Implementasi program making pregnancy safer di puskesmas Kabupaten Nias Selatan

YOU, Megawati, Prof. dr. M.Hakimi, Sp.OG, PhD

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Angka kematian ibu maternal masih tetap dilaporkan setiap tahun, baik secara nasional dan per kabupaten. Kematian ibu maternal ini juga terjadi di wilayah Kabupaten Nias Selatan. Data profil dinas kesehatan tahun 2007 mencatat bahwa kematian ibu hamil sebanyak 14 kasus, kematian ibu bersalin sebanyak 21 kasus, dan kematian ibu nifas sebanyak 7 kasus. Jumlah ini meningkat dibandingkan dengan data tahun 2006 yaitu kematian ibu hamil sebanyak 7 kasus, kematian ibu bersalin sebanyak 12 kasus, dan kematian ibu nifas sebanyak 7 kasus. Pelayanan kesehatan ibu di puskesmas berkaitan erat dengan jumlah kematian ibu. Puskesmas di wilayah kabupaten ini telah melaksanakan program Making Pregnancy Safer untuk mendukung aktifitasaktifitas pelayanan tersebut. Upaya-upaya pelayanan dari program Making Pregnancy Safer masih belum dapat dilakukan secara maksimal sehingga persentase ibu bersalin yang memperoleh pertolongan persalinan oleh tenaga kesehatan yang terampil masih kurang dari 50%. Tujuan Penelitian: Memberikan gambaran dan informasi tentang program Making Pregnancy Safer dalam hal desain organisasi, upaya pelayanan, dan kontrol dapat mempengaruhi pelayanan kesehatan ibu di puskesmas. Metode Penelitian: Penelitian ini merupakan penelitian deskriptif kualitatif dengan rancangan studi kasus. Puskesmas menjadi unit analisis dengan subjek penelitian mencakup kepala puskesmas, staf medis dari unit kesehatan ibu dan anak. Pengumpulan data melalui studi pustaka atau data sekunder untuk mengetahui situasi dan kondisi puskesmas yang menjadi objek penelitian. Wawancara terstruktur dengan menggunakan ceklist untuk mendapatkan data primer tentang implementasi program Making Pregnancy Safer yang mencakup organisasi, upaya pelayanan, dan kontrol bagi pelayanan kesehatan ibu di puskesmas. Hasil: Bidan yang telah memperoleh pelatihan pelayanan kesehatan bagi ibu maternal masih belum memenuhi target 90% bidan terlatih. Bidan yang mengikuti pelatihan APN sebesar 22,9%, Partus dukun-bidan sebesar 32,6,%, PONED sebesar 6,5% dan AMP sebesar 4,4%. Dinas kesehatan kabupaten memilih peserta pelatihan secara adhoc. Pelatihan diselenggarakan oleh dinas kesehatan propinsi dan hanya sekali dalam setahun. Akibatnya, hanya sedikit bidan yang dapat mengikuti pelatihan. Tidak ada dokter, atau dokter ada tetapi peralatan PONED tidak tersedia, dan fasilitas gedung yang buruk merupakan alasan belum adanya puskesmas PONED di Kabupaten Nias Selatan. Sistem rujukan masih belum mampu menurunkan jumlah kematian ibu, karena keterlambatan rujukan dari dukun ke puskesmas, atau dari puskesmas ke rumahsakit. Jarak yang jauh, peralatan puskesmas dan rumahsakit yang kurang memadai, juga transportasi ambulans yang tidak memiliki peralatan lengkap, seringkali menyebabkan ibu terlambat memperoleh pertolongan kegawatdaruratan. Desain organisasi puskesmas merupakan organisasi mesin, dengan pola top down dari dinas kesehatan kabupaten. Pengawasan hanya dilakukan melalui pengiriman laporan setiap bulan ke dinas kesehatan. Supervisi dari dinas kesehatan kabupaten dilakukan tiga bulan sekali, termasuk untuk mengidentifikasi masalah-masalah yang dialami puskesmas.

Background: Maternal mortality rate is still reported every year, both nationally and each district. Maternal mortality also happened in the area of South Nias District. The Data profile owned by Department of Health in 2007 recorded that there were 14 cases of maternal mortality, 21 cases of mother on delivery mortality, and 7 cases of postnatal mortality. This amount was increased compared to data collected in 2006. In the previous year, there were 7 cases of pregnant mother mortality, 12 cases of mother on delivery mortality, and 7 cases of postnatal mortality. Mother health services in Primary Health Care are closely related to maternal mortality rate. The Primary Health Care in this district area has been implemented Making Pregnancy Safer program in order to encourage their health service activities. However, the service efforts from the Making Pregnancy Safer program may not be done maximally yet. As the result, the percentage of mother on delivery who got delivery aid by paramedic was still less than 50%. Object: Giving the description and information about Making Pregnancy Safer program in term of organization design, health service efforts, and control can affect mother health services in Primary Health Care. Methods: This study was qualitative descriptive research and case study design. The Primary Health Care was the analysis unit, and the study subjects were the Head of Primary Health Care, and medical staff of mother and children health unit. The data collecting was done through literature study or secondary data to find out the situation and the condition of the Primary Health Care used as the study object. Structured interview by using checklist was done in order to get primary data about the implementation of Making Pregnancy Safer program. The data included organization, health service efforts, and control for mother health service in primary health care Result: The target of 90 % trained midwifes, that have had maternal health services training, has not accomplished yet. There was 22,9 % midwife that has attended APN (Normal Delivery Education) course, 32,6% shaman-midwife delivery, the PONED was 6,5 % while the AMP was 4,4%. The district department of health chose the course participants by ad hoc. The course was held by the province department of health, which was only once in a year. Consequently, there were only small amount of midwives able to attend the course. There was no doctor, or maybe there was doctor but the PONED equipment was not available, and the bad building facility was the reason why there was no PONED primary health care in South Nias District yet. The referral system can’t afford to reduce the number of maternal mortality due to the delay time of referring mother from shaman to the primary health care, or from primary health care to the hospital. Far distance, inadequate equipment in the primary health care and hospital, and inadequate equipment in the ambulance often resulted in the delay of emergency aid for the mother. Primary health care organization design was a mechanical organization. The pattern was top down from district department of health. The supervision was only done through report delivery to department of health in every month. The supervision from district department of health was done every three months. It included identifying the problems faced by the primary health care.

Kata Kunci : Making Pregnancy Safer, kegawatdaruratan obstetri, pelayanan kesehatan ibu, ibu maternal, organisasi, kontrol, obstetric emergency, mother health services, maternal mother, organization, control