1.

IDENTIFIKASI MASALAH
UPAYA KESEHATAN WAJIB

NO PROGRAM TARGET % PENCAPAIAN % MASALAH%

 UPAYA KESEHATAN PENGEMBANGAN

NO PROGRAM TARGET % PENCAPAIAN % MASALAH%

2. PENETAPAN URUTAN PRIORITAS MASALAH
UPAYA WAJIB

NO MASALAH U S G TOTAL

UPAYA PENGEMBANGAN

NO MASALAH U S G TOTAL
3. URUTAN PRIORITAS MASALAH

NO MASALAH RANGKING
4. TABEL PEMECAHAN MASALAH

No Prioritas Masalah Penyebab Masalah Alternatif Pemecahan Masalah Pemecahan masalah terpilih Ket
AKAR PENYEBAB MASALAH

1. ..........................................................
1. ..........................................................

2. ..........................................................
2. ........................................................

2. ..........................................................
2. ..................

1. .......................................................... 1. ..................................

2. .......................................................... 2. ..........................................................

2. ........................................................

2. ..........................................................
.....................................

2. ..........................................................

kunjungan ibu
hamil K4

..........................................................

...................
1. ..........................................................

2. ..........................................................

2. ........................................................