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Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Published by Universitas Indonesia
ISSN : 19077505     EISSN : 24600601     DOI : https://doi.org/10.7454/kesmas
Core Subject : Health,
Health Professions Public Health
The focus of Kesmas is on public health as discipline and practices related to preventive and promotive measures to enhance the public health through a scientific approach applying a variety of technique. This focus includes areas and scopes such as Biostatistics, Environmental Public Health, Epidemiology, Health Policy, Health Services Research, Nutrition, Occupational Health and Industrial Hygiene, Public Health, Public Health Education and Promotion, Women Health.
Arjuna Subject : Kedokteran - Epidemilogi
Articles 928 Documents
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Kehamilan Pranikah Remaja di Kabupaten Sumedang Omarsari, Sri Dwi; Djuwita, Ratna
Kesmas Vol. 3, No. 2
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Kehamilan pranikah remaja adalah fenomena kehidupan remaja yang dapat mengganggu kesehatan reproduksi secara fisik, mental dan sosial serta komplikasi dan kematian ibu dan bayi. Secara psikososial, remaja dapat terkucil, merasa malu, depresi, putus sekolah, sulit bekerja, miskin dan menambah pertumbuhan penduduk. Tujuan penelitian ini adalah mengetahui gambaran epidemiologi dan faktor determinan dengan kehamilan pranikah remaja di Kabupaten Sumedang. Rancangan studi yang digunakan pada penelitian ini adalah rancangan studi cross sectional. Penelitian ini menemukan prevalensi kehamilan pranikah remaja di Kabupaten Sumedang tinggi (40,5%). Faktor yang berhubungan dengan kehamilan pranikah remaja meliputi usia ketika hamil, frekuensi pacaran, pola asuh orang tua, keutuhan pernikahan orang tua dan keterpaparan teman. Disarankan untuk melakukan peningkatan metoda pelayanan kesehatan reproduksi dan seksualitas dikalangan remaja, menambah jumlah kader remaja (peer educator) melalui pendidikan dan pelatihan. Meningkatkan keterlibatan orang tua mendampingi remaja melalui masa transisi kehidupan, mendirikan pusat konsultasi dan youth centre. Pre-marital pregnancy among teenagers is one phenomenon occurred in adolescent’s life that can affect the reproductive health status physically, mentally and socially. It causes complication leading to death risk for both mother and her infant. Psycho-socially, teenagers could be isolated, felt ashamed, deppressed, being dropped out of school, difficult to find job, sunk into poverty, and increase population growth rate. This research objective is to describe the epidemiologic situation of pre-marital pregnancy among teenagers and to investigate its determinant factors in Sumedang District. This research found prevalence of pre-marital pregnancy of 40.5%. There are several factors related to pre-marital preganncy, that is, age, frequency of having a dating relationship, parental control, success of parental marriage, and peer exposure. Parental control has the highest OR of 2,90. Based on this research it is suggested to improve reproductive health services including teenage sexual education, to increase the number of peer educator through adequate education and training, and to improve parent’s involvement to accompany their teenagers through difficult phase of life’s transition, and to establish consultation for teenager center.
Filariasis Limfatik di Kelurahan Pabean Kota Pekalongan Ramadhani, Tri
Kesmas Vol. 3, No. 2
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Filariasis limfatik masih merupakan masalah kesehatan masyarakat di Indonesia, khususnya di Kota Pekalongan. Hal ini ditandai dengan semakin meningkatnya angka mikrofilaria dan perluasan daerah dengan kasus filariasis limfatik.Tujuan penelitian adalah untuk mengetahui situasi filariasis limfatik di Kelurahan Pabean Kota Pekalongan. Penelitian ini meliputi penduduk dan agent, dalam periode sekitar enam bulan (Juli-Desember 2007) dengan disain studi cross sectional. Pada penelitian ini dilakukan pemeriksaan klinis, survei darah jari dan identifikasi parasit penyebab filariasis limfatik. Hasil penelitian menunjukkan angka mikrofilaria (3,4) angka kesakitan akut filaria (0,4 %) yang tinggi, tetapi angka kesakitan kronis filaria rendah (0,00 %). Parasit penyebab filariasis di Kelurahan Pabean adalah jenis Wuchereria bancrofti dengan kepadatan rerata mikrofilaria yang tinggi. Pengendalian filariasis limfatik di Kelurahan Pabean perlu dilakukan dengan pengobatan massal dan perubahan perilaku masyarakat. Lymphatic filariasis is still being a public health problem in Indonesia, especially in Pekalongan district. This problem marked by the increasing rate of microfilaria and areas with lymphatic filariasis. The aim of this study is to know the epidemiologic situation of lymphatic filariasis in Pabean village Pekalongan district. The research was a cross-sectional design and covered host and agent within the period of July-Desember 2007. Data were collected through clinical survey of acute and chronic filariasis symptoms, blood survey and identification of lymphatic filariasis parasite. The result showed that microfilaremia rate was 3,4%, acute disease rate (ADR) 0,4 % and the chronic disease rate (CDR) 0,00 %. The average of microfilaria density in 1 ml blood was 465,63. Based on microfilaremia identification in the blood, the lymphatic filariasis agent in Pabean village is Wuchereria bancrofti type. Lymphatic filariasis control in Pabean village need to focused on Mass Drug Administration (MDA) and community behavior for healthy life.
Malaria Vivax di Kabupaten Nias Selatan Siahaan, Lambok
Kesmas Vol. 3, No. 1
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Diperkirakan sekitar 2,5 milyar manusia hidup di wilayah endemis malaria dengan ± 300 juta kasus dan ± 1 juta kematian yang sebagian besar adalah anak-anak. Di Indonesia, malaria tak pernah tereradikasi dan mengalami pasang surut dari tahun ke tahun. Di Jawa-Bali, API pada tahun 2001 (0,62%) dan 2004 (0,15‰) dan di luar Jawa-Bali, AMI pada tahun 2001 (26,20‰) dan 2004 (21,20‰) terlihat menurun. Kabupaten Nias Selatan merupakan daerah endemis malaria dengan angka Monthly Malaria Incidence (MoMI) pada 2005 (124,24 ‰). Gempa bumi tektonik dan tsunami dan gempa bumi susulan yang terjadi berpengaruh meningkatkan angka insiden. Lingkungan menjadi lebih kondusif bagi perkembangan vektor penyakit malaria. Hidup di pengungsian dan penurunan daya beli penduduk menurunkan daya tahan tubuh. Kerusakan sarana dan prasarana kesehatan juga sangat berpengaruh pada pregram pencegahan dan pengendalian penyakit. Penelitian ini bertujuan untuk mendapatkan data tentang prevalensi penderita malaria vivax di Kabupaten Nias Selatan. Penelitian dengan desain epidemiologi diskriptif kasus seri ini menegakkan diagnostik malari secara klinis dan laboratorium. di Kabupaten Nias Selatan lebih sedikit daripada malaria spesies plasmodium yang lain. Kasus terbanyak dijumpai pada jenis kelamin perempuan (3,6%) dan kelompok umur 35-44 tahun (1,9%). The South Nias District is an endemic malaria area with Monthly Malaria Incidence (MoMI), in 2005 of 124.24 ‰. The increase of the M0MI rate is influenced by tectonic earthquake and tsunami. The enviroment become more condusive for vector development. Living condition in barrack and the decreasing buying ability affected body immunity. The destruction of health facilities affected prevention and disease control program. The study was conducted to obtain data on prevalence of malaria vivax in South Nias District. Data was collected through structured interviewed in a cross sectional study design. The diagnosis of malaria was made by microscopic blood examination. The prevalence of malaria vivax in South Nias district was 5.1%. Most cases were found among women (3.6%) and 35-44 years of age group (1.9%). It was concluded that in South Nias district, patient of malaria vivax was fewer than other types of malaria.
Pre-Eklampsia Berat di RSUD Bayu Asih Purwakarta Yulianti, Lia; Fikawati, Sandra
Kesmas Vol. 3, No. 1
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Pada periode 2004 - 2005, kejadian pre-eklampsia berat pada ibu hamil di RSUD Bayu Asih Purwakarta meningkat dari 15,2% menjadi 23,6%. Peningkatan kejadian PEB ini diperkirakan dipengaruhi faktor pendidikan, pekerjaan, umur ibu, paritas, umur kehamilan, riwayat penyakit, dan pemeriksaan antenatal. Penelitian ini bertujuan melakukan analisis berbagai faktor determinan pre-eklampsia berat pada Ibu hamil di RSUD Bayu Asih Purwakarta. Penelitian dengan disain studi case control ini dilakukan pada 133 kasus ibu dengan pre-eklampsia berat dan 133 kontrol ibu dengan non pre-eklampsia berat di RSUD Bayu Asih Purwakarta tahun 2004-2005. Metoda analisis yang digunakan adalah metoda analisis regresi logistik ganda. Penelitian ini menemukan faktor-faktor umur ibu, riwayat penyakit, dan pendidikan berhubungan secara bermakna dengan kejadian pre-eklampsia berat. Faktor yang berhubungan paling erat dengan kejadian pre-eklampsia berat adalah riwayat penyakit. Disarankan untuk melakukan penyuluhan pada ibu hamil, khususnya yang berumur >35 tahun dan primigravida dan ibu yang pernah mengalami pre-eklampsia berat agar mampu mendeteksi secara dini gejala dan tanda pre-eklampsia berat untuk segera mencari pelayanan rumah sakit juga melengkapi pengisian data file rekam medis pasien agar dapat memberikan tindakan medis yang sesuai dan tepat. In the period of 2004 - 2005, the severe preeclampsia condition among pregnant woman in RSUD Bayu Asih Purwakarta had been increased from 15,2% to 23,6%. It was predicted that the increase was related to factors such as education, job, mother age, parity, pregnancy age, illness and antenatal care. The objective of this study is to analyse several factors related to severe preeclampsia condition among pregnant woman who delivered in RSUD Bayu Asih Purwakarta in the period of 2004-2005. The study design used in this research is case control that conducted among 133 cases mother who suffered from severe preeclampsia condition and 133 mothers who did not suffer from severe preeclampsia. The method of analysis used in this study is logistic regression method. This research found that mother age, illness, and education were related to severe preeclampsia condition. On the other hand, job, parity, pregnancy age, and antenatal care were not related to the severe preeclampsia condition. Illness has the strongest relationship to severe preeclampsia condition. According to the study results, pregnant women especially those age more than 35 year and primigravida need clear information about severe preeclampsia condition so they can seek the needed health service. The hospital must collect complete information about patiens’ medical record.
Analisis Praktek Bidan pada Pelayanan Ibu Bersalin dan Bayi Baru Lahir Putra, Alhafiza
Kesmas Vol. 3, No. 1
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Sekitar tigapuluh persen kematian bayi terjadi pada periode neonatal yang 80 % di antaranya terjadi pada minggu pertama. Hal tersebut mengindikasikan status kesehatan ibu dan bayi baru lahir yang rendah serta akses dan kualitas pelayanan persalinan masih rendah. Tahun 2006, kematian neonatal di Kabupaten Solo adalah 47 dari 8.250 kelahiran hidup dan di Kecamatan Lembah Gumanti adalah 23 kematian neonatal dari 1,091 kelahiran hidup. Tujuan penelitian ini untuk mengetahui pengaruh praktek bidan di wilayah kerja Puskesmas Alahan Panjang terhadap pelayanan ibu bersalin dan bayi baru lahir pasca persalinan. Penelitian dilakukan dengan metode kualitatif diskusi kelompok terarah, wawancara mendalam dan observasi. Informan adalah seluruh bidan yang bertugas di wilayah kerja Puskesmas Alahan Panjang, ibu bersalin yang persalinannya ditolong oleh informan bidan tersebut. Informan kunci adalah pimpinan dan koordinator program Kesehatan Ibu dan Anak (KIA) Puskesmas Alahan Panjang. Masih ada praktek yang tidak sesuai dengan Standar pelayanan kebidanan, terutama penyuluhan pada ibu bersalin. Supervisi yang dilakukan Pimpinan dan Koordinator Program KIA Puskesmas Alahan Panjang masih kurang. Bidan yang pernah mengikuti pelatihan fungsi bidan dalam pelayananan KIA sarana mendukung atau tindakan bidan dalam pelayanan KIA kurang. In Indonesia both Maternal and Infant Mortality Rates (MMR & IMR) has been significantly reduced. However, those figures were still higher than those of other ASEAN countries. About a third of infant deaths took place in the neonatal period, while 80% of the neonatal deaths happened during the first week of life. This was partly caused by both low accessibility and quality of care. The objective of this study was to assess the midwives’ practice during the provision of services in the post partum and early neonatal period. In addition, this study at Puskesmas Alahan Panjang was also aimed to identify supporting factors in delivering the above services. The design of this study was qualitative research design. The methods of data collection were focus group discussions (FGD), in-depth interview and observation. Results of the study showed that there were many practices of the midwives during postpartum and early neonatal period which did not follow the standard midwifery care by the Ministry of Health. Health education was not properly implemented and oftenly did not even take place. Supervision from the Puskesmas chief or midwife responsible for Maternal and Child Health (MCH) services was insufficient. There were very few midwives who ever joined training in improving their midwifery skills. It is urged that both District Health Office (Dinkes) of Solok and Puskesmas Alahan Panjang improve the competency of the midwives through appropriate training, supervision and provision of equipment and facilities. In addition, strengthening midwives in conducting effective health education program is also strongly recommended. In line with this effort, socialization of recent MCH programs and support for the development of “jorong” (Desa Siaga) is also of outmost importance.
Membangun Bangsa yang Sehat Produktif Sampoerno, Does
Kesmas Vol. 3, No. 1
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Peran kesehatan yang dipahami pihak eksekutif dan legislatif di Indonesia masih terbatas pada pengobatan dan penyembuhan penyakit, bukan membangun sumber daya manusia yang berkualitas. Sejak masa penjajahan, kebijakan kesehatan tersebut didominasi oleh kebijakan kuratif dengan fasilitas kesehatan utama Rumah Sakit, Puskesmas dan Balai Pengobat. Upaya kesehatan tersebut melemahkan argumentasi peran penting kesehatan dalam pembangunan bangsa. Konsep tersebut berpengaruh terhadap tujuan upaya kesehatan mencapai keadaan sehat produktif untuk semua yang dapat mengantarkan penduduk mencapai tingkat sehat produktif. Definisi sehat yang baru tersebut berpengaruh terhadap perubahan paradigma penanganan kesehatan dari “Health Program for Survival” ke “Health Program for Human Development”. Tujuan akhir program kesehatan berubah menjadi sehat produktif yang bernilai ekonomis bagi sebagian besar penduduk. Hak azasi kesehatan menurut WHO mencakup hak informasi, privasi, menikmati kemajuan teknologi kesehatan, pendidikan kesehatan, ketersediaan makanan dan gizi, mencapai standard hidup optimal, dan jaminan sosial. Sudah saatnya upaya kesehatan tidak lagi bertumpu pada pengobatan penyakit, tetapi pada upaya peningkatan dan pemeliharaan kesehatan serta pencegahan penyakit dan penanguulangan risiko. Masyarakat perlu dilibatkan secara aktif dalam pemeliharaan kesehatan melalui pendekatan: (1) “health gain approach” (2) “creation and production of their own health” dan (3) upaya “people’s health empowerment”. The role of health as perceived and understood by executives and legislatives in Indonesia is limited to medication of illness and curative aspect and not perceived as development of quality human resources. Since the Dutch colonial era, health policy in Indonesia is dominated by curative policy emphasizing on health facilities such as hospital, community health center, and health clinic. Those perception, policy, and effort has weakened and suppressed arguments on important roles of health in the development of nation. Newer concept of health stated that the goal of health effort is the achievement of productive health status for all meaning leading most of population to the productive health level. New definition of “health” is influencing the paradigm shift from “Health Program for Survival” to “Health Program for Human Development”. The end objective of health program has changed to productive health with economic value for most of the people. WHO human rights on health includes rights of information, privacy, rights to enjoy the advancement of health technology, health education, adequate food and nutrition, optimal living standard, and social security. Therefore, health effort should not be based on illness medication but on the improvement and maintenance of health, disease prevention, and risk reduction. Communities should be involved actively in health preservation and promotion through (1) “health gain approach” (2) “creation and production of their own health” and (3) “people’s health empowerment”.
Analisis Potensi Pasar dan Atribut Pelayanan Rumah Sakit Islam Depok Ayuningtyas, Dumilah; Fazriah, Hidayani
Kesmas Vol. 3, No. 1
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Di Kota Depok masyarakat muslim yang menjadi komunitas terbesar (91,94%) merupakan pasar potensial rumah sakit. Tujuan penelitian ini adalah mendapat gambaran potensi pasar dan atribut pelayanan rumah sakit yang diharapkan masyarakat muslim. Penelitian yang menggunakan model SERVQUAL ini dimodifikasi dengan 4 karakteristik syariah marketing dan dikelompokkan dalam people, place, symbols, equipment, dan price. Desain penelitian menggunakan metode survey self administered questionaire. Sampel berjumlah 120 diambil dari pasien yang berobat di rumah sakit di Kota Depok. Selain itu, dilakukan studi kualitatif dengan metode indepth interview kepada pakar terkait. Atribut pelayanan rumah sakit Islam pilihan responden yang bersifat universal berupa bentuk pelayanan yang diinginkan. Atribut spesifik tersebut meliputi cara berpakaian, tata ruang, petunjuk arah kiblat, petunjuk dan perlengkapan wudhu pasien, disain interior Islami, mushola di setiap lantai. Atribut fasilitas berupa bimbingan pasien kritis dan bimbingan ruhani. Atribut tarif meliputi komitmen melayani pasien tak mampu, pelayanan tidak terpengaruh tarif kelas dan tidak sepenuhnya profit oriented. Dari hasil indeph interview pakar diformulasikan atribut pelayanan rumah sakit Islam yang bersifat universal dan spesifik. Atribut pelayanan spesifik meliputi aspek fisik, aspek SDM, dan aspek fasilitas. Atribut pembiayaan yang tidak ada pembedaan tarif, tidak menerapkan uang muka. Atribut prosedur pelayanan medis berupa pelayanan bersalin dengan konsep pure gender dan adanya standar operasional prosedur yang memperhatikan aspek layanan gender. Manajemen rumah sakit Islam perlu mempertimbangkan potensi pasar dan merealisasikan atribut universal dan spesifik. Muslim community as the largest population in Indonesia as well as in the city of Depok with the percentage of 91.94%, has been considered as prospective market for Islamic-based business including hospital business. The objective of this study is to investigate the market potential and the service attributes of the Islamic hospitals. The design of study is analytic descriptive with quantitative approach using survey method through self administered questionnaires. The number of samples was 120 taken from the patients nursed in the hospitals in Depok. Qualitative approach was conducted using in-depth interview of related experts. The attributes of service of Islamic hospitals selected by the respondents were universal and specific. The universal attributes were the service models. The specific attribute which indicated Islamic services physically comprised of : Muslim costumes, availability of sign of the direction of kiblah, Islamic interior design, and availability of prayer room. The attributes of facilities including guide for critical patients by particular staff, and costumes for prayer for serious patients, and religious guide for the patients and their family. The attributes of price were to serve poor patients, the services are not influenced by the class tariff and not fully profit-oriented. The specific attributes of service including physical aspects, facility aspects, and human resources aspect. The attributes of costing comprise of: the absence of tariff differences, there is no deposit. The attributes of medical services consist of purely gender-based maternity services, and the existence standard operation procedures which considers the aspects gender-based services. The management of Islamic hospitals should consider their market potencies and implement the universal and specific attributes to enable them to perform Islamic high-quality services.
Faktor Penentu Kontaminasi Bakteriologik pada Makanan Jajanan di Sekolah Dasar Wibawa, Anton
Kesmas Vol. 3, No. 1
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Makanan jajanan merupakan produk pengolahan makanan yang banyak dijumpai di sekitar sekolah dan dikonsumsi secara rutin oleh banyak anak usia sekolah. Selain bermanfaat makanan jajanan juga berisiko menimbulkan masalah kesehatan. Tujuan penelitian ini adalah mengetahui kontaminasi bakteriologi pada makanan jajanan serta faktor yang mempengaruhinya. Penelitian ini menggunakan disain potong lintang (Cross Sectional), dengan sumber data sekunder kegiatan pengawasan makanan dan minuman oleh Dinas Kesehatan Kabupaten Tangerang tahun 2006. Sampel diambil dari 159 Sekolah Dasar di kabupaten Tangerang. Variabel yang diamati adalah : pengetahuan, perilaku, peralatan sarana air bersih, sarana pembuangan limbah, tempat pembuangan sampah dan lokasi usaha, sedangkan variabel terikat adalah kontaminasi makanan oleh bakteri E.Coli. Hasil dari analisis pada penelitian ini menunjukan sampel makanan yang terkontaminasi sebanyak 37,1%. Sekitar (62,9%) berpengetahuan tidak baik, perilaku tidak baik (76,7%), lokasi usaha tidak memenuhi syarat (53,5%), peralatan yang digunakan tidak memenuhi syarat ( 57,2%). Fasilitas sanitasi, tempat sampah tidak memenuhi syarat (93,1%), sarana air bersih (75,5%) tidak memenuhi syarat, sarana pembuangan limbah (86,2%) tidak memenuhi syarat. Pada analisis multivariat diketahui bahwa perilaku merupakan variabel murni yang mempengaruhi terjadinya kontaminasi pada makanan jajanan (p = 0,011) dengan nilai OR 3,2 (95% : CI). Street food is a processed food that can be easily found around schools and consumed routinely by school children. Despite its benefit, street food pose a threatening risk toward health problems. The objective of this study is to investigate bacteriological contamination in street foods and its influencing factors. Design of this study was cross-sectional using secondary data from Health Office Tangerang District year 2006. Subjects were 159 Primary Schools in Tangerang District. Variables observed including knowledge, practice, clean water facilities, waste processing facilities, and location of vendor with E. coli contamination as dependent variable. Analysis of the study shows that 37.1% of street foods in the study was contaminated. Around 62.9% had poor knowledge, 76.7% had poor practice, 53.5% inappropriate location, 57.2% inappropriate utensils, inappropriate sanitation facilities (93.1%), inappropriate clean water facilities (75.5%), and inappropriate waste management facilities (86.2%). The multivariate analysis shows that behaviour was the single dominant variable influencing contamination of street foods (p=0.0011) with OR of 3.2 (95%CI).
Perbandingan Analisis Regresi Logistik dengan Analisis Propensity Score Matching pada Studi Kasus Imunisasi Bayi Utomo, Waras Budi
Kesmas Vol. 2, No. 6
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Analisis multivariat konvensioanal tidak selalu merupakan metode ideal untuk memprediksi efek pajanan pada studi-studi observasional. Ketika distribusi kovariat antara kelompok pajanan berbeda besar, penyesuaan dengan teknik multivariat konvensioanl tidak cukup menyeimbangkan kelompok tersebut. Bias yang tersisa dapat menghambat penarikan kesimpulan yang valid. Tujuan penelitian ini adalah membandingkan hasil analisis multivariat konvensional dengan analisis metoda propensity score matching pada studi kasus data sekunder imunisasi bayi ASUH KAP2 2003. Penelitian ini menemukan nilai OR metoda regresi logistik (0,99) berbeda dengan metoda propensity score matching (0,96). Metoda propensity score matching berhasil menjodohkan 574 subjek (68,27%). Untuk evaluasi pengaruh faktor risiko disarankan menggunakan model PSM karena mengurangi bias seleksi, tetapi untuk analisis faktor determinan yang banyak variabel independent, gunakan matching kerena variabel tersebut mempunyai posisi yang sama. Conventional multivariable analyses may not always be the ideal method for estimating exposure effects in observational studies. Where there are large differences in the distribution of covariates between expose groups, adjusting with conventional multivariable techniques may not adequately balance the groups, and the remaining bias may limit valid causal inference. The objective of this research is to compare the result of convensional multiariate analysis versus propensity score matching analysis in case study of infant immunization using secondary data of ASUH KAP2 2003. Model will be compared without interaction variable. The results show that the OR from logistic regression (0,99) differs to propensity score matching (0,96). Propensity score matching is successful in matching 574 subjects (68,27%). It is recommended to evaluate risk factor effect using PSM model, but to use logistic regression analysis for determinat factor analysis with many independent variables because the variables have the same position.
Peranan Pelatihan Learning Organization pada Perubahan Individu dan Institusi: Pengalaman Kabupaten Cianjur Darmawan, Ede Surya
Kesmas Vol. 2, No. 6
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Abstract

Dalam rangka mendukung peningkatan kapasitas aparat pemerintah daerah dalam melaksanakan peran dan fungsi setelah penerapan kebijakan desentralisasi, Unit Desentralisasi Departemen Kesehatan telah menyusun beberapa rencana strategis yang bertujuan mengantisipasi transisi desentralisasi, diantaranya adalah membangun organisasi pembelajar. Melihat bagaimana peranan pelatihan berpengaruh pada perubahan individu dan institusi pada lingkungan birokrasi yang lebih ketat pada tingkat pemerintah daerah. Penelitian ini adalah sebuah penelitian quasi-eksperimental dengan pre- dan post- intervensi, pengukuran yang berulang kali, dan kontrol yang tidak merata. Kelompok pertama akan menerima pelatihan SLLO (Xa) dan pendampingan (Xb). Kelompok kedua hanya akan berfungsi sebagai kelompok pengontrol. Penelitian ini menemukan: (1) Pelatihan LO efektif untuk meningkatkan pengetahuan, dan pemahaman peserta dalam perspektif kerja, masalah, keinginan mempebaiki diri dan menyebarkan kepada teman kerja. (2) Perubahan tingkat individu meliputi; keinginan memperbaiki perilaku kerja; keterbukaan dan kesiapan pencatatan perilaku; kesediaan menyediakan waktu; lebih banyak mempergunakan analisis penyebab masalah; lebih banyak dialog dan tidak terjebak dengan gejala; keinginan dan upaya menyebarkan LO dalam seminar dan pelatihan. (3) Bentuk perubahan kelompok dan institusi belum terlihat, berupa upaya untuk menyampaikan informasi pelatihan LO kepada peserta lintas sektor yang lebih luas. (4) Pengaruh lingkungan birokrasi pemerintah tingkat kabupaten mengakibatkan; perubahan individu berpengaruh pada perubahan kelompok sedikit; komunikasi membutuhkan waktu banyak; Sulit melakukan dialog antar anggota tim. Pada tingkat kecamatan keadaan berubah lebih baik; Perubahan individu yang berpengaruh pada perubahan kelompok lebih banyak; komunikasi antar anggota lebih cepat; dialog lebih mudah. In order to support local government capacity to implement their role and capacity after the implementation of decentralization policy, The Decentralization Unit of Ministry of Health RI has developed several strategic plans which directed to anticipate decentralization transition, such as learning organization. To objective of this study is to understand the effect of training program on individual and institutional changes in a more strict bureocratic environment. This study is a quasi-experimental study with pre and post intervention study design, several times measurements, and unequally distributed control. The first group receive SLLO training (Xa) and assistance (Xb). The second group is a control group. The study result show that: (1) the LO training is efective to increase knowledge and understanding of the trainees on job perspective, problem solving, self improvement need and distribution to group member (2) The individual level changes include the need to job behavioral improvement, the openness and readiness to record behaviour, more problem analysis, more dialogue and not trapped in surface symptoms, want and need to distribute LO in seminar and training (3) the group and institutional changes has not been seen yet (4) only small effect of individual changes to group level changes, communication needs plenty of time, difficult to conduct dialogue among team members. In sub-district level situation has chenged to a better situation, more effect of individual level cahnges to group level changes, faster communication between group members and easier dialogue.

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