RENCANA PELAKSANAAN KEGIATAN TAHUNAN PROGRA

UPAYA PROMOTIF DAN PRE

TAHUN ANGGARAN 20
PROVINSI : SULAWESI TENGAH
KABUPATEN : TOJO UNA - UNA
KECAMATAN : AMPANA KOTA
TAHUN : 2015

No Kegiatan Sasaran Target

UPAYA KESEHATAN PRIORITAS
I. Kesehatan Ibu Anak (KIA) dan Keluarga Berencana (KB)

a. Kunjungan Rumah Bumil Rist Bumil 76 Bumil Rist x 180 OT x Rp 20,000

b. Kunjungan Rumah Bufas Bufas 100 Bufas x 300 OT x Rp 20,000

c. Kelas Ibu Hamil
x 1 OT x Rp 33,000
x 1 OT x Rp 30,000
x 1 OT x Rp 30,000
x 1 OT x Rp 30,000
x 1 OT x Rp 30,000
x 1 OT x Rp 30,000
x 1 OT x Rp 42,000
Bumil 10 Kelas x 1 OT x Rp 48,000
x 1 OT x Rp 36,000
x 1 OT x Rp 36,000
x 100 Pkt X Rp 10,000
x 170 OK x Rp 10,000
x 3 M2 x Rp 50,000

x 10 OT x Rp 20,000

II. PELAYANAN KESEHATAN ANAK

a. Pelayanan di Posyandu Pemantauan Kesehatan Bayi Balita (Pengukuran Tumbuh Kembang & Pemantauan Perkembanga
3 Posyandu x 90 OT x Rp 33,000
2 Posyandu x 45 OT x Rp 30,000
1 Posyandu x 45 OT x Rp 30,000
2 Posyandu x 45 OT x Rp 30,000
1 Posyandu x 45 OT x Rp 30,000
2 Posyandu x 45 OT x Rp 30,000
2 Posyandu x 45 OT x Rp 42,000
1 Posyandu x 45 OT x Rp 48,000
2 Posyandu x 45 OT x Rp 36,000
 3 Posyandu x 90 OT x Rp 36,000

19 Posyandu x 108 OT x Rp 20,000

b. Pemantauan Neonatus Rist
Neonatus
Neonatus 60 x 270 OT x Rp 20,000
Rist

III. PELAYANAN GIZI

a. Sweeping Penimbangan (D/S)
3 Posyandu x 8 OT x Rp 33,000
2 Posyandu x 4 OT x Rp 30,000
1 Posyandu x 4 OT x Rp 30,000
2 Posyandu x 4 OT x Rp 30,000
1 Posyandu x 4 OT x Rp 30,000
Bayi/Balita
2 Posyandu x 4 OT x Rp 30,000
2 Posyandu x 4 OT x Rp 42,000
1 Posyandu x 4 OT x Rp 48,000
2 Posyandu x 4 OT x Rp 36,000
3 Posyandu x 8 OT x Rp 36,000
b. Sweeping Vit. A
x 1 OT x Rp 33,000
x 1 OT x Rp 30,000
x 1 OT x Rp 30,000
x 1 OT x Rp 30,000
x 1 OT x Rp 30,000
Kelurahan/ x 1 OT x Rp 30,000
Bayi/Balita 10 Desa x 1 OT x Rp 42,000
x 1 OT x Rp 48,000
x 1 OT x Rp 36,000
x 1 OT x Rp 36,000

x 10 OT x Rp 20,000

c. PMT Pemulihan Bayi/Balita Gizi Buruk

Bayi/ Balita 4 Bayi/ Balita 360 OH x Rp 30,000

GB GB
 d. Pemantauan Pemberian PMT Bayi Balita
3 OT x Rp 33,000
Bayi/ Balita Kelurahan/
3 3 OT x Rp 30,000
GB Desa
3 OT x Rp 36,000
e. Sweeping Imunisasi
x 4 OT x Rp 33,000
x 4 OT x Rp 30,000
x 4 OT x Rp 30,000
x 4 OT x Rp 30,000
Kelurahan/ x 4 OT x Rp 30,000
Bayi/Balita 10 Desa x 4 OT x Rp 30,000
x 4 OT x Rp 42,000
x 4 OT x Rp 48,000
x 4 OT x Rp 36,000
x 4 OT x Rp 36,000
f. Pengambilan Vaksin

8 OT Rp 30,000

GENDALIAN
IV PENYAKIT MENULAR
a Penyuluhan
- Penyuluhan Bahaya Penyakit TB dan Kusta
2 OT x Rp 33,000
2 OT x Rp 30,000
2 OT x Rp 30,000
2 OT x Rp 30,000
Kelurahan/ 2 OT x Rp 30,000
Masyarakat 10 Desa 2 OT x Rp 30,000
2 OT x Rp 42,000
2 OT x Rp 48,000
2 OT x Rp 36,000
2 OT x Rp 36,000
220 OK x Rp 10,000
1 Paket x Rp 75,000
- Penyuluhan Bahaya Penyakit Menular Seksual
6 OT x Rp 30,000
SLTP/ 2 OT x Rp 30,000
SLTA 4 OT x Rp 30,000
Siswa 10
2 OT x Rp 42,000
Sederajat 2 OT x Rp 42,000
2 OT x Rp 42,000
1 Paket x Rp 75,000
 - Penyuluhan Bahaya Rokok
6 OT x Rp 30,000
SLTP/ 2 OT x Rp 30,000
SLTA 4 OT x Rp 30,000
Siswa 10
2 OT x Rp 42,000
Sederajat 2 OT x Rp 42,000
2 OT x Rp 42,000
1 Paket x Rp 75,000
- Penyuluhan Bahaya CA Cerviks dan IVA
2 OT x Rp 33,000
2 OT x Rp 30,000
2 OT x Rp 30,000
2 OT x Rp 30,000
2 OT x Rp 30,000
PUS/WUS 10 Kelurahan/ 2 OT x Rp 30,000
Desa
2 OT x Rp 42,000
2 OT x Rp 48,000
2 OT x Rp 36,000
2 OT x Rp 36,000
220 OK x Rp 10,000
1 Paket x Rp 75,000
b Pelacakan Kasus
- Pelacakan Kasus TB
2 OT x Rp 33,000
2 OT x Rp 30,000
2 OT x Rp 30,000
2 OT x Rp 30,000
Kelurahan/ 2 OT x Rp 30,000
10 Desa 2 OT x Rp 30,000
2 OT x Rp 42,000
2 OT x Rp 48,000
2 OT x Rp 36,000
2 OT x Rp 36,000
- Pemantauan Penderita Reaksi Kusta
2 OT x Rp 33,000
2 OT x Rp 30,000
2 OT x Rp 30,000
Kelurahan/ 2 OT x Rp 30,000
10 Desa 2 OT x Rp 30,000
2 OT x Rp 30,000
2 OT x Rp 42,000
2 OT x Rp 48,000
 2 OT x Rp 36,000
2 OT x Rp 36,000
- Pemantauan Daerah Berpotensi KLB
3 OT x Rp 33,000
3 OT x Rp 30,000
3 OT x Rp 30,000
3 OT x Rp 30,000
Kelurahan/ 3 OT x Rp 30,000
10 Desa 3 OT x Rp 30,000
3 OT x Rp 42,000
3 OT x Rp 48,000
3 OT x Rp 36,000
3 OT x Rp 36,000
c Mengendalikan Penyebaran dan menurunkan Jumlah Kasus baru Malaria,DBD
- Survei Jentk dan abatesasi
1 2 OT x Rp 33,000
1 2 OT x Rp 30,000
4 8 OT x Rp 30,000
3 SD/ 6 OT x Rp 30,000
2 SLTP/ 4 OT x Rp 30,000
4 SLTA 8 OT x Rp 30,000
Sederajat
1 2 OT x Rp 48,000
1 2 OT x Rp 36,000
2 4 OT x Rp 36,000
5 10 OT x Rp 42,000
- Penyuluhan dan Screaning Malaria
3 OT x Rp 42,000
Kelurahan/D 3 OT x Rp 48,000
2 esa 200 OK x Rp 10,000
1 Paket x Rp 75,000
- Sosialisasi Kader Jumantk
2 OT x Rp 33,000

2 OT x Rp 30,000

2 OT x Rp 30,000
2 OT x Rp 30,000
Kader 20 Kader 2 OT x Rp 30,000
2 OT x Rp 30,000
2 OT x Rp 42,000
2 OT x Rp 48,000
2 OT x Rp 36,000
2 OT x Rp 36,000
 20 OK Rp 50,000
3 OK Rp 175,000
20 Paket Rp 7,500
Kader 20 Kader
25 OK Rp 10,000
25 OK Rp 25,000
3 M2 Rp 50,000
- Sosialisasi Frambusia
3 OT x Rp 33,000
3 OT x Rp 30,000
3 OT x Rp 30,000
3 OT x Rp 30,000
3 OT x Rp 30,000
3 OT x Rp 30,000
3 OT x Rp 42,000
3 OT x Rp 48,000
3 OT x Rp 36,000
3 OT x Rp 36,000
30 x Rp 50,000
3 x Rp 175,000
30 x Rp 5,000
35 x Rp 10,000
35 x Rp 25,000
3 x Rp 50,000
- Sosialisasi STBM
5 OT x Rp 33,000
5 OT x Rp 30,000
5 OT x Rp 30,000
5 OT x Rp 30,000
5 OT x Rp 30,000
5 OT x Rp 30,000
5 OT x Rp 42,000
Kelurahan/ 5 OT x Rp 48,000
Masy 10 Desa 5 OT x Rp 36,000
5 OT x Rp 36,000
50 OK x Rp 50,000
3 OK x Rp 175,000
50 Paket Rp 10,000
55 OK Rp 10,000
55 OK Rp 25,000
3 M2 Rp 50,000
V. Meningkatkan Akses Masyarakat terhadap sumber air minum dan sanitasi dasar
a Pemeriksaan TTU
1 OT x Rp 33,000
1 OT x Rp 30,000
1 OT x Rp 30,000
1 OT x Rp 30,000
Tempat Tempat Kelurahan/ 1 OT x Rp 30,000
10
Umum Desa 1 OT x Rp 30,000
1 OT x Rp 42,000
1 OT x Rp 48,000
1 OT x Rp 36,000
1 OT x Rp 36,000
b Pemeriksaan TPM
1 OT x Rp 33,000
Tempat 1 OT x Rp 30,000
Pengolahan 6 Kelurahan 1 OT x Rp 30,000
Makanan 1 OT x Rp 30,000
1 OT x Rp 30,000
1 OT x Rp 30,000
c Pemeriksaan Damium
1 OT x Rp 30,000
1 OT x Rp 30,000
Damium 6 Damium 1 OT x Rp 30,000
1 OT x Rp 30,000
1 OT x Rp 30,000
1 OT x Rp 42,000
d Pemeriksaan Sanitasi Hotel / Penginapan
1 OT x Rp 30,000
1 OT x Rp 30,000
Hotel 1 OT x Rp 30,000
6 Hotel/Peng
Penginapan 1 OT x Rp 30,000
1 OT x Rp 30,000
1 OT x Rp 30,000
PENYELENGGARAAN UPAYA PENUNJANG
I MANAJEMEN PUSKESMAS
a Penggerakan Pelaksanaan (P2)
- Lokakarya Mini Puskesmas
Petugas 8 Kegiatan 480 OK x Rp 10,000
 - Pertemuan Lintas Sektor
77 OK X Rp 25,000
77 OK X Rp 10,000
77 OK X Rp 50,000
1 Paket X Rp 150,000
3 M2 X Rp 150,000
- Konsultasi BOK
9 Kunjungan 9 OT x Rp 30,000

- Penatausahaan SPJ BOK

9 Bulan 1 Paket x Rp 2,843,000

b Pengawasan Pengendalian dan Penilaian (P3)

- Supervisi Fasilitatf Bikor
1 OT x Rp 33,000
1 OT x Rp 30,000
1 OT x Rp 30,000
1 OT x Rp 30,000
1 OT x Rp 30,000
10 Desa
1 OT x Rp 30,000
1 OT x Rp 42,000
1 OT x Rp 48,000
1 OT x Rp 36,000
1 OT x Rp 36,000
- Supervisi Pengelola Gudang Obat
Gudang Obat 1 OT x Rp 33,000
1 OT x Rp 30,000
1 OT x Rp 30,000
1 OT x Rp 30,000
Bides/ 1 OT x Rp 30,000
10 Desa
Perawat 1 OT x Rp 30,000
1 OT x Rp 42,000
1 OT x Rp 48,000
1 OT x Rp 36,000
1 OT x Rp 36,000
II Penjaringan Anak Sekolah Dasar
a Penjaringan Anak Sekolah Dasar/Penyuluhan PHBS
1 3 OT x Rp 33,000
1 3 OT x Rp 30,000
Murid Sekolah 1 SD/ 3 OT x Rp 30,000
Dasar 2 Sederajat 6 OT x Rp 30,000
2 6 OT x Rp 30,000
2 6 OT x Rp 30,000
 1 3 OT x Rp 42,000
1 SD/ 3 OT x Rp 48,000
Murid Sekolah 1 Sederajat 3 OT x Rp 36,000
Dasar 2 6 OT x Rp 36,000

750 Lbr x Rp 200

b Pencegahan Penyakit Cacingan Pada Anak

1 1 OT x Rp 33,000
1 1 OT x Rp 30,000
1 1 OT x Rp 30,000
2 2 OT x Rp 30,000
2 SD/ 2 OT x Rp 30,000
Sederajat 2 OT x Rp 30,000
1 OT x Rp 30,000
1 OT x Rp 30,000
1 OT x Rp 30,000
2 OT x Rp 42,000
III PENGEMBANGAN UKBM
a Dukungan operasional Kader posyandu

Kader Posyandu 95 Kader 855 OT x Rp 20,000

b Dukungan Operasional Kader Posbindu

1 Petugas 9 OT x Rp 30,000

5 Kader 45 OT x Rp 20,000

IV PROMOSI KESEHATAN

a Sosialisasi Pendampingan Kader

8 OT x Rp 33,000
6 OT x Rp 30,000
4 OT x Rp 30,000
6 OT x Rp 30,000
Lurah/Kades, 4 OT x Rp 30,000
58 Peserta
Bides, Kader 6 OT x Rp 30,000
6 OT x Rp 42,000
4 OT x Rp 48,000
6 OT x Rp 36,000
8 OT x Rp 36,000
48 OK Rp 50,000
3 OK x Rp 175,000
38 Paket x Rp 10,000
60 OK x Rp 10,000
60 OK x Rp 25,000
3 M2 x Rp 50,000
 b Pelathan/Refresing Kader Posyandu
15 OT x Rp 33,000
15 OT x Rp 30,000
15 OT x Rp 30,000
15 OT x Rp 30,000
15 OT x Rp 30,000
15 OT x Rp 30,000
Kader 3 Hari 30 OK Rp 50,000

18 OJ x Rp 175,000

30 Paket x Rp 5,000
1. 2. 2103. OK x Rp 10,000
105 OK x Rp 25,000
Verivikator : 3 M2 x Rp 50,000

J U M L A H T O T A L
1. 2. 3.

Verivikator :

Mengetahui,
Kepala Dnas Kesehatan
Kabupaten Tojo Una-una

dr. Abd. Rahman. DM. MARS

NIP. 195603041983121002
UNAN PROGRAM BOK PUSKESMAS AMPANA BARAT
MOTIF DAN PREVENTIF
ANGGARAN 2015

Rincian Lokasi Tenaga Sumber

Jadwal Biaya
Pelaksanaan Pelaksanaan Pelaksana Biaya
Rp 84,005,000 BOK
Rp 12,995,000 BOK
Wilker PKM
Transport Bides Ampana Barat Bides Rp 3,600,000

Wilker PKM
Transport Bides Ampana Barat Bides Rp 6,000,000

Rp 3,395,000
Malotong Rp 33,000
Bonerato Rp 30,000
Bailo Baru Rp 30,000
Bailo Rp 30,000
Tranport Petugas Labiabae April s/d Rp 30,000
Bikor
(Bikor) Ampana Desember Rp 30,000
Sansarino Rp 42,000
Saluaba Rp 48,000
Buntongi Rp 36,000
Padang Tumbuo Rp 36,000
ATK Rp 1,000,000
Konsumsi Rp 1,700,000
Spanduk Rp 150,000
Wilker PKM
Transport Bides Bides
Ampana Barat Rp 200,000
Rp 26,190,000 BOK
ntauan Perkembangan) dan Antenatal bagi Ibu Hamil Rp 20,790,000
Malotong Rp 2,970,000
Bonerato Rp 1,350,000
April s/d
Transport Petugas Bailo Baru Team Rp 1,350,000
Desember
Bailo Rp 1,350,000
Labiabae Rp 1,350,000
Ampana Rp 1,350,000
Sansarino Rp 1,890,000
April s/d
Transport Petugas Saluaba Team Rp 2,160,000
Desember
Buntongi Rp 1,620,000
 April s/d
Transport Petugas Team Desember

Padang Tumbuo Rp 3,240,000

Transport Bides
Rp 2,160,000
Rp 5,400,000

Rp 5,400,000

Rp 14,918,000 BOK
Rp 1,656,000
Malotong Rp 264,000
Bonerato Rp 120,000
Bailo Baru Rp 120,000
Bailo Rp 120,000
Labiabae April s/d Rp 120,000
Transport Petugas Team
Ampana Desember Rp 120,000
Sansarino Rp 168,000
Saluaba Rp 192,000
Buntongi Rp 144,000
Padang Tumbuo Rp 288,000
Rp 545,000
Malotong Rp 33,000
Bonerato Rp 30,000
Bailo Baru Rp 30,000
Bailo Rp 30,000
Labiabae Rp 30,000
Transport Petugas Pengelola Gizi September
Ampana Rp 30,000
Sansarino Rp 42,000
Saluaba Rp 48,000
Buntongi Rp 36,000
Padang Tumbuo Rp 36,000
Dukungan Ops Wilker PKM AB Kader Posyandu September Rp 200,000
Kader
Rp 10,800,000

PMT Wilker PKM AB Pengelola Gizi Juni-Agust Rp 10,800,000

 Rp 297,000
Malotong Rp 99,000
Transport Petugas Ampana Pengelola Gizi Juli - Sept Rp 90,000
Buntongi Rp 108,000
Rp 1,380,000
Malotong Rp 132,000
Bonerato Rp 120,000
Bailo Baru Rp 120,000
Bailo Rp 120,000
Labiabae April s/d Rp 120,000
Transpor Petugas Jurim
Ampana Desember Rp 120,000
Sansarino Rp 168,000
Saluaba Rp 192,000
Buntongi Rp 144,000
Padang Tumbuo Rp 144,000
Rp 240,000
April s/d
Transpor Petugas Jurim Rp 240,000
Desember
Rp 29,002,000
BOK
Rp 7,304,000
Rp 2,965,000
Malotong Rp 66,000
Bonerato Rp 60,000
Bailo Baru Rp 60,000
Bailo Rp 60,000
Petugas Promkes/ April s/d
Transpor Petugas Labiabae Rp 60,000
Ampana Pengelola TB & Kusta Desember Rp 60,000
Sansarino Rp 84,000
Saluaba Rp 96,000
Buntongi Rp 72,000
Padang Tumbuo Rp 72,000
Konsumsi Rp 2,200,000
ATK Rp 75,000
Rp 687,000
Bailo Baru Rp 180,000
Bailo Rp 60,000
Ampana Promkes/ Pengelola April s/d Rp 120,000
Transport Petugas Sansarino Kespro Desember Rp 84,000
Sansarino Rp 84,000
Sansarino Rp 84,000
ATK Rp 75,000
 Rp 687,000
Bailo Baru Rp 180,000
Bailo Rp 60,000
Ampana Promkes/ Pengelola April s/d Rp 120,000
Sansarino PTM Desember Rp 84,000
Sansarino Rp 84,000
Sansarino Rp 84,000
ATK Rp 75,000
Rp 2,965,000
Malotong Rp 66,000
Bonerato Rp 60,000
Bailo Baru Rp 60,000
Bailo Rp 60,000
Labiabae Promkes/ Pengelola April s/d Rp 60,000
Transport Petugas
Ampana PTM Desember Rp 60,000
Sansarino Rp 84,000
Saluaba Rp 96,000
Buntongi Rp 72,000
Padang Tumbuo Rp 72,000
Konsumsi Rp 2,200,000
ATK Rp 75,000
Rp 2,415,000 BOK
Rp 690,000
Malotong Rp 66,000
Bonerato Rp 60,000
Bailo Baru Rp 60,000
Bailo Rp 60,000
Labiabae April s/d Rp 60,000
Transport Petugas Team
Ampana Desember Rp 60,000
Sansarino Rp 84,000
Saluaba Rp 96,000
Buntongi Rp 72,000
Padang Tumbuo Rp 72,000
Rp 690,000
Malotong Rp 66,000
Bonerato Rp 60,000
Bailo Baru Rp 60,000
Bailo Dokter, Pengelola April s/d Rp 60,000
Transport Petugas
Labiabae TB & Kusta Desember Rp 60,000
Ampana Rp 60,000
Sansarino Rp 84,000
Saluaba Rp 96,000
 Buntongi Rp 72,000
Padang Tumbuo Rp 72,000
Rp 1,035,000
Malotong Rp 99,000
Bonerato Rp 90,000
Bailo Baru Rp 90,000
Bailo Rp 90,000
Labiabae Oktob s/d Rp 90,000
Transport Petugas Pengelola Surveilans
Ampana Desember Rp 90,000
Sansarino Rp 126,000
Saluaba Rp 144,000
Buntongi Rp 108,000
Padang Tumbuo Rp 108,000
Rp 19,283,000 BOK
Rp 1,638,000
Malotong Rp 66,000
Bonerato Rp 60,000
Bailo Baru Rp 240,000
Bailo Rp 180,000
Labiabae April s/d Rp 120,000
Transport Petugas Team
Ampana Desember Rp 240,000
Saluaba Rp 96,000
Buntongi Rp 72,000
Padang Tumbuo Rp 144,000
Sansarino Rp 420,000
Rp 2,345,000
Sansarino April s/d Rp 126,000
Transpor Petugas Team Desember
Saluaba Rp 144,000
Konsumsi Rp 2,000,000
ATK Rp 75,000
Rp 3,390,000
Malotong Rp 66,000

Bonerato Rp 60,000
Bailo Baru Rp 60,000
Bailo Rp 60,000
Dukungan April s/d
Labiabae Pengelola DBD Rp 60,000
Operasional Desember
Ampana Rp 60,000
Sansarino Rp 84,000
Saluaba Rp 96,000
Buntongi Rp 72,000
Padang Tumbuo Rp 72,000
 Uang Saku Rp 1,000,000
Honor Narasumber Rp 525,000
ATK Peserta Rp 150,000
Snack Rp 250,000
Makan/Minum Rp 625,000
Spanduk Rp 150,000
Rp 4,585,000
Malotong Rp 99,000
Bonerato Rp 90,000
Bailo Baru Rp 90,000
Bailo Rp 90,000
Labiabae April s/d Rp 90,000
Transport Peserta Pengelola Frambusia
Ampana Desember Rp 90,000
Sansarino Rp 126,000
Saluaba Rp 144,000
Buntongi Rp 108,000
Padang Tumbuo Rp 108,000
Uang Saku Rp 1,500,000
Honor Narasumber Rp 525,000
ATK Peserta Rp 150,000
Snack Rp 350,000
Makan/Minum Rp 875,000
Spanduk Rp 150,000
Rp 7,325,000
Malotong Rp 165,000
Bonerato Rp 150,000
Bailo Baru Rp 150,000
Bailo Rp 150,000
Labiabae Rp 150,000
Transport Petugas Pengelola Kesling April s/d
Ampana Desember Rp 150,000
Sansarino Rp 210,000
Saluaba Rp 240,000
Buntongi Rp 180,000
Padang Tumbuo Rp 180,000
Uang Saku Rp 2,500,000
Honor Narasumber Rp 525,000
ATK Peserta Rp 500,000
Snack Rp 550,000
Makan/Minum Rp 1,375,000
Spanduk Rp 150,000
 Rp 900,000 BOK
Rp 345,000
Malotong Rp 33,000
Bonerato Rp 30,000
Bailo Baru Rp 30,000
Bailo Rp 30,000
Labia Bae April s/d Rp 30,000
Transport Petugas Pengelola Kesling
Ampana Desember Rp 30,000
Sansarino Rp 42,000
Saluaba Rp 48,000
Buntongi Rp 36,000
Padang Tumbuo Rp 36,000
Rp 183,000
Malotong Rp 33,000
Bonerato Rp 30,000
Bailo Baru April s/d Rp 30,000
Transport Petugas Pengelola Kesling
Bailo Desember Rp 30,000
Labia Bae Rp 30,000
Ampana Rp 30,000
Rp 192,000
Bonerato Rp 30,000
Bailo Baru Rp 30,000
Bailo April s/d Rp 30,000
Transport Petugas Pengelola Kesling
Labiabae Desember Rp 30,000
Ampana Rp 30,000
Sansarino Rp 42,000
Rp 180,000
Hotel Mulia Rp 30,000
Peng.Santafur Rp 30,000
Hotel Ananda April s/d Rp 30,000
Transport Petugas Pengelola Kesling
Hot.Khayangan Desember Rp 30,000
Peng.Ampana Rp 30,000
Home Stail Rp 30,000
Rp 55,995,000
Rp 15,748,000
Rp 15,058,000 BOK
Rp 4,800,000
April s/d
Snack Rapat Puskesmas Rp 4,800,000
Desember
 Rp 7,145,000
Konsumsi Rp 1,925,000
Snack Rp 770,000
April s/d
Uang Saku Puskesmas Rp 3,850,000
Desember
ATK Rp 150,000
Spanduk Rp 450,000
Rp 270,000
Transport Petugas Pengelola BOK April s/d Des Rp 270,000

Rp 2,843,000
ATK/ Pengelola BOK April s/d Des Rp 2,843,000
Penggandaan
Rp 690,000 BOK
Rp 345,000
Malotong Rp 33,000
Bonerato Rp 30,000
Bailo Baru Rp 30,000
Bailo Rp 30,000
Labiabae April s/d Rp 30,000
Transport Petugas Bikor
Ampana Desember Rp 30,000
Sansarino Rp 42,000
Saluaba Rp 48,000
Buntongi Rp 36,000
Padang Tumbuo Rp 36,000
Rp 345,000
Malotong Rp 33,000
Bonerato Rp 30,000
Bailo Baru Rp 30,000
Bailo Rp 30,000
Labiabae Pengelola Gudang April s/d Rp 30,000
Transport Petugas
Ampana Obat Desember Rp 30,000
Sansarino Rp 42,000
Saluaba Rp 48,000
Buntongi Rp 36,000
Padang Tumbuo Rp 36,000
Rp 2,010,000 BOK
Rp 1,563,000
Malotong Rp 99,000
Bonerato Rp 90,000
Bailo Baru April s/d Rp 90,000
Transport Petugas Team
Bailo Desember Rp 180,000
Labiabae Rp 180,000
Ampana Rp 180,000
 Sansarino Rp 126,000
Saluaba April s/d Rp 144,000
Transport Petugas Team
Buntongi Desember Rp 108,000
Padang Tumbuo Rp 216,000
Penggandaan Rp 150,000
Materi
Rp 447,000
Malotong Rp 33,000
Bonerato Rp 30,000
Bailo Baru Rp 30,000
Bailo Rp 60,000
Labiabae April s/d Rp 60,000
Transport Petugas Pengelola UKS
Ampana Desember Rp 60,000
Sansarino Rp 30,000
Saluaba Rp 30,000
Buntongi Rp 30,000
Padang Tumbuo Rp 84,000
Rp 18,270,000 BOK
Rp 17,100,000
Dukungan Ops Wilker PKM AB April s/d Des Rp 17,100,000
Kader Posyandu
Rp 1,170,000

Transport Petugas Posbindu Rp 270,000

April s/d Des
Dukungan Ops Posbindu Rp 900,000
Kader Posyandu

Rp 19,967,000 BOK

Rp 7,547,000
Malotong Rp 264,000
Bonerato Rp 180,000
Bailo Baru Rp 120,000
Bailo Rp 180,000
Labiabae April s/d Rp 120,000
Transport Bides Bides
Ampana Desember Rp 180,000
Sansarino Rp 252,000
Saluaba Rp 192,000
Buntongi Rp 216,000
Padang Tumbuo Rp 288,000
Uang saku Rp 2,400,000
Honor Fasilitator Rp 525,000
ATK Rp 380,000
Snack Rp 600,000
Makan Minum Rp 1,500,000
Spanduk Rp 150,000
 Rp 12,420,000
Rp 495,000
Rp 450,000
April s/d Rp 450,000
Transport Petugas PKM Ampana Barat Promkes Desember Rp 450,000
Rp 450,000
Rp 450,000
Uang saku Rp 1,500,000
Honor Rp 3,150,000
narasumber
ATK Rp 150,000
4. Snack 5. 6. Rp 2,100,000
Makan Minum Rp 2,625,000
Spanduk Rp 150,000

Rp 140,000,000
4. 5. 6.

Bailo, 30 April 2015

Kepala Puskesmas Ampana Barat

dr.Diah Devawat S.Ked

NIP:19830921 201101 2 010
 RENCANA PELAKSANAAN KEGIATAN BULANAN
UPAYA PROMOT
TAHUN ANG
PROVINSI : SULAWESI TENGAH
KABUPATEN : TOJO UNA - UNA
KECAMATAN : AMPANA KOTA
BULAN : APRIL

Volume
No Kegiatan Sasaran Target Kegiatan
(1) (2) (3) (4) (5)

A. UPAYA KESEHATAN PRIORITAS

I. Kesehatan Ibu Anak (KIA) dan Keluarga Berencana (KB)

a. Kunjungan Rumah Bumil Rist
1 Bumil Rist 1 OT
Bumil Rist 3 Bumil Rist 3 OT
3 Bumil Rist 3 OT
b. Kunjungan Rumah Bufas
2 Bufas 6 OT
4 Bufas 12 OT
2 Bufas 6 OT
2 Bufas 6 OT
1 Bufas 3 OT
Bufas
6 Bufas 18 OT
4 Bufas 12 OT
2 Bufas 6 OT
4 Bufas 12 OT
6 Bufas 18 OT
II. PELAYANAN KESEHATAN ANAK
a. Pelayanan di Posyandu Pemantauan Kesehatan Bayi Balita (Pengukuran Tumbuh Kembang & Pemantauan Perkembangan
3 Posyandu 10 OT
2 Posyandu 5 OT
1 Posyandu 5 OT
2 Posyandu 5 OT
1 Posyandu 5 OT
2 Posyandu 5 OT
Posyandu
2 Posyandu 5 OT
1 Posyandu 5 OT
2 Posyandu 5 OT
3 Posyandu 10 OT

19 Posyandu 12 OT

III. PELAYANAN GIZI

a. Sweeping Penimbangan (D/S)
3 Posyandu 4 OT

Bayi/Balita
(1) (2) (3) (4) (5)
2 Posyandu 2 OT
Bayi/Balita 1 Posyandu 2 OT
2 Posyandu 2 OT
1 Posyandu 2 OT
2 Posyandu 2 OT
2 Posyandu 2 OT
Bayi/Balita 1 Posyandu 2 OT
2 Posyandu 2 OT
3 Posyandu 4 OT
b Pengambilan Vaksin
1 OT
B. PENYELENGGARAAN UPAYA
PENUNJANG
1. Penggerakan Pelaksanaan (P2)
I. MANAJEMEN PUSKESMAS
- Lokakarya Mini Puskesmas
Petugas 60 Petugas 60 OK
- Pembuatan Laporan Bulanan BOK
Pengelola BOK 1 Paket

- Konsultasi BOK
1 Kunj. 1 OT
II. PENGEMBANGAN UKBM
a. Transport Kader dalam Kegiatan Posyandu
Kader 95 Kader 95 Kali
Posyandu
b. Transport Kader dalam Kegiatan Posbindu
1 Kali
Kader Posbindu 5 Kali

J U M L A H T O T A L

Verivikator : 1

Mengetahui,
Kepala Puskesmas Ampana Barat

dr.Diah Devawat S.Ked

NIP:19830921 201101 2 010
ULANAN PROGRAM BOK PUSKESMAS AMPANA BARAT
ROMOTIF DAN PREVENTIF
UN ANGGARAN 2015

Rincian Lokasi Tenaga Jadwal Biaya

Pelaksanaan Pelaksanaan Pelaksana
(6) (7) (8) (9) (10)

Rp 5,288,000

Rp 2,120,000
Rp 140,000
x Rp 20,000 Bonerato Susan Bongkriwan Rp 20,000
x Rp 20,000 Transport Petugas Sansarino Mersi Lembang April Rp 60,000
x Rp 20,000 Padang Tumbuo Wiwin Indrawat Rp 60,000
Rp 1,980,000
x Rp 20,000 Malotong Fairus Safitri Rp 120,000
x Rp 20,000 Bonerato Susan Bongkriwan Rp 240,000
x Rp 20,000 Bailo Baru Megawat Rp 120,000
x Rp 20,000 Ampana Mildawat Rp 120,000
x Rp 20,000 Labiabae Sit Ramlah Rp 60,000
Transport Petugas April
x Rp 20,000 Bailo Devi Damayant Rp 360,000
x Rp 20,000 Sansarino Mercy Lembang Rp 240,000
x Rp 20,000 Saluaba Sri Rahayu AN Rp 120,000
x Rp 20,000 Buntongi Hasnita Rp 240,000
x Rp 20,000 Padang Tumbuo Wiwin Indrawat Rp 360,000
Rp 2,310,000
embangan) dan Antenatal Bagi Ibu Hamil Rp 2,310,000
x Rp 33,000 Malotong Rp 330,000
x Rp 30,000 Bonerato Rp 150,000
x Rp 30,000 Bailo Baru Rp 150,000
x Rp 30,000 Bailo Rp 150,000
x Rp 30,000 Labiabae Rp 150,000
Team
x Rp 30,000 Ampana Rp 150,000
Transport Petugas April
x Rp 42,000 Sansarino Rp 210,000
x Rp 48,000 Saluaba Rp 240,000
x Rp 36,000 Buntongi Rp 180,000
x Rp 36,000 Padang Tumbuo Rp 360,000
Wilker PKM Amp.
x Rp 20,000 Bides Rp 240,000
Barat
Rp 858,000
Rp 828,000
x Rp 33,000 Malotong Rp 132,000

Transport Petugas Team April

 (6) (7) (8) (9) (10)
x Rp 30,000 Bonerato Rp 60,000
x Rp 30,000 Transport Petugas Bailo Baru Team April Rp 60,000
x Rp 30,000 Bailo Rp 60,000
x Rp 30,000 Labiabae Rp 60,000
x Rp 30,000 Ampana Rp 60,000
x Rp 42,000 Sansarino Rp 84,000
x Rp 48,000 Transport Petugas Saluaba Team April Rp 96,000
x Rp 36,000 Buntongi Rp 72,000
x Rp 36,000 Padang Tumbuo Rp 144,000
Rp 30,000
Rp 30,000 Zahra Djafar April Rp 30,000
Rp 3,732,000

Rp 1,702,000
Rp 600,000
x Rp 10,000 Sneck Puskesmas April Rp 600,000
Rp 1,072,000
x Rp 1,072,000 ATK April Rp 1,072,000

Rp 30,000
x Rp 30,000 April Rp 30,000
Rp 2,030,000
Rp 1,900,000
Posyandu Wilker
x Rp 20,000 Transport Petugas Kader April Rp 1,900,000
PKM Amp. Barat
Rp 130,000
x Rp 30,000 Posbindu Wilker Petugas Rp 30,000
Transport Kader April
x Rp 20,000 PKM AB Kader Rp 100,000

Rp 9,020,000

9020000
2 Rp -

Bailo, 30 April 2015

Pengelola BOK

Rosita, A.Md.Kep
NIP:19801031 200902 2 001
A BARAT

Sumber
Biaya
(11)

BOK

BOK

BOK

BOK
(11)

BOK

BOK

BOK
 RENCANA PELAKSANAAN KEGIATAN BULANA
UPAYA PROMOT
TAHUN AN
PROVINSI : SULAWESI TENGAH
KABUPATEN : TOJO UNA - UNA
KECAMATAN : AMPANA KOTA
BULAN : MEI

Volume
No Kegiatan Sasaran Target Kegiatan
(1) (2) (3) (4) (5)

A. UPAYA KESEHATAN PRIORITAS

I. Kesehatan Ibu Anak (KIA) dan Keluarga Berencana (KB)

a. Kunjungan Rumah Bumil Rist
3 Bumil Rist 3
Bumil 2 Bumil Rist 2
3 Bumil Rist 3
b. Kunjungan Rumah Bufas
3 Bufas 9
3 Bufas 9
2 Bufas 6
Bufas 5 Bufas 15
4 Bufas 12
3 Bufas 9
8 Bufas 24
II. PELAYANAN KESEHATAN ANAK
a. Pelayanan di Posyandu Pemantauan Kesehatan Bayi Balita (Pengukuran Tumbuh Kembang & Pemantauan Perkembanga
3 Posyandu 10
2 Posyandu 5
1 Posyandu 5
2 Posyandu 5
1 Posyandu 5
2 Posyandu 5
Posyandu 2 Posyandu 5
1 Posyandu 5
2 Posyandu 5
3 Posyandu 10

19 12
Posyandu
III. PELAYANAN GIZI
a. Pengambilan Vaksin
1 Kali 1
B. PENYELENGGARAAN UPAYA
1 Penggerakan Pelaksanaan (P2)
PENUNJANG
 I. MANAJEMEN PUSKESMAS
- Lokakarya Mini Puskesmas
Petugas 49 Petugas 49
- Pembuatan Laporan Bulanan BOK
1
- Konsultasi BOK

II. PENGEMBANGAN UKBM

a. Transport Kader dalam Kegiatan Posyandu
Kader 95 Kader 5 OT x 19 Posyandu x 1
Posyandu
b. Transport Kader dalam Kegiatan Posbindu
5 Kader 1 OT x 1 Posbindu x 1
Kader Posbindu 5 OT x 1 Posbindu x 1

J U M L A H T O T A L

Verivikator : 1

Mengetahui,
Kepala Puskesmas Ampana Barat

dr.Diah Devawat S.Ked

NIP:19830921 201101 2 010
GIATAN BULANAN PROGRAM BOK PUSKESMAS AMPANA BARAT
UPAYA PROMOTIF DAN PREVENTIF
TAHUN ANGGARAN 2015

Volume Rincian Lokasi Tenaga Jadwal

Kegiatan Pelaksanaan Pelaksanaan Pelaksana
(5) (6) (7) (8) (9)

OT x Rp 20,000 Bailo Devi Damayant

OT x Rp 20,000 Transport Petugas Buntongi Hasnita Mei
OT x Rp 20,000 Padang Tumbuo Wiwin Indrawat

OT x Rp 20,000 Malotong Fairus Safitri

OT x Rp 20,000 Bonerato Susan Bongkriwan
OT x Rp 20,000 Ampana Mildawat
Mei
OT x Rp 20,000 Transport Petugas Bailo Devi Damayant
OT x Rp 20,000 Sansarino Mercy Lembang
OT x Rp 20,000 Buntongi Hasnita
OT x Rp 20,000 Padang Tumbuo Wiwin Indrawat

mantauan Perkembangan) dan Antenatal Bagi Ibu Hamil

OT x Rp 33,000 Malotong
OT x Rp 30,000 Bonerato
OT x Rp 30,000 Bailo Baru
OT x Rp 30,000 Bailo
OT x Rp 30,000 Labiabae
Transport Petugas Team Mei
OT x Rp 30,000 Ampana
OT x Rp 42,000 Sansarino
OT x Rp 48,000 Saluaba
OT x Rp 36,000 Buntongi
OT x Rp 36,000 Padang Tumbuo
20,000 Transport Petugas Wilker PKM Amp.
OT x Rp Bides Mei
Barat

OT Rp 30,000 Mei
OK x Rp 10,000 Sneck Puskesmas Mei

Paket x Rp 13,000 ATK Pengelola BOK Mei

Rp 30,000 Transport Pengelola BOK Mei

Posyandu Wilker
Kali x 20000 Transport Kader Kader Mei
PKM AB

Kali x Rp 30,000 Transport Posbindu Petugas

Mei
Kali x Rp 20,000 Petugas/Kader Wilker PKM AB Kader

Bailo, 30 Mei 2015

Pengelola BOK

Rosita, A.Md.Kep
NIP:19801031 200902 2 001
MPANA BARAT

Sumber
Biaya Biaya
(10) (11)

Rp 4,180,000 BOK

Rp 1,840,000 BOK
Rp 160,000
Rp 60,000
Rp 40,000
Rp 60,000
Rp 1,680,000
Rp 180,000
Rp 180,000
Rp 120,000
Rp 300,000
Rp 240,000
Rp 180,000
Rp 480,000
Rp 2,310,000 BOK
Rp 2,310,000
Rp 330,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 210,000
Rp 240,000
Rp 180,000
Rp 360,000

Rp 240,000
Rp 30,000 BOK
Rp 30,000
Rp 30,000
Rp 2,563,000 BOK
Rp 533,000 BOK
Rp 490,000
Rp 490,000
Rp 13,000
Rp 13,000
Rp 30,000
Rp 30,000
Rp 2,030,000 BOK
Rp 1,900,000
Rp 1,900,000

Rp 130,000
Rp 30,000
Rp 100,000

Rp 6,743,000

6743000
Rp -
 RENCANA PELAKSANAAN KEGIATAN BULAN
UPAYA PROMO
TAHUN A
PROVINSI : SULAWESI TENGAH
KABUPATEN : TOJO UNA - UNA
KECAMATAN : AMPANA KOTA
BULAN : JUNI

Volume
No Kegiatan Sasaran Target Kegiatan
(1) (2) (3) (4) (5)

A. UPAYA KESEHATAN PRIORITAS

I. Kesehatan Ibu Anak (KIA) dan Keluarga Berencana (KB)
Rp
a. Kunjungan Rumah Bumil Rist
2 Bumil Rist 2
Bumil
4 Bumil Rist 4
b. Kunjungan Rumah Bufas
2 Bufas 6
1 Bufas 3
7 Bufas 21
Bufas 2 Bufas 6
2 Bufas 6
1 Bufas 3
4 Bufas 12
II. PELAYANAN KESEHATAN ANAK
a. Pelayanan di Posyandu Pemantauan Kesehatan Bayi Balita (Pengukuran Tumbuh Kembang & Pemantauan Perkemban
3 Posyandu 10
2 Posyandu 5
1 Posyandu 5
2 Posyandu 5
1 Posyandu 5
2 Posyandu 5
Posyandu
2 Posyandu 5
1 Posyandu 5
2 Posyandu 5
3 Posyandu 10

19 Posyandu 12
b. Pemantauan Neonatus Rist
Neonatus 1 Neonatus Rist 1
III. PELAYANAN GIZI
a. PMT Pemulihan Bayi/Balita Gizi Buruk

Bayi/Balita GB 4 Bayi/Balita GB 120

b. Pengambilan Vaksin
1
(1) (2) (3) (4) (5)
IV. Jumlah Kasus baru Malaria,DBD
a. Penyuluhan dan Screaning Malaria
3
Masyarakat 2 Desa
3
177
1
B. PENYELENGGARAAN UPAYA
a. Penggerakan Pelaksanaan (P2)
I. MANAJEMEN PUSKESMAS
- Pembuatan Laporan Bulanan BOK

Pengelola BOK 1

- Konsultasi BOK

Pengelola BOK 1

II. PENGEMBANGAN UKBM

a. Transport Kader dalam Kegiatan Posyandu
Kader 95 Kader 95
Posyandu
b. Transport Kader dalam Kegiatan Posbindu

1 Petugas 1
Kader Posbindu
5 Kader 5

J U M L A H T O T

Verivikator : 1

Mengetahui,
Kepala Puskesmas Ampana Barat

dr.Diah Devawat S.Ked

NIP:19830921 201101 2 010
 BULANAN PROGRAM BOK PUSKESMAS AMPANA BARAT
PROMOTIF DAN PREVENTIF
AHUN ANGGARAN 2015

me Rincian Lokasi Tenaga Jadwal Biaya

tan Pelaksanaan Pelaksanaan Pelaksana
(6) (7) (8) (9) (10)

Rp 9,285,000
Rp 1,260,000
1
Rp 120,000
OT x Rp 20,000 Bonerato Susan Bongkriwan Rp 40,000
Transport Petugas Juni
OT x Rp 20,000 Padang Tumbuo Wiwin Indrawat Rp 80,000
Rp 1,140,000
OT x Rp 20,000 Malotong Fairus Safitri Rp 120,000
OT x Rp 20,000 Bailo Baru Megawat Rp 60,000
OT x Rp 20,000 Bailo Devi Damayant Rp 420,000
Juni
OT x Rp 20,000 Transport Petugas Sansarino Mercy Lembang Rp 120,000
OT x Rp 20,000 Saluaba Sri Rahayu AN Rp 120,000
OT x Rp 20,000 Buntongi Hasnita Rp 60,000
OT x Rp 20,000 Padang Tumbuo Wiwin Indrawat Rp 240,000
Rp 2,330,000
Perkembangan) dan Antenatal Bagi Ibu Hamil Rp 2,310,000
OT x Rp 33,000 Malotong Rp 330,000
OT x Rp 30,000 Bonerato Rp 150,000
OT x Rp 30,000 Bailo Baru Rp 150,000
OT x Rp 30,000 Bailo Rp 150,000
OT x Rp 30,000 Labiabae Rp 150,000
Transport Petugas Team
OT x Rp 30,000 Ampana Rp 150,000
Juni
OT x Rp 42,000 Sansarino Rp 210,000
OT x Rp 48,000 Saluaba Rp 240,000
OT x Rp 36,000 Buntongi Rp 180,000
OT x Rp 36,000 Padang Tumbuo Rp 360,000
20,000 Transport Petugas Wilker PKM Amp.
OT x Rp Bides Rp 240,000
Barat
Rp 20,000
OT x Rp 20,000 Saluaba Sri Rahayu AN Rp 20,000
Rp 3,630,000
Rp 3,600,000
OH x Rp 30,000 PMT Wilker PKM AB Riskiyani Juni Rp 3,600,000

Rp 30,000
OT Rp 30,000 Juni Rp 30,000
 (6) (7) (8) (9) (10)
Rp 2,065,000
Rp 2,065,000
OT x Rp 48,000 Saluaba Rp 144,000
Transport Petugas Team Juni
OT x Rp 42,000 Sansarino Rp 126,000
OK x Rp 10,000 Snack Rp 1,770,000
Paket x Rp 25,000 ATK Rp 25,000
Rp 2,083,000

Rp 53,000
Rp 23,000

Paket x Rp 23,000 ATK Juni Rp 23,000

Rp 30,000

OT Rp 30,000 Transport Petugas Juni Rp 30,000

Rp 2,030,000
Rp 1,900,000
Posyandu Wilker
Kali x Rp 20,000 Transport Kader Kader Juni Rp 1,900,000
PKM AB
Rp 130,000

Kali x Rp 30,000 Transport Petugas Petugas Juni Rp 30,000

Posbindu Wilker
PKM AB
Kali x Rp 20,000 Transport Kader Kader Juni Rp 100,000

T O T A L Rp 11,368,000

2 11368000
Rp -

Bailo, 30 Juni 2015

Pengelola BOK

Rosita, A.Md.Kep
NIP:19801031 200902 2 001
NA BARAT

Sumber
Biaya
(11)

BOK
BOK
1,140,000

BOK

BOK
(11)
BOK
 2065000
Rp 1,795,000
Rp 25,000
 RENCANA PELAKSANAAN KEGIATAN BULANAN PROG
UPAYA PROMOTIF DAN
TAHUN ANGGARA
PROVINSI : SULAWESI TENGAH
KABUPATEN : TOJO UNA - UNA
KECAMATAN : AMPANA KOTA
BULAN : JULI

No Kegiatan Sasaran Target Volume Kegiatan

(1) (2) (3) (4)

A. UPAYA KESEHATAN PRIORITAS

I. Kesehatan Ibu Anak (KIA) dan Keluarga Berencana (KB)

a. Kunjungan Rumah Bumil Rist
3 Bumil Rist 3 OT x Rp 20,000
1 Bumil Rist 1 OT x Rp 20,000
Bumil Rist
3 Bumil Rist 3 OT x Rp 20,000
5 Bumil Rist 5 OT x Rp 20,000
b. Kunjungan Rumah Bufas
3 Bufas 9 OT x Rp 20,000
3 Bufas 9 OT x Rp 20,000
3 Bufas 9 OT x Rp 20,000
Bufas 5 Bufas 15 OT x Rp 20,000
2 Bufas 6 OT x Rp 20,000
3 Bufas 9 OT x Rp 20,000
2 Bufas 6 OT x Rp 20,000
II. PELAYANAN KESEHATAN ANAK
a. Pelayanan di Posyandu Pemantauan Kesehatan Bayi Balita (Pengukuran Tumbuh Kembang & Pemantauan Perkem
3 Posyandu 10 OT x Rp 33,000
2 Posyandu 5 OT x Rp 30,000
1 Posyandu 5 OT x Rp 30,000
Posyandu
2 Posyandu 5 OT x Rp 30,000
1 Posyandu 5 OT x Rp 30,000
2 Posyandu 5 OT x Rp 30,000
2 Posyandu 5 OT x Rp 42,000
1 Posyandu 5 OT x Rp 48,000
2 Posyandu 5 OT x Rp 36,000
3 Posyandu 10 OT x Rp 36,000

19 Posyandu 12 OT x Rp 20,000
 (1) (2) (3) (4)
b. Pemantauan Neonatus Rist
1 OT x Rp 20,000
Neonatus Rist 3 Desa/Kel 1 OT x Rp 20,000
1 OT x Rp 20,000
III. PELAYANAN GIZI
a PMT Pemulihan Bayi/Balita Gizi Buruk

Bayi/Balita GB 4 Bayi/ Balita GB 120 OH x Rp 30,000

b Pemantauan Pemberian PMT Bayi Balita
1 OT x Rp 33,000
4 Bayi/ Balita GB 1 OT x Rp 30,000
Bayi/Balita GB 1 OT x Rp 36,000
c Pengambilan Vaksin
1 OT x Rp 30,000

PENGENDALIAN
IV PENYAKIT MENULAR
a Pemantauan Penderita Reaksi Kusta
2 OT x Rp 30,000
2 OT x Rp 30,000
Masyarakat 5 Desa/Kel 2 OT x Rp 42,000
2 OT x Rp 48,000
2 OT x Rp 36,000
B. PENYELENGGARAAN UPAYA PENUNJANG
I. MANAJEMEN PUSKESMAS
a Penggerakan Pelaksanaan (P2)
- Konsultasi BOK
1 Kunj 1 OT x Rp 30,000
II PENJARINGAN ANAK SEKOLAH DASAR
a. Pencegahan Penyakit Cacingan Pada Anak
1 SD/Sederajat 1 OT x Rp 30,000
Siswa
SD/Sederajat 2 SD/Sederajat 2 OT x Rp 30,000
2 SD/Sederajat 2 OT x Rp 30,000
II. PENGEMBANGAN UKBM
a. Transport Kader dalam Kegiatan Posyandu
Kader 95 Kader 95 OT x Rp 20,000
Posyandu
(1) (2) (3) (4)
b. Transport Kader dalam Kegiatan Posbindu
1 Kali x Rp 30,000

5 Kader 5 Kali x Rp 20,000

Kader Posbindu
J U M L A H T O T A L

Verivikator : 1

Mengetahui,
Kepala Puskesmas Ampana Barat

dr.Diah Devawat S.Ked

NIP:19830921 201101 2 010
BULANAN PROGRAM BOK PUSKESMAS AMPANA BARAT
PROMOTIF DAN PREVENTIF
HUN ANGGARAN 2015

Rincian Lokasi Tenaga Sumber

Jadwal Biaya
Pelaksanaan Pelaksanaan Pelaksana Biaya
(6) (7) (8) (9) (10) (11)

Rp 7,971,000 BOK

Rp 1,500,000 BOK
Rp 240,000
Bonerato Susan Bongkriwang Rp 60,000
Bailo Baru Megawat Rp 20,000
Transport Bides Juli
Bailo Devi Damayant Rp 60,000
Padang Tumbuo Wiwin Indrawat Rp 100,000
Rp 1,260,000
Malotong Fairus Safitri Rp 180,000
Bonerato Susan Bongkriwang Rp 180,000
Bailo Devi Damayant Rp 180,000
Transport Petugas Ampana Mildawat Juli Rp 300,000
Sansarino Mercy Lembang Rp 120,000
Buntongi Hasnita Rp 180,000
Padang Tumbuo Wiwin Indrawat Rp 120,000
Rp 2,370,000 BOK
& Pemantauan Perkembangan) dan Antenatal Bagi Ibu Hamil Rp 2,310,000
Malotong Team Rp 330,000
Bonerato Rp 150,000
Bailo Baru Rp 150,000
Bailo Rp 150,000
Labiabae Rp 150,000
Transport Petugas Juli
Ampana Rp 150,000
Sansarino Rp 210,000
Saluaba Rp 240,000
Buntongi Rp 180,000
Padang Tumbuo Rp 360,000
Transport Bides Wilker PKM Amp. Bides Juli Rp 240,000
Barat
 (6) (7) (8) (9) (10) (11)
Rp 60,000
Bonerato Susan Bongkriwang Rp 20,000
Transport Bides Bailo Devi Damayant Juli Rp 20,000
Saluaba Sri Rahayu AN Rp 20,000
Rp 3,729,000 BOK
Rp 3,600,000
PMT Wilker PKM AB Riskiyani Juli Rp 3,600,000

Rp 99,000
Malotong Rp 33,000
Transport Petugas Ampana Riskiyani Juli Rp 30,000
Buntongi Rp 36,000
Rp 30,000
Transport Petugas Sahra Djafar Rp 30,000

Rp 372,000 BOK
Rp 372,000
Bailo Baru Rp 60,000
Bailo Dr. Diah Devawat Rp 60,000
Transport Petugas Sansarino Susan T Juli Rp 84,000
Saluaba Rp 96,000
Padang Tumbuo Rp 72,000
Rp 2,210,000 BOK
Rp 30,000 BOK

Rp 30,000
Juli Rp 30,000
Rp 150,000 BOK
Rp 150,000
Malotong Rp 30,000
Transport Petugas Bailo Baru Elmawat Juli Rp 60,000
Bailo Rp 60,000
Rp 2,030,000 BOK
Rp 1,900,000
Posyandu Wilker
Transport Petugas Kader Juli Rp 1,900,000
PKM AB
 (6) (7) (8) (9) (10) (11)
Rp 130,000
Transport Petugas Posbindu Petugas Rp 30,000
Juli
Transport Kader Wilker PKM AB Kader Rp 100,000

T O T A L Rp 10,181,000

Bailo, 31 Juli 2015

Pengelola BOK

Rosita, A.Md.Kep
NIP:19801031 200902 2 001
 RENCANA PELAKSANAAN KEGIATAN BULANAN PROGR
UPAYA PROMOTIF DAN P
TAHUN ANGGARAN
PROVINSI : SULAWESI TENGAH
KABUPATEN : TOJO UNA - UNA
KECAMATAN : AMPANA KOTA
BULAN : AGUSTUS

No Kegiatan Sasaran Target

(1) (2) (3) (4)
A. UPAYA Ibu
Kesehatan KESEHATAN PRIORITAS
Anak (KIA) dan Keluarga
I. Berencana (KB)
a. Kunjungan Rumah Bumil Rist
1 Bumil Rist 1 OT x
1 Bumil Rist 1 OT x
4 Bumil Rist 4 OT x
4 Bumil Rist 4 OT x
b. Kunjungan Rumah Bufas
6 Bufas 18 OT x
1 Bufas 3 OT x
3 Bufas 9 OT x
Bufas 2 Bufas 6 OT x
5 Bufas 15 OT x
1 Bufas 3 OT x
2 Bufas 6 OT x
c. Kelas Ibu Hamil
1 OT x
1 OT x
Bumil 1 Kls 10 OK x
12 OK x
3 M x
II. PELAYANAN KESEHATAN ANAK
a. Pelayanan di Posyandu Pemantauan Kesehatan Bayi Balita (Pengukuran Tumbuh Kembang & Pemantauan Perkemb
3 Posyandu 10 OT x
2 Posyandu 5 OT x
1 Posyandu 5 OT x
2 Posyandu 5 OT x
Posyandu
1 Posyandu 5 OT x
2 Posyandu 5 OT x
2 Posyandu 5 OT x
1 Posyandu 5 OT x
(1) (2) (3) (4)
2 Posyandu 5 OT x
3 Posyandu 10 OT x
Posyandu
19 Posyandu 12 OT x

III. PELAYANAN GIZI

a. PMT Pemulihan Bayi/Balita Gizi Buruk
Bayi/ Balita
Bayi/Balita GB 4 120 OH x
GB
b. Pemantauan Pemberian PMT Bayi Balita
1 OT x
Bayi/ Balita
Bayi/Balita GB 4 1 OT x
GB
1 OT x
c. Sweeping Imunisasi
2 OT x
2 OT x
2 OT x
2 OT x
2 OT x
Bayi/Balita 10 Desa/Kel
2 OT x
2 OT x
2 OT x
2 OT x
2 OT x

d. Pengambilan Vaksin 1 OT

IV PENGENDALIAN PENYAKIT MENULAR

a. Penyuluhan
- Penyuluhan Bahaya Penyakit TB dan Kusta
2 OT x
2 OT x
2 OT x
2 OT x
Kelurahan/ 2 OT x
Masyarakat 10 Desa 2 OT x
2 OT x
2 OT x
2 OT x
2 OT x
220 OK x

1 Paket x
(1) (2) (3) (4)
V. Meningkatkan Akses Masyarakat terhadap sumber air minum dan sanitasi dasar
a. Pemeriksaan TPM
1 OT x
Tempat 1 OT x
Pengolahan 6 Kelurahan 1 OT x
Makanan 1 OT x
1 OT x
1 OT x
B. PENYELENGGARAAN UPAYA PENUNJANG
1. Penggerakan Pelaksanaan (P2)
I. MANAJEMEN PUSKESMAS
- Lokakarya Mini Puskesmas
Petugas 55 Petugas 55 OK x
- Pembuatan Laporan Bulanan BOK
1 Bulan 1 Paket x
- Konsultasi BOK
1 Kunj. 1 OT x
Pengawasan Pengendalian
II dan Penilaian (P3)
- Supervisi Fasilitatf Bikor
1 OT x
1 OT x
1 OT x
1 OT x
1 OT x
10 Desa
1 OT x
1 OT x
1 OT x
1 OT x
1 OT x
- Supervisi Pengelola Gudang Obat
Gudang Obat 1 OT x
1 OT x
1 OT x
1 OT x
Bides/ 1 OT x
10 Desa
Perawat 1 OT x
1 OT x
1 OT x
1 OT x
1 OT x
(1) (2) (3) (4)
III PENJARINGAN ANAK SEKOLAH DASAR
a. Penjaringan Anak Sekolah Dasar/Penyuluhan PHBS
1 SD/Sederajat 3 OT x
1 SD/Sederajat 3 OT x
1 SD/Sederajat 3 OT x
2 SD/Sederajat 6 OT x
2 SD/Sederajat 6 OT x
2 SD/Sederajat 6 OT x
1 SD/Sederajat 3 OT x
1 SD/Sederajat 3 OT x
1 SD/Sederajat 3 OT x

750 Lbr x

b. Pencegahan Penyakit Cacingan Pada Anak

2 SD/Sederajat 2 OT x
2 SD/Sederajat 2 OT x
1 SD/Sederajat 1 OT x
1 SD/Sederajat 1 OT x
1 SD/Sederajat 1 OT x
2 SD/Sederajat 2 OT x
IV PENGEMBANGAN UKBM
a. Transport Kader dalam Kegiatan Posyandu
Kader 95 Kali x
Posyandu
b. Transport Kader dan Petugas dalam Kegiatan Posbindu
1 Kali x
Kader Posbindu 5 Kali x
V PROMOSI KESEHATAN

a. Sosialisasi Pendampingan Kader

8 OT x
6 OT x
4 OT x
6 OT x
Lurah/Kades, 4 OT x
58 Peserta
Bides, Kader 6 OT x
6 OT x
4 OT x
6 OT x
8 OT x
48 OK
3 OK x
38 Paket x
60 OK x
(1) (2) (3) (4)
60 OK x
3 M2 x
b. Pelathan/Refresing Kader Posyandu
15 OT x
15 OT x
15 OT x
15 OT x
15 OT x
15 OT x
Kader 3 Hari 30 OK

18 OJ x

30 Paket x
### OK x
### OK x
3 M2 x
J U M L A H T O T A L

Verivikator : 1

Mengetahui,
Kepala Puskesmas Ampana Barat

dr.Diah Devawat S.Ked

NIP:19830921 201101 2 010
EGIATAN BULANAN PROGRAM BOK PUSKESMAS AMPANA BARAT
UPAYA PROMOTIF DAN PREVENTIF
TAHUN ANGGARAN 2015

Rincian Lokasi Tenaga Jadwal

Pelaksanaan Pelaksanaan Pelaksana
(5) (6) (7) (8) (9)

Rp 20,000 Ampana Mildawat

Rp 20,000 Bonerato Susan Bongkriwan
Rp 20,000 Transport Petugas Buntongi Hasnita
Rp 20,000 Padang Tumbuo Wiwin Indrawat

Rp 20,000 Malotong Fairus Safitri

Rp 20,000 Bailo Baru Megawat
Rp 20,000 Ampana Mildawat
Transport Petugas April
Rp 20,000 Bailo Devi Damayant
Rp 20,000 Sansarino Mercy Lembang
Rp 20,000 Saluaba Sri Rahayu AN
Rp 20,000 Padang Tumbuo Wiwin Indrawat

Rp 30,000 Bikor
Transport Petugas Agust
Rp 20,000 Bides
Rp 7,000 ATK Ampana
Rp 10,000 Sneck
Rp 50,000 Spanduk

buh Kembang & Pemantauan Perkembangan) dan Antenatal Bagi Ibu Hamil
Rp 33,000 Malotong
Rp 30,000 Bonerato
Rp 30,000 Bailo Baru
Rp 30,000 Bailo
Transport Petugas Team Agust
Rp 30,000 Labiabae
Rp 30,000 Ampana
Rp 42,000 Sansarino
Rp 48,000 Saluaba
 (5) (6) (7) (8) (9)
Rp 36,000 Buntongi
Transport Petugas Team Agust
Rp 36,000 Padang Tumbuo
20,000 Transport Bides Wilker PKM Amp.
Rp Bides Agust
Barat

Rp 30,000 PMT Wilker PKM AB Riskiyani Agust

Rp 33,000 Malotong
Rp 30,000 Transport Petugas Ampana Riskiyani Agust
Rp 36,000 Buntongi

Rp 33,000 Malotong
Rp 30,000 Bonerato
Rp 30,000 Bailo Baru
Rp 30,000 Bailo
Rp 30,000 Labiabae
Transport Petugas Zahra Djafar Agust
Rp 30,000 Ampana
Rp 42,000 Sansarino
Rp 48,000 Saluaba
Rp 36,000 Buntongi
Rp 36,000 Padang Tumbuo
Rp 30,000 Transport Petugas Zahra Djafar Agust

Rp 33,000 Malotong
Rp 30,000 Bonerato
Rp 30,000 Bailo Baru
Rp 30,000 Bailo
Rp 30,000 Labiabae Petugas Promkes/ April s/d
Transpor Petugas
Rp 30,000 Ampana Pengelola TB & Kusta Desember
Rp 42,000 Sansarino
Rp 48,000 Saluaba
Rp 36,000 Buntongi
Rp 36,000 Padang Tumbuo
Rp 10,000 Konsumsi

Rp 75,000 ATK
 (5) (6) (7) (8) (9)

Rp 33,000 Malotong
Rp 30,000 Bonerato
Rp 30,000 Bailo Baru
Transport Petugas Pengelola Kesling Agust
Rp 30,000 Bailo
Rp 30,000 Labia Bae
Rp 30,000 Ampana

Rp 10,000 Sneck Puskesmas Agust

Rp 100,000 ATK Pengelola BOK Agust

Rp 30,000 Transport Petugas Pengelola BOK Agust

Rp 33,000 Malotong
Rp 30,000 Bonerato
Rp 30,000 Bailo Baru
Rp 30,000 Bailo
Rp 30,000 Labiabae
Transport Petugas Bikor Agust
Rp 30,000 Ampana
Rp 42,000 Sansarino
Rp 48,000 Saluaba
Rp 36,000 Buntongi
Rp 36,000 Padang Tumbuo

Rp 33,000 Malotong
Rp 30,000 Bonerato
Rp 30,000 Bailo Baru
Rp 30,000 Bailo
Rp 30,000 Labiabae
Transport Petugas Pengelola Gudang Obat Agust
Rp 30,000 Ampana
Rp 42,000 Sansarino
Rp 48,000 Saluaba
Rp 36,000 Buntongi
Rp 36,000 Padang Tumbuo
 (5) (6) (7) (8) (9)

Rp 33,000 Malotong
Rp 30,000 Bonerato
Rp 30,000 Bailo Baru
Rp 30,000 Bailo
Rp 30,000 Transport Petugas Labiabae
Rp 30,000 Ampana Team Agust
Rp 42,000 Sansarino
Rp 48,000 Saluaba
Rp 36,000 Buntongi
Penggandaan
Rp 200 Materi

Rp 30,000 Labiabae
Rp 30,000 Ampana
Rp 30,000 Sansarino
Transport Petugas Pengelola UKS Agust
Rp 30,000 Saluaba
Rp 30,000 Buntongi
Rp 42,000 Padang Tumbuo

Transport Posyandu
Rp 20,000 Kader Agust
Petugas Wilker PKM AB

Rp 30,000 Transport Petugas Posbindu Petugas

Agust
Rp 20,000 Transport Kader Wilker PKM AB Kader

Rp 33,000 Malotong
Rp 30,000 Bonerato
Rp 30,000 Bailo Baru
Rp 30,000 Bailo
Rp 30,000 Labiabae
Transport Bides Bides Agust
Rp 30,000 Ampana
Rp 42,000 Sansarino
Rp 48,000 Saluaba
Rp 36,000 Buntongi
Rp 36,000 Padang Tumbuo
Rp 50,000 Uang saku
Rp 175,000 Honor Fasilitator
Rp 10,000 ATK
Rp 10,000 Snack
 (5) (6) (7) (8) (9)
Rp 25,000 Makan Minum
Rp 50,000 Spanduk

Rp 33,000
Rp 30,000
Rp 30,000
Transport Petugas PKM Ampana Barat Promkes Agust
Rp 30,000
Rp 30,000
Rp 30,000
Rp 50,000 Uang saku
Honor
Rp 175,000 narasumber
Rp 5,000 ATK
Rp 10,000 Snack
Rp 25,000 Makan Minum
Rp 50,000 Spanduk

Bailo, Agustus 2015

Pengelola BOK

Rosita, A.Md.Kep
NIP:19801031 200902 2 001
 Sumber
Biaya Biaya
(10) (11)
Rp 11,667,000 BOK 11484000 Rp 183,000
Rp 1,790,000 BOK
Rp 200,000
Rp 20,000
Rp 20,000
Rp 80,000
Rp 80,000
Rp 1,200,000
Rp 360,000
Rp 60,000
Rp 180,000
Rp 120,000
Rp 300,000
Rp 60,000
Rp 120,000
Rp 390,000
Rp 30,000
Rp 20,000
Rp 70,000
Rp 120,000
Rp 150,000
Rp 2,310,000 BOK
Rp 2,310,000
Rp 330,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 210,000
Rp 240,000
 (10) (11)
Rp 180,000
Rp 360,000
Rp 240,000

Rp 4,419,000 BOK
Rp 3,600,000
Rp 3,600,000

Rp 99,000
Rp 33,000
Rp 30,000
Rp 36,000
Rp 690,000
Rp 66,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 72,000
Rp 30,000

Rp 2,965,000 BOK

Rp 2,965,000
Rp 66,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 72,000
Rp 2,200,000

Rp 75,000
 (10) (11)
Rp 183,000 BOK
Rp 183,000
Rp 33,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 25,008,000 25224000 Rp (216,000)

Rp 680,000 BOK
Rp 550,000
Rp 550,000
Rp 100,000
Rp 100,000
Rp 30,000
Rp 30,000

Rp 690,000 BOK
Rp 345,000
Rp 33,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 42,000
Rp 48,000
Rp 36,000
Rp 36,000
Rp 345,000
Rp 33,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 42,000
Rp 48,000
Rp 36,000
Rp 36,000
 (10) (11)
Rp 1,641,000 BOK
Rp 1,347,000
Rp 99,000
Rp 90,000
Rp 90,000
Rp 180,000
Rp 180,000
Rp 180,000
Rp 126,000
Rp 144,000
Rp 108,000
Rp 150,000

Rp 294,000
Rp 60,000
Rp 60,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 84,000
Rp 2,030,000 BOK
Rp 1,900,000
Rp 1,900,000

Rp 130,000
Rp 30,000
Rp 100,000
Rp 19,967,000 BOK

Rp 7,547,000
Rp 264,000
Rp 180,000
Rp 120,000
Rp 180,000
Rp 120,000
Rp 180,000
Rp 252,000
Rp 192,000
Rp 216,000
Rp 288,000
Rp 2,400,000
Rp 525,000
Rp 380,000
Rp 600,000
 (10) (11)
Rp 1,500,000
Rp 150,000
Rp 12,420,000
Rp 495,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 1,500,000
Rp 3,150,000

Rp 150,000
Rp 2,100,000
Rp 2,625,000
Rp 150,000
Rp 36,675,000

9020000
Rp (27,655,000)
 RENCANA PELAKSANAAN KEGIATAN TAHUNAN PROGRAM BOK PUSKESMAS AMPANA BARAT
UPAYA PROMOTIF DAN PREVENTIF
TAHUN ANGGARAN 2015
PROVINSI : SULAWESI TENGAH
KABUPATEN : TOJO UNA - UNA
KECAMATAN : AMPANA KOTA
TAHUN : 2015

Rincian Tenaga
No Kegiatan Sasaran Target Lokasi
Pelaksanaan Pelaksana
Pelaksanaan
UPAYA KESEHATAN PRIORITAS

I. Kesehatan Ibu Anak (KIA) dan Keluarga Berencana (KB)

Wilker PKM Ampana
a. Kunjungan Rumah Bumil Rist Bumil 24 Bumil Rist x 72 OT x Rp 20,000 Transport Bides Bides
Barat
Wilker PKM Ampana
b. Kunjungan Rumah Bufas Bufas 215 Bufas x 645 OT x Rp 20,000 Transport Bides Bides
Barat
c. Kelas Ibu Hamil
x 1 OT x Rp 33,000 Malotong
x 1 OT x Rp 30,000 Bonerato
x 1 OT x Rp 30,000 Bailo Baru
x 1 OT x Rp 30,000 Bailo
x 1 OT x Rp 30,000 Tranport Petugas Labiabae
Bikor
x 1 OT x Rp 30,000 (Bikor) Ampana
x 1 OT x Rp 42,000 Sansarino
Bumil 10 Kelas x 1 OT x Rp 48,000 Saluaba
x 1 OT x Rp 36,000 Buntongi
x 1 OT x Rp 36,000 Padang Tumbuo
x 100 Pkt X Rp 10,000 ATK
x 170 OK x Rp 10,000 Konsumsi
x 3 M2 x Rp 50,000 Spanduk
 Wilker PKM Ampana
x 10 OT x Rp 20,000 Transport Bides Bides
Barat
II. PELAYANAN KESEHATAN ANAK
a. Pelayanan di Posyandu Pemantauan Kesehatan Bayi Balita (Pengukuran Tumbuh Kembang & Pemantauan Perkembangan) dan Antenatal bagi Ibu Hamil
3 Posyandu x 90 OT x Rp 33,000 Malotong
2 Posyandu x 45 OT x Rp 30,000 Bonerato
1 Posyandu x 45 OT x Rp 30,000 Transport Petugas Bailo Baru Team
2 Posyandu x 45 OT x Rp 30,000 Bailo
1 Posyandu x 45 OT x Rp 30,000 Labiabae
2 Posyandu x 45 OT x Rp 30,000 Ampana
2 Posyandu x 45 OT x Rp 42,000 Sansarino
1 Posyandu x 45 OT x Rp 48,000 Transport Petugas Saluaba Team
2 Posyandu x 45 OT x Rp 36,000 Buntongi
3 Posyandu x 90 OT x Rp 36,000 Padang Tumbuo
19 Posyandu x 108 OT x Rp 20,000 Transport Bides
b. Pemantauan Neonatus Rist
Neonatus
Neonatus 4 x 12 OT x Rp 20,000
Rist

III. PELAYANAN GIZI

a. Sweeping Penimbangan (D/S)
3 Posyandu x 8 OT x Rp 33,000 Malotong
2 Posyandu x 4 OT x Rp 30,000 Bonerato
1 Posyandu x 4 OT x Rp 30,000 Bailo Baru
2 Posyandu x 4 OT x Rp 30,000 Bailo
1 Posyandu x 4 OT x Rp 30,000 Labiabae
Bayi/Balita Transport Petugas Team
2 Posyandu x 4 OT x Rp 30,000 Ampana
2 Posyandu x 4 OT x Rp 42,000 Sansarino
1 Posyandu x 4 OT x Rp 48,000 Saluaba
2 Posyandu x 4 OT x Rp 36,000 Buntongi
3 Posyandu x 8 OT x Rp 36,000 Padang Tumbuo
b. Sweeping Vit. A
x 1 OT x Rp 33,000 Malotong
x 1 OT x Rp 30,000 Bonerato
x 1 OT x Rp 30,000 Bailo Baru
x 1 OT x Rp 30,000 Bailo
Transport Petugas Pengelola Gizi
Kelurahan/
Bayi/Balita 10 Desa
 x 1 OT x Rp 30,000 Labiabae
Transport Petugas Pengelola Gizi
Kelurahan/ x 1 OT x Rp 30,000 Ampana
Bayi/Balita 10 Desa x 1 OT x Rp 42,000 Sansarino
x 1 OT x Rp 48,000 Saluaba
x 1 OT x Rp 36,000 Buntongi
x 1 OT x Rp 36,000 Padang Tumbuo
Dukungan Ops Wilker PKM AB
x 10 OT x Rp 20,000 Kader Posyandu
Kader
c. PMT Pemulihan Bayi/Balita Gizi Buruk
Bayi/ Balita 4 Bayi/ Balita 360 OH x Rp 30,000 PMT Wilker PKM AB Pengelola Gizi
GB GB
d. Pemantauan Pemberian PMT Bayi Balita
3 OT x Rp 33,000 Malotong
Bayi/ Balita Kelurahan/
3 3 OT x Rp 30,000 Transport Petugas Ampana Pengelola Gizi
GB Desa
3 OT x Rp 36,000 Buntongi
e. Sweeping Imunisasi
x 4 OT x Rp 33,000 Malotong
x 4 OT x Rp 30,000 Bonerato
x 4 OT x Rp 30,000 Bailo Baru
x 4 OT x Rp 30,000 Bailo
Kelurahan/ x 4 OT x Rp 30,000 Labiabae
Bayi/Balita 10 Transpor Petugas Jurim
Desa x 4 OT x Rp 30,000 Ampana
x 4 OT x Rp 42,000 Sansarino
x 4 OT x Rp 48,000 Saluaba
x 4 OT x Rp 36,000 Buntongi
x 4 OT x Rp 36,000 Padang Tumbuo
f. Pengambilan Vaksin

8 OT Rp 30,000 Transpor Petugas Jurim

IV PENGENDALIAN PENYAKIT MENULAR

a Penyuluhan
- Penyuluhan Bahaya Penyakit TB dan Kusta
2 OT x Rp 33,000 Malotong
2 OT x Rp 30,000 Bonerato
2 OT x Rp 30,000 Bailo Baru
2 OT x Rp 30,000 Bailo
Kelurahan/ Petugas Promkes/
Masyarakat 10 Transpor Petugas
Desa Pengelola TB & Kusta
 Kelurahan/ 2 OT x Rp 30,000 Labiabae Petugas Promkes/
Masyarakat 10 Transpor Petugas
Desa 2 OT x Rp 30,000 Ampana Pengelola TB & Kusta
2 OT x Rp 42,000 Sansarino
2 OT x Rp 48,000 Saluaba
2 OT x Rp 36,000 Buntongi
2 OT x Rp 36,000 Padang Tumbuo
220 OK x Rp 10,000 Konsumsi
1 Paket x Rp 75,000 ATK
- Penyuluhan Bahaya Penyakit Menular Seksual
6 OT x Rp 30,000 Bailo Baru
SLTP/ 2 OT x Rp 30,000 Bailo
SLTA 4 OT x Rp 30,000 Ampana Promkes/ Pengelola
Siswa 10
2 OT x Rp 42,000 Transport Petugas Sansarino Kespro

Sederajat 2 OT x Rp 42,000 Sansarino

2 OT x Rp 42,000 Sansarino
1 Paket x Rp 75,000 ATK
- Penyuluhan Bahaya Rokok
6 OT x Rp 30,000 Bailo Baru
SLTP/ 2 OT x Rp 30,000 Bailo
SLTA 4 OT x Rp 30,000 Ampana Promkes/ Pengelola
Siswa 10
2 OT x Rp 42,000 Sansarino PTM

Sederajat 2 OT x Rp 42,000 Sansarino

2 OT x Rp 42,000 Sansarino
1 Paket x Rp 75,000 ATK
- Penyuluhan Bahaya CA Cerviks dan IVA
2 OT x Rp 33,000 Malotong
2 OT x Rp 30,000 Bonerato
2 OT x Rp 30,000 Bailo Baru
2 OT x Rp 30,000 Bailo
2 OT x Rp 30,000 Labiabae Promkes/ Pengelola
PUS/WUS 10 Kelurahan/ Transport Petugas
2 OT x Rp 30,000 Ampana PTM
Desa
2 OT x Rp 42,000 Sansarino
2 OT x Rp 48,000 Saluaba
2 OT x Rp 36,000 Buntongi
2 OT x Rp 36,000 Padang Tumbuo
220 OK x Rp 10,000 Konsumsi
 1 Paket x Rp 75,000 ATK
b Pelacakan Kasus
- Pelacakan Kasus TB
2 OT x Rp 33,000 Malotong
2 OT x Rp 30,000 Bonerato
2 OT x Rp 30,000 Bailo Baru
2 OT x Rp 30,000 Bailo
Kelurahan/ 2 OT x Rp 30,000 Labiabae
10 Transport Petugas Team
Desa 2 OT x Rp 30,000 Ampana
2 OT x Rp 42,000 Sansarino
2 OT x Rp 48,000 Saluaba
2 OT x Rp 36,000 Buntongi
2 OT x Rp 36,000 Padang Tumbuo
- Pemantauan Penderita Reaksi Kusta
2 OT x Rp 33,000 Malotong
2 OT x Rp 30,000 Bonerato
2 OT x Rp 30,000 Bailo Baru
Kelurahan/ 2 OT x Rp 30,000 Bailo Dokter, Pengelola
10 Transport Petugas
Desa 2 OT x Rp 30,000 Labiabae TB & Kusta
2 OT x Rp 30,000 Ampana
2 OT x Rp 42,000 Sansarino
2 OT x Rp 48,000 Saluaba
2 OT x Rp 36,000 Buntongi
2 OT x Rp 36,000 Padang Tumbuo
- Pemantauan Daerah Berpotensi KLB
3 OT x Rp 33,000 Malotong
3 OT x Rp 30,000 Bonerato
3 OT x Rp 30,000 Bailo Baru
3 OT x Rp 30,000 Bailo
Kelurahan/ 3 OT x Rp 30,000 Labiabae
10 Transport Petugas Pengelola Surveilans
Desa 3 OT x Rp 30,000 Ampana
3 OT x Rp 42,000 Sansarino
3 OT x Rp 48,000 Saluaba
3 OT x Rp 36,000 Buntongi
3 OT x Rp 36,000 Padang Tumbuo
c Mengendalikan Penyebaran dan menurunkan Jumlah Kasus baru Malaria,DBD
- Survei Jentk dan abatesasi
1 2 OT x Rp 33,000 Malotong
1 2 OT x Rp 30,000 Bonerato
4 8 OT x Rp 30,000 Bailo Baru
3 SD/ 6 OT x Rp 30,000 Bailo
2 SLTP/ 4 OT x Rp 30,000 Labiabae
Transport Petugas Team
4 SLTA 8 OT x Rp 30,000 Ampana
Sederajat
1 2 OT x Rp 48,000 Saluaba
1 2 OT x Rp 36,000 Buntongi
2 4 OT x Rp 36,000 Padang Tumbuo
5 10 OT x Rp 42,000 Sansarino
- Penyuluhan dan Screaning Malaria
3 OT x Rp 42,000 Sansarino
Transpor Petugas Team
Kelurahan/D 3 OT x Rp 48,000 Saluaba
2 esa 200 OK x Rp 10,000 Konsumsi
1 Paket x Rp 75,000 ATK
- Sosialisasi Kader Jumantk
2 OT x Rp 33,000 Malotong
2 OT x Rp 30,000 Bonerato
2 OT x Rp 30,000 Bailo Baru
2 OT x Rp 30,000 Bailo
2 OT x Rp 30,000 Dukungan Labiabae
Kader 20 Kader Pengelola DBD
2 OT x Rp 30,000 Operasional Ampana
2 OT x Rp 42,000 Sansarino
2 OT x Rp 48,000 Saluaba
2 OT x Rp 36,000 Buntongi
2 OT x Rp 36,000 Padang Tumbuo
20 OK Rp 50,000 Uang Saku
3 OK Rp 175,000 Honor Narasumber
20 Paket Rp 7,500 ATK Peserta
Kader 20 Kader
25 OK Rp 10,000 Snack
25 OK Rp 25,000 Makan/Minum
3 M2 Rp 50,000 Spanduk
- Sosialisasi Frambusia
3 OT x Rp 33,000 Malotong
3 OT x Rp 30,000 Bonerato
 3 OT x Rp 30,000 Bailo Baru
3 OT x Rp 30,000 Bailo
3 OT x Rp 30,000 Labiabae
Transport Peserta Pengelola Frambusia
3 OT x Rp 30,000 Ampana
3 OT x Rp 42,000 Sansarino
3 OT x Rp 48,000 Saluaba
3 OT x Rp 36,000 Buntongi
3 OT x Rp 36,000 Padang Tumbuo
30 OK x Rp 50,000 Uang Saku
3 OK x Rp 175,000 Honor Narasumber
30 Paket x Rp 5,000 ATK Peserta
35 OK x Rp 10,000 Snack
35 OK x Rp 25,000 Makan/Minum
3 M2 x Rp 50,000 Spanduk
- Sosialisasi STBM
5 OT x Rp 33,000 Malotong
5 OT x Rp 30,000 Bonerato
5 OT x Rp 30,000 Bailo Baru
5 OT x Rp 30,000 Bailo
5 OT x Rp 30,000 Labiabae
Transport Petugas Pengelola Kesling
5 OT x Rp 30,000 Ampana
5 OT x Rp 42,000 Sansarino
Kelurahan/ 5 OT x Rp 48,000 Saluaba
Masy 10 Desa 5 OT x Rp 36,000 Buntongi
5 OT x Rp 36,000 Padang Tumbuo
50 OK x Rp 50,000 Uang Saku
3 OK x Rp 175,000 Honor Narasumber
50 Paket Rp 10,000 ATK Peserta
55 OK Rp 10,000 Snack
55 OK Rp 25,000 Makan/Minum
3 M2 Rp 50,000 Spanduk

V. Meningkatkan Akses Masyarakat terhadap sumber air minum dan sanitasi dasar
a Pemeriksaan TTU
1 OT x Rp 33,000 Malotong
1 OT x Rp 30,000 Bonerato

Tempat Tempat Kelurahan/

 1 OT x Rp 30,000 Bailo Baru
1 OT x Rp 30,000 Bailo
Tempat Tempat Kelurahan/ 1 OT x Rp 30,000 Labia Bae
10 Transport Petugas Pengelola Kesling
Umum Desa 1 OT x Rp 30,000 Ampana
1 OT x Rp 42,000 Sansarino
1 OT x Rp 48,000 Saluaba
1 OT x Rp 36,000 Buntongi
1 OT x Rp 36,000 Padang Tumbuo
b Pemeriksaan TPM
1 OT x Rp 33,000 Malotong
Tempat 1 OT x Rp 30,000 Bonerato
Pengolahan 6 Kelurahan 1 OT x Rp 30,000 Bailo Baru
Transport Petugas Pengelola Kesling
Makanan 1 OT x Rp 30,000 Bailo
1 OT x Rp 30,000 Labia Bae
1 OT x Rp 30,000 Ampana
c Pemeriksaan Damium
1 OT x Rp 30,000 Bonerato
1 OT x Rp 30,000 Bailo Baru
Damium 6 Damium 1 OT x Rp 30,000 Bailo
Transport Petugas Pengelola Kesling
1 OT x Rp 30,000 Labiabae
1 OT x Rp 30,000 Ampana
1 OT x Rp 42,000 Sansarino
d Pemeriksaan Sanitasi Hotel / Penginapan
1 OT x Rp 30,000 Hotel Mulia
1 OT x Rp 30,000 Peng.Santafur
Hotel 1 OT x Rp 30,000 Hotel Ananda
6 Hotel/Peng Transport Petugas Pengelola Kesling
Penginapan 1 OT x Rp 30,000 Hot.Khayangan
1 OT x Rp 30,000 Peng.Ampana
1 OT x Rp 30,000 Home Stail
PENYELENGGARAAN UPAYA PENUNJANG
I MANAJEMEN PUSKESMAS
a Penggerakan Pelaksanaan (P2)
- Lokakarya Mini Puskesmas
Petugas 8 Kegiatan 480 OK x Rp 10,000 Snack Rapat Puskesmas

- Pertemuan Lintas Sektor

 80 OK X Rp 25,000 Konsumsi
80 OK X Rp 10,000 Snack
5 OK X Rp 100,000
65 OK X Rp 50,000 Uang Saku
2 OK X Rp 33,000
2 OK X Rp 30,000
2 OK X Rp 30,000
2 OK X Rp 30,000 Puskesmas
2 OK X Rp 30,000
Transport Peserta
2 OK X Rp 30,000
2 OK X Rp 42,000
2 OK X Rp 48,000
2 OK X Rp 36,000
2 OK X Rp 36,000
1 Paket X Rp 150,000 ATK
3 M2 X Rp 50,000 Spanduk

Konsultasi BOK 9 Kunjungan 9 OT x Rp 30,000 Transport Petugas Pengelola BOK

1 Paket x Rp 2,868,000 Transport Petugas Pengelola BOK

- Penatausahaan SPJ BOK 9 Bulan

b Pengawasan Pengendalian dan Penilaian (P3)

- Supervisi Fasilitatf Bikor
1 OT x Rp 33,000 Malotong
1 OT x Rp 30,000 Bonerato
1 OT x Rp 30,000 Bailo Baru
1 OT x Rp 30,000 Bailo
1 OT x Rp 30,000 Labiabae
10 Desa Bikor
1 OT x Rp 30,000 Transport Petugas Ampana
1 OT x Rp 42,000 Sansarino
1 OT x Rp 48,000 Saluaba
1 OT x Rp 36,000 Buntongi
1 OT x Rp 36,000 Padang Tumbuo
- Supervisi Pengelola Gudang Obat
1 OT x Rp 33,000 Malotong
 1 OT x Rp 30,000 Bonerato
1 OT x Rp 30,000 Bailo Baru
1 OT x Rp 30,000 Bailo
Bides/ 1 OT x Rp 30,000 Labiabae Pengelola Gudang
10 Desa
Perawat 1 OT x Rp 30,000 Ampana Obat
1 OT x Rp 42,000 Sansarino
1 OT x Rp 48,000 Saluaba
1 OT x Rp 36,000 Buntongi
1 OT x Rp 36,000 Padang Tumbuo
II Penjaringan Anak Sekolah Dasar
a. Penjaringan Anak Sekolah Dasar/Penyuluhan PHBS
1 3 OT x Rp 33,000 Malotong
1 3 OT x Rp 30,000 Bonerato
1 SD/ 3 OT x Rp 30,000 Bailo Baru
2 Sederajat 6 OT x Rp 30,000 Bailo
2 6 OT x Rp 30,000 Labiabae
Murid Sekolah 2 6 OT x Rp 30,000 Ampana
Transport Petugas Team
Dasar 1 3 OT x Rp 42,000 Sansarino
1 SD/ 3 OT x Rp 48,000 Saluaba
1 Sederajat 3 OT x Rp 36,000 Buntongi
2 6 OT x Rp 36,000 Padang Tumbuo
750 Lbr x Rp 200 Penggandaan Materi

b Pencegahan Penyakit Cacingan Pada Murid Sekolah Dasar

1 1 OT x Rp 33,000 Malotong
1 1 OT x Rp 30,000 Bonerato
1 1 OT x Rp 30,000 Bailo Baru
2 2 OT x Rp 30,000
Bailo
Murid Sekolah SD/
2 2 OT x Rp 30,000 Labiabae Pengelola UKS
Dasar Sederajat Transport Petugas
2 2 OT x Rp 30,000 Ampana
1 1 OT x Rp 30,000 Sansarino
1 1 OT x Rp 30,000 Saluaba
1 1 OT x Rp 30,000 Buntongi
2 2 OT x Rp 42,000 Padang Tumbuo
III PENGEMBANGAN UKBM
 a Dukungan operasional Kader posyandu

Dukungan Ops
Kader Posyandu 95 Kader 855 OT x Rp 20,000 Kader Wilker PKM AB
Posyandu

b Dukungan Operasional Kader Posbindu

1 Petugas 9 OT x Rp 30,000 Transport Petugas Posbindu

Dukungan Ops
5 Kader 45 OT x Rp 20,000 Kader Posbindu
Posbindu

IV PROMOSI KESEHATAN

a Sosialisasi Pendampingan Kader

8 OT x Rp 33,000 Malotong Bides
6 OT x Rp 30,000 Bonerato
4 OT x Rp 30,000 Bailo Baru
6 OT x Rp 30,000 Bailo
4 OT x Rp 30,000 Labiabae
Transport Petugas
6 OT x Rp 30,000 Ampana
6 OT x Rp 42,000 Sansarino
Lurah/Kades, 4 OT x Rp 48,000 Saluaba
58 Peserta
Bides, Kader 6 OT x Rp 36,000 Buntongi
8 OT x Rp 36,000 Padang Tumbuo
48 OK Rp 50,000 Uang saku
3 OK x Rp 175,000 Honor Fasilitator
38 Paket x Rp 10,000 ATK
60 OK x Rp 10,000 Snack
60 OK x Rp 25,000 Makan Minum
3 M2 x Rp 50,000 Spanduk
b Pelathan/Refresing Kader Posyandu

15 OT x Rp 33,000 Transport Petugas

15 OT x Rp 30,000
15 OT x Rp 30,000 PKM Ampana Barat Promkes
15 OT x Rp 30,000
15 OT x Rp 30,000

Kader 3 Hari
 15 OT x Rp 30,000
Kader 3 Hari
30 OK Rp 50,000 Uang saku
Honor
18 OJ x Rp 175,000 narasumber
30 Paket x Rp 5,000 ATK
210 OK x Rp 10,000 Snack
105 OK x Rp 25,000 Makan Minum
3 M2 x Rp 50,000 Spanduk

J U M L A H T O T A L
1. 1. 2. 2. 3. 4. 5. 5.
3. 4.
Verivikator: :
Verivikator

Mengetahui, Bailo, 30 Agustus 2015

Kepala Dinas Kesehatan Kepala Puskesmas Ampana Barat
Kabupaten Tojo Una-una

dr. Abd. Rahman. DM. MARS dr.Diah Devawat S.Ked

NIP. 195603041983121002 NIP:19830921 201101 2 010
BARAT

Sumber
Jadwal Biaya Biaya

Rp 83,585,000 BOK

Rp 17,735,000 BOK

Rp 1,440,000

Rp 12,900,000
Rp 3,395,000
Rp 33,000
Rp 30,000
Rp 30,000
Rp 30,000
April s/d Rp 30,000
Desember Rp 30,000
Rp 42,000
Rp 48,000
Rp 36,000
Rp 36,000
Rp 1,000,000
Rp 1,700,000
Rp 150,000
 Rp 200,000
Rp 21,030,000 BOK
Rp 20,790,000
Rp 2,970,000
Rp 1,350,000
April s/d
Desember Rp 1,350,000
Rp 1,350,000
Rp 1,350,000
Rp 1,350,000
Rp 1,890,000
April s/d
Desember Rp 2,160,000
Rp 1,620,000
Rp 3,240,000
Rp 2,160,000
Rp 240,000
Rp 240,000

Rp 14,918,000 BOK
Rp 1,656,000
Rp 264,000
Rp 120,000
Rp 120,000
Rp 120,000
April s/d Rp 120,000
Desember Rp 120,000
Rp 168,000
Rp 192,000
Rp 144,000
Rp 288,000
Rp 545,000
Rp 33,000
Rp 30,000
Rp 30,000
Rp 30,000
September
 Rp 30,000
September
Rp 30,000
Rp 42,000
Rp 48,000
Rp 36,000
Rp 36,000
September Rp 200,000

Rp 10,800,000

Juni-Agust Rp 10,800,000

Rp 297,000
Rp 99,000
Juli - Sept Rp 90,000
Rp 108,000
Rp 1,380,000
Rp 132,000
Rp 120,000
Rp 120,000
Rp 120,000
April s/d Rp 120,000
Desember Rp 120,000
Rp 168,000
Rp 192,000
Rp 144,000
Rp 144,000
Rp 240,000
April s/d Rp 240,000
Desember
Rp 29,002,000
BOK
Rp 7,304,000
Rp 2,965,000
Rp 66,000
Rp 60,000
Rp 60,000
Rp 60,000
April s/d
Desember
 April s/d Rp 60,000
Desember Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 72,000
Rp 2,200,000
Rp 75,000
Rp 687,000
Rp 180,000
Rp 60,000
April s/d Rp 120,000
Desember Rp 84,000
Rp 84,000
Rp 84,000
Rp 75,000
Rp 687,000
Rp 180,000
Rp 60,000
April s/d Rp 120,000
Desember Rp 84,000
Rp 84,000
Rp 84,000
Rp 75,000
Rp 2,965,000
Rp 66,000
Rp 60,000
Rp 60,000
Rp 60,000
April s/d Rp 60,000
Desember Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 72,000
Rp 2,200,000
 Rp 75,000
Rp 2,415,000 BOK
Rp 690,000
Rp 66,000
Rp 60,000
Rp 60,000
Rp 60,000
April s/d Rp 60,000
Desember Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 72,000
Rp 690,000
Rp 66,000
Rp 60,000
Rp 60,000
April s/d Rp 60,000
Desember Rp 60,000
Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 72,000
Rp 1,035,000
Rp 99,000
Rp 90,000
Rp 90,000
Rp 90,000
Oktob s/d Rp 90,000
Desember Rp 90,000
Rp 126,000
Rp 144,000
Rp 108,000
Rp 108,000
Rp 19,283,000 BOK
 Rp 1,638,000
Rp 66,000
Rp 60,000
Rp 240,000
Rp 180,000
April s/d Rp 120,000
Desember Rp 240,000
Rp 96,000
Rp 72,000
Rp 144,000
Rp 420,000
Rp 2,345,000
April s/d Rp 126,000
Desember Rp 144,000
Rp 2,000,000
Rp 75,000
Rp 3,390,000
Rp 66,000
Rp 60,000
Rp 60,000
Rp 60,000
April s/d Rp 60,000
Desember Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 72,000
Rp 1,000,000
Rp 525,000
Rp 150,000
Rp 250,000
Rp 625,000
Rp 150,000
Rp 4,585,000
Rp 99,000
Rp 90,000

April s/d
 Rp 90,000
Rp 90,000
April s/d Rp 90,000
Desember Rp 90,000
Rp 126,000
Rp 144,000
Rp 108,000
Rp 108,000
Rp 1,500,000
Rp 525,000
Rp 150,000
Rp 350,000
Rp 875,000
Rp 150,000
Rp 7,325,000
Rp 165,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
April s/d
Desember Rp 150,000
Rp 210,000
Rp 240,000
Rp 180,000
Rp 180,000
Rp 2,500,000
Rp 525,000
Rp 500,000
Rp 550,000
Rp 1,375,000
Rp 150,000

Rp 900,000 BOK
Rp 345,000
Rp 33,000
Rp 30,000

April s/d
 Rp 30,000
Rp 30,000
April s/d Rp 30,000
Desember Rp 30,000
Rp 42,000
Rp 48,000
Rp 36,000
Rp 36,000
Rp 183,000
Rp 33,000
Rp 30,000
April s/d Rp 30,000
Desember Rp 30,000
Rp 30,000
Rp 30,000
Rp 192,000
Rp 30,000
Rp 30,000
April s/d Rp 30,000
Desember Rp 30,000
Rp 30,000
Rp 42,000
Rp 180,000
Rp 30,000
Rp 30,000
April s/d Rp 30,000
Desember Rp 30,000
Rp 30,000
Rp 30,000
Rp 56,415,000
Rp 16,168,000
Rp 15,478,000 BOK
Rp 4,800,000
April s/d Rp 4,800,000
Desember
Rp 7,540,000
 Rp 2,000,000
Rp 800,000
Rp 500,000
Rp 3,250,000
Rp 66,000
Rp 60,000
Rp 60,000
April s/d
Desember Rp 60,000
Rp 60,000
Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 72,000
Rp 150,000
Rp 150,000
April s/d Des
Rp 270,000

April s/d Des Rp 2,868,000

Rp 690,000 BOK
Rp 345,000
Rp 33,000
Rp 30,000
Rp 30,000
Rp 30,000
April s/d Rp 30,000
Desember Rp 30,000
Rp 42,000
Rp 48,000
Rp 36,000
Rp 36,000
Rp 345,000
Rp 33,000
 Rp 30,000
Rp 30,000
Rp 30,000
April s/d Rp 30,000
Desember Rp 30,000
Rp 42,000
Rp 48,000
Rp 36,000
Rp 36,000
Rp 2,010,000 BOK
Rp 1,563,000
Rp 99,000
Rp 90,000
Rp 90,000
Rp 180,000
Rp 180,000
April s/d Rp 180,000
Desember Rp 126,000
Rp 144,000
Rp 108,000
Rp 216,000

Rp 150,000
Rp 447,000
Rp 33,000
Rp 30,000
Rp 30,000

Rp 60,000
April s/d
Desember Rp 60,000
Rp 60,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 84,000
Rp 18,270,000 BOK
 Rp 17,100,000

April s/d Des Rp 17,100,000

Rp 1,170,000

Rp 270,000
April s/d Des
Rp 900,000

Rp 19,967,000 BOK

Rp 7,547,000
April s/d Rp 264,000
Desember
Rp 180,000
Rp 120,000
Rp 180,000
Rp 120,000
Rp 180,000
Rp 252,000
Rp 192,000
Rp 216,000
Rp 288,000
Rp 2,400,000
Rp 525,000
Rp 380,000
Rp 600,000
Rp 1,500,000
Rp 150,000
Rp 12,420,000

Rp 495,000
Rp 450,000
April s/d
Desember Rp 450,000
Rp 450,000
Rp 450,000
 Rp 450,000
Rp 1,500,000
Rp 3,150,000

Rp 150,000
Rp 2,100,000
Rp 2,625,000
Rp 150,000

Rp 140,000,000
6.
Rp 140,000,000
6.

gustus 2015
as Ampana Barat

vawat S.Ked
1 201101 2 010
 RENCANA PELAKSANAAN KEGIATAN BULANAN PROGRAM BOK PUSKESMAS AMPANA BARAT
UPAYA PROMOTIF DAN PREVENTIF
TAHUN ANGGARAN 2015
PROVINSI : SULAWESI TENGAH
KABUPATEN : TOJO UNA - UNA
KECAMATAN : AMPANA KOTA
BULAN : SEPTEMBER

Rincian Lokasi Tenaga

No Kegiatan Sasaran Target Jadwal
Pelaksanaan Pelaksanaan Pelaksana
(1) (2) (3) (4) (5) (6) (7) (8) (9)
A. UPAYA Ibu
Kesehatan KESEHATAN PRIORITAS
Anak (KIA) dan Keluarga
I. Berencana (KB)
a. Kunjungan Rumah Bumil Rist
1 Bumil Rist 1 OT x Rp 20,000 Ampana Mildawat
2 Bumil Rist 1 OT x Rp 20,000 Bonerato Susan Bongkriwan
September
5 Bumil Rist 4 OT x Rp 20,000 Transport Petugas Sansarino Mercy Lembang
2 Bumil Rist 4 OT x Rp 20,000 Padang Tumbuo Wiwin Indrawat
2 Bumil Rist 2 OT x Rp 20,000 Bailo Devi Damayant
b. Kunjungan Rumah Bufas
3 Bufas 9 OT x Rp 20,000 Malotong Fairus Safitri
6 Bufas 18 OT x Rp 20,000 Bonerato Susan Bongkriwan
2 Bufas 6 OT x Rp 20,000 Bailo Baru Megawat
5 Bufas 15 OT x Rp 20,000 Transport Petugas Ampana Mildawat September
Bufas
4 Bufas 12 OT x Rp 20,000 Bailo Devi Damayant
3 Bufas 9 OT x Rp 20,000 Sansarino Mercy Lembang
1 Bufas 3 OT x Rp 20,000 Saluaba Sri Rahayu AN
5 Bufas 15 OT x Rp 20,000 Padang Tumbuo Wiwin Indrawat
c. Kelas Ibu Hamil
3 OT x Rp 30,000 Bikor
Transport Petugas September
3 OT x Rp 20,000 Bides
Bumil 3 Kls 30 OK x Rp 7,000 ATK
36 OK x Rp 10,000 Sneck
II. PELAYANAN KESEHATAN ANAK
a. Pelayanan di Posyandu Pemantauan Kesehatan Bayi Balita (Pengukuran Tumbuh Kembang & Pemantauan Perkembangan) dan Antenatal Bagi Ibu Hamil
3 Posyandu 10 OT x Rp 33,000 Malotong
2 Posyandu 5 OT x Rp 30,000 Bonerato
1 Posyandu 5 OT x Rp 30,000 Bailo Baru
2 Posyandu 5 OT x Rp 30,000 Bailo
Posyandu Transport Petugas Team September
1 Posyandu 5 OT x Rp 30,000 Labiabae
2 Posyandu 5 OT x Rp 30,000 Ampana
2 Posyandu 5 OT x Rp 42,000 Sansarino
1 Posyandu 5 OT x Rp 48,000 Saluaba

2 Posyandu 5 OT x Rp 36,000 Buntongi

Transport Petugas Team September
3 Posyandu 10 OT x Rp 36,000 Padang Tumbuo
Posyandu
20,000 Transport Bides Wilker PKM Amp.
19 Posyandu 12 OT x Rp Bides September
Barat
III. PELAYANAN GIZI
a. Pemantauan Pemberian PMT Bayi Balita
1 OT x Rp 33,000 Malotong
Bayi/ Balita September
Bayi/Balita GB 4 GB 1 OT x Rp 30,000 Transport Petugas Ampana Riskiyani
1 OT x Rp 36,000 Buntongi
b. Sweeping Vit. A
x 1 OT x Rp 33,000 Malotong
x 1 OT x Rp 30,000 Bonerato
x 1 OT x Rp 30,000 Bailo Baru
x 1 OT x Rp 30,000 Bailo
x 1 OT x Rp 30,000 Labiabae
Transport Petugas Pengelola Gizi September
Kelurahan/ x 1 OT x Rp 30,000 Ampana
Bayi/Balita 10 Desa x 1 OT x Rp 42,000 Sansarino
x 1 OT x Rp 48,000 Saluaba
x 1 OT x Rp 36,000 Buntongi
x 1 OT x Rp 36,000 Padang Tumbuo
Dukungan Ops
x 10 OT x Rp 20,000 Wilker PKM AB Kader Posyandu September
Kader

c. Pengambilan Vaksin 1 OT Rp 30,000 Transport Petugas Zahra Djafar September

IV PENGENDALIAN PENYAKIT MENULAR

 a Pelacakan Kasus
- Pelacakan Kasus TB
2 OT x Rp 33,000 Malotong
2 OT x Rp 30,000 Bonerato
2 OT x Rp 30,000 Bailo Baru
2 OT x Rp 30,000 Bailo
2 OT x Rp 30,000 Labiabae
10 Kelurahan/ Transport Petugas Team September
Desa 2 OT x Rp 30,000 Ampana
2 OT x Rp 42,000 Sansarino
2 OT x Rp 48,000 Saluaba
2 OT x Rp 36,000 Buntongi
2 OT x Rp 36,000 Padang Tumbuo
c Mengendalikan Penyebaran dan menurunkan Jumlah Kasus baru Malaria,DBD
- Survei Jentk dan abatesasi
1 2 OT x Rp 33,000 Malotong
1 2 OT x Rp 30,000 Bonerato
4 8 OT x Rp 30,000 Bailo Baru
3 SD/SLTP/ 6 OT x Rp 30,000 Bailo
SLTA Transport Petugas
2 Sederajat 4 OT x Rp 30,000 Labiabae Team September
4 8 OT x Rp 30,000 Ampana
1 2 OT x Rp 48,000 Saluaba

1 2 OT x Rp 36,000 Buntongi
2 4 OT x Rp 36,000 Padang Tumbuo
5 10 OT x Rp 42,000 Sansarino
V. Meningkatkan Akses Masyarakat terhadap sumber air minum dan sanitasi dasar
c Pemeriksaan Damium
1 OT x Rp 30,000 Bonerato
1 OT x Rp 30,000 Bailo Baru
Damium 6 Damium 1 OT x Rp 30,000 Bailo
Transport Petugas Pengelola Kesling September
1 OT x Rp 30,000 Labiabae
1 OT x Rp 30,000 Ampana
1 OT x Rp 42,000 Sansarino
B. PENYELENGGARAAN UPAYA PENUNJANG
1. Penggerakan Pelaksanaan (P2)
I. MANAJEMEN PUSKESMAS
 - Lokakarya Mini Puskesmas
Petugas 55 Petugas 55 OK x Rp 10,000 Sneck Puskesmas
September
- Pembuatan Laporan Bulanan BOK
1 Bulan 1 Paket x Rp 1,160,000 ATK Pengelola BOK
September
- Konsultasi BOK
1 Kunj. 1 OT x Rp 30,000 Transport Petugas Pengelola BOK September

III PENJARINGAN ANAK SEKOLAH DASAR

a. Penjaringan Anak Sekolah Dasar/Penyuluhan PHBS
SD/
2 6 OT x Rp 36,000 Transport Petugas September
Sederajat
IV PENGEMBANGAN UKBM
a. Transport Kader dalam Kegiatan Posyandu
Kader Transport Posyandu
95 Kali x Rp 20,000 Kader September
Posyandu Petugas Wilker PKM AB
b. Transport Kader dan Petugas dalam Kegiatan Posbindu
1 Kali x Rp 30,000 Transport Petugas Posbindu Petugas
September
Kader Posbindu 5 Kali x Rp 20,000 Transport Kader Wilker PKM AB Kader
J U M L A H T O T A L

Verivikator : 1 2

Bailo, September 2015

Mengetahui,
Kepala Puskesmas Ampana Barat Pengelola BOK

dr.Diah Devawat S.Ked Rosita, A.Md.Kep

NIP:19830921 201101 2 010 NIP:19801031 200902 2 001
 Sumber
Biaya Biaya
(10) (11)
Rp 8,204,000 BOK 8012000 Rp 192,000
Rp 2,700,000 BOK
Rp 240,000
Rp 20,000
Rp 20,000
Rp 80,000
Rp 80,000
Rp 40,000
Rp 1,740,000
Rp 180,000
Rp 360,000
Rp 120,000
Rp 300,000
Rp 240,000
Rp 180,000
Rp 60,000
Rp 300,000
Rp 720,000
Rp 90,000
Rp 60,000
Rp 210,000
Rp 360,000
Rp 2,310,000 BOK
Rp 2,310,000
Rp 330,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 210,000
Rp 240,000

Rp 180,000
Rp 360,000
Rp 240,000

Rp 674,000 BOK
Rp 99,000
Rp 33,000
Rp 30,000
Rp 36,000
Rp 545,000
Rp 33,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 42,000
Rp 48,000
Rp 36,000
Rp 36,000
Rp 200,000

Rp 30,000

Rp 2,328,000 BOK
Rp 690,000
Rp 690,000
Rp 66,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 72,000
Rp 1,638,000 BOK
Rp 1,638,000
Rp 66,000
Rp 60,000
Rp 240,000
Rp 180,000
Rp 120,000
Rp 240,000
Rp 96,000

Rp 72,000
Rp 144,000
Rp 420,000
Rp 192,000 BOK
Rp 192,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 42,000
Rp 3,986,000

Rp 1,740,000 BOK
Rp 550,000
Rp 550,000
Rp 1,160,000
Rp 1,160,000
Rp 30,000
Rp 30,000

Rp 216,000 BOK
Rp 216,000
Rp 216,000

Rp 2,030,000 BOK
Rp 1,900,000
Rp 1,900,000

Rp 130,000
Rp 30,000
Rp 100,000
Rp 12,190,000

9020000
Rp (3,170,000)
 RENCANA PELAKSANAAN KEGIATAN BULANAN PROGRAM BOK PUSKESMAS AMPANA BARAT
UPAYA PROMOTIF DAN PREVENTIF
TAHUN ANGGARAN 2015
PROVINSI : SULAWESI TENGAH
KABUPATEN : TOJO UNA - UNA
KECAMATAN : AMPANA KOTA
BULAN : OKTOBER

Rincian Lokasi Tenaga

No Kegiatan Sasaran Target Jadwal
Pelaksanaan Pelaksanaan Pelaksana
(1) (2) (3) (4) (5) (6) (7) (8) (9)
A. UPAYA Ibu
Kesehatan KESEHATAN PRIORITAS
Anak (KIA) dan Keluarga
I. Berencana (KB)
a. Kunjungan Rumah Bumil Rist
2 Bumil Rist 2 OT x Rp 20,000 Bonerato Susan Bongkriwan
1 Bumil Rist 1 OT x Rp 20,000 Transport Petugas Sansarino Mercy Okt
1 Bumil Rist 1 OT x Rp 20,000 Padang Tumbuo Wiwin Indrawat
b. Kunjungan Rumah Bufas
1 Bufas 3 OT x Rp 20,000 Malotong Fairus Safitri
6 Bufas 18 OT x Rp 20,000 Bonerato Susan Bongkriwan
1 Bufas 3 OT x Rp 20,000 Bailo Baru Megawat
5 Bufas 15 OT x Rp 20,000 Ampana Mildawat
Transport Petugas Okt
Bufas 8 Bufas 24 OT x Rp 20,000 Bailo Devi Damayant
1 Bufas 3 OT x Rp 20,000 Sansarino Mercy
2 Bufas 6 OT x Rp 20,000 Buntongi Hasnita
1 Bufas 3 OT x Rp 20,000 Saluaba Sri Rahayu AN
4 Bufas 12 OT x Rp 20,000 Padang Tumbuo Wiwin Indrawat
II. PELAYANAN KESEHATAN ANAK
a. Pelayanan di Posyandu Pemantauan Kesehatan Bayi Balita (Pengukuran Tumbuh Kembang & Pemantauan Perkembangan) dan Antenatal Bagi Ibu Hamil
3 Posyandu 10 OT x Rp 33,000 Malotong
2 Posyandu 5 OT x Rp 30,000 Bonerato
1 Posyandu 5 OT x Rp 30,000 Bailo Baru
2 Posyandu 5 OT x Rp 30,000 Bailo
Transport Petugas Team
Posyandu Okt
 1 Posyandu 5 OT x Rp 30,000 Labiabae
Transport Petugas Team
2 Posyandu 5 OT x Rp 30,000 Ampana
Posyandu Okt
2 Posyandu 5 OT x Rp 42,000 Sansarino
1 Posyandu 5 OT x Rp 48,000 Saluaba
2 Posyandu 5 OT x Rp 36,000 Buntongi
3 Posyandu 10 OT x Rp 36,000 Padang Tumbuo
Transport Bides Wilker PKM Amp.
19 Posyandu 12 OT x Rp 20,000 Bides
Barat
III. PELAYANAN GIZI

b. Pengambilan Vaksin 1 OT Rp 30,000 Transport Petugas Zahra Djafar Okt

IV PENGENDALIAN PENYAKIT MENULAR

a.Penyuluhan
- Penyuluhan Bahaya CA Cerviks dan IVA
2 OT x Rp 33,000 Malotong
2 OT x Rp 30,000 Bonerato
2 OT x Rp 30,000 Bailo Baru
2 OT x Rp 30,000 Bailo
2 OT x Rp 30,000 Labiabae April s/d
Transport Petugas
2 OT x Rp 30,000 Ampana Desember
PUS/WUS 10 Desa/Kel Promkes/ Pengelola PTM
2 OT x Rp 42,000 Sansarino
2 OT x Rp 48,000 Saluaba
2 OT x Rp 36,000 Buntongi
2 OT x Rp 36,000 Padang Tumbuo
220 OK x Rp 10,000 Konsumsi
1 Paket x Rp 75,000 ATK
c Mengendalikan Penyebaran dan menurunkan Jumlah Kasus baru Malaria,DBD
- Sosialisasi Frambusia
3 OT x Rp 33,000 Malotong
3 OT x Rp 30,000 Bonerato
3 OT x Rp 30,000 Bailo Baru
3 OT x Rp 30,000 Bailo
3 OT x Rp 30,000 Labiabae April s/d
Transport Peserta Pengelola Frambusia
3 OT x Rp 30,000 Ampana Desember
 April s/d
Transport Peserta Pengelola Frambusia Desember
3 OT x Rp 42,000 Sansarino
3 OT x Rp 48,000 Saluaba
3 OT x Rp 36,000 Buntongi
3 OT x Rp 36,000 Padang Tumbuo
30 OK x Rp 50,000 Uang Saku
3 OK x Rp 175,000 Honor Narasumber
30 Paket x Rp 5,000 ATK Peserta
35 OK x Rp 10,000 Snack
35 OK x Rp 25,000 Makan/Minum
3 M2 x Rp 50,000 Spanduk
- Pemantauan Daerah Berpotensi KLB
3 OT x Rp 33,000 Malotong
3 OT x Rp 30,000 Bonerato
3 OT x Rp 30,000 Bailo Baru
3 OT x Rp 30,000 Bailo
Kelurahan/ 3 OT x Rp 30,000 Labiabae
10 Transport Petugas Pengelola Surveilans September
Desa 3 OT x Rp 30,000 Ampana
3 OT x Rp 42,000 Sansarino
3 OT x Rp 48,000 Saluaba
3 OT x Rp 36,000 Buntongi
3 OT x Rp 36,000 Padang Tumbuo

V. Meningkatkan Akses Masyarakat terhadap sumber air minum dan sanitasi dasar
d. Pemeriksaan Sanitasi Hotel / Penginapan
1 OT x Rp 30,000 Hotel Mulia
1 OT x Rp 30,000 Peng.Santafur
1 OT x Rp 30,000 Hotel Ananda
1 OT x Rp 30,000 Hot.Khayangan
1 OT x Rp 30,000 Peng.Ampana
1 OT x Rp 30,000 Home Stay
B. PENYELENGGARAAN UPAYA PENUNJANG
1. Penggerakan Pelaksanaan (P2)
I. MANAJEMEN PUSKESMAS
- Lokakarya Mini Puskesmas
 Petugas 55 Petugas 55 OK x Rp 10,000 Sneck Puskesmas Okt
- Pertemuan Lintas Sektor
80 OK X Rp 25,000 Konsumsi
80 OK X Rp 10,000 Snack
5 OK X Rp 100,000 Uang Saku
65 OK X Rp 50,000 Uang Saku
2 OK X Rp 33,000
2 OK X Rp 30,000
2 OK X Rp 30,000
2 OK X Rp 30,000
Puskesmas Okt
2 OK X Rp 30,000
Transport Peserta
2 OK X Rp 30,000
2 OK X Rp 42,000
2 OK X Rp 48,000
2 OK X Rp 36,000
2 OK X Rp 36,000
1 Paket X Rp 150,000 ATK
3 M2 X Rp 50,000 Spanduk
- Pembuatan Laporan Bulanan BOK
1 Bulan 1 Paket x Rp 500,000 ATK Pengelola BOK Okt
- Konsultasi BOK
1 Kunj. 1 OT x Rp 30,000 Transport Petugas Pengelola BOK Okt
 IV PENGEMBANGAN UKBM
a. Transport Kader dalam Kegiatan Posyandu
Kader Transport Posyandu
95 Kali x Rp 20,000 Kader Okt
Posyandu Petugas Wilker PKM AB
b. Transport Kader dan Petugas dalam Kegiatan Posbindu
1 Kali x Rp 30,000 Transport Petugas Posbindu Petugas
Okt
Kader Posbindu 5 Kali x Rp 20,000 Transport Kader Wilker PKM AB Kader
J U M L A H T O T A L

Verivikator : 1 2

Bailo, Oktober 2015

Mengetahui,
Kepala Puskesmas Ampana Barat Pengelola BOK

dr.Diah Devawat S.Ked Rosita, A.Md.Kep

NIP:19830921 201101 2 010 NIP:19801031 200902 2 001
 Sumber
Biaya Biaya
(10) (11)
Rp 12,925,000 BOK
Rp 1,820,000 BOK
Rp 80,000
Rp 40,000
Rp 20,000
Rp 20,000
Rp 1,740,000
Rp 60,000
Rp 360,000
Rp 60,000
Rp 300,000
Rp 480,000
Rp 60,000
Rp 120,000
Rp 60,000
Rp 240,000
Rp 2,310,000 BOK
Rp 2,310,000
Rp 330,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 210,000
Rp 240,000
Rp 180,000
Rp 360,000
Rp 240,000

Rp 30,000 BOK
Rp 30,000

Rp 8,585,000 BOK
Rp 2,965,000
Rp 2,965,000
Rp 66,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 72,000
Rp 2,200,000
Rp 75,000
Rp 5,620,000
Rp 4,585,000
Rp 99,000
Rp 90,000
Rp 90,000
Rp 90,000
Rp 90,000
Rp 90,000
Rp 126,000
Rp 144,000
Rp 108,000
Rp 108,000
Rp 1,500,000
Rp 525,000
Rp 150,000
Rp 350,000
Rp 875,000
Rp 150,000
Rp 1,035,000
Rp 99,000
Rp 90,000
Rp 90,000
Rp 90,000
Rp 90,000
Rp 90,000
Rp 126,000
Rp 144,000
Rp 108,000
Rp 108,000

Rp 180,000 BOK
Rp 180,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 10,650,000

Rp 8,620,000 BOK
Rp 550,000
Rp 550,000
Rp 7,540,000
Rp 2,000,000
Rp 800,000
Rp 500,000
Rp 3,250,000
Rp 66,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 72,000
Rp 150,000
Rp 150,000
Rp 500,000
Rp 500,000
Rp 30,000
Rp 30,000
Rp 2,030,000 BOK
Rp 1,900,000
Rp 1,900,000

Rp 130,000
Rp 30,000
Rp 100,000
Rp 23,575,000

9020000
Rp (14,555,000)
 RENCANA PELAKSANAAN KEGIATAN BULANAN PROGRAM BOK PUSKESMAS AMPA
UPAYA PROMOTIF DAN PREVENTIF
TAHUN ANGGARAN 2015
PROVINSI : SULAWESI TENGAH
KABUPATEN : TOJO UNA - UNA
KECAMATAN : AMPANA KOTA
BULAN : NOVEMBER

Rincian Lokasi
No Kegiatan Sasaran Target Volume Pelaksanaan Pelaksanaan
(1) (2) (3) (4) (5) (6) (7)
A. UPAYA Ibu
Kesehatan KESEHATAN PRIORITAS
Anak (KIA) dan
I. Keluarga Berencana (KB)
a. Kunjungan Rumah Bumil Rist
1 Bumil Rist 1 OT x Rp 20,000 Malotong
2 Bumil Rist 2 OT x Rp 20,000 Transport Petugas Bonerato
1 Bumil Rist 1 OT x Rp 20,000 Bailo
1 Bumil Rist 1 OT x Rp 20,000 Ampana
Bumil Rist
4 Bumil Rist 4 OT x Rp 20,000 Sansarino
1 Bumil Rist 1 OT x Rp 20,000 Saluaba
1 Bumil Rist 1 OT x Rp 20,000 Buntongi
3 Bumil Rist 3 OT x Rp 20,000 Padang Tumbuo
b. Kunjungan Rumah Bufas
1 Bufas 3 OT x Rp 20,000 Malotong
4 Bufas 12 OT x Rp 20,000 Bonerato
1 Bufas 3 OT x Rp 20,000 Bailo Baru
2 Bufas 6 OT x Rp 20,000 Bailo
Transport Petugas
Bufas 7 Bufas 21 OT x Rp 20,000 Ampana
7 Bufas 21 OT x Rp 20,000 Sansarino
1 Bufas 3 OT x Rp 20,000 Buntongi
1 Bufas 3 OT x Rp 20,000 Saluaba
6 Bufas 18 OT x Rp 20,000 Padang Tumbuo
c. Kelas Ibu Hamil
(1) (2) (3) (4) (5) (6) (7)
1 OT x Rp 30,000
Transport Petugas
1 OT x Rp 20,000
6 OK x Rp 5,000 ATK
8 OK x Rp 10,000 Sneck
(1) (2) (3) (4) (5) (6) (7)
II. PELAYANAN KESEHATAN ANAK
a. Pelayanan di Posyandu Pemantauan Kesehatan Bayi Balita (Pengukuran Tumbuh Kembang & Pemantauan Perkembangan) dan Antenatal Bagi Ibu Hamil
3 Posyandu 10 OT x Rp 33,000 Malotong
2 Posyandu 5 OT x Rp 30,000 Bonerato
1 Posyandu 5 OT x Rp 30,000 Bailo Baru
2 Posyandu 5 OT x Rp 30,000 Bailo
1 Posyandu 5 OT x Rp 30,000 Labiabae
Transport Petugas
2 Posyandu 5 OT x Rp 30,000 Ampana
Posyandu
2 Posyandu 5 OT x Rp 42,000 Sansarino
1 Posyandu 5 OT x Rp 48,000 Saluaba
2 Posyandu 5 OT x Rp 36,000 Buntongi
3 Posyandu 10 OT x Rp 36,000 Padang Tumbuo
20,000 Transport Bides Wilker PKM Amp.
19 Posyandu 12 OT x Rp Barat
b. Pemantauan Neonatus Rist
Neonatus x 1 Malotong
1 OT x Rp 20,000
Rist
Neonatus x 1 Bonerato
1 OT x Rp 20,000
Rist
Neonatus x 1 Sansarino
Neonatus Rist 1 OT x Rp 20,000 Transport Bides
Rist
Neonatus x 1 Buntongi
1 OT x Rp 20,000
Rist
Neonatus
2 x 2 OT x Rp 20,000 Padang Tumbuo
Rist
IV PENGENDALIAN PENYAKIT MENULAR
a Penyuluhan
- Penyuluhan Bahaya Penyakit Menular Seksual
6 OT x Rp 30,000 Bailo Baru
SLTP/ 2 OT x Rp 30,000 Bailo
SLTA 4 OT x Rp 30,000 Ampana
Siswa 10
2 OT x Rp 42,000 Transport Petugas Sansarino
Sederajat 2 OT x Rp 42,000 Sansarino
2 OT x Rp 42,000 Sansarino
1 Paket x Rp 75,000 ATK
(1) (2) (3) (4) (5) (6) (7)
B. PENYELENGGARAAN UPAYA PENUNJANG
1. Penggerakan Pelaksanaan (P2)
I. MANAJEMEN PUSKESMAS
- Lokakarya Mini Puskesmas
Petugas 55 Petugas 55 OK x Rp 10,000 Sneck Puskesmas
- Konsultasi BOK
1 Kunj. 1 OT x Rp 30,000 Transport Petugas

IV PENGEMBANGAN UKBM
a. Transport Kader dalam Kegiatan Posyandu
Transport Posyandu
95 Kali x Rp 20,000
Kader Posyandu Petugas Wilker PKM AB
b. Transport Kader dan Petugas dalam Kegiatan Posbindu
1 Kali x Rp 30,000 Transport Petugas Posbindu
Kader Posbindu 5 Kali x Rp 20,000 Transport Kader Wilker PKM AB
J U M L A H T O T A L

Verivikator : 1 2

Mengetahui,
Kepala Puskesmas Ampana Barat

dr.Diah Devawat S.Ked

NIP:19830921 201101 2 010 NIP:198010
ESMAS AMPANA BARAT

Tenaga Sumber
Jadwal Biaya
Pelaksana Biaya
(8) (9) (10) (11)
Rp 5,357,000 BOK
Rp 2,240,000 BOK
Rp 280,000
Fairuz Safitri Rp 20,000
Susan Bongkriwang Nov Rp 40,000
Devi Damayant Rp 20,000
Mildawat Rp 20,000
Mercy Rp 80,000
Sri Rahayu Rp 20,000
Hasnita Rp 20,000
Wiwin Indrawat Rp 60,000
Rp 1,800,000
Fairuz Safitri Rp 60,000
Susan Bongkriwang Rp 240,000
Megawat Rp 60,000
Devi Damayant Rp 120,000
Nov
Mildawat Rp 420,000
Mercy Rp 420,000
Hasnita Rp 60,000
Sri Rahayu Rp 60,000
Wiwin Indrawat Rp 360,000
Rp 160,000
 (8) (9) (10) (11)
Bikor Rp 30,000
Nov
Bides Rp 20,000
Rp 30,000
Rp 80,000
 (8) (9) (10) (11)
Rp 2,430,000 BOK
agi Ibu Hamil Rp 2,310,000
Rp 330,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Team
Rp 150,000
Nov
Rp 210,000
Rp 240,000
Rp 180,000
Rp 360,000
Bides Rp 240,000

Rp 120,000 BOK

Fairuz Safitri Rp 20,000

Susan Bongkriwang Rp 20,000

Mercy Nov Rp 20,000

Hasnita Rp 20,000

Wiwin Indrawat Rp 40,000

Rp 687,000
BOK
Rp 687,000
Rp 687,000
Rp 180,000
Rp 60,000
Promkes/ Pengelola April s/d Rp 120,000
Kespro Desember Rp 84,000
Rp 84,000
Rp 84,000
Rp 75,000
 (8) (9) (10) (11)
Rp 2,610,000

Rp 580,000 BOK
Rp 550,000
Nov Rp 550,000
Rp 30,000
Pengelola BOK Nov Rp 30,000

Rp 2,030,000 BOK
Rp 1,900,000
Kader Nov Rp 1,900,000

Rp 130,000
Petugas Rp 30,000
Nov
Kader Rp 100,000
Rp 7,967,000

9020000
Rp 1,053,000

Bailo, November 2015

Pengelola BOK

Rosita, A.Md.Kep
NIP:19801031 200902 2 001
 RENCANA PELAKSANAAN KEGIATAN BULANAN PROGRAM BOK PUSKESMAS AMPANA
UPAYA PROMOTIF DAN PREVENTIF
TAHUN ANGGARAN 2015
PROVINSI : SULAWESI TENGAH
KABUPATEN : TOJO UNA - UNA
KECAMATAN : AMPANA KOTA
BULAN : DESEMBER

Rincian Lokasi
No Kegiatan Sasaran Target Volume Pelaksanaan Pelaksanaan
(1) (2) (3) (4) (5) (6) (7)
A. UPAYA Ibu
Kesehatan KESEHATAN PRIORITAS
Anak (KIA) dan
I. Keluarga Berencana (KB)
a. Kunjungan Rumah Bumil Rist
1 Bumil Rist 1 OT x Rp 20,000 Malotong
2 Bumil Rist 2 OT x Rp 20,000 Transport Petugas Bonerato
Bumil Rist
2 Bumil Rist 2 OT x Rp 20,000 Bailo
3 Bumil Rist 3 OT x Rp 20,000 Padang Tumbuo
b. Kunjungan Rumah Bufas
3 Bufas 9 OT x Rp 20,000 Malotong
3 Bufas 9 OT x Rp 20,000 Bonerato
3 Bufas 9 OT x Rp 20,000 Bailo
Transport Petugas
Bufas 4 Bufas 12 OT x Rp 20,000 Ampana
5 Bufas 15 OT x Rp 20,000 Sansarino
1 Bufas 2 OT x Rp 20,000 Saluaba
7 Bufas 21 OT x Rp 20,000 Padang Tumbuo
II. PELAYANAN KESEHATAN ANAK
a. Pelayanan di Posyandu Pemantauan Kesehatan Bayi Balita (Pengukuran Tumbuh Kembang & Pemantauan Perkembangan) dan Antenatal Bagi Ibu Hamil
3 Posyandu 10 OT x Rp 33,000 Malotong
2 Posyandu 5 OT x Rp 30,000 Bonerato
1 Posyandu 5 OT x Rp 30,000 Bailo Baru
2 Posyandu 5 OT x Rp 30,000 Bailo
1 Posyandu 5 OT x Rp 30,000 Labiabae
Posyandu Transport Petugas
(1) (2) (3) (4) (5) (6) (7)
Posyandu Transport Petugas
2 Posyandu 5 OT x Rp 30,000 Ampana
2 Posyandu 5 OT x Rp 42,000 Sansarino
1 Posyandu 5 OT x Rp 48,000 Saluaba
2 Posyandu 5 OT x Rp 36,000 Buntongi
3 Posyandu 10 OT x Rp 36,000 Padang Tumbuo
(1) (2) (3) (4) (5) (6) (7)

Transport Bides Wilker PKM Amp.

Posyandu 19 Posyandu 12 OT x Rp 20,000 Barat
b. Pemantauan Neonatus Rist
Neonatus x 1 Bonerato
1 OT x Rp 20,000
Rist
Neonatus Rist
Neonatus x 1 Sansarino
1 OT x Rp 20,000
Rist
III. PELAYANAN GIZI
a. Sweeping Penimbangan (D/S)
3 Posyandu x 4 OT x Rp 33,000 Malotong
2 Posyandu x 2 OT x Rp 30,000 Bonerato
1 Posyandu x 2 OT x Rp 30,000 Bailo Baru
2 Posyandu x 2 OT x Rp 30,000 Bailo
1 Posyandu x 2 OT x Rp 30,000 Labiabae
Bayi/Balita Transport Petugas
2 Posyandu x 2 OT x Rp 30,000 Ampana
2 Posyandu x 2 OT x Rp 42,000 Sansarino
1 Posyandu x 2 OT x Rp 48,000 Saluaba
2 Posyandu x 2 OT x Rp 36,000 Buntongi
3 Posyandu x 4 OT x Rp 36,000 Padang Tumbuo
b. Sweeping Imunisasi
x 2 OT x Rp 33,000 Malotong
x 2 OT x Rp 30,000 Bonerato
x 2 OT x Rp 30,000 Bailo Baru
x 2 OT x Rp 30,000 Bailo
Kelurahan/ x 2 OT x Rp 30,000 Labiabae
Bayi/Balita 10 Transpor Petugas
Desa x 2 OT x Rp 30,000 Ampana
x 2 OT x Rp 42,000 Sansarino
x 2 OT x Rp 48,000 Saluaba
x 2 OT x Rp 36,000 Buntongi
x 2 OT x Rp 36,000 Padang Tumbuo
IV PENGENDALIAN PENYAKIT MENULAR
a Penyuluhan
- Penyuluhan Bahaya Rokok
6 OT x Rp 30,000 Bailo Baru
SLTP/ 2 OT x Rp 30,000 Bailo
SLTA
Siswa 10
(1) (2) (3) (4) SLTP/ (5) (6) (7)
SLTA 4 OT x Rp 30,000 Ampana
Siswa 10
2 OT x Rp 42,000 Sansarino
Sederajat 2 OT x Rp 42,000 Sansarino
2 OT x Rp 42,000 Sansarino
1 Paket x Rp 75,000 ATK
(1) (2) (3) (4) (5) (6) (7)
c Mengendalikan Penyebaran dan menurunkan Jumlah Kasus baru Malaria,DBD
- Sosialisasi STBM
5 OT x Rp 33,000 Malotong
5 OT x Rp 30,000 Bonerato
5 OT x Rp 30,000 Bailo Baru
5 OT x Rp 30,000 Bailo
5 OT x Rp 30,000 Labiabae
Transport Petugas
5 OT x Rp 30,000 Ampana
5 OT x Rp 42,000 Sansarino
5 OT x Rp 48,000 Saluaba
Masy 10 Kelurahan/
Desa 5 OT x Rp 36,000 Buntongi
5 OT x Rp 36,000 Padang Tumbuo
50 OK x Rp 50,000 Uang Saku
3 OK x Rp 175,000 Honor Narasumber
50 Paket Rp 10,000 ATK Peserta
55 OK Rp 10,000 Snack
55 OK Rp 25,000 Makan/Minum
3 M2 Rp 50,000 Spanduk
V. Meningkatkan Akses Masyarakat terhadap sumber air minum dan sanitasi dasar
a Pemeriksaan TTU
1 OT x Rp 33,000 Malotong
1 OT x Rp 30,000 Bonerato
1 OT x Rp 30,000 Bailo Baru
1 OT x Rp 30,000 Bailo
Tempat Tempat 10 Kelurahan/ 1 OT x Rp 30,000 Labia Bae
Transport Petugas
Umum Desa 1 OT x Rp 30,000 Ampana
1 OT x Rp 42,000 Sansarino
1 OT x Rp 48,000 Saluaba
1 OT x Rp 36,000 Buntongi
1 OT x Rp 36,000 Padang Tumbuo
B. PENYELENGGARAAN UPAYA PENUNJANG
1. Penggerakan Pelaksanaan (P2)
I. MANAJEMEN PUSKESMAS
- Lokakarya Mini Puskesmas
Petugas 55 Petugas 55 OK x Rp 10,000 Sneck Puskesmas
(1) (2) (3) (4) (5) (6) (7)
- Konsultasi BOK
1 Kunj. 1 OT x Rp 30,000 Transport Petugas

- Penatausahaan SPJ BOK 9 Bulan 1 Paket x Rp 138,000 Transport Petugas

(1) (2) (3) (4) (5) (6) (7)
IV PENGEMBANGAN UKBM
a. Transport Kader dalam Kegiatan Posyandu
Transport Posyandu
95 Kali x Rp 20,000
Kader Posyandu Petugas Wilker PKM AB
b. Transport Kader dan Petugas dalam Kegiatan Posbindu
1 Kali x Rp 30,000 Transport Petugas Posbindu
Kader Posbindu 5 Kali x Rp 20,000 Transport Kader Wilker PKM AB
J U M L A H T O T A L

Verivikator : 1 2

Bailo, Desemb
Mengetahui,
Kepala Puskesmas Ampana Barat

dr.Diah Devawat S.Ked

NIP:19830921 201101 2 010 NIP:19801031 200
ESMAS AMPANA BARAT

Tenaga Sumber
Jadwal Biaya
Pelaksana Biaya
(8) (9) (10) (11)
Rp 13,925,000 BOK
Rp 1,700,000 BOK
Rp 160,000
Fairuz Safitri Rp 20,000
Susan Bongkriwang Des Rp 40,000
Devi Damayant Rp 40,000
Wiwin Indrawat Rp 60,000
Rp 1,540,000
Fairuz Safitri Rp 180,000
Susan Bongkriwang Rp 180,000
Devi Damayant Rp 180,000
Des
Mildawat Rp 240,000
Mercy Rp 300,000
Sri Rahayu Rp 40,000
Wiwin Indrawat Rp 420,000
Rp 2,350,000 BOK
natal Bagi Ibu Hamil Rp 2,310,000
Rp 330,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Team Des
 (8) (9) (10) (11)
Team Des
Rp 150,000
Rp 210,000
Rp 240,000
Rp 180,000
Rp 360,000
 (8) (9) (10) (11)

Bides Des Rp 240,000

Rp 40,000 BOK

Susan Bongkriwang Rp 20,000

Mercy Rp 20,000

Rp 1,518,000 BOK
Rp 828,000
Rp 132,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 60,000
Team Desember
Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 144,000
Rp 690,000
Rp 66,000
Rp 60,000
Rp 60,000
Rp 60,000
Rp 60,000
Jurim Desember
Rp 60,000
Rp 84,000
Rp 96,000
Rp 72,000
Rp 72,000
Rp 8,012,000 BOK
Rp 687,000
Rp 687,000
Rp 180,000
Rp 60,000
Promkes/ Pengelola Desember
PTM
 (8) (9) (10) (11)
Promkes/ Pengelola Rp 120,000
Desember
PTM Rp 84,000
Rp 84,000
Rp 84,000
Rp 75,000
 (8) (9) (10) (11)
Rp 7,325,000
Rp 7,325,000
Rp 165,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Pengelola Kesling
Des Rp 150,000
Rp 210,000
Rp 240,000
Rp 180,000
Rp 180,000
Rp 2,500,000
Rp 525,000
Rp 500,000
Rp 550,000
Rp 1,375,000
Rp 150,000
Rp 345,000 BOK
Rp 345,000
Rp 33,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Pengelola Kesling Desember
Rp 30,000
Rp 42,000
Rp 48,000
Rp 36,000
Rp 36,000
Rp 2,748,000

Rp 718,000 BOK
Rp 550,000
Des Rp 550,000
 (8) (9) (10) (11)
Rp 30,000
Pengelola BOK Des Rp 30,000

Pengelola BOK Des Rp 138,000

 (8) (9) (10) (11)
Rp 2,030,000 BOK
Rp 1,900,000
Kader Des Rp 1,900,000

Rp 130,000
Petugas Rp 30,000
Des
Kader Rp 100,000
Rp 16,673,000

9020000
Rp (7,653,000)

Bailo, Desember 2015

Pengelola BOK

Rosita, A.Md.Kep
NIP:19801031 200902 2 001