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Analysis on Facilitative Supervision of Primary Healthcare Center Coordinator Midwives to BPM ConcerningPregnancy and Delivery Services in Semarang City Dewi Laila Mahligai Putri; Sri Achadi Nugraheni; Atik Mawarni
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 2 (2013): Agustus 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Supervisi fasilitatif bidan koordinator (bikor) puskesmas terhadap bidan praktek mandiri (BPM)merupakan pembinaan klinis dan manajemen yang dilakukan secara berkesinambungan sertatepat sasaran. Pelaksanaan supervisi fasilitatif yang dilakukan selama ini belum optimal,sehingga perlu upaya pengkajian lebih lanjut. Penelitian ini bertujuan untuk menganalisispelaksanaan supervisi fasilitatif bidan koordinator puskesmas terhadap BPM terkait pelayanankehamilan dan persalinan di Kota Semarang. Penelitian ini menggunakan pendekatan kualitatif.Analisis data menggunakan metode analisis isi (content analysis). Variabel dalam penelitian inimeliputi aspek yang dibina (aspek klinis, non klinis, logistik dan manajemen), cara penilaian dan langkah pelaksanaan. Hasil penelitian menunjukkan bahwa supervisi meliputi semua aspek yang dibina. Belum semua bikor menggunakan daftar tilik asuhan persalinan. Supervisi aspek klinis tidak dilakukan dengan pengamatan langsung. Langkah pelaksanaan pra supervisi : belum ada pelatihan supervisi fasilitatif bagi bikor puskesmas dan buku acuan supervisi fasilitatif tidak diberikan. Langkah pelaksanaan supervisi belum sesuai acuan, karena sifatnya inspeksi mendadak. Disarankan kepada Dinas Kesehatan untuk mengadakan pelatihan supervisi fasilitatif bagi semua bidan koordinator puskesmas. Bagi puskesmas membuat kesepakatan dengan BPM terkait jadual supervisi fasilitatif.Facilitative supervision of primary healthcare center (puskesmas) coordinator midwife (bikor) to self-employed practice midwives (BPM) constituted an ongoing and on-target clinical andmanagerial supervision. Current implementation of facilitative supervision was not optimum;therefore, further study was required. Objective of this study was to analyze the implementation of facilitative supervision of primary healthcare coordinator midwives to BPM concerning pregnancy and delivery services in Semarang city. A qualitative approach was applied in this study. Data were analyzed using content analysis method. Study variables were supervised aspects (clinical, non-clinical, logistic, and managerial aspects), assessment method and implementation stages. Results of the study showed that supervision had included all supervised aspects. Not all bikor used delivery care list. Supervision on clinical aspect did not include direct observation. Pre supervision implementation steps: facilitative supervision training for bikor of the primary healthcare centers had not been done, reference book for facilitative supervision had not been distributed. Steps of the implementation of supervision were not performed according to the guidelines. This was caused by on the spot implementation of supervision.Suggestion for District Health Office is to conduct facilitative supervision for all primary healthcare centers coordinator midwives. Suggestion for primary healthcare center is to make agreement with BPM concerning facilitative supervision schedule

Analysis of Work Performance of Family Planning Field Workers in Male Family Planning Program in Cilacap District Untari Fajar Suryani; Nurjazuli Nurjazuli; Septo Pawelas Arso
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 2 (2013): Agustus 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Target MDG’s untuk mencapai AKI 102/100.000 kelahiran hidup dan AKB 23/1.000 kelahiranhidup dilakukan dengan memperbaiki kesehatan ibu dengan meningkatkan angka pemakaiankontrasepsi dan menurunkan unmet need. Persentase peserta KB mantap pria di KabupatenCilacap menempati urutan terendah yaitu 0,16%. Keberhasilan program KB tidak terlepas darikinerja dan penilaian kinerja erat dengan tugas pokok dan fungsi PLKB. Penelitian inimerupakan penelitian cross sectional, pendekatan kuantitatif. Populasi penelitian PLKB diKabupaten Cilacap. Subjek penelitian 91 PLKB di Kabupaten Cilacap dengan cara simplerandom sampling. Pengumpulan data dilakukan melalui wawancara dan observasi menggunakankuesioner terstruktur. Analisis data menggunakan analisis jalur yang dengan uji T pada programVPLS (Visual Partial Least Square). Hasil penelitian menunjukkan kemampuan dan ketrampilanPLKB dalam kategori baik sebanyak 58,2%, sumber daya dalam kategori baik 71,4%, persepsikepemimpinan dalam kategori baik 57,1%, motivasi dalam kategori baik 70,3%, sikap dalamkategori baik 64,8%, desain pekerjaan dalam kategori baik 53,8% dan imbalan dalam kategoribaik 62,6% dalam pelaksanaan program KB pria. 57,1% memiliki kinerja baik dan 42,9%memiliki kinerja kurang baik. Tidak ada hubungan sikap dengan kinerja (t=-1,089), persepsikepemimpinan dengan sikap (t=1,311), dan imbalan dengan motivasi (t = 1,431). Ada hubungan yang signifikan antara sumber daya dengan motivasi (t=2,897), motivasi dengan sikap (t=2,445), desain pekerjaan dengan motivasi (t=2,242), imbalan dengan sikap (t = 4,523), kemampuan dan keterampilan dengan sikap (t=2,011) dan kemampuan dan keterampilan dengan kinerja PLKB (t=2,906). Kemampuan dan ketrampilan merupakan faktor yang paling dominan berpengaruh terhadap kinerja PLKB dengan prediksi sebesar 11,7%. Disarankan kepada Bapermas, PP, PA dan KB untuk memelihara dan meningkatkan kemampuan dan ketrampilan PLKB melalui up grade program KB dan mengadakan pelatihan-pelatihan secara periodik untuk mempertahankan kemampuan dan ketrampilan. Walaupun sikap tidak berpengaruh secara signifikan tetapi tetap perlu diperhatikan karena sikap dipengaruhi oleh faktor lain seperti imbalan, motivasi, sumber daya dan desain pekerjaan. Target of MDG’s to reach maternal mortality rate of 102/100.000 live-births and infantmortality rate of 23/1000 live-births had been performed by improving maternal health throughincreasing contraceptive prevalence rate and decreasing unmet need. Percentage of male withpermanent birth control in Cilacap district was in the lowest rank, 0.16%. Success of familyplanning program could not be separated from work performance of PLKB (family planning field workers); assessment of PLKB work performance was related to the main duty and functionof PLKB. This was a cross sectional study using quantitative approach. Study population was allPLKB in the district of Cilacap. Study subjects were 91 PLKB in Cilacap district, and they wereselected using simple random sampling method. Data were collected through in-depth interviewand observation guided by structured questionnaire. Data were analyzed by applying pathanalysis and t-test on the VPLS (visual partial least square) program. Results of the studyshowed that ability and skill of PLKB were in good category (58.2%), human resource was in agood category (71.4%), perception on the leadership was in a good category (57.1%),motivation was in a good category (70.3%), attitude was in a good category (64.8%), workdesign was in a good category (53.8%), remuneration was in a good category (62.6%),implementation of male family planning was in a good performance (57.1%) and 42.9% was not good. No association was found betweenattitude and work performance (t= -1.089), between perception on leadership and attitude (t= 1.311), between remuneration and motivation (t= 1.431). Significant associations were found between human resource and motivation (t= 2.897), between motivation and attitude (t= 2.523), between ability, skill and work performance of PLKB (t= 2.906). Ability and skill were dominant factors affecting to the work performance of PLKB; it was predicted to be 11.7%. Suggestions for Bapermas, PP, PA, and KB were to maintain and improve the ability and skill of PLKB through family planning program up grade and to do periodical trainings to keep the ability and skills. Attitude did not affect significantly, however, attitude shall receive attention because attitude are influenced by other factors, such as remuneration, motivation, human resource, and work design.

Factors Related to the Work Performance of Midwives in the IUD Contraception Service in Primary Healthcare Centers of Surabaya City Yasi Anggasari; Martha Irene Kartasurya; Anneke Suparwati
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 2 (2013): Agustus 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Penurunanangka cakupan peserta KB aktif IUD di Surabaya dalam 3 tahun terakhir dari 12,27%menjadi 6,1% menjadi perhatian khusus Dinas Kesehatan Kota Surabaya, hal ini terjadi akibatbelum optimalnya kinerja bidan dalam pelayanan kontrasepsi IUD di Puskesmas wilayahSurabaya. Tujuan penelitian menganalisis faktor-faktor yang berhubungan dengan kinerja bidandalam pelayanan kontrasepsi IUD di Puskesmas Wilayah Kota Surabaya.Penelitian analitikobservasional ini dilakukan dengan pendekatan cross sectional. Populasi penelitian adalahseluruh bidan di Puskesmas kota Surabaya yang memberikan pelayanan KB dan telah mengikutipelatihan CTU (362 bidan). Subjek penelitian 78 responden dipilih secara proporsional stratifiedrandom sampling. Pengumpulan data dilakukan dengan wawancara terstruktur dan observasi.Analisis data menggunakan uji regresi linear ganda.Hasil penelitian menunjukkan kinerja bidandalam pelayanan kontrasepsi IUD di wilayah Kota Surabaya 55,1 % dalam kategori baik.Pengetahuan bidandalam pelayanan kontrasepsi IUD (82,1%) kurang baik khususnya dalam halpenapisan dan konseling pra pemasangan. Motivasi bidan (55,1%) baik, sikap bidan (51,3%)kurang mendukung dalam pelayanan kontrasepsi IUD.Persepsi bidan terhadap kepemimpinankepala puskesmas (52,6%) baik. Persepsi bidan terhadap imbalan yang didapatkan 53,8% baik.Sarana prasarana (53,8%) sudah tersedia dalam menunjang pelayanan kontrasepsi IUD.Motivasi, sikap dan persepsi kepemimpinan berhubungan dengan kinerja bidan sedangkanpengetahuan, persepsi terhadap imbalan dan sarana prasarana tidak berhubungan dengan kinerjabidan dalam pelayanan kontrasepsi IUD. Secara bersama-sama motivasi dan persepsikepemimpinan berhubungan dengan kinerja bidan dalam pelayanan kontrasepsi IUD.DisarankanDKKuntuk melaksanakan supervisi secara langsung dan berkala untuk mengevaluasi danmonitoring pelaksanaan program di setiap Puskesmas serta memberikan motivasi dalamkemudahaan izin belajar bagi bidan yang ingin melanjutkan pendidikan. The decrease of IUD active family planning participants’ coverage in Surabaya in the last three years, from 12.27% to 6.1%, became a special attention for Surabaya district health office. The decrease was caused by inadequate work performance of midwives in implementing IUD contraception service in the primary healthcare centers in Surabaya area. Objective of the study was to analyze factors related to the work performance of midwives in the IUD contraception service in the primary healthcare centers of Surabaya city area. This was an analytical- observational study using cross sectional approach. Study population was all midwives in the primary healthcare centers in Surabaya city who provide family planning service, and who had attended in CTU training (362 midwives). Study subjects were 78 respondents, and they were selected using proportional stratified random sampling method. Data collection was conducted through structured interview and observation. Multiple linear regression tests were applied in the data analysis. Results of the study showed that work performance of midwives in the IUD contraception service in Surabaya city area was in a good category (55.1%). Midwives’ knowledge on IUD contraception service specifically on screening and counseling before insertion was insufficient (82.1%). Motivation of midwives was good (55.1%). Midwives attitude regarding IUD contraception service was not supportive (51.3%). Perception of midwives towards head of primary healthcare center leadership was good (52.6%). Midwives perception on remuneration they received was good (53.8%). Facilities to support IUD contraception service were available (53.8%).Motivation, attitude, and perception on the leadership were associated with midwives’ work performance. However, knowledge, perception of remuneration, and facilities were not associated with midwives’ work performance in the IUD contraception service. Motivation and perception on the leadership, in common, were associated with midwives’ work performance in the IUD contraception service.Suggestions for district health office was to perform supervision directly and periodically, to evaluate and monitor the implementation of program in every primary healthcare center, and to provide permission for midwives who want to take further study.

Analysis on the Effect of Management of Room Coordinator to the Accomplishment of Nursing Care in the Inward Room of Sunan Kalijaga District General Hospital of Demak District Mohammad Fathy Azhari; Nico L Kana; Bambang Edi Warsito
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 2 (2013): Agustus 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Hasil pelaksanaan penerapan Standar Asuhan Keperawatan (SAK) di RSUD Sunan Kalijaga Kabupaten Demak tahun 2011 sebesar 62,49% dan 2012 sebesar 69,49%, kondisi ini masih dibawah target SAK RSUD Sunan Kalijaga Kabupaten Demak yaitu 86% yang diharapkan pada tahun 2015 pencapaian pelaksanaan SAK 100%, hal ini menunjukkan terdapat kesenjangan pencapaian standar asuhan keperawatan, yang diduga belum optimalnya manajemen kepala ruang terhadap pencapaian asuhan keperawatan.Tujuan penelitian adalah menganalisis pengaruh manajemen kepala ruang terhadap pencapaian asuhan keperawatan di ruang rawat inap RSUD Sunan Kalijaga Kabupaten Demak. Penelitian ini merupakan penelitian observasional dengan pendekatan cross sectional. Instrumen penelitian menggunakan kuesioner terstruktur dan checklist observasi terhadap kegiatan asuhan keperawatan. Jumlah sampel 62 perawat pelaksana yang tersebar di 14 ruang rawat inap RSUD Sunan Kalijaga Kabupaten Demak. Analisis bivariat dengan uji chi square dan analisis multivariat dengan uji regresi logistik. Hasil penelitian menunjukkan proporsi perawat pelaksana yang memiliki perencanaan baik 56,5%, pengorganisasian baik 58,1%, penggerakan baik 67,7% dan pengawasan baik 56,5% pada desa tercapai UCI, pencapaian pelaksanaan asuhan keperawatan yang sudah lengkap 80,6%. Hasil analisis bivariat menunjukkan bahwa perencanaan (ρ=0,014), pengorganisasian (ρ=0,010), dan penggerakan (ρ=0,0001) berhubungan dengan pencapaian asuhan keperawatan. Analisis multivariat menunjukkan adanya pengaruh penggerakkan (ρ=0,002;Exp β=10,636) terhadap pencapaian asuhan keperawatan. Disarankan kepada pihak RSUD Sunan Kalijaga Kabupaten Demak untuk meningkatkan komunikasi secara jelas dan efektif, terlibat dalam kolaborasi dan koordinasi dalam memberikan asuhan keperawatan dan meningkatkan manajemen yang baik dengan memberikan motivasi sebagai umpan balik yang baik kepada perawat.hospital (RSUD) of Demak district was 62.49% in 2011 and 69.42% in 2012; this situation wasstill below the SAK of RSUD Sunan Kalijaga Demak district (86%). Expectation of SAKimplementation accomplishment in 2015 was 100%.These facts indicated that there was a gap in the accomplishment of the nursing care standard, and it was suspected that the management of room coordinator towards nursing care accomplishment was not optimal. Objective of this study was to analyze the influence of management of room coordinator to the accomplishment of nursing care in the inward room of RSUD Sunan Kalijaga of Demak district. This was anobservational study using cross sectional approach. Study instruments consisted of structuredquestionnaire and observation checklist of nursing care activity. The number of samples was 62nurses that were distributed in 14 inward rooms of the RSUD Sunan Kalijaga of Demak district.Bivariate analysis was done by applying chi square test, and logistic regression test was appliedfor multivariate analysis. Results of the study showed proportion of nurses who had goodplanning (56.5%), good organization (58.1%), good actuating (67.7%), and good supervision(56.5%) on UCI village. The accomplishment of complete nursing care implementation was80.6%. Results of bivariate analysis showed that planning (ρ=0.014), organizing (ρ= 0.010), and actuating (ρ= 0.0001) were associated with the accomplishment of nursing care. Multivariate analysis indicated the influence of actuating (ρ= 0.002; Exp β= 10.636) towards the accomplishment of nursing care. Suggestions addressed for RSUD Sunan Kalijaga of Demakdistrict are to improve distinct and effective communication, to involve in collaboration andcoordination activities in providing nursing care, and to improve good management byproviding motivation as a good feedback to nurses.

Analysis on the Implementation of Integrated Antenatal Care Program to Pregnant Women with Malaria in Tobelo Primary Healthcare Center of North Halmahera District, North Maluku Province Anna Mieke; Martha Irene Kartasurya; Sutopo Patria Jati
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 2 (2013): Agustus 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Pelayanan antenatal pada ibu hamil dengan malaria merupakan bagian dari pelayanan antenatal terpadu yang difokuskan pada penanganan malaria ibu hamil melalui deteksi dini, pengobatan dan pencegahan malaria serta komplikasinya. Tujuan penelitian ini adalah untuk menganalisis implementasi pelayanan antenatal terpadu malaria pada ibu hamil dari aspek komunikasi,disposisi, ketersediaan sumberdaya dan struktur birokrasi di Puskesmas Tobelo Kecamatan Tobelo Kabupaten Halmahera Utara Provinsi Maluku Utara. Jenis penelitian adalah observasional dengan pendekatan kualitatif. Pemilihan informan dengan cara purposif, data dikumpulkan melalui wawancara mendalam (indepth interview). Analisis data menggunakan metode analisis isi (content analysis). Hasil penelitian menunjukkan bahwa pelayanan antenatal terpadu malaria pada ibu hamil belum dilaksanakan oleh bidan sesuai dengan pedoman penanganan dan pencegahan malaria pada ibu hamil. Hal ini dipengaruhi kurangnya tenaga bidan dan belum adanya SOP yang jelas dan banyak bidan yang belum mengikuti pelatihan tentang pencegahan dan penanganan malaria pada ibu hamil. Komunikasi pemberi informasi tentang pelayanan antenatal terpadu pada ibu hamil dengan malaria melalui pimpinan, tenaga bidan untuk melaksanakan pelayanan antenatal terpadu malaria masih kurang. Disposisi sikap bidan ditunjukkan dengan keinginan dan kemauan dalam mensosialisasikan pelayanan antenatal terpadu malaria. Namun dalam pemberian OAM, bidan masih ragu karena pernah mengalami kematian ibu hamil dengan malaria yang diberi OAM. Belum adanya SOP dan pelatihan sudah diberikan tetapi belum semua bidan mengikutinya. Antenatal care to pregnant women with malaria was a part of an integrated antenatal care; this antenatal care was focused on managing pregnant women with malaria through early detection, treatment and prevention of malaria and its complication. Objective of the study was to analyze the implementation of an integrated antenatal care and malaria service to pregnant women, and the analysis included communication, disposition, availability of resources and bureaucracy structure aspects in Tobelo primary healthcare center (puskesmas), Tobelo district, North Halmahera district, North Maluku province. This was an observational study with qualitative approach. Selection of informants was conducted using purposive sampling. Data were collected through in-depth interview. Content analysis was applied in the data analysis. Results of the study showed that integrated antenatal care and malaria service to pregnant women were not performed properly by midwives.They did not perform the service according to the guideline on the management and prevention of malaria on pregnant women. This was caused by insufficient number of midwives, no clear standard operating procedure (SOP), and a number of midwives who had not attended in the training on prevention and management ofpregnant women with malaria. Communication among people who provided information on the integrated antenatal care to pregnant women with malaria was conducted throughthe leader. The number of midwives who implemented integrated antenatal care and malaria service was still insufficient. Disposition of midwives’ attitude was shown by willingness and eagerness in socializing integrated antenatal care and malaria service. However, midwives were still reluctant in giving OAM due to past experiences about the dead of pregnant women with malaria and OAM treatment. Standard operating procedure was not formulated. Training had been performed; however, not all midwives had been trained.

Analysis of Organizational Culture Change Processin Badan Rumah Sakit Umum Tabanan-Bali Sepri Hariyadi; Sudiro Sudiro; Lucia Ratna Kartika
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 2 (2013): Agustus 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Badan Rumah Sakit Umum Tabanan Bali sejak tahun 2002 telah terjadi perubahan di berbagai aspek organisasi yang kemudian berdampak dan bermakna pada cara pemberian pelayanan selanjutnya meningkatkan jumlah kunjungan pasien dan kesejahteraan karyawan, yang secara keseluruhan mengubah citra rumah sakit. Tujuan penelitian ini menganalisis proses terjadinya perubahan budaya organisasi rumah sakit (asumsi dasar, tata nilai, norma, dan artefak) pada aspek struktur, teknologi, dan orang melalui tahapan-tahapan perubahan (refreezing, freezing, unfreezing). Jenis penelitian observasional, kualitatif. Pengumpulan data dengan wawancara mendalam, pengumpulan dokumen, dan pengamatan langsung. Subjek penelitian terdiri dari informan utama 4 orang manajer (puncak dan menengah), informantriangulasi 3 orang tenaga fungsional (dokter dan perawat). Hasil, pada awalnya organiasi BRSU ada perbedaan pada asumsi dasar, tata nilai, norma, dan artefak. BRSU berstatus UPTD, minim teknologi, terdapat kecurangan pendapatan disetiap bagian, kualitas SDM rendah. Keadaan ini memotivasi direktur (sebagai inisiator) untuk mengubah budaya organisasi rumah sakit. Pelaksanaannya dengan memberikan pemahaman, penyadaran kepada seluruh karyawan yang dituangkan pada Visi, Misi, keyakinan dasar, nilai-nilai dasar, norma, artefak dan motto. Kemudian perubahan yang terjadi pada: 1) struktur pada status RS UPTD menjadi RS LTD oleh bupati dan DPRD, mengikuti standarisasi akreditasi, ISO, Pelayanan piala citra. 2) Teknologi pada SIM RS, system komunikasi, melakukan KSO peralatan. 3) Orang dengan meningkatkan kualitas SDM. Dampak yang terjadi: 1) Peningkatan penghasilan rumah sakit pada tahun 1999 ke 2000 sangat fantastis dari 350-400 juta menjadi 1,6 milyar setahun, 2) Peningkatan penghasilan karyawan secara signifikan. Pengawasan: adanya auditor, kredensial, penyegaran budaya organisasi secara berkala. Dampak perubahan keseluruhan adalah meningkatnya kualitas pelayanan dan tanpa terganggunya kualitas pelayanan setelah terjadi dua kali penggantian pimpinan rumah sakit. Tipe budaya organisasi yang dianut saat ini di BRSU Tabanan adalah tipe budaya organisasi terbuka. Saran, perubahan pasti akan selalu terjadi diharapkan BRSU Tabanan dapat mengendalikan perubahan itu kearah lebih baik tanpa henti baik fisik maupun non fisik. Badan Rumah Sakit Umum (General Hospital Board= BRSU) Tabanan-Bali had changed in many aspects of organization since 2002. These changes had a significant impact on the way to give further services, increasing the number of patients’ visit and staff welfare. These changes, in general, had changed the hospital image. Objective of the study was to analyze the process of hospital organizational culture change (basic assumption, value system, norm, and artifact) on structure, technology, and person aspects through the transformation steps (refreezing, freezing,and unfreezing). This was an observational, qualita tive study. Data were collected through in- depth interview, documentary collection, and direct observation. Studysubjects consisted of four hospital managers (top and middle) as main informants, three functional staffs (physician and nurses) as triangulation informants. Results of the study showed that, at the beginning, there were differences on BRSU organization. The differences included basic assumptions, value system, norm, and artifact. Status of the BRSU was UPTD; and this BRSU had minimal technology, fraudulence revenue in every unit, and low quality of staffs. These situations motivated hospital director (as an initiator) to change hospital organization culture. Implementation of the change was to give understanding and awareness to all hospital staffs through giving vision and mission of the hospital, basic trust,orms,artifacts, and motto. Changes included 1) change of hospital status by District leader and district house of representative, from UPTD to LTD. This change was conducted according to accreditation standard, ISO, and Citra cup service; 2) change on hospital information system (SIM-RS), communication system, and conducting KSO of instruments; 3) change of the quality of hospital human resource. Impact of the changes included 1)increase in 1999-2000 hospital revenue from 350-400 million rupiahs to 1.6 billion rupiahs, 2)significant increase on the staffs’ wages. Supervision was conducted by the presence of an auditors, credential, and periodic refreshment of organizational culture. Impact of the whole changes was improvement of service quality. In addition, no service quality disruption was found after twice changes of hospital directors. The current type of organizational culture in BRSU Tabanan was an open organizational culture type. Suggestion: changes will certainly occur, and BRSU Tabanan is xpected to continuously control the changes towards the better, physically and non-physically

Factors Related to Work Performance of Village Midwives in Applying Informed Choice and Informed Consent in Contraception Service in North Minahasa District Amelia Donsu; Cahya Tri Purnami; Tjondrorini Tjondrorini
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 2 (2013): Agustus 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Penerapan informed choice dan informed consent merupakan upaya untuk meningkatkan cakupan dan kualitas pelayanan KB. Penerapan informed choice dan informed consent di Kabupaten Minahasa Utara belum optimal dilihat dari menurunnya cakupan peserta KB aktif empat tahun terakhir dan peningkatan drop out penggunaan alat kontrasepsi. Tujuan penelitian adalah menganalisis faktor–faktor yang berhubungan dengan kinerja bidan desa dalam penerapan informed choice dan informed consent pada pelayanan kontrasepsi di Kabupaten Minahasa Utara. Jenis penelitian adalah observasional analitik dengan pendekatan crossectional.Cara pengambilan data dilakukan dengan wawancara menggunakan kuesioner. Populasi adalah 100 bidan desa di Kabupaten Minahasa Utara. Lima puluh responden dipilih secara random dari bidan desa yang memenuhi kriteria inklusi dan eksklusi pada tiap puskesmas. Analisis data dilakukan dengan uji chi-square dan regresi logistik. Hasil penelitian menunjukkan bahwa rerata umur responden 34 tahun, dengan rerata masa kerja 11 tahun, pendidikan responden sebagian besar D III Kebidanan. Motivasi, fasilitas, persepsi beban kerja dan kinerja sudah baik tetapi pengetahuan masih kurang dalam hal pemahaman istilah langkah konseling SATUTUJu dan cara pengisian formulir informed consent. Supervisi masih kurang karena belum dilakukan secara rutin. Faktor yang berhubungan dengan kinerja adalah motivasi (ρ= 0,048), fasilitas (ρ=0,001) dan persepsi supervisi (ρ=0,001). Faktor yang berpengaruh secara bersama-sama terhadap kinerja adalah persepsi supervisi (ρ=0,001). Motivasi, fasilitas dan persepsi supervisi berhubungan dengan kinerja bidan desa dalam penerapan informed choice dan informed consent pada pelayanan kontrasepsi. Faktor yang paling kuat berpengaruh terhadap kinerja adalah persepsi supervisi. Application of informed choice and informed consent constituted an effort to increase coverage and quality of family planning (KB) service. Application of informed choice and informed consent in North Minahasa district was not optimum. It could be seen from the facts that coverage of active KB participants decreased in the last four years, and the number of people who dropped out from using contraceptive device increased. Objective of the study was to analyze factors related to work performance of village midwives in applying informed choice and informed consent in contraception service in North Minahasa district. This was an observational-analytical study with cross sectional approach. Data were collected through interview guided by questionnaire. Study population was 100 village midwives in North Minahasa. Fifty respondents were selected randomly from all primary healthcare centers village midwives who fulfilled inclusion and exclusion criteria. Chi-square test and logistic regression were applied in the data analysis. Results of the study showed that mean of respondents’ age was 34 years, mean of respondents’ duration of work was 11 years, and most of respondents’ education was D III Kebidanan. Motivation, facilities, perception on workload, and work performance were good. However, knowledge was still insufficient specifically on understanding term for counseling step ‘SATUTUJU’ and on the method to fill informed consent form. Supervision was still inadequate due to no routine supervision activity. Factors related to work performance were motivation (ρ= 0.048), facility (ρ= 0.001), and perception on supervision (ρ= 0.001). Factor that, in common, influenced work performance were perception on supervision (ρ= 0.001). Motivation, facility, and perception on supervision were related with work performance of village midwives in applying informed choice and informed consent in the contraception service. The strongest factor affecting work performance was perception on supervision.

Analysis on the Implementation of Iron Supplementation Program by Midwives at Primary Healthcare Center in South Minahasa District Sjenny Olga Tuju; Sri Achadi Nugraheni; Lucia Ratna Kartika
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Pelaksanaan program pemberian tablet Fe (besi) di Puskesmas Kabupaten Minahasa Selatan masih dibawah target nasional (78,8 %) target Nasional (90 %) walaupun sudah ada kebijakan tentang program pemberian tablet Fe (besi) pada bidan. Survey pendahuluan yang dlakukan oleh 7 bidan di 7 Puskesmas diperoleh informasi bahwa masih ada bidan yang belum melaksanakan sesuai dengan standar operasional prosedur yang sudah ada. Penelitian ini bertujuan untuk menganalisis faktor yang mempengaruhi implementasi program pemberian tablet Fe (besi) oleh bidan di Puskesmas Wilayah Kabupaten Minahasa Selatan. Jenis penelitian merupakan deskriptif observasional analitik dengan pendekatan cross sectional.Pengumpulan data dilakukan wawancara kuesioner dan observasi langsung pada saat bidan memberikan tablet Fe (besi) di polindes/Posyandu. Jumlah sampel 98 orang bidan desa di 17 kecamatan Kabupaten Minahasa Selatan.yang diambil secara Simple Random Sapling. Analisis univariat, bivariat dilakukan dengan chi-square test dan analisis multivariat dengan regresi logistik Bidan sudah melaksanakan kegiatan-kegiatan dengan kategori baik dalam komunikasi (46,9%),Sumberdaya (52%),Disposisi (57,1%) dan Struktur Birokrasi (53,1%). variabel yang berpengaruh terhadap implementasi program pemberian tablet Fe (besi) adalah birokrasi (nilai p=0,24 ) exp ß=2,584.Saran untuk Dinas Kesehatan Kabupaten Minahasa Selatan adalah : memberikan soaialisasi kepada bidan tentang manfaat dari pengunaan Standar Operasional Prosedur (SOP) pemberian tablet Fe(besi). Memberikan insentif bagi bidan yang telah melaksanakan sesuai dengan standar yangmemenuhi cakupan, diberikan Hb Sahli set bagi semua bidan yang bertugas didesa yang belum mempunyai lat tersebutImplementation of iron tablets supplementation program in the primary healthcare centers of South Minahasa district was still below the national target (78.8%) although there was a policy regarding iron supplementation program by midwives. The national target was 90%. Preliminary survey conducted on 7 midwives showed that there were midwives who had not implemented the program according to the existed standard operating procedure. The objective of this study was to analyze factors affecting the implementation of iron tablets supplementation program by midwives in the primary healthcare centers in the area of South Minahasa district. This was an observational analytical study with cross sectional approach. Data collection was done through interview guided by questionnaire and direct observation to midwives when giving iron tablets in a polindes/posyandu. The number of study samples was 98 village midwives in 17 sub districts of South Minahasa district. They were selected using simple random sampling method. Univariate analysis, bivariate analysis with chi square test, and multivariate analysis with logistic regression were applied in the data analysis. Results of the study showed that midwives had implemented the activities with good category incommunication (46.9%), resources (52%), disposition (57.1%), and structured bureaucracy (53.1%).Variable affecting the implementation of iron tablets supplementation program was bureaucracy (p= 0.24), exp â= 2.584.Suggestions for the South Minahasa district health office were to conduct socialization to midwives regarding the benefits of using standard operating procedures of the implementation of iron tables supplementation; to give incentive for midwives who implement the program according to the standard and reaching the target; to provide Hb Sahli set for all midwives who work in the village and they do not have the Hb Sahli set.

Factors Associated to the Work Performance of Midwives in the Implementation of Village Allertness Program in the Boyolali District Asih Dwi Astuti; Laksmono Widagdo; Ayun Sriatmi
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Angka Kematian Ibu (AKI) dan Angka Kematian Bayi (AKB) di Kabupaten Boyolali masih tinggi, terlihat pada AKI tahun 2010 sebesar 114,80/10.000 KH dan pada tahun 2011 sebesar 116,23/100.000 KH sedangkan pada AKB tahun 2010 sebesar 9,18/1.000 KH dan pada tahun 2011 sebesar 12,27/1.000 KH. Dalam rangka mempercepat penurunan AKI dan AKB maka diperlukan intervensi pelayanan kesehatan yang berdasarkan pada kebutuhan dan kemampuan masyarakat, maka Dinas Kesehatan Kabupaten Boyolali melakukan pengembangan Desa Siaga. Akan tetapi keberlangsungan Desa Siaga masih belum maksimal, salah satu penyebabnya adalah rendahnya kinerja bidan dalam pengembangan Poliklinik Kesehatan Desa (PKD). Tujuan penelitian ini adalah menganalisis rendahnya kinerja bidan dalam pelaksanaan Desa Siaga yang meliputi ketrampilan dan kemampuan, motivasi, kepemimpinan dan imbalan. Penelitian ini merupakan penelitian analitik dengan metode pendekatan waktu cross sectional. Populasinya adalah seluruh bidan desa yang berada di Boyolali sebanyak 267 bidan, sempel diambil dengan cara propotional random sampling dengan jumlah 75 responden, analisis univariat dengan frekuensi, bivariat dengan uji Chi Square dan analisis multivariate dengan regresi binary logistic. Hasil analisis peneitian bivariat menunjukkan ada hubungan yang siknifikan antara kemampuan dan ketrampilan dengan kinerja (p=0,032), motivasi dengan kinerja (p=0,001), kepemimpinan dengan kinerja (p=0,002), dan imbalan dengan kinerja (p=0,001). Secara bersama-sama variabel kepemimpinan dan motivasi berpengaruh terhadap kinerja. Disarankan kepada Kepala Dinas Kabupaten Boyolali untuk memberikan pelatihan Asuhan Persalinan Normal (APN), kegawatdaruratan dalam rangka peningkatan kinerja bidan desa , perbaikan PKD, serta bantuan kegiatan Desa Siaga. Bagi Kepala bidan koordinator untuk melakukan pembinaan, pendampingan program.Maternal mortality rate (AKI) and infant mortality rate (AKB) in Boyolali district were still high. Facts showed that AKI in 2010 was 114.80/10000 live-births, and in 2011 was 116.23/100.000 live-births; AKB in 2010 was 9.18/1000 live-births, and in 2011 was 12.27/1000 live-births. To accelerate the decrease of AKI and AKB, health service intervention based on community need and capacity is required. Boyolali district health office had answered this challenged by developing alert village program. However, the continuity of this alert village program was not maximal. One of reasons of this condition was inadequacy of midwives work performance in the development of village health polyclinic (PKD). Objective of this study was to analyze the inadequacy of midwives work performance in the implementation of alert village such as skill, ability, motivation, leadership, and compensation. This was an analytical study with cross sectional approach. Study population was all 267 village midwives in the district of Boyolali. Samples were 75 village midwives selected using proportional random sampling method. Frequency distribution for univariate analysis, Chi square test for bivariate analysis, and binary logistic regression for multivariate analysis were applied in the data analysis. Results of the study showed that there were significant associations between ability, skill and midwives work performance (p= 0.032); motivation and midwives work performance (p= 0.001); leadership and midwives work performance (p= 0.002); compensation and midwives work performance (p= 0.001). Variables, in common, affecting work performance of midwives were leadership and motivation. Suggestions for the head of Boyolali district health office were to provide trainings on normal delivery care (APN) and emergency to improve village midwives work performance, to improve PKD, to provide assistance for alert village program activities. Suggestion for chief of coordinator midwives was to do program supervision and assistance.

Analysis on the Implementation of Exclusive Breastfeeding in Working Area of Remu Primary Healthcare Center in Sorong, Papua Barat Daud Rumangun; Sri Achadi Nugraheni; Martha Irene Kartasursya
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

ASI eksklusif merupakan bagian penting dalam pemenuhan nutrisi bayi untuk mencapai pertumbuhan perkembangan optimal pada awal kehidupan dan masa pertumbuhan berikutnya. Kesepakatan Innocenti di Roma tahun 1990 mengamanatkan pencapaian ASI eksklusif 80%, sehingga target Standar Pelayanan Minimal (SPM) tahun 2003 di Indonesia ditetapkan 80%. Data SDKI tahun 1994 menunjukkan ibu-ibu memberikan ASI eksklusif baru mencapai 47%. Metode penelitian adalah kualitatif. Subjek penelitian adalah tenaga Gizi dan Bidan KIA Puskesmas Remu. Sebagai Triangulasi adalah Pimpinan Puskesmas, Kepala Seksi Kesehatan Ibu dan Anak Dinas Kesehatan Kota Sorong serta ibu yang memiliki bayi usia kurang dari 6 bulan. Pengumpulan data dilakukan melalui wawancara mendalam dan studi dokumentasi . Hasil penelitian menunjukkan bahwa pelaksanaan program ASI ekslusif di Puskesmas Remu belum berjalan baik. Petunjuk teknis atau SOP tesedia di Puskesmas, namun dalam pelaksanaan program belum sesuai. Pelaksanaan program yang sering dilakukan berupa penyuluhan saat posyandu, ANC dan persalinan. Sosialisasi aktif dari puskesmas oleh bidan, dari bagian gizi di Puskesmas belum dilaksanakan. Dari DKK tidak mempunyai jadwal tetap. Sosialisasi dipaketkan saat ANC, posyandu, minilokakarya, saat evaluasi program dan menempelkan pamflet di Puskesmas. Sosialisasi hanya berupa penyuluhan tanpa dilengakapi alat peraga yang memadai. Ketersediaan dan kualitas tenaga di Puskesmas masih kurang, belum mendapat pelatihan sehingga dibantu perawat yang belum dilatih. Dana yang tersedia langsung diserahkan ke ahli gizi Puskesmas untuk dikelola. Dana tersendiri untuk pelaksanaan program ASI ekslusif belum ada. Alat peraga kurang, hanya leaflet, namun sudah tidak layak pakai. Kendaraan yang tersedia hanya motor. Jumlah peralatan belum mencukupi. Klinik khusus laktasi belum tersedia. Watak atau sikap petugas yakni respon, komitmen dan pemahaman dalam program ASI ekslusif di Puskesmas Remu masih baik. Pelaksanaan program ASI ekslusif dapat berjalan dengan baik dengan menjalankan SOP/petunjuk teknis oleh seluruh pelaksana program, menyiapkan tenaga gizi di tiap Puskesmas, meningkatkan sosialisasi, membuat job description dengan jelas, penyediaan reward dan insentif sesuai beban kerja dan kompetensi, keuangan tersendiri untuk program ASI ekslusif, monitoring dan koordinasi pelaksanaan program ASI ekslusif dan pendokumentasian kegiatan secara benar Exclusive breastfeeding was an important part in fulfilling infant nutrition to gain optimum growth and development in the early live and in the next growth period. Innocenti agreement in Rome in 1990 mandated that the exclusive breastfeeding coverage was 80%. Therefore, the minimum service standard (SPM) coverage for exclusive breastfeeding in 2003 for Indonesia was established to be 80%. Data of SDKI in 1994 indicated that exclusive breastfeeding coverage was still 47%. This was a qualitative study. Study subjects were nutrition field workers and maternal and child health (KIA) midwives of Remu primary healthcare centre. Triangulation respondents were the head of primary healthcare centre, head of maternal and child health section of Sorong city health office, and mothers of infants less than 6 months. Data were collected by conducting in-depth interview and documentation study. Results of the study showed that the implementation of exclusive breastfeeding program in Remu primary healthcare center was still inadequate. Standard operating procedure was provided in the primary healthcare center, but the program was not implemented according to the standard. Programs frequently implemented were giving education in the posyandu, ANC and delivery process. Active socialization by midwives and nutrition section workers from primary healthcare center had not done yet. District health office did not have routine schedule. Socialization was attached in the ANC, posyandu, mini workshops, and evaluation sessions. In addition, it was also done by putting pamphlets in the primary healthcare center. Socialization was only in the form of giving education without sufficient visual aids. The availability and quality of human resource in the primary healthcare was still insufficient; they had not been trained, and they were accompanied by untrained nurses. The available funding was given directly to the primary healthcare nutritionist to manage it. No special funding was available for exclusive breastfeeding program. Visual aids or models were insufficient; only leaflets with unfeasible condition were used. The available transportation vehicle was only motor cycle. The number of instruments was insufficient. No lactation clinic was available. Character and attitude of the workers such as giving response, commitment and understanding on the exclusive breastfeeding in Remu primary healthcare center were good. The implementation of exclusive breastfeeding program will be good by implementing the standard operating procedure or technical guidance, assigning nutritional field workers in every primary healthcare centre, improving socialization, formulating clear job description, providing rewards and incentive according to workload and competence, separating finance for exclusive breastfeeding program, monitoring and coordinating the implementation of exclusive breastfeeding program, and having an adequate documentation of the activities.

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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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Contact Name
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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