The 8 E.L.E.M.E.N.T.S

In the name of Allah, the Most Gracious, Most Merciful

Prior to Declaration of Alma Ata in 1978 regarding Primary Health Care (PHC), Indonesia has developed various forms of primary health care (PHC) in some regions. Since its a primary care, the services provided is not only diagnostic and therapeutic but more to preventive measure involved.

There are eight essentials health services which can be remembered by the mnemonic ELEMENTS :

1. E – Education for Health

2. L – Locally endemic disease control

3. E – Expanded program for immunization

4. M – Maternal and Child Health including responsible parenthood

5. E – Essential drugs

6. N – Nutrition

7. T – Treatment of communicable and non-communicable diseases

8. S - Safe water and sanitation

Community Based Health Activities

Since the main strategies of PHC in health development in Indonesia are to improve the access of community toward quality health services, and to activate and empower community live a healthy life, many activities involving the community has been held. Based on research in 1976 it is noted that 200 community - based health activities (CBHA) have been implemented and carried out within the community. Usually the community chooses health volunteers and the HC provides training for the health volunteers.

The community based health activities are varied, and some of them are :

· Posyandu (integrated service post/ISP) which is managed by health volunteers and spread out in all villages. Posyandu specializes on specific target. For example for children under five years old, for elderly people and for non-communicable disease. The posyandu is categorized into four level of development by using indicators as follows :

a. Pratama or fist level posyandu. I the unstable posyandu, the activities depend on the presence of health personnel.

b. Madya or second level posyandu. It has regular activities, but the program coverage is still less than <>

c. Purnama or third level posyandu. The activities has run regularly, the programme coverage is high (> 50%), but not yet supported by community health fund.

d. Mandiri or self reliant posyandu. It has a regular activity, high programme coverage and supported by community health fund.

· Polindes (village maternity home/VMH) which is managed by midwife. It is expected that every village has one VMH but so far not all villages have it.

· Poskesdes (village health post/VHP) which is managed by midwife and health volunteers. It is a community institution beyond VMH, to cover other public health services. Each VMH will be improved to be VHP.

· Village medicine post which is managed by health volunteers and usually is situated in remote area which is far from health service institution.

· Village malaria post which is managed by health volunteers. Its main role is to help in detecting malaria disease and curing it.

· Islamic school health post, which is managed by Islamic school student, the main role is to improve the healthy behaviors for Islamic school students.

· Occupational health post, which is managed by health volunteers who are appointed from the informal workers.

· Saka Bhakti Husada (Health Scout), which is managed by health volunteers and is developed in the scout organization. This organization activity covers various aspects such as nutrition, environment health, maternal and child health, disease prevention and narcotics and drugs.

Task Shifting

Task shifting is the name now given to a process of delegation whereby tasks are moved, where appropriate, to less specialized health workers. By reorganizing the workforce in this way, task shifting can make more efficient use of the human resources currently available. It is also implemented in PHC in Indonesia. Nurses are able to do doctors' job when doctors are in short supply. Health volunteers can potentially deliver a wide range of health services to the community especially in educating them as it it is a part of an important prevention intervention. This will free the time of doctors and qualified nurses thus allowing them to focus on serious cases or those with special needs.

In conclusion, the function of PHC does not only plays role in curing people, but also preventing them. Those who involved are not only the medical workers but also non medical people which is from the community, thus,making the access to health services easier and the development of health is more efficient. Wassalam.

References:

http://www.searo.who.int/LinkFiles/Conference_INO-13-July.pdf

http://www.who.int/healthsystems/task_shifting_booklet.pdf