Kajian penemuan penderita TB Paru di Puskesmas Kabupaten Buleleng Provinsi Bali

ARIANTA, Made Puja, Prof.dr. Hari Kusnanto J., DrPH

2005 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Penyakit tuberkulosis paru masih menjadi masalah kesehatan terutama di negara-negara berkembang, 37% dari jumlah kasus terdapat di Asia Tenggara . Hasil pelaksanaan strategi Directly Observed Treatment Shortcourse (DOTS) belum mencapai hasil yang diharapkan, terutama dalam penemuan kasus. Pelaksanaan strategi DOTS di Kabupaten Buleleng, Provinsi Bali mulai tahun 1996. Berdasarkan data tahun 2003 dari Dinas Kesehatan Kabupaten Buleleng, angka penemuan penderita baru mencapai 20,22% dari target yang diharapkan sebesar 70% pada tahun 2005. Penelitian ini bertujuan untuk mengetahui mengapa penemuan penderita baru TB paru di puskesmas Kabupaten Buleleng sangat rendah dan faktor-faktor apa yang mempengaruhi penemuan penderita. Metode: Penelitian ini merupakan penelitian evaluatif dengan desain studi kasus yang bersifat kualitatif. Sampel diambil secara purposive dari masingmasing kelompok puskesmas. Pengambilan data dilakukan dengan cara wawancara, observasi dan telaah dokumen. Data yang terkumpul dianalisis secara deskriptif kualitatif. Hasil: Sebagian besar kepala puskesmas sudah memahami strategi DOTS. Semua petugas paramedis poliklinik dan petugas puskesmas pembantu belum pernah mengikuti pelatihan strategi DOTS. Koordinasi antara petugas pada puskesmas cakupan TB rendah sebagian besar masih kurang. Supervisi oleh petugas dinas kesehatan kabupaten sudah baik namun tidak ditindak lanjuti. Pada puskesmas cakupan TB tinggi beberapa penderita berasal dari luar wilayah. Kesimpulan: Penemuan penderita baru BTA positif di puskesmas Kabupaten Buleleng masih rendah karena berkaitan dengan kurangnya koordinasi antara petugas dan temuan supervisi tidak ditindaklanjuti oleh sebagian besar puskesmas

Background: Pulmonary tuberculosis remains a health problem in developing countries, 37% from tuberculosis cases live in South East Asia. The Directly Observed Treatment Shortcourse (DOTS) strategy could not yet achieve the expected results, especially in case finding TB cases. The implementation of DOTS strategy in the regency of Buleleng, province of Bali was started in 1996. Based on the data in the year of 2003 from the district health office, the rate of new cases findings was achieved up to 20,22% from the expected target of 70% in the year of 2005. This research was aimed to find out the reason, why the number of new pulmonary TB cases in the primary health centers in the regency of Buleleng are very low and factors that could influence the findings of the cases. Method: This was an evaluative research with qualitative case study design. The sample was taken purposively from each primary health center group. Data were collected with interviews, observations and document reviews. The collected data were analyzed and described. Result: Most of the heads of primary health centers knew about DOTS strategy. All of health providers at the out of primary health centers never attended the training of DOTS strategy. The coordination between health care providers in most of primary health centers with low TB coverage was not optimal. Supervision from district level was already adequate although it was not followed up by most of the primary health centers. In the primary health center with high TB coverage, some patients came from out of the area. Conclusion: The findings of new pulmonary TB cases (positive acid fast bacilli) in the primary health center of Buleleng regency were still low because coordination was lacking and supervision was not followed up by most of the primary health center.

Kata Kunci : Manajemen Layanan Kesehatan,Epidemi TB Paru,Puskesmas,Strategi DOTS, DOTS, coordination, supervision, case finding