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Implementation ff Midwive-Traditional Birth Attendants Partnership by Midwives in Buton District, Southeast Sulawesi, (A Case Study on Wakaokili Primary Healthcare Center) Hermawati Hermawati; Tjahjono Kuntjoro; Ayun Sriatmi
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 1 (2013): April 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Terbatasnya pemahaman pentingnya persalinan Nakes terlatih menjadikan dukun sebagai pilihan penolong persalinan, disamping faktor sosial ekonomi, budaya, dan kinerja bidan, yang berdampak peningkatan AKI di Kabupaten Buton. Cakupan persalinan oleh tenaga kesehatan masih rendah, ditandai rendahnya jumlah dukun bermitra dan rendahnya rujukankehamilan dan rujukan persalinan dukun di Puskesmas Wakaokili. Inilah cermin Program Kemitraan Bidan-Dukun oleh Bidan Desa di Puskesmas Wakaokili. Jenis penelitian deskriptif kualitatif. Pengumpulan data dengan wawancara mendalam pada 4 bidan desa dan 9 dukun bersalin sebagai informan utama. Data dianalisis menggunakan metode content analysis. Penelitian menunjukkan tujuan dan indikator keberhasilan program kurang dipahami, tidak ada aturan tertulis, tidak ada SOP dan pencatatan khusus kemitraan bidan-dukun. Diseminasi program bersifat pengenalan, pelaporan tidak didiskusikan. Pembinaan dan magang dukuntidak ada. Sikap pelaksana terhadap kemitraan cenderung mendua dan sumber daya kurang mendukung. Terbukti lingkungan ekonomi, sosial dan politik mempengaruhi keberhasilan program.Kata Kunci : Puskesmas, Program Kemitraan Bidan-Dukun .The limited knowledge on the importance of health workers deliveries, together with some other factors such as economies, social and culture, made traditional birth attendants became a choice of delivery services. This condition resulted in the increase of Maternal MortalityRate in Buton District. The coverage of health workers deliveries in Wakaokili was still low. It was marked by the low rate of traditional birth attendance-midwives’ partnership and deliveries referral to the midwives, as well as high rates of traditional birth attendancedeliveries. This study was a descriptive qualitative study. Data were collected by in depth interviews on 4 village midwives and 9 traditional birth attendants as the main informants. Data were analyzed by content analysis method. Results showed that the goals and program success indicators were not understood well. Dissemination was only an introduction and the report was not discussed. There was no coaching or internship program. The attitude tended to be ambivalent and the resources were not supportive. It is proven that economic, social and political environment influence the program results.

Sistem Informasi Kerentanan Gizi Buruk di Distrik Sentani, Kabupaten Jayapura dengan Metode Analytic Hierarchy Process Yokelin Tokoro; Dharmaputra Palekahelu; Andeka Rocky Tanaamah
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 1 (2013): April 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

This study is aimed to determine the vulnerability of malnutrition in every village of SentaniDistrict by analyzing the factors of malnutrition acording to UNICEF standard usingAnalytical Hierarchy Proses method. These factors include nutrition, infectious diseases,parenting, food availability, sanitation, and poverty. These factors are known as the criteria inthe AHP process that use to determine the preferred alternative (the village) which isvulnerable to malnutrition. The result of this study can be used as a Decision SupportSystem (DSS) to help the stakeholders in addressing the malnutrition problems on the righttarget by pressing the factors

The Corelation between Perception of Leadership Practice and Perception of Service Quality by Medical and Paramedical Staff in Perinatal Room Kraton Hospital, Pekalongan Moh. Hasyim Purwadi; Sudiro Sudiro; Cahya Tri Purnami
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 1 (2013): April 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Pelayanan perinatal merupakan salah satu pelayanan unggulan di RSUD Kraton.Keterbatasan tenaga kesehatan terlatih dan kurangnya peralatan serta kurangnya dukunganpimpinan terhadap rumahsakit sayang bayi merupakan permasalahan yang dijumpai dalampelayanan perinatal di RSUD Kraton.Tujuan penelitian ini adalah menganalisis pengaruhpersepsi tentang praktek kepemimpinan terhadap persepsi mutu pelayanan di ruang perinatalRSUD Kraton Kab. Pekalongan. Jenis penelitian adalah analitik kuantitatif observasionaldengan pendekatan belah lintang (cross sectional). Pengumpulan data menggunakankuesioner dan observasi. Populasi sama dengan sampel penelitian adalah seluruh tenagamedis dan paramedis di ruang perinatal RSUD Kraton sebanyak 36 orang. Data dianalisisdengan uji korelasi Pearson product moment dan rank Spearman dilanjutkan uji regresilogistik. Hasil penilitian ini menunjukkan bahwa persepsi tentang praktek kepemimpinanmenantang proses: kategori baik (58,3%); menginspirasi visi bersama: kategori cukup(58,3%); memberdayakan orang lain untuk berbuat: kategori baik (63,9%), menjadi model:kategori cukup (52,8%); mendorong semangat: kategori baik (50%), dan persepsi tentangmutu pelayanan: kategori baik (55,6%). Ada hubungan antara persepsi praktek kepemimpinantentang menantang proses (r=0,832, p=0,0001), menginspirasi visi bersama ( =0,78,p=0,0001), mendorong semangat ( =0,615, p=0,0001) dan menjadi model ( =0,445,p=0,007) dengan persepsi mutu pelayanan perinatal. Tidak ada hubungan antara persepsipraktek kepemimpinan tentang memberdayakan orang lain untuk berbuat (r=0,252, p=0.139)dengan persepsi mutu pelayanan perinatal. Hasil uji regresi logistik menunjukkan bahwapersepsi praktek kepemimpinan menginspirasi visi bersama mempunyai pengaruh palingbesar terhadap persepsi mutu pelayanan perinatal (exp β = 84,5), diikuti praktekkepemimpinan mendorong semangat (exp β = 22,8) dan praktek kepemimpinan menjadimodel (exp β = 6,4).Perinatal service is one of eminent services in Kraton Hospital. Limitation of trained staff andless completeness of equipment as well as less leadership supports for “infant caringhospital” has been problems in the perinatal service in Kraton Hospital.ResearchObjective was to analyze influence of leadership practice perception to service qualityperception in perinatal room Kraton Hospital. Type of research was observationalquantitative analytic, with cross sectional approach. Data collection used questioner andobservation. Sample was total population. Those were all medical staff and paramedical staffin perinatal room Kraton Hospital, totally 36 respondents. Data analysis used Pearsonproduct moment correlation and Rank Spearman followed by logistic regression. Resultsshowed that perception of challenging process of leadership practice had category good(58.3%); inspiring of shared vision had category moderate (58.3%); empowering others hadcategory good (63.9%); become a model had category moderate (52.8%); driving spirit hadcategory good (50%); and perception of quality of services had category good (55.6%).There was a correlation between challenging process of leadership practices (ρ=0.832;p=0.0001); inspiring shared vision ( =0.78, p=0.0001); driving spirits ( =0.615,p=0.0001) and become a model ( =0.445, p=0.007) and perception of quality of perinatalservices. There was no correlation between perception of empowering others of leadershipand (ρ=0.252, p=0.139). Logistic Regression analysis showed that perception of inspiringshared vision of leadership had the greatest influence to perception of perinatal qualityservices (exp β = 84.5), followed by driving spirit of leadership (exp β = 22,8) and become amodel (exp β = 6,4).

Analisis Pemanfaatan Bantuan Operasional Kesehatan dalam Upaya Peningkatan Kesehatan Ibu dan Anak di Puskesmas Wilayah Kerja Dinas Kesehatan Kabupaten Kudus Andini Aridewi; Martha Irene Kartasurya; Ayun Sriatmi
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 1 (2013): April 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Bantuan Operasional Kesehatan (BOK) telah dimanfaatkan untuk penyelenggaraan upayapromotif dan preventif termasuk peningkatan kesehatan ibu dan anak (KIA) di Puskesmaswilayah kerja Dinas Kesehatan Kabupaten Kudus, namun kasus kematian ibu dan anak diKabupaten Kudus cenderung meningkat. Penelitian ini bertujuan untuk menjelaskanpemanfaatan BOK dalam upaya peningkatan KIA di Puskesmas wilayah kerja DinasKesehatan Kabupaten Kudus tahun 2011. Penelitian ini menggunakan metode kualitatifdengan membandingkan antara Puskesmas serapan tinggi yang berhasil menekan kasuskematian ibu dan bayi dengan Puskesmas serapan rendah dan kurang berhasil dalam menekankasus kematian ibu dan bayi. Pengambilan data dengan wawancara mendalam terhadapinforman utama Kepala Puskesmas serta informan triangulasi bidan koordinator KIA danDinas Kesehatan Kabupaten Kudus. Analisis data menggunakan metode analisis isi.Hasil penelitian menunjukkan pada Puskesmas dengan serapan tinggi dan berhasil menekankasus, pemahaman tentang juknis BOK jelas, pelaksanaan kegiatan sesuai dengan laporan dandilaksanakan secara tim, ada keterlibatan pelaksana dalam penyusunan Plan of Action (POA)serta ada evaluasi pelaksanaan kegiatan. Selain itu pada Puskesmas yang berhasil, pelaksanakegiatan juga menyusun kelengkapan data pendukung sehingga pembuatan laporan tidakhanya dibebankan kepada Tim Pengelola BOK Puskesmas. Demi keberhasilan implementasikebijakan pemanfaatan BOK untuk peningkatan kesehatan ibu dan anak, perlu penerapanfungsi manajemen yang benar di Puskesmas yang meliputi perencanaan, pelaksanaan, danevaluasi.Health Operational Aid (BOK) had been utilized for the implementation of promotive andpreventive services. This included maternal and child health improvement in the primaryhealthcare centers of Kudus district health office work area. However, maternal and childmortality in Kudus district tended to increase. The study objective was to explain theutilization of Health Operational Aid in the maternal and child health improvement efforts inthe primary healthcare centers of Kudus health office. This was a qualitative study. This studycompared utilization of BOK in high absorbing primary healthcare centers that succeeded in32minimizing maternal and infant mortality cases and in low absorbing primary healthcarecenters that did not succeed in minimizing maternal and infant mortality cases. Data werecollected through in-depth interview to main informants namely the head of primaryhealthcare centers, and triangulation informants namely maternal and child healthcoordinator midwives and head of Kudus district health office. Content analysis was appliedin the data analysis.Results of the study showed that in the high absorbing primaryhealthcare centers that succeeded in minimizing cases: understanding about healthoperational aid technical guideline was clear; implementation of activities was according tothe reports; executors were involved in a plan of action formulation; and there was anevaluation on the activity implementation. In addition, in the success primary healthcarecenters, it was found that executors of the activities arranged the completeness of supportingdata; therefore, report making was not done only by the management team of primaryhealthcare center’ health operational aid. To be successful in the health operational aidutilization for maternal and child health, application of a right management function in theprimary healthcare center is needed. This management function includes planning,implementation and evaluation

Analysis of Leadership’s Factors in Nursing Care Quality Effort at Hemodialysis Unit of B Class Hospital Yulius Widiyarta; Sudiro Sudiro; Bambang Edi Warsito
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 1 (2013): April 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Layanan unit Hemodialisa sebagai layanan unggulan masih bermasalah pada komitmen dankomunikasi kepemimpinan keperawatan. Penelitian ini betujuan untuk menjelaskan faktorkepemimpinan : komunikasi dan komitmen dalam upaya pelayanan keperawatan yangbermutu di Unit Hemodialisa di RS Tipe B. Penelitian ini dilakukan secara kualitatif denganmetode wawancara mendalam dan observasi. Subjek penelitian terdiri dari 11 orang yaitu 3orang informan utama (1 perawat kepala ruang dan 2 perawat) dan 8 orang informantriangulasi (1 dokter penanggung jawab unit hemodialisa, 4 perawat dan 3 pasien). Observasidilakukan dengan menggunakan check list atau daftar tilik. Hasil penelitian menunjukkanfaktor komunikasi yang terdiri dari fungsi instruksi, konsultasi, partisipasi, delegasi danpengendalian sudah dilakukan oleh pimpinan. Fungsi instruksi dilaksanakan denganmemberikan arahan tetapi strategi tidak disampaikan. Fungsi konsultasi sudah dilaksanakantetapi masukan tidak direspon oleh kepala ruang. Fungsi delegasi sudah dijalankan dari kepalaruangkepada kepala tim. Fungsi partisipasi sudah dilaksanakan. Fungsi pengendaliandilaksanakan dengan pengawasan langsung tetapi belum ada mekanisme monitoring danevaluasi . Untuk faktor komitmen, yang sudah dilakukan adalah komitmen untuk menjaditeladan dan pemberian motivasi sedangkan komitmen untuk melakukan monitoring danmenjalankan SOP belum dilaksanakan. Pelayanan keperawatan sudah dirasakan cukup baikoleh pasien dan kolaborasi antar petugas medis sudah berjalan dengan baik tetapi belum adapenjaminan mutu pelayanan keperawatan. Sarana dan prasarana sesuai persyaratan dariDepkes dan Pernefri belum dipenuhi. Simpulan, faktor komunikasi kepemimpinan belumsemuanya dilaksanakan oleh pimpinan keperawatan. Komitmen untuk menjadi teladan danmemberikan motivasi sudah dilaksanakan. Komitmen untuk melaksanakan SOP sertamelakukan monitoring dan evaluasi belum dilaksanakan. Saran, kepemimpinan keperawatanagar meningkatkan fungsi komunikasi, pelaksanaan SOP serta melakukan monitoring danevaluasi sebagai bentuk upaya penjaminan mutu pelayanan keperawatan.Haemodialysis unit service as an eminent service had been still a problematic in nursingleadership commitment and communication. This study objective was to explain the factors ofleadership : communication and commitment to quality nursing care effort in HaemodialysisUnit at the Type B Hospital. The research was conducted in-depth qualitative interviews andobservation. Research subjects consisted of 11 people : 3 key informants (1 head room nurseand 2 nurses) and 8 triangulation informants (1 physician responsible hemodialysis unit, 4nurses and 3 patients). Observations carried out by using a check list.The results shows thatthe communication factors consists of instruction, consultation, participation, delegation andcontrolling functions have been done by the head room nurse. The instruction function hasbeen implemented by providing direction but the strategy has not been delivered yet.Consulting function has been already implemented but the suggestion has not been respondedby the head room nurse. Delegation function has been functioning from the head room nurseto the team head nurse. Participation function has been implemented. Controlling functionhas been carried out under the direct supervision but there have been no monitoring andevaluation mechanisms. Commitment factor has been a model and a motivation, while thecommitment to monitor and to do using SOP has not been implemented. The nursing care hasbeen perceived quite well by patients and collaboration among medical officers has beengood but there has no assurance of quality nursing care. Facilities and infrastructuresaccording to the requirements of the Department of Health and Pernefri have not beenfulfilled. Conclusion, leadership communication factors have not all done by nursingleadership. Commitment to be a model and and a motivation have been implemented.Commitment to implement the SOP and conduct monitoring and evaluation have not beenconducted. Suggestions, nursing leadership should improve the functioning of nursingleadership communication, implementation of SOPs and conduct monitoring and evaluationas an effort to guarantee quality of nursing care

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

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.

Implementasi Program Manajemen Terpadu Balita Sakit (MTBS) Puskesmas Wilayah Kabupaten Pasuruan Nikmatul Firdaus; Sudiro Sudiro; Atik Mawarni
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 1 (2013): April 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Pada tahun 2006 sosialisasi program MTBS dan pelatihan kepada petugas puskesmas telah dilakukan, dimana masing-masing Puskesmas diwakili oleh 1 orang tenaga medis (dokter) dan 2 orang tenaga paramedis(bidan, perawat). Akan tetapi kematian balita di kabupaten Pasuruan mengalami kenaikan, yaitu tahun 2007 sebesar 5,2/1000 kelahiran hidup, tahun 2008 sebesar 5,4/1000 kelahiran hidup dan tahun 2009 sebesar 6,1/1000 kelahiran hidup. Darikematian tersebut diketahui penyebabnya antara lain karena gizi buruk, pneumonia, DBD,diare serta infeksi. Oleh karena itu perlu dilakukan analisis terhadap faktor faktor dalam implementasi program MTBS di Puskesmas Kabupaten Pasuruan. Jenis penelitian adalah deskriptif kualitatif, metode sampling yang digunakan adalah purposive sampling. Sebagai informan utama adalah petugas MTBS (dokter, bidan, perawat) di Puskesmas wilayahperkotaan dan pinggiran kota yang melakukan MTBS, berjumlah 12 orang. Sedangkan sebagai informan triangulasi adalah 4 kepala Puskesmas, satu Kasie Kesga Dinas Kesehatan Kabupaten Pasuruan. Variabel dalam penelitian ini adalah faktor komunikasi, faktor sumber daya, faktor disposisi, serta faktor struktur birokrasi. Penelitian memberikan hasil sosialisasi dan pelatihan program MTBS sudah dilakukan. Petugas yang melayani balita sakit belum menunjang keberhasilan pencapaian tujuan MTBS oleh karena belum semua petugas mendapatkan pelatihan MTBS, jumlah petugas tidak sebanding dengan jumlah balita sakityang berkunjung. Seluruh petugas MTBS mempunyai sikap positif untuk mendukung program MTBS. Meskipun sudah tersedia SOP namun tidak semua petugas menggunakannya dalam melayani MTBS. Pembinaan dari DKK belum dilakukan rutin, supervisi masih bersifat umum, serta tidak ada tindak lanjut yang diberikan. Agar pelayanan MTBS terlaksana dengan baik maka perlu ditingkatkan sosialisasi SOP yang disertai pelatihan yang meratauntuk semua petugas serta supervisi yang spesifik pada MTBS.Data in 2007-2010 showed that integrated management of childhood illness (IMCI) activities increased. However, IMCI coverage had not reached the target established by Pasuruan district health office, which was 80%. Preliminary study indicated that not all under-five children who visited health centers received IMCI services. It was caused by no availability of IMCI facilities, unscheduled supervision, and no feedback. The objective of this study was to explain IMCI program implementation from policy aspect in primary healthcare centers in Pasuruan district. This was an observational qualitative study with cross sectional approach. Study population was all primary healthcare centers that performed IMCI in Pasuruan district. Main informants were IMCI team that consisted of physicians, midwives, nurses. Triangulation informants were policy makers such as head of primary healthcare center, head of family health section, and consumers. Results of the study showed that in 4 primary healthcare centers with high IMCI coverage, communication had been performed (socialization and marketing); however, there was no specific organizational structure (unstructured). Viewed from resources side, not all human resource received IMCI training; not all facilities of IMCI were fulfilled; specific funding for IMCI program was not allocated. In relation to disposition, all workers had positive attitude in supporting IMCI program. Bureaucracy structure was not optimal; there was a standard operating procedure, but it was not implemented correctly in practice. There was recording and reporting, but routine supervision and feedback was not performed. Based on the results of study, it was suggested and recommended to keep doing IMCI program socialization, human resource improvement, facility fulfillment, improvement of workers by conducting IMCI training, implementing arrangement for reporting and recording to district health office, improvement in supervision quality by giving feedback to district health office.

Evaluation on the Implementation of Mobile Clinic Program in Maternal Health Service in Sorong City of West Papua Province Adriana Egam; Martha Irene Kartasurya; Ayun Sriatmi
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 2 (2013): Agustus 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Kementerian Kesehatan melaksanakan program Mobile Clinic, untuk lebih mendekatkan akses pelayanan kesehatan pada masyarakat di Tanah Papua. Target cakupan mobile clinic masih belum tercapai, walaupun biaya yang dikeluarkan sangat besar. Tujuan penelitian adalah melakukan evaluasi pelaksanaan program mobile clinic dalam pelayanan kesehatan ibu di Kota Sorong Propinsi Papua Barat. Jenis penelitian ini adalah deskriptif kualitatif, Informan utama adalah seluruh tim mobile clinic Kota Sorong. Informan triangulasi adalah kader mobile clinic dan pengelola program mobile clinic. Pengumpulan data dilakukan melalui indepth interview dan focus group discussion. Pengolahan data dilakukan dengan metode analsis isi (content analysis). Hasil penelitian menunjukkan bahwa perencanaan sudah dilakukan oleh semua tim mobile clinic. Ada kendala keterbatasan tenaga pada 2 puskesmas sehingga perlu penunjukan tenaga pelaksana dari unit kerja lain. Pengorganisasian dengan pemberdayaan kader sudah terlaksana dengan baik. Pada penggerakkan dan pelaksanaan terdapat dua kebijakan yang tidak sesuai Juknis yakni penambahan tenaga dan pergantian personil TMC (Tim Mobile Clinic). Penambahan tenaga meningkatkan pencapaian cakupan dan penambahan jenis pelayanan yaitu ANC terpadu. Pergantian personil TMC pada tenaga yang tidak dilatih berdampak tidak tercapainya target cakupan. Kerjasama tim, lintas program dan lintas sektoral terjalin baik.Pelaporan tidak lengkap dan supervise yang dilakukan tidak memberikan masukan. Sulitnya jangkauan dan besarnya biaya transportasi tidak menghambat pelayanan karena didukung alokasi dana yang memadai. Direkomendasikan agar program dilakukan kembali dengan perbaikan petunjuk teknis dan biaya yang disesuaikan dengan Perda Ministry of Health implemented mobile clinic program to bring health service access closer to the community in Papua land. Target coverage of mobile clinic program was not attained, although the cost spent was very high. Objective of the study was to evaluate the implementation of mobile clinic program in maternal health service in Sorong city of West Papua province. This was a descriptive-qualitative study. Main informants were all team of mobile clinic of Sorong city. Triangulation informants were mobile clinic cadres and mobile clinic managers. Content analysis was applied in the data management. Results of the study showed that planning had been done by all mobile clinic teams. There were limited staffs in two primary healthcarecenters(puskesmas), and this situation allowed choosing executor workers from other work units. Organizational activities with empowerment of cadres had been done properly. There were two policies that did not agree with technical guidelines in the actuating and implementing of the program namely addition of staffs and changing of mobile clinic team (TMC) personnel.Addition of the staffs increased coverage and added type of service. The added type of service was an integrated antenatal care (ANC). The change of TMC personnel with untrained personnel caused a fail to attain the target coverage. Collaboration among teams, cross programs and sectors had been performed well. Reporting was not good, and supervision done did not provide inputs. Difficulty in reaching location and expensive transportation costs did not hamper services due to sufficient funding allocation support. Reimplementation of the program with technical guidance improvement and budget aligned with Perda is recommended.

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

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 Affecting Village Midwives Work Performance in Conducting Early Detection of High Risk Pregnancy in the Antenatal Care in South Bengkulu District Harlen Yunita; Tjahjono Kuntjoro; Cahya Tri Purnami
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 2 (2013): Agustus 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Pelayanan antenatal adalah memberikan pelayanan kesehatan bagi ibu hamil dan janinnya sesuai standar minimal 7T serta minimal empat kali pemeriksaan selama kehamilan. Standar waktu tersebut untuk menjamin perlindungan kepada ibu hamil, berupa deteksi dini faktor risiko, pencegahan dan penanganan komplikasi. Berdasarkan cakupan Pemantauan Wilayah Setempat Kesehatan Ibu dan Anak (PWS-KIA), angka kematian ibu dan bayi serta survei awal terhadap bidan desa disimpulkan bahwa masih rendahnya kineja bidan desa.Tujuan penelitian adalah mengetahui faktor apa saja yang mempengaruhi kinerja bidan desa dalam deteksi dini resiko tinggi ibu hamil pada pelayanan antenatal. Jenis penelitian bersifat explanatory research dengan pendekatan cross sectional. Pengumpulan data menggunakan kuesioner terstruktur danobservasi. Populasi penelitian adalah bidan desa, dengan sampel 93 responden diambil denganteknik simple random sampling. Hasil penelitian menunjukkan 73,1% bidan desa pada rentangumur 25-35 tahun dan 37,6% rentang masa kerja 36-60 bulan. Analisis bivariat dengan tabulasisilang dan uji Pearson Product Moment menunjukkan bahwa variabel yang berhubungan dengankinerja yaitu pengetahuan (ρ=0,000), motivasi (ρ=0,004), persepsi supervisi bidan koordinator(ρ=0,016), persepsi beban kerja (ρ=0,047). Analisis multivariat dengan uji regresi logistikberganda menunjukkan adanya pengaruh bersama-sama variabel pengetahuan dan saranaprasarana dengan nilai signifikansi 0,000 dan R2 0,394, berarti 39,4% variabel kinerja dapatdijelaskan oleh variasi dari kedua variabel tersebut. Dinas Kesehatan Kabupaten diharapkanmemberi pelatihan, melengkapi sarana prasarana bidan desa sebelum bekerja di desa,membentuk tim atau panitia sebagai wadah konsultasi. Puskesmas agar melengkapi saranapendokumentasian, kepala puskesmas dan bidan koordinator aktif mengadakan pembinaan. Antenatal care provided health service for pregnant women and their fetuses according to theminimum standard of 7T, and minimum of four examinations during pregnancy. These standards were intended to assure protection to pregnant women, such as risk factors early detection,complication prevention and management. Based on the coverage of maternal and children local area monitoring (PWS-KIA), maternal and infant mortality rates, and preliminary survey to village midwives, it was concluded that work performance of village midwives was still inadequate. Objective of this study was to identify factors affecting work performance of village midwives in conducting early detection of high risk pregnancy in the antenatal care. This was an explanatory research with cross sectional approach. Data were collected using structuredquestionnaire and observation. Study population was village midwives. Samples consisted of 93respondents who were selected using simple random sampling technique. Results of the studyshowed that 73.1% of village midwives’ age were in the range of 25-35 years old, and 37.6% of village midwifes duration of work were in the range of 36-60 months. Bivariate analysis withcross tabulation and Pearson Product Moment test indicated that variables related to workperformance were knowledge (p= 0.000), motivation (p= 0.004), perception on supervision ofcoordinator midwives (p= 0.016), and perception on workload (p= 0.047). Multivariate analysisusing multivariate logistic regression test indicated common effect of knowledge and facilitiesvariables with significance value of 0.000 and r 2 = 0.394; it meant that 39.4% of workperformance variable could be explained by variation of those two variables. District healthoffice is expected to provide training, to complete facilities for village midwives before startingto work in the village; to form team or committee as a consultation place. Puskesmas is expected to complete documentation facilities; head of puskesmas and coordinator midwives are advised to actively doing supervision.

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Prodi Magister Ilmu Kesehatan Masyarakat Fakultas Kesehatan Masyarakat UNDIP, Jalan Professor Soedarto, Tembalang, Kota Semarang, Jawa Tengah 50275, Indonesia

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Editorial Address Prodi Magister Ilmu Kesehatan Masyarakat Fakultas Kesehatan Masyarakat UNDIP, Jalan Professor Soedarto, Tembalang, Kota Semarang, Jawa Tengah 50275, Indonesia

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Prodi Magister Ilmu Kesehatan Masyarakat Fakultas Kesehatan Masyarakat UNDIP, Jalan Professor Soedarto, Tembalang, Kota Semarang, Jawa Tengah 50275, Indonesia

Location
Kota semarang,

Jawa tengah

INDONESIA