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Background: Progress towards health-for-all must be supported by quality health facilities that are available to everyone. However, health care facilities in remote and underdeveloped areas, borderland, and outlying islands or Daerah Terpencil, Tertinggal, Perbatasan dan Kepulauan (DTPK) are facing some constraints to have access to health coverage.Aim: This study aimed to provide a comprehensive picture of the readiness of primary healthcare centers or puskesmas as the main provider of primary health services located in remote areas.Methods: Observations were taken from 18 primary healthcare centers in locations that had been identified by the government as remote and underdeveloped areas, borderland, and outlying islands in 3 provinces: Bengkulu, Nusa Tenggara Timur (East Nusa Tenggara), and South Sulawesi.Results: The findings reveal that many facilities in primary healthcare centers are still insufficient. In particular, roads to primary healthcare centers are in poor physical conditions, operational hours are too short, and doctors and lab technicians are unavailable. The good news is that primary healthcare centers have managed to run many indoor and outdoor activities, such as health education classes and detection of priority diseases in the community. Regarding primary healthcare centers’ finances, they largely depend on public funding to support their increasing expenses to provide health services, pay worker salaries, and run indoor and outdoor activities.Conclusions: Overall, some constraints faced by the primary healthcare centers in DTPK include difficult access to facilities and temporary health personnel. All of this information provides valuable inputs to policymakers in building a health infrastructure and human resources for health in DTPK. Keywords: Remote area, Human resources for health, Primary healthcare center.

Set data Susenas telah mendasari banyak riset ilmiah dan kebijakan di negara kita dari tahun 1960an. Akan tetapi ada fitur-fitur Susenas yang belum dipahami benar oleh para penggunanya. Artikel ini mengangkat dua fitur yang dapat menghasilkan inferensi yang tidak akurat, bahkan tidak mendasar. Yang pertama adalah variabel pengeluaran di Susenas tidaklah mengukur pengeluaran pribadi rumah tangga, melainkan mengukur level konsumsi rumah tangga. Ini dikarenakan variabel pengeluaran di Susenas menambahkan nilai berbagai bantuan ekonomi yang diterima rumah tangga dalam pembelian barang dan jasa. Implikasinya adalah variabel pengeluaran ini yang sering lebih lanjut dipakai untuk pancaran pendapatan rumah tangga, menaksir terlalu tinggi daya beli rumah tangga berpenghasilan rendah yang mendapat banyak bantuan ekonomi, termasuk subsidi Pemerintah. Fitur Susenas kedua yang diangkat adalah adanya perubahan struktur kuesioner Susenas tahun 2015 dan selanjutnya yang dapat mengganggu analisa tren pengeluaran dari tahun ke tahun. Khususnya untuk pengeluaran kesehatan, perubahan survei ini berbarengan dengan pencapaian tahun pertama program Jaminan Kesehatan Nasional (JKN) yang dimulai di tahun 2014. Evaluasi JKN menjadi lebih rumit karena peniliti harus memisahkan dampak riil JKN terhadap penggunaan servis kesehatan dari perubahan sintesis yang disebabkan oleh perubahan desain survei.

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Economically disadvantaged families often cannot pay for healthcare. Since Jaminan Kesehatan Nasional (JKN) was launched in 2014, the government expands subsidies for these families, identified based on consumption. However, this criterion would misclassify families with low purchasing power as economically advantaged because they have large consumption, financed through social assistance. This paper uses the income from the main job instead to determine families’ economic rank. Based on 35 percent of families with the lowest income, utilisation increases with insurance availability. Predictions using consumption as the gauge for economic rank are underestimated, up to 71 percent for inpatient services. .................................................... Masyarakat dengan status ekonomi rendah sering kali tidak mampu memenuhi kebutuhan kesehatannya. Sejak Jaminan Kesehatan Nasional (JKN) diluncurkan pada tahun 2014, Pemerintah memperluas subsidi iuran bagi keluarga tidak mampu yang diidentifikasi menurut nilai konsumsi. Masalahnya, kriteria ini akan mengategorikan keluarga tidak mampu sebagai mampu karena nilai konsumsi yang besar dibiayai oleh pihak lain. Sebagai alternatif, kajian ini menggolongkan keluarga berdasarkan besaran penghasilan yang didapatkan dari pekerjaan. Untuk 35 persen keluarga berpenghasilan terendah, probabilitas utilisasi ditemukan meningkat dengan ketersediaan jaminan kesehatan. Penggunaan besaran konsumsi sebagai acuan peringkat ekonomi terlalu kecil menafsir pengaruh kepesertaan jaminan kesehatan pada utilisasi, sampai sebanyak 71 persen pada pelayanan rawat inap.

Abstract  The condition of public health in disadvantaged areas has become a public highlight lately such as the high prevalence of child malnutrition and infectious diseases. This can be related to the lack of utilization of health services and the health behavior of the community itself. This study aims to provide a more comprehensive picture of clean and healthy living behaviors, health conditions, and the use of health services in disadvantages areas. Inference is made based on primary data collected at the household-level and public primary health centre in areas  classified as disadvantaged, border and outer islands (DTPK) based on Presidential Decree Number 131 year 2015, and areas with the need for health workers, some of which are locations for the Nusantara Sehat (NS) program placement This study uses quantitative methods and analysis used in the form of descriptive analysis. The results show that most households have adopted some of the clean healthy behaviors that were implemented by the Ministry of Health. Almost all households know the location of the public health centre for treatment, but 47% of patients did not find a doctor when visiting the public health centre.It was also found that 36% of households choose to seek selt-medication when sick. For maternal and child health, it is known that already 66% of deliveries are assisted by midwives, and most of children under five years have received basic immunisation. What still needs to be improved is the knowledge of health and housing infrastucture that supports clean and healthy living. Suggestion for  policymakers to equalize the distribution of health workers and to innovate health promotion programs in advantaged areas. Abstrak Kondisi kesehatan masyarakat di daerah tertinggal menjadi soroton publik belakangan ini seperti tingginya prevalensi gizi buruk pada balita maupun penyakit infeksi. Hal tersebut bisa dikaitkan dengan kurangnya pemanfaatan pelayanan kesehatan maupun perilaku kesehatan masyarakat itu sendiri. Kajian ini bertujuan untuk memberikan gambaran yang lebih komprehensif tentang perilaku hidup bersih dan sehat, kondisi kesehatan, serta penggunaan pelayanan kesehatan di daerah tertinggal. Inferensi dibuat berdasarkan data primer yang dikoleksi di tingkat rumah tangga dan puskesmas di daerah yang tergolong daerah tertinggal, perbatasan, dan kepulauan terluar (DTPK) berdasarkan Peraturan Presiden (Perpres) No. 131 tahun 2015 dan daerah berkebutuhan tenaga kesehatan yang beberapa diantaranya menjadi lokasi penempatan program Nusantara Sehat. Metode penelitian ini menggunakan metode kuantitatif dan analisis yang digunakan berupa analisis deskriptif. Hasil kajian menunjukkan bahwa sebagian besar rumah tangga telah mengadopsi sebagian perilaku hidup bersih dan sehat seperti yang dicanangkan Kementrian Kesehatan RI. Hampir semua rumah tangga mengetahui lokasi Puskesmas untuk berobat, tetapi 47% pasien tidak menemukan dokter saat berkunjung ke puskesmas. Ditemukan juga bahwa 36% rumah tangga memilih untuk berobat sendiri ketika sakit. Untuk kesehatan ibu dan anak, diketahui bahwa sudah 66% persalinan dibantu oleh bidan dan sebagian besar balita telah menerima imunisasi dasar. Hal yang masih perlu ditingkatkan adalah pengetahuan tentang kesehatan dan prasarana rumah yang menunjang perilaku hidup bersih sehat. Saran bagi pembuat kebijakan untuk melakukan pemerataan distribusi tenaga kesehatan maupun menginovasikan program promotif kesehatan di daerah tertinggal.

The Nusantara Sehat Team (NST), established in 2015 and consist of multi-professional health workers, implemented to provide comprehensive services at remote primary health cares (PHCs) for two years. This study aimed to explore how the NST leverages the Interprofessional Collaboration (IPC) and its impact on the future career prospects of health workers. Using a qualitative approach, the information was gathered from 48 informants drawn from the current 30 NST recruits and 18 alumni through semi-structured interviews. Of these 48, 20 were clinical practitioners, while the rest were non-clinical health workers. The findings revealed several challenges in promoting collaborative practice, including the community's high demand for curative services, the unclear division of tasks among the NST and local PHC staff, and inadequate health facility support. The curriculum of IPC was yet to be included in the pre-service education and in-service training before NST, allowing the staff to enter the workplace and collaborate, especially in the backward areas. The institutional support through macro and meso policies has yet to enable collaborative-practice ready workers adequately. Other factors such as personal values, family expectations, gender roles, and career sustainability also affected the retention of personnel in the NST.