Analysis of Needs Planning, Realization and Optimization of Health Human Resources at the UPT of Public Health Center, Blitar District

The crucial problem of Health Human Resources currently facing is the number, distribution, and quality of health workers. Therefore, it is necessary to take concrete steps in addressing the challenges of this problem by meeting the availability of quality Health Human Resources according to needs, distributed fairly and evenly, and utilized efficiently and effectively. The focus of this research is how the planning of needs, realization and optimization of health human resources at the UPT Community Health Center in Blitar district. This type of research is quantitative qualitative with a case study approach. The results of this study illustrate that in running the public health center program still varies Adequacy of availability of health human resources that are less than ideal, both strategic and non-medical personnel. The planning mechanism for health human resource needs is carried out periodically once a year and used as a proposal report to the Health Office. Development planning still has obstacles due to lack of understanding of the manager program and there is no standard format yet. As an effort to optimize health human resources at the UPT Community Health Center, efforts were made to maximize the existing health human resources by giving multiple assignments and several strategies carried out by the head of the UPT Community Health Center in Blitar district. The realization of the planning for calculating the need for health Human Resources made annually from the UPT Community Health Center as a report to the Health Office has been realized, although not yet fully.


INTRODUCTION
Health development aims to increase awareness, willingness and ability to live a healthy life for everyone, so that the highest degree of health can be achieved as an investment for the development of socially and economically productive human resources. In order for health development to run well it needs to be supported by resources. Health of human, obstacles, constraints and challenges to health development are increasingly complex, both global and national strategic issues. National level strategic issues include differences in health status, decentralization and democracy that are not yet optimal, the number and types of health human resources are not in accordance with the needs, quality, distribution of health human resources is not yet adequate health service infrastructure inadequate and not yet optimal health-oriented development.
Fulfillment of health human resources which is a crucial problem is the number, distribution and quality of health workers. There is a shortage of various types of personnel in a number of health service facilities.Employment conditions in Blitar Regency in 2019 the number of Community Health Center was 24 with 18 inpatient health centers and 6 outpatient health centers with 9 types of strategic personnel as follows: doctors 34, 25 dentists, 217 nurses, 264 midwives, 19 public health, health environment 14, nutritionists 36, pharmacy 34, medical technology experts 17.Based on the planning for the needs of health human resources, 16 (62.50%) Community Health Center without 9 types of strategic health personnel (SISDMK report of the Health Office of Blitar Regency, December 2019).
The results of the initial interviews conducted with the Head of the Health Human Resources Division of the Blitar District Health Office stated that the Blitar District Health Center still lacks health workers both in quantity and quality. There are still some Community Health Center that do not have a general practitioner, dentist. For nurses, midwives at the Community Health Center already exist but the quantity does not meet the standards. Likewise promkes, environmental health, nutrition and ATLM personnel. To fulfill the actual number has been done in various ways, including submission of healthy archipelago personnel, placement of internship doctors, recruitment from BOK funds and not forgetting proposal through the formation of CPNS.
Based on the description of the situation and condition of health problems, the crucial problem faced from the national to the district level is the number, distribution, and quality of health workers. Therefore, it is necessary to take concrete steps in addressing these challenges by meeting the availability of quality human resources according to needs, distributed fairly. and evenly, and utilized efficiently and effectively. Based on the above conditions, the authors are interested in researching the analysis of planning needs, realization and optimization of health human resources at the UPT Community Health Center Blitar Regency.

MATERIALS AND METHODS
This research method is quantitative qualitative with a type of case study approach. Research time 1 -30 June 2020 The population in quantitative research is all UPT Community Health Center in Blitar Regency with total sampling and qualitative with in-depth interviews with 15 main informants, namely the head of the UPT Community Health Center, 15 informants triangulation techniques namely the manager of the Health HR needs planning program, the Head of the Public Health Center Administration, the officers who have concurrent positions, while the source triangulation informants are 2 from the Blitar District Health Office. Quantitative data analysis is carried out descriptively in the form of a frequency distribution table regarding the availability of health human resources in each UPT Community Health Center in Blitar Regency, while qualitative with data reduction, data presentation and data verification. Number of ethical approval is 2226 / KEPK / XII / 2020

RESULTS
From the results of quantitative research, it was found that the availability of 9 (nine) types of strategic health personnel at the UPT Community Health Center Blitar Regency was 15 (62.5%) in the poor category and 9 (37.5%) the UPT Community Health Center with good categories. There are 2 (two) UPT Community Health Center that do not have a general practitioner, one UPT Community Health Center does not have a dentist, one UPT Community Health Center does not have nutritionists, one UPT Community Health Center does not have Promkes personnel, two UPT Community Health Center do not have ATLM personnel, four UPT Community Health Center do not have personnel Environmental health and one UPT Community Health Center do not have pharmacists and / pharmacist assistants. From the quantitative results, to explore in-depth what little is known or understood about the problem and a detailed understanding of a phenomenon requires qualitative research.

The mechanism for planning the needs of the health human resources at the UPT Community Health Center a. Program
The results of interviews with informants about existing programs at the UPT Community Health Center illustrated that the UKM program development carried out varied, namely 7 programs (33.3%), 8 programs (40%) and 9 programs (26.7%). UKP activities in all Community Health Center work according to the Permenkes. Most of the essential UKM are 11 (73.3% Community Health Center run five programs and 4 (26.6%) Community Health Center work on 6 essential UKM programs b. Adequacy of Health Human Resources at Community Health Center The 15 informants provided information that in the Community Health Center in Blitar district 100% was still less than the ideal adequacy of both strategic and non-medical personnel. Adequacy of health human resources at the Community Health Center in carrying out existing program activities, both the UKM and UKP programs is still lacking. There are two Community Health Center that do not have a general practitioner, one Community Health Center does not have a dentist, one Community Health Center does not have a health promotion staff, one Community Health Center does not have a staff pharmacists and / or pharmaceutical technical personnel, as well as two Community Health Center do not have Medical Laboratory Technologists and one Community Health Center does not have nutritionists. Quantitative types of nurses, midwives, are still lacking in the Community Health Center.
c. Planning mechanism for health human resources needs at UPT Community Health Center At the UPT Community Health Center in Blitar Regency, the health Human Resources needs planning mechanism from 15 informants stated that the health Human Resources needs planning mechanism is made periodically every year by referring to existing regulations and is carried out at the Community Health Center coordinated by the Head of the Community Health Center Administration Subag. Calculation of ideal needs for the number and level of positions Each type of health worker as well as non-health worker is carried out through a workload analysis and minimum standards of the Community Health Center. Planning for health human resources at the UPT Community Health Center in Blitar Regency is carried out based on the workload of each Healt human resources by using an information system in the form of an application for planning the needs of Health Human Resources from the Ministry of Health. The final result is sent as a report to the Blitar District Health Office.
From the implementation mechanism for calculating the health human resources need planning at the UPT Community Health Center in Blitar district, there are obstacles, namely the change of officers. The new officers have not yet mastered the planning calculations as stated by the informants 2.Health development planning efforts at UPT Community Health Center The 15 informants at the UPT Community Health Center in Blitar district, only 20% of the UPT Community Health Center have made plans for the development of Health Human Resources for Health and 80% have not made plans for the development of Health human resources for Health. The efforts for planning the development of Human Resources for Health at the Health Center are through sending training held by the District Health Office and some internal training from Community Health Center and seminars and study assignments to higher levels. There are several obstacles to making HRH development planning documents, including lack of understanding of program managers, the standard format for development planning is not yet available so that the Health human resources development planning document is not optimal.

Efforts to utilize / optimize the Health human resources at the UPT Community Health Center
Statement of 15 informants at the UPT Community Health Center in Blitar Regency in order to use them as an effort to optimize the HRH at the UPT Community Health Center that 100% of the informants stated that their use was made by optimally empowering the HRH at the UPT Community Health Center by giving multiple tasks

The strategy of the Head of UPT Community Health Center in optimizing the Health human resouces at the UPT Community Health Center.
The 15 informants at the UPT Community Health Center in Blitar Regency, the strategy of the Head of the Community Health Center in optimizing the Health Human resources is as follows: giving double tasks, increasing cross-program and cross-sector cooperation, proposing additional Healt human resources to the Health Office, utilizing and optimizing existing apprentices, contracts and internships, providing support for Existing staff in carrying out the task, proposing the procurement of additional personnel from BLUD funds and facilitating the existing Healt human resources to improve careers and always trying to provide solutions if there are problems from the existing Health human resources.

Implementation / realization of Health human resources needs planning at UPT Community Health Center
The realization of the planning for HRH needs at the UPT Community Health Center in Blitar Regency from the existing informants stated that the planning made had been realized from the local government even though its fulfillment was not automatically fulfilled, but progress from year to year always increased from 2018, 2019, both the fulfillment of the CPNS formation as well as other formations, namely local government contracts, contracts from BOK funds and internship doctors.

Health Human Resorces needs planning mechanism at UPT Community Health Center a. Community Health Center program
In this study it is in accordance with the mandate of the Minister of Health Regulation No. 43 of 2019 concerning Community Health Center which states that the Community Health Center has the task of implementing health policies to achieve health development goals in its working area. In carrying out the duties of the Community Health Center it has the function of organizing the first level of essential UKM and UKP in its working area. the first level consists of essential UKM and development UKM.

b. Adequacy of Health Human Resources for Health at UPT Community Health Center
In accordance with Permenkes No. 43 of 2019 concerning Public Health Centers with minimum health Human Resources types, there must be doctors and / or primary care doctors, dentists, nurses, midwives, health promotion and behavioral science personnel, environmental sanitation workers, nutritionists, pharmacists and / or technical personnel pharmacy, and medical laboratory technology experts and non-medical personnel.

c. Health Human Recources needs planning mechanism at UPT Community Health Center
The results of this study are in accordance with Permenkes No. 33 of 2015 that planning for health human resource needs is carried out by taking into account the needs of health human resources which are prioritized both in primary health efforts as well as secondary and tertiary health efforts. Planning which includes types, quantities and qualifications is carried out by increasing and strengthen linkages with other elements in the management of development and empowerment of health human resources by taking into account health development goals and trends in health problems.

d. Health Human Recources development planning efforts at UPT Community Health Center
The results of the research are in accordance with Perlan No. 10 of 2018 concerning the development of ASN competencies, including: 1) education, 2) classical training includes training, seminars and courses, 3) non-classical training with internships According to the 2019 Ministry of Health which states that the factors that influence the development of health workers are internal and external factors. Internal factors include the vision, mission of the organization, the nature and type of technology organization activities used by the organization. External factors include government policies, community socio-culture and science and technology development.

e. Efforts to utilize / optimize theHealth Human Resources at the UPT Community Health Center
The results of this study are in accordance with Mahendra Anshari's opinion. One of the methods of Human Resources development, among others, is through assignments, namely the addition of duties and responsibilities in the same position. Usually employees who are involved in this program are employees who stand out among other employees.
The results of this study are in accordance with the problems described by the Ministry of Health in 2011 that the strategic problems in the utilization of health human resources that are faced today are the distribution of quality health human resources which is still lacking, career development, reward systems and sanctions are not yet as they should be, and regulations to support health human resources are still limited. (Ministry of Health. 2011)

f. Strategy of the Head of UPT Community Health Center in optimizing the HRH at the UPT Community Health Center
The results of the research on the strategy of the head of the UPT Community Health Center in optimizing the health center human resources are supported by the opinion of Tjitoherijanto et al. (2008) that the human resource development strategy is a planning of how the quality of human resources is able to develop better, increase work ability, skills and good loyalty to The strategies include 1) Providing opportunities for employees to contribute ideas. As part of the organization, employees are an element that supports the running of the organization's wheels. It is the obligation of a leader to listen to what subordinates say so that employees as subordinates develop ideas, ideas needed by the organization. 2) Giving rewards and punishments. 3) Giving appreciation is a strategy for developing a human resource strategy for the work results of employees. This is needed to further motivate an employee for his performance. Good appreciation is given to employees who have dedication, ideas, good ideas and loyalty to the organization.
Meanwhile, giving multiple assignments in accordance with Mahendra Anshari's opinion is one of the methods of developing human resources through assignments, namely adding tasks and responsibilities in the same position.

g. Implementation / realization of health Human Resources needs planning at UPT Community Health Center
The results of this study are in line with the 2015 Ministry of Health, which states that the purpose of planning for HRH needs is to produce an appropriate HRH requirement plan including the type, quantity and qualifications according to organizational needs based on appropriate planning methods in order to achieve health development goals (Ministry of Health, 2015).
The realization that has been fulfilled in stages is supported by the opinion of Noe 2012 and Gomes 1995 that the factors that influence include budget constraints so that the realization of planning needs is phased in. The realization of the planning for Healt human resorces needs at the UPT Community Health Center in Blitar district is also in line with the mandate in the Health Law No. 36 of 2009 article 21 that the government regulates planning, procurement, utilization and guidance and supervision of the quality of health human resources in the context of providing health services.

CONCLUSION
The planning mechanism for health human resources needs at the UPT Community Health Center in Blitar Regency is made periodically once a year by referring to existing regulations and is carried out by the Head of the Community Health Center Administration Subag Most of it, namely 80% of the UPT Community Health Center in Blitar Regency have not made human resource development plans. This is because there are obstacles, namely the lack of understanding of program managers about the planning of the development of the Health human resouces and there is no standard format and application for planning the development of the Health human resouces From the results of this study, some of the strategies of the head of the UPT Community Health Center in optimizing the Health Human resouces at the UPT Community Health Center stated as follows: • Give multiple assignments • Increase cross-program and cross-sector cooperation • Suggestion for additional health human resources to the health office • Utilizing and optimizing existing internships, contracts and internship doctors.
• Provide support for staff in carrying out their duties • Suggestion for additional procurement of health human resources through BLUD Community Health Center • Improve staff careers with various trainings, seminars and study assignments The realization of the annual calculation of Health human resources needs from the UPT Community Health Center as a report to the Health Office has been realized, although not yet fully. The progress from 2018, 2019 has always improved from the formation of CPNS, regional contracts, BOK contracts, and fulfillment of internship doctors.

ACKNOWLEDGMENTS
Our gratitude goes to all who contributed to this research, to the main informants and the triangulation informants, as well as all those who could not be named individually

CONFLICTS OF INTEREST:
There is no conflict of interest in this study