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.

Latar Belakang: Saat ini terdapat 1,3 miliar penduduk di dunia berisiko tertular filariasis pada lebih dari 83 negara dan 50% orang terinfeksi tinggal di Asia Tenggara termasuk Indonesia. Indikator keberhasilan pengendalian filariasis yang telah ditetapkan Kementerian Kesehatan berdasarkan pedoman WHO yaitu kabupaten/kota endemis yang berhasil menurunkan angka mikrofilaria menjadi < 1% dengan menerapkan Mass Drug Administration (MDA) minimal cakupan pengobatan >65% populasi. Pemberian Obat Pencegahan Massal (POPM) dengan Diethylcarbamazine citrate dan Albendazole telah dilakukan di Kota Pekalongan sejak tahun 2011-2015 dengan cakupan pengobatan sebesar >65%, namun hasil evaluasi mini TAS tahun 2019 prevalensi antigen masih > 2%. Berdasarkan pedoman WHO, program POPM Kota Pekalongan harus diperpanjang selama 2 tahun dengan obat Ivermectin, Diethylcarbamazine citrate dan Albendazole (IDA), namun cakupan pengobatan IDA putaran pertama <65%. Perlu dilakukan penelitian untuk membuat model evaluasi POPM filariasis agar dapat dilakukan perbaikan dalam program serta meningkatkan cakupan pengobatan. Metode: Penelitian ini menggunakan desain mixed methods sekuensial eksplanatori dengan jumlah sampel sebanyak 646 sampel untuk data kuantitatif (pengambilan darah jari sebanyak 300µl untuk pemeriksaan antigen dan wawancara terstruktur kuesioner) dan 9 informan dari petugas kesehatan dan penduduk untuk data kualitatif (input, proses, out, outcome program, serta perilaku minum obat penduduk). Penelitian dilakukan pada total 10 kelurahan di daerah endemik Kota Pekalongan dengan teknik sampling menggunakan sistem cluster (40 cluster RW) dipilih secara consecutive sampling. Hasil: Didapatkan model evaluasi pada aspek input yang memerlukan perbaikan berupa evaluasi pendanaan, pada evaluasi aspek proses didapatkan evaluasi pendampingan petugas kesehatan pada masyarakat dengan kriteria tertentu dengan perbaikan komunikasi untuk sosialisasi pengobatan, didapatkan juga model evaluasi pada aspek output dan outcome. Kesimpulan: Model evaluasi program POPM yang tepat yaitu model evaluasi komprehensif (input, proses, ouput, outcome), pada bagian proses harus dioptimalkan pada evaluasi pendampingan petugas kesehatan pada praktik minum obat untuk masyarakat dengan kriteria tertentu dan perbaikan komunikasi untuk sosialisasi melalui pendekatan kuantitatif dan kualitatif, untuk dapat meningkatan cakupan pengobatan dan sosialisasi yang merata. Saran : Model evaluasi program Pemberian Obat Pencegahan Massal yang komprehensif (input, proses, output, outcome) perlu dilakukan agar dapat memperbaiki pendampingan petugas kesehatan dalam praktik minum obat dan perbaikan komuniasi sosialisasi pengobatan pada masyarakat dengan kriteria tertentu untuk dapat meningkatkan cakupan pengobatan di daerah endemik tipe perkotaan.

Background: Currently, there are 1.3 billion people in the world at risk of contracting filariasis in more than 83 countries and 50% of infected people live in Southeast Asia, including Indonesia. The indicators for the success of filariasis control that have been determined by the Ministry of Health based on WHO guidelines are endemic districts/cities that have succeeded in reducing the number of microfilariae to <1% by implementing Mass Drug Administration (MDA) with a minimum treatment coverage of >65% of the population. Mass Preventive Drug Administration (POPM) with Diethylcarbamazine citrate and Albendazole have been carried out in Pekalongan City since 2011-2015 with a treatment coverage of >65%. However, the 2019 TAS mini-evaluation results showed that antigen prevalence was still >2%. Based on WHO guidelines, the Pekalongan City POPM program should be extended for 2 years with Ivermectin, Diethylcarbamazine citrate, and Albendazole (IDA) drugs, but the coverage of the first round of IDA treatment was <65%. Research needs to be conducted to create an evaluation model for POPM filariasis so that improvements can be made to the program and treatment coverage can be increased. Method: This study used a mixed methods sequential explanatory design with a sample size of 646 samples for quantitative data (taking 300µl of finger blood for antigen examination and structured questionnaire interviews) and 9 informants from health workers and residents for qualitative data (input, process, output, program outcome, and residents' medication-taking behavior). The research was conducted in 10 sub-districts in the endemic area of Pekalongan City using a sampling technique using a cluster system (40 RW clusters) selected using consecutive sampling. Results: An evaluation model was obtained for the input aspect that required improvement in the form of funding evaluation, in the process aspect evaluation an evaluation of health worker assistance was obtained for the community with certain criteria with improved communication for treatment socialization, an evaluation model was also obtained for the output and outcome aspects. Conclusion: The appropriate evaluation model for the POPM program is comprehensive (input, process, output, outcome). The process section must be optimized in the evaluation of health worker assistance in the practice of taking medication for the community with certain criteria and improving communication for socialization through quantitative and qualitative approaches, to increase the coverage of treatment and socialization evenly. Suggestion: A comprehensive evaluation model for the Mass Preventive Drug Administration program (input, process, output, outcome) needs to be carried out to improve the assistance of health workers in the practice of taking medication and improve communication and socialization of treatment in the community with certain criteria to be able to increase treatment coverage in endemic urban areas.