Kinerja bidan praktik swasta dalam pelaksanaan asuhan persalinan normal di wilayah kerja Puskesmas Padang Pasir dan Kuranji Kota Padang

MARIATI, Ulvi, dr. Rossi Sanusi, MPA.,Ph.D

2006 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebijakan dan Manaj.

Latar Belakang: Persalinan di kota Padang tahun 2004 berjumlah 14013 kelahiran, 87,5% ditolong oleh tenaga kesehatan dan 60% di antaranya ditolong oleh Bidan Praktik Swasta (BPS). Kematian maternal 72/100.000 KH penyebab terbanyak adalah pendarahan, toksemia, gravidarum dan infeksi, 30% diantara kematian berasal dari persalinan yang dibantu BPS. Tujuan: Membandingkan kinerja BPS dalam pelaksanaan Asuhan Persainan Normal (APN) di wilayah kerja Puskesmas Padang Pasir dan Puskesmas Kuranji. Metodologi: Subjek penelitian: 12 BPS di wilayah kerja Pukesmas Padang Pasir dan 14 BPS di wilayah kerja Puskesmas Kuranji. Pengumpulan data oleh tim pengamat terlatih dengan pengamatan langsung pada saat pertolongan persalinan sambil menceklis hasil pengamatannya pada instrument. Kategori kinerja baik (= 75% poin APN dilaksanakan). Untuk membandingkan kinerja dan jumlah BPS di kedua wilayah kerja ditetapkan nilai beda presentasi minimum bermakna adalah 5%. Hasil: Persentase BPS kinerja baik dalam lima dimensi pelaksanaan APN: pembuatan keputusan klinik (Padang Pasir 91,7% dan Kuranji 92,9% dengan beda persentase 1,2), asuhan sayang ibu dan sayang bayi (Padang Pasir 75,0% dan Kuranji 78,6% dengan beda persentase 3,6), pencegahan infeksi (Padang Pasir 75,0% dan Kuranji 78,6% dengan beda persentase 3,6), pencatatan/dokumentasi (Padang Pasir 58,3% dan Kuranji 50,0% dengan beda persentase 8,3, beda bermakna), rujukan (Padang Pasir 58,3% dan Kuranji 42,8% dengan beda persentase 15,3, beda bermakna). Kesimpulan: Pertama, Kinerja BPS di kedua wilayah kerja Puskesmas Padang Pasir dan Kuranji dalam pelaksanaan APN untuk dimensi pembuatan keputusan klinik, asuhan sayang ibu dan sayang bayi dan pencegahan infeksi sudah baik dan beda tidak bermakna. Kedua, kinerja BPS di wilayah kerja puskesmas Padang Pasir (Angka Kematian Ibu rendah) dalam pelaksanaan APN untuk dimensi pencatatan/dokumentasi dan rujukan lebih baik dan beda bermakna dari kinerja BPS puskesmas Kuranji (Angka Kematian Ibu tinggi) dalam dimensi yang sama. Ketiga, Kinerja BPS di wilayah kerja puskesmas kuranji (angka kematian ibu tinggi) berkaitan erat dengan lemahnya kinerja BPS dalam pelaksanaan APN dimensi pencatatan/dokumentasi dan rujukan.

Background: There were as many as 14013 childbirths at Padang Municipality in 2004, of which 87,5% was assisted by health staff and 60% of it was done by private practiced midwife. Maternal mortality rate is 72/100.000 births alive and the greatest causes of death are bleeding, toxemia, gravid arum and infection, of which 30% of them derives childbirths assisted by private practicing midwives. Objective: To compare performance of private practicing midwives in the implementation of Normal Childbirths Care (NCC) at working areas of Padang Pasir and Kuranji Community Health Center. Method: Subject of study were as many as 12 private practicing midwives at Padang Pasir and 14 at Kuranji Community Health Center. Data collection was done by trained observatory team through direct observation during childbirths assistance who at the same time made checklist of the observation result on the Instrument. Good performance category = 75% of NCC points implemented. To compare performance and number of private practicing midwives at both areas, value of minimum presentation difference (5%) was determined. Result: Percentage of good performance of private practicing midwives in five dimensions of NCC Implementation was: clinical decision making (Padang Pasir 91,7% and Kuranji 92,9% with percentage difference 1.2), care for mother and babies (Padang Pasir 75,0% and Kuranji 78,6%), with percentage difference 3.6) infection prevention (Padang Pasir 75,0% and Kuranji 78,6% with percentage difference 3.6), documentation (Padang Pasir 58,3% and Kuranji 50,0%, with meaningful percentage difference 8.3), referral (Padang Pasir 58,3% and Kuranji 42,8%, meaningful percentage difference 15.3). Conclusion: 1) Performance of private practicing midwives at the working areas of Padang Pasir and Kuranji Community Health Center in the implementation of NCC for dimensions of clinical decision making, care for mother and babies and infection prevention was relatively good and showed no insignificant difference. 2) Performance of private practicing midwives at the working area of Padang Pasir Community Health Center in the (low maternal mortality rate) within the same dimensions. 3) Performance of private practicing midwives at the working area of Kuranji Community Health Center (high maternal mortality rate) was closely related to weak performance of private practicing midwives in the implementation of NCC for dimensions of documentation and referral.

Kata Kunci : Manajemen Layanan Kesehatan,Asuhan Persalinan,Kinerja Bidan Praktek, work performance, private practicing midwife, normal childbirth care