Standard 4.5 Control of non-communicable diseases and their risk factors.

Standard 4.5 Control of non-communicable diseases and their risk factors.

Control of non-communicable diseases and their risk factors is carried out in an effort to improve health services towards universal health coverage, especially strengthening primary health services by encouraging promotive and preventive efforts. The Community Health Center carries out control of the main non-communicable diseases which include hypertension, diabetes mellitus, breast and cervical cancer, Chronic Obstructive Pulmonary Disease (COPD), as well as the Refer-Back Program (PRB) for non-communicable diseases (NCD) and other catastrophic diseases in accordance with competency at the level primary, as well as handling NCD risk factors through integrated non-communicable disease services (Pandu PTM) in accordance with the Pandu algorithm.

 

a. Criterion 4.5.1

Non-communicable disease prevention and control programs and their risk factors are planned, implemented, monitored and followed up.

1) Main Thoughts:

a) Increases in risk factors and non-communicable diseases not only have an impact on increasing morbidity, mortality and disability rates, but also result in loss of productivity which has an impact on the economic burden at the individual, family and community levels.

b) Efforts to control non-communicable diseases are carried out through various promotive and preventive activities without neglecting curative and rehabilitative measures.

c) Early detection or screening needs to be carried out to prevent an increase in PTM cases.

d) Efforts to control risk factors for non-communicable diseases, such as unhealthy eating patterns, lack of physical activity, smoking and other risk factors, are carried out in an integrated manner through a family approach with PIS-PK and community movements.

e) Promotive and preventive activities are carried out through the following efforts:

(1) Promotional

This effort is carried out by providing the widest possible information and education to the public so that awareness grows to take responsibility for their own health and the environment, including, among other things, by:

(a) carry out health promotion/KIE regarding the prevention and control of non-communicable diseases to the community at least once a month, including, among other things, healthy food consumption patterns and balanced nutrition, obesity prevention, smoking cessation, physical activity, risk factors for cervical cancer and breast cancer , other NCD risk factors, use of information and communication technology and other NCD materials; And

(b) provide KIE PTM media in printed form, downloadable links, or in other forms of media.

(2) Preventive

(a) Implementation of UKBM through the PTM Integrated Development Post (Posbindu).

1. Implementation of UKBM through PTM posbindu is carried out periodically and regularly and in accordance with the number of targets in carrying out early detection of NCD risk factors carried out by trained posbindu cadres.

(a) Measure Body Weight (BB);

(b) Measure Body Height (TB);

(c) Measure Blood Pressure (BP);

(d) Current Blood Sugar (GDs);

(e) Body Mass Index (BMI) and Abdominal Circumference (LP); And

(f) Examination of visual acuity (tumbling or counting fingers) and hearing acuity using a modified whisper test;

(g) COPD screening with the PUMA (Prevalence Study and Regular Practice, Diagnosis and TreatMent, Among General Practitioners in Populations at Risk of COPD in Latin America) questionnaire. The PUMA instrument is used to detect COPD using seven questionnaires with a score of more than seven, the patient is directed to continue the examination with spiro to confirm the diagnosis. Carried out at FKTP and posbindu by cadres or health workers;

(h) Providing education is carried out according to needs.

2. The stages of posyandu activities consist of five stages, namely

(a) participant registration;

(b) FR interview;

(c) FR measurements consisting of weight measurements, height measurements, abdominal circumference measurements, BMI calculations, PUMA interviews, as well as visual acuity and hearing acuity checks;

(d) FR PTM examination which consists of measuring blood pressure and checking blood sugar levels; And

(e) FR PTM identification, education, and early follow-up.

3. Maintenance of PTM posbindu supporting facilities is carried out by calibrating digital measuring instruments.

(b) Providing smoking cessation (UBM) counseling services through trained personnel.

(c) Creation of Non-Smoking Areas (KTR) in the Puskesmas environment through collaboration with district/city regional health offices and related agencies to encourage and supervise the implementation of KTR in seven settings (health facilities, schools, workplaces, places of worship, public transportation, places children's play area, and other designated public places).

(d) Prevention at FKTP is carried out through early detection of breast cancer and cervical cancer with clinical breast examination (SADANIS) and visual inspection with acetic acid (IVA) in women aged 30-50 years who have had sexual contact.

f) Curative and rehabilitative activities are carried out, among other things, through efforts

(1) strengthening access to integrated PTM services at Community Health Centers by strengthening the skills of health workers in handling PTM and PTM risk factors in accordance with the authority and competence at FKTP;

(2) strengthening the referral system from UKBM to FKTP;

(3) following up on the PTM Referback Program (PRB);

(4) follow up on community-based palliative services in accordance with the Standards; And

(5) providing services in accordance with clinical practice guidelines for doctors at Community Health Centers and NCD disease algorithms, including services for hypertension, DM, and early detection of cervical cancer and breast cancer.

g) Implementation of PTM by Puskesmas is carried out through the following activities:

(1) utilize obesity charts at the Community Health Center and outside the Community Health Center;

(2) provide guidance to PTM posbindu at least twice per year;

(3) providing a prediction chart for NCD risk factors for Community Health Centers that have implemented PTM Pandu; And

(4) strengthening skills in handling NCD cases, especially among doctors and health workers, which is carried out to prevent complications by training/workshops/increasing technical skills in handling NCD cases.

h) Determining stunting performance indicators is integrated with determining Puskesmas performance indicators.

i) Puskesmas carries out measurements and analysis of predetermined performance indicators. Analysis of indicator achievements is carried out using analytical methods in accordance with applicable guidelines and guidance, for example by referring to the situation analysis method contained in the Community Health Center Management Guidebook.

j) Recording and reporting of non-communicable disease control services and risk factors, both manually and electronically, is carried out completely, accurately, on time and in accordance with procedures. Reporting to the head of the community health center and district/city regional health service and/or other parties refers to the provisions of statutory regulations. Reporting to the head of the community health center can be done in writing or delivered directly through meetings such as monthly mini workshops, management review meetings, and other forums.

k) Implementation of monitoring, evaluation and follow-up is carried out in an integrated manner across programs and across sectors.

l) The non-communicable disease management program plan and its risk factors are prepared by prioritizing promotive and preventive efforts based on the results of analysis of non-communicable disease problems in the Puskesmas work area with cross-program involvement that is integrated with the RUK and RPK of UKM services as well as UKP, laboratory and pharmacy.

2) Assessment Elements:

a) Performance indicators for controlling non-communicable diseases are determined, accompanied by achievements and analysis (R, D, W).

b) Established a Non-Communicable Disease control program including a plan to increase the capacity of personnel related to P2PTM (R,W).

c) Non-communicable disease control activities are coordinated and implemented in accordance with plans that have been prepared jointly across programs and across sectors in accordance with established policies, guidelines, procedures and terms of reference (R,D,W).

d) Stages of PTM activities and inspections are carried out at Posbindu in accordance with applicable regulations (R,D,O,W).

e) Integrated management of Non-Communicable Diseases is carried out starting from diagnosis, treatment, monitoring, evaluation and follow-up in accordance with clinical practice guidelines and NCD service algorithms by competent health personnel (D, O, W).

f) Monitoring, evaluation and follow-up are carried out on the implementation of non-communicable disease control programs (D,W).

g) Recording is carried out and reporting is carried out to the head of the community health center and the district/city regional health service in accordance with established procedures (R, D, W).