<![CDATA[Aim: The study uses all the puskesmas in Cirebon to develop a direct and indirect effect model on health center services' effectiveness.Methods. A mixed-methods design use questionnaire cross-sectional survey and an in-depth qualitative interview. The population is all puskesmas in Cirebon Regency. A sample of 212 respondents was drawn from all puskesmas with inclusion criteria (1) health effort implementer, (2) minimum 1-year working period, (3) continuous health officers at least one year, and a minimum education of D3 health. As the dependent variable, the effectiveness of health center services is measured by [...]. The independent variables include leadership commitment, intermediate variables: strengthening basic health programs and confounding: gender, age, education, years of service. Analysis using Structural Equation Modeling (SEM) and qualitatively based on relevant themes. Conclusion: Puskesmas service effectiveness is influenced by (1) direct effects of (a) leadership commitment, policy governance, and strengthening basic health programs; and (2) indirect effect of (b) commitment to leadership and policy governance through strengthening basic health programs and (c) commitment to leadership, policy governance and strengthening basic health efforts disrupted by gender and education.]]>
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