KAPASITAS PUSKESMAS PONED DAN NON PONED DALAM PENGELOLAAN KASUS EMERGENCY OBSTETRIC DI KABUPATEN BANTUL

Nur Allailiyah, Prof. dr. Djaswadi D, MPH, SpOG(K),Ph.D.

2011 | Tesis | S2 Kesehatan Masyarakat/KIA

Latar belakang: Akses bagi ibu yang mengalami komplikasi terhadap fasilitas yang mampu memberikan intervensi berkualitas menjadi faktor penting untuk menyelamatkan kehidupan mereka. Angka kematian ibu DI Kabupaten Bantul pada 2 tahun terakhir (2008 - 2009) sama sekali tidak mengalami penurunan yaitu sebesar 140 per 100.000 kelahiran hidup. Angka ini masih sangat jauh diatas target maksimal kabupaten Bantul yaitu 65 per 100.000 kelahiran hidup. Data menunjukkan sejumlah 12, 97% ibu di Kabupaten Bantul yang mengalami komplikasi kehamilan dan persalinan masih ada 36,2% yang tidak ditangani, ini berarti akses kasus emergency obstetric terhadap pelayanan obstetrik yang essensial masih sangat rendah. Tingginya angka kematian ibu ini dapat pula menjadi petunjuk betapa buruknya kualitas pelayanan emergency obstetric di Kabupaten Bantul. Tujuan penelitian: Untuk memberikan gambaran dan informasi tentang kapasitas teknis dan manajerial pada puskesmas dalam pengelolaan kasus emergency obstetric di Kabupaten Bantul. Metode penelitian: Penelitian ini merupakan penelitian deskriptif analitik dengan kuantitatif dan kualitatif analitik dengan rancangan crosssectional. Puskesmas menjadi unit analisis penelitian dengan subyeknya adalah kepala puskesmas dan bidan koordinator. Pengumpulan data dilaksanakan melalui studi pustaka untuk mengetahui kapasitas puskesmas dalam hal input menggunakan cheklist. Wawancara terstruktur dilakukan untuk mendapatkan data primer tentang kapasitas puskesmas dalam hal proses, observasi dilakukan untuk mendapatkan informasi dalam kemampuan teknis terutama dalam hal pelaksanaan evidence best practice dalam pengelolaan kasus emergency obstetric. Analisis: Analisis data kuantitatif pada penelitian ini menggunakan analisis univariat. Analisis kualitatif dilakukan dengan teknis pattern matching atau membandingkan kesesuaian data yang didapat dengan rekomendasi Depkes. Hasil: Hanya ada 1 (16.67%) puskesmas di Kabupaten Bantul yang mampu PONED, 83.33% kompetensi baik pada puskesmas PONED dan 47,62% bidan dengan kompetensi baik pada puskesmas non PONED. Dari sisi manajerial didapatkan 50% Puskesmas PONED leadership baik dan Puskesmas non PONED 33.33% leadership baik. Ketersedian alat di Puskesmas PONED 50% lengkap dan Puskesmas non PONED 100 % tidak lengkap. Kendala pelaksanaan PONED pada umumnya disebabkan karena kurangnya motivasi dan komitmen provider terhadap pengelolaan kasus yang dipicu oleh kurangnya monitoring dan kontrol secara periodik dan kurangnya dukungan insentif bagi kompensasi kinerja serta besarnya tanggung jawab yang diemban provider. Kesimpulan: Dari sisi teknis dan sistem pendukung Puskesmas PONED seharusnya mampu mengimplementasikan PONED namun disebabkan manajemen yang lemah maka sebagian besar Puskesmas PONED tidak berjalan. Sedangkan pada Puskesmas non PONED secara umum belum memiliki kapasitas yang cukup untuk mengelola kasus emergency obstetric baik secara teknis maupun manajerial.

Background: An access for mothers with complications to facilities capable of providing quality intervention becomes an important factor to save their lives. From the report of Bantul District Profile, it was obtained the data that the maternal mortality in two years (2008-2009) did not experience a decrease in the amount of 140 per 100,000 live births. This figure is still very far above the maximum target of Bantul District which is 65 per 100,000 live births. One of the causes of high maternal mortality rate is likely triggered by a number of obstetric emergencies cases which are not handled. The data show a total of 12.97% of women with pregnancy and childbirth complications in which 36.2% of the percentage are not addressed. This means access to emergency obstetric cases to essential obstetric care is still very low. The high maternal mortality rate can also be a clue about how bad the quality of emergency obstetric care in Bantul District. Objective: To provide an overview and information about the technical and managerial capacity at the community health center in the management of obstetric emergency cases in Bantul District. Methods: This was a descriptive qualitative and quantitative study with a crosssectional design. Community Health Center (CHC) became the unit of analysis with the subject of the CHC Head and midwife coordinator. The data collection was carried out through literature study or secondary data to determine the capacity of CHC in terms of checklist use input. Structured interviews were conducted to obtain primary data about the capacity of CHC in terms of process and observations were conducted to obtain information in the technical ability, especially in terms of implementing evidence best practices and CHC management in the management of emergency obstetric cases. Qualitative analysis was done by pattern matching or comparing the technical suitability of the pattern data corresponding to the initial assumptions of the researcher. Analysis of quantitative data in this study used univariate analysis. Results: It was found only 1 (16.67%) from the good technical side for midwife’s competency in Poned (83.33%) and in non Poned (47.62%). In terms of managerial, it was found that good leadership practices in BEONC CHC were 3 (50%) while in non BEONC CHC were 7 (33.33%). From the managerial point of view it was obtained 50% in BEONC CHC with good leadership and 33.33% in non BEONC CHC with good leadership as well. The equipment availability in BEONC CHC were 50% complete and in non BEONC CHC were 100% incomplete. The constraints of conducting BEONC CHC action in general were about less motivation and commitment of the provider towards case management and it was stimulated by less periodic monitoring and controlling and also less rewards to providers as work compensation and responsibility. Conclusion: In terms of technical support and systems, actually BEONC CHC was able to implement BEONC but generally it was not fully supported by good management so that there were still many health centers not able to manage a standardized program. At the non BEONC CHC, sufficient capacity was not generally possessed to manage emergency obstetric cases, both technical and managerial.

Kata Kunci : Kapasitas, pengelolaan kasus emergency obstetric, puskesmas PONED dan puskesmas non PONED.