Factors related to the performance of health workers at the Poasia public health center in Kendari city, southeast Sulawesi province, Indonesia 2024

 Corresponding author: Rahman Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. Factors related to the performance of health workers at the Poasia public health center in Kendari city, southeast Sulawesi province, Indonesia 2024 Ruslan Majid, Cindy Permata Sari and Rahman * Department of Public Health, Public Health Faculty, Halu Oleo University, Kendari, Indonesia. World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 553-559 Publication history: Received on 15 March 2025; revised on 23 April 2025; accepted on 26 April 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.22.1.0444 Abstract Background: The Minimum Service Standards (SPM) are an important reference in assessing the performance of health services in Indonesia, as regulated in the Indonesian Minister of Health. Based on the SPM of the Poasia Health Center in Kendari City in 2023, the SPM indicator has not reached the target, with the achievement of health services for pregnant women at 82%, basic education age at 85%, productive age at 85%, the elderly at 76%, hypertension patients at 47%, mental disorders at 82%, and the risk of HIV infection at 67%. Methods: The research method used the Cross-Sectional Study approach. The population in this study is all health workers of the Paonia Health Center which totals 113 people. The sample withdrawal technique uses total sampling. Data was obtained by interviews using questionnaires, analyzed by Chi Square statistical test at α = 5%. Results: The results showed that there was a relationship between workload (p value = 0.000), work motivation (p value = 0.002) and the performance of health workers at the Paonia Health Center in Kendari City, and there was no relationship between work discipline (p value = 0.326), organizational culture (p value = 0.156) and the performance of health workers at BLUD UPTD Paonia Health Center in Kendari City. Conclusion: There is a relationship between workload, work motivation, and no relationship between work discipline, organizational culture. It is recommended that the health center be more active in monitoring existing human resources, especially related to workload, and it is expected that the leaders of the health center provide motivation/rewards to employees so that employees can further improve their performance. Keywords: Workload; Work Discipline; Organizational Culture; Work Motivation; Performance 1. Introduction Organizational performance is the accumulation of individual and group performance. The good performance of the individual will have a positive impact on the group and the organization as a whole. Therefore, improving individual and group performance is essential for organizational success (1). Puskesmas as a public organization is expected to provide quality health services with a focus on promotive and preventive efforts. The Minimum Service Standard (SPM) aims to control the services of the Puskesmas and set a target for health service indicators, which includes 12 types of services (2). SPM achievement varies every year and is influenced by various factors such as health workers, the environment and society. Inequality in one of these factors can affect the results of SPM and the public health development index in the area (3). World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 553-559 554 According to World Health Organization (WHO) data, maternal deaths occurred almost every two minutes in 2020. Around 287,000 women died due to pregnancy or childbirth complications (4). There were about 2.4 million newborns who died in 2020 overall (5). The number of deaths of children under five in the world set a record low of 4.9 million in 2022, but the figure still represents one report of death every six seconds (6). In 2020, 57 million people died every year, of which 36 million were caused by one of the diseases, namely hypertension (7). In 2020, the largest number of new TB cases occurred in the WHO South-East Asian Region, with 43% of new cases (8). About 37.7 million people were living with HIV worldwide at the end of 2020 and 680,000 people died from HIVrelated causes (9). In Indonesia, the number of maternal deaths in 2023 reached 4,482, while deaths of toddlers (0-59 months) increased to 34,226 from 21,447 in 2022. The coverage of pregnant women's health services decreased to 85.6% and childbirth in health facilities to 87.2%. Complete basic immunization in infants dropped to 95.4%. However, the monitoring of the growth of toddlers increased to 82.3%. The coverage of health services in primary and secondary schools increased significantly, reaching 95.1% and 93.9% respectively. The discovery of TB cases increased to 77.5%, but has not yet reached the target of 90%. HIV-positive cases reached 57,299. The percentage of people with severe mental disorders (ODGJ) who receive services has increased to 88.1%, with a target of 90% for 2023 (Ministry of Health Profile, 2023). In Southeast Sulawesi, the coverage of health services has varied significantly in recent years. The coverage of health services for K1 pregnant women has decreased from 89.20% in 2022 to 79.85% in 2023. Meanwhile, the coverage of health services for pregnant women in K4 has remained stagnant at around 74% over the past two years. The coverage of childbirth in health facilities (fasyankes) has also not reached the target of 100%, with around 21-22% of deliveries still carried out outside health facilities. Coverage of first neonatal visits (KN1) and complete neonatal visits showed fluctuations, with KN1 declining from 99.60% in 2021 to 95.01% in 2022, before slightly increasing to 96.04% in 2023. However, complete basic immunization coverage (IDL) decreased from 90.24% in 2022 to 84.27% in 2023. Monitoring of the growth and development of toddlers showed an increase from 50% to 61.77%, although it is still far from the 100% SPM target. In the education sector, the coverage of health services in elementary and secondary schools increased from 80.80% in 2022 to 88.59% in 2023, while junior high schools/MTS also increased, although high schools/MA decreased from 74.50% to 69.82%. Health services for the elderly reached 62.03%, and the percentage of hypertension patients who received services according to standards only reached 38.81%. On the other hand, services for DM patients increased to 85.79%, but are still far from the 100% target. Health services for people with mental disorders (ODGJ) of 65.81%, have also not reached the national target (10). In Kendari City, the coverage of health services for K4 pregnant women showed an increase from 89.59% in 2022 to 90.75% in 2023. However, there was a decrease in coverage from 2021 to 2022, from 95.74% to 62.61%. Childbirth in health facilities in 2022 reached 95.75%, an increase from 93.70% in 2021. The coverage of childbirth assistance by health workers in health facilities is an indicator of SPM which is expected to reach the target of 100%. Complete KN coverage decreased from 99.86% in 2021 to 99.21% in 2022. Meanwhile, basic immunization coverage increased from 74.49% in 2021 to 95.81% in 2022, but has not reached the SPM target of 100%. Health services for students in 2022 are 85.56% for Grade 1 SD/MI, 83.34% for SMP/MTS, and 87.69% for SMA/MA. All three are still below the national target of 100%. In terms of hypertension, the percentage of patients who received services according to standards in 2022 reached 78.99%. The estimated number of DM sufferers in 2022 is 3,438 people, with 92.35% having received health services according to standards. For severe ODGJ, out of 455 people targeted, 378 (83.08%) received appropriate health services (11). Based on SPM data from the 2023 Poasia Health Center in Kendari City, the SPM indicator has not reached the target, with the achievement of health services for pregnant women at 82%, basic education age at 85%, productive age at 85%, the elderly at 76%, hypertension at 47%, mental disorders at 82%, and the risk of HIV infection at 67%. This achievement shows that the team's performance is not optimal, both internally and externally (12). The Minimum Service Standards (SPM) are an important reference in assessing the performance of health services in Indonesia, as stipulated in the Indonesian Minister of Health Regulation Number 741/Menkes/Per/VII/2008. SPM is not only an indicator, but also a benchmark for the success of health services provided by officers at health centers. In the midst of the challenges faced by health workers, a deep understanding of the factors that affect the achievement of SPM is crcial. World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 553-559 555 Based on the results of initial observations made by researchers in November 2024 at the Poasia Health Center, various problems were found that could affect the achievement of SPM. One of them is the inconsistency in the arrival time of several health workers at the Poasia Health Center. This shows that there are potential problems in the discipline that can have a direct impact on the quality of services provided to the community. The low discipline also reflects the influence of organizational culture that is not optimal in instilling work values that support the achievement of SPM. Furthermore, the factor that affects the performance of health workers is the workload. Where the results of interviews conducted with 10 civil servant health workers, that at the Poasia Health Center often do two/more jobs at the same time, where this condition can potentially cause fatigue. Another factor that is no less important is work motivation. High motivation, both from within the individual and from external factors such as awards, recognition, and incentives, can increase the enthusiasm of health workers to provide the best service. Based on this, the researcher is interested in conducting research with the title "Factors Related to the Performance of Health Workers at BLUD UPTD Poasia Health Center, Kendari City in 2024". 2. Method Research This research is a type of descriptive research using a quantitative approach method with a Cross-Sectional Study design. The sample in the study was all health workers at the Poasia Health Center totaling 113 respondents to the total sampling method. Data were obtained by interviews using questionnaires, analyzed by Chi Square statistical test at α = 5%. 3. Results and Discussion 3.1. The Relationship between Workload and Health Worker Performance at BLUD UPTD Poasia Health Center, Kendari City in 2024 Table 1 The Relationship between Workload and Health Worker Performance at BLUD UPTD Poasia Health Center, Kendari City in 2024 Workload Performance Sum p-value Good % Less % n % Heavy 29 41,4 41 58,6 70 100 0,000 Keep 35 81,4 8 18,6 43 100 Total 64 56,6 49 43,4 113 100 Source: Primary Data 2025 Based on table 1, it shows that of the 70 respondents (100%) who have a heavy workload, there are 29 respondents (41.4%) who have good performance and 41 respondents (58.6%) who have poor performance. Meanwhile, of the 43 respondents (100%) who had a moderate workload, there were 35 respondents (81.4%) who had good performance and 8 respondents (18.6%) who had poor performance. The Chi-Square statistical test obtained a p value = 0.000, because the p value < 0.05 then Ho is rejected and H₁ is accepted. This shows that there is a relationship between workload and the performance of health workers at BLUD UPTD Poasia Health Center, Kendari City. Workload is something that is very closely related to a job, where individuals give an assessment of a number of demands of tasks or activities that require mental and physical activity that he must complete in a certain time. Workers who have an excessive workload will reduce productivity and quality of work results, and there is a possibility that the implementation of work is not on time, less satisfactory and results in disappointment (13). The results of the study obtained a p value = 0.000, this shows that there is a relationship between workload and the performance of health workers at the Poasia Health Center in Kendari City. This is because the workload received by employees is quite varied, such as the number of responsibilities that must be completed, and the time given is limited, causing fatigue for employees due to excessive workload. World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 553-559 556 The results of this study showed that from 69 respondents, the highest percentage of respondents had a heavy workload with poor performance as many as 41 people (58.6%), this is because some health workers said that they do a lot of work every day that must be completed immediately. Especially if in one day the number of patients who come is very large, not to mention that health workers must conduct a thorough examination, and input patient data. Meanwhile, the results of the study also showed that of the 44 respondents, the highest percentage had a moderate workload with good performance as many as 35 people (81.4%), this is because some health workers said that they had a well-managed amount of work, with enough time to complete their tasks. The results of this study are in line with the research (14) Based on the Chi Squaire test, it was found that there was a relationship between workload and the performance of health workers at the Margorejo Health Center, South Metro District with a p-vailue of 0.006. Research conducted by (15) which states that there is a meaningful relationship between workload and the performance of nurses at Batam Hospital with p value (0,027). 3.2. The Relationship between Work Discipline and the Performance of Health Workers at BLUD UPTD Poasia Health Center, Kendari City Table 2 The Relationship between Discipline and the Performance of Health Workers at BLUD UPTD Poasia Health Center, Kendari City in 2024 Work Discipline Performance Sum p-value Good % Less % n % Enough 60 58,3 43 41,7 103 100 0,326 Less 4 40,0 6 60,0 10 100 Total 64 56,6 49 43,4 113 100 Source: Primary Data 2025 Based on table 2, it shows that of the 103 respondents (100%) who have sufficient work discipline, there are 60 respondents (58.3%) who have good performance and 43 respondents (41.7%) who have poor performance. Meanwhile, of the 10 respondents (100%) who had less discipline, there were 4 respondents (40.0%) who had good performance and 6 respondents (60.0%) who had poor performance. Chi-Square statistical test where 1 cell has an expected count value of less than 5, then the value is Exact. (2 sided) Fisher exact Test is 0.326, because the p value < 0.05 is accepted and H₁ is rejected. This shows that there is no relationship between work discipline and the performance of health workers at BLUD UPTD Poasia Health Center, Kendari City. Discipline is a tool in forming an orderly personality in carrying out an activity. Work discipline is a managerial effort to encourage members of the organization to comply with various applicable regulations. Work discipline reflects attitudes, behaviors, and actions that are in line with organizational rules, both written and unwritten (16). The results of this study show that from 103 respondents, the highest percentage of respondents have sufficient work discipline with good performance as many as 60 people (58.3%), this is because the majority of health workers have good work discipline where they always comply with the regulations that have been set and always carry out their duties with full responsibility. Meanwhile, the results of the study also showed that of the 10 respondents, the highest percentage of people had less discipline with less performance as many as 6 people (60.0%), this is because some health workers do not comply with the regulations that have been set by the health center. This research is in line with research conducted by (17) where there is no relationship between work discipline and the performance of health workers at the Limijati Children's Maternity Hospital, Bandung City. The results of statistical tests showed that there was no relationship between work discipline p value (0,392) on performance Limijati Children's Maternity Hospital Bandung City. World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 553-559 557 3.3. The Relationship between Organizational Culture and the Performance of Health Workers at BLUD UPTD Poasia Health Center, Kendari City in 2024 Table 3 The Relationship between Organizational Culture and the Performance of Health Workers at the Blud uptd Health Center of Poasia Health Center, Kendari City in 2024 Organizational Culture Performance Sum p-value Good % Less % n % Enough 55 60,4 36 39,6 91 100 0,156 Less 9 40,9 13 59,1 22 100 Total 64 56,6 49 43,4 113 100 Source: Primary Data 2025 Based on table 3, it shows that of the 91 respondents (100%) who have enough organizational culture, there are 55 respondents (60.4%) who have good performance and 36 respondents (39.6%) who have poor performance. Meanwhile, of the 22 respondents (100%) who had a lacking organizational culture, there were 9 respondents (40.9%) who had good performance and 13 respondents (59.1%) who had poor performance. The Chi-Square statistical test obtained a p value = 0.156, because the p value < 0.05, Ho is accepted and H₁ is rejected. This shows that there is no relationship between organizational culture and the performance of health workers at BLUD UPTD Poasia Health Center in Kendari City. Organizational culture is a set of assumptions that can be accepted and implicitly shared and held by a group to determine how it can be perceived, thought about and respond to its diverse environment (18). The results of this study show that from 91 respondents, the highest percentage of respondents have a sufficient organizational culture with good performance as many as 50 people (60.4%), this is because the organizational culture at the Poasia Health Center is reflected in the positive example of leaders, good communication between employees, and the support of colleagues in completing tasks. Meanwhile, the results of the study also showed that out of 10 respondents, the highest percentage had a lack of organizational culture with poor performance as many as 13 people (59.1%), this is because some health workers stated that they quite agreed that health institutions have provided opportunities for self-development and careers. However, they feel that these opportunities are not even or maximum, so there are still limitations in improving overall competence. This research is not in line with the research conducted by (19) which states that there is a relationship between organizational culture and the performance of health workers. In addition, this research is also not in line with the research conducted by (20) where there is a relationship between organizational culture and the performance of health workers at Mutiara Sorong Hospital. The results of the statistical test show that there is a cultural relationship between the organization p value (0,001) performance at Mutiara Sorong Hospital. 3.4. The Relationship between Work Motivation and Health Worker Performance at BLUD UPTD Poasia Health Center, Kendari City in 2024 Table 4 The Relationship between Work Motivation and Health Worker Performance at BLUD UPTD Poasia Health Center, Kendari City in 2024 Work motivation Performance Total p-value Good % Less % n % Enough 59 64,1 33 35,9 92 100 0,002 Less 5 23,8 16 76,2 21 100 Total 64 56,6 49 43,4 113 100 Source: Primary Data 2025 World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 553-559 558 Based on table 4, it shows that of the 92 respondents (100%) who have sufficient work motivation, there are 59 respondents (64.1%) who have good performance and 33 respondents (35.9%) who have poor performance. Meanwhile, of the 21 respondents (100%) who had a low workload, there were 5 respondents (23.8%) who had good performance and 16 respondents (76.2%) who had poor performance. The Chi-Square statistical test obtained a p value = 0.002, because the p value < 0.05 then Ho is rejected and H₁ is accepted. This shows that there is a relationship between motivation and the performance of health workers at BLUD UPTD Poasia Health Center, Kendari City. Motivation is a set of attitudes and values that influence individuals to achieve specific things according to individual goals. Meanwhile, work motivation is a skill, in directing employees and organizations to want to work successfully, so that the desires of employees and organizational goals will be achieved (13). The results of this study show that out of 113 respondents, the highest percentage of respondents have sufficient work motivation with sufficient performance of 73 people (79.3%), this is because health workers feel encouraged to complete their tasks as well as possible. So, the higher the level of motivation of a person, the higher the performance of health workers, the facilities obtained by health workers are in accordance with the workload they do and the salary they get is also sufficient for the daily needs of respondents in meeting their needs. If the salaries received by the officers are in accordance with the work they do, the health workers will be more enthusiastic in working so that the performance of health workers will be better. In addition, another thing obtained at the research site was the motivation or support from fellow colleagues, so that the social environment that existed between fellow health workers at the Poasia Health Center was very well established. This research is in line with research conducted by (21) which states that there is a relationship between work motivation and the performance of health workers in health centers Memories of Percut Sei Tuan Deli Serdang Regency with p value (0.000). Supported by research (22)) that work motivation is the most related factor to the performance of health workers at the Lampung Mediation Health Center. Moreover This research is in line with research conducted by (23) which states that there is a relationship between work motivation and the performance of health workers at the Cikarang Health Center with p value (0,03). 4. Conclusion Based on the results of the study on the relationship between workload, discipline, organizational culture and work motivation with the performance of health workers at the Poasia Health Center in Kendari City in 2024, it can be concluded that there is a relationship between workload, work motivation and no relationship between work discipline and organizational culture on the performance of health workers in the regional public service agency (BLUD) of the Poasia Health Center in Kendari City in 2024. Therefore, there needs to be a proportionate work shift mechanism and reward as a form of appreciation for health workers to increase work motivation and have implications for improving performance. Compliance with ethical standards Disclosure of conflict of interest No conflict of interest to be disclosed. References [1] Kikhau AMO, Littik SKA, Berek NC, Muntasir, Junias MS. Analysis of the Performance of Baumata and Naibonat Health Center Officers on the Achievement of Minimum Health Service Standards in Kupang Regency. Public Heal Risk Assessment J. 2024; 1(2):84–94. [2] Subject A. Analysis of Constraint Factors in the Implementation of Minimum Service Standards in the Health Sector at the Palengaan Health Center at the Pamekasan Regency Health Office. 2021; 1–18. [3] Christanti J, Juliantini M. Analysis of the Availability of Health Workers on the Achievement of Health Center Performance Indicators in Ketapang Regency in 2019. Praxis (Bern 1994). 2020; 3(1):1. World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 553-559 559 [4] Mujahadatuljannah, Susanti Suhartati, Anita Z. Optimizing ANC Visits by Providing Education for Pregnant Women and Notebooks of Coming Bumil (Cadres Monitoring Pregnant Women's Visits) in Tumbang Ruran Village. 2024; 1(1):61–7. [5] Diah Amalia Mirzanti Djamil, Harismayanti PY. The Effect of Old Partus on the Incidence of Asphyxia in Newborns at Prof. Dr.H. Aloei Saboe Hospital, Gorontalo City. J Nurse. 2023; 6(1):65–75. [6] WHO. Health Profile in 2022. 2021; [7] Handayani S, Hipson M. Factors related to the incidence of asphyxia in newborns. J Ilm Multi Sci Kesehat [Internet]. 2023; 15(1):212–21. Available from: https://jurnal.stikes-aisyiyahpalembang.ac.id/index.php/Kep/article/view/ [8] Nortajulu B. Factors Associated with Pulmonary TB Recovery. J Prof. Nurse Researcher 2022; 4(4):153–8. [9] World Health Organization. World health statistics 2021: Monitoring health for the SDGs, sustainable development goals. World Health Organization.2021. https://www.who.int/publications/i/item/9789240027053 [10] Southeast Sulawesi Health Office. Southeast Sulawesi Health Profile. Kendari.2022. [11] Kendari Health Dinask. Profile of the Kendari City Health Office. 2022. [12] Poasia Health Center. Profile of Poasia Health Center in Kendari City. 2023. [13] Shah JS. The Influence of Workload and Bureaucratic Leadership Style on Employee Performance at Ub Guest House. 2022; [14] Asih A, Nurwinda N, Listina F. The Relationship between Workload and Health Worker Performance at the Margorejo Health Center in 2023. 2024; 1:23–31. [15] TY Febrina, Z Edward NN. The relationship between workload and nurse performance in the inpatient installation of Harapan Bunda Hospital, Batam City. 2020; [16] Fair D. The Influence of Work Environment, Workload, Work Discipline and Work Motivation on Job Satisfaction (Case Study on Perumda Dharma Jaya Employees). 2022; [17] Pamungkas G, Tamara MD, Rahmawati P. Factors Related to the Performance of Front Office Unit Officers at Limijati Children's Hospital, Bandung City in 2022. J Immanuel Health Sciences. 2023; 16(2):65–72. [18] D Soelistya, R Purwani Setyanongrum NA. Organizational Culture in Practice. 2022. [19] Nudianti RM, Rina A, Eff Y, Jus I. Retna Mutiara Nudianti 1* , Aprilita Rina Yanti Eff 2 , Idrus Jus'at 3. 2024; 8:5624– 39. [20] Ilham GG, Lantara NF, Arfah A. The Influence of Organizational Culture, Motivation, Compensation and Leadership Style on Employee Performance at Mutiara Sorong Hospital. J Account Financ. 2022; 4(1):48–64. [21] Harefa F, Dachi RA, Brahmana NE, Ketaren O, Manurung K. Factors related to the performance of health workers at the Kenangan Percut Sei Tuan Health Center, Deli Serdang Regency. J Heal Technol Med. 2021; 7(2):1024–38. [22] Andayani Y. Health Officer at the South Lampung Inpatient Health Center in 2023. J Ners. 2024; 8(1):1045–53. [23] Hutagaol EK et al. Analysis of Workload and Motivation for the Performance of the Cikarang Health Center in Facing Hydrometeorology in Bekasi Regency in 2023. Inov J Soc Sci Res. 2023; 3(5):8686–95.