Evaluasi kinerja pelayanan antenatal antara Puskesmas cakupan tinggi dengan puskesmas cakupan rendah menggunakan pendekatan Balanced Scorecard di Kabupaten Bekasi

ERNAWATI, Prof.dr. Djaswadi Dasuki, MPH,SpOG(K).,PhD

2007 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kes. Ibu dan Anak-Ke

Latar Belakang: Puskesmas sebagai unit pelayanan dasar diharapkan mampu memberikan pelayanan antenatal berkualitas. Di Kabupaten Bekasi cakupan KIA pada tahun 2006 adalah K1 (87,5%) dan cakupan K4 (77,8%). Jumlah kematian ibu tahun 2006 sebanyak 21 orang. Dari 34 puskesmas yang mencapai target cakupan KIA hanya 4 (empat) puskesmas (11,76%). Hal ini menggambarkan bahwa kinerja pelayanan KIA masih belum optimal dan perlu dilakukan evaluasi guna perbaikan kinerja pelayanan KIA dimasa datang. Pengukuran kinerja yang dilakukan menggunakan balanced scorecard yang meliputi empat persfektif yaitu keuangan, kepuasan pelanggan, proses pelayanan dan pengembangan sumber daya manusia. Tujuan: Mengevaluasi kinerja pelayanan antenatal antara puskesmas cakupan tinggi dengan puskesmas yang cakupan rendah di Kabupaten Bekasi dengan menggunakan pendekatan balanced scorecard. Metode: Jenis penelitian observasional dengan rancangan cross sectional dilengkapi dengan data kualitatif. Subjek penelitian adalah kepala Puskesmas, bidan penanggung jawab dan pelaksana pelayanan antenatal di ruang KIA, serta seluruh ibu hamil yang mendapatkan pelayanan K4. Lokasi Penelitian di Puskesmas Mekarmukti dan Cibarusah. Instrumen menggunakan kuesioner, check list dan pedoman wawancara. Analisis data menggunakan analisis univariat, bivariat dengan uji Chi-square (χ²) dan stratifikasi. Hasil : Analisis menunjukkan hubungan pendidikan/pelatihan dengan cakupan antenatal (χ² = 10,015; p = 0,002; PR = 4,026; 95%CI = 1,667- 9,724) dan kepuasan pasien (χ² = 4,607; p = 0,032; PR = 2,516; 95%CI = 1,080-6,348) sedangkan pelayanan sesuai standar tidak berhubungan dengan cakupan antenatal. Analisis stratifikasi diketahui ada perbedaan pendidikan/pelatihan terhadap cakupan antenatal yaitu Puskesmas Mekarmukti lebih baik dibandingkan Cibarusah(χ² = 5,662; p = 0,017; PR = 4,407; 95%CI = 1,082-18,789), kepuasan pasien di Puskesmas Mekarmukti lebih baik dibandingkan Puskesmas Cibarusah (χ² = 6,935; p = 0,008; PR = 8; 95%CI = 1,256-84,624). Data kualitatif tentang kinerja keuangan menunjukkan di Puskesmas Mekarmukti lebih baik daripada Puskesmas Cibarusah. Kesimpulan: Ada perbedaan pendidikan/pelatihan petugas dan tingkat kepuasan pasien antara Puskesmas Mekarmukti dan Cibarusah. Tidak ada perbedaan standar pelayanan antenatal dan dana operasional antara Pusekesmas Mekarmukti dan Cibarusah.

Background: Community Health Center (CHC) is hoped to give quality antenatal care. However, maternal and child health coverage in Bekasi District has not achieved the targeted standard yet. First visit of pregnant mothers in 2006 was 87.5% and fourth visit coverage was 77.8%. There were 21 cases of maternal mortality in 2005 and only four out of 34 CHCs achieved the target of maternal and child coverage. These show that maternal and child health care performance is not optimal; therefore, improvement should be made. One of performance measurements is balanced scorecard which includes four perspectives, namely finance, costumers’ satisfaction, internal business, and learning and growth. Objective: To evaluate antenatal care performance between high coverage CHC and low coverage CHC using balanced scorecard approach in Bekasi District. Method: This was an observational study with cross sectional study design. Qualitative data were used in this study. The subjects were the head of CHCs, the midwives responsible for the implementation of antenatal care in maternal and child health room, and all pregnant mothers receiving forth visit care. The study was performed in Mekarmukti and Cibarusah CHCs. Study instruments were questionnaire, checklist, and interview guide. Univariate analysis and bivariate analysis with chi-square test and stratification were used. Results: There was an association between providers’ education/training and antenatal coverage (χ2 = 10.015; p = 0.002; PR = 4.026; CI 95% = 1.667-9.724), and patients’ satisfaction (χ2 = 4.607; p = 0.032; PR = 2.516; CI 95% = 1.080-6.348), while standardized care was not related to antenatal care coverage. Stratification analysis showed that antenatal care coverage in Mekarmukti CHC was better than that in Cibarusah CHC (χ2 = 5.662; p = 0.017; PR = 4.407; CI 95% = 1.082-18.789), patients’ satisfaction in Mekarmukti CHC was better than that in Cibarusah CHC (χ2 = 6.935; p = 0.008; PR = 8; CI 95% = 1.256-84.624). Based on the qualitative data, there was no difference in finance performance in both CHCs. Conclusions: There is a difference between providers’ education/training and the level of patients’ satisfaction in Mekarmukti and Cibarusah CHCs. There is no difference in Mekarmukti and Cibarusah CHCs operational fund and standard antenatal care.

Kata Kunci : Puskesmas,Kinerja Layanan Antenatal, Balanced scorecard, performance, antenatal coverage