Evaluation of Environmental Sanitation Hygiene Program in Prevention of Diarrhea Incidence in The Working Area of Kolaka District Health Office

Evaluation of Environmental Sanitation Hygiene in Prevention of Diarrhea Incidence in The Working Area of Kolaka District Health Office Mung Rahadi 1 *, Lilis Sulistyorini 2, Satya Haksama 3 Environmental Health Department, Public Health Faculty, Airlangga University Surabaya, Indonesia 1,2 Department of Health Administration and Policy, Public Health Faculty, Airlangga University, Surabaya, Indonesia 3 E-mail: mungrahadi@gmail.com 1 Abstract- This research aimed to evaluate the implementation of environmental sanitation hygiene program in the prevention of diarrhea in the working area of Kolaka District Health Office 2014. The type of research was observational research in descriptive form of summative evaluation. The location of research was Kolaka PHC, Wundulako PHC, and Pomalaa PHC. Time of data collection on the Moon from March to May 2015. The subjects taken by purposive sampling, with a sample size of each health center as much as two respondents, the head of PHC and the sanitarian, bringing the total number of samples as many as 6 people. Evaluation results of the input component showed that three health centers include worth enough. Evaluation results of the process component showed that three of health centers include excellent. Evaluation results of the output component showed that Wundulako PHC and Pomalaa PHC include less, and just Kolaka PHC include good. Evaluation result of the impact component showed that three health centers include very less. The conclusion of this research was the implementation of environmental sanitation hygiene program in the prevention of diarrhea in the working area of Kolaka District Health Office 2014 relatively enough. Expected health centers and the Kolaka District Health Office will seek the STRTS and SIKTS existence, additional funds for program activities, completeness equipments and methods, as well as increase promotive and cooperation with crosssectoral and cross-program in order to strengthen environmental sanitation hygiene program and prevention of diarrheal disease incidence. Keywords:- Evaluation, Environmental sanitation hygiene program, Prevention of diarrheal disease incidence. 1. INTRODUCTION Poor environmental health is one of the risk factors for the incidence of diarrheal disease, namely with the interaction between the disease agent, host and environmental factors potentially increasing the incidence of diarrheal disease incidence. Diarrhea is an infectious disease caused by microorganisms including bacteria, viruses and other parasites such as fungi, worms and protozoa. Diarrheal diseases characterized by increased frequency of bowel movements than usual (three or more every day) that accompanied the change in the shape and consistency of the stools of patients to a liquid with or without mucus and blood. 1 Study result of EHRA (Environmental Health Risk Assessment) in Kolaka 2012 showed that the highest incidences of diarrhea attack on toddler age group (> 25%). The level of contamination of water sources were protected, including very vulnerable (> 95%). The percentage of household latrine ownership above 80%, but in terms of quality aspects including unsafe septic tanks (>50%), thus potentially causing environmental pollution, especially the water source. 2 The working area of the District Health Office of Kolaka consists of 9 non-nursing health centers and three health centers nursing spread across 12 districts, with a total population in 2013 amounted to 337 242 inhabitants. The achievement of environmental health programs in District of Kolaka as indicators of healthy latrines, wastewater disposal healthy, and healthy landfills throughout the last 5 years was below the program target of P2PL Center (<75%). Diarrheal diseases in District of Kolaka included in the category of 10 most diseases. Data of diarrhea in District of Kolaka throughout the last 5 years showed a trend of increasing cases, ranging from 3,867 cases in 2013 to be 7395 cases in 2013 with a morbidity rate of 2,193 per 100,000 populations, so that it requires the existence of early awareness of the potential for disease occurrence diare. 3 The implementation of environmental sanitation hygiene program in the working area of The District Health Office of Kolaka every year desperately need a summative evaluation activity. The research aimed to 23

evaluate the implementation of environmental sanitation hygiene program in the prevention of diarrhea in the working area of the District Health Office of Kolaka in 2014. 2. RESEARCH METHODS The research was observational in descriptive form of summative evaluation. Location of research carried out in three health centers among others the Public Health Center of Kolaka, Public Health Centre of Wundulako, and Public Health Centre of Pomalaa conducted from March to May 2015. Subjects were taken by purposive sampling was sampling technique with certain consideration.4 Subjects in this study was the chief officer of health centers and sanitarian with a total sample of 6 people. Data were obtained through in-depth interviews with 6 respondents and field observations. Primary data and secondary data that have been collected were then analyzed and interpreted in descriptive with system approach (input, process, output and impact) and the results were presented in tabular form. 3. RESULTS 3.1 Input Of Environmental Sanitation Hygiene Implementation of environmental sanitation hygiene program at the health center must be supported the input of program, namely personnel, fund, equipment, materials, and methods. a. Personnel observations showed that in 2014 the number of sanitarian in each health center 1-3 people, means the number of sanitarian at 3 health centers in Kolaka based on the type of quantity data has qualified ( 1 personnel). Education competence of sanitarian in every health center was a minimum of a bachelor's or bachelor ( D III / S1 ), means sanitarian education competencies in three health centers in Kolaka have qualified. Ownership of Certificate of Sanitarian Registration (STRTS) and Certificate of Sanitarian Work Permit (SIKTS) by sanitarian in every health center yet, means the quality of sanitarian at three health centers in Kolaka were not eligible. Sanitarian in every health center has turned out ever follow the trainning of program, namely the training of Community Based Total Sanitation, means that the quality of sanitarian at three health centers in Kolaka based on data of ever follow the program training has been qualified. Each health center has been having a minimum of one sanitarian that did not hold double duty so as to focus on the program, means the quality of sanitarian at three health centers in Kolaka based on the data did not hold double duty has been qualified. b. Fund observations showed that funds of environmental sanitation hygiene program at three health centers in Kolaka not qualify (<7% of the total budget of every health center). c. Equipments observations, showed that the type of equipment used in the implementation of environmental sanitation hygiene program at each health center in good condition and functioning but incomplete, due to the equipment package of the implementation of environmental sanitation hygiene did not exist, means the equipment for environmental sanitation hygiene program at three health centers in Kolaka not eligible. d. Materials observations, showed that the materials used in the implementation of environmental sanitation hygiene program at each health center in good condition, functional and complete, means material for environmental sanitation hygiene program at three health centers in Kolaka eligible. e. Methods observations, showed that the method for the implementation of environmental sanitation hygiene program at each health center was exist but incomplete. The method referred to in this research was in the form of regulations, such as PMK No. 416/Menkes/ PER /1990, KMK No. 829 of 1999, KMK No.1116/Menkes/SK/VIII/2003, KMK No.1457/Menkes/ SK/X/2003, KMK No.1479/Menkes/SK/X/2003, KMK No. 128/Menkes/ SK/II/2004, PMK No. 32 In 2013, PMK No.1 In 2014, PMK No.75 Year 2014, and Guidance of Preparation Planning in 2014 from P2PL center. It means the method for environmental sanitation hygiene program at three health centers in Kolaka not eligible. The overall result of the input of program The evaluation results of the overall of the input component of program consisting of 9 types of data collected from three health centers, it turned out the type of data that qualified amounted to 5 types of data, namely: sanitarian quantity, education competence, follow the training of program, no holds double duty, and materials, so as to obtain a score of 55.56%. This score puts the input component of program from three health centers included enough, because the interval score was in > 40% - 60%. Results of evaluation for program input component in 24

the working area of Kolaka District Health Office in 2014 can be seen in the following table (Table 1). Table 1. Evaluation Results of The Input Component of Environmental Sanitation Hygiene In The Working Area of District Health office of Kolaka 2014 No Data Collected Public Health Center (MS / TMS) Kolaka Wund ulako Pom alaa 1 Sanitarian Quantity MS MS MS 2 Education Competence MS MS MS 3 Having STRTS & SIKTS TMS TMS TMS 4 Follow the Training of program MS MS MS 5 No Holds Double Duty MS MS MS 6 Fund TMS TMS TMS 7 Equipments TMS TMS TMS 8 Materials MS MS MS 9 Methods TMS TMS TMS Totaly TMS (Not Eligible) 4 4 4 Totaly MS (Eligible) 5 5 5 MS Score (%) 55,56 55,56 55,56 Value Score enough enough enou gh 3.2 Process of Environmental Sanitation Hygiene Implementation of environmental sanitation hygiene program at the health center requires the planning, implementation, and good judgment so that program objectives can be achieved. a. Planning observation showed that in 2014 every health center has made the planning activities of environmental sanitation hygiene program, means planning of environmental sanitation hygiene program at three health centers in Kolaka has qualified. b. Implementation observation showed that in 2014 every health center has been conducting environmental sanitation hygiene program according to plan activities that have been made, means the implementation of environmental sanitation hygiene program at three health centers in Kolaka has qualified. c. Monitoring and Control and Assessment observations showed that in 2014 every health center has conducted an assessment of environmental sanitation hygiene program activities, one of them through activities small workshop in health centers, which means that monitoring and control and assessment of environmental sanitation hygiene program at three health centers in Kolaka have qualified. The Overall Results of the Evaluation results of the overall of the components of program consisted of three types of data collected from three health centers, included planning, implementation, monitoring and control and assessment has been qualified, so as to obtain a score of 100.00%. This score puts the component of program from 3 health centers including scales extremely well, interval score was in > 80.00%. Evaluation results of the program processes component in the working area of Kolaka District Health Office 2014 can be seen in the following table (Table 2). Table 2. Evaluation Results of The Process Component of Environmental Sanitation Hygiene In The Working Area of District Health office of Kolaka 2014 No Data Collected Public Health Center (MS / TMS) Kolaka Wund ulako Poma laa 1 Planning MS MS MS 2 Implementati on MS MS MS 3 Monitoring Control & Assessment MS MS MS TotalyTMS (No Eligible) 0 0 0 Jumlah MS (Eligible) 3 3 3 MS Score(%) 100,0 Value Score 100,00 100,00 Very Very Good Good 0 Very Good 3.3 Output of Environmental Sanitation Hygiene Coverage of Clean water facilities qualify (SAB MS) observation, showed that coverage of clean water facilities qualify at Public Health Center of Kolaka and Wundulako has been qualified (> 67%), while the Public Health Centre of Pomalaa was not eligible. 25

a. Coverage of Healthy latrines observation, showed that of the three health centers in Kolaka turned out just Public Health Centre of Kolaka which has healthy latrine coverage has been qualified (> 75%), while the Public Health Centre of Wundulako and Pomalaa were not eligible. b. Coverage of Wastewater Disposal Healthy (SPAL Sehat) observation, showed that of the three health centers in Kolaka turned out just Public Health Centre of Kolaka which has healthy wastewater disposal coverage has been qualified, while the Public Health Centre of Wundulako and Pomalaa were not eligible. c. Landfills healthy (TPS Sehat) observation, showed that healthy landfills coverage at 3 health centers in Kolaka have been qualified (> 75%). d. The Percentage of Completeness of Reporting observations, as well as based on the book registers incoming reports in The District Health Office of Kolaka 2014, showed in fact that percentage of completeness of reporting from three health centers in Kolaka were not eligible (<90%). e. The Percentage of Accuracy of Reports observations, as well as based on the book registers incoming reports in The District Health Office of Kolaka 2014, showed in fact that percentage of accuracy of reports from three health centers in Kolaka were not eligible (<80%). No Table 3. Evaluation Results of The Output Component of Environmental Sanitation Hygiene In The Working Area of District Health office of Kolaka 2014 Data Collected Public Health Center (MS / TMS) Kola ka Wundu lako Pom alaa 1 Coverage of SAB MS MS MS TMS 2 Coverage of Healthy Latrine MS TMS TMS 3 Coverage of SPAL Sehat MS TMS TMS 4 Coverage of TPS Sehat MS MS MS 5 Percentage of Completeness of The Report TMS TMS TMS 6 Percentage of Accuracy of Reports TMS TMS TMS Totaly TMS (Not Eligible) 2 4 5 Totaly MS (Eligible) 4 2 1 MS Score (%) 66,67 33,33 16,67 Value Score Good Fewer Less 3.4 Impact of Environmental Sanitation Hygiene The evaluation results of the overall of the impact component of program consisting of one type of data collected, it turned out all of three health centers were not eligible. Results of evaluation for program impact component in the working area of the District Health Office of Kolaka in 2014 can be seen in the following table (Table 4). The overall results of the program output The evaluation results of the overall of the output component of program consisting of 6 types of data collected from three health centers, it turned out Public Health Center of Kolaka had four types of data qualified (a score of 66.67%), Public Health Centers of Wundulako had two types of data qualified (a score of 33.33 %), and Public Health Center of Pomalaa had one kind of data qualified (a score of 16.67%). Results of evaluation for program output component in the working area of the District Health Office of Kolaka in 2014 can be seen in the following table (Table 3). 26

Table 4. Evaluation Results of The Impact Component of Environmental Sanitation Hygiene In The Working Area of District Health office of Kolaka 2014 No Data Collected Public Health Center Kola ka Wundu lako Pom alaa 1 Target Discovery 826 425 644 of Cases of Diarrhea 2014 Target Discovery 902 464 704 of Cases of Diarrhea 2015 Diarrhea 634 515 1.235 Incidence Value 2014 Diarrhea 227 177 421 Incidence Value Jan Apr 2014 Diarrhea 27,48 41,65 65,37 Coverage Jan April 2014 (%) Diarrhea 249 264 503 Incidence Value Jan Apr 2015 Diarrhea 27,61 56,90 71,45 Coverage Jan April 2015 (%) Trend (%) 0,47 36,61 9,30 Result TMS TMS TMS TotalyTMS 1 1 1 Totaly MS 0 0 0 MS Score (%) 0,00 0,00 0,00 Value Score Less Less Less 3.5 Evaluation of Environmental Sanitation Hygiene Hygiene program at three health centers in The Working Area of Kolaka District Health Office in 2014 can be seen in Table 5 below. Table 5. Evaluation Results of The Environmental Sanitation Hygiene In The Working Area of District Health office of Kolaka 2014. No Data Collected Public Health Center (MS / TMS) Kolaka Wund ulako Pom alaa 1 Sanitarian Quantity MS MS MS 2 Education Competence MS MS MS 3 Having STRTS & SIKTS TMS TMS TMS 4 Following The Training of MS MS MS 5 No Holds Double Duty MS MS MS 6 Fund TMS TMS TMS 7 Equipment TMS TMS TMS 8 Materialls MS MS MS 9 Methods TMS TMS TMS 10 Planning MS MS MS 11 Implementation MS MS MS 12 Monitoring Control & Assessment MS MS MS 13 Coverage of SAB MS MS MS TMS 14 Coverage of Healthy Latrine MS TMS TMS 15 Coverage of SPAL Sehat MS TMS TMS 16 Coverage of TPS Sehat MS MS MS 17 Percentage of Completeness of The Report TMS TMS TMS 18 Percentage of Accuracy Reports TMS TMS TMS 19 Diarrhea Incidence TMS TMS TMS Totaly TMS (Not Eligible) 7 9 10 Totaly MS (Eligible) 12 10 9 MS Score (%) 63,16 52,63 47,37 Value Score Good Enoug h Enou gh 27

4. DISCUSSION 4.1 Input of Environmental Sanitation Hygiene Information about health issues, resources (personnel, funds, equipment, materials, methods) and National Policy System (SKN) developed an important element in supporting the implementation of program. 5 a. Personnel The health worker is any person who devote themselves in the field of health and have knowledge or skills through education in the field of health for specific types require the authority to make health efforts. 8 Human resources ( HR ) executive health as health effort was needed in case of insufficient quantity, type, and quality, and distributed in a fair and equitable, as demanded by the needs of health development. 5 observations in three health centers showed similar results, namely: Quantity Quantity of sanitarian in the working area of the District Health Office of Kolaka 2014 which amounted to 1-3 people per health center. The availability of the sanitarian when referring to the KMK No. 1116/Menkes/SK/VIII/2003 on Guidelines for the Implementation of Health Epidemiologic Surveillance System turned out to has qualified, the minimum was 1 personnel in the working area of health center. The adequacy of this personne, if utilized effectively and efficiently certainly strongly support the implementation of environmental sanitation hygiene program. Quality Sanitarian officer quality can be determined by knowing the qualifications sanitarian as executive officer of environmental sanitation hygiene program that includes: education competence of sanitarian; having STRTS (Certificate of Sanitarian Registration) and SIKTS (Certificate of Work Permit), follow the training of environmental sanitation hygiene program; and no holds double duty. Sanitarian officer quality in the working area of the District Health Office of Kolaka 2014 as executive officer of environmental sanitation hygiene program showed that: 1. Education Competence of sanitarian minimally educated D III / S1. 2. Sanitarian officer has been trained environmental sanitation hygiene program, namely the training of Community Based Total Sanitation 3. Sanitarian officer did not holds double duty. Education competencies possessed the sanitarian officer when referring to the KMK No. 1116/Menkes/SK/VIII/2003 turned out to have met the standard, ie at least there is one person skilled labor (D III/S1) at each healt center. The officer quality associated with the fourth of the above are in accordance with the requirements of environmental sanitation hygiene program requirements, except for ownership requirements STRTS and SIKTS that were not owned, so it did not fit the mandate of KMK No. 373/Menkes /SK/III / 2007 on Standards of Professional Sanitarian, and PMK No. 32 Year 2013 on the Implementation of Works Sanitarian which requires the importance of ownership STRTS and SIKTS by sanitarian personnel in carrying out the work sanitarian at health centers. It shows that every sanitarian officer to be able to carry out his job should have STRTS and every sanitarian officer who do work in health care facilities are required to have SIKTS. b. Fund Health financing that adequacy, effective and efficient, equitable and transparent, holds a very vital role for organizing health care in order to achieve the goal of health development. Funding sources of health financing, including environmental sanitation hygiene program can be obtained from various sources, among others: the central government, local government, private, and community and resources lainnya. 5 Sources of financing environmental sanitation hygiene program in the working area of the District Health Office of Kolaka in 2014 obtained from sources that the central fund of the Health Operational Assistance (BOK). Health Operational Assistance (BOK) is a central government aid to local governments to accelerate the achievement of MDGs in health by 2015, through improving the performance of health center, Poskesdes/Polindes, IHC, and other UKBM health service delivery promotion and preventif. 7 Total costs were available for environmental sanitation hygiene program in the working area of the Kolaka District Health Office 2014 was not yet in accordance with the needs of environmental sanitation hygiene program. This was certainly a need to get the attention given the insufficient availability of funds could be a problem in financing activities of environmental sanitation hygiene program. c. Equipments The type of equipment used in the implementation of environmental sanitation hygiene program in the working area of Kolaka District Health Office in 2014 available / in no good condition and functioning but incomplete. The type of equipment in the working area of Kolaka District Health Office 2014 when referring to the KMK No. 1116 / Menkes / SK / VIII / 2003 has 28

yet to meet the needs of the program, which should be available in a complete computer packages, communication tools package, equipment package of implementation of environmental sanitation hygiene, and complete two-wheeled vehicles. This was certainly a need to get the attention given the availability of less adequate equipments could be a problem in the implementation and results of the activities of environmental sanitation hygiene program. d. Materials Materials supplies used in the implementation of environmental sanitation hygiene program in the working area of Kolaka District Health Office in 2014 were available / no good condition, functional and complete. Materials supplies in the working area of Kolaka District Health Office 2014 when referring to the KMK No. 1116 / Menkes / SK / VIII / 2003 has met the standard requirements of the program, which should be available in complete literature package, the package guidelines for surveillance of diarrheal disease risk factors, form packets, packet writing materials, package printers completeness materials, disinfecting materials, and letters tasks. e. Methods Methods is a method used in the implementation of the program so that the predetermined goal will be achieved. The method used in the implementation of environmental sanitation hygiene program in the working area of Kolaka District Health Office 2014 was still incomplete, there were only the BOK technical guidelines 2014 and permanent procedures of sanitation clinic, so it was not as it should be. It was necessary to get attention, because of the absence of appropriate methods and complete would make the implementation of the program did not match the target or targets, which cuuld ultimately affect the final result. 4.2 Process of Environmental Sanitation Hygiene Process is an activity that is carried out in accordance with the policies, (decisions of the input) in accordance with the general strategy or operasional. 8 The process of environmental sanitation hygiene program in the working area of Kolaka District Health Office 2014 includes planning, implementation, monitoring, control and assessments were as followed: 1. Planning Public Health Centre in Kolaka 2014 has made the planning activities of environmental sanitation hygiene program. Officers involved in the preparation of environmental health planning are programmers, which are then discussed together in miniworkshop of health center to listen to the input of the head of health center and other programmers. Obstacles in the preparation of environmental sanitation hygiene program planning among which funding barriers, support facilities were still lacking, and the target was not met. 2. Implementation Plan activities environmental sanitation hygiene program that has been created by health centers in 2014 have been implemented, but in practice there were things that became an obstacle factors among which the lack of public participation, lack of funding, lack of water proofing equipment, and distribution of disinfectant were late. Efforts were needed to overcome these obstacles include holding public education, implementing cooperation cross-program and cross-sector, proposing the addition of the funding request, provision of water proofing tools, and facilitate the distribution of disinfectant. Executor of activity was sanitarian, but in fact needed for cooperation cross-programs like the health promotion officer, midwives and cooperation crosssectors such as the sub-district head, village head, Tim Mover of Family Welfare Improvement, and cadres. 3. Monitoring, control and assessment Assessment of activities of environmental sanitation hygiene program in the working area of Kolaka District Health Office in 2014 have been implemented, one through activities small workshop in health center. The person conducting the evaluation of the minimum was the head of health center usually done at the end of the activity, but in practice there were obstacles was the lack of community participation and results of operations did not meet the target. The activity stages of activity program process when referring to the PMK No. 1 Year 2014 on Technical Guidelines for Health Operational Assistance (BOK) 2014 and KMK No. 128 / Menkes / SK / II / 2004 on Basic Policy of Public Health Center finds that it meets the standard requirements of the program.. 4.3 Output of Environmental Sanitation Hygiene Output is an activity that has been carried out (in number and time). Measured results of the achievement of each type of activity pelayanan.8 Outputs of environmental sanitation hygiene program which the results measured from the achievement of the type of servicing activities include: coverage of SAB MS, healthy latrine coverage, healthy SPAL coverage, healthy TPS coverage, percentage of completeness of the report, and percentage of accuracy of reports.. 29

a. Coverage of clean water facilities qualify (SAB MS). The achievement of SAB MS in the working area of Kolaka District Health Office in 2014 has exceeded the target of Guidelines Planning of P2PL 2014 (> 67%), with the exception of one health center which still below the target namely Public Health Centre of Pomalaa. This means that the SAB condition was used as access to drinking water for the population in the working area of Kolaka District Health Office in 2014 relatively safe, so that this condition could potentially break the chain of transmission of diarrheal disease. This achievement results was as an early warning to raise vigilance of the incidence of diarrheal disease. This was in line with the results of research by Kamaruddin (2004) which showed that there was a relationship between incidence of diarrhea with environmental factors, namely the availability of latrines, clean water sources, landfills, and personal hygiene. Results of research conducted by Alidan (2002) also showed that the coverage of clean water and the incidence of diarrhea have a moderate relationship that was r = 0.365 and based on the results of statistical test showed a significant relationship pvalue < α (0.048). b. Healthy Latrine Coverage The achievement of healthy latrine in the working area of Kolaka District Health Office in 2014 has not reached the target of Guidelines Planning of P2PL 2014 (> 75%), except Public Health Center of Kolaka that has exceeded the target. It showed that the condition of latrines was owned by the community as part of the proper sanitation access for the population in the working area of Kolaka District Health Office in 2014 prone to pollute the surrounding environment both soil and water source, so it could potentially be a source of disease transmission based environment such as diarrhea. This was in line with the results of research conducted by Alidan (2002) showed that the latrine coverage and the incidence of diarrhea have a moderate relationship that was r = 0.374 and based on the results of statistical tests show a significant association pvalue < α (0.042) and was strengthened research by Kamaruddin (2004 ) which indicates that there was a relationship between diarrhea with environmental factors, namely the availability of latrines, clean water sources, landfills, and personal hygiene. c. Coverage of Wastewater Disposal (SPAL) Healthy The achievement of healthy SPAL in the working area of Kolaka District Health Office in 2014 has not reached the target of Guidelines Planning of P2PL 2014 (> 75%), except Public Health Center of Kolaka that has exceeded the target. It showed that the condition of SPAL was owned by the community as part of the proper sanitation access for the population in the working area of Kolaka District Health Office in 2014 prone to pollute the surrounding environment both soil and water source, so it could potentially be a source of disease transmission based environment such as diarrhea. This was in line with the results of research by Hiswani (2003) which showed that cases of diarrheal disease was associated with human behavior, clean water supply, wastewater disposal and environmental health in the dry season. d. Coverage landfills (TPS) healthy The achievement of healthy TPS in the working area of Kolaka District Health Office in 2014 has exceeded the target of Guidelines Planning of P2PL 2014 (> 75%). This means that the TPS condition was used as access to drinking water for the population in the working area of Kolaka District Health Office in 2014 relatively safe, so that this condition could potentially break the chain of transmission of diarrheal disease. This achievement results are expected to be maintained and even the attainment of the performance improved steadily. This was in line with the results of research by Kamaruddin (2004) which showed that there was a relationship between incidence of diarrhea with environmental factors, namely the availability of latrines, clean water sources, landfills, and personal hygiene. e. Percentage of Completeness of The Report The achievement of the percentage of completeness of the report in the working area of Kolaka District Health Office in 2014 has not yet reached the target based KMK No. 1479 / Menkes / SK / X / 2003 on Guidelines for the Implementation of Epidemiology Surveillance System of Infectious Diseases and Non Communicable Diseases Integrated ( 90%). It showed that the condition of recording and reporting system from environmental sanitation hygiene program in the working area of Kolaka District Health Office in 2014 is still not good, so it can impact on a tiered reporting system within the framework of the implementation of epidemiologic surveillance system of health. f. Percentage of accuracy of reports The achievement of the percentage of accuracy of reports in the working area of Kolaka District Health Office in 2014 has not yet reached the target based KMK No. 1479 / Menkes / SK / X / 2003 on Guidelines for the Implementation of Epidemiology Surveillance System of Infectious Diseases and Non Communicable Diseases Integrated ( 80%). It showed that the condition of recording and reporting system from environmental sanitation hygiene 30

program in the working area of Kolaka District Health Office in 2014 is still not good, so it can impact on a tiered reporting system within the framework of the implementation of epidemiologic surveillance system of health. 4.4 Impact of Environmental Sanitation Hygiene Impact is informatio that is associated with health status and declining issues kesehatan.8 Achievement of public health status as program impact on this research was measured by comparison of the incidence of cases of diarrhea indicators discovery of all ages between 2014 to 2015 according to target of P2PL program, namely by comparing the results of the achievement of the percentage of cases of diarrhea In January-April 2014, with the achievement percentage of the number of cases of diarrhea January - April 2015. Achievement of the number of diarrhea cases in the working area of Kolaka District Health Office in 2014 by virtue of the Director General. P2PL No. PM.01.08 / III.4 / 715/2014 regarding the correction calculation of Target Scope Diarrhea, there are two health centers exceeded the number of diarrheal case target, namely Public Health Centers of Wundulako and Public Health Center of Pomalaa, while Public Health Centre of Kolaka remained below the target. The comparison of counting the number of cases of diarrhea per diarrheal case target based on the same month in different years by comparing results of calculation between the month of January up to April 2014 with January - April 2015 could be found that the three health centers trend of the incidence of the diarrheal disease has increased. This has been duly made attention as an early warning for increased vigilance would be the occurrence of extraordinary events (KLB) diarrhea. Hiswani research results (2003) mentioned that cases of diarrheal disease is associated with human behavior, clean water supply, wastewater disposal and environmental health in the dry season. This was reinforced by the results of research Kamaruddin (2004) which showed that there was a relationship between incidence of diarrhea with environmental factors, namely the availability of latrines, clean water sources, landfills, and personal hygiene. Epidemiological surveillance is an activity that is very important in supporting the control and eradication of infectious diseases. Epidemiological Surveillance implementation has not gone well will certainly have an impact on the process of ongoing transmission in the community (Wuryanto, 2008). 4.5 Evaluation of Environmental Sanitation Hygiene evaluation is a systematic process of determination of the value, purpose, effectiveness or suitability something in accordance with the criteria and objectives set earlier. 13 Evaluation of environmental sanitation hygiene program as a whole, showed that the implementation of environmental sanitation hygiene program in the working area of Kolaka District Health Office in 2014 were categorized as enough, even one health center that the implementation of environmental sanitation hygiene program including categories good, namely Public Health Centre of Kolaka. This showed that the implementation of environmental sanitation hygiene program in the prevention of diarrhea in the working area of Kolaka District Health Office in 2014 relatively enough. 5. CONCLUSION 1. The input components of environmental sanitation hygiene program in the working area of Kolaka District Health Office in 2014 included worth enough. 2. The process components of environmental sanitation hygiene program in the working area of Kolaka District Health Office in 2014 included excellent. 3. The output component of environmental sanitation hygiene program in the working area of Kolaka District Health Office in 2014 included less. 4. The impact component of environmental sanitation hygiene program in the working area of Kolaka District Health Office in 2014 included very less. 5. Implementation of environmental sanitation hygiene program in the prevention of diarrhea in the working area of Kolaka District Health Office in 2014 relatively enough. 6. Priority of problems of environmental sanitation hygiene program in the working area of Kolaka District Health Office in 2014 were: a. Trend of diarrhea incidence in health centers has increased. b. The sanitarian did not have STRTS and SIKTS. c. The achievement of targets of activities were unmet. d. Community participation was still low. 6. SUGGESTION 1. Public Health Centre or sanitarian needs to coordinate with the district professional organizations in order handling STRTS and SIKTS. 2. Public Health Centre and Kolaka District Health Office need to support the improvement funds to environmental sanitation hygiene program. 3. Public Health Centre needs to pursue the completeness of methods and equipments for 31

supporting environmental sanitation hygiene program is lacking. 4. Public Health Centre needs to increase triggers activities for the community-based total sanitation (CBTS) and community sanitation efforts. 5. Public Health Centre needs to increase efforts to promote health education about the diarrheal disease. 6. Sanitarian needs cooperation cross-programs and cross-sectors in improving public participation and prevention of diarrheal disease incidence REFERENCES [1] Markum. Ilmu Kesehatan Anak. Buku Ajar Jilid 1, Bagian Kesehatan Anak. Universitas Indonesia, Jakarta. 1998. [2] Dinas Kesehatan Kabupaten Kolaka. Laporan Studi EHRA Tahun 2012. Kolaka. 2012. [3] Dinas Kesehatan Kabupaten Kolaka. Profil Dinas Kesehatan Tahun 2013.Kolaka. 2014. [4] Sugiyono. Metode Penelitian Kuantitatif Kualitatif dan R dan D. Bandung.Alfabeta. 2011. [5] Peraturan Presiden Republik Indonesia Nomor 72 Tahun 2012. Sistem Kesehatan Nasional. Jakarta. 2012. [6] Undang-Undang Republik Indonesia Nomor 36 Tahun 2009. Kesehatan. Jakarta. 2009. [7] Peraturan Menteri Kesehatan Republik Indonesia Nomor 1 Tahun 2014. Juknis BOK Tahun 2014. Jakarta. Depkes RI. 2014. [8] Supriyanto S. dan Damayanti N. A. Perencanaan dan Evaluasi. Surabaya. Airlangga University Press. 2007. [9] Kamaruddin. Faktor-Faktor Yang Berhubungan Dengan Kejadian Diare Di Desa Rhing Blang Kecamatan Meureudu Kabupaten Pidie Nanggroe Aceh Darussalam Tahun 2004. FKM- USU, Medan. 2004. [10] Alidan. Hubungan Cakupan Penyediaan Air Bersih Dan Jamban Dengan Insiden Diare Di Kabupaten Lampung Selatan Tahun 2002. Laporan Magang, FKM-UI. Depok. 2002. [11] Hiswani. DiareMerupakan Salah Satu Masalah Kesehatan Masyarakat yang Kejadiannya Sangat Erat dengan Keadaan Sanitasi Lingkungan. USU. Medan. 2003. [12] Wuryantoro. Arie. Surveilans Penyakit Demam Berdarah Dengue (DBD) Dan Permasalahannya Di Kota Semarang. Seminar Nasional Mewujudkan Kemandirian Kesehatan Masyarakat Berbasis Preventif dan Promotif. 2008. [13] Karding K.A. Evaluasi Pelaksanaan Bantuan Operasional Sekolah (Bos) Sekolah Menengah Pertama Negeri Di Kota Semarang. Tesis, http://eprints.undip.ac.id/16087/1/abdul_kad IR_KARDING.pdf. 2008 (Sitasi 22 Juni 2015). [14] Keputusan Menteri Kesehatan Republik Indonesia Nomor 1116/MENKES/SK/VIII/2003. Pedoman Penyelenggaraan Sistem Surveilans Epidemiologi. Jakarta. Depkes RI. 2003. [15] Keputusan Menteri Kesehatan Republik Indonesia Nomor 416/MENKES/PER/IX/1990. Syarat-Syarat Dan Pengawasan Kualitas Air. Jakarta. Depkes RI. 2003. [16] Keputusan Menteri Kesehatan Republik Indonesia Nomor 829/MENKES/SK/VII/1999.Persyaratan Kesehatan Perumahan. Jakarta. Depkes RI. 2003. [17] Keputusan Menteri Kesehatan Republik Indonesia Nomor 1457/MENKES/SK/X/2003.Standar Pelayanan Minimal Bidang Kesehatan Di Kabupaten/Kota. Jakarta. Depkes RI. 2003. [18] Keputusan Menteri Kesehatan Republik Indonesia Nomor 1479/MENKES/SK/X/2003. Pedoman Penyelenggaraan Sistem Surveilans Epidemiologi Penyakit Menular Dan Penyakit Tidak Menular Terpadu. Jakarta. Depkes RI. 2003. [19] Keputusan Menteri Kesehatan Republik Indonesia Nomor 128/MENKES/SK/II/2004. Kebijakan Dasar Pusat Kesehatan Masyarakat. Jakarta. Depkes RI. 2004. [20] Kementerian Kesehatan Republik Indonesia. Petunjuk Penyususnan Perencanaan Pengendalian Penyakit Dan Penyehatan Lingkungan Tahun 2014, DitJen P2PL Kemenkes. RI. 2014. [21] Peraturan Menteri Kesehatan Republik Indonesia Nomor 32 Tahun 2013. Penyelenggaraan Pekerjaan Tenaga Sanitarian. Jakarta. Kemenkes RI. 2013. [22] Peraturan Menteri Kesehatan Republik Indonesia Nomor 75 Tahun 2014. Pusat Kesehatan Masyarakat. Jakarta. Kemenkes RI. 2014. [23] Rahadi, M., Evaluasi Hygiene Sanitasi Lingkungan Dalam Pencegahan Kejadian Diare Di Wilayah Kerja Dinas Kesehatan Kabupaten Kolaka, Tesis, FKM-UNAIR. Surabaya. 2015.. 32