Under-utilization of Community Health Centers in Purworejo Regency, Central Java

The basic strategy of the Ministry of Health to achieve Health For All In Indonesia 2010 is through health paradigm, decentralization, professionalism and health service management. Community health centers play an important role to achieve the goal. Unfortunately, underutilization of community health centers is still a problem in Purworejo. The purpose of this study was to know the utilization of community health centers using a sociological health approach. Qualitative research by observation, in-depth interview and focus group discussion were done among different types of group. The study was done in Purworejo District on February and March 2000. The main problems related to under-utilization of community health centers are mostly on administration (less quality services, un-efficient, long hours waiting), strong bureaucratic system (physician has a dominant power, overlapping programs, poor coordination and integration with other divisions) and cultural behavior of the community (labeling/stigma, self-care dominant, lack of community participation). To overcome under-utilization of community health centers the administration and bureaucracy should be changed into more efficient, not bureaucratic management. In addition social changes of the community culture is needed. As a consequence through these changes the staff of the health centers will be more efficient and effective.