The Analysis of Health Functional Position Level Requirements in Indonesian's Urban Health Centers

International Journal of Advanced Science and Technology
Vol. 29, No. 4s, (2020), pp. 1750-1764
THE ANALYSIS OF HEALTH FUNCTIONAL POSITION LEVEL

REQUIREMENTS IN INDONESIAN’S URBAN HEALTH CENTERS
Meldasari Said*1, Raden Madhakomala2, Fahmi Idris3
123
Universitas Negeri Jakarta 13220, Indonesia
Abstract
This study aims to identify the type of health functional position and the level of functional position
appropriate to be placed in the health center. This is because the placement of health workers in the
Indonesian Public Health Center (Puskesmas) is still not standard. It is characterized by the absence of
government regulations, both central and regional, which explicitly state the right type of functional health
position to be placed in the puskesmas. This study used a job-fit comparison method. Through a
questionnaire distributed to health workers serving in selected puskesmas in DKI Jakarta and the city of
Banjarbaru, South Kalimantan province, each health worker was asked to fill in the tasks that he/she had
done, then compared with job descriptions of each type of health functional position that was contained in
each of the Minister of Utilization of the State Apparatus. Based on this comparison, there is a range of
levels of functional health positions that could be placed in urban health centers, which regulates the
functional level requirements of 15 functional health positions cover of Public Health Instructors,
Sanitarians, Doctors, Dentists, Nurses, Dental Nurses, Midwives, Nutritionists, Health Laboratory Staff,
Radiographers, Pharmacists, Assistant Pharmacists, Epidemiologists, Entomologists, and Medical
Recorders.
Keywords: Health Functional Position, Health Workers, Health Centers, Puskesmas, Job Fit Comparison
Method, Human Resource Management
1. Introduction
Since 1 January 2014, the National Health Insurance (JKN) has been implemented in the Healthy Indonesia
Program, which provides free health services to all Indonesians. This makes the puskesmas as a first-level
health service facility increasingly busy with community treatment efforts. If the first-level health service
facilities are not strengthened, the community will access the advanced health facilities so that the
phenomenon of the hospital as a giant puskesmas will re-occur (Rahma, Arso, & Suparwati, 2015). Studies
show that human health resources in the aggregate and significantly contribute to three health indicators,
especially on maternal, infant and under-five mortality rates (Anand & Bärnighausen, 2004). To achieve
health goals in a population is highly dependent on providing services that are effective, efficient,
accessible, appropriate and of high quality by personnel, present in sufficient quantities, and appropriately
allocated in a variety of jobs and different geographical areas (Dussault & Dubois, 2003). For this reason,
the human resource management function needs to be substantially improved in the public sector as a whole,
and especially in the health sector (Hongoro & Mcpake, 2004).
In Article 16 paragraph 3 of the Minister of Health Regulation No. 75 of 2014 concerning Puskesmas, it is
stated that each Puskesmas must have a minimum of 9 types of health workers, namely, Doctors, Dentists,
Nurses, Midwives, Public health workers, Environmental health workers, Medical laboratory technology
experts, Nutritionist, and Pharmacy.
However, it must be realized that in the health sector there are 28 functional positions that can be assumed
by these health workers as regulated in Minister of Health Regulation No. 73 of 2013 concerning General
Functional Position within the Ministry of Health. However, in the implementation of the placement of
functional positions, health standards are not yet standard among Puskesmas, and the
ISSN: 2005-4238 IJAST

Copyright ⓒ 2020 SERSC 1750
Vol. 29, No. 4s, (2020), pp. 1750-1764
requirements/qualifications for principals which include job levels are not standard either. This is because
the interpretations of the types of health workers in puskesmas can vary. For example, in Law Number 36
the Year 2014 concerning Health Workers, what is meant by Public Health Workers consists of health
epidemiologists, health promotion staff and behavioral sciences, occupational health advisers, health policy
and administration personnel, biostatistics and population personnel, and reproductive health personnel and
family. Based on the above explanation it is not clear which functional positions are appropriate to be placed
in puskesmas.
Seen from a number of regulations in the health sector in DKI Jakarta Province, no regulations have been
found that explicitly mention the formation and type of health workers needed at the Puskesmas. DKI
Jakarta Provincial Governor Regulation Number 334 of 2014 concerning the Establishment of Organization
and Work Procedures of the Puskesmas did not mention the list of functional position groups needed at the
Puskesmas. This regulation only states that functional position groups are regulated in the Governor's
Regulation as part of the Health Office functional position arrangements (article 14 paragraph 4).
In addition, the DKI Jakarta Provincial Governor Regulation No. 233 of 2014 concerning the Organization
and Work Procedures of the Health Service did not mention details about functional positions. It was only
in Governor Regulation No. 31 of 2016 concerning the Formation of Health Functional Occupations
mentioned 28 types of health functional positions as regulated in Minister of Health Regulation No. 73 of
2013 concerning General Functional Positions in the Ministry of Health. In several articles in Governor
Regulation No. 233 of 2014 it mentions several types and levels of functional health positions that may be
placed to provide health services according to their field of knowledge in regional health service facilities,
including: (1) Doctors, (2) Nurses, (3 ) Dentists, (4) Pharmacists, (5) Assistant Pharmacists, (6) Health
laboratory staff, (7) Midwives, (8) Dental nurses, (9) Sanitarians, (10) Nutritionists, (11) Radiographers,
(12) ) Medical recorders, (13) Electromedical technicians, (14) Physiotherapists, (15) Optician
refractionists, (16) Speech therapists, (17) Occupational therapists, (18) Blood transfusion technicians, (19)
Medical physicists, and (20) Clinical psychologist. However, this regulation also does not explicitly
mention the types and levels of functional health positions that can be placed at the Puskesmas.
In the City of Banjarbaru, South Kalimantan province, there is also no regulation that explicitly mentions
the formation and type of functional health positions needed at the Puskesmas. Banjarbaru Mayor
Regulation Number 76 the Year 2017 Concerning Establishment of Organization and Work Procedure of
Health Office and Puskesmas does not mention the list of functional position groups needed at Puskesmas.
This regulation only mentions the person in charge of health programs at the Puskesmas. Thus the functional
health positions needed at the Banjarbaru health center also did not explicitly mention both the type and
level of position that showed qualifications for the abilities and work experience needed at each puskesmas.
In the absence of standards regarding the placement of health functional workers in puskesmas, it is feared
that community service standards will be different. It may be that in one puskesmas the patient will meet
with senior or experienced health workers, whereas in another puskesmas the patient will only encounter a
newly graduated health worker so that the delivery of health services will be uneven in the quality of service.
The quality of health services refers to the level of perfection of health services in generating satisfaction
in each patient according to the level of satisfaction of the average population, as well as the needs and
demands, the more perfect the satisfaction, the better the quality of health services (Setia, Muhyi, & Husaini,
2017). As a result of the difference in the placement of health workers raises the question that which
functional health positions are appropriate to be placed in puskesmas? As well as what level of the
functional position is appropriate for serving patients at the puskesmas?
2. Concepts
In Indonesia, the first level of health services is carried out by the Puskesmas. Community Health Center
(Puskesmas) according to Minister of Health Regulation Number 75 the Year 2014 is a health service
facility that organizes public health efforts and first-level individual health efforts, by prioritizing promotive
and preventive efforts, to achieve the highest degree of public health in the working area. Along with the

Vol. 29, No. 4s, (2020), pp. 1750-1764
growing demands in health services, increased attention is being focused on human resources management
(HRM). Specifically, human resources are one of three principle health system inputs, with the other two
major inputs being physical capital and consumables (Kabene, Orchard, Howard, Soriano, & Leduc, 2006).
The World Health Organization (WHO) defines health workers or health workers as "... all people engaged
in actions whose primary intent is to enhance health." (Chen et al., 2006). Based on these definitions, The
International Standard Classification of Occupation (ISCO) classifies all workers engaged in the health
sector as health workers, as shown in the figure below (Chen et al., 2004).
Figure 1 Classification of Health Workers Based on ISCO-88
In the above classification, health workers are divided into:

a. Health Service Providers, such as health professionals (Doctors, Nurses, Midwives, etc.),
supporting professionals (Radiologists, Dental Assistants, Laboratory Experts, etc.), and
communities in other health fields (Traditional Medicine Specialist, Acupuncturist, and others).
b. Supporting workers in the field of health management, such as administrators in hospitals,
accountants in hospitals, ambulance drivers, and others.
Kabene et al also explained human resources, when asked for health care, can be defined as the different
types of clinical and non-clinical staff responsible for public and individual health intervention (Kabene et
al., 2006).
In order not to cause confusion over the definition of health workers mentioned in ISCO, in Indonesia the
above definition is more likely to be referred to as Human Health Resources (HRK), namely "... professional
health workers including strategic health workers and non-professional health workers as well as
supporting/supporting personnel health involved and worked and devoted himself as in the effort and
management of health. "(Decree of the Minister of Health No. 857 of 2009 concerning Performance
Assessment of Health HR at the Puskesmas).
Furthermore, Law Number 36 Year 2014 Regarding Health Workers confirms the definition of health
professionals as Health Workers which in Article 1 states; "Health Workers are all people who devote
themselves in the field of health and have knowledge and / or skills through education in the health sector
which for certain types require authority to carry out health efforts." In article 11 of Law Number 36 the
Year 2014 states health workers are grouped into the:

Vol. 29, No. 4s, (2020), pp. 1750-1764
a. Medical personnel, consisting of Doctors, Dentists, Specialists, and Specialist Dentists.

b. Clinical psychology personnel, namely Clinical Psychologists
c. Nursing staff, including various types of nurses.
d. Midwifery, namely Midwife.
e. Pharmaceutical workers, including Pharmacists and Pharmaceutical Technical Workers.
f. Community health workers, consisting of Health Epidemiologists, Health Promoters, Occupational
Health Guides, Health Administrators, Biostatistics and Population Personnel, and Reproductive
and Family Health Personnel.
g. Environmental health workers, consisting of Environmental Sanitation, Health Entomologists, and
Health Microbiologists.
h. Nutritionists, including nutritionists and dietitians.
i. Physical ignition energy, consisting of Physiotherapist, Occupational Therapist, Speech Therapist,
and Acupuncture.
j. Medical technicians, including Medical Recorders and Health Information, Cardiovascular
Technicians, Blood Service Technicians, Optional / Optometrist Refractionists, Dental
Technicians, Anesthesiologists, Dental and Mouth Therapists, and Audiologists.
k. Biomedical engineering personnel, consisting of Radiographers, Electromedics, Medical
Laboratory Technology Experts, Medical Physicists, Radiotherapists, and (38) Prosthetic
Orthotics.
l. Traditional health workers, consisting of Herb Health Traditional Workers, and Traditional Health
Workers Skills.
Health workers in the Puskesmas are mostly occupied by functional health officials who are Civil Servants
(PNS). The rests are contract workers in the health sector or non-PNS honorary staff or Non-permanent
Employees (PTT). According to Law Number 5 of 2014 concerning State Civil Apparatus (ASN), a
Functional Position is a group of positions that contain functions and duties related to functional services
based on specific expertise and skills. As is known, based on Minister of Health Regulation No. 73 of 2013
concerning General Functional Positions in the Ministry of Health there are already 28 functional positions.
Each functional position is regulated in a Decree of the Minister of Administrative Reform (Kepmenpan)
or Regulation of the Minister of Administrative Reform (Permenpan) that establishes and regulates
functional positions, including functional positions in the health sector. The twenty-eight functional health
positions consist of 1) Health Administrator, 2) Pharmacist, 3) Pharmacist Assistant, 4) Midwife, 5) Doctor,
6) Clinical Educator Doctor, 7) Dentist, 8) Epidemiologist, 9) Entomologist, 10) Physiotherapist, 11)
Medical Physicists, 12) Nutritionists, 13) Prosthetic Orthotics, 14) Occupational Therapists, 15)
Occupational Health Counselors, 16) Public Health Instructors, 17) Nurses, 18) Dental Nurses, 19) Medical
Recorders, 20) Health Laboratory Staff, 21) Clinical Psychologists, 22) Radiographers, 23) Optometric
Refractionists, 24) Sanitarians, 25) Dental Technicians, 26) Electromedical Technicians, 27) Blood
Transfusion Technicians, and 28) Speech Therapists.
According to Law number 5 of 2014 concerning State Civil Apparatus, functional positions consist of
functional positions of expertise and functional positions of skills. Each position has the following levels:
1) functional position of expertise, consisting of the following range of positions; main expert; associate;
junior expert; and the first expert. 2) Skills functional positions, consisting of the following range of
positions (starting from highest to lowest); supervisor; proficient; skilled; and beginner.
For functional positions, expertise generally has minimum educational requirements equivalent to S1.
Whereas functional skills generally require a minimum education level of D3. However, if examined
through the duties and functions of the Puskesmas, it appears that not all types of functional positions in
the health sector mentioned above are needed in the Puskesmas. Even the appropriate functional position
to be placed at the Puskesmas has not yet been regulated in detail. For this reason, it is necessary to analyze
the positions in the Puskesmas.

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Job analysis forms the basis for many activities in the field of human resource management. Job analysis is
the most important technique in human resource management (Amstrong, 2009). Job analysis classifies one
position with another, within an organization, and is based on observation and study. Job analysis activities
include identifying job descriptions and / or job classifications. Job analysis is the procedure for determining
the duties and skills requirements of a job and the kind of person who should be hired for (Dessler, 2011).
More than that, Bowin and Harvey have discussed the significance of job analysis to human resource
management but they found job analysis as a strategic human resource (HR) management practice having
a prospective contribution in the organizational performance (Ashraf, 2017).
3. Methodology
This study was not conducted on health workers in all Puskesmas in Indonesia, but only in DKI Jakarta and
the city of Banjarbaru, South Kalimantan. The selection of the Puskesmas was not random but adjusted to
the availability of resources available for the study, although it was endeavored to represent the Puskesmas
categories as far as possible.
Research design, according to E. A. Surachman, is all the processes required in conducting research (Nazir,
2014). Referring to Shah's opinion, the design of this study is a descriptive-analytical study design (Nazir,
2014). Called descriptive because this study to find facts with the right interpretation. This includes
exploring activities to accurately portray the characteristics of several phenomena (in this case functional
positions at the Puskesmas) and formulating something (in this case the Functional Position Standards at
the Puskesmas). The formulation was made after analysis in the form of comparison as stated above.
Because it involves a position (job), then more precisely the design of this study is called a job fit analysis
by comparison method.
a. Samples and Respondents
The sample of Puskesmas in this study was selected with certain consideration/purposive sampling
(Sugiono, 2009). The reference for it is the territory and the Puskesmas category. The Puskesmas category
observed was urban Puskesmas. On a regional basis, regions that can represent specific regions are selected,
namely regions that tend to develop into megapolitans, and general urban areas, namely regions in Indonesia
in general.
Based on these opinions and considerations, the study areas and Puskesmas categories are determined as
follows:
1) Special Region:
DKI Jakarta
No Regions Puskesmas Names Type of Services
1. Jakarta Pusat Menteng District Outpatient – Delivery
Room - PONED
2. Jakarta Timur Ciracas District Inpatient – Delivery Room –
PONED
3. Jakarta Selatan Mampang Prapatan District Inpatient – Delivery Room –
PONED
4. Jakarta Barat Palmerah District Outpatient – Delivery Room
- PONED
5. Jakarta Utara Kelapa Gading District Outpatient – Delivery Room
- PONED

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2) Urban Common Areas:

Banjarbaru City, South Kalimantan Province
No Region Puskesmas Names Type of Services
1. Banjarbaru Guntung Manggis Outpatient
2. Banjarbaru Guntung Payung Outpatient
3. Banjarbaru Banjarbaru Selatan Outpatient
4. Banjarbaru Banjarbaru Utara Outpatient
5. Banjarbaru Landasan Ulin Outpatient
6. Banjarbaru Sei Ulin Outpatient
Respondents from this study are stakeholders of functional positions in selected Puskesmas. In each selected
Puskesmas, an inventory is carried out using a checklist to find out the types of functional health positions
in the Puskesmas and their assistants. If one position is held by more than one person, then all stakeholders
who meet the requirements become respondents. The respondent's requirements are:
1) Has held a functional position (if it is official as a functional official) or has carried out duties as a
functional official (if not yet an official as a functional official) for at least 1 (one) year at his
Puskesmas.
2) Status as a Civil Servant (PNS) or contract / honorary officer.
The informants in this study were mainly structural officials who were direct supervisors of the respondents,
or if not, the Head of the Puskesmas. This informant was not only treated as a resource for verification but
also as a respondent to explore information on human resource management (HRM) practiced at the local
health center.
This study requires primary data and secondary data. First: The collection of primary data from functional
position stakeholders in the sample Puskesmas was done through filling out the questionnaire as a primary
data collection tool, which was supplemented by interviews and focus group discussions.
Second: This study cannot also be called a full field survey (primary data collection), because it also
includes a study of information contained in documents and that comes from secondary data. The review
of information in the document is mainly carried out on decisions or regulations regarding the functional
positions under study, which are used as a reference in analyzing the results of primary (field) data
collection.
Secondary data in the form of information in documents, specifically in the form of decisions or regulations
regarding functional positions in the health sector, was collected from the Ministry of Health. Secondary
data in the form of documents about Puskesmas were collected in the regions, both at the Puskesmas
concerned and at the City Health Office.
b. Data Processing and Analysis Techniques
This study can also be called a qualitative study because it uses more non-quantitative analysis (not using
statistical formulas). Based on this, further items can be formulated that can be used as the contents of the
Standards for the Functional Position of Health Workers in Puskesmas.
Questionnaires from functional position respondent respondents that have been filled and verified, then
processed by collecting them in groups according to the category of functional position type.

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4. Results
To be able to carry out the duties and functions or services of the Puskesmas as mandated in the Ministry
of Health Regulation Number 75 of 2014, functional positions are required as illustrated in the following
table.
No Health Center Services Health Functional Needed
1. Health promotion services Community health counselor
2. environmental health services Sanitarian, Entomologist
3. MCH and Family Planning services Doctors, Nurses, Midwives
4. nutrition services Nutritionist
5. Disease prevention and control services Doctors, Dentists, Epidemiologists,
Entomologists, health laboratory staff
6. Outpatient Doctors, Dentists, Nurses, Midwives, Dental
Nurses, health laboratory staff, Medical
Recorders
7. Emergency services Doctors, Nurses, Midwives, Medical Recorders
8. One day service Doctors, Nurses, Midwives, Medical Recorders
9. Home care Doctors, Nurses, Midwives, Medical Recorders
10. Inpatient Doctors, Nurses, Midwives, health laboratory
staff, Radiographers, Medical Recorders
11. Puskesmas Management All functional health workers
12. Pharmacy Services Pharmacist, Pharmacist Assistant
13. Public Health Services Nurse
14. Laboratory Services Health Laboratory Staff
Observing the description above, it can be concluded that the functional positions that should be in the
Puskesmas consist of; (1) Public Health Instructors, (2) Sanitarians, (3) Doctors, (4) Dentists, (5) Nurses,
(6) Dental Nurses, (7) Midwives, (8) Nutritionists, (9) Health Laboratory Staff, (10) Radiographers, (11)
Pharmacists, (12) Assistant Pharmacists, (13) Epidemiologists, (14) Entomologists, and (15) Medical
Recorders.
However, this study found 3 functional positions that were generally not found in the Puskesmas, namely
(1) Epidemiologist, (2) Entomologist, and (3) Medical Recorders. If you look at the Puskesmas category,
you can find various other functional positions (outside the three functional positions) that are not in the
Puskesmas. In the urban Puskesmas in DKI Jakarta, there are only three functional positions that do not
exist. But in the Banjarbaru City Health Center, the absence of functional positions was increased by
Radiographers and Pharmacist Assistants. The full distribution of functional positions that do not exist in
the two urban Puskesmas can be seen in the following table.

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Urban Puskesmas Functional Positions which does not exist

DKI Jakarta Epidemiologist, Entomologist, Medical
Recorder (3 functional positions)
Kota Banjarbaru Epidemiologist, Entomologist, Medical
Recorder, Radiographer, Pharmacist Assistant
(5 functional positions)
Thus, the current functional positions in the selected Puskesmas in DKI Jakarta and the city of
Banjarbaru, South Kalimantan are as follows.
No Jakarta City No Banjarbaru City
1. Community Health Instructor 1. Community Health Instructor
2. Sanitarian 2. Sanitarian
3. Doctor 3. Doctor
4. Dentist 4. Dentist
5. Nurse 5. Nurse
6. Dental Nurse 6. Dental Nurse
7. Midwife 7. Midwife
8. Nutritionist 8. Nutritionist
9. Health Laboratory Staff 9. Health Laboratory Staff
10. Radiographers 10. Pharmacists
11. Pharmacists
12. Pharmacist Assistant
The job descriptions for each functional position obtained from each Puskesmas category are then referred
to the job description contained in the Minister of Utilization of the State Apparatus Regulation of each
functional position concerned. From the activity of referring/comparing, finally, it can be seen the range
(range) of levels of each functional position in each Puskesmas category. The range of functional positions
in DKI Jakarta (Puskesmas) and Banjarbaru City Puskesmas are shown in the following table.
No Fuctional Position Jakarta City Banjarbaru City

Rank Class Rank Class
1. Public Health Executor up to Administrator Implementer Administrator
Instructor Associate (II/c) up to up to (II/c) up to
Expert Junior Main Associate Junior Main
Advisor (IV/c) Expert Advisor (IV/c)
2. Sanitarian Novice Junior Novice Junior
Executor up to Administrator Executor up Administrator
(II/a) up to to Supervisor (II/a) up to

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Advance Junior Officer Officer lev.I

Executor lev.I (III/b) (III/d)
3. Doctor Junior Junior Officer Junior Expert Junior Officer
Expert lev.I (III/b) lev.I (III/b)
4. Dentist Junior Expert Junior Officer First Expert Junior Officer
up to Associate lev.I (III/b) up up to lev.I (III/b) up
Expert to Junior Main Associate to Junior Main
5. Nurse Skilled up to Administrator Skilled up to Administrator
Junior Expert (II/c) up to Junior Expert (II/c) up to
Junior Officer Officer lev.I
lev.I (III/b) (III/d)
6. Dental Nurse Skilled up to Administrator Skilled up to Administrator
Junior Expert (II/c) up to Supervisor (II/c) up to
Junior Officer Officer lev.I
lev.I (III/b) (III/b)
7. Midwives Novice Junior Novice Junior
Advance (II/a) up to to Supervisor (II/a) up to
Executor Junior Officer Officer lev.I
8. Nutritionist Executor up to Administrator Executor up Administrator
Supervisor (II/c) up to to Supervisor (II/c) up to
Officer lev.I Officer lev.I
(III/d) (III/d)
9. Health Laboratory Advance Junior Officer Executor up Administrator
Staff Executor up to lev.I (III/b) up to Supervisor (II/c) Officer
Supervisor to Officer lev.I lev.I (III/d)
(III/d)
10. Radiographist Skilled up to Administrator - -
Supervisor (II/c) up to
Officer lev.I
(III/d)
11. Pharmacist Junior Expert Junior Officer Junior Expert Junior Officer
12. Pharmacist Executor up to Administrator - -
Assistant Advance (II/c) up to
Executor Junior Officer
lev.I (III/b)
From these results, it appears that this study did not get a job description for Radiographers and Pharmacist
Assistants at the Banjarbaru City Health Center. This is due to the absence of these functional positions.
Likewise with the functional positions of Epidemiologists, Entomologists, and Medical Recorders in all
Puskesmas categories. What is also interesting is the functional position of the Doctor, which only reaches

Vol. 29, No. 4s, (2020), pp. 1750-1764
the Junior Expert in all Puskesmas categories. This happens because doctors at the Puskesmas are generally
contracted workers (PTT) who only work for 2-3 years and carry out simple tasks.
To complete the table above, a review was conducted to obtain equal functional positions in terms of the
initial education of its principals. Radiographers and Medical Recorders have the preliminary educational
equivalent of their principals with Nutritionists, namely D3 (Diploma of 3 years). Epidemiologist,
Entomologist, and Assistant Pharmacist with the initial educational equality of their leader with the
Midwife, namely high school or D1 (Diploma of 1 year). Whereas for the top-level functional positions
Doctors can refer to Dentists. Thus, for these functional positions a range of positions in the Puskesmas can
be made as follows.
No Functional Jakarta City Banjarbaru City
Position
Rank Class Rank Class
1. Doctor Junior Expert Junior Officer Junior Expert Junior Officer
Advisor(IV/c) Expert Advisor(IV/c)
2. Epidemiologist Novice Junior Novice Junior
Executor up to Administrator Executor up executor (II/a)
Advance (II/a) up to to Supervisor up to Officer
Executor Junior Officer lev.I (III/b)
lev.I (III/b)
3. Entomologist Novice Junior Novice Junior
Advance (II/a) up to to Supervisor (II/a) up to
Executor Junior Officer Officer lev.I
4. Medical Recorder Executor up to Administrator Executor up Administrator
(III/d) (III/d)
5. Radiographist Executor up to Administrator Executor up Administrator
(III/d) (III/d)
6. Pharmacist Executor up to Administrator Novice Junior
Assistant Advance (II/c) s/d Executor up Administrator
Executor Junior Officer to Supervisor (II/a) up to
lev.I (III/b) Officer lev.I
(III/b)
5. Conclusions and Discussion

a. Conclusion
Law Number 36 the Year 2014 regarding Health Workers stipulates that health workers must have a
minimum qualification of Diploma Three, except medical personnel. Based on the aforementioned
provisions and the formulation above, a Functional Position Standard can be drawn up for 15 Functional

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Positions that must be available at the Puskesmas. DKI Jakarta can be considered to represent metropolitan
urban areas, and the city of Banjarbaru represents Urban Health Centers.
1) Urban Health Center (DKI Jakarta)
a) Public Health Instructor:
• Lowest Level: Executor (Administrator / II-C)
• Highest Level: Associate Expert (Junior Main Advisor / IV-C)
b) Sanitarians:
• Highest Level: Advanced Executor (Junior Officer level I / III-B)
c) Doctor:
• Lowest Level: First Expert (Junior Officer Level I / III-B)
d) Dentist:
• Lowest Level: Junior Expert (Junior Officer Level I / III-B)
e) Nurse:
• Lowest Level: Skilled (Administrator / II-C)
• Highest Level: Junior Expert (Junior Officer Level I / III-B)
f) Dental Nurse:
• Highest Level: Junior Expert (Junior Officer Level I / III-B)
g) Midwife:
• Highest Level: Advanced Executor (Junior Officer Level I / III-B)
h) Nutritionist:
• Highest Level: Supervisor (Officer Level I / III-D)
i) Health Laboratory Staff:
• Lowest Level: Advanced Executor (Junior Officer Level I / III-B)
• The Highest Level: Supervisor (Officer Level I / III-D)
j) Radiographers:
k) Pharmacists:

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l) Pharmacist Assistant:
• Highest Level: Advanced Executor (Junior Officer Tk. I / III-B)
m) Epidemiologist:
n) Entomologists:
o) Medical Recorder:
2) Urban Health Center (City of Banjarbaru)

a) Public Health Instructor:
b) Sanitarians:
c) Doctor:
d) Dentist:
e) Nurse:
• Highest Level: Junior Expert (Officer Level I / III-D)
f) Dental Nurse:
g) Midwife:
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h) Nutritionist:
i) Health Laboratory Staff:
j) Radiographers:
k) Pharmacists:
• Highest Level: Associate Expert (Junior Main Advisor (IV-C)
l) Pharmacist Assistant:
m) Epidemiologist:
n) Entomologists:
o) Medical Recorder:
b. Discussion
Problems encountered relating to functional positions in the Puskesmas are mainly as follows.
1) The lack of functional position standards that must exist in the Puskesmas causes the District / City
Health Office not to know for certain the types of health workers who must be placed in the
Puskesmas.
2) The lack of types of health workers in the Puskesmas causes several functional positions that are
not needed. As a result, the functional positions are held by existing health workers, so that they
are carried out in a casual way and are not / less professional.
3) There is an overlapping of tasks between levels, causing no difference in tasks in the field between
one level and another (one level of functional position can do another level of tasks from the same
functional position).
4) Administrative staff in Puskesmas are very lacking, so many administrative tasks (such as
administration, statistics, reporting, etc.) become additional tasks for functional position

Vol. 29, No. 4s, (2020), pp. 1750-1764
stakeholders. In addition to being burdensome for functional office stakeholders, this also causes
the less professional implementation of administrative tasks because the executor is not / less
competent.
5) There are still many functional position stakeholders in Puskesmas who have not officially served
(do not yet have an official decree as a functional position holder). Their appointment as functional
officials is based on a decree from the Regent / Mayor and / or the Head of the Puskesmas. Thus
the functional occupational health holders do not get their rights (for example allowances for office)
adequately, depending on the financial capacity of the region.
6) Candidates for civil servants (CPNS) health workers, contracts (no permanent employee/PTT, etc.),
and volunteers cannot be designated as official functional positions, so their motivation to carry out
their duties is lacking, due to the absence of office allowance. Whereas Law Number 5 of 2014
concerning State Civil Apparatus (ASN) states that functional positions can be assumed by ASN
(which consists of Civil Servants and Government Employees with Work Agreements).
7) Lack of competence, responsiveness, and innovative functional position stakeholders at the
Puskesmas.
8) Based on the results of interviews with the Head of Puskesmas in big cities (metropolitan) such as
DKI Jakarta, the workload of functional officials, especially doctors, nurses, and midwives is quite
large, so that the required number of officeholders according to workload.
9) Lack of knowledge of the Head of the Puskesmas in Human Resources management.
References
[1] Amstrong, M. (2009). Amstrong"s Handbook of Human Resource Management Practice (11th
ed.). London: Kogan Page.
[2] Anand, S., & Bärnighausen, T. (2004). Human resources and health outcomes : cross-country.
The, 364: 1603–(October 30, 2004), 1603–1609. https://doi.org/https://doi.org/10.1016/S0140-
6736(04)17313-3
[3] Ashraf, J. (2017). Examining the Public Sector Recruitment and Selection in Relation to Job
Analysis in Pakistan. 1309134(31 Mar 2017).
[4] Chen, L., Evans, D., Evans, T., Sadana, R., Stilwell, B., Travis, P., … Zurn, P. (2006). Working
Together for Health: The World Health Report 2006.
https://doi.org/https://www.who.int/whr/2006/whr06_en.pdf
[5] Chen, L., Evans, T., Anand, S., Boufford, J. I., Brown, H., Chowdhury, M., … Michael, S.
(2004). Human resources for health : overcoming the crisis. The Lancet Journal, 364(figure 1),
1984–1990. https://doi.org/https://doi.org/10.1016/S0140-6736(04)17482-5
[6] Dessler, G. (2011). Human Resource Management (12th editi; E. Svendsen, ed.). Essex: Pearson
Education Limited.
[7] Dussault, G., & Dubois, C.-A. (2003). Human resources for health policies: a critical component
in health policies. Human Resources for Health, 1(1), 1. https://doi.org/10.1186/1478-4491-1-1
[8] Hongoro, C., & Mcpake, B. (2004). How to bridge the gap in human resources for health. The
Lancet Journal, VOLUME 364(October 16, 2004), 1451–1456.
https://doi.org/https://doi.org/10.1016/S0140-6736(04)17229-2
[9] Kabene, S. M., Orchard, C., Howard, J. M., Soriano, M. A., & Leduc, R. (2006). The importance
of human resources management in health care: A global context. Human Resources for Health,
4(27 July 2006), 1–17. https://doi.org/10.1186/1478-4491-4-20
[10] Nazir, M. (2014). Metode Penelitian. Jakarta: Ghalia Indonesia.
[11] Rahma, A., Arso, S. P., & Suparwati, A. (2015). Implementasi Fungsi Pokok Pelayanan Primer
Puskesmas Sebagai Gatekeeper Dalam Program Jaminan Kesehatan Nasional(Studi Di
Puskesmas Juwana Kabupaten Pati). Jurnal Kesehatan Masyarakat (e-Journal), 3(3l), 1–11.
https://doi.org/http://ejournal-s1.undip.ac.id/index.php/jkm IMPLEMENTASI

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[12] Setia, L., Muhyi, R., & Husaini. (2017). Pengaruh Mutu Pelayanan Terhadap Persepsi Kepuasan
Pasien di Laboratorium Puskesmas Kota Banjarbaru Tahun 2016. Jurnal Berkala Kesehatan, 3(1
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[13] Sugiono. (2009). Metode Penelitian Pendekatan Kuantitatif, Kualitatif dan R & D. Bandung:
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[14] Republik of Indonesia Law Number 5 of 2014 concerning State Civil Apparatus
[15] Republik of Indonesia Law Number 36 the Year 2014 concerning Health Workers
[16] Republik of Indonesia Minister of Health Regulation No. 73 of 2013 concerning General
Functional Position within the Ministry of Health
[17] Republik of Indonesia's Minister of Health Regulation No. 75 of 2014 concerning Puskesmas
[18] Decree of the Minister of Health No. 857 of 2009 concerning Performance Assessment of Health
HR at the Puskesmas
[19] DKI Jakarta Provincial Governor Regulation No. 233 of 2014 concerning the Organization and
Work Procedures of the Health Service
[20] DKI Jakarta Provincial Governor Regulation Number 334 of 2014 concerning the Establishment
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[21] DKI Jakarta Provincial Governor Regulation No. 31 of 2016 concerning the Formation of Health
Functional Occupations
[22] Banjarbaru Mayor Regulation Number 76 the Year 2017 Concerning Establishment of
Organization and Work Procedure of Health Office and Puskesmas


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International Journal of Advanced Science and Technology

Vol. 29, No. 4s, (2020), pp. 1750-1764

THE ANALYSIS OF HEALTH FUNCTIONAL POSITION LEVEL

ISSN: 2005-4238 IJAST

ISSN: 2005-4238 IJAST

Figure 1 Classification of Health Workers Based on ISCO-88

In the above classification, health workers are divided into:

ISSN: 2005-4238 IJAST

a. Medical personnel, consisting of Doctors, Dentists, Specialists, and Specialist Dentists.

ISSN: 2005-4238 IJAST

ISSN: 2005-4238 IJAST

2) Urban Common Areas:

ISSN: 2005-4238 IJAST

ISSN: 2005-4238 IJAST

Urban Puskesmas Functional Positions which does not exist

No Fuctional Position Jakarta City Banjarbaru City

ISSN: 2005-4238 IJAST

Advance Junior Officer Officer lev.I

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5. Conclusions and Discussion

ISSN: 2005-4238 IJAST

ISSN: 2005-4238 IJAST

• Highest Level: Associate Expert (Junior Main Advisor / IV-C)

2) Urban Health Center (City of Banjarbaru)

• The Highest Level: Supervisor (Officer Level I / III-D)

ISSN: 2005-4238 IJAST

ISSN: 2005-4238 IJAST

ISSN: 2005-4238 IJAST

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