POPM filariasis menurunkan kasus namun eliminasi belum tercapai di seluruh kecamatan. Kesimpulan penelitian ini menegaskan bahwa Implementasi POPM filariasis di Kecamatan Membalong didukung kebijakan yang kuat dan strategi adaptif, namun masih terkendala kekurangan SDM, pencatatan logistik manual, dan pemantauan minum obat yang belum optimal. Cakupan pemberian obat tinggi, tetapi eliminasi belum tercapai karena masih ada wilayah dengan MF rate di atas ambang batas. Temuan ini menegaskan perlunya penguatan SDM, sistem pencatatan, dan kolaborasi lintas sektor.  Dalam IKK, hal ini menunjukkan efektivitas kebijakan masih perlu evaluasi dan penyesuaian strategi agar eliminasi filariasis dapat dicapai secara berkelanjutan.

Lymphatic filariasis remains a public health challenge in Indonesia, especially in endemic areas such as Membalong Subdistrict, Belitung Regency, which has received elimination certification; however, the microfilaria rate in several regions still exceeds the national threshold. This study aims to analyze the implementation of the Mass Drug Administration (MDA) program for filariasis prevention in Membalong Subdistrict in 2023 using a qualitative approach and case study design. Data were collected through in-depth interviews and document reviews involving program implementers at two primary health centers (Puskesmas) and the District Health Office. The analysis applied the Donabedian model, reinforced with the Policy Quality Index (IKK) from LAN, and Van Meter and Van Horn’s implementation model to evaluate aspects of structure, process, as well as output and outcome in terms of program impact. The findings on the structural aspect indicate that the filariasis MDA policy in Membalong is effective as the program’s foundation and fulfills policy quality indicators according to the IKK approach. The implementation strategy is considered adaptive, shown by schedule adjustments, door-to-door sweeping, and cross-sectoral involvement. However, challenges remain, such as limited human resources and manual logistic recording, which pose potential risks. Facilities and infrastructure are generally adequate, and funding meets the needs, although there are differences in budgeting systems between health centers. In terms of process, communication and coordination among stakeholders are established, but need strengthening, as these are essential in the IKK process dimension, which also determines the quality of policy implementation. Target population data collection has been conducted in detail, though its accuracy is still affected by population mobility. Socialization activities have been carried out, but have not fully reached all community groups. Medicine distribution has followed technical guidelines, but not all targets have attended and consumed the drugs at service posts. Sweeping has effectively increased coverage, but human resource and time constraints have hindered optimal implementation. The flexibility of sweeping is an important indicator in the IKK process dimension for assessing policy effectiveness. Adverse events after MDA were mostly mild and well managed, but reporting and monitoring remain passive. Monitoring and evaluation are structured but still hampered by compliance issues, manual reporting, and lack of integration. This highlights the need to strengthen IKK indicators, especially in effectiveness, efficiency, and feedback in policy implementation. In terms of output, drug coverage in Membalong is high, but microfilaria prevalence remains above 1% in some areas. According to the IKK, success is measured not just by coverage numbers, but by valid drug consumption and real impact. The number of drugs used matches the target, but discrepancies remain between drugs distributed and those actually consumed. Blood survey results show that the MF rate in the Simpang Rusa health center area is still above 1%. The outcome aspect indicates that the MDA program has reduced cases but elimination has not yet been achieved throughout the subdistrict. The study concludes that MDA implementation in Membalong is supported by strong policy and adaptive strategies, but still faces barriers such as limited human resources, manual logistics recording, and suboptimal drug consumption monitoring. Coverage is high, but elimination has not been achieved, as some areas still have MF rates above the threshold. These findings underscore the need to strengthen human resources, data recording systems, and cross-sector collaboration. According to the IKK, this suggests that policy effectiveness still requires evaluation and strategic adjustment to achieve sustainable filariasis elimination.