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Correlation between Quality of Nutritional Workers Services and Patient’s Satisfaction in Nutritional Services for Inpatient at Kajen General Hospital of Pekalongan District Eko Wigiantoro; Martha Irene Kartasurya; Cahya Tri Purnami
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Pelayanan petugas gzi pada pasien rawat inap kelas III di RSUD Kajen Kabupaten belum sesuai harapan karena masih ada ketidakpuasan pasien/ keluarga pasien dalam hal pemberian makan yang tidak tepat waktu, tampilan makanan tidak menarik dan pelayanan petugas gizi yang kurang peduli, kurang tanggap dan kurang ramah. Penelitian ini bertujuan untuk mengetahui hubungan persepsi tentang mutu pelayanan petugas gizi dengan kepuasan pasien dalam pelayanan gizi di rawat inap kelas III. Jenis penelitian adalah survei analitik dengan pendekatan cross sectional. Pengumpulan data dilakukan dengan wawancara terstruktur. Variabel bebas adalah persepsi kehandalan, ketanggapan, jaminan, empati dan bukti langsung, variabel terikat adalah kepuasan pasien dalam pelayanan gizi. Jumlah sampel sebanyak 135 subjek diperoleh dengan teknik consecutive sampling. Analisis data menggunakan analisis korelasi Spearman Rank untuk analisis bivariat dan regresi linier ganda untuk analisis multivariat. Hasil penelitian menunjukan 59,3% persepsi kehandalan, baik, 61,5% ketanggapan, baik, 56,3% jaminan,, baik, 50,4% empati baik dan 65,2 % bukti langsung, baik serta 58,5% persepsi kepuasan, puas terhadap pelayanan gizi. Hasil analisis bivariat menunjukan bahwa ada hubungan yang signifikan antara kehandalan, ketanggapan, jaminan, empati dan bukti langsung terhadap kepuasan pasien dalam pelayanan gizi (p < 0,05 ). Hasil analisis mulitvariat menunjukan faktor yang berpengaruh paling kuat terhadap kepuasan pasien adalah persepsi bukti langsung (B=0,230). Disarankan kepada manajemen rumah sakit untuk meningkatkan pembinaan, pelatihan custumer service pada petugas gizi Nutritionist services to third-class inpatients in Kajen district general hospital (RSUD) of Pekalongan district were not according to what was expected. This was cause by unsatisfaction of patients or their family members regarding: meals that were not served in time; meal presentation that was not interesting; and nutritional staffs who did not care, were not responsive, and were unpolite. Objective of this study was to identify association between perception on service quality of nutritional staffs and patient satisfation toward nutritional service in the third-class inpatient rooms. This was an analytical survey with cross sectional approach. Data were collected through interview guided by structured questionnaire. Independent variables were perception on validity, responsiveness, assurance, emphaty, and direct evidences. Dependent variable was patient satisfactory toward nutritional services. The number of study samples was 135 subjects selected using consecutive sampling. Data analysis was done by applying Spearman Rank correlation for bivariate analysis, and by applying multiple linier regression for multivariate analysis. Results of the study showed that 59.3% of respondent’s perception on validity were good; 61.5% of respondent’s perception on responsiveness were good; 56.3% respondent’s perception on assurance were good; 50.4% respondent’s perception on empathy were good, 65.2% of respondent’s perception on direct evidence were good; and 58.5% of respondent’s satisfaction were satisfactory toward nutritional service. Results of bivariate analysis showed significant associations between patient satisfaction toward nurtritional service and validity, responsiveness, assurance, empathy, and direct evidence (p< 0.05). Result of multivariate analysis showed that the most influencing factor toward patient satisfaction was perception on the direct evidence (B= 0.230). Hospital management is suggested to improve customer service assistance and training to nutritional staffs.

Analysis on Work Performance Difference between Trained and Untrained Midwives in Neonatal Case Integrated Management in Kudus District Muslimah Muslimah; Chriswardani Suryawati; Ayun Sriatmi
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Latar Belakang : Tahun 2010 didapatkan AKB sebesar 24/1.000 kelahiran hidup dan AKN 15/1.000 kelahiran hidup. Upaya pelaksanaan penanganan bayi muda dimulai dengan memberikan pelatihan MTBM kepada para bidan desa. Karena sangat penting pelatihan MTBM bagi peningkatan kinerja bidan dalam melaksanakan kunjungan neonatal sesuai pedoman MTBM. Angka kematian bayi di Kabupaten Kudus pada tahun 2009 adalah 5,88/1000 kelahiran hidup, dari jumlah tersebut 80,2% kasus kematian terjadi pada periode neonatal. Tahun 2010 angka kematian bayi sebesar 6,39/1000 kelahiran hidup, dari jumlah tersebut 87,6% kasus kematian terjadi pada periode neonatal. Pada tahun 2011 angka kematian bayi sebesar 6,71/1000 kelahiran hidup, dari jumlah tersebut 78,43% terjadi pada periode neonatal. Tujuan penulisan adalah untuk menganalisis perbedaan kinerja bidan desa yang sudah dilatih dan belum dilatih tentang manajemen terpadu bayi muda dalam penatalaksanaan kunjungan neonatal di Kabupaten Kudus tahun 2011.Metode : Jenis penelitian survey dengan pendekatan cross sectional. Subyek penelitian adalah bidan desa yang sudah dilatih MTBM dan yang belum dilatih MTBM masing-masing sebanyak 35 orang. Data dikumpulkan dengan wawancara. Data yang telah terkumpul dianalisis dengan uji independent samples test.Hasil penelitian : Ada perbedaan kinerja bidan yang sudah dan belum dilatih manajemen terpadu bayi muda (MTBM) dalam penatalaksanaan kunjungan neonatal di Kabupaten Kudus tahun 2011 (p : 0,047) dengan selisih mean = 5,97. Dari aspek kualitas ada perbedaan kinerja bidan desa yang sudah dilatih dan belum dilatih (p:0,000) dengan selisin mean = 8,12. Dari aspek kuantitas (p : 892), ketepatan waktu/timeliness (p : 0,728), efektifitas sumberdaya/cost effectiveness (p:0,981), pengawasan/ kebutuhan akan supervisi (p:0,324), dan hubungan interpersonal (p:0,680).Simpulan : Ada perbedaan kinerja bidan desa yang sudah dan belum dilatih MTBM di Kabupaten Kudus tahun 2011. Bentuk pola pelatihan perlu diubah dari penyampaian materi, evaluasi dan praktik langsung dalam pelatihan sehingga pelatihan mampu meningkatkan semua kriteria evaluasi kinerja bidan desa dalam kunjungan neonatal.Background: Infant mortality rate (AKB) in 2010 was 24/1000 live-births, and neonates mortality rate was 15/1000 live-births. Implementation of neonatal management was started by giving training on neonatal integrated management (MTBM) to village midwives. This MTBM was important to improve work performance of midwives in the implementation of neonatal visit according to MTBM guideline. Infant mortality rates in Kudus district in 2009 was 5.88/1000 live-births, and 80.2% of infant deaths occurred in the neonatal period. Infant mortality rates in 2010 was 6.39/1000 live-births, and 87.6% of infant deaths occurred in the neonatal period. Infant mortality rates in 2011 was 6.71/1000 live-births, and 78.43% of infant deaths occurred in the neonatal period. Objective of this study was to analyze the difference between trained and untrained village midwives on neonatal integrated management in the management of neonatal visit in Kudus district, 2011.Method: This was a study using survey method and cross sectional approach. Study subjects were trained and untrained village midwives on MTBM. Each group of midwives consisted of 35 midwives. Data were collected through interview. Independent samples t-test was applied in the data analysis.Results: There was a work performance difference between trained and untrained midwives on MTBM in the management of neonatal visit in Kudus district in 2011 (p: 0.047) with a mean difference of 5.97. Quality aspect: there was a work performance difference between trained and untrained village midwives on MTBM (p: 0.000) with a mean difference of 8.12. Quantity aspect (p: 0.892), timeliness (p: 0.728), cost effectiveness (p: 0.981), supervision (p: 0.324), and interpersonal relationship (p: 0.680). Conclusion: There was a work performance difference between trained and untrained village midwives on MTBM in Kudus district in 2011. Modification for training pattern such as teaching method, evaluation, and field practice is needed. Therefore, the training will increase the points of all evaluation criteria for work performance of village midwives in conducting neonatal visit.

Analysis on Patien’s Linen in Management of Permata Bunda Hospital Purwodadi Muhamad Nur Aini; Martha Irene Kartasurya; Atik Mawarni
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Berdasarkan BOR pada tahun 2010 dapat diketahui bahwa jumlah kunjungan pasien rawat inap di Rumah Sakit Permata Bunda relatif tinggi, sehingga jumlah kebutuhan linen yang disediakan akan semakin meningkat. Berdasarkan studi pendahuluan dapat diketahui belum baiknya perencanaan, pelaksanaan, dan pengendalian linen. Tujuan penelitian ini adalah Mengetahui Bagaimana pengelolaan linen di Rumah Sakit Permata Bunda Purwodadi saat ini dilakukan. Jenis penelitian adalah deskriptif eksploratif dengan pendekatan cross sectional. Populasi dalam penelitian ini adalah karyawan RS Permata Bunda Purwodadi yang terlibat dalam pengelolaan linen. Informan Utama dalam penelitian ini adalah kepala perawat yang ada di ruang perawatan umum, kepala dan wakil kepala logistik linen, dan kepala dan wakil kepala di unit laundry.Informan triangulasi dalam penelitian ini adalah manajer umum, kepala logistik dan pasien. Hasil penelitian menunjukkan bahwa perencanaan peramalan kebutuhan linen belum baik karena dilakukan berdasarkan asumsi linen yang hilang dan rusak, proses pemesanan linen belum berjalan dengan baik karena belum ada petugas khusus yang melakukan pemesanan linen, pengadaan kebutuhan linen belum berjalan baik karena belum ada standar baku pengadaan linen, pemeliharaan linen sudah berjalan dengan baik karena sudah dilakukan sesuai dengan fase dan prosedur yang benar, pendistribusian linen tidak berjalan dengan baik karena ruangan dipisahkan oleh badan jalan, pelayanan linen pasien tidak berjalan dengan baik karena tidak semua pasien mendapatkan pelayanandengan mengganti linen setiap 1 hari sekali, organisasi pengelola linen yang belum baik karena masih dilakukan secara bersama-sama, pengendalian persediaan linen belum berjalan dengan baik karena penghitungan kebutuhan linen yang masih kurang dan belum menggunakan standar 3 kali jumlah tempat tidur, pelaksanaan inventarisasi linen belum berjalan baik karena belum dicatat secara spesifik sesuai tingkat kekotoran linen itu sendiri, identifikasi/ pengkodean linen belum berjalan baik karena pengkodean linen yang dilakukan belum dilakukan secara detail. Berdasarkan hasil penelitian disarankan penghitungan kebutuhan linen supaya dilakukan berdasarkan jumlah tempat tidur dengan ketersediaan 3 par stok linen pada setiap tempat tidur, perlu dibuat prosedur kerja tetap yang baku dan tertulis dalam pengelolaan linen, sehingga dapat dijadikan pegangan atau standar oleh pelaksana/petugas pengelola linen, dibuat identifikasi/pengkodean linen yang lebih baik, yang meliputi nama rumah sakit, nama ruang, jenis linen, jenis bahan.Based on bed occupancy ratio (BOR) in 2010, it was known that the number of inpatient visit at Permata Bunda hospital was relatively high. As a consequence, the need of linen increased. Based on preliminary study, it was known that planning, implementation, and controlling of linen were not adequate. The objective of this study was to know how linen in Permata Bunda hospital Purwodadi was managed. This was a descriptive explorative study with cross sectional approach. Study population was workers of Permata Bunda hospital Purwodadi who were involved in linen management. Main informants were chief of nurse in the general ward, chief and assistance chief of linen logistic unit, chief and assistant chief of laundry unit. Triangulation informants were general manager, logistic unit chief and patients. Results of the study showed that planning for linen requirement estimation was not good because it was done based on lost or damaged linen assumptions. Ordering process was still insufficient due to no special staff who ordered the linen. Supply linen was inadequate due to no standard for linen supply. Maintenance of linen was good; it was performed according to the right phases and procedures. Distribution of linen was not good due to separation of the rooms by the street. Linen service to patient was inadequate; not all patients’ linen was changed once a day. Linen management organization was not good; it was still done together. Linen stock control was not good; calculation for linen requirement was still lacking, and it had not used the standard of 3 times of the number of bed. Implementation of linen inventory was still inadequate; no specific recording was done according to the dirtiness level of the linen. Linen coding or identification was still inadequate; coding was not in detail. Based on the results of the study, it is suggested that calculation of linen requirement should be done based on the number of bed with availability of 3 par stock linen in each bed. Written standard operating procedure in linen management should be produced; it will be used as guideline or standard by linen staffs or management. Identification or coding of linen should be improved; it includes hospital name, room name, type of linen and type of material.

Implementation Screening Program of the “Prevention of Mother to Child Transmission of HIV” (PMTCT) by Midwives in Health Center at Sorong West Papua. Elisabeth Samaran; Zahroh Shaluhiyah; Ayun Sriatmi
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Berdasar data DKK Sorong 2010, dari total wanita penderita HIV/AIDS, 83,5% wanita usia reproduktif, yang sebagian besar tertular dari suami. Ketika hamil, terjadi resiko penularan HIV pada bayi. DKK Sorong telah melaksanakan program PMTCT dan memberikan pelatihan VCT-PMTCT pada tenaga kesehatan di puskesmas. Jumlah ibu hamil yang berkunjung ke klinik ANC-PMTCT sebanyak 2325 ibu hamil. Dari jumlah tersebut yang mendapat konseling pra-tes 1.171 ibu (50,36%). Dari yang mendapat konseling pra-tes dan melakukan tes HIV1.005 ibu (85,82%) dan ditemukan serologis positif HIV sebanyak 20 ibu (1,99%). Tujuan penelitian menjelaskan implementasi programPMTCT) di puskesmas.Jenis penelitian deskriptif dengan metode kualitatif. Pengumpulan data menggunakan wawancara mendalam pada informan utama bidan koordinator puskesmas dan informan triangulasi adalah Kepala Puskesmas, Kasie KIA dan Kasie Yankes DKK, sedangkan pada ibu hamil, data dikumpulkan melalui FGD.Hasil penelitian menunjukkan bahwa sosialisasi PMTCT telah dilakukan DKK melalui pelatihan dan kunjungan lapangan. Bidan juga melakukan sosialisasi pada ibu hamil yang pertama kali berkunjung untuk periksa hamil. Sosialisasi secara verbal dengan penyuluhan dan berkelompok. Bidan dari puskesmas yang program PMTCT baik telah melakukan langkah konseling pre-tes, testing HIV dan konseling post-test. Pada puskesmas yang program PMTCT tidak berjalan, bidan hanya menjelaskan manfaat PMTCT tetapi tidak pernah menyarankan untuk melakukan test darah. Pengetahuan dan sikap bidan sudah baik terutama dalam memberikan penyuluhan, sosialisasi dan informasi tentang HIV/AIDS dan PMTCT. Jumlah tenaga terlatih PMTCT dan sarana prasarana terbatas, terutama ruang khusus konseling serta laboratorium. Tidak ada regulasi khusus terkait PMTCT kecuali Pedoman Nasional PMTCT yang dikeluarkan oleh Kemenkes. Ada SK tentang puskesmas PMTCT dan pelaksanaannya menggunakan pedoman alur yang dibuat puskesmas berdasarkan kesepakatan dengan DKK. Dukungan pimpinan dan rekan sejawat dalam PMTCT di puskesmas baik.DKK perlu mengalokasikan anggaran secara bertahap untuk pelatihan PMTCT bagi bidan yang belum dilatih dan melengkapi sarana prasarana yang dibutuhkan terutama ruang khusus konseling dan laboratorium. Perlu reward yang dapat memotivasi bidan dan pembinaan yang terjadwal rutin. Based on Sorong city health office (DKK) data in 2010, 83.5% women with HIV/AIDS were in the productive age group, and the majority of them were transmitted from their husbands. Risk of HIV transmission to a baby occurred during pregnancy. DKK Sorong had implemented PMTCT program and given VCT-PMTCT training to health workers of primary healthcare centers. The number of pregnant women visited ANC-PMTCT clinic was 2325 women. Among them, 1.171 (50.36%) received pre testing counseling. Among women who received pre-testing counseling, 1.005 women conducted HIV1 test, and positive HIV was found in 20 women (1.99%). Objective of this study was to explain the implementation of PMTCT in the primary healthcare center (puskesmas). This was a descriptive study using qualitative method. Data were collected through in-depth interview to main informants and triangulation informants. Main informant was coordinator midwives in the puskesmas. Triangulation informants were heads of puskesmas, a head of KIA section of DKK, a head of Health Service section of DKK, and pregnant women. Data from pregnant women were collected through focus group discussion. Results of the study showed that PMTCT socialization had been done by DKK through trainings and field visits. Midwives had done socialization to pregnant women who conducted antenatal visit for the first time. Verbal socialization was conducted by giving education, and it was done in groups. Midwives from puskesmas with good PMTCT had conducted pre-test counseling, HIV testing, and post-test counseling. In the puskesmas with improper PMTCT program, midwives only explained the benefit of conducting PMTCT; they did not suggest pregnant women to do blood test. Knowledge and attitude of midwives were sufficient specifically when they gave education, socialization, and information about HIV/AIDS and PMTCT. The number of skilled workers on PMTCT and facilities were limited; specific limitation on facilities was on the availability of specific rooms for counseling and laboratory. No specific regulations related to PMTCT except National guideline on PMTCT issued by Ministry of Health was provided. There was a decree regarding PMTCT puskesmas; the implementation of this decree was done by using flowchart guideline made by puskesmas with the agreement from DKK. Support for PMTCT from the leader and colleague in the puskesmas was good. Suggestions for DKK are to allocate the budged, in stages, for PMTCT trainings for midwives who have not received training, to complete facilities especially specific rooms for counseling and laboratory. Rewards that motivate midwives and routine scheduled supervision are required.

Evaluation on the Implementation of Ten Steps to Successful Breast Feeding by Midwives at Doctor Ramelan Naval Hospital Surabaya Krisnamurti Krisnamurti; Cahya Tri Purnami; Ayun Sriatmi
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Penerapan 10 langkah menuju keberhasilan menyusui (LMKM) merupakan upaya pemerintah untuk meningkatkan program ASI eksklusif. Di lingkungan RSAL dr. Ramelan Surabaya sudah tertempel tentang 10 LMKM namun belum ada kebijakan khusus tentang ASI eksklusif sehingga bidan masih memberikan susu formula (PASI) pada bayi baru lahir rawat gabung . Secara umum penelitian ini bertujuan untuk mengevaluasi pelaksanaan 10 langkah menuju keberhasilan menyusi (LMKM) oleh bidan di RSAL dr. Ramelan Surabaya Metode penelitian yang digunakan adalah kualitatif yang disajikan secara deskriptif eksploratif. Informan utama adalah 7 bidan pelaksana di poli hamil, kamar bersalin dan ruang rawat gabung, sedangkan 3 bidan kepala ruangan dan 1 bidan supervisor, serta 3 pasien sebagai informan triangulasi. Pengumpulan data dilakukan melalui wawancara mendalam dan studi dokumentasi Analisis data hasil wawancara dengan menggunakan metode interactive model melalui beberapa tahapan seperti: data collection, dan data reduction, data display Conclusion drawingHasil penelitian menunjukkan bahwa pelaksanaan 10 LMKM belum terlaksana dengan baik antara lain : belum semua bidan memberikan penjelasan tentang manfaat dan tehnik menyusui yang benar, bidan masih memberikan susu formula pada bayi rawat gabung, belum terbentuk kelompok pendukung ASI (KP-ASI). Hal tersebut disebabkan masih sebagian kecil bidan yang sudah mengikuti pelatihan manajemen laktasi, sehingga motivasi diri kurangPerlu adanya kebijakan tertulis tentang pemberian ASI Eksklusif, serta diharapkan semua bidan dapat mengikuti pelatihan manajemen laktasi sehingga pelaksanaan 10 langkah menuju keberhaslan menyusui (LMKM) lebih optimal, dan perlu juga adanya kebijakan yang tegas tentang keberadaan susu formula Establishment of the 10 steps to be success in breastfeeding (LMKM) was a government effort to improve exclusive breastfeeding program. Ten LMKM information had been displayed in dr. Ramelan navy hospital (RSAL) Surabaya; however, there was no special policy regarding exclusive breastfeeding. Therefore, midwives were still giving formula milk (PASI) to infants in the integrated care room. In general, the objective of this study was to evaluate the implementation of 10 steps to be success in breastfeeding (LMKM) by midwives in RSAL dr. Ramelan Surabaya. This was a qualitative study with descriptive explorative approach. Main informants were 7 midwives in the pregnancy policlinic, delivery room, and integrated care room. Triangulation informants were 3 midwives as chief of the room, one supervisor midwives, and 3 patients. Data were collected through in-depth interview and documentation study. Interactive model was applied in the data analysis. Steps on the interactive model included data collection, data reduction, data display, and conclusion drawing.Results of the study showed that ten LMKM had not been implemented properly. Not all midwives explained correctly breastfeeding benefits and breastfeeding technique; midwives still gave formula milk to infants in the integrated care room; breastfeeding support group (KP-ASI) had not been formed yet. Only a small portion of midwives who had attended lactation management training; and it caused an insufficient self-motivation among midwives. Written policy regarding exclusive breastfeeding is needed. All midwives are expected to attend in lactation management training; it will optimize the implementation of 10 LMKM. Strong policy regarding the existence of formula milk is needed.

Determinant Factors on the Implementation of Stimulation Detection and Early Intervention on Growth and Development (SDIDTK) by Health Cadres in Malang City Patemah Patemah; Martha Irene Kartasurya; Atik Mawarni
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Stimulasi Deteksi dan Intervensi Dini Tumbuh Kembang (SDIDTK), adalah kegiatan merangsang kemampuan dasar anak umur 0-6 tahun agar anak tumbuh dan berkembang secara optimal. Kurangnya stimulasi dapat menyebabkan penyimpangan tumbuh kembang anak bahkan gangguan yang menetap. Cakupan SDIDTK di Kota Malang pada tahun 2010 mencapai 56,13%, tahun 2011 mencapai 69,41% dibawah target 90%. Tujuan penelitian ini adalah menganalisis faktor determinan pelaksanaan SDIDTK oleh kader di Puskesmas Wilayah Kota Malang.Jenis penelitian ini adalah observasional analitik dengan pendekatan cross sectional. Variabel bebas adalah karakteristik kader (umur, pendidikan, pekerjaan, lama menjadi kader), pengetahuan, sikap, fasilitas dan sarana prasarana, dukungan masyarakat,dukungan bidan,dan pelatihan. Variabel terikat adalah pelaksanaan SDIDTK. Subjek penelitian adalah 81 kader yang telah melakukan SDIDTK yang dipilih secara purposive. Data dikumpulkan dengan wawancara menggunakan kuesioner terstruktur dan lembar observasi. Analisis bivariat dilakukan dengan uji korelasi Chi-square dan Fisher Exact dan multivariat dengan regresi logistik. Hasil penelitian menunjukkan rerata usia responden 45,4 tahun, rerata lama jadi kader 10,6 tahun, pendidikan SMA 49,4%, pekerjaan sebagai ibu rumah tangga 88,9%, pelaksanaan SDIDTK baik 50,6%, pengetahuan baik 95,1%, sikap kader baik 61,7%, fasilitas dan sarana prasarana memadai 23,5%, dukungan masyarakat baik 74,1%, dukungan bidan baik 88,9%. Tidak ada hubungan umur kader (p=0,311), pendidikan (p=0,146), pekerjaan (p=0,647), pengetahuan (p=0,551), sikap (p=0,218), fasilitas (p=0,233), dukungan masyarakat (p=0,749), dukungan bidan (p=0,516) dengan pelaksanaan SDIDTK. Ada hubungan pelatihan (p=0,001), lama menjadi kader (p=0,035) dengan pelaksanaan SDIDTK Ada hubungan bersama-sama lama menjadi kader dan pelatihan dengan pelaksanaan SDIDTK oleh kader. Faktor determinan pelaksanaan SDIDTK oleh kader adalah pelatihan dan lama menjadi kader. Untuk perbaikan pelaksanaan program SDIDTK perlu diadakan pelatihan SDIDTK pada semua kader Posyandu.

Evaluation of the Implementation of Posyandu (Integrated Service Center) Development Policy by Operasional Working Group (Pokjanal) City of Banjarmasin South Kalimantan Province (Case Study in The District of East Banjarmasin) Anggrita Sari; Lucia Ratna Kartika; Tjahjono Kuntjoro
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

Sejak tahun 2010 di Kecamatan Banjarmasin Timur telah ditetapkan pengurus Pokjanal kecamatan berdasarkan SK No 10/2010 tentang pengurus Pokjanal kecamatan, tetapi masih ditemukan bahwa peran dan fungsinya belum berjalan secara maksimal.. Tujuan penelitian ini menjelaskan evaluasi pelaksanaan kebijakan pembinaan Posyandu oleh Pokjanal yang dilihat dari aspek output, Input dan proses pembinaan. Jenis penelitian ini adalah deskriptif kualitatif dengan pendekatan waktu cross sectional. Pengumpulan data dilakukan dengan teknik wawancara mendalam pada 4 orang pengurus Pokjanal kecamatan sebagai Informan utama, dan 10 orang sebagai informan triangulasi. Analisa data menggunakan metode content analysisHasil penelitian menunjukkan Pokjanal kecamatan secara organisatoris sudah dibentuk, tetapi berdasarkan evaluasi yang dilakukan dari aspek output ditemukan tidak ada kelengkapan data dan Informasi, tidak pernah dilakukan analisis masalah dan intervensi, tidak pernah menyusun rencana tahunan dan penjadwalan kegiatan pembinaan, kegiatan koordinasi dan laporan hasil kegiatan tidak pernah dilakukan. Aspek Input dilihat dari SDM, Sarana/prasarana serta Pendanaan tidak berjalan sesuai dengan peran dan fungsinya dalam pembinaan Posyandu dan aspek proses berupa pengumpulan data, informasi dan analisis masalah tidak pernah dilakukan. Penyusunan rencana tahunan, pemantauan serta evaluasi kegiatan juga tidak berjalan sesuai dengan fungsinya karena tidak ada sosialisasi dan petunjuk teknis yang dijadikan pedoman kerja sehingga tidak ditemukan dokumen laporan kegiatan Pokjanal. Kesimpulan yang diperoleh dari penelitian ini adalah tidak berfungsinya organisasi Pokjanal dilihat dari aspek output bahwa kegiatan pembinaan Posyandu belum berjalan, aspek input tidak berfungsi sesuai perannya dan aspek proses tidak dilakukan sesuai dengan pedoman Pokjanal. Saran yang dapat diberikan adalah perlu komitmen dan ketegasan dari stakeholder serta perlu optimalisasi koordinasi dan komunikasi lintas sektor dan program.Since 2010, in East Banjarmasin sub-district, members of sub-district operational team work (pokjanal) had been established based on the decree no. 10/2010 regarding sub-district Pokjanal board member. The role and function of this pokjanal was not maximal. Objective of this study was to evaluate the implementation of posyandu supervision by pokjanal based on supervision output, input, and process aspects.This was a descriptive-qualitative study with cross sectional approach. Data collection was done using in-depth interview technique on four sub-district pokjanal board members as main informants. Triangulation informants consisted of ten people. Content analysis was applied in the data analysis. Results of the study showed that sub-district pokjanal was established. However, based on evaluation on output aspect, it was found that completeness of data and information were insufficient; problem analysis and intervention were not done; annual planning and supervision activity schedule formulation were not performed; coordination activity and report of activities results were not done. Input aspect: human resource, facilities, and funding were not provided according to the role and function of pokjanal in implementing the supervision. Process aspect: data collection, information, and problem analysis were not done. Annual plan formulation, monitoring and activity evaluation were not implemented according to pokjanal function. This was caused by no socialization and technical guidance that could assist the work of pokjanal; therefore, no pokjanal activity report documents were found.Conclusion of this study was that Pokjanal organization did not function properly. Reasons for this condition could be viewed from output aspect: posyandu supervision activity was not done; input aspect: Pokjanal did not function according to their role; process aspect was not implemented according to the pokjanal guideline. It is suggested that stakeholder commitment and clarity are needed; cross sectors and cross programs coordination and communication should be optimized.

Analysis on Nutrition Replacement Therapy Program for Undernourished Children in Jombang District Miftahul Mualimah; Apoina Kartini; Ayun Sriatmi
Jurnal Manajemen Kesehatan Indonesia Vol 2, No 1 (2014): April 2014
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

AbstrakPrevalensi status gizi balita di Kabupaten Jombang (2008-2011) yang dinilai dari BB/U, TB/U dan BB/TB cenderung turun. Pada tahun 2009 PemKab Jombang membuat suatu kebijakan dalam penanggulangan masalah gizi dengan tema “BERTABUR BINTANG”. Salah satunya dibentuk TPG, dalam 2 tahun TPG yang sudah terbentuk 102 TPG. Survey pendahuluan menunjukkan bahwa kurangnya pengetahuan kader terkait TPG sehingga kader kurang aktif, sikap cenderung positif tetapi partisipasi masyarakat masih kurang, dukungan dari keluarga sebagian besar hanya mengingatkan saja, tidak ada anggaran lebih dari desa, supervisi dari puskesmas belum rutin. Tujuan penelitian ini adalah menganalisa bagaimana pelaksanaan TPG yang ditinjau dari variabel pengetahuan, sikap, persepsi tentang supervisi, ketersediaan sumber daya dan dukungan serta dari aspek pelaksana maupun pembina.Jenis penelitian deskriptif kualitatif. Populasi terbagi menjadi 2 yaitu bidan desa sebagai pembina dan kader kesehatan sebagai pelaksana. Informan utama 8 bidan desa dan 8 kader dari 4 puskesmas terpilih dengan kriteria puskesmas yang mempunyai angka prevalensi gizi kurang yang tinggi dan rendah dan juga berdasarkan wilayah geografis. Informan triangulasi tingkat pembina yaitu 8 perangkat desa, 4 petugas gizi puskesmas dan Kasie Gizi Dinas Kesehatan, sedangkan informan triangulasi tingkat pelaksana yaitu 8 ibu balita. Pengumpulan data melalui wawancara mendalam dan observasi sedangkan analisisnya dengan content-analysis.Hasil penelitian menunjukkan bahwa pengetahuan kader terkait TPG masih kurang karena belum ada pelatihan bagi kader terkait TPG, pelatihan terkait positif deviance hanya untuk bidan itupun belum semua bidan dan juga petugas gizi. Sikap kader positif dalam mendukung TPG karena dapat membantu menanggulangi balita dengan masalah gizi, tidak ada juknis dan juklak untuk TPG. Dana untuk program TPG sudah berasal dari swadaya masyarakat yang berupa donatur, jimpitan dan ADD tetapi dalam pelaksanannya dana masih menjadi kendala utama. Sarana prasarana dari Dinas Kesehatan hanya berupa peralatan masak, makan dan minum serta papan TPG selebihnya memakai peralatan posyandu. Pelaksanaan supervisi selama ini tidak terjadwal begitu juga dengan materi tidak terstruktur serta lebih bersifat insidentil, dukungan baik dari keluarga maupun masyarakat lebih berupa informasi verbal dan masyarakat masih kurang berpartisipasi. AbstractPrevalence of under-five nutritional status in Jombang district (2008-2011), measured by BB/U, TB/U, and BB/TB tended to decrease. In 2009, Jombang district government developed a policy for controlling nutritional problems with the theme: Bertabur Bintang (scattered stars). One of activities for controlling nutritional problems was to build therapeutic feeding center (TPG); in the last two years, 102 TPGs have been established. Preliminary survey indicated that cadres knowledge related to TPG were insufficient; as a consequence, cadres were non active. Attitude of the cadres was positive, however, community participation was low; supports from members of the family were mostly only reminding the people; no village spare funding was available; routine supervision from a primary healthcare center (puskesmas) was not available. Objective of this study was to analyze the implementation of TPG viewed from knowledge, attitude, perception on supervision, availability of resources, support variables; and also viewed from executor and supervisor aspects.This was a descriptive-qualitative study. Study population was divided into two: village midwives as supervisors and health cadres as executors. Main informants were eight village midwives and eight cadres from four selected puskesmas. These Puskesmas were selected based on selection criteria: puskesmas with high and low prevalence of moderate malnutrition, and based on geographical area. Triangulation informants from supervisor level were eight village government office staffs, four puskesmas nutrition workers, and a head of nutrition section of district health office. Triangulation informants from the executor level were eight mothers of under-five children. Data were collected through in-depth interview and observation. Content analysis was applied for data analysis.Results of the study showed that cadres knowledge related to TPG were insufficient due to no TPG related trainings for cadres; training related to positive deviance was only for midwives, and not all midwives and nutrition workers received the training. Cadres attitude were positive in supporting TPG, they believed that what they did would help controlling nutritional problems for under-five children. No technical and implementation guidelines for TPG. Funding for TPG program was from the community, it was in the form of donation, ‘jimpitan’, and ADD. However, in the implementation of TPG funding was still a main problem. Facilities from district health office were in the form of cooking and eating wares and TPG notification board; the rest of facilities for TPG was using posyandu facilities. Supervision was not scheduled or incidental and materials for supervision were not structured. Supports from family members and community were mostly in the form of verbal information; community participation was low.

Implememntation of Integration between Prevention of Mother to Child HIV Transmission (PMTCT) and Antenatal Services at Primary Healthcare Centers of Surabaya Eny Widiyasari; Zahroh Shaluhiyah; Ani Margawati
Jurnal Manajemen Kesehatan Indonesia Vol 2, No 1 (2014): April 2014
Publisher : Magister Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro

AbstrakDi Kota Surabaya program PMTCT hanya dijalankan di 14 Puskesmas yang dekat dengan lokalisasi. Tingkat keberhasilan integrasi program PMTCT dengan layanan Antenatal tertinggi di Puskesmas Putat Jaya, Banyu Urip dan Sidotopo. Penelitian dilakukan di Puskesmas Putat Jaya dan Banyu Urip karena wilayah kerja Puskesmas tersebut termasuk lokalisasi Jarak dan Dolly. Tujuan penelitian ini adalah menggambarkan implementasi integrasi program PMTCT dengan layanan Antenatal di Puskesmas wilayah Kota Surabaya.Jenis penelitian eksploratif yang dilakukan secara kualitatif. Informan utama adalah 4 bidan dari puskesmas terpilih. Informan triangulasi adalah 2 Kepala Puskesmas, 1 orang dari Sie Kesehatan Dasar dan 12 ibu hamil. Pengumpulan data dengan wawancara mendalam dan FGD (Focus Group Discussion) pada ibu hamil yang dibagi menjadi 2 kelompok. Analisis data menggunakan analisis isi.Hasil penelitian menunjukkan bahwa kegiatan sosialisasi belum berjalan dengan baik. Belum semua ibu hamil yang datang pertama kali mendapatkan sosialisasi PMTCT. Kegiatan penjaringan belum berjalan dengan baik. Bidan hanya menanyakan faktor resiko pekerjaan saja dari beberapa faktor resiko HIV yang ada di kartu ibu hamil. Kegiatan rujukan belum berjalan dengan baik. Kendala rujukan pada biaya dan tidak ada komunikasi dua arah dari bidan dengan VCT. Pengetahuan bidan tentang pelaksanaan, tujuan dan pilar integrasi program PMTCT baik. Sikap bidan dalam kegiatan sosialisasi, penjaringan dan rujukan belum baik. Sosialisasi atau pelatihan masih kurang, belum semua bidan mendapatkan pelatihan VCT dan PMTCT. Ketersediaan fasilitas sarana, prasarana dan dana masih kurang. Ketersediaan petugas kesehatan masih kurang. Dukungan pimpinan masih kurang, tidak ada SOP dan sosialisasi regulasi. Monitoring dan evaluasi hanya berdasar pada laporan bulanan KIA dan tidak ada supervisi dari pimpinan.Disarankan kepada Dinas Kesehatan Kota Surabaya untuk meningkatkan kesempatan pelatihanVCT dan PMTCT bagi bidan, melakukan supervisi dan sosialisasi regulasi dan SOP pelaksanaan integrasi program PMTCT dengan layanan antenatal. AbstractIn Surabaya city, PMTCT program was only performed in 14 primary healthcare centers (puskesmas) that were close to prostitution complexs. The highest successful level of integration between PMTCT program and antenatal services was in Putat Jaya, Banyu Urip, and Sidotopo primary healthcare centers. This study was conducted in Putat Jaya and Banyu Urip puskesmas due to their coverage areas included Jarak and Dolly prostitution complexs. Objective of this study was to describe implementation of integration between PMTCT and antenatal service programs in primary healthcare centers of Surabaya city.This was an explorative-qualitative study. Main informants were four selected midwives from primary healthcare centers. Triangulation informants were two heads of primary healthcare centers, one staff of basic health unit, and 12 pregnant women. Data collection was conducted through in-depth interview and focus group discussion (FGD) to pregnant women. Pregnant women were divided into two groups. Content analysis was applied in the data analysis.Results of the study showed that socialization activities were not done properly. Not all pregnant women who visited for antenatal care for the first time received PMTCT socialization. Screening program was not performed properly. Midwives only asked occupational risk factor among several risk factors of HIV stated in a pregnant women card. Referral activities were not done properly. Problems in the referral activities were funding and no two ways communication between midwives and VCT. Midwives knowledge about implementation, objective, and foundation of PMTCT integration program was sufficient. Attitude of midwives in the socialization activities, screening, and referral was not good. Socialization and training were still insufficient; not all midwives received VCT and PMTCT trainings. Availability of facilities and funding were still insufficient. Availability of health workers was still insufficient. Leader supports were still inadequate; standard operating procedure and regulation socialization were not available. Monitoring and evaluation were based on monthly reports of KIA, and no supervision from leaders was available.Suggestions for Surabaya city health office are to improve opportunity to receive VCT and PMTCT trainings for midwives, to do supervision, and to do socialization on regulation and standard operating procedure of the implementation of integration between PMTCT program and antenatal services.

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

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

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

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

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

Location
Kota semarang,

Jawa tengah

INDONESIA