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Laksmono Widagdo
Fakultas Kesehatan Masyarakat, Universitas Diponegoro, Semarang
Decision Sciences, Operations Research & Management Health Professions

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Evaluation on Integerated Health Post Monitoring Process by Health Workers in Singkawang City Primary Healthcare Centers,West Kalimantan Dwi Sulistyawati; Laksmono Widagdo; Cahya Tri Purnami
Jurnal Manajemen Kesehatan Indonesia Vol 2, No 1 (2014): April 2014
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (346.139 KB) | DOI: 10.14710/jmki.2.1.2014.%p

Abstract

AbstrakAngka Kematian Bayi (AKB) di Singkawang Tahun 2011 masih tinggi yaitu 9/1000 Kelahiran Hidup (Nilai Absolut 44 kematian). Di Posyandu, pelayanan dasar yang bermanfaat bagi penurunan AKB adalah program Gizi dan Penanggulangan diare. Sementara perkembangan Posyandu di Kota Singkawang Tahun 2011 masih belum optimal, Jumlah Posyandu Aktif 9,7 % dari 134 Unit. Kasus Balita BGM dan Balita gizi buruk yang berhasil ditemukan di Posyandu pada Tahun 2011 masih kecil yaitu 5,1% dan 1,09% dari jumlah kasus di lapangan. Kebijakan di Singkawang tentang Posyandu yaitu mendelegasikan kegiatan pembinaan kepada bidan di wilayah kerjanya. Kendala yang dialami bidan dalam pembinaan Posyandu yaitu Pelaksanaan pembinaan 5 meja posyandu kurang optimal, jarang dilaksanakan kunjungan rumah, kader mengalami masalah dalam kegiatan penyuluhan, Dana pembinaan Posyandu kecil.Metode Penelitian ini bersifat kualitatif. Informan utama adalah bidan pembina, informan triangulasi kader, ibu pengguna posyandu dan koordinator posyandu. Pengumpulan data dilakukan dengan wawancara mendalam menggunakan pedoman wawancara. Metode analisis yang digunakan adalah Content Analysis (Analisis isi).Hasil penelitian dalam hal kegiatan pembinaan posyandu, terdapat ketidaksesuaian dalam pelaksanaan rapat koordinasi, Pembinaan SIP (Sistem Informasi Posyandu) dan pembinaan pencatatan pelaporan, yaitu hanya terjadi antara koordinator posyandu dan kader tanpa melibatkan bidan pembina posyandu tersebut. Umur tenaga kesehatan yang muda membuat pengunjung kurang percaya karena anggapan kurangnya pengalaman yang dimiliki petugas, terdapat suku tertentu masih sulit mengimunisasikan balitanya di posyandu, tenaga kesehatan dari puskesmas induk datang terlambat, belum tersedianya tempat yang layak untuk posyandu, tenaga kesehatan yang belum mendapatkan pelatihan serta belum ada kebijakan berupa uraian tugas dan alur kerja dalam pembinaan posyandu.Perlu dilakukan koordinasi antar tenaga kesehatan terutama koordinator posyandu dengan bidan di lapangan dalam kegiatan pembinaan, melibatkan tenaga kesehatan yang relatif muda, pendekatan kepada sesepuh suku tertentu, pengaturan waktu petugas puskesmas agar tidak datang terlambat, bersama masyarakat mengupayakan tempat yang layak untuk posyandu , pengadaan pelatihan dan perumusan kebijakan terkait pembinaan posyandu. AbstractInfant mortality rate (IMR) in Singkawang in 2011 was high, 9/1000 live births (absolute number of death was 44). In the integrated health service post (Posyandu), basic services that would reduce IMR were nutritional program and diarrhea control. The development of posyandu in Singkawang in 2011 was not optimal, and the total number of active posyandu was 9.7% of 134 units. Cases of under-five children with ‘below the red line (BGM)’ and with severe malnutrition found in the posyandu in 2011 were still low; it was 5.1% and 1.09% respectively from all cases in the field. Policy regarding posyandu in Singkawang was to delegate supervision activity to local midwives. Problems faced by midwives in the posyandu supervision were the implementation of supervision for 5 tables was not optimal, home visits were rarely conducted, cadres had difficulty in conducting education activities, and funding for posyandu supervision was insufficient.This was a qualitative study. Main informants were midwives supervisors, and triangulation informants were cadres, mothers who participated in the posyandu, and coordinator of posyandu. Data collection was done by conducted in-depth interview using interview guidelines. Method of analysis used was content analysis.Results of the study showed that there was inappropriate implementation of coordination meeting; supervision of posyandu information system (SIP) and supervision of reporting and recording were not properly done; this supervision was only between posyandu coordinator and cadres; it did not include midwives who were the supervisors of the posyandu. Young health workers who served in the posyandu made posyandu participants uncomfortable. The participants of posyandu felt that health workers had insufficient experiences. There was a tribe that was reluctant to have their children immunized in the posyandu. Health workers from the main puskesmas came late; no proper place for posyandu was provided; health workers who had not received training, and there was no job description and work procedure in the supervision of posyandu.Coordination among health workers are needed specifically for posyandu coordinator and midwives in the field during supervision, and it includes relative young health workers; an approach to key persons are needed; time management for puskesmas workers is required to avoid they come late in the posyandu; appropriate place for posyandu should be provided together with the community; training and formulation of policies related to posyandu supervision are required.
Factors Related to the Midwaves’ Work Performance on Anemic Pregnant Women Manegement in Singkawang City, Kalimantan Barat U. Evi Nasla; Laksmono Widagdo; Cahya Tri Purnami
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 2 (2013): Agustus 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1235.312 KB) | DOI: 10.14710/jmki.1.2.2013.%p

Abstract

WHO memperkirakan sekitar 40% kematian ibu di negara berkembang berkaitan dengan anemia dalam kehamilan. Deteksi kasus anemia pada kehamilan belum dilakukan sesuai dengan standar pengelolaan anemia pada kehamilan. Maka dilakukan analisis faktor- faktor yang mempengaruhi kinerja bidan dalam pengelolaan anemia pada kehamilan di Kota Singkawang.Jenis penelitian survei analitik dengan pendekatan Retrospektif. Jumlah sampel 52 bidan Puskesmas wilayah Kota Singkawang dipilih secara proportional stratified random sampling dengan kriteria inklusi. Pengumpulan data dengan kuesioner terstruktur dan observasi langsung. Data dianalisis dengan uji korelasi Spearman Rank dan Regresi Logistik.Hasil penelitian mayoritas responden berusia antara 20-35 tahun (63,5%), pendidikan DIII/DIV/S1 Kebidanan (90,4%), masa kerja ≥10 tahun (55,8%). Kinerja bidan mempunyai kategori baik (59,6%), pengetahuan baik (51,9%), sarana prasarana lengkap (53,8%), kepemimpinan baik (63,5%), motivasi baik (55,8%), komunikasi baik (53,8%). Semua variabel bebas (pengetahuan, sarana prasarana, kepemimpinan, motivasi dan komunikasi) hubungan dengan kinerja bidan dalam pengelolaan anemia pada kehamilan (p < 0,05). Variabel yang berpengaruh terhadap kinerja bidan dalam pengelolaan anemia pada kehamilan adalah pengetahuan (p=0,002) dan kepemimpinan (p=0,006). Disarankan untuk Dinas Kesehatan dan Puskesmas memfasilitasi bidan dalam meningkatkan pengetahuan dan ketrampilan melalui pendidikan formal dan pelatihan-pelatihan, meningkatkan supervisi dan rapat koordinasi, menyediakan sarana prasarana pendukung dalam pengelolaan anemia. World Health Organization estimated that about 40% maternal mortality in developing countries was related to anemia during pregnancy. Detection of anemia cases during pregnancy was not conducted according to standard of management for anemia during pregnancy. Therefore, analysis factors affecting work performance of midwives in the management of anemia during pregnancy in Singkawang city. This was an analytical survey with retrospective approach. The number of samples was 52 midwives of primary healthcare centers in Singkawang city. They were selected using proportional stratified random sampling method, and they fulfilled inclusion criteria. Data were collected using structured questionnaire and direct observation. Spearman Rank correlation test and logistic regression were applied in the data analysis. Results of the study showed that majority of respondents’ age was 20-35 years old (63.5%), highest level of education was DIII/DIV/S1 midwifery (90.4%), work period was 10 years or more (55.8%). Work performance of midwives was in a good category (59.6%), respondents’ knowledge were good (51.9%), facilities were complete (53.8%), leadership was good (63.5%), motivation was good (55.8%), communication was good (53.8%). All independent variables (knowledge, facilities, leadership, motivation, and communication) were associated with work performance of midwives in the management of anemia during pregnancy (p< 0.05). Variables affecting the work performance of midwives in the management of anemia during pregnancy were knowledge (p= 0.002) and leadership (p= 0.006). Suggestions for district health office and primary healthcare centers were to facilitate midwives to improve their knowledge and skills through formal education and trainings, to improve supervision and coordination meetings, to provide supporting facilities in the management of anemia.
Factors Associated to the Work Performance of Midwives in the Implementation of Village Allertness Program in the Boyolali District Asih Dwi Astuti; Laksmono Widagdo; Ayun Sriatmi
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (464.906 KB) | DOI: 10.14710/jmki.1.3.2013.%p

Abstract

Angka Kematian Ibu (AKI) dan Angka Kematian Bayi (AKB) di Kabupaten Boyolali masih tinggi, terlihat pada AKI tahun 2010 sebesar 114,80/10.000 KH dan pada tahun 2011 sebesar 116,23/100.000 KH sedangkan pada AKB tahun 2010 sebesar 9,18/1.000 KH dan pada tahun 2011 sebesar 12,27/1.000 KH. Dalam rangka mempercepat penurunan AKI dan AKB maka diperlukan intervensi pelayanan kesehatan yang berdasarkan pada kebutuhan dan kemampuan masyarakat, maka Dinas Kesehatan Kabupaten Boyolali melakukan pengembangan Desa Siaga. Akan tetapi keberlangsungan Desa Siaga masih belum maksimal, salah satu penyebabnya adalah rendahnya kinerja bidan dalam pengembangan Poliklinik Kesehatan Desa (PKD). Tujuan penelitian ini adalah menganalisis rendahnya kinerja bidan dalam pelaksanaan Desa Siaga yang meliputi ketrampilan dan kemampuan, motivasi, kepemimpinan dan imbalan.     Penelitian ini merupakan penelitian analitik dengan metode pendekatan waktu cross sectional. Populasinya adalah seluruh bidan desa yang berada di Boyolali sebanyak 267 bidan, sempel diambil dengan cara propotional random sampling dengan jumlah 75 responden, analisis univariat dengan frekuensi, bivariat dengan uji Chi Square dan analisis multivariate dengan regresi binary logistic.    Hasil analisis peneitian bivariat menunjukkan ada hubungan yang siknifikan antara kemampuan dan ketrampilan dengan kinerja (p=0,032), motivasi dengan kinerja (p=0,001), kepemimpinan dengan kinerja (p=0,002), dan imbalan dengan kinerja (p=0,001). Secara bersama-sama variabel kepemimpinan dan motivasi  berpengaruh terhadap kinerja.    Disarankan kepada Kepala Dinas Kabupaten Boyolali untuk memberikan pelatihan Asuhan Persalinan Normal (APN), kegawatdaruratan dalam rangka peningkatan kinerja bidan desa , perbaikan PKD, serta bantuan kegiatan Desa Siaga. Bagi Kepala bidan koordinator untuk melakukan pembinaan, pendampingan program.Maternal mortality rate (AKI) and infant mortality rate (AKB) in Boyolali district were still high. Facts showed that AKI in 2010 was 114.80/10000 live-births, and in 2011 was 116.23/100.000 live-births; AKB in 2010 was 9.18/1000 live-births, and in 2011 was 12.27/1000 live-births. To accelerate the decrease of AKI and AKB, health service intervention based on community need and capacity is required. Boyolali district health office had answered this challenged by developing alert village program. However, the continuity of this alert village program was not maximal. One of reasons of this condition was inadequacy of midwives work performance in the development of village health polyclinic (PKD). Objective of this study was to analyze the inadequacy of midwives work performance in the implementation of alert village such as skill, ability, motivation, leadership, and compensation. This was an analytical study with cross sectional approach. Study population was all 267 village midwives in the district of Boyolali. Samples were 75 village midwives selected using proportional random sampling method. Frequency distribution for univariate analysis, Chi square test for bivariate analysis, and binary logistic regression for multivariate analysis were applied in the data analysis. Results of the study showed that there were significant associations between ability, skill and midwives work performance (p= 0.032); motivation and midwives work performance (p= 0.001); leadership and midwives work performance (p= 0.002); compensation and midwives work performance (p= 0.001). Variables, in common, affecting work performance of midwives were leadership and motivation. Suggestions for the head of Boyolali district health office were to provide trainings on normal delivery care (APN) and emergency to improve village midwives work performance, to improve PKD, to provide assistance for alert village program activities. Suggestion for chief of coordinator midwives was to do program supervision and assistance. 
Pelaksanaan Program Perencanaan Persalinan dan Pencegahan Komplikasi (P4K) Ditinjau dari Aspek Bidan Desa sebagai Pelaksana di Kabupaten Jepara Sokhiyatun Sokhiyatun; Laksmono Widagdo; Ayun Sriatmi
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 1 (2013): April 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (663.146 KB) | DOI: 10.14710/jmki.1.1.2013.%p

Abstract

Kematian ibu di Kabupaten Jepara tahun 2011 sebesar 24 orang (AKI 113/100.00 KelahiranHidup), terutama pada periode kehamilan dan persalinan yang diakibatkan perdarahan.Program P4K sebagai terobosan untuk mengurangi kematian ibu telah dilaksanakan diKabupaten Jepara sejak tahun 2009. Survey pendahuluan menunjukkan meski cakupanindikator P4K sudah baik, namun tidak semua kolom stiker diisi, bidan hanya memberikanstiker pada ibu hamil dan seringkali tidak mendiskusikan rencana persalinan dengan ibu hamildan keluarga. Tujuan penelitian yaitu menjelaskan pelaksanaan P4K dari aspek bidan desasebagai pelaksana di wilayah puskesmas Kabupaten Jepara tahun 2012. Jenis penelitiandeskriptif observasional dengan metode kualitatif. Populasi seluruh bidan desa yang ada diKabupaten Jepara, Informan utama 8 bidan desa dari 4 puskesmas terpilih dengan kriteriapuskesmas di daerah perkotaan sebanyak 2 puskesmas dan 2 puskesmas daerah pedesaan.Informan triangulasi yaitu ibu hamil (8 orang), kader kesehatan (8 orang), Bidan Koordinator(4 orang ) dan Kasie Kesga Dinas Kesehatan. Pengumpulan data melalui wawancaramendalam.. Analisis data dilakukan dengan content-analysis. Berdasarkan hasil penelitiandiperoleh informasi umur bidan desa antara 25–36 tahun, berpendidikan D3 Kebidanan danmasa kerja 3-15 tahundengan rata-rata kerja 9 tahun. Pengetahuan dan sikap bidan tentangP4K sudah baik karena dari 8 bidan sudah memahami tujuan dari P4K dan mendukung P4Kdengan alasan program tersebut dapat membantu pencapaian program KIA, meski pelatihankhusus P4K tidak ada, hanya penunjang dari P4K yaitu APN dan BBLR, namun dana khususpenunjang kegiatan P4K, tidak tersedia. Buku KIA dan stiker P4K sebagai sarana danprasarana tersedia cukup, namun bidan kit belum lengkap. Tidak ada SOP khusus P4K,kecuali SOP penapisan awal dan deteksi bumil resti. Indikator keberhasilan yang dipahamibidan bahwa stiker harus terpasang di setiap rumah ibu hamil yang ada di wilayahnya. Bidandesa melakukan aspek perencanaan persalinan cukup baik, serta melakukan koordinasi dankomunikasi melalui sosialisasi dan pertemuan rutin. The number of maternal death in the district of Jepara in 2011 was 24 people (MMR 113/100.000 live births). It was mainly in pregnancy and delivery periods due to bleeding. Delivery planning and complication prevention program (P4K) as a breakthrough program to reduce maternal mortality had been done in Jepara district since 2009. Preliminary survey showed that although P4K coverage was good, yet not all columns in the stickers were fulfilled. Midwives only gave stickers to pregnant women, and most of midwives did not discuss delivery planning with pregnant women and their family. Objective of this study was to explain the implementation of P4K from midwives aspects as the executors in the area of primary healthcare center (puskesmas) in Jepara district in 2012. This was a descriptive observational study using qualitative method. Study population was all village midwives in Jepara district. Main informants were 8 village midwives from 4 selected puskesmas. These puskesmas were two puskesmas from urban areas and two puskesmas from rural areas. Triangulation informants were 8 pregnant women, 8 health cadres, 4 coordinator midwives, and a head of family health unit of local district health office. Data were collected through in-depth interview. Content analysis was applied in the data analysis. Results of the study showed that age of village midwives was 25-36 years old; level of education was D3 in midwifery. Length of working was 3-15 years with the average of 9 years. Knowledge and attitude of midwives regarding P4K were good; 8 midwives had understood the purpose of P4K, and they supported P4K because it could help KIA program accomplishment. No special training on P4K was conducted; however, support of P4K training was conducted such as APN and BBLR trainings. No specific funding for P4K program was provided. Facilities, KIA books and P4K stickers, were sufficient. On the other hand, midwives kit was not complete. No specific standard operating procedure (SOP) was provided except SOP for early screening and for high risk pregnancy detection. Indicator of success understood by midwives was that stickers should be attached in every house of the pregnant women living in the work coverage area of midwives. Village midwives did a good delivery planning aspect, and they conducted coordination and communication through socialization and routine meetings.
Co-Authors Asih Dwi Astuti Ayun Sriatmi Cahya Tri Purnami Dwi Sulistyawati Sokhiyatun Sokhiyatun U. Evi Nasla