KETERLIBATAN PUSKESMAS DAN TIM PELAKSANA DB4MK TINGKAT DUSUN DALAM PELAKSANAAN KEBIJAKAN DB4MK PLUS DI KECAMATAN DLINGO KABUPATEN BANTUL

Raden Rara Endah Wahyuni, Prof.dr. Adi Utarini, M.Sc, MPH, Ph.D.

2013 | Tesis | S2 Kesehatan Masyarakat/MMPK

Latar Belakang: DB4MK Plus adalah bentuk penghargaan/reward yang diberikan pada dusun yang memenuhi kriteria bebas kematian ibu, bebas kematian bayi, bebas kasus gizi buruk dan bebas kasus DBD ditambah dengan seluruh persalinan ditolong oleh tenaga kesehatan, D/S 90% dalam 12 bulan dan ABJ 95%. Dalam meraih status DB4MK Plus diperlukan keterlibatan puskesmas dan Tim Pelaksana DB4MK Tingkat Dusun (TP DB4MK Dusun). Tujuan Penelitian: Mengetahui keterlibatan puskesmas dan TP DB4MK Tingkat Dusun dalam pelaksanaan kebijakan DB4MK Plus di Kecamatan Dlingo. Metode Penelitian: Penelitian kualitatif dengan rancangan studi kasus. Informan sejumlah 50 orang yang terdiri dari camat, kepala desa, kepala dusun, kader, kepala puskesmas, petugas gizi, bidan desa, petugas promkes dan petugas kesling. Pengambilan data melalui wawancara mendalam dan DKT. Hasil Penelitian : Bentuk keterlibatan puskesmas dalam pelaksanaan DB4MK Plus meliputi kegiatan advokasi yang dilaksanakan kepala puskesmas kepada camat, lurah, kepala dusun dan lintas sektor sehingga terbentuk Tim DB4MK Tingkat Kecamatan, Desa dan Dusun. Kepala puskesmas dan staf puskesmas melaksanakan sosialisasi kepada Tim Pelaksana DB4MK Tingkat Kecamatan, Desa, Dusun dan masyarakat melalui pertemuan di kecamatan, desa, dusun, dan posyandu. Puskesmas melaksanakan pertemuan koordinasi lintas program dengan semua petugas puskesmas. Puskesmas juga melakukan koordinasi lintas sektoral dengan kecamatan, desa dan instansi lintas sektor untuk membahas mekanisme pelaksanaan DB4MK. Kepala puskesmas melakukan pembinaan internal kepada staf puskesmas melalui pertemuan program secara rutin dan pembinaan eksternal kepada TP DB4MK Dusun melalui pertemuan dan pelatihan. Petugas puskesmas bersamaTim Pelaksana DB4MK Tingkat Dusun melakukan pemantauan kegiatan posyandu, PSN, PMT untuk kasus gizi buruk, ibu hamil dan neonatal yang mempunyai resiko tinggi. Keterlibatan Tim Pelaksana DB4MK Tingkat Dusun dalam upaya meraih status DB4MK Plus dalam bentuk peran kepala dusun dan peran kader. Kepala Dusun berperan dalam memimpin dan menggerakkan masyarakat, sedangkan kader berperan dalam menggerakkan dan melaksanakan kegiatan bersama masyarakat. Dusun yang berhasil meraih status DB4MK Plus merupakan dusun yang kepala dusun, kader dan masyarakatnya aktif melaksanakan kegiatan pemberdayaan masyarakat. Kesimpulan : Peran kepala dusun serta peran kader yang terwadahi dalam TP DB4MK Tingkat Dusun menentukan keberhasilan dusun dalam meraih status DB4MK Plus. Perlu diupayakan peningkatan peran kepala dusun dan kader khususnya bagi dusun yang belum mampu meraih status DB4MK.

Background: DB4MK Plus is a program which that involving distribution of rewards to the sub village that met the conditions of free maternal mortality, free infant mortality, free malnutrition, free dengue hemorrhagic fever (DHF), plus all health professional-attended childbirths, D/S of 90% within the last 12 months, and ABJ of 95%. To achieve the rewards, it requires participation of the health centers and DB4MK Implementation Team at the sub village level. Objective: To find out the participation of the health center and sub village DB4MK team at the sub village in the implementation of DB4MK Plus program at Dlingo Sub-district. Method: A qualitative study was conducted using case study design. Informants were 50 including sub-district head (camat), village head (lurah), present sub village head (kepala dusun), health cadres, and head of health center, nutritionist, village midwives, health promotion staff, and environmental health staffs. Data were collected by means of in-depth interviews and focus group discussion. Results: Participation of health center in DB4MK Plus came in the form of advocacy programs given by the head of health center to the sub-district chief, village chief, sub village chiefs, and cross-sector parties that formed DB4MK implementation team at sub-district, village, sub village and community levels by means of meetings in the sub-district, village, sub village and Posyandu. The health center conducted cross program coordinative meetings that involved all the health center staffs and head cross sector coordination meetings with the relevant parties at the sub-district, village, and sub village level to discuss the mechanism of DB4MK Plus implementation. The health center provided internal development for the staffs by means of routine meetings and external development for the members of DB4MK implementation team at sub-district by means of coordinative meetings and training. Along with DB4MK implementation team at sub-district, the health center staffs monitored the implementation of Posyandu, mosquito elimination with PSN, PMT to malnutrision cases, pregnant women and high risk neonates. Partipation of sub village DB4MK implementation team came in the form of head sub village and health cadres’ roles. Participation of head sub village came in the form of roles in leading and mobilizing the community, while the health cadres mobilized in implemented the programs along with the community members. Sub village that was succesful in achieving DB4MK Plus status was one with activelly participacing of sub village chief, cadres and community in community empowerment programs. Conclusion: The roles of the sub village chief and health cadres that formed sub village DB4MK Plus implementation team determines that success of the village in achieving DB4MK Plus status. Those sub villages that did not achiev the status need active participation of the sub village chief and the health cadre.

Kata Kunci : DB4MK Plus, puskesmas, keterlibatan, Bantul.