Studi Kualitatif Tantangan dan Strategi Implementasi Active Case Finding (ACF) TB di Puskesmas Depok II, Sleman

HAFIZHA ULYA NAFI'U, Dr. Dra. Retna Siwi Padmawati, M.A, ; dr. Bagas Suryo Bintoro, Ph.D.,

2026 | Tesis | S2 Ilmu Kesehatan Masyarakat

 

Tuberkulosis (TB) masih menjadi masalah kesehatan masyarakat prioritas di Indonesia sebagai salah satu negara dengan beban TB tertinggi di dunia. Puskesmas Depok II, Kabupaten Sleman, tercatat memiliki capaian temuan kasus TB yang tinggi pada tahun 2025 sehingga implementasi strategi Active Case Finding (ACF) menjadi sangat penting dalam upaya percepatan eliminasi TB. Penelitian ini bertujuan untuk mengkaji dan menganalisis implementasi program ACF TB di Puskesmas Depok II menggunakan pendekatan sistem Donabedian (input, proses, dan outcome), serta menyoroti kontribusi promosi kesehatan dalam mendukung keberhasilan program. Penelitian ini menggunakan pendekatan kualitatif dengan desain studi kasus. Pengumpulan data dilakukan pada Desember 2025 - Februari 2026 melalui wawancara mendalam terhadap 14 informan yang terdiri dari programmer TB, tenaga kesehatan, kader, pasien, kepala puskesmas, perwakilan dinas kesehatan, tokoh masyarakat, dan NGO TB. Data dianalisis menggunakan analisis tematik Miles dan Huberman melalui tahapan reduksi data, penyajian data, dan penarikan kesimpulan, dengan bantuan perangkat lunak NVivo 12. Hasil penelitian menunjukkan bahwa pada komponen input, pelaksanaan ACF TB didukung oleh kebijakan nasional dan daerah, ketersediaan sumber daya manusia, jejaring layanan, serta kemitraan lintas sektor, meskipun masih terdapat keterbatasan fleksibilitas anggaran, ketergantungan pada fasilitas rujukan radiologi, dan dukungan sarana promosi kesehatan. Pada komponen proses, implementasi ACF tidak hanya berfokus pada skrining dan pemeriksaan klinis, tetapi juga melibatkan strategi promosi kesehatan melalui edukasi, advokasi, kemitraan, dan pendekatan sosial untuk mengatasi stigma serta kesenjangan niat masyarakat. Pada komponen outcome, ACF berkontribusi terhadap peningkatan penemuan kasus, perluasan cakupan skrining, peningkatan kepatuhan pengobatan, serta penguatan pencegahan melalui pemberian Tuberculosis Preventive Treatment (TPT) pada kontak serumah. Penelitian ini menegaskan bahwa keberhasilan implementasi ACF TB di tingkat pelayanan primer sangat dipengaruhi oleh integrasi antara dukungan sistem, strategi promosi kesehatan, serta penguatan jejaring dan kemitraan komunitas guna menjamin efektivitas dan keberlanjutan program.

Tuberculosis (TB) remains a priority public health problem in Indonesia, which is one of the countries with the highest TB burden in the world. Depok II Primary Health Center in Sleman Regency recorded a high TB case detection rate in 2025, making the implementation of the Active Case Finding (ACF) strategy highly important in accelerating TB elimination efforts. This study aims to examine and analyze the implementation of the TB ACF program at Depok II Primary Health Center using the Donabedian systems approach (input, process, and outcome), while highlighting the contribution of health promotion in supporting program success. This research employed a qualitative approach with a case study design. Data were collected from December 2025 to February 2026 through in-depth interviews with 14 informants, including TB program officers, healthcare workers, community health volunteers (cadres), patients, the head of the primary health center, representatives from the district health office, community leaders, and TB-focused NGOs. Data were analyzed using thematic analysis by Miles and Huberman, which involves data reduction, data display, and conclusion drawing, supported by NVivo 12 software. The findings indicate that in the input component, the implementation of TB ACF was supported by national and regional policies, the availability of human resources, service networks, and cross-sector partnerships. However, challenges remained, including limited budget flexibility, dependence on referral facilities for radiological examinations, and insufficient health promotion infrastructure. In the process component, ACF implementation focused not only on screening and clinical examinations but also incorporated health promotion strategies through education, advocacy, partnerships, and social approaches to address stigma and intention gaps within the community. In the outcome component, ACF contributed to increased case detection, expanded screening coverage, improved treatment adherence, and strengthened prevention efforts through the provision of Tuberculosis Preventive Treatment (TPT) for household contacts. This study emphasizes that the successful implementation of TB ACF at the primary healthcare level is strongly influenced by the integration of system support, health promotion strategies, and strengthened community networks and partnerships to ensure program effectiveness and sustainability.

Kata Kunci : Tuberkulosis, Active Case Finding, Promosi Kesehatan, Puskesmas, Studi Kualitatif