<![CDATA[Public healthcare reform in Indonesia has encouraged Puskesmas to adopt the Regional Public Service Agency (BLUD) financial management model, which provides greater financial flexibility while requiring stronger accountability and performance management. Evaluating BLUD performance through multiple dimensions is therefore important for identifying structural strengths and weaknesses that may not be reflected in financial indicators alone. This study aimed to evaluate the performance of BLUD Puskesmas Air Putih, Samarinda City, in 2024 using the four perspectives of the Balanced Scorecard. A descriptive quantitative approach with a single-case study design was employed. Secondary data were obtained from institutional documents, including the revised Business and Budget Plan, monthly financial realisation reports, Minimum Service Standards (SPM) records, the Application for Facilities, Infrastructure, and Medical Equipment (ASPAK), and workforce-needs data. Performance was analysed across the financial, customer, internal business process, and learning and growth perspectives. The financial perspective showed 97.08% effectiveness, 95.85% efficiency, and 25.35% independence. Five months experienced monthly deficits. The average SPM achievement was 61.4%, with strong maternal and child health performance but low non-communicable disease screening achievement, particularly hypertension at 11.31%. SPA completeness reached 83.96%, while only 1 of 193 mandatory-calibration medical devices had been calibrated. Workforce analysis showed that 66.3% of mapped positions were understaffed. BLUD Puskesmas Air Putih demonstrated uneven performance across the four Balanced Scorecard perspectives. Overall, the findings revealed financial dependence, service gaps, equipment quality risks, and workforce shortages across the four perspectives.]]>
