Manajemen pelayanan kesehatan Ibu dan ANak dan kualitas Antenatal Care di Puskesmas Kecamatan Semarang Barat

WIDOWATI, Christina, Prof.dr. Mohamad Hakimi, SpOG.,PhD

2005 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebijakan dan Manaj.

Latar Belakang : Salah satu sasaran utama pembangunan kesehatan adalah menurunkan angka kematian ibu. Tingginya angka kematian ibu tersebut selain disebabkan oleh faktor rendahnya kondisi kesehatan dan gizi buruk, secara umum juga disebabkan karena rendahnya kualitas penanganan kehamilan dan kelahiran. Hal tersebut dapat dicegah melalui pelayanan Ante Natal (ANC) yang mampu mendeteksi dan menangani kasus resiko tinggi, memberikan pertolongan persalinan yang bersih dan aman serta pelayanan rujukan kebidanan yang terjangkau saat diperlukan. Oleh karena itu perlu adanya pengelolaan pelaksanaan pelayanan Kesehatan Ibu dan Anak (KIA) yang baik bukan saja pada sisi kemampuan teknis medis pelayanan ANC tetapi juga pada peningkatan kemampuan manajemennya. Tujuan penelitian : Untuk mengetahui pelaksanaan Manajemen Pelayanan KIA dan Kualitas Pelayanan Ante Natal (ANC) di Puskesmas. Metode Penelitian : Penelitian studi kasus dengan dengan rancangan cross sectional dan disajikan secara deskriptif kualitatif. Obyek penelitian adalah kegiatan manajemen pelayanan KIA dan Kualitas ANC. Lokasi penelitian dilakukan di Puskesmas se-Kecamatan Semarang Barat Kota Semarang. Subyek penelitian adalah Kepala Puskesmas, Bidan pengelola KIA dan Bidan pelaksana ANC. Hasil Penelitian : Dari hasil wawancara mendalam, diskusi kelompok terarah, Pengisian Kuesioner, Observasi dan penelusuran dokumen, diperoleh : Gambaran kualitas pelayanan ANC belum sesuai standar karena kemampuan bidan masih kurang, fasilitas belum lengkap, Hanya satu bidan dari dua belas bidan responden yang patuh pada standar. Gambaran fungsi-fungsi manajemen KIA belum sepenuhnya dilakukan karena Puskesmas tidak memiliki kewenangan dan kemampuan untuk merencanakan program, dana, SDM , sarana. Pada Struktur organisasi dan Job’s description terjadi tugas rangkap oleh petugas karena tidak ada tenaga khusus untuk mengelola organisasi. Tidak ada ketepatan antara jadwal dan pelaksanaan kegiatan. Evaluasi, umpan balik dan validasi data hanya dilakukan setahun sekali (AMP tidak teratur dilaksanakan). Kesimpulan: Gambaran kualitas pelayanan ANC masih belum standar. Sebagian besar pelaksana ANC belum patuh pada standar, dari dua belas bidan hanya satu yang patuh. Gambaran fungsi-fungsi manajemen KIA (perencanaan, pengorganisasian, pelaksanaan dan pengawasan) di puskesmas se-Kecamatan Semarang Barat belum dilakukan sepenuhnya. Dinas Kesehatan maupun Kepala Puskesmas belum memiliki sistem pengawasan yang efektif dan terarah.

Background : One of the main targets of health development is decreasing maternal mortality rate. The high rate of maternal mortality was because of low health condition and bad nutrition factors, and generally was also because of low quality of pregnancy and birth. This could be prevented through Ante Natal Care service which could detect and handle the high risk case, giving health and safe delivery assistance as well as reachable midwifery referral service when necessary. Therefore, a good management of maternal and perinatal health (KIA) service implementation not only concerned on the ability of ANC service medical technique instead the improvement of management ability. Objective : to find out the implementation of KIA service management and Ante Natal Care (ANC) service quality in the Primary Health Care. Method : This research was case study with cross sectional design and presented with descriptive qualitative. The object of this research was activity in KIA service management as well as ANC quality. This research was located in all Primary Health Cares in West Semarang sub districts, Semarang municipality. The subject of this research was the head of primary health care, midwife organizer of KIA and midwife of ANC. Result : From the result of in depth interview, focus group discussion, filling questioner, document observation and tracing; it was obtained that the description of KIA service management was not suitable with the standard because midwife’s ability still now, the facility was incomplete and only one midwife out of twelve midwifes who obeyed the standard. The description of KIA management functions was not all being implemented since the Primary Health Care did not have authority and ability to plan the program, funding, human resources and facility. In the organization structure and Job’s description, there was a double function of the officer because there was no special officer to manage the organization. There was no accuracy between schedule and activity implementation. Evaluation, feedback and data validation were only being implemented once a year (AMP was not regularly implemented). Conclusion : The description of ANC service was not yet standardized. Most of the ANC implementer was not yet obeyed the standard and only one out of twelve midwives who obeyed it. The description of KIA management function (planning, organizing, actuating and controlling) in all Primary Health Cares in West Semarang sub district was not yet implemented. Health office or Head of Primary Health Care did not have effective and directed control system.

Kata Kunci : Manajemen Layanan Kesehatan,Antenatal Care,Puskesmas