Correlation Between the Health of Children Under Five Years and

Health Service Readiness at Health Centers in Indonesia: Analysis

of Riskesdas 2018 and Rifaskes 2019 Data

Sefrina Werni

1*2

, Emma Rachmawati

, Helda Khusun

2,3

and Harimat Hendarwan

Agency for Health Policies Development of Ministry of Health, Jakarta, Indonesia

Faculty of Public Health Sciences, Graduate School University of Muhammadiyah Prof. Dr. Hamka, Jakarta, Indonesia

Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition (SEAMEO RECFON),

Pusat Kajian Gizi Regional (PKGR) University Indonesia, Indonesia

Center for Preclinical and Clinical Medicine Research, Health Research Organization,

National Research and Innovation Agency, Jakarta, Indonesia

Keywords: Sub-Index, Health of Children Under Five Years, Readiness of Health Services, Riskesdas, Rifaskes.

Abstract: Based on the description of the health of children under five years of age from the Riskesdas 2018 data, a sub-

index score for the health of children under five was created as one of the IPKM indicators. As for the

description of health service readiness for children under five years from the Rifaskes 2019 data, a sub-index

of health service readiness for children under five years was created based on the SARA (Service Availability

and Readiness Assessment) concept taken in the same year. This study aims to look at the relationship between

the health of children under five years of age and the readiness of health services for children under five years

of age at community health centers. The research data uses secondary data and is a further analysis of the

Riskesdas 2018 data and Rifaskes 2019 data. The design of Riskesdas is cross sectional, while Rifaskes is

designed in total coverage. In this study, a correlation analysis has been carried out on the two Research sub-

index values. The results of the analysis of the relationship between the health sub-index for children under

five years and the health service readiness sub-index for children under five years at community health centers

show a p-value = 0.000 (p <0.05), which means that there is a significant relationship, the correlation value r

= 0.346, which is a positive unidirectional. There is significant correlation, positive unidirectional between

the health of children under five years and the readiness of health services for children under five years at

community health centers.

1 INTRODUCTION

Based on data World Bank stated that the infant

mortality rate in the world in 2019 reached 28.2 per

1000 live births (Data Bank, 2019). According to

reports United National International Children's

Emergency Fund (UNICEF), the death rate in the

Asian region is 35 deaths, per 1,000 live births

(UNICEF, 2020). In Indonesia, the results of the 2017

Indonesian demographic and Health Survey (IDHS)

show an under-five mortality rate of 32 per 1,000 live

births (SDKI, 2017). In the 2021 Indonesia Health

Profile, there were 27,566 under-five deaths (“Profil

Statistik Kesehatan 2021,” 2021).

The government has made efforts to detect

problems as early as possible with children's health,

which can cause health problems and death.

Monitoring of the health, growth, and development of

children under five is needed, as is their handling at

various levels of health services. Public health centers

are the first-level health service facility that organizes

toddler health efforts in accordance with Minister of

Health Regulation No. 43 of 2019 concerning public

health centers (“Peraturan Menteri Kesehatan RI No

43 Tahun 2019 Tentang Puskesmas,” 2019).

Under-five health service activities at the public

health centers that are indicators of improving the

health status of under-fives are weighing, measuring

body length and height, monitoring development,

giving vitamin A (age 6–59 months), completing

basic immunization, and providing services for sick

under-fives using the Integrated Management of

Childhood Illness (IMCI) approach. In 2021, in

194

Werni, S., Rachmawati, E., Khusun, H. and Hendarwan, H.

Correlation Between the Health of Children Under Five Years and Health Service Readiness at Health Centers in Indonesia: Analysis of Riskesdas 2018 and Rifaskes 2019 Data.

DOI: 10.5220/0012903200004564

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 5th International Conference on Social Determinants of Health (ICSDH 2023), pages 194-197

ISBN: 978-989-758-727-6; ISSN: 2975-8297

Indonesia, the average percentage of children under

five who are weighed will be 69% per month. The

percentage of children under five whose growth and

development were monitored was 69.6%.

Meanwhile, the strategic plan target is 70%, which

shows that the target of a visit coverage percentage of

under-fives is not achieved, whose growth and

development are monitored. In 2021, the national

complete basic immunization coverage will be

84.2%; this figure also does not meet the 2021

Strategic Plan target, which is 93.6% (Laporan Riset

Fasilitas Kesehatan (RIFASKES) 2019 Puskesmas,

2019).

Basic health research (Riskesdas) is carried out by

calculating the Community Health Development

Index (IPKM) as a tool to measure the success of

public health development at the provincial and

district/city levels. One of the seven indicators

measured is under-five health services (Tjandrarini,

2018). The Community Health Development Index

(CHDI) from the existing Riskesdas data was then

complemented by the existence of a health service

facility index from the 2019 Health Facilities

Research (Rifaskes) data. In 2021, research will be

carried out to assess and monitor the availability of

health services and the readiness of the health sector

in public health centers in Indonesia by using an

assessment tool for health facilities that meet the

Service Availability and Readiness Assessment

(SARA).

Based on the results of this research, an index of

health service facilities, especially public health

centers, will be compiled, which will provide an

overview of the readiness of health services in

districts, cities, and provinces. Among the facilities

index, there is a readiness sub-index for service health

under five (Hendarwan, 2021). The 2018 Riskesdas

data describes the pre-existing health conditions of

children under five, and the 2019 Rifaskes data can

provide an overview of the state of readiness of the

public health centers in providing under-five health

services. The study will be carried out based on the

under-five health sub-index values from the 2018

Riskesdas research and the under-five health service

readiness subindex using the SARA concept from the

2019 Rifaskes research.

2 METHODS

The research data uses secondary data and is a further

analysis of the 2018 Riskesdas data and the 2019

Rifaskes data. The 2018 Riskesdas samples analyzed

in this study were children aged 0–59 months, for a

total of 93,620 children. The 2019 Rifaskes sample

was taken in total coverage. The public health center

data used is public health center data as of June 2018

for 9,909 public health centers in 514 districts or

cities in 34 provinces in Indonesia. At the time the

Riskesdas data collection took place in 2018, the

public health centers data had already been set for the

2019 Riskesdas.

The children under five who were sampled in the

2018 Riskesdas were domiciled in the working area

of the public health centers that were sampled in the

2019 Riskesdas. The research analysis unit was

districts or cities, so this study analyzed a total of 514

districts or cities in Indonesia.

The lowest sub-index value is 0, and the highest is

1. If it is close to 1, it indicates conditions in the

district or city are improving; if it is close to 0, it

indicates conditions have not improved. The median

value is taken, namely 0.50, and an analysis of the

mapping of districts and cities that are ≤ 0.50 and >

0.50 is carried out.

In this study, a correlation analysis was conducted

to see the relationship between the under-five health

sub-index and the under-five health service readiness

sub-index.

3 RESULTS

3.1 Mapping the Under-Five Health

sub-Index

The value of the under-five health sub-index has been

obtained from 514 districts and cities in 34 provinces.

From the results of the sub-index values, mapping is

made at the provincial level using the digital map

method, as shown in Figure 1.

The highest under-five health sub-index score was

in DI Yogyakarta Province, which was 0.81, and Bali,

which was 0.80. The lowest values are in Papua

Province, which is 0.53, and Maluku, which is 0.56.

The highest score in the district or city is in Tabanan

Regency, Bali Province, at 0.90, and the lowest score

is in Paniai Regency, Papua Province, at 0.31. If a

mapping analysis is carried out for districts or cities

that are ≤ 0.50 and > 0.50, the under-five health sub-

index values are 7.0% (36 districts or cities) that are

≤ 0.50 and as many as 93.0% (476 districts or cities)

that are > 0.50.

Correlation Between the Health of Children Under Five Years and Health Service Readiness at Health Centers in Indonesia: Analysis of

Riskesdas 2018 and Rifaskes 2019 Data

195

Figure 1: Mapping of the under-five health sub-index in

Indonesia in 2018.

3.2 Mapping of Toddler Health Service

Readiness Sub-Index

Based on the results of the sub-index values, mapping

was made at the provincial level using the digital map

method, as shown in Figure 2.

The highest under-five health service readiness

sub-index score was in the DI Yogyakarta and Central

Java provinces,

namely 0.81. The lowest value in

Papua

Province is 0.69. The highest score in the

district or city is Tidore. Islands Regency, North

Maluku Province, 0.93, and the lowest score is in

Puncak Jaya Regency, 0.39, Papua Province. If a

mapping analysis is carried out for districts or cities

that are ≤ 0.50 and > 0.50, the sub-index value for

under-five health service readiness is 0.4% (2 districts

or cities) that are ≤ 0.50 and as many as 99.6% (511

districts or cities) that are > 0.50.

Figure 2: Mapping the sub-index of readiness for children

under five in health services in Indonesia in 2021.

The results of the analysis of the relationship

between the independent variable, namely the under-

five health sub-index, and the dependent variable,

namely the under-five health service readiness sub-

index, used the correlation test shown in table 1

below.

Table 1: The relationship between the children under five

health sub-index and the service readiness sub-index for

children under five health.

Independent

variables

Dependent

variables

Significance

(p-value)

Correlation

coefficient

(

)

1 2 4 5

Health sub-

index for

children under

five years

Health

Service

Readiness

Sub-Index

for Children

Under Five

Years Ol

0.000

0.346

The results of the analysis of the relationship

between the under-five health sub-index and the

under-five health service readiness sub-index at the

public health centers obtained p-values of 0.000

<0.05, meaning that there is a significant relationship

(correlation). With the correlation coefficient (r) of

0.346 > r table 0.088, it can be concluded that there is

a relationship (correlation). The correlation

coefficient has a low value, so the relationship is

weak. The correlation coefficient number is positive,

so the relationship between the two indicators is

unidirectional. Thus, it can be interpreted that

increasing the readiness of health services can

improve the health of children under five.

The degree of health is influenced by

environmental factors, behavioral factors, health

service factors, and genetic factors (heredity) (“Teori

H.L.BLUM,” n.d.). In other research, it is stated that,

apart from environmental factors and health service

factors, economic factors and maternal education

factors influence the level of health in society

(Handayani, 2014).

Utilization of health services is influenced by age

and health care coverage (Logen, Y., & Balqis, 2015).

Apart from that, the influence of the work,

knowledge, and attitudes of mothers is also related to

health services for children under five (Sumarni &

Prabandari, 2021).

4 DISCUSSION

Increasing the availability of facilities and

infrastructure or health service facilities and the

readiness of services according to standards can

support the fulfillment of the quality of health

services and the health status of children under five

(Suparmi et al., 2018). The results of this study are in

accordance with Liu, L., et al. (2019) stated that better

ICSDH 2023 - The International Conference on Social Determinants of Health

196

facilities would be associated with higher

opportunities for utilization of child health services.

The higher the health service readiness sub-index

value, the higher the under-five health sub-index

value. Improving the quality of health care facilities

can provide a way to encourage higher utilization of

health services so as to reduce child morbidity and

mortality (Liu et al., 2019). Strengthening the health

system in the form of human resources (HR),

laboratories, and equipment, as well as the provision

of medicines, is urgently needed at the public health

centers (Parameswaran & Agrawal, 2019).

5 CONCLUSION

There is a relationship between children's health and

the readiness of children's health services at health

centers in Indonesia.

REFERENCES

Data Bank, W. (2019). Angka Kematian Bayi di Dunia

tahun 2019. Https://Data.Worldbank.Org/.

Handayani, T. S. (2014). Faktor-faktor yang

Mempengaruhi Derajat Kesehatan Masyarakat (Faktor

Ekonomi, Pendidikan Ibu, Lingkungan, dan Pelayanan

Kesehatan) Studi Kasus di Aceh, Papua, Bangka

Belitung, Sulawesi Utara, Jawa Tengah, dan Daerah

Istimewa Yogyakarta. https://Etd.Ugm.Ac.Id/Home/

Detail_pencarian/68997.

Hendarwan, H. (2021). Pengembangan Indeka Puskesmas

(Analisis Lanjut Rifaskes 2019). Badan Litbangkes

Kementerian Kesehatan RI.

Laporan Riset Fasilitas Kesehatan (RIFASKES) 2019

Puskesmas. (2019). Badan Penelitian dan

Pengembangan Kesehatan Kementerian Kesehatan RI.

https://www.litbang.kemkes.go.id/laporan-hasil-riset-

fasilitas-kesehatan/

Liu, L., Leslie, H. H., Joshua, M., & Kruk, M. E. (2019).

Exploring the association between sick child healthcare

utilisation and health facility quality in Malawi: A

cross-sectional study. BMJ Open, 9(7).

https://doi.org/10.1136/bmjopen-2019-029631

Logen, Y., & Balqis, D. (2015). Faktor yang berhubungan

dengan Pemanfaatan Pelayanan Kesehatan oleh

pemulung di TPA Tamangapa. Skripsi. Universitas

Hasanudin. Universitas Hasanudin, Core.Ac.Uk, 1–12.

Parameswaran, K., & Agrawal, T. (2019). Readiness of

primary health centers and community health centers

for providing noncommunicable diseases-related

services in Bengaluru, South India. International

Journal of Noncommunicable Diseases, 4(3), 73.

https://doi.org/10.4103/jncd.jncd_45_18

Peraturan Menteri Kesehatan RI No 43 tahun 2019 tentang

Puskesmas. (2019). Kementeri Kesehatan RI, 1–159.

Profil Statistik Kesehatan 2021. (2021). In Badan Pusat

Statistik.

https://www.bps.go.id/publication/download.html?nrb

vfeve=MGYyMDczMjM5MDI2MzMzNDJhMWY2Y

jAx&xzmn=aHR0cHM6Ly93d3cuYnBzLmdvLmlkL3

B1YmxpY2F0aW9uLzIwMjEvMTIvMjIvMGYyMDc

zMjM5MDI2MzMzNDJhMWY2YjAxL3Byb2ZpbC1

zdGF0aXN0aWsta2VzZWhhdGFuLTIwMjEuaHRtbA

%3D%3D&twoadfnoarf

SDKI, 2017. (2017). Laporan Survei Demografi Kesehatan

Indonesia Tahun 2017. In Kementrian Kesehatan

Republik Indonesia.

https://pusdatin.kemkes.go.id/resources/download/pus

datin/profil-kesehatan-indonesia/Profil-Kesehatan-

indonesia-2019.pdf

Sumarni, & Prabandari, F. (2021). Faktor-faktor yang

mempengaruhi Pelayanan kesehatan balita Pada Masa

Pandemi Covid-19 di Kabupaten Banyumas. Jurnal

Bina Cipta Husada, XVII(1), 37–50.

Suparmi, S., Maisya, I. B., Rizkianti, A., Sari, K., Rosha, B.

C., Amaliah, N., Pambudi, J., Wiryawan, Y., Putro, G.,

Soekotjo, N. E. W., Daisy, L., & Sari, M. (2018).

Pelayanan Manajemen Terpadu Balita Sakit (MTBS)

pada Puskesmas di Regional Timur Indonesia. Media

Penelitian Dan Pengembangan Kesehatan, 28(4), 271–

278. https://doi.org/10.22435/mpk.v28i4.125

Teori H.L.BLUM. (n.d.). https://Wimee.Wordpress.com/

2011/06/20/Teori-h-l-Blum/.

Tjandrarini, D. H. dkk 2019. (2018). Indeks Pembangunan

Kesehatan Masyarakat (IPKM 2018) (T. dkk Trihono

(Ed.)).

UNICEF. (2020). UNICEF : Tingkat Kematian Anak di

Bawah 5 Tahun Secara Global Turun Drastis.

Https://Databoks.Katadata.Co.Id/Datapublish/2021/1

2/21/Unicef-Tingkat-Kematian-Anak-Di-Bawah-5-

Tahun-Secara-Global-Turun-Drastis, 2021.

https://databoks.katadata.co.id/datapublish/2021/12/21

/unicef-tingkat-kematian-anak-di-bawah-5-tahun-

secara-global-turun-drastis

Correlation Between the Health of Children Under Five Years and Health Service Readiness at Health Centers in Indonesia: Analysis of

Riskesdas 2018 and Rifaskes 2019 Data

197