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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
Jurnal Manajemen Kesehatan Indonesia
Published by Universitas Diponegoro
ISSN : 23033622     EISSN : 25487213.     DOI : -
Core Subject : Health, Science,
Decision Sciences, Operations Research & Management Health Professions
Arjuna Subject : -
Articles 10 Documents
 1 
Search results for , issue "Vol 3, No 1 (2015): April 2015" : 10 Documents clear
Analysis on Determinants of Pulmonary Tuberculosis Officer Motivations In Tuberculosis Case Invention in Semarang Regency (A Case Study in Several Primary Health Care Centers) Joyo Minardo; Ayun Sriatmi; Septo Pawelas Arso
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 1 (2015): April 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (274.01 KB) | DOI: 10.14710/jmki.3.1.2015.%p

Abstract

Penderita Tuberkulosis dengan status Basil Tahan Asam (BTA) positif dapat menularkan ke 1015 orang lain setiap tahunnya, sehingga penemuan kasus penting dilaksanakan. Cakupan penemuan kasus tuberkulosis dengan BTA positif di Kabupaten Semarang tahun 2009 jauh di bawah cakupan nasional. Rendahnya disebabkan karena motivasi petugas yang kurang. Tujuan penelitian ini untuk menganalisis faktor yang dapat menurunkan motivasi petugas TB dalam  penemuan kasus di Kabupaten Semarang. Penelitian dilakukan dengan metode kualitatif.  Pengumpulan data primer dilakukan dengan wawancara mendalam, dan data sekunder dengantelaah dokumentasi. Subjek penelitian adalah petugas Tuberkulosis Paru di Puskesmas.  Pemilihan subjek dilakukan secara purposive. Informan utama berjumlah 18 orang, terdiri dari 6 orang perawat, 6 orang Analis dan 6 orang dokter kepala Puskesmas. Informan triangulasi adalah 6 orang petugas BP, dan satu orang Kasie P2M Dinkes Kabupaten Semarang. Analisis data dilakukan dengan content analysis. Hasil penelitian menunjukkan bahwa motivasi  petugas rendah karena pekerjaannya merupakan penunjukkan pimpinan Puskesmas dan membutuhkan waktu yang lama serta berisiko tertular oleh penderita. Tanggung jawab dalam menyelesaikan pekerjaan kurang karena beban pekerjaan yang banyak, bekerja tanpa target dan motivasi. Petugas tidak mendapatkan kompensasi, membutuhkan dukungan dari pimpinan untuk mengeluarkan ide dan gagasan dalam penemuan kasus. Sarana transportasi untuk penemuan kasus tidak ada. Puskemas tidak memiliki rencana implementasi kebijakan program penemuan kasus, dan sistem supervisi terhadap cakupan penemuan kasus belum optimal. Disimpulkan bahwa motivasi petugas Tuberculosis Paru dalam penemuan kasus masih rendah, karena belum ada dukungan dan tanggung jawab masih kurang serta sistem kompensasi dan supervisi yang belum ada. Tuberculosis patients with positive acid fast bacilli (BTA) were able to infect 10-15 other people every year; therefore case detection was important to be implemented. Detection coverage of tuberculosis cases with positive BTA in Semarang district was far below national coverage. This low coverage could be caused by low motivation of tuberculosis (TB) health workers. Objective of this study was to analyze factors that decreased motivation of TB workers in conducting case detection in Semarang district. This was a qualitative study. Primary data collection was done by conducting in-depth interview; secondary data collection was done by conducting documentation review. Study subjects were lung tuberculosis workers in the primary healthcare centers. Subjects were purposively selected. The number of main informants was 18 people. The main informants were six nurses, 6 analysts, and six heads of primary health care centers. Triangulation informants were six polyclinic health workers, and one head of communicable disease control unit of Semarang district health office. Content analysis method was applied in the data analysis. Results of the study showed that motivation of TB workers was low due to the works were assigned by the primary healthcare centers leader, the work took longer time, and workers were at risk to get infection from patients. Responsibility to finish the works was low due to high amount of workload, work without target and motivation. TB workers did not get compensation; they needed support from the leader to express their ideas in the case detection. Transportation facility for case detection was not provided. The primary healthcare centers did not have planning to implement case detection program policy. Supervision system on case detection coverage was not optimal. In conclusion, motivation of lung tuberculosis workers in case detection was low. It was caused by no supports, insufficient responsibility, and no compensation and supervision.
Quality Management of Emergency Room (ER) Services in the District General Hospital of Kudus Elok Mariyatul Qibtiyah; Sudiro Sudiro; Lucia Ratna Kartika Wulan
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 1 (2015): April 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (152.143 KB) | DOI: 10.14710/jmki.3.1.2015.%p

Abstract

Mutu pelayanan Instalasi Gawat Darurat (IGD) RSUD Kudus yang meliputi sumber daya manusia, kebijakan dan prosedur serta sarana prasarana IGD belum sesuai standar IGD RS level III. Penelitian ini bertujuan untuk mengetahui manajemen mutu pelayanan IGD yang meliputi proses manajemen mutu, kepemimpinan mutu dan organisasi mutu. Jenis penelitian ini dilakukan secara kualitatif menggunakan metode observasi, Focus Group Discussion (FGD) dan wawancara mendalam. Subyek sebanyak 13 orang terdiri atas: 4 orang sebagai informan utama, 9 orang sebagai informan triangulasi terdiri atas 3 orang petugas IGD RSUD Kudus dan 6 orang keluarga pasien. Variabel yang diukur adalah proses manajemen mutu, kepemimpinan mutu, organisasi mutu dan mutu pelayanan IGD RSUD Kudus. Hasil penelitian ini meliputi perencanaan mutu: jumlah dan kompetensi petugas kurang, belum ada pedoman orientasi, belum ada pedoman mutasi, pengadaan, pemeliharaan dan kalibrasi alat kurang. Pengendalian mutu : evaluasi kinerja belum ada. Peningkatan mutu : peningkatan sumber daya manusia kurang, belum ada pedoman pelatihan, belum ada pengaturan anggaran terintegrasi dengan pengadaan sarana prasarana dan sarana prasarana kurang. Kepemimpinan mutu : gaya demokratis dengan kebijakan yang jelas. Organisasi mutu: pengalaman manajemen dan kompetensi Kepala IGD baik, perubahan yang mundukung mutu pelayanan IGD bisa diterima baik. Mutu pelayanan IGD meliputi SDM yaitu kepala IGD yang mempunyai kriteria khusus baik, petugas IGD yang mempunyai kriteria khusus kurang, sarana prasarana kurang, kebijakan dan prosedur kurang. Kesimpulan penelitian ini adalah proses manajemen mutu IGD RSUD Kudus belum berjalan baik, gaya kepemimpinan demokratis dengan kebijakan jelas, organisasi mutu berjalan baik, petugas IGD belum memenuhi kriteria khusus. Saran penelitian ini adalah mengadakan rapat kerja guna menyusun rencana strategis dan kebijakan pimpinan yang jelas sebagai arah dan pedoman yang dituangkan dalam program kerja tahunan di RSUD Kudus. Service quality of an emergency room unit (IGD) of Kudus District General Hospital (RSUD) included human resource, policy, procedure and facility of IGD. This was not fit properly with level III IGD standard. Objective of this study was to identify service quality management of IGD including quality management process, quality of leadership, and quality of organization. This was a qualitative study using observation, focus group discussion, and in-depth interview methods. Study subjects were 13 people: four main informants, nine triangulation informants. Triangulation informants included 3 workers at IGD of RSUD Kudus, and six patient’s family members. Measured variables were quality management, quality of leadership, organizational quality, and service quality of IGD of RSUD Kudus. Results of this study included quality planning: the number of workers and worker’s competence were insufficient; no orientation guideline and transfer or workers guideline were provided; maintenance and instrument calibration were insufficient. Quality control: no evaluation of work performance was provided. Quality improvement: human resource improvement was not adequate; no training guideline was provided; no integrated budget regulation was performed; supply of facilities was not adequate. Quality of leadership: Democratic style with understandable policy was applied. Organizational quality: management experience and the competence of head of IGD were good; changes that supported IGD service quality were well accepted; Service quality of IGD, that included human resource such as chief of IGD with special criteria, was good. IGD workers with special criteria were insufficient. Facilities were insufficient. Policy and procedure were insufficient. In conclusion, the quality management process of IGD RSUD Kudus was insufficient; democratic leadership with understandable policy was applied; organizational quality was good; IGD workers were not matched with specific qualification. Suggestions: to conduct meeting to formulate clear strategic plan and clear leader policy as guidelines. It should be included in the annual working program in RSUD Kudus.
Supplementary Feeding Program Evaluation Restoration Malnourished In Children Under Five In The District Wonogiri Seen From Input and Process Aspects Ratna Indriati; Sri Achadi Nugraheni; Apoina Kartini
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 1 (2015): April 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (217.747 KB) | DOI: 10.14710/jmki.3.1.2015.%p

Abstract

Salah satu upaya untuk mengatasi masalah kurang gizi di Kabupaten Wonogiri adalah dengan program PMT-P. Program ini sudah dilakukan sejak tahun 2007 namun belum menunjukkan hasil yang bermakna. Hasil studi pendahuluan menunjukkan masih ada kendala dalam aspek input dan proses dalam pelaksanaan program ini. Tujuan penelitian untuk mengevaluasi pelaksanaan program PMT-P balita kurang gizi. Jenis penelitian observasional analitik dengan metode kualitatif untuk mengevaluasi pelaksanaan program PMT-P oleh TPG dan kuantitatif untuk membandingkan pelaksanaan program PMT-P oleh bidan desa antara puskesmas yang mengalami peningkatan dan penurunan kasus balita kurang gizi. Informan utama 4 TPG dari 4 puskesmas yang mengalami peningkatan dan penurunan kasus balita kurang gizi. Informan triangulasi yaitu 4 kepala puskesmas, Kasi Kesga dan Gizi DKK, 4 bidan desa, 4 kader posyandu, dan ibu balita penerima PMT-P. Subjek penelitian kuantitatif adalah 60 bidan desa yang dipilih secara purposif dari puskesmas tersebut. Pengumpulan data kualitatif melalui wawancara mendalam dan kuantitatif dengan angket. Analisis data kualitatif dengan contentanalysis dan kuantitatif dengan uji statistik Mann Whitney. Pelaksanaan PMT-P di puskesmas yang mengalami penurunan kasus kurang gizi lebih banyak yang optimal (83,3%) dibandingkan puskesmas yang mengalami peningkatan kasus (56,7%). Perbedaan mencolok pada pelaksanaan meliputi sosialisasi ke masyarakat, registrasi sasaran, pemantauan daya terima makanan tambahan, penggunaan kartu pemantauan serta pendampingan bidan terhadap kader lebih banyak dilakukan oleh puskesmas yang mengalami penurunan kasus balita kurang gizi. Pemberian paket PMT-P di puskesmas yang mengalami peningkatan kasus dilakukan pada semua balita dengan rata-rata pemberian selama satu bulan. Selain itu puskesmas kurang melibatkan perangkat desa dan kecamatan dalam PMT-P. Penentuan sasaran dengan tepat dan peningkatan peran serta masyarakat dapat menurunkan kasus kurang gizi. One of efforts to solve undernourishment problems in Wonogiri district was a recovery food supplement distribution (PMT-P) program. This program has been implemented since 2007. However, it had not shown significant results. Preliminary studies showed that there were problems in input and process aspects in the implementation of this program. Objective of the study was to evaluate the implementation of PMT-P program for undernourished under-five children (balita). This was an observational-analytical study. A qualitative method was applied to evaluate the implementation of PMT-P program by TPG. A quantitative method was used to compare the implementation of PMT-P program by midwives in the primary healthcare centers (puskesmas) with increasing and decreasing numbers of undernourished under-five children cases. The main informants were four TPG from four puskesmas that experienced the increase and decrease numbers of undernourished under-five children cases. Triangulation informants were four heads of puskesmas, a head of Kesga and nutrition section of the district health office, four village midwives, four posyandu cadres, and mothers of under-five children who received PMT-P. Subject of the quantitative study were 60 midwives selected purposively from each puskesmas. Qualitative data were collected through in-depth interview; quantitative data were collected using questionnaire. Content analysis was applied for qualitative data analysis, and Mann-Whitney statistic test was applied for quantitative data analysis. Implementation of PMT- P in puskesmas that experienced the decrease of the number of undernourished cases was more optimal (83.3%) than in puskesmas that experienced the increase of the cases (56.7%). Distinct difference that was shown in the implementation included socialization to the community, target registration, monitoring of PMT absorption ability, monitoring card usage. Midwives accompaniment to cadres was conducted more frequent by puskesmas that experienced the decrease of the number of undernourished under-five children cases. PMT-P packages were distributed continually to all under-five children in the puskesmas that experienced the increase of the cases for a month in average. Additionally, puskesmas did not optimally involve village staffs and sub district office staffs in the PMT-P program activities. The implementation of PMT- P in puskesmas that experienced the decrease of undernourished cases is better. Accurate determination of the target and improvement of community involvement should be able to decrease undernourished cases.
Factors Related to the Use of Long Term Contraception Method (A Study on Contraceptive Users in Kabupaten Sidoarjo, East Java Province) Djauharoh A. Hadie; Martha Irene Kartasurya; Cahya Tri Purnami
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 1 (2015): April 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (322.685 KB) | DOI: 10.14710/jmki.3.1.2015.%p

Abstract

Laju pertumbuhan penduduk Indonesia cukup tinggi, sehingga penggunaan MKJP sangat diperlukan. Penggunaan MKJP di Kabupaten Sidoarjo cenderung menurun, dan lebih rendah dibanding penggunaan MKJP di tingkat Provinsi. Penelitian ini bertujuan untuk menganalisis hubungan pengetahuan, sikap akseptor terhadap MKJP, dan akses pelayanan KB, serta sikappetugas dalam pelayanan KB dengan penggunaan MKJP di Kabupaten Sidoarjo Provinsi Jawa Timur. Jenis penelitian adalah observasional analitik dengan disain Cross Sectional. Populasi penelitian adalah akseptor aktif di Kabupaten Sidoarjo. Subyek sejumlah 100 orang akseptor MKJP dan non MKJP, dipilih secara purposif. Pengumpulan data menggunakan data primer dan sekunder, dan dianalisis secara deskriptif menggunakan distribusi frekuensi, Analisis bivariat dilakukan dengan uji Chi-Square, dan analisis multivariat dengan Regresi Logistik ganda. Hasil penelitian menunjukkan 63% responden berumur lebih dari 30 tahun, 54% berpendidikan Dasar, 65% bekerja sebagai ibu rumah tangga, 52% berpenghasilan kurang dari UMR, 79% memiliki paritas rendah (<3), dan 81% umur anak terkecil ≥ 3 tahun. Analisis bivariat didapatkan ada hubungan pengetahuan (p=0,0001), sikap akseptor terhadap MKJP (p=0,001), sikap akseptor terhadap akses pelayanan KB dengan penggunaan MKJP (p=0,019). Sikap petugas dalam pelayanan KB (p=0,715) tidak berhubungan dengan penggunaan MKJP. Variabel yang bersamasama berhubungan dengan penggunaan MKJP adalah pengetahuan, sikap akseptor tehadap MKJP, dan akses pelayanan KB. Faktor yang berhubungan paling kuat dengan penggunaan MKJP adalah pengetahuan akseptor tentang MKJP. Growth rate of Indonesian population was high, and long term contraception method (MKJP) was needed. The use of MKJP in Sidoarjo district tended to decrease; it was lower than the use of MKJP in province level. Objective of this study was to analyze association between knowledge, attitude of acceptors towards MKJP, family planning access, workers attitude in the family panning (KB) service and the use of MKJP in Sidoarjo district, East Java province. This was an observational-analytical and quantitative study using cross sectional approach. Study population was active acceptors in Sidoarjo district.Study subjects were 100 MKJP and non MKJP acceptors who were purposively selected. Data collection was done by collecting primary and secondary data. Data was analyzed by applying descriptive analysis, Chi-Square test, and multiple logistic regressions. Results of the study showed that 63% of respondents were more than 30 years old, 54% of respondents’ level of education were elementary school, 65% of respondents worked as housewives, 52% of respondents had salary below the minimum regional pay (UMR), 79% of respondents had low parity (< 3), and 81% of respondents had the last child with age 3 years old or higher. Results of bivariate analysis showed association between the use of MKJP and knowledge (p= 0.0001), acceptor attitude towards MKJP (p= 0.019), acceptor attitude towards AKB service accessibility (p= 0.019). Workers attitude in the KB service (p= 0.715) did not associate with the use of MKJP. Variables that jointly rellated to the use of MKJP were knowledge, attitude of acceptor towards MKJP, and accessibility to KB service. The strongest factor that associated with the use of MKJP was knowledge of acceptor about MKJP.
Evaluation on the Implementation of Maternal and Child Health Service Reporting by Coordinator Midwives at Primary Healthcare Centers in Nabire District, Papua Province Yokbeth Kareth; Cahya Tri Purnami; Ayun Sriatmi
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 1 (2015): April 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (353.532 KB) | DOI: 10.14710/jmki.3.1.2015.%p

Abstract

Pencatatan data pelayanan KIA di Dinas Kesehatan Kabupaten nabire tidak lengkap karena data dari puskesmas  tidak masuk tepat waktu. Disisi lain, hasil PWS digunakan untuk perencanaan program KIA dalam rangkan penurunan AKI. Tujuan penelitian adalah menjelaskan pelaksanaan pencatatan data pelayanan KIA dan pelaporannya oleh Bidan Koordinator di puskesmas Distrik Nabire. Penelitian menggunakan metode kualitatif. Informan utama bidan koordinator dan informan triangulasi bidan desa, kepala puskesmas dan Kasie KIA DKK. Pengumpulan data dengan wawancara mendalam dan dianalisis dengan content analysis. Hasil penelitian menunjukkan bahwa puskesmas yang pencatatan & pelaporan KIA baik, bidan koordinatornya melakukan pencatatan lengkap dan mengumpulkan tepat waktu setiap tanggal 10 ke DKK. Bidan telah mendapat pelatihan khusus tentang pencatatan & pelaporan KIA. Pada puskesmas yang pencatatan & pelaporan KIA kurang baik, bikor tidak mengisi kolom-kolom isian format secara lengkap dan tidak mengerti cara mengisi format isian yang sering berubah. Bidan belum mendapat pelatihan khusus. Keberhasilan dalam kelengkapan pencatatan & ketepatan pelaporan dipengaruhi oleh kelengkapan dan ketepatan pelaporan bidan pustu ke puskesmas. Keterlambatan disebabkan oleh jarak dan akses geografis yang sulit terjangkau serta beban kerja yang berat. Semua bikor mempunyai sikap dan motivasi baik. Supervisi Kepala Puskesmas yang pencatatan & pelaporan KIAnya baik dilakukan sebulan sekali dan yang kurang baik 3 bulan sekali. Supervisi DKK ke puskesmas yang baik 3 bulan sekali dan puskesmas yang kurang baik 6 bulan sekali. Disarankan agar DKK mengalokasikan anggaran untuk pelatihan khusus pencatatan & pelaporan KIA bagi bikor yang belum dilatih serta mengusahakan melengkapi sarana prasarana terutama di puskesmas dengan akses yang sulit.  Recording of KIA (maternal and children health) data in Nabire district health office (DKK) was not complete because data from primary healthcare centers (puskesmas) did not arrive at DKK Nabire on time. On the other side, results of PWS (local monitoring area) were used for KIA program planning in order to reduce AKI (maternal mortality rate). Objective of this study was to explain the implementation of recording and reporting KIA service data by coordinator midwives in puskesmas of Nabire district. This was a qualitative study. Main informant was coordinator midwives, and triangulation informants were village midwives, heads of puskesmas, and heads of KIA section of DKK. Data were collected through in depth interview. Content analysis method was applied in the data analysis.Results of the study showed that in the puskesmas with good KIA recording and reporting, coordinator midwives did complete recording and reporting and submit them on time, every 10 th day of the month, to the district health office; midwives had received special training regarding KIA recording and reporting. In the puskesmas with inadequate KIA reporting and recording, coordinator midwives did not fill the provided coulombs in the forms completely, and they did not know how to fill the forms that were changed frequently; midwives had not received special training. Successfulness in completion of recording and reporting punctuality was influenced by completeness and punctuality of reporting by midwives in the subsidiary primary healthcare center to the main primary healthcare center. The delay was caused by distance and difficult geographical accessibility, and heavy workload. All coordinator midwives had good attitude and motivation. Supervision by head of puskesmas with good KIA recording and reporting was done every month, and for the puskesmas with inadequate KIA recording and reporting was done every 3 months. Supervision by DKK to puskesmas with good KIA recording and reporting was done every 3 months, and to puskesmas with inadequate KIA recording and reporting was done every 6 months.Suggestions for DKK are to allocate budget for special training in KIA recording and reporting for coordinator midwives who have not received training, and to complete facilities especially in puskesmas with difficult accessibility.
Implementation on the Referral System of High Risk Pregnant Women from Villages Midwives to Primary Healthcare Center with Basic Obstetric and Neonatal Emergency Care in Banjar District, South Kalimantan (a Case Study in Sungkai Primary Healthcare Center) Adriana Palimbo; Ayun Sriatmi; Tjahjono Kuntjoro
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 1 (2015): April 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (419.291 KB) | DOI: 10.14710/jmki.3.1.2015.%p

Abstract

Kualitas pelayanan rujukan kebidanan tidak bisa terlepas dari system rujukan yang dilaksanakan oleh bidan desa sebagai pos pelayanan terdepan di masyarakat. Selain karena faktor sistem penanganan kasusnya yang kurang sesuai dengan prinsip dasar merujuk, diduga juga karena keterlambatan menganal tanda bahaya dan mengambil keputusan dan terlambat mendapat pelayanan di fasilitas kesehatan. Tujuan penelitian adalah menjelaskan pelaksanaan sistem rujukan ibu hamil risiko tinggi oleh bidan desa ke Puskesmas PONED Kabupaten Banjar tahun 2011. Penelitian ini adalah penelitian observasional menggunakan rancangan deskriptif kualitatif, dalam bentuk studi kasus untuk menggambarkan dan memahami fenomena yang berkaitan dengan pendekatan crossectional. Instrumen penelitian adalah bidan desa Puskesmas Sungkai yang melakukan rujukan kasus ibu hamil risiko tinggi ke Puskesmas PONED. Data dikumpulkan dengan wawancara mendalam dan dianalisis dengan teknik kualitatif. Hasil penelitian menunjukkan bahwa masih ada bidan desa yang melakukan stabilisasi diluar kewenangan. Sebagian besar masyarakat menggunakan pembiayaan Jamkesmas, tetapi dari biaya dan ketersediaan transportasi/ambulan desa dan keperluan lain masih masih kurang memadai bagi pasien Jamkesmas. Selama proses pendampingan bidan sebagian besar hanya mendampingi jika pasien dirujuk ke RS swasta, tetapi hal sama tidak dilakukan pada pasein Jamkesmas. Dalam merujuk ibu hamil ke puskesmas PONED bidan desa tidak membawa surat pengantar rujukan, tetapi hal sama juga tidak dilakukan saat merujuk ke RS swasta. Bidan menyertakan surat dan lampiran buku KIA jika ke RS umum untuk tujuan klem Jamkesmas. Berdasarkan hasil penelitian tersebut disarankan kepada Dinas Kesehatan untuk melengkapi jumlah tenaga bidan desa dan kualifikasinya, serta kecukupan alat/obat/bahan di Polindes/Poskesdes. Bagi Puskesmas untuk melakukan pembinaan dan supervisi bidan di desa dan ada pembagian tugas yang jelas untuk bidan desa di wilayah kerjanya. Quality of obstetrical referral service could not be separated from referral system done by village midwives as a front health service post in the community. Obstetric case management that was not fully follow a basic principle of referral, delays to identify signs of dangerous pregnancy condition, delay to make decision, and delay to obtain services in the health facility were factors related to the quality of obstetrical referral service. The objective of this study was to explain the implementation of high risk pregnancy referral system by village midwives to PONED primary healthcare center Banjar district, 2011. This was an observational study using descriptive qualitative design. This study was in the form of a case study to describe and to comprehend related phenomena using cross sectional approach. Study instrument was village midwives from Sungkai primary healthcare center who referred high risk pregnant women to PONED primary healthcare center. Data were collected by conducting in-depth interview. Qualitative technique was applied to analyze the data. Results of the study showed that village midwives still performed stabilization beyond their authority. Majority of people in the community used Jamkesmas (community health insurance) funding; however, funding and transportation or village ambulance availability and other needs were insufficient for Jamkesmas patients. During midwives accompaniment, most of them only accompanied when the patient was referred to the private hospital, and they did not do that for Jamkesmas patients. Midwives did not bring reference letter to PONED primary healthcare centers when they were referring pregnant women; it was also done when they were referring pregnant women to private hospitals. Midwives included a letter and KIA book as an enclosure when they referred the patient to the general hospital for Jamkesmas claim purpose. Based on the study results, suggestions given to the head of district health office were to provide additional number of village midwives with its qualification; to assure the availability and sufficiency of instrument, medicine and materials in Polindes or Poskesdes; Suggestions for primary healthcare office were to conduct guidance and supervision for village midwives, to distribute clearly the job assignments to village midwives in their work areas.
Analysis on Low Rate Utilization of Delivery Services by Health Workers at Wakaokili Community Health Center in Buton Regency Ira Yusnita; Chriswardani Suryawati; Ayun Sriatmi
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 1 (2015): April 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (613.563 KB) | DOI: 10.14710/jmki.3.1.2015.%p

Abstract

Pemanfaatan layanan persalinan tenaga kesehatan di Indonesia masih rendah terutama di daerah pedesaan. Kondisi ini juga terjadi pada masyarakat di wilayah kerja Puskesmas Wakaokili Kabupaten Buton, dimana pada saat hamil sebagian besar ibu memeriksakan diri ke bidan tetapi saat bersalin lebih memilih dukun. Pemerintah telah melakukan berbagai upaya meningkatkan minat masyarakat untuk bersalin pada tenaga kesehatan namun sampai saat ini belum mencapai hasil yang diinginkan. Untuk itu penelitian ini dirancangan dengan pendekatan kualitatif, metode studi kasus guna memahami alasan yang melatar belakangi rendahnya pemanfaatkan layanan persalinan oleh masyarakat. Pengumpulan data dengan wawancara menggunakan pedoman wawancara dan observasi langsung pada layanan kesehatan. Jumlah informan utama 36 orang terbagi dalam 2 kelompok yaitu kelompok sasaran langsung program meliputi ibu bersalin oleh bidan, dukun dan oleh keluarga beserta para suami. Serta kelompok sasaran tidak langsung program yaitu Toma/Toga dan kader kesehatan. Adapun informan triangulasi bidan, dukun dan kepala Puskesmas Wakaokili serta Kabid Kesga DKK Buton. Hasil penelitian diketahui bahwa alasan yang melatarbelakangi rendahnya pemanfaatkan layanan persalinan tenaga kesehatan yaitu karena mereka tidak mengenal bidan di desa, karena tidak memahami manfaat persalinan oleh tenaga kesehatan, biaya di dukun lebih terjangkau dan karena bidan tidak selalu ada saat dibutuhkan. Selain itu adanya kepercayaan masyarakat bahwa lancar tidaknya persalinan bukan ditentukan oleh penolong persalinan tetapi oleh perbuatan ibu semasa hamil. Juga adanya keyakinan terhadap doa-doa yang dimiliki oleh dukun atau suami menyebabkan masyarakat selalu menyertakan dukun dalam kehamilan dan persalinan guna kelancaran proses persalinan. Untuk itu diharapkan bidan lebih aktif melakukan pendekatan pada warga binaanya. Juga puskesmas dan kepada Dinas Kesehatan untuk melakukan upaya peningkatan pengetahuan masyarakat, kapasitasi dan pembinaan dukun dan juga mengkaji ulang insentif bagi bidan dalam rangka peningkatan kunjungan pada bumil baik di rumah maupun yang di kebun.    Utilization of delivery service by health workers in Indonesia was still low especially in rural areas. This condition occurred in communities in the work area of Wakaokili primary healthcare center (puskesmas) Buton district. Most of pregnant women in this community did antenatal care to midwives, however they chose traditional delivery assistant (dukun bayi) to assist their delivery process. Government had done many efforts to increase community interest to give birth with health workers assistance. However, this effort had not reached what was expected. This was a case study with qualitative approach. Objective of the study was to understand the background for low utilization of delivery services by the community. Data were collected through interview guided by interview guideline, and direct observation in the health services. The number of main informants was 36 people. They were divided into 2 groups. Those groups were direct target program group that included post-delivery women assisted by midwives, dukun bayi, and house member including husbands; indirect target program group consisted of community leaders and cadres. Triangulation informants were midwives, dukun bayi, the head of Wakaokili primary healthcare center, and the head of family health department of Buton district health office. Results of the study showed that background for the low utilization of delivery services by health workers was that community did not know village midwives; community did not understand benefits of giving birth assisted by health workers; the cost of giving birth assisted by dukun bayi was affordable; midwives were not always ready when needed. In addition, there was a stigma that smoothness of delivery process was not determined by who assisted the delivery but by what had been done by the mothers during pregnancy. Furthermore, there was a belief towards praying words spoken by dukun bayi or husbands; this was one of reasons why dukun bayi was included in the delivery process. They believed that dukun would make the delivery process success. Midwives are expected to be more active to approach their supervised community. Primary healthcare center and district health office are suggested to do efforts to improve community knowledge, to train and assist dukun, and to review the incentive for midwives in order to be able increase the number of visits to pregnant women in their house or in the field.
Correlation Between Village Midwife’s Characteristics And Behavior In Neonatal Care At Primary Health Care Center Area In Klaten District Endah Purwaningsih; Martha Irene Kartasurya; Atik Mawarni
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 1 (2015): April 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (356.067 KB) | DOI: 10.14710/jmki.3.1.2015.%p

Abstract

Angka Kematian Bayi di Kabupaten Klaten pada tahun 2011 sebesar 13,346/ 1000 kelahiran hidup dan tahun 2012 AKB sebesar 10,36 per 1000 kelahiran hidup. Kematian bayi tersebut terjadi pada bayi umur 0 – 28 hari atau periode neonatal. Cakupan pelayanan kunjungan neonatus oleh bidan di Kabupaten Klaten dari tahun 2009 sampai dengan 2012 mengalami menurunan dari kunjungan murni dan kunjungan lengkap. Dalam pelayanan neonatus bidan desa hampir tidak semua melalukan sesuai dengan standar pelayanan minimal. Tujuan penelitian ini adalah untuk mengetahui hubungan karakteristik bidan desa dengan pelayanan neonatus di wilayah Puskesmas Kabupaten Klaten tahun 2013. Metodologi penelitian observasional survey ini dilaksanakan dengan pendekatan cross sectional. Sampel dalam penelitian ini adalah 82 bidan desa di Kabupaten Klaten yang diambil secara Cluster Random Sampling. Instrumen penelitian menggunakan kuesioner dan lembar observasi. Data primer maupun sekunder diolah dan dianalisis secara univariat dengan distribusi frekuensi dan persentase, bivariat dengan Korelasi Chi Square. Hasil penelitian menunjukkan bahwa hubungan karakteristik dengan perilaku bidan desa dalam pelayanan neonatus di Kabupaten Klaten adalah ada hubungan karakteristik dengan pengetahuan yaitu: umur (p = 0.002), pendidikan (p = 0.000), pelatihan (p = 0,011) dan lama kerja (p = 0,000). Ada hubungan karakteristik dengan sikap yaitu: umur (p = 0,005), pendidikan (p = 0,000), pelatihan (p = 0,003), lama kerja (p = 0,000) dan pengetahuan (p = 0,000). Tidak ada hubungan karakteristik dengan pelayanan neonatus yaitu: umur (p = 0.354), pendidikan (p = 0,751), pelatihan (p = 0.336) dan lama kerja (p = 0.950), pengetahuan (p = 0,739) dan sikap ( p = 0,896). Disarankan bagi Dinas Kesehatan Klaten untuk meningkatkan pengetahuan Bidan Desa terutama tentang pelayanan neonatus melalui pelatihan dan sosialisasi buku KIA serta MTBM bagi semua Bidan Desa. Melakukan supervisi ke bidan desa dalam pelayanan KIA.  Infant Mortality Rate (IMR) in District of Klaten in 2011 and in 2012 respectively was 13.346/1,000 live births and 10.36/1,000 live births. The aged of infant mortalities ranged from 0 to 28 days or during a neonatal period. The coverage of neonatal services provided by village midwives in District of Klaten from year of 2009 to year of 2012 decreased in terms of pure and complete visits. Almost all village midwives did not provide the neonatal services which were in accordance with minimum services standards. This research aimed to find out about the relationship between characteristics of village midwives and neonatal services at health centers in District of Klaten in 2013. This was observational-survey research using cross-sectional approach. Number of samples was 82 village midwives in District of Klaten selected by a technique of Cluster Random Sampling. Research instruments used a questionnaire and an observation sheet. Primary and secondary data were analyzed using methods of univariate analysis (frequency distribution and percentage) and bivariate analysis (chi-square test). The result of this research revealed that variables of age (p=0.002), education (p=0.000), training (p=0.011), and work period (p=0.000) significantly related to a variable of knowledge. Furthermore, variables of age (p=0.005), education (p=0.000), training (p=0.003), work period (p=0.000), and knowledge (p=0.000) significantly related to a variable of attitude. On the other hand, variables of age (p=0.354), education (p=0.751), training (p=0.336), work period (p=0.950), knowledge (p=0.739), and attitude (p=0.896) did not relate to the neonatal services. As a suggestion, Klaten District Health Office needs to improve the knowledge of village midwives especially about neonatal services by conducting training and socialization of a Maternal and Child Health (MCH) book and Integrated Management of Young Infants for them. In addition, supervision needs to be done to village midwives in MCH services.
Implementation System Analysis of Integrated Health Service Post of Model at Work Area of Private Companies in Cilacap Ernawati Ernawati; Laksmono Widagdo; Atik Mawarni
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 1 (2015): April 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (312.799 KB) | DOI: 10.14710/jmki.3.1.2015.%p

Abstract

Peran serta masyarakat untuk ikut berpartisipasi dalam menurunkan AKI dan AKB dapat dilakukan dengan cara yang sederhana yaitu dengan mengikuti kegiatan posyandu. Posyandu merupakan salah satu kegiatan yang didalamnya terdapat pelaksanaan program-programpemerintah terkait pelayanan kehamilan, balita, PUS dan lansia. Dari berbagai jenis atau strata posyandu terdapat “Posyandu Model “ yang kegiatannya sudah dikembangkan dan terintegrasi. Posyandu model diharapkan mampu menjadi wadah yang dapat meningkatkan peran serta masyarakat untuk mendukung program-program MDG’s. Kabupaten Cilacap merupakan wilayah industri karena terdapat perusahaan-perusahaan besar, mulai tahun 2009 DKK Cilacap bekerjasama dengan perusahaan swasta mengenai program CSR. Hal ini diharapkan mampu mendukung program penurunan AKI dan AKB. Terdapat 10 Posyandu model yang menjadi binaan perusahaan swasta tersebut, yang berada pada 6 kelurahan disekitar wilayah perusahaan (Zona I, II dan III). Tujuan penelitian ini untuk menganalisis sistem pelaksanaan posyandu model (Di Wilayah Binaan Perusahaan Swasta). Desain penelitian ini adalah cross sectional dengan pendekatan kualitatif. Pemilihan informan dengan cara purposive, pengambilan data melalui wawancara (indepth interview) pada informan utama 6 ketua pokja IV, 6 Lurah/Kepala Desa, 10 kader dan 1 humas perusahaan swasta. Analisis data menggunakan metode analisis isi (content analysis). Hasil penelitian dari variabel input yaitu mengenai SDM, jumlah kader pada posyandu model lebih banyak mencapai 10 orang. Sumber dana utama dari iuran warga, pihak perusahaan lebih banyak memberikan bantuan dalam bentuk modal usaha dan perlengkapan. Tempat posyandu mempengaruhi kenyamanan kader maupun masyarakat dalam melaksanakan kegiatan. Pada proses ditemukan belum semua posyandu membuat rencana tahunan, pendirian posyandu model diperkuat dengan SK lurah. Belum dilakukan evaluasi rutin dari instansi terkait. Kegiatan integrasi yang aktif dan sudah berjalan dengan baik Pos PAUD. Disarankan untukdinas kesehatan maupun instansi terkait (Bapermas dan Dinas Pendidikan) melaksanakansupervisi terhadap kegiatan pengembangan dan integrasi tersebut, serta pendampingan danevaluasi secara rutin Community participation in decreasing Maternal and Infant Mortality Rate can be simply done by following activities of Integrated Health Service Post (IHSP). In addition, Integrated Health Service Post of Model is one of the IHSP types that has developed and integrated activities. The IHSP of model is hoped to be a place that can increase community participation in Millennium Development Goals (MDGs) program. District of Cilacap is an industry area. Since 2009, Cilacap District Health Office has collaborated with private companies in terms of the Corporate Social Responsibility (CSR) program. The collaboration aimed to support the program of diminishing Maternal and Infant Mortality Rate. There are any 10 IHSP of model located in 6 villages surrounding companies (Zone I, II, and III). This research aimed to analyze the implementation system of IHSP of model (in work area of private companies). This was cross-sectional research with qualitative approach. Informants were selected purposively. Data were collected by doing indepth interview on 6 persons who were head of work group IV, 6 persons who were head of village, and 1 company public relation. Additionally, data were analyzed using a method of content analysis. The results of this research revealed that regarding an input variable, a maximum number of cadres at IHSP of model was 10 persons. Furthermore, a main source of funding was from resident tuition. Otherwise, companies contributed business capital and equipment. As a suggestion, District Health Office and related institutions (Community Empowerment Body and Education Office) need to supervise activities of development and integration, mentor, and evaluate routinely.
Determinant Factors of Formula Milk Feeding to Infant of 0-6 months (A Study to the Mothers of the Infants of 7-12 months in the Area of Public Health Centers in Demak Regency) Ida Nurmawati; Sri Achadi Nugraheni; Apoina Kartini
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 1 (2015): April 2015
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (236.104 KB) | DOI: 10.14710/jmki.3.1.2015.%p

Abstract

Cakupan ASI Eksklusif di Kabupaten Demak sebesar 41,3% masih di bawah Standar Pelayanan Minimal Provinsi Jawa Tengah. Rendahnya cakupan ASI Eksklusif dikarenakan masih banyak ibu yang memberikan susu formula pada bayi usia 0-6 bulan. Tujuan penelitian adalah menganalisis faktor determinan pemberian susu formula pada bayi usia 0-6 bulan. Jenis penelitian ini merupakan Explanatory Survey dengan pendekatan cross sectional. Pengumpulan data dilakukan dengan wawancara menggunakan kuesioner terstruktur yang telah diuji validitas dan reliabilitasnya. Subyek 77 ibu bayi usia 7-12 bulan yang dipilih dengan Clustered Random Sampling. Analisis bivariat menggunakan uji chi square dan analisis multivariat menggunakan regresi logistik. Hasil penelitian menunjukkan bahwa pemberian susu formula pada bayi usia 0-6 bulan sebesar 72,7%. Karakteristik ibu : 55,8% berpendidikan dasar, 64,9% tidak bekerja, 50,6% berpendapatan keluarga tinggi. Sebagian besar ibu berpengetahuan kurang (92,2%), bersikap negatif (50,6%), melaksanakan IMD (80,5%), tidak memiliki fasilitas untuk pemberian ASI (51,9%), akses yang jauh (64,9%), petugas kesehatan tidak mendukung (50,6%), keluarga mendukung (50,6%), dan teman tidak mendukung (57,1%). Ada hubungan pengetahuan (p=0,005), status bekerja (p=0,038), pendapatan keluarga (p=0,034), sikap (p=0,002), dukungan petugas kesehatan (p=0,013), dan dukungan keluarga (p=0,0001) dengan pemberian susu formula pada bayi usia 0-6 bulan. Tidak ada hubungan pendidikan (p=0,690), pelaksanaan IMD (p=0,215), ketersediaan fasilitas (p=0,185), akses susu formula (p=0,942), dan dukungan teman (p=0,438) dengan pemberian susu formula pada bayi usia 0-6 bulan. Variabel yang berpengaruh  secara bersama-sama terhadap pemberian susu formula adalah dukungan keluarga  (ExpB=41,863) dan sikap ibu (ExpB=6,996) terhadap pemberian susu formula. Dinas Kesehatan Kabupaten Demak perlu meningkatkan pengetahuan ibu dan keluarga ibu dengan memberikan informasi tentang ASI Eksklusif dan dampak negatif susu formula. Coverage of Exclusive Breastfeeding in District of Demak was 41.3% below the Minimum Service Standards in Province of Central Java. It was due to most of the mothers preferred to provide formula milk for their babies aged 0-6 months. This research aimed to analyze determinant factors of providing formula milk for babies aged 0-6 months. This was Explanatory Survey with cross-sectional approach. Data were collected by interview using a structured questionnaire which had been tested validity and reliability. Number of respondents were 77 mothers of babies aged 7-12 months selected using Clustered Random Sampling. Furthermore, data were analysed using bivariate analyses consisted of Chi Square test and multivariate analyses (Logistic Regression test). The result of this research showed that most of the respondents had provided formula milk to their babies aged 0-6 months (72.7%). Most of them had basic education (55.8%), did not work (64.9%), had high family income (50.6%), had low knowledge (92.2%), had negative attitude (50.6%), did early initiation of breastfeeding (EIB) (80.5%), and did not have facilities for providing breastfeeding (51.9%). In addition, most of them had far access (64.9%), did not have health worker support (50.6%), had family support (50.6%), and did not have friend support (57.1%). Factors of knowledge (p=0.005), work status (p=0.038), family income (p=0.034), attitude (p=0.002), health worker support (p=0.013), and family support (p=0.0001) had significant relationship with providing formula milk aged 0-6 months. Otherwise, factors of education (p=0.690), implementing EIB (p=0.215), availability of facilities (p=0.185), access to formula milk (p=0.942), and friend support (p=0.438) were not significant. Furthermore, factors of family support (ExpB=41.863) and attitude (ExpB=6.996) jointly influenced providing formula milk. As suggestions, Demak District Health Office needs to improve knowledge of mothers and their families regarding information of exclusive breastfeeding and adverse effects of formula milk.

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