Pemanfaatan pertolongan persalinan tenaga kesehatan oleh peserta Program Jaminan Pemeliharaan Kesehatan Masyarakat Miskin (JPKMM) di Kabupaten Halmahera Selatan

DJAMA, Nuzliati T, dr. Ova Emilia, M.Med.,SpOG.,Ph.D

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

Latar Belakang: Proporsi persalinan yang ditolong oleh tenaga kesehatan terlatih di Indonesia masih sebesar 68,4%. Krisis moneter yang terjadi sekitar tahun 1997 telah memberikan andil meningkatnya biaya kesehatan, sehingga menekan akses penduduk miskin terhadap pelayanan kesehatan. Hambatan utama pelayanan kesehatan masyarakat miskin adalah masalah pembiayaan kesehatan dan transportasi. Tujuan: Mengetahui peningkatan pemanfaatan pertolongan persalinan oleh tenaga kesehatan oleh peserta program Askeskin serta menilai faktor-faktor yang ikut mempengaruhi pemanfaatan pertolongan persalinan oleh tenaga kesehatan. Metode: Penelitian ini menggunakan metode kuantitatif dan kualitatif. Metode kuantitatif adalah penelitian observasional dengan rancangan cross sectional, dimana kepesertaan Askeskin sebagai variabel bebas dan pemanfaatan pertolongan persalinan oleh tenaga kesehatan sebagai variabel terikat diamati dalam waktu bersamaan. Sampel penelitian adalah ibu melahirkan pada tahun 2006 berjumlah 104 orang. Metode analisis kuantitatif menggunakan analisis univariabel dengan distribusi frekuensi dan analisis bivariabel dengan uji chi-square, analisis multivariabel menggunakan uji regresi logistik. Metode kualitatif dengan teknik wawancara mendalam (indepth interview). Hasil Penelitian: Ada hubungan yang bermakna antara peserta Askeskin dengan pemanfaatan pertolongan persalinan tenaga kesehatan (OR=4,23, 95%CI=1,43-12-47, p=0,00). Variabel transportasi dan keberadaan bidan menunjukkan hubungan yang bermakna dengan pemanfaatan pertolongan persalinan tenaga kesehatan (OR=4,5, 95%CI=1,45-13,96, p=0,00) dan (OR=4,43, 95%CI=1,56-12,57, p=0,00). Variabel waktu tempuh tidak menunjukkan hubungan yang bermakna dengan pemanfaatan pertolongan persalinan tenaga kesehatan. Kesimpulan: Peserta Askeskin lebih banyak memanfaatkan pertolongan persalinan tenaga kesehatan dari yang tidak peserta Askeskin dan secara statistik ada hubungan yang bermakna. Faktor lain yang ikut mempengaruhi pemanfaatan pertolongan persalinan tenaga kesehatan adalah: transportasi dan keberadaan bidan di tempat pelayanan. Variabel transportasi dan keberadaan bidan di tempat pelayanan merupakan variabel pengganggu terhadap kepesertaan Askeskin dan pemanfaatan pertolongan persalinan tenaga kesehatan.

Background: The proportion of childbirth assisted by skilled health professionals is still as much as 68.4%. Monetary crisis which happened in 1997 has contributed to the increase of health cost which limits access of poor community to health services. Major problems of health service for poor community are cost and transportation. Objective: To find out the utilization of childbirth assistance provided by health professionals by participants of health care insurance program for poor community and factors affecting the utilization of childbirth assistance provided by health professionals. Methods: The study was a cross sectional observation which used both qualitative and quantitative approaches. Participation in the health insurance for poor community as independent variable and the utilization of childbirth assistance provided by health professionals as dependent variable were simultaneously observed. Samples of the study were as many as 104 mothers who gave birth in 2006. Quantitative analysis used univariable with frequency distribution, bivariable with chi square and multivariable with logistic regression test. Qualitative analysis used indepth interview. Result: The result of bivariable analysis showed that there was significant relationship between participation in health care insurance program for poor community and the utilization of childbirth assistance provided by health professionals (RP=3.28, 95%CI=1.86-5.81, p=0.000). Statistically there was significant relationship between distance and the utilization of childbirth assistance provided by health professionals (RP=2.14, 95%CI=1.21-3.76, p=0.008). There was statistically significant relationship between transportation and the utilization of childbirth assistance provided by health professionals (RP=3.4, 95%CI=1.99-5.79, p=0.000). Availability of midwives and the utilization of childbirth assistance provided by health professional statistically had significant relationship (RP=2.86, 95%CI=1.47-5.59, p=0.007). Conclusion: Participants of health care insurance for poor community utilized childbirth assistance provided by health professionals more than those who were not participants. Statistically there was significant relationship between participation in health care insurance and the utilization of childbirth assistance provided by health professionals. Other factors affecting the utilization of childbirth assistance provided by health professionals were distance, transportation and availability of midwives at the service point. Transportation and availability of midwives at the service point were confounding variables of participation in health care insurance for poor community and the utilization of childbirth assistance provided by health professionals.

Kata Kunci : Persalinan,Program ASKESKIN,Pertolongan Tenaga Kesehatan,childbirth assistance, health professionals, program of health insurance for poor community