Effectiveness of Health Services in controlling the Increase in the Number of Hypertension Suffering Cases in Community Health Centers Sangurara Palu

Efforts to control non-communicable diseases, especially hypertension as one of the diseases with the greatest prevalence in Indonesia, need to be of concern to the government and health workers in public health services. Managing health service management is one way to control hypertension cases in society. This community service program was carried out by first carrying out a preliminary study as an initial stage of activities to formulate problems and determine priority issues related to controlling hypertension cases at the Sangurara Palu Community Health Center. In this program, several activities are carried out that can support the successful control of hypertension cases, such as education and outreach regarding the prevention, treatment and care of hypertension. From the implementation of activities to overcome the problem of the effectiveness of controlling hypertension cases, it can be used as input for the Sangurara Community Health Center in the management of community health center management related to the number of hypertension cases.


INTRODUCTION
Hypertension or high blood pressure is an increase in systolic blood pressure of more than 140 mmHg and diastolic blood pressure of more than 90 mmHg in two measurements with an interval of five minutes in a well-rested/calm state.Data from the World Health Organization (WHO) shows that around 1.13 billion people in the world have hypertension, meaning that 1 in 3 people in the world are diagnosed with hypertension.The number of people with hypertension continues to increase every year, it is estimated that by 2025 there will be 1.5 billion people affected by hypertension, and it is estimated that every year 9.4 million people die from hypertension and its complications (Ministry of Health, 2019).The high incidence of hypertension as has been explained can be influenced by many factors, including age, pregnancy/hereditary history, smoking habits, exercise habits and body mass index.Age ≥ 40 years has a high risk of developing hypertension, meaning that the older you are, the greater the risk of developing hypertension due to changes in the structure of large blood vessels and the blood vessels become stiff (Sartik, 2017).Many hypertensive patients have uncontrolled blood pressure and the number continues to increase.Participation of all parties, including doctors from various fields specializing in hypertension, government, private sector and society is needed so that hypertension can be controlled (Ministry of Health, 2013).Hypertension is often referred to as the "silent killer", realizing it, sufferers experience complications in vital organs such as the heart, brain or kidneys.Symptoms due to hypertension, such as dizziness, visual disturbances and headaches, often occur when hypertension is advanced when blood pressure has reached a certain significant number (Triyanto, 2014).Efforts to manage hypertension can be carried out using two approaches, namely pharmacological and non-pharmacological approaches.Pharmacological efforts in general for hypertension sufferers are started if they are in grade 1 sufferers (having systolic blood pressure 140-159 mmHg and diastolic 90-99 mmHg) who do not experience a decrease in blood pressure after > 6 months of living a healthy lifestyle and in patients with grade ≥ 2 hypertension (having systolic blood pressure of 160-179 mmHg and diastolic 100-109 mmHg.Non-pharmacological efforts can be made by the sufferer adopting a healthy lifestyle, measuring body weight, reducing salt intake, exercising, reducing alcohol consumption and stopping smoking (Perki, 2015).From the information above regarding the dangers of hypertension, strategies are needed that can help sufferers to get better health, especially in services.Strategy is the determination of an organization's long-term goals, as well as the implementation of a series of actions and allocation of resources that are important to achieve these goals (Kotler, 2005).Amin (2015) added that there are at least three definitions of strategy.First, strategy is a declaration of intent that defines ways to achieve goals and pays serious attention to the allocation of company resources that are important for the long term and matching resources and capabilities with the external environment.Second, strategy is a perspective where critical issues or success factors can be discussed, and strategic decisions aim to make a large and long-term impact on the behavior and success of the organization.Third, strategy is basically about setting goals (strategic objectives) and allocating or adjusting resources to opportunities (resource-based strategic) so as to achieve strategic suitability between strategic objectives and their resource base.The results of a preliminary study at the Sangurara Health Center UPTD, where in 2022 data related to hypertension will be 4592 with a percentage of 48.91% of the total number of targets related to hypertension sufferers in the Sangurara Palu Health Center working area.The aim of this program is to determine the effectiveness of health services in controlling increase in the number of cases of hypertension sufferers at the Sangurara Health Center, Palu.

METHOD
In the residency assignment, the author analyzed the situation in a preliminary study at the Sangurara Health Center in Palu regarding data on hypertension sufferers in 2022, then analyzed the results of the preliminary study using using a fishbone diagram which concludes the problem of ineffective services to control the increasing number of patients suffering from hypertension.In this program, several activities are carried out that can support the successful control of hypertension cases.

RESULT
The service activity was carried out on March 15 2023 and a preliminary study had previously been carried out.The results of the preliminary study concluded that there is a problem, namely services to control the increasing number of patients suffering from hypertension Table 1

. Fishbone diagram based on preliminary studies at Community Health Centers Sangurara Palu
Based on the results of the problem analysis, priority problems to be implemented are determined, namely adding health workers and increasing education about hypertension, both online and offline, such as outreach, adding posters and others.

DISCUSSION
The first step that can be taken is to formulate a strategy to increase education regarding hypertension by using social media, posters, pamphlets and others.Where educational appeals made via social media must use the appropriate social media application Generally it can be seen by the wider community such as Facebook, Instagram, YouTube videos and others.Then, through poster media, it must be placed in an open place or a place where people can generally see it easily, such as at the front of the entrance and in the waiting room so that it can be seen by all people who visit the Sangurara Palu Health Center, then apart from that, pamphlets are also distributed to all The people who come to the Sangurara Palu Community Health Center are without exception.Then it is also necessary to carry out and increase socialization to the community so that the educational message related to hypertension can be conveyed evenly to all people in the working area of the Sangurara Palu Community Health Center, whether the socialization is carried out through associations in one place, namely by gathering the community through invitations or circulars to attend.socialization events on predetermined days and places, or by visiting the homes of people who have been registered as hypertension sufferers to carry out checks on their health developments according to the schedule that has been determined for each patient.Apart from that, to support the effectiveness of health services in controlling the increasing number of hypertension sufferers, additional competent health personnel are needed.This is because the lack of health workers on duty makes the existing health workers quite tired at work due to the large number of cases of hypertension sufferers at the Sangurara Palu Community Health Center, so that some health workers have to carry out other tasks outside of their own duties or double duty so that more patients suffer.hypertension that can be treated or treated within a certain period of time.

CONCLUSION
By implementing this community service, it can be concluded that the strategy that can be used to control the number of cases of hypertension sufferers at the Sangurara Palu Community Health Center is by increasing education about hypertension to the community, either through social media.internet media, conducting outreach, and adding/recruiting new health employees.The author's suggestion in this report is that it is hoped that the Sangurara Palu Health Center will speed up implementation plans related to providing education, outreach and additional health workers in order to minimize the number of cases of hypertension sufferers, so that control of the level of cases of hypertension sufferers at the Palu Sangurara Health Center can be handled well.