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Abstrak :
Di negara berkembang termasuk Indonesia, setiap tahun lebih dari 11 juta anak memnggal sebelum mereka berusia lima tahun, dan terbanyak meninggal sebelum berusia satu tahun. Tujuh dari sepuluh kematian balita disebabkan diantaranya oleh (ISPA) terutama pnemonia. WHO dan UNICEF mengembangkan suatu strategi yang disebut Integrated Management of Childhood Illness (MCI) dan di Indonesia diadopsi menjadi Manajemen Terpadu Balita Sakit ( MTBS ). Pada tahun 2001 Propinsi Riau mulai melakukan uji coba penerapan MTBS di dua kabupatenl kota yaitu Kabupaten Kampar dan Kota Pekanbaru Berdasarkan basil evaluasi pendekatan MTBS, di Puskesmas Rumbai pada tahun 2001, cakupan pnemonia meningkat sangat tinggi yaitu 15 kali lipat dari sebelumnya, artinya selama ini banyak kasus pnemonia di masyarakat yang tidak terdeteksi, dan dengan algoritma MTBS kasus pnemonia dapat ditemukan. Tujuan dari penelitian ini untuk menilai validitas dan reliabilitas dari algoritma MTBS dalam mendiagnostik pnemonia dengan menghitung sensitifitas, spesifisitas, nilai duga positif, rasio kemungkinan, dan kesesuaian kappa Cohen. Metodologi adalah penelitian diagnostik dengan rancangan penelitian krosseksionaI analitik . Subyek penelitian adalah balita sakit dengan batuk dan kesukaran bemafas, berumur 2 - 59 bulan yang datang berobat ke RSUD Pekanbaru, selama saw bulan yaitu Januari 2003. Setiap subyek diperiksa oleh lima pemeriksa yaitu perawatl,2, dokter 1,2, dan dokter spesialis anak sebagai gold standard, dan berdasarkan pemeriksaan dokter anak ditentukan apakah anak perlu dilakukan pemeriksaan foto thorak atau tidak. Hasil : Dad 112 balita yang diperiksa terdapat laki-laki 59 ( 50,9 %) dan perempuan 53 ( 49,1 % ), umur rata-rata adalah 24 bulan, dirnana umur terendah adalah umur 2 bulan dan tertinggi adalah 59 bulan. Dan 1 12 balita yang diperiksa sebanyak 63 balita di foto thorak berdasarkan pennintaan dokter spesialis anak kemudian didiagnosis sebagai pnemonia 58 balita dan 5 batuk bukan pnemonia_Klasifikasi pnemonia berdacarkan algoritma MTBS yang dilakukan oleh perawat 1,2 dan dokter 1,2 yang dibandingkan dengan gold standard adalah sebagai berikut : Sensitivitas : 78 % (CI 65,1 -- 86,4 %), 76 % (CI 63,5 - 85,0 %), 81 % (CI 69,1- 89,1 %) and 78 % (CI 65,3 - 86,4 %). Spesifisitas: 89 % (CI 77,8 - 94,8 %), 89 % (CI 77,8 - 94,8 %), 91 % (CI 80,1 - 96,0 %) and 94 % (CI 84,9 - 98,1 %). Nilai duga positif : 88 % (CI 76,6 - 94,5 %) 88 % (CI 76,2 - 94,4 %), 90 % (CI 79,4 - 95,8 %) and 94 % (CI 83,2 - 97,9 %). Nilai dugs negatif : 79 % (Cl 66,9 -- 87,1 %), 77 % (CI 65,6 - 86,0 %), 82 % (Cl 70,1-89,4 % ) and 80 % (CI 68,3 - 87,7 %). Rasio kemungkinan : 7,0 9 % (CI 3,2 - 15 %), 6,90 % (CI 3,1 - 14,7 %), 9 % (CI 3,7 --20,3) and 13 % (CI 4,6 -- 42,3). Nilai Kappa Cohen : 0.66, 0,64, 0,72 dan 0,72 (p< 0.0001). Kesimpulan algoritma MTBS dapat digunakan dengan cukup akurat untuk menjaring kasus pnemonia baik oleh perawat maupun dokter, sehingga pendekatan. MTBS valid dan reliabel dalam mendiagnosis pnemonia. Algoritma MTBS sangat bermanfaat bila digunakan pada daerah dengan sumber daya yang kurang.

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Diagnostic Test of The Integrated Management of Childhood Illness (INICI) for Diagnosing Pneumonia in The General Hospital of Pekanbaru, 2003In the developing countries, every year more than 11 million children die before they reach their fifth birthday. Many of them die before the first year of life. Seven out of ten of these deaths are due to acute respiratory infections (mostly pneumonia), diarrhea, measles, malaria or malnutrition and the death is often clued to a combination of these conditions. Both WHO and UNICEF had developed the Integrated Management of Childhood Illness (IMCI) approach, which was then adopted in Indonesia in 1997. In 2001, the Province of Riau started to implement the IMCI approach in two districts namely: Kampar and City of Pekanbaru. Based on a monitoring of the IMCI approach in Puskesmas ( Public Health Centre) Rumbai Pekanbaru, pneumonia cases was found to be very high, i.e 15 times larger than that of the previous number. This data suggests that there are likely many pneumonia cases which are not detected in the community. The objectives of study were to asses .the validity of the algorithm of the IMCI for diagnosing pneumonia by calculating its sensitivity, specificity, predictive values and likelihood ratio. In addition, it was also to asses the reliability of algorithm of the IMCI for diagnosing pneumonia by estimating the inter-observer agreement. The method of the study was a diagnostic study using a cross-sectional design. The sample of the study were under-five children (aged 2-59 months) coming to General Hospital of Pekanbaru with complain of cough and difficult breathing. Data collection took place from January to February, 2001 Each subject was examined by 5 examiners: 2 nurses, 2 general physicians (GP) and 1 pediatrician. Based on pediatrician examination, the chest X-ray was then made. The result of the examination of the pediatrician was used as a gold standard. In addition, results of the x Ray was examined by a radiologist. This result is also considered for gold standard. A total of 1 12 children were assessed 59 (50,9 %) boys and 53 (49,1 %) girls, with a median age of 24 months ( the age was range, 2 to 59 months ). A total of 63 children underwent a chest x - ray and the results showed 58 pneumonia and 5 No pneumonia. The classification of the pneumonia done by both the nurse 1,2 and General Physician 1,2 were compared with the gold standard.

Abstrak :
Tesis ini membahas penatalaksanaan bdita sakit dengan gejala diare menunrt standar Manzgemen Terpadu Balita Sakit (MTBS) di Aceh, Jawa Tengah, Jawa Timur, Kalimautan Selatan, Nusa Tenggara Timur, Sulawesi Tenggra, dan Sumatera Utara. Hasil analisis multivariat menunjuklran tidak ada satu pun variabel bebas yang berhubrmgan secara bermakna deagan tingkat kepatuhan petugas clalarn melakukan penilaian menurut standar MTBS. Selain itu variabel pelatihan memiliki hubungan bermakna dengan lresesuaian antara klasiiikasi yang ditetaplran petugas dengan klasifilrasi menurut pengamat, dan merupalran variabel bebas yang dominan terhadap kesesuaian antara klasifikasi yang ditetapkan petugas dengan klasilikasi menunrt pengamat dengan nilai OR sebesar 27,7. Sedanglran pelatihan dan kelengkapan alat merupalum faktor dominan terhadap kesesuaian antara pengobatan yang diberikan dengan klasilikasi yang ditetapkan petugas (tanpa tablet zinc). Selain itu variabel pelatihan juga merupalran faktor dominan terhadap kesesuaian antara pengobatan yang diberilran petugas dengan pengobatan menurut pengamat. Satu hal yang rnenjadi catatan panting dalam pemberian pengobatan adalah masih nendahnya kepatuhan baik petugas maupun pengamat dalam melaksanakau pedornan yaitu memberikan tablet zinc pada anal: dengan gejala diare. Saran, peninglratan keterampilan petugas mengenai pelaksanaan MTBS dan peningkatan dukungan fasilitas di setiap pclayanan kesehatan. ......This thesis is examined the treatment of childhood illness with diarrhoea as symptom according to Integrated Management of Childhood Illness (IMCI) in Aceh, Central Java, East Java, South Kalimantan, East Nusa Tenggara, Southeast Sulawesi and North Sumatera using a Cross Sectional Design with sample size is l06. The result of multivariate analysis is indicated none of independent variables are statistically significant to the health stafPs assessment compliance in evaluation related to IMCI. Training has showed significance in statistic among classification that set up by health stat? and classification according to evaluator. It is also a dominant independent variable with OR=27.7. Training and comprehensive tools is a dominant factor to the treatment related to the classification that set up by health stai¥`(without zinc tablet). Training itself is a dominant liactor to the treatment according to the classification of the health staff and evaluator. Suggestion, skill improvement of health about [MCI implementation and facility support improvement in every health center.

Abstrak :
Dengan meningkatnya tuntutan masyarakat terhadap mutu pelayanan kesehatan, maka fungsi pelayanan kesehatan secara bertahap harus terus ditingkatkan. Salah satu indikator untuk mengukur mutu pelayanan kesehatan adalah kepuasan pasien. Kepuasan pasien dipengaruhi oleh banyak faktor diantaranya adalah karakteristik pengantar balita dan kepatuhan petugas kesehatan terhadap standar pelayanan yang telah ditetapkan dalam pemeriksaan balita sakit. Tujuan penelitian ini adalah untuk mendapatkan gambaran tingkat kepuasan pengantar balita, untuk mengetahui hubungan antara kepuasan dengan karakteristik pengantar balita dan pemeriksaan balita sakit serta untuk mengetahui faktor yang paling dominan berhubungan dengan kepuasan pengantar balita. Rancangan penelitian adalah cross sectional, dilakukan di poli anak puskesmas uji coba DKI Jakarta pada bulan Mei 2001. Populasi penelitian adalah seluruh pengantar balita sakit yang berkunjung ke poli anak di lima puskesmas uji coba MTBS DKI Jakarta, dan balita tersebut mendapatkan pelayanan dengan pendekatan manajemen terpadu balita sakit. Sampel penelitian sebanyak 96 responden diambil secara proporsional dari lima puskesmas uji coba dan dilakukan secara purposive. Hasil penelitian menunjukkan bahwa tingkat kepuasan total dengan mean 72,7% terdapat 56,3% pengantar balita menyatakan puas. Tingkat kepuasan ini terdiri dari dimensi keterjangkauan pelayanan 55,2% puas, fasilitas puskesmas 54,2% puas, peralatan pemeriksaan dan obat-obatan 53,1% puas, kemampuan pelayanan 51% puas dan hubungan interpersonal petugas kesehatan dengan pengantar balita 51% puas. Faktor yang ada hubungan bermakna dengan tingkat kepuasan adalah jenis kelamin, umur, penghasilan dan kepatuhan petugas dalam pemeriksaan balita sakit. Pemeriksaan dengan kepatuhan tinggi (80%) menunjukkan 75,5% responder menyatakan puas. Sedangkan faktor yang paling dominan berhubungan dengan tingkat kepuasan adalah kepatuhan petugas dalam pemeriksaan balita sakit. Peningkatan mutu pelayanan harus dilakukan secara terus menerus, salah satu upaya adalah dengan meningkatkan kepatuhan petugas dalam pelayanan dengan pendekatan manajemen terpadu balita sakit. Keterpaduan program terkait dalam MTBS sangat diperlukan terutama untuk perencanaan, pelaksanaan, pemantauan dan evaluasi terhadap penerapan pendekatan MTBS di puskesmas. ...... Factors related to the satisfaction of the deliverer of the childhood illness (children under five years of age) which treated by the integrated management of childhood illness approach in children division of try out public health centers of DKI Jakarta, in May 2001The increasing demand of the community to qualified health care had forced this institution to improve their quality gradually and continuously. One of indicators to judge the quality of health care is patients? satisfaction. Patients? satisfaction is influenced by many factors such as the characteristic of the childhood illness deliverer and the obedience of health provider toward standard of care in examining the childhood illness. The purpose of this research is to describe the satisfaction of the childhood illness deliverer and their examination of childhood illness as well as the most dominant factor related to their satisfaction. The research used cross sectional design, conducted in children division of try out public health centers in May 2001. The population is all the childhood illness deliverer who visited children division in five try out public health centers by using the integrated management childhood illness approach, in DKI Jakarta. Samples are 96 respondents who had been taken purposively and proportionally in five those public health centers. The result of this research showed that 56,3% respondents were satisfied. Satisfaction level was consist of 53,2% of care achievability, 54,2% of facility, 53,1% of examination tool and medicine, 51% of care, 51% of interpersonal relationship with health provider. The most dominant factor to the satisfaction level is the obedience of health providers in examining the childhood illness. Considering the result of this research, I suggest to carry out this approach because it will be useful especially in planning, actuating, supervising as well as evaluating which should be focused on the obedience of health providers.

Abstrak :
Sejak tahun 1997, Departemen Kesehatan bekerjasama dengan WHO telah mengembangkan suatu pendekatan dalam tatalaksana balita sakit di tingkat pelayanan kesehatan dasar yang selanjutnya disebut sebagai Manajemen Terpadu Balita Sakit (MTBS). Kabupaten Sidoarjo Jawa Timur dengan dana bantuan WHO pada tahun 1997 pula telah mulai menerapkan pendekatan MTBS di 6 puskesmas. Tujuan penelitian ini adalah untuk memperoleh gambaran tingkat kepatuhan petugas pelaksana MTBS dan kepuasan ibu balita yang mendapat pelayanan dengan menggunakan tatalaksana MTBS di Kabupaten Sidoarjo. Penelitian ini menggunakan disain cross sectional dengan pendekatan kuantitatif dan kualitatif dengan jumlah sample sebanyak 12 petugas pelaksana MTBS dan 120 ibu balita. Pengumpulan data dilakukan dengan pengamatan secara langsung pada saat petugas memeriksa balita sakit dengan menggunakan daftar tilik dan wawancara terhadap ibu balita setelah selesai pelayanan dengan menggunakan kuesioner, kemudian dilakukan wawancara mendalam kepada petugas dan diskusi kelompok terarah dengan ibu balita. Hasil penelitian memperlihatkan bahwa pada tingkat kepatuhan petugas dengan menggunakan cut off point 90 dalam niiai kisaran kepatuhan tertinggi 100 dan terendah 83,32 maka sebanyak 65,80% petugas patuh dalam melakukan penilaian dan klasifikasi, 9I,70% petugas patuh dalam menentukan tindakan dan 66,70% petugas patuh dalam memberikan konseling. Untuk tingkat kepuasan ibu balita, dengan cut off point 29 dari total score 40, maka secara umum ibu balita menyatakan puas mendapat pelayanan dengan tatalaksana MTBS, tetapi masih ada 8,34% ibu balita yang tidak puas dalam hal keinginannya untuk kembali. Dengan uji statistik, pada p~,43 terdapat hubungan yang bermakna antara kepatuhan petugas dalam penilaian dan klasifikasi penyakit dengan kepuasan ibu balita dalam hal keinginannya untuk kembali membawa anaknya berobat ke puskesmas. Kesimpulan secara umum, tingkat kepatuhan petugas daIam tatalaksana MTBS sudah cukup baik, demikian pula kepuasan ibu balita terhadap pelayanan kesehatan dengan menggunakan tatalaksana sudah cukup tinggi. Maka disarankan kepada Dinas Kesehatan Kabupaten Sidoarjo untuk tetap mempertahankan kualitas bimbingan dan supervisinya agar kelangsungan pendekatan ini tetap terjaga. Bagi puskesmas perlunya memberikan penghargaan tertentu bagi petugas yang patuh untuk mempertahankan tingkat kepatuhan petugas , dan untuk meningkatkan kepuasan ibu perlu dilakukan sosialisasi tentang MTBS. Bagi Departemen Kesehatan perlu mempertimbangkan cut off point tingkat kepatuhan, disesuaikan dengan telah berapa lama puskesmas menerapkan MTBS. ......Relationship on the Compliance Rate of Health Workers and the Satisfaction Rate of Mothers on the Integrated Management of Childhood Illness at Distric Sidoarjo East Java year 2002Since 1997, the Ministry of Health Republic of Indonesia in collaboration with the World Health Organization has developed an approach in managing sick child underfive at the primary health services known as Integrated Management of Childhood Illness (LMCI). District of Sidoarjo, using WHO budget has started socializing the IMCI in 6 health centers on 1997. The objective of this study is to have a description of health worker's compliance and mother's satisfaction towards IMCI implementation in district Sidoarjo. The study will use cross sectional design with quantitative and qualitative approach with sum of sample to 12 IMCI-implement health workers and 120 mothers. Data collection is conducted by direct observation to health workers during sick child examination using a checklist and exit interviews to mothers using questionnaires then followed by an indepth interview to the health workers and focus group discussion to the mothers. The study showed that means of staff compliance score on IMCI procedures are 92,18; 96,56; 93,06 and 95,45 respectivety for patient assessment & classificatioiu; determine treatment; giving counseling; and average total compliance using cut-off 90, it is showed that compliance on treatment determination is highest with 91,70% respondent midwifes. Followed by giving counseling (66,70%) and assessment & classification (65,50%). Furthermore, this study showed level of satisfaction for IMCI service on high (by using cut-off score of 29 of total score 40), except that there are 8,30% of mothers who expreseed will not return for the IMCI services at the health center. Furthermore, using Chi Square statistic with exact p-value approach, it is showed that there is a significant relationship between compliance in assessment & classification and satisfaction in intention to return for the same services (p~,03). In conclusion, the compliance rate of health workers towards the IMCI achieve a higher level than Ministry of Health suggestion (80% comply)) similar results are shown for the mother satisfaction in health treatment. This study suggest the District Health Office of Sidoarjo to maintain its quality of IMCI services with adequate supervision and monitoring evaluation. Furthermore, Puskesmas manager should identify staff with excellent compliance and reward them adequately. For other staff, the manager may promote continuously the IMCI services. At last but not least, this study suggest the Ministry of Health recruits level of compliance based local experience on applying IMCI services.

Abstrak :
Analysis on the Compliance Rate of Health Personnel towards the Integrated Management of Childhood Illness at DKI Jakarta Health Center Year 2001The Ministry of Health Republic of Indonesia in collaboration with the World Health Organization, since 1997, has developed an approach in managing sick child under-five at the primary health services known as Integrated Management of Childhood Illness (IMCI). Today, IMCI has been implemented in 26 provinces (of 30 provinces present) covering 128 districts/municipalities in Indonesia. The province of DKI Jakarta, using regional budget 2000, has started socializing the IMCI to 14 health centers in 5 regions of Jakarta. How is the compliance of health worker in implementing the IMCI has never been studied. The objective of this study is to have a outline information on factors related to the health worker's compliance towards IMCI implementation at HC in Jakarta. The study will use "cross-sectional" design with quantitative and qualitative approach and total sample of 23 IMCI-implement health workers. Data collection is conducted by direct observation to the health workers during sick child examination using a checklist. After the observation, the health workers will fill in a questionnaire. Some secondary data will also be collected using the checklist for Monitoring IMCI record and checklist for supporting facilities. The result of the study shows that of 23 IMCI-implement health workers in DKI Jakarta 21.72% comply with interval value 58.61% - 90.28%, with cut off point value 80. The Internal factors is proven to have significant correlation with health worker's compliance with p = 0.04. While the external factors is proven to have significant correlation with human resources/MMCI facilities with p = 0.02 and leader's commitment with p = 0.009. In conclusion, the compliance rate of HC personnel in DKI Jakarta towards IMCI has not adequate. It is suggested to the Provincial Health Services DKI Jakarta to provide a health policy in managing sick child under-five using IMCI approach and at the same time improving quality of its monitoring and supervision. Health Center needs to have a clear task description for each of their personnel and a continued monitoring/supervision. A reward system should also be considered. The Ministry of Health needs to review the IMCI Monitoring and Supervision Checklist also considers Cut of Point of IMCI compliance rate and finalizing the Essential Drug for IMCI.

Abstrak :
The focus of the social science research on child health in developing countries is mainly confined in identifying the underlying determinants of morbidity and mortality. The underlying determinants of treatment seeking behavior during common childhood illnesses largely remain unexplored though it is an outcome of interactions among a number of spatial. demographic and socioeconomic factors. Treatment seeking in either the public or the private medical sector is also important as motivation to seek quality treatment by incurring cost associated with it. Using data from National Family and Health Survey (NFHS-2), 1998-99, this paper tries to identify various factors. which might have direct or indirect linkages with treatment seeking behavior during common childhood illnesses. The result of multinomial logistic regressions show that spatial factors like region and place of residence demographic factors like child's age, birth order and sex of the child and socioeconomic factors such as maternal education. standard of living of the household, religion anti caste. work status of the mother and exposure to mass media are significantly associated with treatment seeking behavior, especially in seeking treatment front private medical sector.

Abstrak :
Manajemen Terpadu Balita Sakit (MTBS) merupakan suatu pendekatan terhadap balita sakit yang dilakukan secara terpadu dengan memadukan pelayanan promosi, pencegahan, serta pengobatan terhadap lima penyakit penyebab utama kematian pada bayi dan balita di negara berkembang, yaitu pnemonia, diare, campak, dan malaria serta malnutrisi. Sistem informasi MTBS merupakan salah satu sarana untuk memantau pelaksanaan MTBS yang sampai saat ini belum berjalan secara optimal. Penelitian ini bertujuan untuk memperbaiki sistem informasi MTBS. Studi ini telah mengembangkan suatu sistem informasi MTBS di tingkat kabupaten/kota dengan menggunakan program aplikasi Microsoft Acces dan Microsoft Visual Basic 6.0. Dengan diterapkannya aplikasi ini akan memudahkan pelaksanaan pemantauan terhadap pelaksanaan MTBS di Propinsi Jawa Tengah khususnya di Kabupaten Kebumen. Selain itu juga untuk mengetahui cakupan, angka kejadian dan rasio pemakaian obat. Studi kasus dilakukan untuk Program ISPA dan Diare, karena tingginya angka kesakitan da kematian balita yang disebabkan kedua penyakit tersebut. Dari hasil uji coba skstem informasi tersebut dengan menggunakan data Kabupaten Kebumen diketahui bahwa ketidaktepatan petugas Puskesmas Prembun pada bulan Desember tahun 2002 dalam mengklasifikasikan keluhan batuk dan diare balita umur 2 bulan sampai 5 tahun masing-masing adalah 19,05% dan 28,57%, Untuk keluhan diare umur 1 minggu sampai 2 bulan adalah 100%. Sedangkan ketidaktepatan petugas Puskesmas Prembun pada bulan Desember tahun 2002 dalam menentukan tindakan untuk keluhan batuk balita umur 2 bulan sampai 5 tahun masing-masing adalah 57,14%, Sedangkan di Puskesmas Kebumen II pada bulan Januari tahun 2003 angka kejadian diare 34,63 dan cakupan diare 42,69%. Pada bulan Februari tahun 2003 di Puskesmas Kebumen 11 cakupan pnemonia desa Tersobo 16,67% dan desa Prembun 2,7%. Sedangkan angka kejadian untuk desa Tersobo 12,82 dan desa Prembun 2,43. Rasio pemakaian obat kedua desa tersebut 0,33. Pada bulan Februari tahun 2003 cakupan penderita pnemonia Puskesmas Kebumen II 6,52% dan Puskesmas Prembun 10%. Angka kejadian Puskesmas Kebumen II 6,04 dan Puskesmas Prembun 9,3. Rasio pemakaian obat untuk kedua puskesmas tersebut 0,33. Selanjutnya disarankan agar sistem ini dapat dipergunakan dan diterapkan di semua Kabupaten /Kota. Daftar bacaan : 24 (1989 - 2002) Development Information System of Integrated Management of Childhood Illness (IMCI) to District/Municipal Level (Cases Study for ARI and Diarrhea Program at Kebumen District Central Java Province)Integrated Management of Childhood Illness (IMCI) ks an approach toward child illness which is integrated with promotion service, prevention, and also treatment to five diseases those are pneumonia, diarrhea, measles, and malaria as the main causal factors of death in baby and child at developing countries. IMCI information system in a tool to monitor carrying out of IMCI which is not run optimal yet until now. This research aims to improve IMCI informatkon system. This study has developed an IMCI information to district/municipal level by using Microsoft Access and Microsoft Visual Basic 6.0 application program. By using this application it will be copy to monitoring the implementation of IMCI at Central Java Province, especially at Kebumen District. It is also to knowing coverage, incidence rate, and medicine use ratio. Case study of ARI and Diarrhea is done because thekr illness rate and death rate are high. For the try out of this system by using data of Kebumen District it is known that incorrect of health workers Prembun Public Health Centre on December 2002 in classifying complaint of cough and diarrhea to child who have age 2 month until 5 years old are 19.01% and 28.57%. For diarrhea complaint in one week to 2 month is 100%. While an incorrect of health workers Prembun Public Health Centre on December 2002 in taking action to complaint of cough to child who have age 2 month until 5 years old are 57.14%. While in Kebumen II Public Health Centre on January 2003 incidence rate of diarrhea 34.63 and coverage 42.69% On February 2003 Kebumen II Public Health Centre at coverage pneumonka of Tersobo village 16.67% and Prembun village 2.7%. Incidence rate Tersobo village 12.82 and Prembun village 2.43, Ratio of medicine used each villages are 0.33. On February 2003 coverage pneumonia of Kebumen II Public Health Centre 6.52% and Prembun Public Health Centre 10%. Inckdence rates Kebumen II Public Health Centre 6.04 and Prembun Public Health Centre 9.3. Ratio of medicine used each Public Health Care 0.33..The suggestion for further research is this system can be used and implemented at all district/municipal level. References : 24 (1989 - 2002)