From Zero To Hero With UKS (Health School Unit) Building Health Conscious Generations at Schools
Health Office of Bandung City (Dinas Kesehatan Kota Bandung)

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Usaha Kesehatan Sekolah (School Health Effort), here in after abbreviated as UKS, is a program set in the Decision Letter of 4 Ministers in 1984, which was renewed in 2003. The School Health Effort(UKS) programs which are known as Trias UKS, include: 1. Health Education, referring to an effort to educate students on matters pertaining health, especially the Clean and Healthy Life Behavior education, hereinafter abbreviated as CHLB. 2. Health Services, referring to check-ups on students health status, including physical, mental (specific to Junior High and Senior High), eyes, and teeth check-ups and so forth, which are conducted by public health centers. 3. Healthy School Environment Supervision, referring to education for students in order to keep the school environment healthy, completed with facilities and infrastructures such as toilets and washbasin according which are in good order sufficient for the ratio of number of students. According to the results of evaluations and observations in the previous years, some conditions in 2013 are illustrated as follows: 1. The UKS activities reviewed in terms of facilities/infrastructures, knowledge, students attitude toward health sector, school canteen, daily food/nutrition, dental health, personal health and so forth in general still showed that the pricinples of healthy life and the health status of students had yet to reach the expected level. 2. The targeted health effort viewed based on the school coverage, the students in relation to the compulsory education, organization quality, employement and facilities/infrastructure had not been balanced with the effort of UKS goal achievement. There were 85 schools within the work area, comprising 21 kindergartens, 26 elementary, 11 junior high and 27 senior high, with total number of students of 44.000. The coverage of number of healthy schools was still zero. 3. The clean and healthy life behavior (CHLB) of the educational institution structure had yet reached the expected level, with program coverage of only 43% as compared to the minimum target of 65%. 4. The health problems faced by students are: a. Basic sanitation that had yet met health requirements b. Poor CHLB, such as rarely washing hands, which caused communicable diseases whose morbidity was high. 5. Inadequate Human Resources: a. Lack of teachers who taught health education/managed UKS, while the standard requires that there is a minimum of 1 teacher who manages UKS at every school. b. Lack of Little Doctors and Adoslecent Health Cadres trained on health (education and services), while the national standard requires 10% of the total number of the students of a school. 6. Limitation in UKS facilities and infrastructures a. Inadequate UKS rooms and UKS kit. Some schools even did not have any UKS room, so when there was a student who felt sick, he or she would rest in teacher office. b. Insufficient health media such as poster, leaflet, flip chart, and so on. 7. Inadequate recording and reporting for example facility of student’s health report book. 8. Lack of coordination and commitment of the whole stakeholders in the implementation of UKS program.

B. Strategic Approach

 2. What was the solution?
- Usaha Kesehatan Sekolah or UKS (School Health Effort), is an effort made for improving the health of school-age children, starting from kindergarteners to senior high schoolers, aiming to be a paradigm or technology transfer of Clean and Healthy Life Behavior culture, thus UKS is regarded as an investment for the future generations who have advatange in healthy physical quality that allows for competitive adavantage for facing the globalization era. The School Health Effort programs popularly known as Trias UK, including 1). Health Education; 2). Health Services; and, 3). Healthy School Environment Supervisionare essential for the realization of healthy and smart students. - The purposes of UKS programs are to enhance students’ healthy life behavior and health status, to realize healthy school environment that allows for growth and development that are harmoneous and optimum, and to actively participate in the improvement of health condition of the entire school community. - The UKS supervision program at Puskesmas Talaga Bodas has been intensively implemented since 2013 by making numerous breakthroughs and innovations and by involving all relevant stakeholders, including we invite companies to allocate their CSR in the development of healthy schools through the making of facilities and infrastructures such as washbasin and student health report book and through the improvement of other infrastructures, which will help build clean and healthy life behavior.

 3. How did the initiative solve the problem and improve people’s lives?
I. The introduction to the brand new approach through the healthy school competition system for every 3 years, and the initiation of MOU on the health fund for school. II. The use of IT System along with Whatsapp group between the related parties, such as from the District evel, Public Health Centre (Puskesmas) and School Officer, therefore kind of effective communication and coordination can be achieved. III. The improvement of the active participation from all engaged parties namely the student, School Principal, Foundation Officer and student parent committee, Supervision Team, UKS at district level (Puskesmas and District Officer), the Office of Educational Affairs, Department of Religious Affairs and Indonesian Red Cross Society (PMI) IV. The Student Health Rate during the health screening and routine medical check up shows a significant increase V. Several great achievements in terms of the Healthy School Supervision for period of 2013 to 2014, such as : • SD BPI placed the 1st rank for the Healthy School Competition at Bandung City level; • SMAN 8 placed the 1st rank for the Healthy School Competition at Bandung City level; • TP UKS of Lenkong District placed the 3rd rank Competition at Bandung City level; • consolation prize winner II Kid Doctor Competition at Bandung City level for period of 2014- 2015: • SD BPI placed the 1st rank for the Healthy School Competition at Provincial Level of West Java Province • SD BPI placed the 2nd rank for the Healthy School Competition at nATIONAL Level of the Republic of Indonesia • SDN KarangPawulang placed consolation prize winner I for the Healthy School Competition at Bandung City Level; • SMPN 13 placed consolation prize winner II for the Healthy School Competition at Bandung City Level; • SMKN 4 placed consolation prize winner II for the Healthy School Competition at Bandung City Level; • TP UKS of Lenkong District placed 3rd rank for Competition at Bandung City Level; • Achieved the 3rd rank for Kid Doctor Competition at Bandung City Level For Period of 2015 – 2016 : • TP UKS of Lengkong District placed the 1st rank Competition at Bandung City level • TK Pertiwi placed the 1st rank for the Healthy School Competition at Bandung City level • SMPN 13 placed the 1st rank for the Healthy School Competition at Bandung City level • SMAN 8 placed the 3rd rank for the Healthy School Competition at Bandung City level; • SDN KarangPawulang placed the JuaraHarapan I for the Healthy School Competition at Bandung City level For Period of 2016 – 2017 : • SMPN 13 placed the 1st rank for the Healthy School Competition at Provincial Level of West Java Province • TK Pertiwi placed the 2ND rank for the Healthy School Competition at Provincial Level of West Java Province • TK GAGAS CERIA placed the 2nd rank for the Healthy School Competition at Bandung City level • SD KARTIKA X-1 placed the 2nd rank for the Healthy School Competition at Bandung City level

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The implementation of supervision and healthy school competition in UPT Puskesmas TalagaBodas employees a newer and different system which are elaborated as follows: 1. An innovation in which Healthy School Competition at the district level is only held once in 3 years. Every year, top three winners are selected. The first winner is prepared for the competition of current year, the second winner is prepared for the next year and the third winner is prepared for the following year. 2. Promoting the development of good health condition at schools using collaborative means as follows: a. Inviting active participation of all school community. Principals, teachers, students and their parents and all school community. b. Engage school to manage Student Health Effort Fund such as simple health insurance, where every student is charged Rp.1000.- every month for health financing. c. Improving the commitment and coordiation using WhatsApp group. 3. Improving the efficiency of health service provision, such as: a. In consultation and student health screening we collaborate with health institutions, such as Department of Public Health Sciences Padjajaran University, StiKes Aisyiyah. b. Adolescent Friendly Health Services is provided through counselling via SMS/WhatsApp. c. The results of health screening at some schools are presented online using Medisis App, so the results of health screening can be reported directly on the same day. d. Initiate IMBAS program as an effort of accelerating the realization of healthy schools, inwhich schools that have become winners are obliged to supervise 5 other schools as impacted school. 4. Improving the quality of health services and responsive to community needs, among others: a. In the case of health education provided with innovative and fun ways and suitable to the needs of the students. b. Invites companies to engage in CSR to distribute as part of the reward.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
After identifying all matters related to UKS which have not met the target, the head of UPT Puskesmas Talaga Bodas, dr. Siska Gerfianti, M.Hkes together with the holder of UKS programs, drg. Deddy Kusmayadi and Drg. Rissa, felt that it was necessary to form UKS Team at the district level which is headed by the head of Lengkong District, Dra. Lusi Susilayani, and to engage all stakeholders relevant in the UKS program at the district level to: a. Establish managerial structure of UKS Coach of Lengkong District in order to from cooridation and commitment in the government party by involving all parties relevant to this program, namely Teams of PKK or Pembinaan Kesejahteraan Keluarga (Family Welfare Movement Team), PMI or Palang Merah Indonesia (Indonesian Red Cross), Education Office Subdivision, KUA or Kantor Urusan Agama (Office of Religious Affairs), representatives of schools and public figures. It is followed with the formation of UKS TEAM of UPT Puskesmas Talaga Bodas consisting of people in charge in networking public health centers, namely Puskesmas Suryalaya, Puskesmas Cijagra Lama and Puskesmas Cijagra Baru. This way the commitment of all stakeholders can be developed well. b. Doing supervision at appointed schools using collaborative and persuasive supervision and personal approach to principals involved to raise awareness on the importance of healthy life culture at schools. Then, inviting all school community inlcuding students’ parents to take an active part in UKS programs so that the achievement of healthy status at schools can be accelerated. c. Making a new competition system and supervision which is not sporadic natured, the main goal of which is to change the behavior of students and all school community into clean and health life behavior. Competition only serves as a means to raise the awareness on the importance of creating healthy school facilities and infrastructures in order to create healthy generations at school because we are aware that Bandung City citizens have the culture of competing in good deeds. d. Implementing Trias UKS using collaborative approach by involving companies with CSR to support UKS programs, especially assisting in the making of facilities and infrastructures, such as the building of washbasin, provision of students’ health report book and so forth.
 6. How was the strategy implemented and what resources were mobilized?
Chronological: a. In March 2013, the head of Community Health Center Talagabodas together with the Lengkong districts heads and Students Health Units Team choose a school that will be sent to represent Lengkong districts, namely: 1)Elementary Level: SD BPI, 2)Junior High Level: SMP 13, 3)Senior High Level: SMAN 8. b. On May 2013 SD BPI and SMAN 8 ranked 1st and have the right to represent Bandung in provincial level, SMPN 13 won 2nd place. c. On June 2013, SD BPI we proposed to get CSR of PT Enesis, by installing hand sanitizer as a reward. d. On June 2013, SD BPI win 1st place in national level and become the 2nd champion in best performance category. In 2014 SMAN 8 get 2nd places in provincial level. e. February 21, 2014 we formed a school healthy coordinator consisting of schools who had been a champion, the coordinator of the primary level is Mrs. Diah Aryanti of SD BPI, coordinator of the junior and senior high school is Ms. Euis of SMAN 8. We started our IMPACT program, which is the Competition winners are required to develop five other schools. f. April 2014, we conducted meetings with the Bank, Boehringer Ingelheim and Biofarma to help preparing infrastructure of Secretariat School Health Unit at Lengkong district space and PKPR space. g. On January 23, 2015 we prepared again for new competition with new championship system. The new systems are as follows: 1st winner will represent in city level competition in 2015, 2nd place will be represented in 2016 and 3rd place will be represented in 2017. h. March 11, 2015 we sent 4 representatives namely TK Pertiwi, SD Karang Pawulang, SMPN 13 and SMAN 8. And the all 4 enter the top six. i. TK Pertiwi and SMPN 13 was selected as a champion in municipal level and represent to the provincial level. And in 2016 SMP 13 won in Provincial level and have the right to represent at national level. j. On October 6, 2015 receiving CSR Healthy Living Mission from PT Reckitt Benckisser by installing 100 washtafel for schools champion as a reward. k. On October 27, 2015 LSS judging at national level for SMP 13. l. On February 2, won the Top 99 Public Service Innovation in 2015 with Prolanis program (Program Management of Chronic Diseases Diabetes Mellitus and Hypertension). m. In March 2016 the proposal UKS From Zero to Hero get the Top 99 Public Service Innovation. March 10, direct exposure by Mr. Ridwan Kamil the Mayor of Bandung at Kemenpan-RB. n. On March 17, 2016 visitation by the assessment of Kemenpan-RB team to Talagabodas and schools such as SD BPI, SMP 13, SMA 8 and TK Pertiwi. o. March 29, 2016 awarding the second phase sink inaugurate of 170 units of PT Reckitt Benckisser in SMP 13. p. On March 30 to April 2, 2016 were granted the Top 35 of the 2016 Public Service Innovation KemenPAN-RB, event Exhibition at Surabaya, East Java. q. On May 10-18, 2016 LSS Bandung level, represented by the SD Kartika and TK Pertiwi. r. On October 27, 2016 declaration of Healthy Living Mission and the World Hand Washing Day with Mayor of Bandung in SD Karang Pawulang to welcome delegates from 19 countries ILE-International Learning Exchange for SMILE-GIZ program. s. On November 5, 2016 received 50,000 bottles of harpic toilet bowl cleaner that submitted by Reckitt Benckisser Marketing Director Mr. Salman Faris to the Mayoress of Bandung in SMP 13. t. Preparing to return to the LSS in 2017, preparing to follow UNPSA.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
1. Coach team of UKS Bandung 2. Coach team of Lengkong UKS District , in which there is a team of Students Health Unit Community Health Centers Talagabodas UPT. 3. Principal and Students Health Unit team in each school involved. 4. The involved school committee and school foundations. 5. All students and parents. 6. Invites companies to engage in CSR to distribute as part of the reward for healthy school that tailored to the needs of students, for example: 1. PT Nestle Indonesia in the Nestle Healthy Kids program, delivering health education books for primary level children PHBs in the form of a series of storybooks consisting of 11 books per set, with 11 titles related to health education. These books are given in SD BPI, BPK Penabur, SD, SD Gagas Ceria, SD Kartika, SD Alfa Centauri, and SD Bhayangkara, and lots more. 2. PT Enesis distribute hand sanitizer in every classroom that have difficult access in the manufacturing the washbasins as many as 100 units. 3. PT Reckitt Benckisser distribute CSR in Dettol Healthy Living Mission program to build 270 sink and provide 50,000 bottles of Harpic toilet cleaners. 4. PT Boehringer Ingelheim provides funds to increase the competence of doctors that manage Students Health Units (UKS) program. 5. PT Biofarma and BTPN provides funds for the renovation of Students Health Units/UKS and PKPR Secretariat. 6. FRPBS (Forum Rembug Peduli Bandung sehat) and BJB (Bank of West Java-Banten) facilitates student with health report cards as much as1,500 books. 7. And other assistances in the form of goodie bags from many others that are too numerous to mention one by one.

 8. What were the most successful outputs and why was the initiative effective?
I. The introduction to the brand new approach through the healthy school competition system for every 3 years, and the initiation of MOU on the health fund for school. II. The use of IT System with WhatsApp group between the related parties, such as from the District level, Public Health Centre and School Officer. III. The improvement of the active participation from all engaged parties namely the student, School Principal, Foundation Officer and student parent committee, Supervision Team, UKS at district level. IV. The Student Health Rate during the health screening and routine medical check-up shows a significant increase. V. Several great achievements of Healthy School Supervision from 2013 to 2014, such as : • SD BPI the 1st rank for Healthy School Competition at City level; • SMAN 8 the 1st rank for Healthy School Competition at City level; • TP UKS of Lengkong District the 3rd rank Competition at City level; • Consolation prize winner II Kid Doctor Competition at City level for period of 2014-2015; • SD BPI the 1st rank for Healthy School Competition at Provincial Level; • SD BPI the 2nd rank for Healthy School Competition at National Level; • SDN Karang Pawulang placed consolation prize winner I for Healthy School Competition at City Level; • SMPN 13 placed consolation prize winner II for Healthy School Competition at City Level; • SMKN 4 placed consolation prize winner II for Healthy School Competition at City Level; • TP UKS of Lengkong District the 3rd rank for Competition at City Level; • Achieved the 3rd rank for Kid Doctor Competition at City Level. For Period of 2015–2016 : • TP UKS of Lengkong District the 1st rank Competition at City level; • TK Pertiwi the 1st rank for Healthy School Competition at City level; • SMPN 13 the 1st rank for Healthy School Competition at City level; • SMAN 8 the 3rd rank for Healthy School Competition at City level; • SDN Karang Pawulang the consolation prize I for Healthy School Competition at City level. For Period of 2016–2017 : • SMPN 13 the 1st rank for Healthy School Competition at Provincial Level; • TK Pertiwi the 2nd rank for Healthy School Competition at Provincial Level; • TK GAGAS CERIA the 2nd rank for Healthy School Competition at City level; • SD KARTIKA X-1 the 2nd rank for Healthy School Competition at City level.

 9. What were the main obstacles encountered and how were they overcome?
a. The rejection from the School parties/officers, including the parents of students during the initial stage of UKS programme initiation, since the school deemed that this programme was merely a ceremonial competition which may led into a huge expenses and could interrupt the educational process. While for the activity operations, the school itself also encountered a dificulty. These obstacles could be settled by maintaining the good relationship, creating a persuasive and personal approach, and ultimately, building the understanding that the purpose of UKS supervision is to increase the students health rate as the human resource for the future. b. The effort to change the current behaviour into the Clean and Healthy Living Behaviour, actually it was so time, effort consuming and so thoughtfull. The solutions had been taken were to colaborate with all parties by sustainably providing the health socialization, conducting the health screening, conducting the kid doctor training and building the youth health cadres. c. The lack of good coordination at the Supervisor level, since they had been used to the old established pattern, which meetings must be held in face to face and it always required a big expenses. The solution for these issue was by using WhatsApp group which so much helpful in communication. Therefore, all members can get their work done even in a distance location. d. The limited Human Resources, with the limited numbers of Human Resources, the schedule was arrange in a such kind, therefore the task delegation may be done in the even manner, and a solid teamwork can be achieved, in addition, some cooperations with the Nursery Academy, Faculty of Medicines, Faculty of Dentistry from reputable universities in Bandung City, therefore it may assist the duty of UKS workers, accordingly a targeted Health Check Up & Health Socialization can be well-achieved.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
a. For the Puskesmas. For us, this represents that the programme has been successfully carried out gradually. We could also result in a prominent Achievmentseither at Bandung City Level, West Java Province Level and National Level. We also become the object of work visit from several areas in terms of UKS programme. And we also become the assessment focus of the Healthy City Competition at the National Level, Swasti Saba. b. For School. There are an improvement in the health facility and infrastructure, imporovement in the student’s heath rate, achievement in term of the healthy school category, and the increased awareness and participation in order to achieve the optimum health rate. c. The assistances from various party for the outstanding school. It can motivate the other schools to follow our path. d. Several schools have become the Supervisor (IMBAS) for the other schools, such as SD BPI. The School Principal and teachers who are engaged as the speakers and references for the other schools.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
1. For the Puskesmas. For us, this represents that the programme has been successfully carried out gradually. We could also result in a prominent Achievmentseither at Bandung City Level, West Java Province Level and National Level. We also become the object of work visit from several areas in terms of UKS programme. And we also become the assessment focus of the Healthy City Competition at the National Level, Swasti Saba. 2. The Target of the health initiative/ effort as being viewed from the school coverage, and the students when being associated to the compulsory education, the quality of programme implementation has been reached. The number of students who have obtained the health screening reflecting 100% achievement, along with the sustainable priodical screening and sustainable socialization. The Clean and Healthy Living Behaviour has also reached the targeted rate, in addition, the threat of such diseases against the students is still the major issue by the existence of epidemic disease and the malnutrition or overnutrition issues. This satisfying result can be seen from the decreased numbers of ill students and the increased students health status during the health screening and periodic health check up.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
- Pelayanan Kesehatan Peduli Remaja (PKPR) or Adolescent Freiendly Health Services is provided through counselling via SMS/WA so students can access the service for consulting about the health problems they have without being embrassed. We also provide PKPR consultation room at Puskesmas Talaga Bodas for teenagers who want to have face to face consultations. PKPR rooms are designed in a way that is comfortable for teenagers, especially for female teenagers who have so many problems in facing their reproductive organs growth. - Basic sanitations which have met the health requirements : Toilet, fresh water have been settled by the fulfillment of the required numbers of toilet in accordance with the comparison to the numbers of student. Most of the healthy schools have provided an adequate numbers of toilet with good quality standards. The comparison of the female toilet is 1:25 female students, and for the male toilet is 1:40 male students. Moreover we provide feminine napkins in toilet to assistant those who have their periods/ menstruation.

Contact Information

Institution Name:   Health Office of Bandung City (Dinas Kesehatan Kota Bandung)
Institution Type:   Local Government  
Contact Person:   Siska Gerfianti
Title:   Head of Talahgabodas Public Health Center  
Telephone/ Fax:   +62 85222990088
Institution's / Project's Website:  
E-mail:   s.gerfianti@yahoo.com  
Address:   Talagabodas St.
Postal Code:   40262
City:   Bandung
State/Province:   West java
Country:  

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