PROYEKSI PENDAPATAN PAD

Tahun Hasil Pembulatan Asumsi Kenaikan (%) Asumsi hitungan

2016 9 162,412,000.00
2017 177,029,000.00 8 177,029,080.00
2018 191,191,000.00 7 191,191,406.40
2019 204,574,000.00 6 204,574,804.85
2020 216,849,000.00 5 216,849,293.14
2021 227,691,000.00 5 227,691,757.80
2002 239,076,000.00 5 239,076,345.69
812,303,800.00

Tahun Asumsi 2 Medis Kenaikan rata rata

2016 1,469,716,000.00 14,294,000.00 0.9632010566

2017 1,484,010,000.00 14,305,856.40
2018 1,498,315,856.40 14,443,764.86
2019 1,512,759,621.26 14,583,002.75
2020 1,527,342,624.00 14,723,582.90
2021 1,542,066,206.90 14,865,518.23
2002 1,556,931,725.13 15,008,821.83

PROYEKSI PENDAPATAN NON KAPITASI

Tahun Asumsi pendapatan asumsi kenaikan Asumsi pembulatan
2016 650,486,000 21,813,000.00
2017 672,299,000 21,513,568.00
2018 693,812,568.00 22,202,002.18 693,812,000.00
2019 716,014,570.18 22,912,466.25 716,014,000.00
2020 738,927,036.42 23,645,665.17 738,927,000.00
2021 762,572,701.59 24,402,326.45 762,572,000.00
2002 786,975,028.04 25,183,200.90 786,975,000.00

PROYEKSI PENDAPATAN BOK

Tahun Asumsi pendapatan asumsi kenaikan Asumsi pembulatan
2017 592,477,000.00 18,959,264.00
2018 611,436,264.00 19,565,960.45 611,500,000.00
2019 631,002,224.45 20,192,071.18 631,000,000.00
2020 651,194,295.63 20,838,217.46 652,000,000.00
2021 672,032,513.09 21,505,040.42 672,000,000.00
2002 693,537,553.51 22,193,201.71 693,000,000.00
 PROYEKSI PENDAPATAN JAMPERSAL
Tahun Asumsi pendapatan asumsi kenaikan Asumsi pembulatan
2017 72,500,000.00 3,625,000.00
2018 76,125,000.00 2,436,000.00 76,125,000.00
2019 78,561,000.00 2,513,952.00 78,561,000.00
2020 81,074,952.00 2,594,398.46 81,074,000.00
2021 83,669,350.46 2,677,419.21 83,669,000.00
2002 86,346,769.68 2,763,096.63 86,347,000.00

82.547.528 82,547,528.00 4,127,376.40

236.142.561 236,142,561.00 11,807,128.05

318.690.089 318,690,089.00 15,934,504.45

168.858.200 168,858,200.00 8,442,910.00

2.800.368.627,37 280,036,862,737.00 14,001,843,136.85
3.469.046.491 3,469,046,491.00 173,452,324.55
22.218.900

POLI KIA
1 CATIN 3 13 468
2 USG
3
4 TINDAKAN
5 IUD
INPLAN

KBKP

58138
23000
35138
 2015 2016 4998000
Asumsi Penambahan 1.     Catatan Medik 2,515,000.00 5,398,000.00 2883000
14,617,080.00 2.     Tindakan 30,765,000.00 31,890,000.00 1125000
14,162,326.40 3.     Rawat Jalan 93,966,000.00 98,964,000.00 4998000
13,383,398.45 4.     Rawat Inap 18,200,000.00 23,015,000.00 4815000
12,274,488.29 5.     Laboratorium 2,955,000.00 3,145,000.00 190000
10,842,464.66 148,401,000.00 162,412,000.00 14011000
11,384,587.89
11,953,817.28

Kenaikan Jumlah Asumsi Jumlah Asumsi 3 (tiga medis)

anggota Anggota

269,820.00 -
272,421.06 272421 1,498,315,500.00 49.53
275,047.20 275047 1,650,282,000.00 50.01
277,698.66 333238 1,999,428,000.00 60.59
280,375.67 336450 2,018,700,000.00 61.17
283,078.50 333969 2,003,814,000.00 60.72

650,486,000 21,813,000.00 3.2445385163

672,299,000 21,513,568.00
693,812,568.00 22,202,002.18 194,267,360.00 194,260,000.00
716,014,570.18 22,912,466.25 200,483,920.00 200,484,000.00
738,927,036.42 23,645,665.17 206,899,560.00 206,899,000.00
762,572,701.59 24,402,326.45 213,520,160.00 213,520,000.00
786,975,028.04 25,183,200.90 220,353,000.00 220,353,000.00
 206,368.82 10,318.44 515.92

590,356.40 29,517.82 1,475.89

796,725.22 39,836.26 1,991.81

422,145.50 21,107.28 1,055.36

700,092,156.84 35,004,607.84 1,750,230.39
8,672,616.23 433,630.81 21,681.54

15000 7020000
30000000
43200000

Janu September
22386 22764 378
KBKP
April September
95 95 Angka kontak
Rujukan No RS
Prolanis
 999.6
114.6322067594 2,515 2,699 184
3.6567528035
5.3189451504 23,491.50 19,792.80 (3,699)
26.456043956 455 383.58 (71)
6.4297800338
9.4413110424

Asumsi Jumlah Asumsi 3 (tiga

Anggota medis) jasa 0prasional

272421 1,498,315,500.00 898,989,300.00 400,000,000.00

275047 1,650,282,000.00 22920.5833 990,169,200.00 410,000,000.00
333238 1,999,428,000.00 27769.8333 1,199,656,800.00 450,000,000.00
336450 2,018,700,000.00 28037.5 1,211,220,000.00 470,000,000.00
333969 2,003,814,000.00 27830.75 1,202,288,400.00 500,000,000.00

Ranap Rujukan
siamis
499,552,000.00 299,731,200.00 1 32400000 7
515,530,000.00 309,318,000.00 2 26600000 9
532,028,000.00 319,216,800.00 3 22700000 6
549,052,000.00 329,431,200.00 4 43920000 6
566,622,000.00 339,973,200.00 5 48960000 6

6 37980000 7
212560000 41
212,560,000.00 4,756,000.00
 Alkes obat bmhp

-
199,326,200.00 599,326,200.00 4.13 493,991,200.00 1,392,980,500.00
250,112,800.00 660,112,800.00 4.17 509,802,000.00 1,499,971,200.00
349,771,200.00 799,771,200.00 5.05 526,115,800.00 1,725,772,600.00
337,480,000.00 807,480,000.00 5.10 542,951,200.00 1,754,171,200.00
301,525,600.00 801,525,600.00 5.06 560,326,200.00 1,762,614,600.00

Rujukan persalinan
banjar normal DTED pasca pra
14 9 1 11
14 7 0 14
13 13 4 1 13
8 13 3 9
12 8 7 1 8

7 13 6 3 7
68 63 21 5 62
9,248,000.00 44,100,000.00 19,950,000.00 875,000.00 7,750,000.00 299,239,000.00
86,679,000.00
28.9664783
 80,000,000.00
82,000,000.00
90,000,000.00
94,000,000.00
100,000,000.00

73821000
598,478,000.00
672,299,000.00
PAD Anggaran Pendapatan Peningkatan Pelayanan
Honor BLUD kebersihan listrik
2016
2017
2018 191,191,000.00 31,800,000.00 5,000,000.00 16,500,000.00
2019 204,574,000.00 59,400,000.00 5,000,000.00 16,500,000.00
2020 216,849,000.00 89,400,000.00 5,000,000.00 16,500,000.00
2021 227,691,000.00 95,400,000.00 5,000,000.00 16,500,000.00
2002 239,076,000.00 95,400,000.00 5,000,000.00 16,500,000.00

Kotret listrik tlp Mamin pegawai

Januari 1,639,020.00 152,444.00 60480000
1,012,000.00 154,710.00
1,615,000.00 207,173.00
1,517,000.00 211,924.00
807,500.00 122,831.00
1,390,000.00 238,167.00
7,980,520.00 1,087,249.00
15,961,040.00 2,174,498.00

700000
tlpn sewa tanah monitoring pustuo pajak Kendaraan mamin petugas jaga

2,250,000.00 16,000,000.00 3,000,000.00 1,700,000.00 60,480,000.00

2,250,000.00 16,000,000.00 3,000,000.00 1,700,000.00 60,480,000.00
2,250,000.00 16,000,000.00 3,000,000.00 1,700,000.00 60,480,000.00
2,250,000.00 16,000,000.00 3,000,000.00 1,700,000.00 60,480,000.00
2,250,000.00 16,000,000.00 3,000,000.00 1,700,000.00 60,480,000.00

mamin pasien
Akreditasi Bintek SDM
Honor 37,500,000.00 10000000
ATK 2,000,000.00
Mamin 18,750,000.00
Transport 22,500,000.00
Bintek 36,000,000.00
116,750,000.00
31800000 59400000

1725772600 1392980500 1499371200

10000000 10000000

1434780500 1568771200
 2016 2017
obat 30,266,619.00 353,149,200.00
bmhp 2,696,586.00 90,140,752.00
ATK Materai Ganda Jumlah

1,000,000.00 2,400,000.00 300,000.00 300,000.00 140,730,000.00

1,000,000.00 2,400,000.00 300,000.00 300,000.00 168,330,000.00
1,000,000.00 2,400,000.00 300,000.00 300,000.00 198,330,000.00
1,000,000.00 2,400,000.00 300,000.00 300,000.00 204,330,000.00
1,000,000.00 2,400,000.00 300,000.00 300,000.00 204,330,000.00

92930000 92930000 92930000 92930000 92930000

58400000 58400000 58400000 58.400.000 58400000

1434780500 1568771200 1825172600 1859571500 1868014600

1,591,110,500 1,732,101,200 1,978,002,600 1,954,001,500 2,935,394,600

89400000 95400000 95400000

1725772600 1754171500 1762614600

10000000 10000000 10000000

1825172600 1859571500 1868014600

 DAK JKN
4,400,000.00 4,400,000

143,771,200.00 143,771,200

10,000,000.00 10,000,000

25,000,000.00 25,000,000

72,000,000.00 72,000,000

275,675,000.00 275,675,000

84,480,000.00 84,480,000

100,180,000.00 100,180,000

3,600,000.00 3,600,000

2,250,000.00 2,250,000

7,500,000.00 7,500,000

3,000,000.00 3,000,000

8,000,000.00 731,856,200
739,856,200.00

731,856,200.00
4,400,000.00
143,771,200.00
10,000,000.00
25,000,000.00
72,000,000.00
275,675,000.00
84,480,000.00
100,180,000.00
3,600,000.00
2,250,000.00
7,500,000.00
3,000,000.00

31.800.000 59.400.000 89.400.000 95.400.000 95.400.000

1.392.980.500 1.499.971200 1.725.772600 1.754.171.200 1.762..614.600

10.000.000 10.000.000 10.000.000 10.000.000 10.000.000

54.900.000 57.200.000 59.700.000 62.200.000 65.200.000

 sisa anggaran

108,930,000.00 50,461,000.00 92,930,000.00

108,930,000.00 36,244,000.00 92,930,000.00
108,930,000.00 18,519,000.00 92,930,000.00
108,930,000.00 23,361,000.00 128,585,000.00 92,930,000.00
108,930,000.00 34,746,000.00 92,930,000.00

30,000,000.00 2400000

12000000
4,200,000.00

UKM 3,000,000

4200000 4.200.000 5000000

46800000 46.800.000 6000000

72000000 72.000.000 30000000

123,000,000.00 58400000

Peningkatan Pelayanan dan Penanggulangan Masalah

Kesehatan

1.  Transport lokal 86,400,000 86,400,000 86,400,000 86,400,000

2.  Belanja alat tulis kantor 3,000,000 3,000,000 3,000,000 3,000,000

3.  Belanja cetak 3,000,000 3,000,000 3,000,000 3,000,000

4. Penanggunalangan gizi 22,500,000 24,750,000 27,000,000 27,000,000

Jumlah 114,900,000 117,150,000 119,400,000 119,400,000

Sumber Dana

-   APBD/APBN 114,900,000 117,150,000 119,400,000 119,400,000

-   BLUD

Penyelenggaraan Penyehatan Lingkungan

1.  Honorarium Panitia Pelaksana Kegiatan 2.400.000 2.400.000 2.400.000 2.400.000

2. Pengelolaan limbah medis dan limbah domestic 24.000.000 24.000.000 24.000.000 24.000.000

3.  Belanja Peralatan Kebersihan Dan Bahan

10,000,000 10,000,000 10,000,000 10,000,000
Pembersih

4.  Belanja Pembuatan taman Vertikal 10,000,000 - - -

Jumlah 36.400.000 32.400.000 32.400.000 32.400.000

Sumber Dana

-   APBD/APBN 36.400.000 32.400.000 32.400.000 32.400.000

-   BLUD

Penyuluhan Masyarakat tentang Pola Hidup Sehat

1.  Belanja Media promosi 24,000,000 24,000,000 24,000,000 24,000,000

2.  Belanja Alat Tulis Kantor 2,000,000 2,000,000 2,000,000 2,000,000

 3.  Belanja Penggandaan 1,500,000 1,500,000 1,500,000 1,500,000

4. Belanja Cetak 1,000,000 1,000,000 1,000,000 1,000,000

5.  Belanja Makanan Dan Minuman Kegiataan 43,200,000 43,200,000 43,200,000 43,200,000

6.  Belanja Tranport lokal 176,760,000 176,760,000 176,760,000 176,760,000

Jumlah 248,460,000 248,460,000 248,460,000 248,460,000

77,933,800 817,790,000
1.    Honorarium petugas pelaksanaan
4,400,000 4,400,000 4,400,000 4,400,000
kegiatan

2.    Belanja Obat 100,326,200 110,112,800 126,525,600 142,480,000

Belanja BMHP 74,000,000 80,000,000 80,000,000 100,000,000

Bahan Kimia 10,000,000 10,000,000 15,000,000 15,000,000

3.    Belanja bahan perawatan 72,000,000 72,000,000 72,000,000 72,000,000

peralatan/perlengkapan rumah tangga

5.    Makan dan Minum Pasien 272,575,000 265,850,000 274,125,000 274,900,000

6.    Makan dan Minum petugas 84,480,000 84,480,000 84,480,000 84,480,000

Rujukan 100,180,000 100,180,000 100,180,000 100,180,000

transport lokal 3,600,000 3,600,000 3,600,000 3,600,000

Materai 4,500,000 2,250,000 2,250,000 2,250,000

ATK 7,500,000 7,500,000 7,500,000 7,500,000

Ganda 3,000,000 3,000,000 3,000,000 3,000,000

cetak 8,000,000 8,000,000 8,000,000 8,000,000

744,561,200 751,372,800 781,060,600 817,790,000

744,561,200 751,372,800 781,060,600 817,790,000

736,561,200 743,372,800 773,060,600 809,790,000

1.    Honorarium panitia pelaksanaan

8.820.000
kegiatan
2.    Belanja alat tulis kantor

3.    Belanja paket/pengiriman 10.37

4.    Belanja cetak
5.    Belanja makanan dan minuman
kegiatan
Jumlah

Pengadaan fasilitas pelayanan medis dan non medis

1.      Honorarium panitia
7,600,000 7,600,000 7,600,000 7,600,000
pelaksana kegiatan
2.      Belanja 1,920,000 1,920,000 1,920,000 1,920,000
dokumen/administrasi tende
3.      Belanja Modal Alkes 15,000,000 50,000,000 80,000,000 80,000,000
 4.      Belanja Modal yang
berkaitan langsung dengan 80000000 82000000 90000000 94000000
pelayanan kesehatan
Jumlah 104,520,000 141,520,000 179,520,000 183,520,000
 70.00%
30.00%
42.00%
58.00%

86,400,000 1,800,000

3,000,000 1,000,000

3,000,000 1,000,000

27,000,000

119,400,000 3,800,000

119,400,000

2.400.000

24.000.000

10,000,000

32.400.000

32.400.000

24,000,000 24,000,000

2,000,000 2,000,000
 1,500,000 1,500,000

1,000,000 1,000,000

43,200,000 43,200,000

176,760,000 48,960,000

248,460,000 120,660,000

739,856,200
4,400,000 2,000,000

143,771,200

10,000,000

25,000,000

72,000,000 48,000,000

275,675,000 259,200,000

84,480,000 18,000,000

100,180,000 67,440,000

3,600,000

2,250,000

7,500,000

3,000,000
394,640,000
8,000,000

739,856,200

739,856,200

731,856,200

7,600,000

1,920,000

90,000,000
 100000000

199,520,000
 299 299 601 302 598 900
888 899 875 875 1787 1774 900 601
4879 4879 4390 9269 9758 9269 1763 1774
17091 12701 12284 12284 29792 24985 9269 14148
7362 7362 15131 15131 14724 22493 29375 24985
3015 18146 3446 3446 21161 21592 22493 22493
33534 44286 36727 41307 77820 81013 6461 21592
70261 85593
2737 2872 2861 485
135 -11
4.700557 -0.38448
2181398000
 947 2078
462 1131
48.7856389 54.42733
2553273000 2569689600
371875000 16416600
14.5646392 0.638855
Aset tetap
Tanh
Alat kes modal 2,800,368,627.37 80,000,000.00 82,000,000.00 90,000,000.00
2,800,368,627.37 2,880,368,627.37 2,962,368,627.37 3,052,368,627.37
Bangunan 250,000,000.00 250,000,000.00 250,000,000.00
3,469,046,491.00 3,719,046,491.00 3,969,046,491.00 4,219,046,491.00

168,858,200.00 168,858,200.00 168,858,200.00 168,858,200.00

2,800,368,627.37 2,880,368,627.37 2,962,368,627.37 3,052,368,627.37
3,469,046,491.00 3,719,046,491.00 3,969,046,491.00 4,219,046,491.00
22,218,900.00 22,218,900.00 22,218,900.00 22,218,900.00
6,460,492,218.37 6,790,492,218.37 7,122,492,218.37 7,462,492,218.37
- - - -
- - - -

54,461,000 40,244,000 22,519,000

82,547,528.00 137,008,528 177,252,528 199,771,528
2,361,425.61 2,385,039.87 2,408,890.26
236,142,561.00 238,503,986.61 240,889,026.48 243,297,916.74

82547528 137,008,528 177,252,528 199,771,528

236142561 238,503,986.61 240,889,026.48 243,297,916.74

318,690,089.00 375,512,514.61 418,141,554.48 443,069,444.74

6,460,492,218.37 6,790,492,218.37 7,122,492,218.37

318,690,089.00 375,512,514.61 418,141,554.48
6,779,182,307.37 7,166,004,732.98 7,540,633,772.85

2,017,540,000.00 2,152,903,000.00 2,161,722,000.00 2,521,506,000.00

0 191,191,000 204,574,000 216,849,000
2,017,540,000.00 2,344,094,000 2,366,296,000 2,738,355,000
 94,000,000.00 100,000,000.00
3,146,368,627.37 3,246,368,627.37
250,000,000.00 250,000,000.00
4,469,046,491.00 4,719,046,491.00

168,858,200.00 168,858,200.00
3,146,368,627.37 3,246,368,627.37
4,469,046,491.00 4,719,046,491.00
22,218,900.00 22,218,900.00
7,806,492,218.37 8,156,492,218.37
- -
- -

27,361,000 38,746,000
227,132,528 265,878,528
2,432,979.17 2,457,308.96
245,730,895.91 248,188,204.87

227,132,528 265,878,528

245,730,895.91 248,188,204.87

472,863,423.91 514,066,732.87

7,462,492,218.37 7,806,492,218.37 8,156,492,218.37

443,069,444.74 472,863,423.91 514,066,732.87
7,905,561,663.11 8,279,355,642.28 8,670,558,951.24

2,553,581,000.00 2,551,713,000.00
227,691,000 239,076,000
2,781,272,000 2,790,789,000
 PRYOYEKSI PENDAPATAN BLUD
PUSKESMAS RANCAH /TAHUN 2018

Jumlah Rata- Jumlah Rata- Rata2

NO rata klien/
rata klien/ hari /tahun
bulan
A RETRIBUSI
1 KARCIS 68 1700 20400
CM
2 CM 8 200 2400
KIR
3 KIR Dokter 66 792
4 KIR Haji 12 144
5 KIR NIKAH 10 120
B IGD
1 Pelayanan IGD 1 25 300
2 Day Care 1 25 300

C Rawat Inap
1 Perawatan 12 432
2 Pemasangan Infus 12 144
3 Pemasangan Catheter 3 36
4 EKG 8 96
5 Nebu 10 120
6 Perawatan dengan fasilitas tambahan 4 144
7 O2 10 360
8 visite 37 1332
D KIA/KB
1 USG 15 180
2 TINDIK 1 12
3 Inspekulo 1 12
4 IVA TEST 10 120
5 Pemasangan /Cabut IUD 2 24
6 Pemasangan /Cabut implant 4 48
E PONED
1 Persalinan Normal 1 12
2 Persalinan dengan tindakan Emergensi dasar 6
3 Blu light 5 60
4 Inkubator 5 60
5 Manual 3
6 Digital 3
 AMBULANS
1 CIAMIS 1 12
2 BANJAR 1 12
3 PURWOKWRTO
4 Pemulangan Jenazah 2 24
FISIOTERAFI
1 Pijat tanpa alat 1 25 300
2 Therafi dengan alat 1 25 300
3 therafi latihan 2 50 600
F POLI GIGI
1 Pencabutan gigi sulung 2 24 288
2 Pencabutan Gigi tetap 2 50 600
3 Scalling 1 12
4 Tambal 2 24
G Ruang Bedah Minor
1 Debridement 4 100 1200
2 Penjahitan Luka Kecil 5 60
3 Penjahitan Sedang 5 60
4 Ektraksi Corpus Alineum 1 12
5 bedah lipom/klapus

4 Buka Jahitan 10 120

H Laboratorium
1 Urin 10 120
2 Darah lengkap 5 60
3 Kimia darah 2 24
4 Serologi 2 24
tes kehamilan 10 120
I Ruang Konseling
1 Konseling Gizi 10 120
2 Konseling ASI 10 120
3 Konseling Kespro 5 60
4 Konseling Kesling 10 120
Jumlah
Cost Retribusi Proyeksi Pendapatan
(Rp)

102,000,000.00 8,500,000.00
5,000.00 102,000,000.00
4,800,000.00
2,000.00 4,800,000.00 400,000.00
22,080,000.00 1,840,000.00
15,000.00 11,880,000.00 990,000.00
50,000.00 7,200,000.00 600,000.00
25,000.00 3,000,000.00 250,000.00
15,000,000.00 1,250,000.00
20,000.00 6,000,000.00 500,000.00
30,000.00 9,000,000.00 750,000.00

52,020,000.00 2,850,000.00
60,000.00 25,920,000.00 720,000.00
25,000.00 3,600,000.00 300,000.00
25,000.00 900,000.00 75,000.00 2,895,000.00
25,000.00 2,400,000.00 200,000.00 193.00
40,000.00 4,800,000.00 400,000.00 19.30
100,000.00 14,400,000.00 400,000.00
20,000.00 7,200,000.00 200,000.00
15,000.00 19,980,000.00 555,000.00
17,520,000.00 1,460,000.00 231.60
50,000.00 9,000,000.00 750,000.00
15,000.00 180,000.00 15,000.00
25,000.00 300,000.00 25,000.00
25,000.00 3,000,000.00 250,000.00
70,000.00 1,680,000.00 140,000.00
70,000.00 3,360,000.00 280,000.00
26,400,000.00 1,600,000.00
600,000.00 7,200,000.00 600,000.00
700,000.00 4,200,000.00 -
100,000.00 6,000,000.00 500,000.00
100,000.00 6,000,000.00 500,000.00
650,000.00 1,950,000.00 -
350,000.00 1,050,000.00 -
 4,380,000.00 465,000.00
220,000.00 2,640,000.00 220,000.00
145,000.00 1,740,000.00 145,000.00
- -
50,000.00 1,200,000.00 100,000.00
9,000,000.00 1,500,000.00
15,000.00 4,500,000.00 375,000.00
15,000.00 4,500,000.00 375,000.00
15,000.00 9,000,000.00 750,000.00
20,100,000.00 1,675,000.00
15,000.00 4,320,000.00 360,000.00
25,000.00 15,000,000.00 1,250,000.00
25,000.00 300,000.00 25,000.00
20,000.00 480,000.00 40,000.00
24,660,000.00 2,055,000.00
15,000.00 18,000,000.00 1,500,000.00
30,000.00 1,800,000.00 150,000.00
45,000.00 2,700,000.00 225,000.00
30,000.00 360,000.00 30,000.00
-

15,000.00 1,800,000.00 150,000.00

4,500,000.00 525,000.00
10,000.00 1,200,000.00 100,000.00
35,000.00 2,100,000.00 175,000.00
35,000.00 840,000.00 70,000.00
15,000.00 360,000.00 30,000.00
15,000.00 1,800,000.00 150,000.00
1,680,000.00 140,000.00
4,000.00 480,000.00
4,000.00 480,000.00
4,000.00 240,000.00
4,000.00 480,000.00
277,260,000.00
 1699
1615
1794
1634
1638
1333
30 1717
1709
1843
1829
16811 1681.1 67.244

5700000
114
42.00 2 8.40 75,600.00 907,200.00
2 - -
26.00 2 5.20 46,800.00 561,600.00
10.00 2 2.00 18,000.00 216,000.00
1,684,800.00

listrik 4,000,000.00
materai 2,010,000.00
g0rden 10,000,000.00
spanduk 10,000,000.00
plang 2,000,000.00
peraga 6,000,000.00
limbah 12,400,000.00

lokal 5,400,000.00
bintek 26,500,000.00
tinta 3,000,000.00
interior 9,000,000.00
audio 5,000,000.00
note book 15,000,000.00
printer 4,000,000.00
kursi 25,000,000.00
microphon 1,000,000.00
handicam 10,000,000.00
plang nam 5,000,000.00
155,310,000.00
 Luas
bangunan :
1. 
1 Meningkatnya Sesuai
Standarisasi
standar
Minimum

Jumlah
klasifikasi
ketenagaan
Pelayanan
dan sesuai
standar
minimum

Ketersediaan
Kualitas Kesehatan
alat : 100%
Evaliasi
kinerja :
>84%
Alat
Pelayanan dikalibrasi
: 100%

Kondisi Alat
Baik : 100%

Puskesmas

Dalam bidang

medis,

Penunjang

Medis, dan

Administrative
 2. Program
upaya
kesehatan
wajib,
pengembanga
n dan
penunjang

Meningkatnya
cakupan
pelayanan
2
kesehatan
dasar bagi Penyusunan
masyarakat standar
37,500,000 - - - -
pelayanan
kesehatan

3. Program
Upaya
kesahatan
perorangan

4. Program
pengadaan
sarana dan
prasana yang
berkaitan
langsung
dengan
pelayanan
kesehatan
 Meningkatnya
cakupan
kunjungan
IGD, Rawat
Jalan dan
Rawat Inap

p
a
ni
ti
a 2,000,000.00 - - - -
p
el
a
k
n
sj
a
al
a
18,750,000.00 - - - -
t
t
ul
k
is
a
n
a
n
d 22,500,000.00 - - - -
a
n
m
in
u
s
p
o
rt 36,000,000 - - - -
L
u
a
Jumlah 116.750.000

Sumber Dana
-   
APB
116.750.000
D/AP
BN
-   
- - - - -
BLUD
Peningkatan
upaya
kesehatan
wajib,
pengembanga
n dan
penunjang
 p
a
ni
ti
a 8.820.000
p
el
a
k
snj
a
al
a
t
t
ul
a
is
p
a
k 10.37
e
t/
p
  
B
Meningkatnya el
ketersediaan a
fasilitas nj
pelayanan a
kesehatan c
e
tk
a
n
a
n
d
a
n
m
in
u
Jumlah

Sumber Dana
-   
APB
D/AP
BN
-   
BLUD

Peningkatan
komunikasi,
informasi dan
edukasi (ide)
pencegahan
dan
pengobatan
penyakit

p
e
t
u
g
a 2,000,000 2,000,000 2,000,000 2,000,000 2,000,000
s
p
el
a
k
B
s
el
a 100,326,200 110,112,800 126,525,600 142,480,000 134,771,200
nj
a
el
a
74,000,000 80,000,000 80,000,000 100,000,000 10,000,000
nj
a
nj
a
B 10,000,000 10,000,000 15,000,000 15,000,000 25,000,000
a
h
a
 t
a
n
p
e
r
al
a 36,000,000 38,400,000 40,800,000 43,200,000 57,600,000
t
a
n
/
p
e
rl
n
d
a
n 21,600,000 23,040,000 24,480,000 27,360,000 28,800,000
M
in
u
n
d
a
n
M 18,000,000 18,000,000 18,000,000 18,000,000 18,000,000
in
u
m
ia
y
a 67,440,000 67,440,000 67,440,000 67,440,000 67,440,000
r
uj
Jumlah 329,366,200 348,992,800 374,245,600 415,480,000 343,611,200

Sumber Dana
-   
APB - - - - -
D/AP
BN
-   
329,366,200 348,992,800 374,245,600 415,480,000 343,611,200
BLUD
Pengadaan
fasilitas
4 pelayanan 7,600,000 7,600,000 7,600,000 7,600,000 7,600,000
medis dan
non medis

1,920,000 1,920,000 1,920,000 1,920,000 1,920,000

 15,000,000 50,000,000 80,000,000 80,000,000 90,000,000

80.000.000 82.000.000 90.000.000 94.000,000 100,000.00

104,520,000 141,520,000 179,520,000 183,520,000 199,520,000

Jumlah

Sumber Dana
-   
APB
- - - - -
D/AP
BN
-   
BLU 7,600,000 7,600,000 7,600,000 7,600,000 7,600,000
D
Lampiran 2

Tujuan : meningkatkan kemitraan dengan pihak-pihak yang memiliki komitmen dan Visi yang sama dalam membangunderajat kesehatan di Wilayah Kecamatan Rancah

ARAH STRATEGI

NO UKURAN PAGU INDIKATIF (Rp)

SASARAN KEBERHASI PROGRAM KEGIATAN
LAN 2018 2021 2020 2021 2022

Meningkatny
a kerjasama
dengan lintas
sector terkait
tingkat -     
kecamatan, Jumlah
tingkat desa peran 1 Program
dalam upaya serta Upaya
1
mewujuudka aparatur kesehatan
n Kecamatan daerah : Masyarakat
sehat di minimal
wilayah 10 orang
Kecamatan
Sehat di
Kecamatan
Rancah
 -     
Jumlah
kegiatan
yang
dikerjaka
n dengan
lintas
sektor :
24
-     
kegiatan
Adanya
kemudah
an
petugas
dalam
rangka
pelayana
n
kesehata
n luar
gedung

1  . Monev
Desa/Kecam 4.200.000 4.200.000 4.200.000 4.200.000 4.200.000
atan Sehat
Meningkatny
a peran serta
pihak
ketigadalam
pembanguna
n kesehatan
bagi
masyarakat

2 program
Kemitraan
Peningkatan
Pelayanan
Kesehatan

2 .Transpotr
46.800.000 46.800.000 46.800.000 46.800.000 46.800.000
Petugas

3. Paket
72.000.000 72.000.000 72.000.000 72.000.000 72.000.000
Pertemuan

Jumlah 123.000.000 123.000.000 123.000.000 123.000.000 123.000.000

Sumber Dana
-   
APB
123.000.000 123.000.000 123.000.000 123.000.000 123.000.000
D/AP
BN
 -   
BLU - - - - -
D

Kemitraan
dalam
penyedian
obat dan - - 10.000.000 12.000.000 14.000.000
BMHP
Sewa
bangunan
apotek
Kemitraan
dalam
pengelolaan
lahan parkIr 5.000.000 5.000.000 6.000.000 7.000.000

Sewa tanah
lahan parkir
Kemitraan
dalam
2 penggunaan 16.000.000 16.000.000 16.000.000 16.000.000 16.000.000
lahan
gedung

Jumlah 16.000.000 21.000.000 31.000.000 34.000.000 37.000.000

Sumber Dana
-   
APB
- - - - -
D/AP
BN
-   
BLU 16.000.000 21.000.000 31.000.000 34.000.000 37.000.000
D

lampiran 3.

Tujuan : meningkatkan Peran Aktif Masyarakat dalam Pembangunan Bidang Kesehatan

ARAH STRATEGI

NO UKURAN PAGU INDIKATIF (Rp)

SASARAN KEBERHASIL PROGRAM KEGIATAN
AN 2018 2019 2020 2021 2022

Peningkatan
Pelayanan
dan
Penanggulan
gan Masalah
Kesehatan

1.   
Program
Promosi
Kesehata 1. 
n dan Transport 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000
Pemberd local
ayaan
Masyarak
at

2. 
Belanja
1,000,000 1,000,000 1,000,000 1,000,000 1,000,000
alat tulis
kantor
3. 
Belanja 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000
cetak
Jumla
3,800,000 3,800,000 3,800,000 3,800,000 3,800,000
h
 Sumber Dana
-   
APB
3,800,000 3,800,000 3,800,000 3,800,000 3,800,000
D/AP
BN
-   
- - - - -
BLUD
Penyelen
ggaraan
Penyehat
an
Lingkung
an
1. 
Honorariu
m Panitia
2.400.000 2.400.000 2.400.000 2.400.000 2.400.000
Pelaksan
a
Kegiatan
2. 
Pengelola
an limbah
medis 24.000.000 24.000.000 24.000.000 24.000.000 24.000.000
dan
Tercapainya limbah
cakupan- domestic
Meningkatnya 3. 
cakupan
peran serta Belanja
kegiatan
aktif dari Peralatan
PHBS di
masyarakat Kebersiha
rumah tangga, 6.000.000 6.000.000 6.000.000 6.000.000 6.000.000
1 dalam n Dan
sekolah,
menangani Bahan
tempat kerja,
kesehatan Pembersi
institusi
secara h
4. 
kesehatan
mandiri Belanja
dan tempat
umum Pembuata 4.000.000 - - - -
n taman
Vertikal

Jumla
36.400.000 32.400.000 32.400.000 32.400.000 32.400.000
h
Sumber Dana
-   
APB
- - - - -
D/AP
BN
-   
36.400.000 32.400.000 32.400.000 32.400.000 32.400.000
BLUD
Penyuluhan
Masyarakat
tentang Pola
Hidup Sehat
1. 
Belanja
24,000,000 24,000,000 24,000,000 24,000,000 24,000,000
Media
promosi
2. 
Belanja
2,000,000 2,000,000 2,000,000 2,000,000 2,000,000
Alat Tulis
Kantor
3. 
Belanja
1,500,000 1,500,000 1,500,000 1,500,000 1,500,000
Penggand
aan
4. Belanja
1,000,000 1,000,000 1,000,000 1,000,000 1,000,000
Cetak
5. 
Belanja
Makanan
43,200,000 43,200,000 43,200,000 43,200,000 43,200,000
Dan
Minuman
Kegiataan
6. 
Belanja
48,960,000 48,960,000 48,960,000 48,960,000 48,960,000
Tranport
local
Jumla
120,660,000 120,660,000 120,660,000 120,660,000 120,660,000
h
Sumber Dana
 -   
APB
120,660,000 120,660,000 120,660,000 120,660,000 120,660,000
D/AP
BN
-   
BLUD

Lampiran 4

Tujuan : Meningkatkan Efisiensi dan Efektifitas Pemanfaatan sumberdaya

ARAH STRATEGI

NO PAGU INDIKATIF (Rp)

SASARAN UKURAN KEBERHASILAN PROGRAM KEGIATAN
2018 2019

Meningkatnya
kualitas 1 Standar
pengelolaan Pelayanan
1
keuangan, administrasiKe
sarana dan sehatan
prasarana

1 Rata-rata pertumbuhan sales Gross ratio (SGR) per tahun

sebesar…%

Tahun 2014 2015 2016

% SGR 0,00 6,76 31,54

Tahun 2014 2015 2016

% CSR 73,5 100,2 95,2

Meningkatnya
kontribusi hasil
usaha dalam
menunjang
pendanaan
Puskesmas

1   Standar
Pelaporan
Keuang
Penyusunan
Standar
Analisis
Belanja
Pelayanan
Kesehatan

Meningkatnya
Kualitas dan
Kuantitas SDM
 Rekrument pegawai :13 orang

Izin Pendidikan dan /atau pelatihan 5 orang pertahun

3. Peningkatan
kualitas dan
kuantitas
sumber daya
manuasia

1
Honorarium
panitianpela 2.400.000 2.400.000
ksana
kegiatan
2.Belanja listrik 16.500.000 16.500.000
3 Belanja
Telepon 2.250.000 2.250.000
4 Belanja
ATK 1.000.000 1.000.000
5 Belanja
makanan
dan 60.480.000 60.480.000
minuman
Petugas
7. Belanja
pengganda 300 300
an
8. Belanja
300 300
materai

9. Belanja
1.700.000 1.700.000
Pajak

10.             
Belanja 5.000.000. 5.000.000.
Kebersihan
6 Belanja
perjalanan
dinas 3.000.000 3.000.000
dalam
daerah
Juml
ah
Sumber Dana 92.930.000 92.930.000
-   
APB
- -
D/AP
BN
-   
BLU 92.930.000 92.930.000
D
1.  
Honorarium 2.400.000 2.400.000
Pelaksana
kegiatan
 12.000.000 12.000.000

3,000,000 3,000,000

5.000.000 5.000.000

5 Belanja
makanan dan
minuman 6.000.000 6.000.000
kegiatan

6 Belanja
perjalanan dinas 30.000.000 30.000.000
dalam daerah
Juml
58.400.000 58.400.000
ah
Sumber Dana
-   
APB
- -
D/AP
BN
-   
BLU 58.400.000 58.400.000
D
Penggajian
dan insentif
petugas
1
Honorariu
m 31.800.000 59.400.000
pegawai
BLUD
2
Pembayar
1.392.980.500 1.499.971200
an jasa
JKN
3
Pelatihan
10.000.000 10.000.000
dan
Bintek
4. Jasa
pelayana
3 54.900.000 57.200.000
n
tindakam
Juml 1.434.780’500 1.568.771.200
ah
Sumber Dana
-   
APB
- -
D/AP
BN
-   
BLU 1.434.780’500 1.568.771.200
D
Sumber Dana
-   
APB
- -
JUMLAH D/AP
BN
-   
BLU 1,591,110,500 1,732,101,200
D
Jumlah 1,591,110,500 1,732,101,200
kesehatan di Wilayah Kecamatan Rancah

PENANGGU
NG JAWAB
KEGIATAN
 -

PENANGGU
NG JAWAB
KEGIATAN
STRATEGI
PENANGGUNG
PAGU INDIKATIF (Rp) JAWAB
KEGIATAN
2020 2021 2022

Koordinator

Admen
 2.400.000 2.400.000 2.400.000

16.500.000 16.500.000 16.500.000

2.250.000 2.250.000 2.250.000

1.000.000 1.000.000 1.000.000

60.480.000 60.480.000 60.480.000

300 300 300

300 300 300

1.700.000 1.700.000 1.700.000

5.000.000. 5.000.000. 5.000.000.

3.000.000 3.000.000 3.000.000

92.930.000 92.930.000 92.930.000

- - -

92.930.000 92.930.000 92.930.000

2.400.000 2.400.000 2.400.000

 12.000.000 12.000.000 12.000.000

3,000,000 3,000,000 3,000,000

5.000.000 5.000.000 5.000.000

6.000.000 6.000.000 6.000.000

30.000.000 30.000.000 30.000.000

58.400.000 58.400.000 58.400.000

- - -

58.400.000 58.400.000 58.400.000

89.400.000 95.400.000 95.400.000

1.725.772600 1.754.171.200 1.762..614.600

10.000.000 10.000.000 10.000.000

59.700.000 62.200.000 65.200.000

1.825.172.600 1.859.571.500 1.868.014.600

- - -

1.825.172.600 1.859.571.500 1.868.014.600

- - -

1,978,002,600 1,954,001,500 2,935,394,600

1,978,002,600 1,954,001,500 2,935,394,600

 2018 2019 20120
8,390,000.00 142,390,000.00 161,140,000.00

611,500,000 631,000,000 652,000,000

BOK 603,110,000.00 488,610,000.00 490,860,000.00
1 akre 116,750,000
2 wajib
3 UKP
4 satpras
5 UKM 123000000 123000000 123000000

6 Mitra
7 Promkes 114,900,000 117,150,000 119,400,000

248,460,000 248,460,000 248,460,000

8 standar administrasi
9 standa keuangan
10 SDM
12,405,000.00 13,081,000.00 12,134,000.00

76,125,000 78,561,000 81,074,000

JAMPERSAL 63720000 65480000 68940000
1 akre
2 wajib

4,320,000 5,280,000 6,240,000

4,500,000 3,000,000 3,000,000
3 UKP
4 satpras
5 UKM
Mitra
7 Promkes
8 standar administrasi
9 standa keuangan
10 SDM 54900000 57200000 59700000

344,307,300.00 165,892,000.00 210,896,800.00

2,344,094,000 2,366,296,000 2,738,355,000

JKN 1,999,786,700.00 2,200,404,000.00 2,527,458,200.00

 1 akre
2 wajib
3 UKP 329,366,200 348,992,800 374,245,600

4 satpras 209,040,000 283,040,000 359,040,000

5 UKM
6 Mitra
7 Promkes 36.400.000 32.400.000 32.400.000

8 standar administrasi
9 standa keuangan 58400000 58400000 58400000
10 SDM 10000000 10000000 10000000
1392980500 1499971200 1725772600

191,191,000 191,191,000 191,191,000

113,291,000 94,074,000 66,349,000

191,191,000 204,574,000 216,849,000

Retribusi 77,900,000.0 110,500,000.0 150,500,000.0

1 akre
2 wajib
3 UKP
4 satpras
5 UKM
6 Mitra 16000000 21000000 31000000

7 Promkes
8 standar administrasi 30,100,000.0 30,100,000.0 30,100,000.0
9 standa keuangan
10 SDM 31,800,000.0 59,400,000.0 89,400,000.0
 2021 2022
181,140,000.00 202,140,000.00 8,390,000

672,000,000 693,000,000 12,405,000

490,860,000.00 490,860,000.00 0 0 54,900,000
344,307,300
420,002,300

20,795,000
123000000 123000000 764,309,600

119,400,000 119,400,000

248,460,000 248,460,000

11,749,000.00 10,947,000.00 31800000

83,669,000 86,347,000 1392980500

71920000 75400000 0 0 10000000

54900000

1,489,680,500
209,040,000

6,720,000 7,200,000 1,698,720,500

3,000,000 3,000,000
3,168,449,000
1,469,728,500

62200000 65200000

176,180,800.00 217,123,200.00

2,781,272,000 2,790,789,000

2,605,091,200.00 2,573,665,800.00 0 0
 415,480,000 343,611,200

367,040,000 399,040,000

32.400.000 32.400.000

58400000 58400000
10000000 10000000
1754171200 1762614600

191,191,000 191,191,000

68,191,000 76,576,000

227,691,000 239,076,000

159,500,000.0 162,500,000.0 0 0

34000000 37000000

30,100,000.0 30,100,000.0

95,400,000.0 95,400,000.0
 142,390,000 161,140,000 181,140,000 202,140,000

13,081,000 12,134,000 11,749,000 10,947,000

57,200,000 59,700,000 62,200,000 65,200,000
165,892,000 210,896,800 176,180,800 217,123,200
378,563,000 443,870,800 431,269,800 495,410,200

155,471,000 173,274,000 192,889,000 213,087,000

544,455,000 654,767,600 607,450,600 712,533,400

59400000 89400000 95400000 95400000

1499971200 1725772600 1754171200 1762614600

10000000 10000000 10000000 10000000

57200000 59700000 62200000 65200000

1,626,571,200 1,884,872,600 1,921,771,200 1,933,214,600

283,040,000 359,040,000 367,040,000 399,040,000

1,909,611,200 2,243,912,600 2,288,811,200 2,332,254,600

3,240,187,000 3,665,759,000 3,737,271,000 3,770,466,000

1,330,575,800 1,421,846,400 1,448,459,800 1,438,211,400
 7,600,000

1,920,000

15,000,000

80,000,000.00

104,520,000

209,040,000
 92930000
62830000

Estimasi 2017

Januari 123,123,500.00 22386 22386

Pebruari 123,332,500.00 22424 22424 38
Maret 122,348,000.00 22245 22245 -179
April 116,392,325.00 22170 22170 -75
Mei 117,254,450.00 22334 22334 164
30,100,000.00 Juni 118,147,925.00 22504 22504 170
Juli 118,179,275.00 22510 22510 6
124 17.714286
Agustus 123,904,000.00 22528 18
september 124,003,000.00 22546
Oktober 124,102,000.00 22564
Nopember 124,201,000.00 22582
Desember 124,300,000.00 22600
1,459,287,975.00
1,574,265,500.00 114,977,525.00
984,500.00
 7,600,000 7,600,000 7,600,000 7,600,000

1,920,000 1,920,000 1,920,000 1,920,000

50,000,000 80,000,000 80,000,000 90,000,000

82,000,000.00 90,000,000.00 94,000,000.00 100,000,000.00

141,520,000 179,520,000 183,520,000 199,520,000

283,040,000 359,040,000 367,040,000 399,040,000

Jasa Oprasional Murni Silpa rekening
Jumlah ops Obat BMHP alkes
73,874,100.00 49,249,400.00
73,999,500.00 49,333,000.00
73,408,800.00 48,939,200.00
69,835,395.00 46,556,930.00
70,352,670.00 46,901,780.00
70,888,755.00 47,259,170.00
70,907,565.00 47,271,710.00
- -
74,342,400.00 49,561,600.00
74,401,800.00 49,601,200.00
74,461,200.00 49,640,800.00
74,520,600.00 49,680,400.00
74,580,000.00 49,720,000.00
875,572,785.00 583,715,190.00
Silpa rekening