Tuberculosis Control Based on Integrated Primary Healthcare at Mulyorejo Community Health Center in Surabaya

Lilik Djuari; Daryn Ikrima Mumtaz  Zahravi; Diva Khansadea  Fyamanda; Dini  Agustin; Fadli  Januar; Farahdiva Audrey  Widyanrika; Erlisa Pamodya  Wardani; Fawwaz Rahman  Hakim; Athalia  Khairunnisa; Ranti Ana  Ningsih; Erna  Mindarti

doi:10.60074/visikes.v25i2.15809

Authors

Lilik Djuari Department of Public Heath-Preventive Medicine, Faculty of Medicine, Universitas Airlangga
Daryn Ikrima Mumtaz Zahravi Medical Student, Faculty of Medicine, Universitas Airlangga
Diva Khansadea Fyamanda Medical Student, Faculty of Medicine, Universitas Airlangga
Dini Agustin Medical Student, Faculty of Medicine, Universitas Airlangga
Fadli Januar Medical Student, Faculty of Medicine, Universitas Airlangga
Farahdiva Audrey Widyanrika Medical Student, Faculty of Medicine, Universitas Airlangga
Erlisa Pramodya Wardani Medical Student, Faculty of Medicine, Universitas Airlangga
Fawwaz Rahman Hakim Medical Student, Faculty of Medicine, Universitas Airlangga
Athalia Khairunnisa Medical Student, Faculty of Medicine, Universitas Airlangga
Ranti Ana Ningsih Mulyorejo Community Health Center
Erna Mindarti Mulyorejo Community Health Center

DOI:

https://doi.org/10.60074/visikes.v25i2.15809

Keywords:

tuberculosis, integrated primary healthcare, community health center, disease control, primary health care

Abstract

Tuberculosis (TB) remains an important public health problem requiring strengthened control at the primary health care level. This study aimed to analyze TB control problems and formulate alternative solutions based on Integrated Primary Care (ILP) principles at the Mulyorejo Community Health Center, Surabaya. A descriptive analytical design with a case study approach was used. Data were obtained from the 2024 Community Health Center Performance Assessment (PKP), TB program reports, health profiles of Surabaya City and East Java Province, discussions with the TB program officer and relevant health workers, and observations of TB control activities. Priority problems were identified using the Urgency, Seriousness, and Growth (USG) method, followed by root-cause analysis using a fishbone diagram. The coverage of TB case detection and treatment reached 50% against a program target of 90%, resulting in a 40-percentage-point gap. USG analysis identified low TB case detection and treatment coverage as the highest-priority problem, with a score of 15. Fishbone analysis identified interconnected factors, including limited human resources and workload, predominantly passive case finding, limitations in screening activities, limited community and cadre involvement, and challenges in recording and reporting. Alternative solutions included community-based TB education, the use of educational media, and strengthening community health cadre involvement in TB case finding and prevention. TB control at the Mulyorejo Community Health Center has not yet achieved the program target. An integrated approach involving active case finding, community and cadre engagement, health education, treatment adherence support, and improved use of TB program data is needed within the ILP framework.

References

Kementerian Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MENKES/2015/2023 tentang Petunjuk Teknis Integrasi Pelayanan Kesehatan Primer. Jakarta: Kementerian Kesehatan Republik Indonesia; 2023. p. 1–23.

World Health Organization. Global Tuberculosis Report 2025 [Internet]. Geneva: World Health Organization; 2025 [cited 2026 Feb 9]. Available from: https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2025

Kementerian Kesehatan Republik Indonesia. Strategi Nasional Penanggulangan Tuberkulosis di Indonesia 2020-2024 [Internet]. Jakarta: Kementerian Kesehatan Republik Indonesia; 2020. Available from: https://kebijakan.tbindonesia.or.id/kebijakan-tbc/strategi-nasional-penanggulangan-tuberkulosis-di-indonesia-2020-2024/

Dinas Kesehatan Provinsi Jawa Timur. Profil Kesehatan Provinsi Jawa Timur Tahun 2023 [Internet]. Surabaya: Dinas Kesehatan Provinsi Jawa Timur; 2024 [cited 2026 Feb 9]. Available from: https://dinkes.jatimprov.go.id/userfile/dokumen/PROFIL KESEHATAN PROVINSI JAWA TIMUR TAHUN 2023.pdf

Dinas Kesehatan Kota Surabaya. Profil Kesehatan Kota Surabaya Tahun 2023 [Internet]. Surabaya: Dinas Kesehatan Kota Surabaya; 2024 [cited 2025 Dec 29]. Available from: https://drive.google.com/file/d/1xHtZSOaOxUGBh2JkrMx_tN-_s_tFJR3/view

Puskesmas Mulyorejo. Penilaian Kinerja Puskesmas (PKP) Puskesmas Mulyorejo 2024. Surabaya: Puskesmas Mulyorejo; 2024.

Hadiwijaya H, Alexsander A, Dani R. Model gate keeper pusat pelayanan kesehatan masyarakat (Studi di Unit Pelayanan Teknis Daerah Kesehatan Masyarakat Ujung Karang Kabupaten Bengkulu Tengah). J Manaj Modal Insan Dan Bisnis [Internet]. 2025 [cited 2026 Feb 9];6(1):181–93. Available from: https://jurnal.imsi.or.id/index.php/jmmib/article/view/237

Burke RM, Nliwasa M, Feasey HRA, Chaisson LH, Golub JE, Naufal F, et al. Community-based active case-finding interventions for tuberculosis: A systematic review. Lancet Public Health [Internet]. 2021 [cited 2026 Feb 9];6(5):e283–99. Available from: https://pubmed.ncbi.nlm.nih.gov/33765456/

Tsarwah A, Surahman Batara A, Rizki Amelia A. Implementasi strategi penemuan kasus tuberkulosis berbasis masyarakat di Puskesmas Paccerakkang Kota Makassar tahun 2019. Window of Public Health Journal [Internet]. 2020 [cited 2026 Oct 1];1(2):98–110. Available from: https://jurnal.fkm.umi.ac.id/index.php/woph/article/view/16

Pai M, Heitkamp P, Pillay Y. Integration of tuberculosis services within primary health care: Converting challenges into opportunities. Lancet Prim Care [Internet]. 2025 [cited 2026 Feb 9];1(4):100056. Available from: https://www.thelancet.com/action/showFullText?pii=S3050514325000561

Oktavia Mait T, Rosyida R, Sulistyawati S. Evaluasi kesiapan Promkes dalam implementasi program Integrasi Layanan Primer (ILP) di Puskesmas. J Penelit Inov [Internet]. 2025 [cited 2026 Feb 9];5(1):133–40. Available from: https://jurnal-id.com/index.php/jupin/article/view/1029

Prodyanatasari A, Pratiwi WN, Astutik WS, Laksono A, Werdiningsih W, Anikasari E, et al. “SEHATI LESTARI”: Strengthening health cadres to realize a TB-free and healthy community. Darmabakti Cendekia J Community Serv Engag [Internet]. 2025 [cited 2026 Feb 9];7(2):125–32. Available from: https://ejournal.unair.ac.id/DC/article/view/77127

Candra Dewi S, Sunarti S, Suryani D, Rokhmayanti R. Active tuberculosis case discovery using the adaptation model in the City of Yogyakarta. J Kesehat [Internet]. 2024 [cited 2026 Oct 1];17(1):1–11. Available from: https://journals2.ums.ac.id/jk/article/view/2394

Diana GN, Marlinton S, Damayanti E, Astuti AW. Dampak stigma dan diskriminasi pada penderita tuberkulosis: The impact of stigma and discrimination on tuberculosis patients. J Ilm Kebidanan Dan Kesehat [Internet]. 2024 [cited 2026 Feb 9];2(2):61–70. Available from: https://salnesia.id/jibi/article/view/1175

Wihastiningrum ZD, Kusuma AS. Strategi komunikasi inovatif dalam mengeliminasi tuberkulosis di Wonogiri: Studi kasus Mentari Sehat Indonesia. J Indones Manaj Inform Dan Komun [Internet]. 2025 [cited 2026 Feb 9];6(2):1096–114. Available from: https://journal.stmiki.ac.id/index.php/jimik/article/view/1395

Setyoningrum RA, Pratama Putra Chafid A, Hapsari R, Rosyada A, Helmi Imaduddin M, Shafira Deshpande K, et al. Flipchart and booklet as media to increase cadre’s knowledge about latent tuberculosis prevention in children. J Community Med Public Health Res [Internet]. 2023 [cited 2026 Oct 1];4(1):33–9. Available from: https://e-journal.unair.ac.id/JCMPHR/article/view/42323

Aritonang YR, Sujianto S. Network governance dalam layanan tuberkulosis di fasilitas kesehatan pemerintah dan swasta berbasis kabupaten/kota di Kota Pekanbaru. J Multidisiplin Ilmu Akad [Internet]. 2025 [cited 2026 Feb 9];2(3):360–9. Available from: https://www.ejurnal.kampusakademik.co.id/index.php/jmia/article/view/4812