evaluasi distribusi dan penyimpanan vaksin di dinas kesehatan ...

EVALUASI DISTRIBUSI DAN PENYIMPANAN VAKSIN
DI DINAS KESEHATAN KABUPATEN MAJENE
SULAWESI BARAT
TESIS
Untuk Memenuhi Sebagian Persyaratan
Mencapai Derajat Sarjana S2
Program Studi Ilmu Kesehatan Masyarakat
Minat Utama Manajemen dan Kebijakan Obat
Diajukan Oleh :
UMMU KALSUM T
09/293473/PKU/10984
Kepada
PROGRAM PASCASARJANA
FAKULTAS KEDOKTERAN
UNIVERSITAS GADJAH MADA
YOGYAKARTA
2011

SUMMARY
INTRODUCTION
Effectiveness of Immunization has been proven, globally, nationally and locally.
Immunization program objectives can be achieved with a variety of operational
strategies in the field, among others, through increased knowledge of human resources
through training, provision of infrastructure and logistics chain to target the vaccine to
reduce morbidity and mortality from diseases preventable by immunization.
full immunization in Indonesia, still relatively low at 46.2%. This shows the efforts of
disease prevention has not received a serious attention. Provinces with the worst full
immunization coverage was 13.0% of West Sulawesi in 2007 (Aminullah, 2009). The
lowest coverage contained in the District of Majene (6.7%).
Vaccines used for immunization. The vaccine is a pharmaceutical supplies a
different treatment with drugs or other pharmaceutical supplies. Vaccines require
special treatment compared with the others. This is because the vaccine can be easily
damaged if not stored in the refrigerator to maintain temperature stability.
Currently officers have all noticed the composition of the storage of vaccines, health
center officials there who have not made special note of the vaccine storage
refrigerator, in making a vaccine for immunization services are not yet available
thermometer at district health office. The officer relied only in immunization VVM when
shooting vaccine, it is caused by jurim knowledge is still limited in terms of distribution.
This has become one of the causes of the health center in Ulumanda Kab.
Majene can not run the immunization for 5 months , it is because the vaccine at the
health centers had been damaged. The vaccine has been placed in refrigeration (cold
chain) but the errors start from the distribution to storage process, resulting in the
condition becomes unstable and is no longer fit for use. Based on data in 2010,
approximately 397 flacon vaccines was reported damaged and 105 flacon were
reported expired so it can not be used anymore. Thus, it is necessary for re-evaluation
the distribution and storage of vaccines for the immunization program implementation in
Majene distric and to all health centers in the District of Majene. Because, in Majene’s
District Health Office have never done an evaluation of distribution and storage of

vaccines, both by health personnel in the health office, health personnel in
healthcenters or by other parties.
METHODS
This study is a descriptive qualitative and quantitative research, with a design
case study. Data collected in the form of quantitative data through observation of
documents in district health offices and health centers as well as qualitative data in the
form of in-depth interviews. The research was conducted in Majene’s District. Include at
Majene’s Health Office and 8 health centers in the District which are Banggae health
center I, Banggae health center II, health center Pamboang, health center Sendana I,
Tammero'do health center, health center Sendana II, health centers Malunda and health
centers Ulumanda. Subjects of the research were Majene’s Chief District Medical
Officer, Head of Prevention and Eradication of Disease, Section Chief of Investigations
and Disease Prevention, Wasor (Deputy Supervisor) of immunization, head of the clinic
at all health centers and immunization staff in all health centers.
RESULTS AND DISCUSSIONS
1. Immunization Policy
Minister of RI Health Decree No. 1611/Menkes/SK/XI/2005 District did not follow
up with written policies, but only in the form of an agreement between the district health
office with health centers. Vaccine storage policy from distric health office was to
support concerning the room / storage of vaccines. Storage of vaccines in the district
health office does not carry a single gate system at the Installation of Pharmacy District
(IFK), but stored in the warehouse section of the P2P program under the authority of the
district health office. Public Drug Policy Based Management, Drug Program and
Supplies Health Ministry of Health, stated that public drug management, drug programs,
and medical supplies carried by a single system gates (Gate One Policy) at IFK.
Storage of vaccines in the clinic was placed in a special room with a room separate
immunization program to another.
Immunization programs in Majene’s policy include the achievement of UCI policy
that is a complete basic immunization coverage of at least 80% of infants in 100% rural /

urban villages in 2010. These activities are to socializing immunization programs by a
cadre of immunization programs to the community. Policy pursued in the form of
accelerated achievement of UCI by health office of West Sulawesi province, involving all
the district health offices in West Sulawesi.
2. Human Resources (HR) Implementing Immunization
Human resources Implementing Immunization in Majene’s Health office distric
comprising 1) Head of Division (Head) Prevention and Eradication of Diseases have this
level of education Strata-2 Public Health and has experienced two years as Head, 2)
Head of Section (Kasi) Observations and Disease Prevention has Strata-2 level of
education and experienced in Public Health for 6 months as Kasi, and 3) Wasor (Deputy
Supervisor) of Immunization at district health office. Majene has Strata-1 education level
Sanitarian, has become Wasor for 6 months experience and has never attended
training on immunization programs.
Executive staff in the clinic amounted to one person is 62%. Executive staff
amounted 2 persons is 38. Level of education in each health center is majority D3 of
nursing as much as 64%, 18% obstetrics D3, Bachelor of Public Health (SKM) as much
as 9% and the School Health Nurse (SPK) as much as 9%. Experience (tenure) of
executive staff in the immunization program at each health center, 4 people (37%) had
experienced > 5 years, 4 people (37%) had 2-5 years of experience, 3 people (26%)
had experienced of less than 1 year. From 11 workers in health centers that have been
implementing immunization programs : 7 people (64%) of them have completed the
training, while 4 people (36%) had never attended training at all.
3. Immunization Program Management Budget
Budget distribution and storage of vaccines at all health centers and health
offices are still lacking. This is based on the available fund is not in accordance with the
budgetary needs of each health center and district health office. From the results of indepth
interviews with two health centers stated the budget is adequate for the health
center Banggae I, and Banggae II, while the district health offices and clinics of other
states budget distribution and storage of the vaccine is still lacking. Enough budget
statement by the clinic Banggae I and II due to the distance and travel time of both

centers are close to the district health office as well as the difference between the
budget shortfall is smaller than the other health centers.
4. Availability of Vaccines
The availability of vaccine in the warehouse district health office for 2010 meets
the needs of the vaccine. Vaccine needs in the warehouse majene’s district health
office. in 2010 was 9834 while the stock of available flacon is 10,490 flacon, which
means that the availability of vaccines at Majene’s district health office is available with
either. The amount of vaccine distributed to health centers 10 490 flacon.
The availability of vaccines in every district health centers in Majene for 2010 is
always available to do well because they only take the vaccine if vaccine stocks have
been thinned at the health center, clinic staff did not perform specific calculations in
making the vaccine in each district health office.
5. Management Information System (MIS)
Manual recording and reporting on district health office. was good. For a good
data, only health center Banggae I and health center Pamboang that have a good
record. Another Community Health Center clinic is Banggae II, Sendana I, Tammero'do,
Sendana II, Malunda and Ulumanda recording is still incomplete. For example recording
of a vaccine targeted at the health centers need not be done, no synchronization
between the recording of vaccine distributed and the District Health Office received the
vaccine clinic, recording the temperature at the clinic is usually done on weekends and
sometimes do not record the temperature twice a day, and the temperature charts in
clinic Malunda only recorded up to March alone, then never recorded again.
6. Facilities and Infrastructures
Facilities and infrastructure in the health office has been adequate (score 90).
Adequate facilities and infrastructure in health centers Banggae I (score 75), Banggae II
(score 75), Pamboang (score 70), Sendana II (score 70) and Malunda (score 75), and
inadequate in the clinic Tammero'do (score 50), Sendana II (score 70) and Ulumanda
(score 40).

7. Supervision
Implementation of supervision by the center in 2010 at Majene’s District Health
Office has never done. Implementation of supervision by the province only be done
once a year. It is not in accordance with the Guidelines for supportive supervision
Immunization Program. Implementing supervision by the district is in compliance with
the guidelines of three months. Personnel response in immunization clinic about
supervising the implementation ever undertaken in Majene is not effective because not
oriented in "problem solving".
1. Vaccine Distribution
Vaccine-making system at the district health office use a combination of first and
second way, which is sometimes the vaccine is distributed as district health office will
supervise the clinic, or picked up by the officers jurim clinic. For frequencies which more
commonly used is picking up the vaccines by jurim’s clinic because of the frequency of
erratic demand is also adapted to the existing stock in each clinic, causing increased
operational costs. At the time of distribution, the vaccine carrier, and thermometers are
not just relying on VVM conditions only.
None of the clinic that has a SOP as a guideline for acceptance / taking the
vaccine in health centers. This is because the warehouse did not have health office
program SOP acceptance / taking the vaccine. Means of transportation to transport the
vaccine from the district health office to each clinic by using a motorcycle owned by
each clinic. Things that affect the distribution of vaccine is the distance and travel time
from the district health office to the clinic. The farther the distance between the district
health office to the clinic so the longer the distance.
9. Vaccine Storage
there is no Standard Operating Procedure (SOP) for vaccine storage in District
Health Office, as well as in health centers that have neither the storage SOP. This is
caused by there is no suggestion from the head of the procurement about this SOP.
The storage of vaccines at district health office has been good (95%). Health centre
Banggae I (90%), and Banggae II (90%), Pamboang (80%), and Malunda (75%)
showed good vaccine storage conditions. Puskesmas Sendana I (70%) and Sendana II

(70%) shows the condition of the medium storage. health centre Tammero'do (55%),
and Ulumanda (45%) showed unfavorable storage conditions. The minimum vaccines
storage caused by the lack of knowledge by the immunization officer, therefore, it
requires an SOP for storage as the standard guidelines.
District health office and health center clinic office, knows that health center
Banggae I, Banggae II, Pamboang, and Sendana I that monitor the temperature with
both morning and afternoon, while the clinic Tammero'do, Sendana II, Malunda and
Ulumanda do not properly monitor the temperature.
10. Complete Coverage of Basic Immunization
Achievement of coverage for complete basic immunization in each health center
for Banggae I, Pamboang, Sendana I, II and Malunda Sendana has met the target
achievement of all antigens and some even exceeding 100%. Puskesmas Banggae II
has met achievement targets except BCG that still below standard. Other Community
Health Center still do not meet the standards of achievement HB0 Tammero'do which
still below standard. Health Center who do not meet all the antigenic target is Ulumanda
clinic. None of All the basic immunization antigens of that meet the standards, in
another sense none of which reached achievement targets.
11. Target achievement of UCI
Target achievement of UCI in the District. Majene in 2010, there were only two
health centers that achieve 100% of health centers and Malunda Pamboang, whereas
the other clinic is still below the standard UCI clinic Banggae I, Banggae II, Sendana I,
Tammero'do and Sendana II, and the achievement of UCI lowest 25% of the clinic
Ulumanda.
CONCLUSIONS AND SUGGESTIONS :
Conclusions
1. Management support that affect the distribution and storage of vaccines in Majene
district health office, are:
a. The policy of Immunization programs in Majene still a discourse. There are currently
no legally written policy aspects of the Government.

. Human resources for Immunization programs at Majene’s Health Office District still
inadequate because of the level of knowledge and skills that still lacking and the
number of workers still do not meet the standards.
c. Immunization program operating budgets at Majene’s district health office and clinics
are exist, but this budget is not sufficient.
d. The availability of vaccines at Majene’s district health office and clinics have been
sufficient.
e. Management information system of manual recording and reporting were optimal at
district health office, but in some health centers have not optimal. The use of PWS
software has been used in all health centers and district health office.
f. Facilities and infrastructure at the district health office are adequate, while in every
clinic has not been sufficient.
g. Implementation of supervision by the Province do not meet the standards because it
is done once a year. Supervision by the district to each health center has been
standardized because it is done once in 3 months, but the effect of these supervision
is not effective.
2. Distribution of vaccines is not optimal because the level of workers knowledge about
immunizations are still less specially related in the correct way to bring vaccines and
vaccine unavailability of SOP distribution in every clinic.
3. Storage of vaccines in the health office has not conducted a door at IFK, the vaccine
program stored in the warehouse district health office. Storage of vaccines in all health
centers still do not meet the standards and if it based the presentation, Ulumanda health
center clinic has the worst storage conditions among all health centers.
4. Effectiveness of immunization programs in Majene District was effective when we
viewed from the basis of complete infant immunization coverage achieved in all health
centers. Except Ulumanda clinic that still has not been effective. If we review the 2010
target of achieving UCI immunization program effectiveness in Majene Distric, it has not
been effective, because only two districts that meet the achievement target which are
Malunda and Pamboang.

Suggestion
1. Suggestions for management support that affect the distribution and storage of
vaccines in Majene’s district health office, including:
a. Advocacy for policies to be written in the Government of Majene District. One-door
policy at IFK need to be followed for the management of drugs and vaccines more
monitored at IFK.
b. The addition of immunization staff for health center that have only one immunization
officers and standards of need-based guidelines. Increasing the knowledge and
skills about the distribution and storage of vaccines based on the guidelines.
c. The addition of the operational budget for the distribution and storage of vaccines,
especially for the clinic which far from the district.
d. Availability of a vaccine tailored to the needs of the vaccine through the planning
method of vaccine needs.
e. Synchronization of recording and reporting at district health office in each health
center, as well as increasing knowledge about personnel management software for
the immunization clinic.
f. Improving facilities and infrastructure for the clinic that still below standard and
supplying generators at each health center and district health office.
g. Improving implementation of the supervision by the Province. Special training for
district supervisors in supervisioning to the clinic so that the implementation of
supervision more effective.
2. It is better if the implementation of distribution done by district health office staff, so
the quality of vaccines is more save and it refers to the SOP distribution of vaccines.
Majene district health office and clinic in order to implement a quality management
system by making the SOP distribution and storage refers to the guidelines from the
center. This is to avoid the careless of implementation in the field.
3. Optimization of the knowledge workers on the procedures for proper vaccine storage
standards compliant. Ulumanda health center should be given special attention and
treatment in the budget, facilities and infrastructure, and HR-related distribution and
storage of vaccines.

4. Target achievement of the full basic immunization coverage and the UCI are still
below the standards can be improved over again. With the immunization program
management approach is more structured, both for human resource management,
vaccine and logistics, implementation of policies and programs that more real, and the
commitment between all parties concerned.