Study of origin puskesmas (public health centre) visitors in Karanganom, Klaten District, 2020

Puskesmas is a service facility that organises public health efforts and first-level health efforts by prioritising health improvement and prevention efforts to achieve the highest degree of public health at the kecamatan level. Therefore, this study aims to determine the distribution of the number of patients at Karanganom Health Centre in 2020. The data used is data from Karanganom Health Centre which contains a table of patient/visitor distribution. The results showed that the distribution of puskesmas patients was quite evenly distributed, bu the number of patients tended to be small or not more than twice the total population of the Karanganom sub-district.


Introduction
Based on the Indonesian law number 36 of 2019 concerning public health, health development aims to increase awareness of healthy living for all people in order torealise the highest possible public health.The community health centre is one ofthe most important health service facilities in Indonesia, because it can provide comprehensive, integrated and sustainable services to the community in a certain working area in the formof basic health efforts an disdirectly under the administrative and technical supervisi on of the district office.The Minister of Health of the Republic of Indonesia number 75 of 2014 concerning community health centres (PUSKESMAS) is a service facility that organises public health efforts and first-level health efforts by prioritising health pro motion and prevention efforts to achieve the highest degree of public health [1].Health development is carried out in health centres with the aim of creating acommunity that : a. Healthy behaviours include awareness, willingness, and ability to live ahealthylife.b.Able to access quality health services.c.Have an optimal level of health.
One of the health centres in Klaten district is Karanganom health centre, this health centre is one of the health centres in Klaten which has been equipped with an emergency room (emergency department) and in patient care.Puskesmas Karanganom's working area covers 19 villages, of the 19 villages the Karanganom puskesmas provides services to 59,375 people in 2020, this number is still lame with the total population of Karanganom sub-district in 2020 of 58,354 people, said to be lame because in general the number of visitors to the Karanganom puskesmas is still inferior to the Juwiring sub-district puskesmas with 71,667 people in 2020 with a total population of 47,588 people.Therefore, it can be seen from the comparison of the number of visitors at the Karanganom puskesmas and in Juwiring Sub-District where the total population is greaterin Kecamatan KaRanganom than in Kecamatan Juwiring.However, the utilization of puskesmas is more in Karanganom kecamatan.Based on the above problems, the researcheris interested in conducting research on the distribution of the area of origin of visitors/patients at the Karanganom Community Health Centre, Klaten Regency.Based on the background described above, the problem formulation can befound: 1. What is the distribution of puskesmas visitors/patients in Karanganom sub-district?2. What is the distribution map of the Karanganom Health Centre visit or area In some previous studies such as the one conducted by Santun Pustaka (2001) [2] in the table above, the reviewer only focused on the effectiveness of the Puskesmas and its use, while this Study focuses more on the distribution nof the area of origin of Puskesmas visitors/patients.
In this study,objectives can bedrawn,among others: 1. Analysing the distribution of patients/visitors of Karanganom Health Centre 2. Analysing factors influencing utilization at Puskesmas Karanganom

Study location
The research location of the public health centre (puskesmas) is located in the Karanganom sub-district area astronomically located on the line 110 o 26'14''-110 o 47'51'' east longitude and between 7 o 32'19''-7 o 48'33'' with a total area of Karanganom sub-district which is 24 km 2  While the Geographical location of Karanganom sub-district is limited by four other sub districts in Klaten district, namely: 1. North: Polanharjo sub-district 2. East: Ceper sub-district 3. South: Ngawen sub-district 4. West: Jatinom sub-district Figure 1 Kecamatan Karanganom is a strategic area because of its location on the main road of Klaten Regency.Thus this area has good accessibility and High population mobility.This will affect the utilization of public facilities in Karanganom sub-district, including the utilization of community healthes.Kecamatan Karanganom consists of 19 villages with different sizes of each village.

Figure 1. Administrative map of Karanganom sub-district as the research studyarea Physical condition
The physical condition of the research area is a description of the physical condition of the area which includes soil type, climate, and land use.This physical description is indispensable in making policies related to development carried out in Karanganom sub-district, Klaten district.

Soil Type
Soil is a loose natural body that covers most of the earth's surface and has distinctive physical, chemical, biological and morphological characteristics as are sultofalong series of various factors formation process.The type of soilin Karanganom kecamaan is regosol soil.

Climate
Climate is the state of the weather or the entirety of weather symptomsin a particular area throughout the year from year to year.Climate is one of the physical factors that can affect living things, such as human end eavours in agriculture.To know the state of the climatein an area can be known from the most important element of climate, namely rain fall.

Tools and materials
Table 1 Tools used in the study and their functions data used in there search along with functions and sources tables 2 and 3 material tools and data used table 2 The data used in this study are primary and secondary data, primary data obtained from medical officers and employees of the Karanganom puskesmas, including visitor data and several other pull factors as thing sthat influence the population in the use of puskesmas, such as accessibility, free health services, availability of puskesmas facilities so that the data is expected to represent the entire population to obtain a complete and accurate picture of the current situation according to the research.Meanwhile, secondary data in this study were obtained from officedocuments related to research problems in the form of an overview ofthe office, location data, demographics, and other data related to this research collected from agencies or offices such as puskesmas and the Karanganom sub-district office.

The stage of checking the collected data.
The stage of checking the collected data to ensure the completeness of filling out each data collection instrument [6].

Stages ofediting.
Namely processing data by re-examining the data obtained [7].The editing stage carried out by researchers in this study, namely presenting the results of data collection presented in sentences that areasy to understand.

Stages of interpretation.
Is the process of trying to obtain deeper meaning and meaning of the results of the research being conducted [8].
2.5.5.Data checking stage.In this step the researcher checks the data collected.Checked whetheritis complete and complete as expected by there searcher.

Stages of making a map of patient distribution results.
From the data obtained, a distribution map of patients/visitors to the Karanganom puskesmas was made.
5 2.5.7.Stage of analysis.The data collected based on the above methods were then tabulated and grouped based on the patient's village of origin, then analysed according to the results and maps.
2.5.8.Discussion and conclusion.After completing the analysis and grouping according to the patient's village of origin, a discussion is made and after that a conclusion is made according to the discussion.

Function Puskesmas Karanganom in Karanganom sub-district
Puskesmas as a place of health services in order to improve the degree of public health has a vital function, namely: 1.As a centre for health development 2. As a centre for fostering community participation in the health sector 3.As a first-level health care centre

Facilities and programmes at Karanganom Health Centre
In general, health services organized by Puskesmas include treatment services, prevention efforts, and health improvement and health recovery [9].Meanwhile, Karanganom Community Health Centre it self has the following service programmes:

Distribution of health centre patients
Karangaom health centre data Influence factor: Out patient treatment with additional in patient facilitiesas medically in dicated.

Health screening services.
Services provided for patients at risk of chronic diseases, such as type 2 diabetes, hypertension, and cervical cancer.

Maternal and child health services
Checking the condition of pregnant women, assisting childbirth, postpartum care, breast feeding, family planning, and basic immunisation for infants and children.Specialised in assisting normal labour.

Health Services for BPJS users at Karanganom Community Health Centre
In addition to paid services, Karanganom Health Centreal so serves patients who are BPJS (Social Security Organisation Agency) participants because since 2014 the Indonesian government has established a national health insurance system.By becoming a BPJS participant and paying dues according to their obligations, participants are entitled to ge thealth services according to their rights.The advantage of being a member of BPJS is getting health services at are ducedcostor even at no costat all [10].6. Karanganom Health Centre service area One of the health centres in Klaten district is Karanganom Health Centre, this health centreis one of the health centres in Klaten that has been equipped with an emergency room (emergency room installation) and in patient care.The location of this puskesmas facilitates access for the community in obtaining services because it is in the middle of the Karanganom sub-district area, precisely the road leading to the city of Klaten.This health centre covers 19 villages, namely: 1.

7.
Jeblog Village this number is still unequal to the total population of the Karanganom sub-districtin 2020 of 58,354 people, it is said to be unequal because it can be seen from the visits tothe Karanganom puskesmas which are only a small difference from the total population of Karanganom sub-district, it is said to be unequal because it is seen from the visits to the Karanganom puskesmas which are only slightly different from the total population of Karanganom sub-district.This is because each resident does not only get sick once a year, which islame because the minimum number of puskesmas visits/patients should be at least twice the total number of residents in the sub-district.Inaddition, in general, the number of visitors to the Karanganom puskesmas is still in ferior to the Juwiring sub-district puskesmas with 71,667 people in 2020 with a total population of 47,588.Therefore, it can be seen from the comparison of the number of visitors at the Karanganom puskesmas and in Juwiring sub-district where the total population is greater in Karanganom subdistrict than in Juwiring sub-district.But the utilisation of puskesmas is more in Juwiring sub-district.This can be said because there are many health facilities in Karanganom sub-district besides the Karanganom puskesmas, there are private clinics and doctors who open practices a thome as well as traditional medicine such as duku desa,etc.Besides that, each village also has a village health centre (PUSKESDES) which already has the first level of health facilities so that puskesmas visitors are not so many as in other sub-districts.

Discussions
In general, the distribution of puskesmas in the Karanganom sub-district is fairly evenly distributed, but there are two villages with higher utilisation of puskesmas, namely Blanceran village and Soropaten village.This is because the Karanganom puskesmas is the closest health facility to the village apart from the village health centre.In addition, the level of visits by the Karanganom subdistrict community to the Karanganom Puskesmas is very minimal, this can be seen from the total number of puskesmas visitors which is not more than 2 times the total population in Karanganom District.Namely as many as 58,354 people while the total number of visits to Puskesmas Karanganom is only 59,375 people.Only Blanceran and Soropaten villages havea high total number of visits to Karanganom Health Centre.In addition, in general, the number of visitors to the Karanganom puskesmas is still inferior to the Juwiring sub-district puskesmas with 71,667 people in 2020 with a total population of 47,588.Therefore, it can be seen that the comparison of the number of visitors at the puskesmas Karanganom and Juwiring sub-districts where the total population is greater in Karanganom sub-district than in Juwiring sub-district.
This can be caused because there areso many health facilities other than Puskesmas in Karanganom sub-district and they are easily accessible.As well as residents who choose traditional medicine and the existence of traditional healers/tabibs in each village, so that the visits to the Karanganom Health Centre are very minimal.In this case, it can be said that the Karanganom Health Centre lacks the trust of the community in Karanganom sub-district, as evidence of the lack of residents in Karanganom subdistrict preferring to seek treatment at health facilities other than the Karanganom Health Centre.Also seek treatment from traditional medicine or village healers.This can be leveled with a certain approach, such as sub-district officersor Karanganom puskesmas officers improving services and diligently socialising to villagers, especially to residents whose villages have minimal visits to Karanganom puskesmas.In addition, there is also a need for additional services to patients at the Karanganom puskesmas to be further improved and to be more friendly to patients.
In addition, the Karanganom Community Health Centre should increase guidance on traditional medicine, considering that there are still many peoplein Karanganom sub-district who believe in traditional medicine.

Conclusions
This study was made to determine the distribution and numberof visitors or patients at the Karanganom District Health Centre.The results showed that the distribution of patients at Karanganom puskesmas tended to be evenly distributed, each village ranging between 1500 -3000 patients in 2020.
Although the distribution is evenly distributed, interms of number sittends to be small because the population of Karanganom sub-district with a total of 58,354 people with patient visits to Karanganom puskesmas is 59,375 people.This is less than 2 times.Compared to the Puskesmas in Juwiring subdistrict, which almost doubled the visits in the same year, it happened because of several things as mentioned in the discussion above.Therefore, several steps are needed to increase visitors or patients at the Puskesmas in Karanganom sub-district.

Table 1 .
Previous Research

Table 3 .
Data Used In The Study 2.5.Stages of data processing2.5.1.Data collection.Data collection is the initial process of a study.
Temporarily care for emergency patientsIn addition to the program, Puskesmas Karanganom of course also has qualified health facilities to support health services at Puskesmas Karanganom in general, health services provided by Karanganom puskesmas include, treatment services, prevention/prevention, promotive/health improvement and rehabilitation/recovery, specifically Karanganom puskesmas services include:1.First-leveloutpatientcare. Provides disease prevention, consultation and treatment advice to patients who do not require hospitalisation.2. First-level hospitalisation.

Table 5 .
Number of visitors to Juwiring Health Centre in 2018, 2019, and 2020

Table 6 .
Distribution of Puskesmas Patients Per Village in Karanganom Sub-District