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Evaluation on Integrated Health Post Cadres Training Management in Paruga Primary Healthcare Centers at Bima City Nusa Tenggara Barat Province Rostinah Rostinah; Laksmi Widajanti; Lucia Ratna Kartika Wulan
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 3 (2015): Desember 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

ABSTRAKPelatihan Kader Posyandu di Puskesmas Paruga Kota Bima belum meningkatkan kompetensi kader Posyandu karena penimbangan bayi dan balita di Posyandu hanya mencapai 70%, lebih rendah dari target SPM yaitu 80%. Tujuan penelitian adalah melakukan evaluasi terhadap pelatihan kader Posyandu dan menganalisis hasil evaluasi untuk perbaikan pelaksanaan pelatihan kader Posyandu di Puskesmas Rasanae Timur. Pelaksanaan Penelitian dilakukan secara kualitatif dan kuantitatif. Evaluasi pelaksanaan pelatihan dilakukan secara kualitatif dengan wawancara mendalam di Puskesmas Paruga Kota Bima. Informan utama adalah Tim Pelaksana Pelatihan kader Posyandu. Analisis kualitatif dilakukan dengan analisis isi. Evaluasi uji coba Informan metode pelatihan dilakukan secara kuantitatif di Puskesmas Rasanae Timur dengan membandingkan dua kelompok sasaran dengan menggunakan metode konvensional dan Belajar Berdasarkan Masalah (BBM). Subjek penelitian adalah Tim Pelaksana Pelatihan dan kader Posyandu sejumlah 28 orang pada kelompok konvensional dan 38 orang pada kelompok Belajar Berdasarkan Masalah (BBM). Analisis data dilakukan dengan analisis bivariat uji Paired t-test. Hasil penelitian menunjukkan bahwa kualitas SDM masih rendah dan tidak memiliki pedoman pelatihan dalam manajemen pelatihan kader. Perencanaan tidak melibatkan kader, pelaksanaan pelatihan tidak sesuai dengan tujuan pelatihan dan evaluasi belum dilakukan pada pelatihan. Pelatihan kader dengan metode Belajar Berdasarkan Masalah dan konvensional meningkatkan pengetahuan dan keterampilan kader. Metode BBM meningkatkan kompetensi dan kepuasan kader Posyandu lebih tinggi daripada metode konvensional. Perencanaan pelatihan seharusnya melibatkan kader Posyandu, dilakukan penyusunan pedoman pelatihan dan dilaksanakan sesuai tujuan serta dilakukan evaluasi. Pelatihan dengan metode Belajar Berdasarkan Masalah meningkatkan kompetensi kader lebih baik daripada metode konvensional.Kata kunci : Evaluasi, Manajemen Pelatihan, Kader Posyandu, Belajar Berdasarkan MasalahABSTRACTTraining of posyandu (integrated service post) cadres in Paruga primary healthcare center (puskesmas) Bima city did not improve the posyandu cadres’ competency. It was indicated by only 70% infants and under-five children weighed their bodyweight in the posyandu; this was below the SPM (80%). Objective of this study was to evaluate training of posyandu cadres, and to analyze the evaluation results to improve the implementation of posyandu cadre trainings in East Rasanae primary healthcare centers. This was a qualitative and quantitative study. Evaluation of the training implementation was done qualitatively by conducting in-depth interview at Paruga primary healthcare center, Bima city Main informant was task force team for posyandu cadre training. Content analysis was applied in the qualitative analysis. Evaluation of a pilot testing on training method was done quantitatively in the East Rasanae puskesmas. Two target groups, one with conventional method and the other with problem based learning (BBM) method, were compared. Study subjects were training taskforce, 28 posyandu cadres in the conventional method group, and 38 cadres in the problem based learning method group. Paired t-test was applied in the bivariate analysis. Results of the study showed that human resource quality was inadequate, and no standard guidelines for cadre training management. Cadres were not involved in the planning, implementation of training did not match with the training purposes, and training evaluation was not conducted. Cadre training with problem based learning and conventional methods improved knowledge and skill of the cadres. The improvement of knowledge and skill of cadres was higher in the BBM method group than in the conventional method group. Similarly, cadre satisfaction was higher in the BBM method group than in the conventional method group. Training plan should involve posyandu cadres; training guidelines should be made; training implementation should be done according to the training purposes, and evaluation should be conducted. Training with BBM method is better in increasing cadre competence than conventional method.Keywords : evaluation, training management, posyandu cadre, problem-based learning

Analysis on the Implementation of Delivery Assurance Programme by Village Midwives in Lumajang District Warih Respitowati; Martha Irene Kartasurya; Lucia Ratna Kartika Wulan
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 2 (2015): Agustus 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

ABSTRAKImplementasi jaminan persalinan di Kabupaten Lumajang masih belum sesuai petunjuk teknis seperti pelaksanaan KB pasca salin. Tujuan dari penelitian ini adalah menjelaskan implementasi program jaminan persalinan oleh bidan desa di Kabupaten Lumajang. Jenis penelitian ini adalah penelitian eksplanatif. Informan utama yaitu 2 orang bidan desa dari puskesmas PONED dan non PONED dengan cakupan persalinan tertinggi dan 2 orang bidan desa dengan cakupan persalinan terendah dari masing-masing puskesmas. Informan triangulasi berjumlah 8 orang yang terdiri dari 1 orang pengelola jampersal Dinas Kesehatan, 1 orang verifikator jampersal, 2 orang kepala puskesmas dan 8 orang pasien jampersal. Data didapatkan melalui indepth interview serta menggunakan metode observasi terhadap sarana dan prasarana polindes. Analisis data penelitian ini menggunakan content analysis. Hasil penelitian menunjukkan bahwa pelaksanaan program jaminan persalinan belum sesuai dengan petunjuk teknis dalam hal KB pasca salin. Namun demikian pelayanan KIA sudah sesuai standar pelayanan minimal. Dalam hal ukuran dasar dan tujuan kebijakan belum ada aturan tambahan di tingkat Kabupaten, hanya berupa himbauan. Dana masih dirasakan kurang memadai, fasilitas tidak dipenuhi dan kompetensi sumber daya manusia belum ditingkatkan. Ada dukungan bidan pelaksana terhadap program tetapi kompetensi pelaksana masih belum ditingkatkan. Sosialisasi dilaksanakan mendadak melalui perwakilan puskesmas. Kondisi ekonomi masyarakat membuat ibu bersalin lebih mudah dirujuk dengan adanya program jampersal akan tetapi semua bidan masih merasa program ini hanya sebuah kewajiban. Pelaksanaan jaminan persalinan belum dilaksanakan secara lengkap karena belum ada kebijakan pendukung, keterbatasan sumber daya, sosialisasi belum menyeluruh dan dirasakan sebagai kewajiban yang memberatkan.Kata kunci : Implementasi, Jaminan Persalinan, Bidan Desa.ABSTRACTImplementation of delivery assurance (Jampersal) program in Lumajang district was not doneaccording to the technical guideline; it was not done by way of the implementation of KB after delivery program was done. Objective of this study was to explain the implementation of delivery assurance program by village midwives in Lumajang district. This was an explanatory study. Main informants were two village midwives from PONED and non PONED primary healthcare centers (Puskesmas) with the highest delivery coverage, and two villagemidwives from each puskesmas with the lowest delivery coverage. Triangulation informants were 12 people. Those people were one Jampersal manager from district health office, one Jampersal verification person, two heads of Puskesmas, and 8 Jampersal patients. Data were collected through in-depth interview and observation to Polindes (village polyclinic) facility. Content analysis method was applied in the data analysis. Results of the study showed that activities of delivery assurance service were conducted using minimal standard service. Delivery assurance policy was a right policy to solve health cost problems. Executors of the policy were village midwives who had competency that suited with program purposes. Target and environment supported the program implementation. Basic indicator and purpose of the policy were clear and understandable for village midwives. However, funding was not maximal, and it caused many complaints from midwives. Communication and coordination were adequate; however social condition and community economy did not completely support the implementation of post-delivery KB (family planning). Funding for Jampersal was very small for both delivery assistance and consumable materials. This condition made the implementation of program was only for fulfilling the responsibility. Recommended suggestions for Lumajang district health office are to provide regulations related to post-delivery KB, to do proper planning regarding resources requirement to support serviceimplementation. Monitoring on the usage of KIA (Mother and Children) book should be done by Puskesmas to minimize technical problems such as double claim due to using double KIA book.Keywords : implementation, delivery assurance, village midwives

Factors Associated to the Performance of Village Midwives in the Institutionalization of Local Area Monitoring in Maternal and Child Health (MCH- LAM) at Majalengka District West Java Province Wawan Kurniawan; Cahya Tri Purnami; Lucia Ratna Kartika Wulan
Jurnal Manajemen Kesehatan Indonesia Vol 2, No 3 (2014): Desember 2014
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Upaya pemantauan cakupan pelayanan KIA yang dikenal dengan Pemantauan Wilayah Setempat Kesehatan Ibu dan Anak (PWS-KIA) merupakan salah satu tugas bidan. Pelaksanaan PWS-KIA dengan baik dapat digunakan untuk melakukan tindak lanjut dan perbaikan pelayanan KIA. Namun berdasarkan data pelaksanaan PWS-KIA tahun 2011 hanya 40% bidan yang melakukan tahapan kegiatan PWS KIA secara lengkap. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang berhubungan dengan kinerja Bidan Desa dalam Pelembagaan PWS-KIA di Wilayah KabupatenMajalengka Provinsi Jawa Barat Tahun 2011. Penelitian ini merupakan penelitian observasional dengan pengumpulan data secara cross sectional. Populasi penelitian ini adalah semua bidan desa yang ada di wilayah kerja Dinas Kesehatan Kabupaten Majalengka, yaitu 360 bidan tersebar di 31 Puskesmas dengan sampel sebanyak 190 secara simple random sampling. Pengumpulan data dilakukan dengan wawancara dan observasi menggunakan kuesioner dan lembar pengamatan serta analisis data dilakukan secara univariat, bivariat, dan multivariat. Dari hasil penelitian didapatkan bahwa kurang dari setengahnya (42,1%) Kinerja Bidan Desa dalam pelembagaan PWS-KIA kurang baik. Dari hasil analisis didapatkan variabel yang berhubungan dengan kinerja bidan dalam pelembagaan PWS-KIA di wilayah Kabupaten Majalengka Tahun 2011 adalah pengetahuan, ketersediaan sarana dan fasilitas PWS-KIA, pembinaan Kepala Puskesmas, dukungan Kepala Desa (nilai p < 0,05). Secara bersama-sama variabel yang berpengaruh paling besar adalah dukungan/ketersediaan sarana dan fasilitas PWS KIA dengan nilai exp (â)=9,784 (nilai p =0,000). Disarankan kepada Dinas Kesehatan Kab. Majalengka/Puskesmas, dalam rangka meningkatkan kinerja bidan desa dalam pelembagaan PWS-KIA adalah memberikan dukungan sarana dan fasilitas PWS-KIA berupa penyediaan buku pedoman PWS-KIA, alat tulis/perlengkapan kantor, peralatan komputer; pelatihan pengelolaan data PWS-KIA berbasis komputer; pembekalan bidan desa pada awal tugas; dan supervisi oleh Kepala Puskesmas kepada bidan desa; serta koordinasi kepada Kepala Desa maupun kepada Camat dalam rangka dalam pelembagaan PWS-KIA. Monitoring effort on maternal and child health (KIA) service coverage known as local area monitoring of maternal and child health (PWS-KIA) was one of midwives duties. Good implementation of PWS-KIA could be used to follow up and improve KIA service. However, based on PWS-KIA implementation data in 2011, only 40% midwives who performed complete steps of PWS-KIA activities. Objective of this study was to analyze factors related to work performance of midwives to institutionalize PWS-KIA in Majalengka district area of West Java province, 2011. This was an observational study, and data was collected cross sectionally. Study population was all village midwives who resided in the work area of Majalengka district health office. These 360 midwives were distributed in 31 primary healthcare centers. Samples were 190 midwives. They were selected using simple random sampling method. Data collection was done through interview and observation using questionnair and observation form. Univariate, bivariate, and multivariate analysis were applied in the data analysis. Results of the study showed that work performance of less than a half (42.1%) of village midwives who institutionalized PWS-KIA was inadequate. Variables related to work performance of midwives who institutionalized PWS-KIA in Majalengka district area in 2011 were knowledge, availability of PWS- KIA facility, supervision of the head of puskesmas, and village leader support (p< 0.05). The most influencing variables was support/ the availability of PWS-KIA facilities (exp (â)= 9.784, p= 0.000). Suggestions for Majalengka district health office or primary healthcare centers are to provide PWS-KIA facility support to improve work performance of village midwives who institutionalized PWS-KIA; the support is in the form of providing PWS-KIA guideline books, stationery, computer devices; to conduct training on computer based PWS-KIA management data; to provide training for village midwives in their first duty; to conduct supervision by the head of primary healthcare center to village midwives; .to conduct coordination with village leader and sub district leader for PWS-KIA institutionalization.

Factors Related to the Implementation of Infection Prevention Procedures on Normal Delivery Cares in Pati District (Study on Normal Delivery Care Trained Midwives) Ulin Nafiah; Cahya Tri Purnami; Lucia Ratna Kartika Wulan
Jurnal Manajemen Kesehatan Indonesia Vol 2, No 2 (2014): Agustus 2014
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

AbstrakAKI di Kabupaten Pati tahun 2011 meningkat lagi menjadi 24 kasus (116.17/100.000 KH) dengan penyebab langsung kematian ibu masih saja didominasi oleh perdarahan 3 kasus (12.5%), infeksi 2 kasus (8.33%), hipertensi 8 kasus (33.33%), eklamsi 1 kasus. Tujuan penelitian adalah untuk menganalisis beberapa faktor yang mempengaruhi pelaksanaan tindakan pencegahan infeksi pada pertolongan persalinan oleh bidan desa pasca pelatihan asuhan persalinan normal di Kabupaten Pati.Jenis penelitian observasional dengan pendekatan cross sectional Populasi adalah seluruh bidandesa pasca pelatihan APN. Jumlah sempel 69 bidan desa pasca pelatihan APN dipilih secara purposive dengan kriteria inklusi. Pengumpulan data dengan kuesioner terstruktur dan observasi langsung. Data dianalisis secara kuantitatif dengan uji korelasi Chi-square dengan metode Yate Correction dan regresi logistik linear.Responden mempunyai pengetahuan baik (76,2%), responden mempunyai sikap baik (75,0%), responden mempunyai motivasi baik (71,4%), responden mempunyai persepsi terhadap supervisi baik (69,8%), responden mempunyai peralatan lengkap (70,8%), responden melaksanakan prosedur pencegahan infeksi dalam kategori baik (59,4%). Faktor yang mempengaruhi pelaksanaan prosedur pencegahan infeksi adalah pengetahuan (ρ = 0,001), sikap (ρ = 0,0001), motivasi (ρ = 0.004), supervisi (ρ = 0,046), peralatan (ρ = 0,008).Semua variabel (pengetahuan, sikap, motivasi, supervisi, dan peralatan) berpengaruh terhadap pelaksanaan prosedur pencegahan infeksi karena nilai signifikan dibawah 0.05 (p-value < 0.05) namun variabel yang paling berpengaruh adalah sikap (p-value = 0.000, Exp(B) =9.6000) dan pengetahuan (p-value = 0.001, Exp(B) = 6.400).Kepada Dinas Kesehatan dan organisasi IBI Kabupaten Pati untuk memberikan pembinaan agar lebih meningkatkan ketrampilan dan pengetahuan bidan desa yang terkait dengan tugas dan fungsi bidan lewat pelatihan-pelatihan, supervisi yang positif terutama tentang prosedur pencegahan infeksi pada pertolongan persalinan. AbstractMaternal mortality rate (AKI) in Pati district in 2011 increased to 24 cases (116.17/100000 live- births). Direct causes of maternal death were dominated by hemorrhage (3 cases or 12.5%), infection (2 cases or 8.33%), hypertension (8 cases or 33.33%), and eclamsia (1 case). Therefore, analysis of factors affecting the implementation of infection prevention actions in the delivery assisted by village midwives with post normal-delivery care (APN) training in Pati district was done. This was an observational study with cross sectional approach. The number of samples was 69 village midwives with post APN training. They were selected purposively according to the inclusion criteria. Data were collected through interview guided by structured questionnaire and through direct observation. Data were analyzed quantitatively by applying Chi Square test, Yate Correction, and linear logistic regression. Results of the study showed that respondents had good knowledge (76.2%), good attitude (75.0%), good motivation (71.4%), good perception on supervision (69.8%), complete instruments (70.8%), and good category for the implementation of infection prevention procedure (59.4%). Factors affecting the implementation of infection prevention procedure were knowledge (p= 0.001), attitude (p= 0.0001), motivation (p= 0.004), supervision (p= 0.046), instruments (p= 0.008). All variables (knowledge, attitude, motivation, supervision, and instruments) influenced the implementation of infection prevention procedure (p-value d” 0.05). However, the most influencing variables were attitude (p= 0.000, Exp(B) = 9.60) and knowledge (p= 0.001, Exp(B) = 6.40). Suggestions for district health office and IBI organization of Pati district are to give guidance to improve skills and knowledge of village midwives related to the job and function of midwives; it can be done through trainings, positive supervision mainly on infection prevention procedure in delivery assistance.

Analysis on the Influence of Director Leadership Style to Patient Safety Culture in Hermina Pandanaran Hospital Yuni Kartika; Sudiro Sudiro; Lucia Ratna Kartika Wulan
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 2 (2015): Agustus 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

ABSTRAKRS Hermina Pandanaran menetapkan kebijakan tentang program keselamatan pasien yang berpedoman tujuh langkah keselamatan pasien, tetapi budaya keselamatan pasien belum terlaksana dengan baik. Tujuan penelitian ini adalah menjelaskan gaya kepemimpinan transformasional direktur sesuai tujuh langkah keselamatan pasien rumah sakit dalam pelaksanaan budaya keselamatan pasien di RS Hermina Pandanaran. Jenis penelitian ini adalah kualitatif. Informan utama adalah ketua dan anggota tim Keselamatan Pasien Rumah Sakit meliputi wakil direktur medis, manajer penunjang medis, manajer keperawatan, manajer rumah tangga dan perawat PPI. Informan triangulasi pihak yang terkait dalam program keselamatan pasien rumah sakit. Pengumpulan data dilakukan melalui indepth interview dan observasi. Pengolahan data dilakukan dengan metode analsis isi (content analysis). Hasil penelitian menunjukkan bahwa gaya kepemimpinan transformasional direktur telah melibatkan staf dalam menerapkan budaya keselamatan pasien, terutama non blaming culture dan budaya belajar dari insiden, tetapi budaya pelaporan belum berjalan dengan baik. Tujuh langkah keselamatan pasien RS belum dilaksanakan seluruhnya, yaitu belum memotivasi staf dengan optimal, menjabarkan langkah-langkah penanganan insiden keselamatan pasien secara langsung di lapangan, menetapkan kebijakan tentang diklat keselamatan pasien, mengembangkan sistem pengelolaan risiko, melaksanakan pelatihan RCA di rumah sakit.Disarankan agar direktur rumah sakit lebih sering melakukan sosialisasi budaya pelaporan kepada staf dengan menekankan non blaming culture, menjabarkan langkah-langkah penanganan insiden keselamatan pasien dan melaksanakan asesmen risiko. Direktur diharapkan turun langsung ke lapangan melalui ronde keselamatan pasien dan menetapkan kebijakan tentang diklat keselamatan pasien termasuk pelatihan RCA dalam bentuk Surat Keputusan agar berjalan sesuai ketentuan dan hasilnya dapat dievaluasi.Kata kunci : Kepemimpinan, Budaya, Keselamatan Pasien, Rumah SakitABSTRACTHermina Pandanaran hospital had established a policy regarding patient safety program based on seven steps of patient safety. However, patient safety culture had not adequately performed. Objective of this study was to explain transformational leadership style of a director according to seven steps of hospital patient safety in order to implement patient safety culture in Hermina Pandanaran hospital. This was a qualitative study. Main informants were a head and team member of hospital patient safety; it included a hospital medical deputy director, a medical support manager, a nursing manager, a domestic affair manager, and PPI nurses. Triangulation informants were people who involved in the hospital patient safety program. Data management was done by applying content analysis method. Results of the study showed that transformational leadership style of a director involved staffs in the implementation of patient safety culture especially none blaming culture and learning fromincident culture. However, reporting culture was not implemented properly. Seven steps of hospital patient safety were not done completely; staffs had not been motivated optimally, steps to manage patient safety incident were not described directly in the field, policy regarding patient safety was not established, risk management system was not developed, RCA training in the hospital was not implemented. Suggestions for hospital director are to do more frequent socialization on reporting culture with stressing on non-blaming culture to staffs; to describe steps on the management of patient safety incident and conducting risk assessment. Director is expected to go directly to the field and involved in the patient safety round, and to establish a policy regarding patient safety education and training including RCA training. It could be in the form of decree in order the implementation of policy was done properly, and the results could be evaluated.Keywords : Leadership, culture, patient safety, hospital

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