Jenis Puskesmas

01Regulatory Foundation and Definition

Puskesmas (Pusat Kesehatan Masyarakat) is a health care facility that provides health services to the community at the subdistrict level. It is classified as a first-level health facility (FKTP) and prioritizes promotive and preventive health efforts to achieve optimal public health status. In accordance with Permenkes No. 19 Tahun 2024, Puskesmas carries out two main functions: the delivery of community health efforts (UKM) at the primary level and the delivery of individual health services (UKP) at the primary level.

The regulation makes clear that while Puskesmas serves the wider population through health promotion and disease prevention, it does not neglect the quality of individual patient care. The Puskesmas is led by a Kepala Puskesmas who is accountable to the District/City Health Office (Dinas Kesehatan Kabupaten/Kota).

The exam often tests whether candidates understand the dual mandate of UKM and UKP, and that UKM (promotive/preventive) takes priority over UKP (curative/rehabilitative) at the Puskesmas level. This distinguishes Puskesmas from hospitals, where curative care is central.

02Categories by Territorial Characteristics (Karakteristik Wilayah Kerja)

Based on the characteristics of the working area, Puskesmas are categorized into three types: Puskesmas kawasan tidak terpencil (non-remote), Puskesmas kawasan terpencil (remote), and Puskesmas kawasan sangat terpencil (very remote). These build upon three underlying territorial settings: urban (perkotaan), rural (perdesaan), and remote/very remote (terpencil/sangat terpencil).

Classification Table: Territorial Types

The urban Puskesmas must meet at least 3 of 4 urban criteria, which include: more than 50% of the population engaged in non-agrarian activities; proximity to urban facilities such as schools within 2.5 km, markets within 2 km, hospitals within 5 km, or hotels; more than 90% of households having electricity; and access to roads and transportation leading to urban facilities.

The rural Puskesmas similarly requires at least 3 of 4 rural criteria, including: more than 50% of the population in agrarian or maritime activities; schools beyond 2.5 km, markets beyond 2 km, hospitals beyond 5 km, with no hotel; household electricity coverage below 90%; and available but limited road access.

For the remote and very remote categories, the Puskesmas serves communities in areas that are hard to reach, prone to natural disasters, or located on small islands and coastal zones. Health workers may be granted expanded competencies and clinical authority, and services can be organized through island-cluster or mobile health delivery models.

Remoteness Scoring System

The determination of remoteness category uses a scoring formula based on characteristics of the working area. Scored criteria include factors such as geographic accessibility, disaster risk, frequency and duration of public transportation, and supply chain reliability.

The category must be formally determined (ditetapkan) by the Bupati/Walikota of the district/city. This is a favorite exam point: the authority to categorize lies with the local government head, not the Puskesmas itself, not the provincial government, and not the central Ministry of Health.

03Categories by Service Capability (Kemampuan Pelayanan)

Based on service capability, Puskesmas are divided into Puskesmas nonrawat inap (non-inpatient) and Puskesmas rawat inap (inpatient).

Comparison Table: Non-Inpatient vs. Inpatient Puskesmas

A Puskesmas rawat inap is established for non-remote Puskesmas in rural, remote, and very remote areas that are more than 5 km from a hospital and/or more than 120 minutes of travel time away. Inpatient care at a Puskesmas is limited to cases requiring a maximum of 5 days of hospitalization, with patients needing further care referred to a hospital in a planned manner. The maximum bed count is 10.

A frequently tested concept is the upgrade pathway: the transition to inpatient status is done gradually from a nonrawat inap Puskesmas, except for terpencil and sangat terpencil categories, which may be established directly as rawat inap. This exception exists because remote areas often have no hospital access, making inpatient capability immediately necessary rather than optional.

04The Cluster (Klaster) System

Under Permenkes No. 19/2024, the internal structure of Puskesmas has been reorganized from the previous program-based model into a cluster-based system aligned with the Integrated Primary Care framework (Integrasi Layanan Primer / ILP).

Cluster Table

Each cluster is led by a cluster coordinator (penanggung jawab klaster) who is a functional health officer appointed by the Kepala Puskesmas. There is no longer a structural position of Kepala Sub Bagian Tata Usaha in the new organizational model.

The exam may test this structural change. The elimination of the Kasubag Tata Usaha as a structural position and the shift to cluster-based leadership under functional health officers is a new concept introduced in the 2024 regulation.

05Network System (Jaringan and Jejaring)

The Puskesmas does not operate in isolation. It functions within a two-layered support system:

Jaringan Puskesmas (Internal Network)

These are facilities that operate directly under the authority and management of the Puskesmas:

Jejaring Puskesmas (External Network)

These are independent health facilities and organizations that coordinate with the Puskesmas but are not under its direct management:

The Puskesmas networking system includes structures based on administrative territory, educational institutions, workplaces, referral systems, and cross-sector partnerships.

The exam frequently tests whether candidates understand the difference between jaringan (facilities owned and managed by the Puskesmas) and jejaring (independent facilities that coordinate with the Puskesmas). A Pustu is jaringan; a private clinic is jejaring.

06Functions and Authority

The Puskesmas serves as: a provider of primary health services in its working area, a site for education and training of medical and health workers, a facility for the professional internship program (internsip), and a venue for health research and development.

07Distinguishing Puskesmas from Similar Facilities

08Traps and High-Yield Pearls

The most common mistake students make with this topic is confusing the two classification axes. A Puskesmas is always categorized on both axes simultaneously. For example, a facility can be a "Puskesmas rawat inap di kawasan terpencil" or a "Puskesmas nonrawat inap di kawasan perkotaan." The territorial category and the service capability category are independent of each other and must both be stated.

Another frequent trap involves the authority to determine categories. Students often incorrectly attribute this to the Dinas Kesehatan or the Ministry of Health. The correct answer is the Bupati/Walikota.

A third common error is the bed count for rawat inap Puskesmas. When a vignette describes a primary care facility with more than 10 inpatient beds, that facility cannot be a Puskesmas rawat inap. Similarly, if the inpatient stay described exceeds 5 days and the patient has not been referred, the vignette is signaling a deviation from the standard.

Students should also remember that in remote and very remote areas, health workers may be granted expanded clinical authority beyond their usual scope of practice. This is a regulatory provision, not a workaround. It is legal and expected in those settings, and exam questions may test whether candidates recognize this expanded scope as appropriate rather than as a violation.

Finally, the shift from program-based organizational structure to the klaster system under Permenkes 19/2024 is a recent change. Questions testing the new organizational model will look for whether students can identify the five clusters and recognize that the Kasubag Tata Usaha structural position no longer exists.

The core competency being tested across all Puskesmas questions is whether the candidate understands the role of the Puskesmas as the backbone of primary care in the Indonesian health system, with its dual UKM-UKP function, its territorial adaptations, and the regulatory framework that governs its operation.