Kualitas Pelayanan Pemeriksaan Antenatal oleh Bidan di Puskesmas

Abstract The maternal mortality rate in Indonesia is still high and still far from the established target of SDG's, which is 305 compared to 102 maternal deaths per 100,000 live births. Adequate pregnancy screening services are needed to reduce maternal mortality. This study aims to determine the quality of antenatal care (ANC) services at public health centers (midwives competence and support facilities and service infrastructure). Data collection was conducted in 212 health centers and the sample size is 224 midwives in the health centers. Midwives were observed at the time of antenatal care. The observed ANC components were 5T, 7T, and 9T. In addition, it was observed also the availability of facilities, infrastructure, and medicines related to ANC in health centers. The midwives who performed the ANC correctly and well for the 9T, 7T, and 5T components were 18.8%, 23.2%, and 31.7%. Only 20.4% of health center have all equipment, medicines, and supporting media of ANC 9T service. Only one-fifth of midwives perform complete and correct ANC services for the 9T service components. Midwife knowledge in doing ANC 9T is better for those who have profession less than 20 years old and hold at least diploma degree midwifery. Keywords : Antenatal Care, Midwives, Health Center Abstrak Angka kematian ibu di Indonesia masih tinggi dan masih jauh dari target SDG’s yang telah ditetapkan, yaitu 305 dibandingkan dengan 102 kematian ibu per 100.000 kelahiran hidup. Pelayanan pemeriksaan kehamilan yang adekuat sangat dibutuhkan untuk menurunkan angka kematian ibu. Penelitian ini bertujuan mengetahui kualitas pelayanan pemeriksaan kehamilan atau antenatal care (ANC) di puskesmas (kompetensi bidan serta dukungan sarana dan prasarana pelayanan). Pengumpulan data dilakukan di 212 puskesmas dengan jumlah sampel 224 orang bidan. Bidan diamati pada saat melakukan pelayanan ANC. Komponen ANC yang diamati adalah 5T, 7T, dan 9T. Selain itu diamati juga ketersediaan sarana, prasarana, dan obat-obatan terkait dengan ANC di puskesmas. Bidan yang melakukan ANC dengan benar dan baik untuk komponen 9T, 7T, dan 5T secara berturut – turut adalah 18,8%, 23,2%, dan 31,7%. Hanya 20,4% puskesmas telah memiliki seluruh peralatan, obat, dan media penunjang pelayanan ANC 9T. Hanya seperlima bidan melakukan pelayanan ANC secara lengkap dan benar untuk komponen pelayanan 9T. Pengetahuan bidan dalam melakukan ANC 9T lebih baik pada mereka yang menjalani profesinya kurang dari 20 tahun dan berpendidikan minimal D3 kebidanan. Kata kunci : ANC, Bidan, Puskesma

Pemanfaatan Pelayanan Kesehatan Sasaran Program Jaminan Tabalong Sehat di Kabupaten Tabalong Kalimantan Selatan

Abstrak Pemerintah Kabupaten Tabalong Kalimantan Selatan menerapkan pelayanan kesehatan gratis di Puskesmas melalui program Jaminan Tabalong Sehat (JTS) sejak tahun 2008. Peserta JTS adalah seluruh penduduk Tabalong yang tidak memiliki asuransi atau jaminan kesehatan. Penelitian ini bertujuan mengetahui faktor-faktor yang berhubungan dengan pemanfaatan pelayanan kesehatan di puskesmas. Penelitian ini menggunakan desain cross sectional dan wawancara mendalam. Sampel uji sebanyak 253 rumah tangga sasaran program JTS, diambil dari 405 sampel rumah tangga yang dipilih secara sistematik, dari klaster 15 desa/kelurahan di tiga wilayah puskesmas terpilih. Hasil penelitian menunjukkan bahwa pemanfaatan pelayanan kesehatan gratis di puskesmas belum optimal. Sebanyak 52% rumah tangga pernah memanfaatkan pelayanan kesehatan puskesmas dalam setahun terakhir. Faktor yang berhubungan dengan pemanfaatan pelayanan kesehatan di puskesmas adalah pengetahuan, kemauan untuk membayar/WTP, adanya penyakit tertentu, waktu tempuh, kemudahan dan biaya transportasi. Rendahnya pemanfaatan pelayanan kesehatan di puskemas yang sudah digratiskan disebabkan karena kurang optimalnya kegiatan puskesmas, kurangnya sosialisasi ke masyarakat dan sasaran masyarakat yang disubsidi kurang tepat. Kata kunci: Pemanfaatan pelayanan kesehatan, Puskesmas, Subsidi, Tabalong Abstract Government of Tabalong District have been giving free health care subsidies at public health centre (PHC) through Tabalong Health Security (Jaminan Tabalong Sehat /JTS) program since 2008. Targetting of JTS program are all of Tabalong citizens that have not covered by health insurance or other health security programs. The objective of this research was to know the factors that related with utilization of health services at PHC in Tabalong District. Approach of this research were cross sectional design and deep interview. Sampels were 253 targetting household taken form 405 household that selected by systematic random from 15 villages cluster at three selected PHC areas. The result showed that utilization of free health services subsidies were not optimize yet. Just 52% of household utilized health services at PHC in the last year. The factors that related with health services utilization at PHC are knowledge, willingness to pay (WTP), diseases avalaibility, travelling time, easiness and cost of transportation. The low rates utilization of free health care were also caused by un-optimize of PHC’s activities, lack of promotion the JTS programs, not matching of subsidies targetting. Keywords: Health services utilization, public health centre, subsidy, Tabalon

Evaluasi Penyelenggaraan Pendidikan DIII Kebidanan di 5 Provinsi Wilayah Binaan GAVI

Abstrak Kualitas pendidikan tenaga kesehatan yang belum merata salah satu masalah sumber daya manusia kesehatan di Indonesia. Bidan adalah tenaga kesehatan yang menempuh pendidikan kebidanan di institusi DIII kebidanan. Institusi kebidanan dituntut mampu menghasilkan bidan yang berkualitas dan kompeten sebagai pemberi layanan kesehatan ibu dan anak. Global Alliance Vaccines and Immunization (GAVI) sebagai organisasi internasional mendorong dilakukannya penelitian pendidikan DIII kebidanan di Indonesia. Penelitian bertujuan untuk mendapatkan gambaran penyelenggaraan pendidikan DIII kebidanan melalui pendekatan sistem input, proses, dan output. Penelitian menggunakan desain potong lintang dengan pendekatan kuantitatif yang dilaksanakan di 18 institusi pendidikan DIII kebidanan di 5 provinsi, yaitu Jawa Barat, Banten, Sulawesi Selatan, Papua Barat, dan Papua pada tahun 2013. Analisis menggunakan uji chi-square. Hasil penelitian menggambarkan adanya perbedaan baik pada input, proses, maupun output antar institusi pendidikan menurut wilayah maupun kepemilikan institusi. Terdapat perbedaan pengetahuan dan keterampilan mahasiswa menurut wilayah dan provinsi (p<0,05). Terdapat perbedaan pengetahuan mahasiswa di institusi pendidikan DIII kebidanan berdasarkan kepemilikan institusi. Tidak terdapat perbedaan keterampilan mahasiswa di institusi pendidikan DIII kebidanan milik pemerintah dan swasta (p=0,062). Perlu peningkatan kualitas penyelenggaraan pendidikan DIII kebidanan agar menghasilkan lulusan yang kompeten berbasis wilayah dan kepemilikan institusi pendidikan DIII kebidanan. Kata kunci: pendidikan vokasi, kebidanan, GAVI Abstract The unequality in health workers education quality is one of human resources for health’s problems in Indonesia. Ones who want to become a midwife should attend midwifery education. Diploma III (vocational) midwifery education institution as an education provider of midwifery must produce qualified and competent midwives that will perform their function as maternal and child health (MCH) care provider. The Global Alliance Vaccines and Immunization (GAVI) as an international organization that focuses on the MCH programs in Indonesia, encourages research aiming to describe implementation of Diploma III midwifery education through a system approach (input, process and output). This is a cross-sectional study with quantitative approach that was held in 18 Diploma III midwifery education institution which were spread in 5 provinces: West Java, Banten, South Sulawesi, West Papua and Papua in 2013. The analysis used were chi-square test. The results described differences either on input, process, and output among educational institutions by region and institutional ownership. There was a difference of students’ knowledge and skill by region and province (p <0,05). There was also a difference of the students’ knowledge in midwifery education institution based on institutional ownership. There were no differences in student skills between public and private educational institution (p = 0,062). It is necessary to improve the quality of DIII midwifery education in order to produce competent graduates based on the region and the ownership. Keywords : vocational education, midwifery, GAV

Implementasi Pelayanan Neonatal Emergensi Komprehensif di Rumah Sakit PONEK di Indonesia

Abstrak Angka kematian neonatal dan angka kematian balita di Indonesia masih tinggi. Kasus kegawatdaruratan merupakan penyebab tingginya angka kematian tersebut. Rumah sakit Pelayanan Obstetrik dan Neonatal Emergensi Komprehensif (PONEK) 24 jam merupakan rumah sakit rujukan dengan visi mempercepat penurunan angka kematian neonatus dan angka kematian balita. Penelitian ini bertujuan untuk mengetahui implementasi pelayanan neonatal emergensi pada rumah sakit PONEK 24 jam di Indonesia. Penelitian didesain dengan pendekatan mix method yaitu pembauran antara studi kuantitatif dan kualitatif. Studi kuantitatif adalah cross sectional dan studi kualitatif adalah Rapid Assesment Procedure yang dilakukan pada tahun 2014. Penelitian dilakukan di rumah sakit di Indonesia dengan kriteria rumah sakit PONEK 24 jam, telah menerima sosialisasi tentang PONEK, dipilih secara random di 7 provinsi di Indonesia masing-masing 2 rumah sakit tiap provinsi. Berdasarkan kriteria tersebut sebanyak 14 rumah sakit diobservasi dalam penelitian ini. Data kuantitatif yang dikumpulkan meliputi pelayanan klinis, manajemen, sarana dan prasarana, ketenagaan dan pendanaan. Data dikumpulkan dengan cara observasi, telaah dokumen dan wawancara. Data kualitatif yang dikumpulkan meliputi proses, hambatan, dan keberhasilan PONEK dengan cara indepth interview dengan informan kunci direktur rumah sakit, ketua komite medik dan dokter spesialis. Hasil penelitian menunjukkan bahwa sebagian besar rumah sakit telah melaksanakan pelayanan neonatal emergensi 24 jam, KMC dan aksesibilitas darah yang memadai. Pelayanan neonatal emergensi telah didukung dengan jenis tenaga profesional, komitmen direktur rumah sakit yang tinggi, MoU dengan IDI, kerjasama dengan NGO serta ruangan, sarana dan prasarana yang memadai. Keberhasilan rumah sakit PONEK 24 jam didukung oleh kesadaran masyarakat untuk memanfaatkan layanan rumahsakit. Namun di beberapa rumah sakit kurangnya tenaga terlatih, jumlah tenaga, tidak ada tim, sarana dan prasarana serta ruangan menjadi alasan rumah sakit tidak melaksanakan PONEK. Kesimpulan: beberapa rumah sakit telah melaksanakan pelayanan neonatal emergensi komprehensif 24 jam, namun masih perlu mendapat perhatian dalam hal pelatihan dan jumlah tenaga, biaya, sarana dan prasarana serta ruangan yang memadai. Kata kunci: neonatal, emergensi, rumah sakit, rujukan Abstract Neonatal under-five mortality rate in Indonesia was still high, while the emergency cases were the most of its causes. Emergency neonatal care (EmNC) hospital was a referral provider to accelerate decline in neonatal and under-five mortality. This research aimed to observe the implementation of emergency neonatal services at referal hospitals in Indonesia. This study was a cross sectional study with quantitative and qualitative design. The study was conducted in all of referal hospital in Indonesia with criterian socialized emergency neonatal care. Based on these criteria as many as 14 hospitals in 7 provinces were observed in this study. The quantitative data collected includes clinical services, management, facilities and infrastructure, manpower and funding. Data were collected by observation, document review and interview. The qualitative were collected including the process, constraints, and attainment of emergencies services by indepth interviews to directors, medical committee heads, and specialists as informants. The results show that most hospitals provided 24-hour emergency neonatal services, KMC and adequate blood accessibility. Emergency neonatal care has been supported by professionals (i.e doctor, obsgyn, anaesthetician, etc), commitment of hospital director, MoU with IDI and NGOs. The attainment of emergency neonatal care was supported by public awareness to utilize hospital services. Skilled physician, room, essensial supplies and equipment for performing certain emergency neonatal care functions were not available in several surveyed hospital. Some hospitals have implemented comprehensive emergency neonatal care, but still need number of skilled pshycisian, budget facilities, supplies and equipment. Keywords: neonatal, emergency, hospital, referal syste

The evaluation of Nusantara Sehat program using Nusantara Sehat Public Health Index

Latar Belakang: Faktor geografi Indonesia yang berupa daratan, lautan, pegunungan, dan pulau-pulau yang tersebar menyebabkan distribusi tenaga kesehatan dan akses pelayanan kesehatan yang tidak optimal. Berdasarkan Peraturan menteri kesehatan yang telah ditetapkan, pemerintah berupaya mendayagunakan secara khusus sumber daya manusia kesehatan dalam kurun waktu tertentu dengan jumlah dan jenis tertentu, agar meningkatkan akses dan mutu pelayanan kesehatan pada fasilitas pelayanan kesehatan khususnya di wilayah Daerah Tertinggal, Perbatasan, dan Kepulauan (DTPK) dan Daerah Bermasalah Kesehatan (DBK) melalui Program Nusantara Sehat (NS). Metode: Tahun 2015 telah ditugaskan Tim NS Batch 1 dan 2 pada 120 Puskesmas di DTPK dan DBK selama 2 tahun. Kemudian pada tahun 2017 setelah masa tugas berakhir, diadakan evaluasi program yang bertujuan untuk mengetahui dampak program NS terhadap indeks kesehatan masyarakat dengan menggunakan desain Pre and Post-Test Intervention with Control. Evaluasi dilakukan di 15 provinsi, 27 kabupaten, dan 60 Puskesmas pada bulan Februari - Desember 2017. Hasil: Hasil evaluasi program menunjukkan bahwa pada tahun 2017 terjadi perubahan rata-rata indeks kesehatan masyarakat dibandingkan dengan tahun 2015, baik pada Puskesmas intervensi maupun kontrol (p=0,000). Kemudian hasil uji independen t-test terhadap delta perubahan indeks menunjukkan bahwa peningkatan indeks kesehatan masyarakat pada Puskesmas intervensi lebih besar dibandingkan dengan Puskesmas kontrol (p=0,046). Kesimpulan: penugasan Tim NS pada Puskesmas telah membawa perbaikan indeks kesehatan masyarakat yang lebih baik. Diperlukan pengamatan lebih jauh terkait sustainabilitas Program NS dan analisis biaya manfaat (cost benefit analysis) terhadap Program NS.  Kata Kunci: Evaluasi program, Nusantara Sehat, Indeks Kesehatan Masyarakat, Indonesia.   Abstract Backgrounds: Indonesia’s geographical factors in the form of land, oceans, mountains, and scattered islands have caused the distribution of health workforce and access to health services are not optimal. Based on the Minister of Health regulation, the government seeks to utilize health human resources specifically for a certain period, with certain number and types, in order to improve access and quality of health service to health service facilities, especially in remote area through the Nusantara Sehat Program (Health Indonesia Program-NS). Methods: In 2015, NS Team Batch 1 and 2 were assigned to 120 primary health care center (Puskesmas) in remote areas for 2 years. Then in 2017 after the term ends, NS program evaluation were conducted in 15 provinces, 27 districts, and 60 Puskesmas from Feb to Dec 2017. Results: This evaluation aims to analyze the impact of NS program on public health index using Pre and Post Test Intervention with Control Design. The results of program evaluation showed that in 2017 there was a change in the average public health index compared to 2015, both in intervention and control Puskesmas (p = 0,000). The independent t-test result on the delta of index change indicated that public health index improvement at intervention Puskesmas is greater than the control (p = 0,046). Conclusion: The assignment of NS Team at the Puskesmas has brought improvement of public health index. Further observations are needed regarding the sustainability and the cost benefit analysis of NS Program.  Keywords: Program evaluation, Nusantara Sehat, Public Health Index, Indonesia

Analisis Implementasi Standar Pelayanan Minimal Bidang Kesehatan Kabupaten/kota

Ministry of Health has set a Health Minimum Service Standards (HMSS) for District/City by Minister of Health Decree No. 741/Menkes/Per/VII/2008, which consist of 18 indicators. After three years of implementation, an analysis of the HMSS implementation has conducted. Using a cross-sectional study design, site selection is done purposively to represent Eastern, Central, and Western part of Indonesia. There were nine districts/cities of 9 provinces selected. The analysis showed that problems in the implementation of HMSS are: some indicators do not meet the SMART criteria, inconsistency between the title of indicators, operational definitions and formulas, wide gap in the coverage both within the district at different times and among districts/cities. Differences also occur at the operational level, including dissemination of HMSS, advocacy, monitoring and evaluation. It is recommended that the Ministry of Health should provide sufficient training, proper socialization of HMSS, set up a special unit to monitor and facilitate the implementation of HMSS. The existing MSS should be revised, no longer focusing on the achievement of the program but rather based on a form of health care provided. In addition, revision is necessary to gain consistency between definitions, operational definitions and formulas of HMSS indicators

A Case Study on the Implementation of Local Health Insurance Benefit Packages

Background: The variation of benefit packages implemented by some local social health insurance schemes (Jamkesda) become an important issue in the effort to integrating them into National Health Insurance (JKN). This study aims to describe implementation of Jamkesda's benefit packages as a basic consideration in integration to JKN. Methods: Design of this study is case study with qualitative and quantitative aproaches, conducted 2013–2014 in all of districts/cities which already have Jamkesda. Primary and secondary data was collected. Primary data has been collected by focus group discussion, interview, observation, and self administered questioner. Secondary data collected from many sources such as articles, journal, official document, statistics data, and others. Results:Of this study show there is no significant relationship between fiscal capacity group and benefit packages (continuity correction, p value = 0.065). But, districts/cities with high fiscal capacity (high and very high) seem likely to have probability 1,920 bigger than lower capacity districts/cities in giving equal or more benefit than existing national social health insurance (Jamkesmas) (Mantel-Haenszel, Common Odds Ratio Estimates = 1.920; Confidence Interval 95% =1.008–3.658; asymp. Sig 2 sided = 0.047). There is variation of benefit packages between each Jamkesda. Qualitative results show there are many obstacles faced in giving benefit health services, such as limited community accessibility to health facilities, the absence of health workforce, and lack of health infrastructure and equipment. Recomendation: This study recommends to set a national minimum benefit packages and equalizing percetion of local decission maker

Fetal Monitor Calibration Among Public Hospitals in Indonesia

Background: Periodic calibration for diagnostic tool in hospitals is essential for accurate diagnosis. The purpose of analysis was to identify the dominant factors related to implementation of periodic calibration of the fetal monitor in the hospitals. Methods: Analysis data using a part of Rifaskes 2011 data among selected hospitals in Indonesia which had fetal monitors. To identify the dominant factors related to fetal monitor on time calibration compared with not doing calibration fetal monitor we used relative risk approach. Results: Out of the 297 hospitals that met the inclusion criteria which had fetal monitor, 82 (27.6%) hospitals calibrated the monitor on time, and 132 hospitals did not perform calibration. The accredited hospitals compared with not accredited hospitals had more performing on time fetal monitor calibration. Compared with not accredited hospitals, the accredited hospitals for 5 services, for 12 services, and for 16 services had 2.2-fold, 2-fold, and 3.4-fold to perform on time fetal monitor calibration respectively. Conclusion: The accredited hospitals compared with not accredited hospitals had more on time performed fetal monitor calibration. (Health Science Indones 2013;1:7-10

Analisa Kesiapan Integrasi Jaminan Kesehatan Daerah (Jamkesda)

The implementation Of National Social Health Insurance by BPJS-Health that has been started on January,I, 2014 gives an impact to integrating local health insurance into national scheme.This study aims to describe implementation of local social health insurance as a basic in formulating policy model whichallows integration of local health insurance, particularly in the area of management, benefit packages, and government payed member in the frame of health decentralization policy. Study design is embeddedmulticases, using case study interpretatif method. Primary and secondary data were collected by explorativeapproach. Study area includes implementation of social local health insurance at 33 provinces, conducted in2013-2014. Results of this study show a gap in understanding and capacity of local authorities in managinglocal health insurance; various characteristics of local social health insurance in term of local monetarycapacity, benefit packages, management, and government payed member. This study recommends toaccomodate public health effort financing into benefit packages scheme, perception equalizing betweennational and local policy maker in understanding policy steps, and giving more flexibility forprovince/district/municipal in local social health insurance integration policy