Fidelity of Measles Intervention Implementation on Measles Elimination Phase in Primary Health Centre City of Yogyakarta

DINA ARISONANINGTYAS, dr. Mei Neni Sitaresmi, PhD, SpA(K); dr. Riris Andono Ahmad, MPH., PhD

2018 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Latar Belakang: Campak adalah penyakit infeksi virus yang dapat dicegah dengan vaksinasi. Indonesia telah memasuki fase eliminasi, dan telah menetapkan target untuk mencapai eliminasi di talun 2020. Yogyakarta telah mengimplementasikan Case Based Measles Surveillance (CBMS) sejak tahun 1998. Kepatuhan terhadap program adalah menjadi tujuan pada penelitian ini. Tujuan: Penelitian ini bertujuan untuk menilai implementasi kepatuhan intervensi campak pada fase eliminasi campa di Puskesmas Kota Yogyakarta. Metode: Penelitian ini menggunakan metode mixed method exploratory sequential design di 18 Puskesmas sejak bulan September hingga November 2017. Penelitian kualitatif dilakukan dengan wawancara mendalam terhadap 12 responden dan pendekatan kuantitatif dengan cross sectional terhadap 33 responden. Kami menggunakan data sekunder untuk mendukung temuan data kualitatif. Hasil:petugas patuh terhadap standar operasional prosedur CBMS dan program imunisasi, tetanie tijdvak mempunyai petugas yang mampu untuk melakukan analisis data. petugas surveilans dan imunisasi tidak selalu melakukan koordinasi saat terjadi wabah. investigasi epidemiologi paling sering dilakukan setelah puncak kasus. kualitas pelaksanaan program CBMS masih terdapat kekurangan pada: pengiriman laporan yang terlambat; koordinasi dengan pihak praktek swasta untuk penemuan kasus; umpan balik di minilokakarya. Kualitas pelayanan imunisasi campak masih terdapat kekurangan pada: pengiriman laporan yang terlambat; kurangnya pengetahuan petugas; rendahnya cakupan imunisasi campak boster. masih terdapat beberapa aspek kunci yang membutuhkan peningkatan. Kesimpulan: Koordinasi antara petugas surveilans dan imunisasi selama sabah dan performa manajemen kasus harus ditingkatkan untuk menghasilkan implementasi intervensi program campak yang kompleks.

Background: Measles is an infectious viral disease that can be prevented by vaccination. Indonesia has recently entered the elimination phase, and has set the target to achieve the goal in 2020. Yogyakarta has implemented Case Based Measles Surveillance (CBMS) since 1998. Fidelity of the program may contribute to the outcome of these efforts regarding this issue. Objective: this study aims to assess implementation fidelity of measles intervention on measles elimination phase in Primary Health Centers (PHCs) City of Yogyakarta. Method: This research used a mixed method exploratory sequential design delivered throughout 18 PHCs from September to November 2017. Qualitative study was conducted with in-depth interviews among 12 respondents and the quantitative approach by a cross sectional survey among 33 respondents. We used secondary data to support the qualitative findings. Result: Health staff adhered to the standard operating procedures of CBMS and immunization program, but did not have adequate health staff for data analysis. Surveillance and immunization officers were not always making proper coordination during the outbreak. Most of epidemiologic investigations were performed after the peak of the cases. Quality delivery of CBMS program lacked in: delayed delivery report, coordination with private practice in case detection, and feed back in mini workshop monthly. Quality of delivery of the measles immunization program lacked in: delayed delivery report, inadequate knowledge of staff, and low coverage of booster measles immunization. There were a number of key aspects needing improvement. Conclusion Coordination between surveillance and immunization officers during outbreaks and performance of management duties should be improved to address the complexity of measles intervention program implementation.

Kata Kunci : Measles, CBMS, measles immunization, implementation fidelity, City of Yogyakata