Analysis of the Planning Process at the Health Center Level at the Poso Regency Health Office

One of the activities required by every puskesmas (Community Health Center) in overcoming the problems faced in each area is planning at the puskesmas level. To accommodate the need to increase the ability and coverage of health services in an integrated and integrated manner with the problems that exist in the work environment of the Puskesmas. The purpose of this study was to analyze the planning process at the Puskesmas level at the Poso District Health Office. This type of research is qualitative and the unit of analysis from the implementation of this research is carried out on 2 (two) Puskesmas in the Poso District Health Office. Meanwhile, the research informants were employees/staff of the related puskesmas and the key informant was the Head of the Poso District Health Office as a triangulation check for the validity of the data. The results of the research based on the preparation stage, a planning team was formed by the Head of the Puskesmas, in the situation analysis stage the problem analysis process was carried out through Encuesta Mawas Diri (SMD), the problem formulation stage using the USG method (Uraaatanga metoaaa) problems, the last stage was the preparation of the RUK (Proposed Activity Plan) which are prepared at the puskesmas still refer to the applicable government policies. Suggestions in this study are expected that the puskesmas in the Poso District Health Office can arrange their annual activity plans optimally, while still fostering community participation in improving community health status.


Introduction
Community Health Centers, hereinafter referred to as Puskesmas, are health service facilities that carry out public health efforts and first-level individual health efforts, with prioritizing promotive and preventive efforts, to achieve the highest public health status in their working areas (Permenkes, 2014).
Planning is the first step taken in an effort to achieve goals, meaning that planning is an effort to concretize the steps that must be taken where the basics have been laid in the organization's strategy. Planning that is prepared through proper identification of problems based on accurate data, and obtained in the right way and at the right time, will be able to direct the health efforts carried out by the Health Center in achieving its goals and objectives. In an effort to cover the widest possible target community that must be served, and given the limited availability of resources, health services must be implemented in an integrated manner, both across programs and across sectors. The head of the Puskesmas (Community Health Center) must be able to build cooperation and coordinate programs internally at the Puskesmas and externally with cross-sector partners. Coordination with cross-sector is very necessary, because the causes and background of certain health problems may only be solved by cross-sectoral partners.
The Puskesmas planning process will follow the regional development planning cycle, starting from the village/Sub-district level, then compiled at the sub-district level and then proposed to the district/city health office. The planning of the Puskesmas that is needed is integrated with cross-sectoral sub-districts, which will be proposed through the sub-district to the district/city local government (Ministry of Health, 2016).

Scope of Health Planning
Health management is one part of 3 parts of health development, namely implementation, coaching/management and development of basic health efforts, namely; (1) Planning; (2) Execution; (3) Control of supervision and assessment of Health Efforts. Health planning focuses on efforts to improve the performance of the health system. Planning is the first function in the management function, which precedes the functions of organizing, manpower, leadership and control.
Planning is intended to help achieve organizational goals. By assuming certain future conditions and analyzing the consequences of each action uncertainty can be reduced and future successes have a greater probability (Reinke, 2018). The benefits of an organizational plan are; (1) Help managers to see the future; (2) Better coordination, coordination can occur between parts of the organization and between current and future satisfaction; (3) Emphasis on organizational goals. With planning organizational goals can be focused because organizational goals are the starting point for planning, managers will always be reminded of these goals (Wijono, 2018).

Integrated Health Planning and Budgeting
Health planning is a dynamic and continuous process, including the process of formulating plans and the process of implementing the plans that have been determined. There are several systematic planning steps. Systematic planning is structured as a separate process, or planning as part of the management function. The steps or procedures in planning follow a systematic flow, meaning that they must follow a certain sequence. (Supriyanto, 2007). The success of a plan, apart from administrative and technical factors, is also often determined by the political will of policy actors. Each planning stage requires its own planning techniques and tools.

Factors Affecting the Success of the Planning Process
The success of planning mainly depends on knowledge, attitudes and motivation (Mills, et.al, 1991). The most important factor in planning is the integration between management elements in the form of human and non-human resources or internal factors.
Humans are the most important factor in management that can determine success or failure in dealing with the goals and objectives set. Internal factors in an organization cannot be separated from environmental factors or external factors must be considered and calculated carefully, because environmental factors can support but can also hinder (Soedjadi, 1995).
The education factor obtained, the development of existing science and technology, applicable laws and policies, the physical location where he is located and others, will affect attitudes and behavior and this behavior can be attached to the individual or organization, and behavior is only inherent in humans as individuals (Thoha, 2007).
Another factor that is no less important that affects a person's attitude is motivation. With motivation, an individual can effectively do his job. This is closely related to job satisfaction. According to Gerungan, motivation is something that creates enthusiasm or work motivation (Gerungan, 1982: 23). The greater the work motivation will increase work performance. Thus it can be said that work motivation is a very important factor in achieving organizational goals (Sinaga, 2018).

Planning Coordination
Planning coordination is important in the planning process. Planning will be efficient if there is coordination that is cored in the communication process between planning agencies and interested actors both horizontally and vertically. These activities are carried out through a planning coordination forum with relevant agencies including the community. Coordination within the government bureaucracy is essentially an effort to integrate (integrate) various interrelated interests and activities in order to achieve common goals and objectives (LAN RI, 1996). In relation to development, coordination needs to be implemented from between parts of projects, programs, sectors, sub-sectors to inter-sectors. It is further explained that in order to strengthen coordination in the parts carried out are complex, multi-sectoral, multi-functional, then coordination can be in the form of Teams, Committees, Working Groups, or Task Forces.

Health Center Level Planning (PTP)
Health center level planning, known as micro planning, is one of the functions of Puskesmas management. Together with the mini-workshops and the stratification of the Puskesmas, the three are one unit as a tool to carry out the management function (Health, D. 2006).
The definition of Puskesmas planning is as an effort to detail the activities of health efforts in order to achieve the desired public health status in a certain period in the future, so that the planning of the Puskesmas level is a systematic process of activities to compile and prepare activities to be carried out by the Puskesmas. in the following year to increase the coverage and quality of health services to the community in an effort to overcome local health problems (Health, D. 2006).

Conceptual Framework
Based on the literature review, the conceptual framework for conducting this research is as follows:

Types and Design of Research
This type of research is qualitative, with the aim and revealaboutthe process of preparing planning at the puskesmas level in the Poso District Health Office by evaluating the planning of puskesmas level programs (Sugiyono, 2018).

Analysis Unit and Research Subjects
The analysis unit of this research was conducted on puskesmas in poso district health office environment, namely as many as 2 puskesmas. Based on the table, it is known that of the 5 informants at the Sulewana Health Center and Taripa Health Center, 4 informants were male and only 1 was female. There were 1 informants with age 50 years and <50 years as many as 4 people.

Planning
The Puskesmas planning process will follow the regional development planning cycle, starting from the village/kelurahan level, then compiled at the sub-district level and then proposed to the district/city health office. The planning of the Puskesmas is needed to be integrated with the sub-district cross-sector, which will be proposed through the sub-district to the district/city government. The Puskesmas will prepare a 5 (five) annual plan and the details of the annual plan based on the results of the previous year's evaluation and referring to health policies from the administrative levels above, both district/city, provincial, and central. For the purposes of preparing the Puskesmas planning, it is necessary to harmonize it with the Healthy Indonesia Program with a Family Approach and other national health programs. The planning stage begins with preparation (Permenkes, 2016).
Based on the results of interviews with informants at the Puskesmas, it was found that in the process of preparing for the planning at the puskesmas level, a planning team was formed by the head of the puskesmas as an initial stage which referred to the planning guidelines at the puskesmas level and the Minister of Health regarding puskesmas, then there were planning guidelines from the Health Department. However, the constraint is the lack of human resources in the field of management so that puskesmas still need experts in the management process so that planning can be carried out properly and provide maximum results.
In addition, the informants also know that the planning of the Puskesmas level is basically every organization must have a good plan to run the organization, and especially in the Puskesmas must have a plan which is part of the management process. Health center level planning is regulated in Permenkes No. 44 of 2016 and stated in the Public Health Center Management Manual. An analysis of the importance of planning at the Poso District Health Center from interviews showed that respondents knew that the implementation of puskesmas activities was largely determined by good planning.
According to Dhewi's research (2018) in Puskesmas in the city of Medan, the results of the study showed that all informants were aware of the planning of the puskesmas level in the city of Medan. Public health centers in the city of Medan have implemented or prepared a plan at the puskesmas level which is usually called the Plan Of Action (POA) for the puskesmas which is routinely made every year in accordance with the provisions of 4 stages in the planning guidelines (Dhewi, 2018).
The stages in the five-year puskesmas plan begin with preparing Puskesmas staff who are involved in the process of preparing the puskesmas five-year plan in order to obtain common views and knowledge to carry out the planning phase. This stage is carried out by the head of the puskesmas forming a puskesmas management team whose members consist of a regional development team, a family development team, a puskesmas accreditation team, and a puskesmas information system team. Furthermore, the head of the puskesmas explained the puskesmas management guidelines to the team so that they could understand these guidelines for the success of preparing the puskesmas five-year plan and the study team. This is in accordance with what was done at the Puskesmas in Poso Regency, but the obstacle for us in the team formation process was the lack of competent personnel in the field of management. For now, most of our puskesmas are nurses and midwives. We need a team that is quite competent in their respective fields to be able to support the implementation of an activity.
The Puskesmas level planning carried out in Poso Regency will directly support or boost the success of activities at the Puskesmas because in the puskesmas level planning there are plans that are prepared based on the problems that exist in the Puskesmas in carrying out service activities and it is certain if we make this plan based on the what is proposed is in accordance with the facts on the ground that what must be implemented is indeed automatic in the implementation of future activities, this will definitely succeed because it is carried out based on the existing problems.

Situation Analysis
The elements of the process are all the stages carried out in the planning of the Puskesmas level in the form of the preparation stage, the situation analysis stage, the stage of preparing the proposed activity plan and the stage of preparing the activity implementation plan. The situation analysis stage is intended to obtain information about the situation and identify health problems faced by the Puskesmas, in order to formulate service needs and fulfill rational community expectations in accordance with the conditions of the working area at the Puskesmas (Montain, 2019). The process of collecting performance data at the Puskesmas in Poso City is known that the data analysis process at the puskesmas is carried out in several stages, namely collecting data on the performance of the Puskesmas and describing the health status of the community. Then analyze the data and analyze the problem through the Self Insight Survey (SMD) which comes from the community's point of view. In the preparation of the five-year plan for the Puskesmas, data analysis was carried out by collecting data on the performance of the Puskesmas, a description of the health status of the community in the working area of the Puskesmas in the last 4 years. Meanwhile, the preparation of the One-Year Health Center Plan data is taken within one year. Based on the results of interviews with informants, it is known that the performance data of the Puskesmas is obtained from the performance data of SMEs which are summarized in the report on the achievement of MSS in the health sector and the performance data of the UKP which is summarized in the report on the condition of the number of disease cases. Puskesmas performance data are summarized in the Puskesmas information system, puskesmas profile data and patient satisfaction surveys. The process of analyzing data at the Puskesmas was carried out based on the description of the health status of the community that occurred previously.
The performance data of the Puskesmas is collected in 2 parts, namely the performance data of Community Health Efforts (UKM) through out-of-building programs which are summarized in the report on the achievements of the Minimum Service Standards (SPM) program in the health sector, and performance data in the building called Individual Health Efforts (UKP). which is summarized in the condition report on the number of cases of the disease. Health center performance data is needed in the preparation of the Five-Year Plan and One-Year Plan of the Puskesmas. Puskesmas performance data are the results of puskesmas activities recorded in the Puskesmas Information System (SIP), Puskesmas Profile data, as well as patient satisfaction survey data summarized in the Puskesmas Quality assessment data.
Based on the results of this research, it is known that the purpose of problem analysis is to understand the problem clearly and specifically, make it easier to determine problem priorities and make it easier to determine alternative problem solving. In addition, it is also important in the planning process because it can identify the actual health problems and how to provide health services to the community through the data and information collected. Because data and information are important, because it reduces uncertainty, with accurate data and information, uncertainty about a situation or problem can be reduced, making it easier to determine the priority scale with data and information will help in determining the priority scale of various existing problems, making it easier calculating resource requirements (resources) in the planning process, it is necessary to calculate resource requirements due to limited resources so that data and information will provide an overview of existing resources (Sudirman, 2019).
Self-Introspection Survey is an activity to identify the conditions and problems faced by the community, as well as the potential of the community to overcome these problems. The potentials include the availability of resources, as well as opportunities that can be mobilized. This is important to be identified by the community itself, so that the community can then be mobilized to participate actively in strengthening its improvement efforts, according to the limits of their authority (Hesti, 2018).
The stages start from collecting primary and secondary data, processing and presenting data on existing problems and potentials and building an agreement with the community and village/kelurahan heads, to jointly address health problems in the community. The SMD/CSS instruments are prepared by the Puskesmas according to the problems faced and the problems that the Puskesmas will address. The instruments compiled include a data collection format

Problem Formulation
The formulation of the problem is carried out as in the preparation of the Five-Year Plan of puskesmas. The problem is formulated based on the principle of 5W1H (What, Who, When, Where, Why and How/ What is the problem, who is affected by the problem, when the problem occurs, where the problem occurs, why and how the problem occurs) (Muninjaya, 2014). Based on the results of interviews with informants, it is known that in the process of identifying problems at the Puskesmas, it is done by making a list of problems which are then grouped by type of effort, targets, achievements and problems encountered in the field. The list of problems is presented in tabular form to be further sorted by priority of problems and become the main material for the preparation of the RKA.
Based on the results of interviews with informants, it is known that the priority of the problem is chosen based on the agreement of the team by considering the ability of the puskesmas in terms of infrastructure and human resources. The results of the study indicate that equipment such as computers and their devices are indispensable tools. In addition, the formats as guidelines sourced from the Poso City Health Office are also important in the implementation of planning at the Puskesmas level. Then in some puskesmas also use vehicles to collect the data needed in the preparation of the plan. In addition, based on the informant's statement, information was also obtained that so far there has been no special training at the district level for the preparation of this Puskesmas level planning. The information obtained from the district health office is that the resources available for conducting this management training are not yet qualified, and because the ministry always conducts this management training.
The results of the observation matrix used by the puskesmas are in accordance with the guidelines consisting of 12 column variables. The format for planning the puskesmas level itself has been regulated in the Minister of Health Regulation No. 44 of 2016. For the situation analysis phase, there is a cause-and-effect diagram of Ishikawa (Fishbone) and a Problem Tree. For the RUK and RPK themselves, a matrix is given which will later contain the activities of the Puskesmas. The matrix consists of 12 details columns as follows; Health Efforts, Activities, Objectives, Targets, Targets, Responsible Persons, Resource Needs, Partners, Implementation Time, Budget Requirements, Performance Indicators, and Funding Sources. The matrix can be developed according to local needs and policies but without reducing the existing column variables.
Based on the results of the explanation above, it can be seen that from the results of data analysis, the formulation of the problem was carried out. Problem is the gap between expectation and reality. This stage is carried out through: a. Problem Identification b. Setting the Order of Priority Problems c. Finding the Root Cause of the Problem d. Define Problem