Regular Supervision Saves Lives: The Role of Puskesmas in Ensuring Food Hygiene and Sanitation in Gianyar, Bali

Foodborne diseases remain a major public health concern in tourist destinations such as Gianyar, Bali, where food hygiene and sanitation are critical for community health and economic sustainability. Community health centers (puskesmas) are mandated to supervise food establishments, yet evidence on the effectiveness of supervision remains limited. This study assessed the relationship between puskesmas supervision and hygiene compliance among food establishments in Gianyar Regency. A cross-sectional study was conducted from January to December 2024 across eight puskesmas. A stratified random sample of 120 food establishments (15 per puskesmas) was assessed using a checklist based on Ministry of Health Regulation No. 1096/2011. Supervision practices were documented through interviews and record reviews. Descriptive analysis and chi-square tests were applied, followed by logistic regression. Only 39.2% of establishments were fully compliant, while 35.0% showed moderate and 25.8% poor compliance. Common deficiencies included inadequate handwashing facilities, improper food storage, and a lack of pest control. Establishments receiving regular supervision (≥ 4 inspections/year) demonstrated significantly higher compliance than those with irregular supervision (51.0% vs. 22.5%, p < 0.01). Food handler knowledge and clean water availability were also significant predictors. Regular puskesmas supervision is strongly associated with improved food hygiene compliance.