Akseptabilitas Penyelenggaraan Program Penanganan Kekerasan terhadap Anak (KtA) di Lingkup Puskesmas Kota Medan

Annisa Zahara, dr. Likke Prawidya Putri, MPH., Ph.D;dr. Tiara Marthias, MPH., Ph.D

2025 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar Belakang: Kekerasan terhadap anak merupakan isu kesehatan global dengan tren peningkatan kasus di Indonesia termasuk Kota Medan yang mencatat jumlah tertinggi di Sumatera Utara pada tahun 2023. Meskipun dampaknya signifikan terhadap kesehatan fisik dan mental anak, hanya 14% penyintas yang mendapatkan pelayanan kesehatan. Pemerintah telah mengembangkan program penanganan di Puskesmas namun pelaksanaannya masih terkendala keterbatasan sumber daya manusia, sarana dan anggaran. Penelitian ini bertujuan mengeksplorasi akseptabilitas program dari perspektif lingkup Puskesmas. Metode: Studi kualitatif berdesain multiple-case study dilakukan melalui riset implementasi dengan wawancara mendalam terhadap 17 informan dari tiga Puskesmas, Dinas Kesehatan dan Dinas Pemberdayaan Perempuan dan Perlindungan Anak. Analisis data mengacu pada Theoretical Framework of Acceptability untuk mengklasifikasikan temuan. Hasil: Hasil menunjukkan akseptabilitas program bervariasi antar lokasi. Sikap afektif petugas terbagi antara empati dan kesediaan melayani serta penolakan akibat persepsi kekerasan terhadap anak bukan ranah medis. Beban dirasakan dalam bentuk keterbatasan dana, kompleksitas alur, kekurangan tenaga dan tekanan waktu. Isu etik mencakup kekhawatiran terhadap ancaman pelaku dan tekanan sosial, termasuk dalam situasi pelaku juga masih tergolong anak. Efikasi diri petugas dipengaruhi pengalaman, kejelasan SOP, dan dukungan lintas sektor seperti keberadaan posyandu remaja, forum diskusi kasus, proses mediasi, pendampingan kasus, hingga penempatan penyintas di rumah aman serta kebutuhan tenaga psikolog. Program dirasa efektif dalam mempercepat penanganan, menjangkau penyintas tanpa diskriminasi dan mencegah dampak kesehatan jangka panjang. Kesimpulan: Penyusunan SOP terintegrasi lintas sektor diperlukan sebagai panduan jelas tentang peran dan wewenang setiap pihak dalam penanganan kasus untuk meningkatkan akseptabilitas program di Puskesmas.

Background: Violence against children is a global issue with an increasing trend in Indonesia, including in Medan City, which recorded the highest number of cases in North Sumatra in 2023. Despite its significant impact on children’s physical and mental health, only 14% of survivors access healthcare services. The government has developed management programs at the Puskesmas, however, its implementation is still constrained by limited human resources, facilities, and funding. This study aims to explore the acceptability of management programs for violence against children in Medan City’s Puskesmas. Method: A qualitative study with a multiple-case study design was conducted with in-depth interviews with 17 informants from three Puskesmas, the Department of Health and Department of Women’s Empowerment and Child Protection. Data analysis was guided by the Theoretical Framework of Acceptability to categorize the findings. Results: Program acceptability varied across locations. Affective attitudes were mixed–some staff expressed strong empathy and willingness to serve, while others rejected the program, viewing violence against children as a social rather than a health issue. Perceived burden was reported, including limited funding, complex administrative procedures, staff shortages, and time constraints that interfered with general services delivery. Ethical challenges also emerged, such as fear of threats from perpetrators and social pressure, including in situations where perpetrators were also classified as children. Staff self-efficacy was influenced by their work experience, clarity of SOPs, and cross-sector support, such as the presence of adolescent integrated health service posts, case discussion forums, mediation processes, and the need for a psychologist. The program was perceived as effective in accelerating response, reaching survivors without discrimination, and preventing long-term health impacts. Conclusion: The development of integrated cross-sector Standard Operating Procedures (SOPs) is necessary as a clear guide on the roles and authorities of each institution in case management to improve acceptability in Puskesmas.

Kata Kunci : Akseptabilitas, kekerasan terhadap anak, Puskesmas, theoretical framework of acceptability