Evaluasi Program Pencegahan dan Pengendalian Campak di Kota Yogyakarta Tahun 2018-2024

Boy Shandy, dr. Vicka Oktaria, MPH, Ph.D; dr. Risalia Reni Arisanti, MPH

2025 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Campak adalah penyakit yang sangat menular dan dapat menyebabkan komplikasi serius hingga kematian, terutama pada anak-anak. Data 2022 menunjukkan peningkatan signifikan kasus campak di Indonesia, termasuk di Provinsi DI Yogyakarta yang mengalami Kejadian Luar Biasa (KLB) suspek campak pada 2022-2023. Meski cakupan imunisasi MR1 di Kota Yogyakarta mencapai ?95?lam enam tahun terakhir, dan rata-rata cakupan MR2 sebesar 81,3?lum mampu mencegah terjadinya KLB campak. Penelitian ini bertujuan untuk mengevaluasi implementasi rantai dingin vaksin dan mengidentifikasi faktor-faktor yang memengaruhi ketepatan waktu vaksinasi campak pada bayi/baduta di Kota Yogyakarta. 

Metode: Studi ini mencakup tiga sub-studi penelitian. Sub-studi evaluasi program manajemen rantai dingin vaksin dengan metode deskriptif, sub-studi evaluasi sistem surveilans manajemen rantai dingin vaksin dengan metode deskriptif, dan studi analitik faktor yang memengaruhi ketepatan waktu vaksinasi menggunakan explanatory sequential mixed methods.

Hasil: Evaluasi menunjukkan bahwa program rantai dingin vaksin di Kota Yogyakarta memiliki kekuatan dalam perencanaan logistik dan dukungan anggaran, namun masih terdapat kelemahan seperti kurangnya pelatihan petugas, ketiadaan SOP, kondisi peralatan yang tidak standar, serta lemahnya pemantauan suhu dan proses distribusi. Hal ini berpotensi merusak kualitas vaksin. Dalam surveilans rantai dingin, aspek pencatatan, pelaporan, dan jejaring dinilai baik, namun masih lemah dalam analisis data, respons dan kontrol, serta supervisi. Secara kuantitatif, ketepatan waktu imunisasi MR1 dan MR2 meningkat selama dan setelah pandemi, namun lebih rendah pada jadwal imunisasi yang non-mingguan dan di wilayah KLB campak. Imunisasi ganda terbukti sangat meningkatkan ketepatan waktu MR2. Studi kualitatif mengidentifikasi bahwa ketepatan waktu imunisasi dipengaruhi oleh kombinasi faktor individu (pengetahuan, keterampilan, motivasi petugas) dan faktor kontekstual (dukungan supervisi dan kebijakan yang adaptif, community engagement, dan ketersediaan logistik vaksin).

Kesimpulan: Implementasi program dan sistem surveilans rantai dingin vaksin di Kota Yogyakarta masih menghadapi tantangan yang berdampak pada kualitas vaksin. Ketepatan waktu imunisasi MR1 dan MR2 dipengaruhi oleh dinamika sistem layanan, kebijakan, serta faktor individual dan lingkungan petugas kesehatan. Intervensi berbasis penguatan sistem dan dukungan sumber daya sangat dibutuhkan untuk meningkatkan mutu pelayanan imunisasi campak.

Background: Measles is a highly contagious disease that can lead to serious complications and death, particularly among children. Data in 2022 indicate a significant increase in measles cases in Indonesia, including Yogyakarta City, which experienced a measles outbreak in 2022 and 2023. Although MR1 immunization coverage in Yogyakarta City has consistently reached ?95% over the past six years, and the average MR2 coverage of 81.3% has not been sufficient to prevent measles outbreaks. This study aimed to evaluate the implementation of the vaccine cold chain system and identify factors influencing the timeliness of measles vaccination among infants and young children in Yogyakarta City.

Methods: This research consisted of three sub-studies: (1) a descriptive evaluation of vaccine cold chain implementation; (2) a descriptive evaluation of the cold chain surveillance system; and (3) an analytical study using an explanatory sequential mixed-methods design to examine factors associated with timely measles vaccination.

Results: The evaluation revealed strengths in vaccine cold chain implementation, including well-organized logistics planning and sufficient budget allocation. However, several weaknesses were identified, such as inadequate staff training, absence of clear SOPs, substandard equipment, limited temperature monitoring, and weak vaccine distribution practices—contributing to compromised vaccine quality. In the surveillance system, aspects such as recording, reporting, and networking were found to be strong, while weaknesses remained in data analysis, response and control, and supervisory practices. Quantitative findings showed that timeliness of MR1 and MR2 immunization improved during and after the pandemic but was lower among health centers with non-weekly immunization schedules and in outbreak-affected areas. Receiving multiple vaccinations was significantly associated with higher MR2 timeliness. Qualitative findings highlighted that timeliness was influenced by a combination of individual factors (knowledge, technical skills, professional commitment) and contextual factors (supervision and policy support, community engagement, vaccine logistic).

Conclusion: The implementation of the vaccine cold chain program and surveillance system in Yogyakarta City continues to face systemic challenges that impact vaccine quality. Timeliness of MR1 and MR2 immunization is shaped by service delivery dynamics, policy, and health workers’ individual and environmental factors. System-strengthening interventions and adequate resource support are urgently needed to improve the quality of measles immunization services.

Kata Kunci : rantai dingin, vaksin, ketepatan waktu, imunisasi, campak