Vitamin A Program for Giving Toddlers in Posyandu Neighborhoods Ledeng with CIPP Model

This study aims to evaluate the facilities of the Posyandu (Integrated Health Service Post) in the vitamin A supplementation program for toddlers at Posyandu Ledeng. The vitamin A supplementation program at Posyandu Ledeng was evaluated using the CIPP (Context, Input, Process, Product) model to assess the program's context, resources utilized, program implementation, and achieved outcomes. The evaluation results showed that although the vitamin A supplementation program was implemented successfully, there are still deficiencies in the available facilities. The measuring equipment for body weight and height and the storage facilities for vitamin A are inadequate, and there is a need to replenish the vitamin A stock. These facility shortcomings can impact the program's effectiveness and the quality of healthcare services at Posyandu Ledeng. Therefore, it is necessary to update and improve the facilities and inventory management to enhance the effectiveness of this program, ensuring its sustainability and success in providing vitamin A supplementation to toddlers at Posyandu Ledeng.


A B S T R A C T A R T I C L E I N F O
This study aims to evaluate the facilities of the Posyandu (Integrated Health Service Post) in the vitamin A supplementation program for toddlers at Posyandu Ledeng.The vitamin A supplementation program at Posyandu Ledeng was evaluated using the CIPP (Context, Input, Process, Product) model to assess the program's context, resources utilized, program implementation, and achieved outcomes.
The evaluation results showed that although the vitamin A supplementation program was implemented successfully, there are still deficiencies in the available facilities.The measuring equipment for body weight and height and the storage facilities for vitamin A are inadequate, and there is a need to replenish the vitamin A stock.These facility shortcomings can impact the program's effectiveness and the quality of healthcare services at Posyandu Ledeng.Therefore, it is necessary to update and improve the facilities and inventory management to enhance the effectiveness of this program, ensuring its sustainability and success in providing vitamin A supplementation to toddlers at Posyandu Ledeng.

INTRODUCTION
The vitamin A program for toddlers at Posyandu Kelurahan Ledeng is one of the important programs in an effort to improve the health and quality of life of early childhood children.Vitamin A has a very vital role in the growth and development of children (Rahmi, 2019), as well as maintaining endurance and preventing vitamin A deficiency which can cause serious health problems in toddlers.
Giving vitamin A to toddlers has a very important role in maintaining the health and quality of life of early childhood (Apriliani et al., 2021).Vitamin A is an essential nutrient for optimal growth, development, and body function (Dharmayanti, 2014).The reason why giving vitamin A to toddlers is very important is a) vitamin A plays a role in maintaining eye and vision health (Al-Fariqi et al., 2020).Vitamin A deficiency can lead to serious vision problems, including night blindness and xerophthalmia (dryness of the surface of the eye) (Smith et al., 2000).By giving vitamin A to toddlers, the risk of vision problems can be minimized, b) vitamin A plays an important role in the growth and development of body cells and tissues, including bone growth, tooth formation, and immune system development.Providing adequate vitamin A to toddlers helps ensure that they grow well and reach their growth and development potential (Hati et al., 2014) vitamin A plays a role in boosting immunity (Widiyanto et al., 2022).Toddlers who lack vitamin A have a weak immune system and are prone to infectious diseases, such as diarrhea, respiratory infections, and measles (Destiana et al., 2020).By providing vitamin A, the immune system of toddlers can be improved, so they are better able to fight diseases and infections.

Vitamin A
Vitamin A deficiency is a serious problem in some areas that have limited access to nutritious foods (Pattinama, 2009).Routine administration of vitamin A to toddlers is one effective strategy to prevent vitamin A deficiency (Permatasari et al., 2021).This is important to prevent negative impacts that can affect the health and development of toddlers (Ekayanthi et al., 2019).In order to improve the health and quality of life of toddlers, the vitamin A program for toddlers at the Posyandu of Ledeng Village has a significant role.By ensuring toddlers get adequate vitamin A intake, it is expected to reduce the risk of health problems associated with vitamin A deficiency and improve their overall health and quality of life (Ramlah, 2021).

Place of Implementation
Kelurahan Ledeng as an area that has a fairly high population density and there are many families with toddlers, has implemented this vitamin A program through Posyandu.Posyandu is a community health service center that is a place to monitor the growth and development of toddlers, health counseling, and routine provision of vitamin A to toddlers (Hafifah et al., 2020).However, in order to increase the effectiveness of the vitamin A program for toddlers at the Posyandu Kelurahan Ledeng, it is necessary to evaluate this program.Program evaluation is an important step to measure the extent to which this program has had a positive impact, as well as identify strengths and weaknesses in its implementation (Muryadi, 2017).This program evaluation will also provide deeper insight into the factors that influence the success of the program and provide direction for future program improvement and development (Dewi et al., 2017).

Community Education Program Evaluation Model
In this context, this study aims to evaluate the vitamin A program for toddlers at the Posyandu Kelurahan Ledeng.The evaluation will be conducted using the CIPP (Context, Input, Process, Product) model, which involves the analysis of the Community Education Program Evaluation Model to the context of the program, the inputs used, the implementation process, and the products or results that have been achieved from this program.With a deep understanding of the success and constraints of this program, it is hoped that effective steps can be taken in improving the quality and impact of the vitamin A program for toddlers at the Posyandu Kelurahan Ledeng.The CIPP (Context, Input, Process, Product) model is a program evaluation approach involving four main components.The following is an explanation of the evaluation of community education programs with the CIPP model for "Vitamin A Giving Program to Toddlers at Posyandu Kelurahan Ledeng" (1) At the context evaluation stage, the program evaluation will evaluate the background and context of the vitamin A program for toddlers at Posyandu in Kelurahan Ledeng.This evaluation will involve an analysis of the health needs and challenges of toddlers in the village, potential community participation, available resources, and other factors that can affect program implementation (Manghayu, 2018).The evaluation will also collect data on policies and regulations related to vitamin A delivery programs as well as relevant social and cultural aspects.(2) At the input evaluation stage, the evaluation will evaluate aspects related to the input or program input.This includes an analysis of available resources, such as health workers, facilities, and funding used to support program implementation.Evaluation will also involve analysis of program planning, including communication strategies, extension approaches, and vitamin A distribution plans to toddlers (Doherty et al., 2010).In addition, the evaluation will also evaluate the availability of guidelines and standard operating procedures governing program implementation.(3) The process evaluation stage involves evaluating the implementation of the vitamin A program for toddlers at the Posyandu Kelurahan Ledeng.This evaluation will involve direct observation of program activities, including assessment of the implementation of communication strategies, counseling to mothers under five, vitamin A distribution, and community involvement in the program (Priyono, 2020).The evaluation will also identify obstacles or obstacles faced in program implementation as well as factors that contribute to program success (Octavianie, 2020).( 4) At the product evaluation stage, the evaluation will evaluate the results or products achieved from the vitamin A program for toddlers at the Posyandu Kelurahan Ledeng.This evaluation includes an assessment of the effectiveness of the program in achieving the goals that have been set, such as increasing the participation of mothers under five, increasing their knowledge and understanding of the importance of giving vitamin A, meeting the needs of vitamin A in toddlers, and improving the nutritional status of toddlers after the program.The evaluation will also measure the impact of the program on the health and quality of life of toddlers, including the reduction in vitamin A deficiency rates and its impact on the incidence of infectious diseases (Kamei et al., 2011).

METHODS
A research method is a scientific method used to obtain data for a specific purpose.The word scientific in the Big Indonesian Dictionary (KBBI) has a scientific meaning or meets the requirements (grammar) of science so that it can be explained its truth.Research method is a scientific way or step to obtain data or truth that is carried out systematically based on logic and facts.To find the results of a child's character growth that is influenced by the initial language in interacting, namely the mother tongue, research needs to be done.The research used is qualitative research.Qualitative research is a method used to obtain deep data, Research methods are scientific methods used to obtain data for certain purposes (Sugiyono, 2017).The word scientific in the Big Indonesian Dictionary (KBBI) has a scientific meaning or meets the requirements (grammar) of science so that it can be explained its truth.Research method is a scientific way or step to obtain data or truth that is carried out systematically based on logic and facts.To find the results of a child's character growth that is influenced by the initial language in interacting, namely the mother tongue, research needs to be done.The research used is qualitative research.
A research method is a scientific method used to obtain data for a specific purpose.The word scientific in the Big Indonesian Dictionary (KBBI) has a scientific meaning or meets the requirements (grammar) of science so that it can be explained its truth.Research method is a scientific way or step to obtain data or truth that is carried out systematically based on logic and facts.To find the results of a child's character growth that is influenced by the initial language in interacting, namely the mother tongue, research needs to be done.The research used is qualitative research.According to Sugiyono (2017), qualitative research is a method used to obtain deep data.

RESULTS AND DISCUSSION
Posyandu (Integrated Service Post) is one of the important components in the health service system in Indonesia.Posyandu is a community health service center that provides promotive and preventive services to pregnant women, infants, toddlers, and families.The provisions of posyandu provisions in accordance with health regulations are regulated in various policy documents and guidelines issued by the Ministry of Health of the Republic of Indonesia.Posyandu Ledeng is a health institution located in Ledeng Village located on Jl Sersan Surip No. 92/169 A, RT/003 RW/004 Kelurahan Ledeng, Bandung City.This posyandu has an important role in providing public health services, especially for toddlers, pregnant women and the elderly.Posyandu Ledeng has been operating for several years and is the center of public health activities in the region.Posyandu Ledeng has a significant role in improving the health and quality of life of the surrounding community.With continuous services and educational efforts, Posyandu Ledeng can be an effective institution in promoting public health and preventing diseases, especially in toddlers in Ledeng Village.However, the implementation and facilities are still not optimal and adequate in accordance with the guidelines for posyandu development.
The general guidelines for posyandu development in accordance with the Ministry of Health of the Republic of Indonesia are, (1) Posyandu must have a decent and safe place to carry out service activities.Facilities required include waiting rooms, consultation rooms, examination rooms, immunization rooms, and adequate clean water and sanitation facilities.
(2) Posyandu must have trained health workers, including midwives, nurses, health cadres, and other officers who meet the established competency standards.These health workers are responsible for providing health services to the community, including health checks, immunizations, growth monitoring, and health counseling.(3) Posyandu shall conduct routine activities in accordance with the established schedule, such as measuring the weight and height of toddlers, health checks for pregnant women, immunization, and health counseling to mothers and families.( 4) Posyandu must record data on health services carried out, such as data on toddler growth, immunization, examination of pregnant women, and other activities.This data is important for monitoring and evaluating health service programs at posyandu.

Analysis of Posyandu in Ledeng
Posyandu Ledeng, if based on analysis, still does not meet some of the provisions stipulated in the General Guidelines for Posyandu Development issued by the Ministry of Health of the Republic of Indonesia are (1), related to places and facilities, Posyandu Ledeng still faces several obstacles.For example, the waiting room available is limited and not adequate enough to accommodate the number of visitors who come.In addition, clean water and sanitation facilities at Posyandu Ledeng also need to be improved.Limited access to clean water can affect the cleanliness and sterilization of health equipment used, so that it can have an impact on the safety and effectiveness of the services provided.( 2), with regard to health workers, Posyandu Ledeng may face challenges in terms of adequacy of the number of trained health workers.The limited number of midwives, nurses, and other health workers can affect the quality and quantity of health services provided to the community at Posyandu Ledeng.It is important to pay attention to the improvement of human resources involved in the program, including through additional training and recruitment if needed.(3), in the case of routine activities, Posyandu Ledeng needs to update and improve the schedule and type of activities carried out in accordance with established guidelines.For example, measurements of toddler weight and height and health checks for pregnant women and infants must be carried out regularly and regularly.Immunization and health counseling to mothers and families should also be an integral part of Posyandu Ledeng's activities.( 4), in the case of routine activities, Posyandu Ledeng needs to update and improve the schedule and type of activities carried out in accordance with established guidelines.For example, measurements of toddler weight and height and health checks for pregnant women and infants must be carried out regularly and regularly.Immunization and health counseling to mothers and families should also be an integral part of Posyandu Ledeng improvement activities, such as training and the use of a more efficient recording system.

Program Vitamin A Discussion
Then the results of the discussion showed that the vitamin A program for toddlers at Posyandu Ledeng was running well in terms of compliance and community participation.Parents or caregivers of toddlers have realized the important benefits of vitamin A and follow this program well.The attendance rate of toddlers has also increased significantly.Although this program is running well, there are still shortcomings in the facilities available at Posyandu Ledeng.In a study published in the journal "Healthcare Facilities Management" in 2023, it was found that most Posyandu in the region are experiencing a lack of adequate facilities and equipment to effectively administer vitamin A delivery programs.
The most common lack of facilities is the availability of limited space and lack of adequate storage facilities to store vitamin A stocks.In addition, some Posyandu also experience problems in the accessibility of clean water needed for hygiene and sterilization of equipment.In the face of this lack of facilities, it is necessary to make efforts to improve and improve infrastructure at Posyandu Ledeng.Local governments can play an important role in adequate budget allocation to improve facilities and equipment at Posyandu.Adequate resources, such as more space and secure storage facilities, will have a positive impact on the smooth running of the vitamin A delivery program.Discussions and consultations can be conducted to evaluate and find possible alternatives, such as the procurement of temporary storage facilities or the use of technology that can assist in vitamin A stock management.
In its implementation, the role of nurses at Posyandu Ledeng is very important.They are responsible for providing information to parents or caregivers about the benefits of vitamin A and the correct way of giving it to toddlers.In this case, the communicative and educative approach taken by nurses helps parents or caregivers to understand the importance of adherence to the program.The challenge faced in running this program is low awareness from some parents or caregivers about the benefits of vitamin A. Therefore, nurses continue to socialize and educate through regular meetings at Posyandu, social media, and informative brochures.In an effort to improve compliance, nurses also provide reminders via text messages or posters at Posyandu.
Through this program, positive changes have been seen.Toddler attendance rates are increasing, and some parents report positive changes in their children's health and fitness after getting regular doses of vitamin A. This is in line with research findings showing increased immunity and protection against infectious diseases in toddlers who get vitamin A consistently.Limitations in weight and height measuring facilities for toddlers.Accurate and consistent measurements are essential in monitoring a toddler's growth and development and determining the appropriate dose of vitamin A. Therefore, it is necessary to update adequate body measuring facilities so that the data obtained can be more accurate and can be used for more effective monitoring.In addition, there is a need to update vitamin A storage facilities at Posyandu Ledeng.Proper and safe storage is necessary to maintain the quality of vitamin A to remain effective and not damaged.Adequate storage facilities will help maintain adequate stocks of vitamin A ready to use at all times.In addition, an efficient stock management system is also needed to monitor the availability and re-procure vitamin A in a timely manner.
In overcoming this shortage, it is necessary to improve and update the facilities at Posyandu Ledeng.This could involve adequate budget allocations to update toddler weight and height measuring facilities as well as vitamin A storage.In addition, additional training and education to health workers at Posyandu on accurate measurement and management of vitamin A stocks is also needed.Improving their knowledge and skills will help increase the effectiveness of vitamin A administration programs.

Product Evaluation Results
Based on the evaluation of the vitamin A program at Posyandu Ledeng, the results show several important things.First, this program has succeeded in increasing the participation of mothers under five in the program.Through effective communication strategies and appropriate counseling approaches, mothers of toddlers are increasingly realizing the importance of vitamin A for their children's health.Second, this program has also succeeded in improving the knowledge and understanding of mothers of toddlers about the benefits and how to use vitamin A. They become more skilled in giving the right dose to their children, thus increasing the fulfillment of vitamin A needs in toddlers.Third, this program has a positive impact on the nutritional status of toddlers.With regular provision of vitamin A, there has been a significant increase in the reduction in the rate of vitamin A deficiency and a reduction in the incidence of infectious diseases in toddlers at Posyandu Ledeng.However, there are several obstacles that need to be considered.Weight and height measuring facilities still need to be updated to ensure measurement accuracy.In addition,