PENILAIAN KINERJA PELAYANAN ANTENATAL PADA PUSKESMAS ISO DAN PUSKESMAS TIDAK ISO DI KABUPATEN SLEM

AMALINA TRI SUSILANI, Prof. Djaswadi Dasuki, SpOG(K), MPH, PhD,

2011 | Tesis | S2 Kesehatan Masyarakat/KIA

Latar Belakang: Pelayanan antenatal bermutu merupakan pelayanan medik dasar yang strategis untuk memelihara kesehatan dan deteksi dini gangguan kehamilan. Hasil riset kesehatan dasar oleh Litbang Kesmas tahun 2008 ibu hamil dilakukan pemeriksaan secara lengkap sebanyak 84,5% yang seharusnya 100%. Di Sleman cakupan antenatal untuk kunjungan K4 pada tahun 2009 menurun dan tidak mencapai target standar nasional sebesar 95% serta angka kematian ibu (5 orang) dan bayi (105 bayi). Oleh karena itu, penilaian kinerja terutama pada Puskesmas baik yang sudah berstandar ISO maupun yang tidak berstandar ISO di Sleman perlu dilakukan. Tujuan penelitian: Untuk mengetahui kinerja pelayanan antenatal antara Puskesmas ISO dan Puskesmas tidak ISO dengan menggunakan BSC. Metode penelitian: Jenis penelitian observasional dengan rancangan retrospektif. Penelitian dilakukan di dua puskesmas, yaitu Puskesmas ISO (Ngaglik I) serta Puskesmas tidak ISO (Turi), pemilihan lokasi berdasarkan pusposive sampling. Sampel penelitian adalah Kepala Puskesmas, Bidan koordinator dan pelaksana di ruang KIA serta ibu hamil trimester III. Pengujian data dilakukan dengan analisis univariat, bivariat, dan multivariate. Hasil: Kepatuhan petugas dalam melakukan pelayanan standar tehadap kepuasan pasien terdapat hubungan yang signifikan pada Puskesmas ISO ditunjukkan nilai korelasi 0,65 dengan p<0,05. Loyalitas pasien di Puskesmas ISO lebih baik dibandingkan Puskesmas tidak ISO (c 2 = 10,53; p = 0,001; PR=3,20; 95%CI=1,37- 7,47). Hasil analisis multivariat faktor motivasi dan pelatihan memberikan kontribusi terhadap cakupan pelayanan antenatal 5,58 kali lebih baik pada pasien yang loyal daripada pasien yang tidak loyal (OR=5,58; 95%CI=1,20-27,87). Kesimpulan: Kinerja pelayanan antenatal pada Puskesmas ISO lebih baik dibanding Puskesmas tidak ISO dilihat dengan penilaian BSC.

Background: Quality antenatal care is a strategic basic medical service to maintain health and early detection of pregnancy disorders. The results of basic health research by the Public Health Research and Development in 2008 showed that pregnant women carrying out a complete examination were as many as 84.5% that should have been 100%. In Sleman, coverage of antenatal visits for V4 in 2009 declined and did not reach the target of national standards by 95% and the maternal mortality rate reached 5 persons and infant mortality reached 105 cases. Therefore, performance assessment, especially in health centers that have been standardized both ISO and non- ISO in Sleman, needs to be done. Objective: To determine the performance of antenatal care between health centers with ISO and health centers without ISO using the BSC. Method: This was an observational study with retrospective design. The study was conducted at two health centers, namely ISO Health Center (Ngaglik I) and non ISO Health Center (Turi). The selection of sites was based purposive sampling. Study sample was the Head of Health center, midwife coordinator and implementers in the MCH room and third trimester pregnant women. The data analysis was done by univariate, bivariate, and multivariate analyses. Results: Officers’ compliance in the service standards to the satisfaction of patients showed a significant relationship in Ngaglik I Health Center indicated with a correlation score of 0.65 with p value <0.05. The patients’ loyalty in Ngaglik I Health Center was better than Turi Health Center (c 2 = 10.53, p = 0.001; PR = 3.20, 95% CI = 1.37 to 7.47). The results of multivariate analysis on motivational and training factors contributed to the coverage of antenatal care 5.58 times better in the patients who were loyal than those who were disloyal (OR = 5.58, 95% CI = 1.20 to 27.87). Conclusion: Assessment of antenatal care at the health centers with ISO better than without ISO seen with the BSC assessment.

Kata Kunci : Pelayanan antenatal, Penilaian Kinerja, Puskesmas ISO.