LINTAS Diarrhea Program Implementation for Toddlers at Community Health Centers: A Qualitative Study

Abstract

Background: Diarrhea remains a leading cause of morbidity and mortality among children under five in developing countries. Despite the availability of a structured management protocol the LINTAS Diarrhea Program coverage rates at community health centers in Indonesia consistently fall short of the 100% national target, indicating significant implementation gaps.

Objective: This study aimed to evaluate the implementation of the LINTAS Diarrhea Program for toddlers at a primary health care center in West Sumatra using a systems approach encompassing input, process, and output components.

Methods: A descriptive qualitative case study design was employed. Data were collected through in-depth interviews with nine purposively selected informants, field observations, and document reviews. Thematic analysis was conducted following the stages of data reduction, data display, and conclusion drawing. Validity was ensured through source triangulation and method triangulation.

Results: Program implementation was constrained across all system components. Key input deficiencies included incomplete policy dissemination, dual-role burden on personnel, insufficient operational funding, and lack of health promotion media. Process-level problems included suboptimal program target setting, non-compliance with standard zinc dosing protocols, inadequate preventive counseling, and delayed recording and reporting. At the output level, the program achieved only 76% of its 100% target for toddler diarrhea case management.

Conclusion and Recommendation: The underperformance of the LINTAS Diarrhea Program is attributable to systemic weaknesses in human resources, funding, infrastructure, and program governance. Health centers should prioritize policy re-socialization, dedicated staffing, adequate supply chains, and structured community education to improve program coverage and reduce diarrhea-related morbidity in toddlers.