Performance Analysis in the Village Midwife Neonatal Care in Infants with Low Birth Weight in PHC Pati

Number of Low Birth Weight Babies (LBWB) cases and Maternal Mortality Rate from 2009 to 2010 was high. The result of preliminary study revealed that the performance of village midwives in providing neonatal services for LBWB had not been optimal, recording results of neonatal services had not been done well, available facilities had not been used optimally, and supervision was just conducted based on the reports of activities. This research aimed to explain village midwives' performance in providing neonatal services in District of Pati. This was descriptive-qualitative research with analytic-qualitative approach. Informants were village midwives at work area of Health Centers in District of Pati. Data were collected using indepth interview and analyzed using content analysis. The result of this research showed that village midwives in providing neonatal services had not conducted in accordance with the service standards for LBWB especially in terms of the methods and the schedule of services. In addition, resources had not been used optimally, availability of facilities had not been distributed equally, and baby proofing tools were prepared independently. Form of monitoring was supportive supervision and had not been in accordance with midwives' necessity namely scheduled, routine, materials and time integrated with the activities of providing neonatal for LBWB. Additionally, cooperation had been done comprehensively

Analysis on Nutrition Replacement Therapy Program for Undernourished Children in Jombang District

Prevalence of under-five nutritional status in Jombang district (2008-2011), measured by BB/U,TB/U, and BB/TB tended to decrease. In 2009, Jombang district government developed a policy for controlling nutritional problems with the theme: Bertabur Bintang (scattered stars). One of activitiesfor controlling nutritional problems was to build therapeutic feeding center (TPG); in the last twoyears, 102 TPGs have been established. Preliminary survey indicated that cadres knowledge relatedto TPG were insufficient; as a consequence, cadres were non active. Attitude of the cadres waspositive, however, community participation was low; supports from members of the family weremostly only reminding the people; no village spare funding was available; routine supervision froma primary healthcare center (puskesmas) was not available. Objective of this study was to analyzethe implementation of TPG viewed from knowledge, attitude, perception on supervision, availabilityof resources, support variables; and also viewed from executor and supervisor aspects.This was a descriptive-qualitative study. Study population was divided into two: village midwives assupervisors and health cadres as executors. Main informants were eight village midwives and eightcadres from four selected puskesmas. These Puskesmas were selected based on selection criteria:puskesmas with high and low prevalence of moderate malnutrition, and based on geographical area.Triangulation informants from supervisor level were eight village government office staffs, fourpuskesmas nutrition workers, and a head of nutrition section of district health office. Triangulationinformants from the executor level were eight mothers of under-five children. Data were collectedthrough in-depth interview and observation. Content analysis was applied for data analysis.Results of the study showed that cadres knowledge related to TPG were insufficient due to no TPGrelated trainings for cadres; training related to positive deviance was only for midwives, and notall midwives and nutrition workers received the training. Cadres attitude were positive in supportingTPG, they believed that what they did would help controlling nutritional problems for under-fivechildren. No technical and implementation guidelines for TPG. Funding for TPG program wasfrom the community, it was in the form of donation, ‘jimpitan', and ADD. However, in theimplementation of TPG funding was still a main problem. Facilities from district health office werein the form of cooking and eating wares and TPG notification board; the rest of facilities for TPGwas using posyandu facilities. Supervision was not scheduled or incidental and materials forsupervision were not structured. Supports from family members and community were mostly in theform of verbal information; community participation was low

Analysis on Factors Associated with the Implementation of the Pulmonary Tuberculosis Care Finding in Tuberculosis Control Program at Primary Healthcare Center in Semarang

Success of tuberculosis (TB) control in Semarang city varied. Based on the case detection of pulmonary TB among 37 primary health centers (puskesmas) in Semarang city, only 2 puskesmas reached the target of 55% or more. Those Puskesmas were Karangdoro (76.67%) and Ngesrep (63.89%). The other 35 puskesmas had not reached the target. The objective of this study was to identify factors related to the implementation of pulmonary TB case detection in TB control program at Puskesmas in Semarang city. This was an explanatory research with cross sectional approach. Study population was all pulmonary TB coordinators at puskesmas in Semarang city with the total number of 37 persons. Bivariate and multivariate methods were implemented for analyzing the data. Results of the study using statistical test indicated significant association between communication factor and pulmonary TB case detection (p: 0.009), resource factor and pulmonary TB case detection (p: 0.010), disposition factor and pulmonary TB case detection (p: 0.016) and SOP factor and pulmonary TB case detection (p: 0.012) To improve a good communication, Health Office needs to include untrained workers to make the procedure of budgeting report easier, to provide laboratory facilities such as microscope to satellite puskesmas, to do routine report verification every 3 months to avoid over reporting and under reporting pulmonary TB data in order to obtain valid coverage, to do supervision by health office staffs using check list, to write pulmonary TB case detection planning documents by involving head of puskesmas and/or puskesmas pulmonary TB coordinators. Heads of puskesmas have to monitor their pulmonary TB coordinators to be involved in the pulmonary TB coordinator meeting every month, to make puskesmas planning on the pulmonary TB case detection and planning on providing the laboratory instrument that is microscopic to make it easier for laboratory workers to examine sputum of pulmonary TB suspects and to involve pulmonary TB workers in the training conducted by either district or provincial health office

Analysis on Low Rate Utilization of Delivery Services by Health Workers at Wakaokili Community Health Center in Buton Regency

Utilization of delivery service by health workers in Indonesia was still low especially in ruralareas. This condition occurred in communities in the work area of Wakaokili primary healthcarecanter (puskesmas) Buton district. Most of pregnant women in this community did antenatal careto midwives, however they chose traditional delivery assistant (dukun bayi) to assist theirdelivery process. Government had done many efforts to increase community interest to give birthwith health workers assistance. However, this effort had not reached what was expected. Thiswas a case study with qualitative approach. Objective of the study was to understand the background for low utilization of delivery services by the community. Data were collectedthrough interview guided by interview guideline, and direct observation in the health services.The number of main informants was 36 people. They were divided into 2 groups. Those groupswere direct target program group that included post-delivery women assisted by midwives,dukun bayi, and house member including husbands; indirect target program group consisted ofcommunity leaders and cadres. Triangulation informants were midwives, dukun bayi, the head ofWakaokili primary healthcare center, and the head of family health department of Buton districthealth office. Results of the study showed that background for the low utilization of deliveryservices by health workers was that community did not know village midwives; community didnot understand benefits of giving birth assisted by health workers; the cost of giving birthassisted by dukun bayi was affordable; midwives were not always ready when needed. Inaddition, there was a stigma that smoothness of delivery process was not determined by whoassisted the delivery but by what had been done by the mothers during pregnancy. Furthermore,there was a belief towards praying words spoken by dukun bayi or husbands; this was one ofreasons why dukun bayi was included in the delivery process. They believed that dukun wouldmake the delivery process success. Midwives are expected to be more active to approach theirsupervised community. Primary healthcare center and district health office are suggested to doefforts to improve community knowledge, to train and assist dukun, and to review the incentivefor midwives in order to be able increase the number of visits to pregnant women in their houseor in the field

Evaluation on the Implementation of Ten Steps to Successful Breast Feeding by Midwives at Doctor Ramelan Naval Hospital Surabaya

Establishment of the 10 steps to be success in breastfeeding (LMKM) was a government effort toimprove exclusive breastfeeding program. Ten LMKM information had been displayed in dr. Ramelannavy hospital (RSAL) Surabaya; however, there was no special policy regarding exclusivebreastfeeding. Therefore, midwives were still giving formula milk (PASI) to infants in the integratedcare room. In general, the objective of this study was to evaluate the implementation of 10 steps tobe success in breastfeeding (LMKM) by midwives in RSAL dr. Ramelan Surabaya.This was a qualitative study with descriptive explorative approach. Main informants were 7 midwivesin the pregnancy policlinic, delivery room, and integrated care room. Triangulation informantswere 3 midwives as chief of the room, one supervisor midwives, and 3 patients. Data were collectedthrough in-depth interview and documentation study. Interactive model was applied in the data analysis. Steps on the interactive model included data collection, data reduction, data display, andconclusion drawing.Results of the study showed that ten LMKM had not been implemented properly. Not all midwivesexplained correctly breastfeeding benefits and breastfeeding technique; midwives still gave formulamilk to infants in the integrated care room; breastfeeding support group (KP-ASI) had not beenformed yet. Only a small portion of midwives who had attended lactation management training;and it caused an insufficient self-motivation among midwives.Written policy regarding exclusive breastfeeding is needed. All midwives are expected to attend inlactation management training; it will optimize the implementation of 10 LMKM. Strong policyregarding the existence of formula milk is needed

Implementation Ff Midwive-Traditional Birth Attendants Partnership by Midwives in Buton District, Southeast Sulawesi, (a Case Study on Wakaokili Primary Healthcare Center)

The limited knowledge on the importance of health workers deliveries, together with someother factors such as economies, social and culture, made traditional birth attendants becamea choice of delivery services. This condition resulted in the increase of Maternal MortalityRate in Buton District. The coverage of health workers deliveries in Wakaokili was still low. Itwas marked by the low rate of traditional birth attendance-midwives' partnership anddeliveries referral to the midwives, as well as high rates of traditional birth attendancedeliveries. This study was a descriptive qualitative study. Data were collected by in depthinterviews on 4 village midwives and 9 traditional birth attendants as the main informants.Data were analyzed by content analysis method. Results showed that the goals and programsuccess indicators were not understood well. Dissemination was only an introduction and thereport was not discussed. There was no coaching or internship program. The attitude tendedto be ambivalent and the resources were not supportive. It is proven that economic, social andpolitical environment influence the program results

Evaluation on Drug Planning for Basic Health Services at Pharmaceutical Warehouses of Gunung Mas District, Central Kalimantan

Planning was an activity to determine type and amount of drugs according to the need. Weakplanning was indicated by no stored drugs or drugs accumulation in the storage. Drug planning inGunung Mas district pharmacy storage (GFK) was based on inaccurate data; therefore, distortionin the drug planning precision and in the level of drug availability occurred. Objective of this studywas to evaluate drug planning at GFK Gunung Mas based on the obedience of GFK workers inimplementing drug planning guideline.This was a descriptive study. Study variables were 1) ability of workers that was based on theireducation, workload, training, and supervision; 2) obedience of workers in implementing drug planning guideline. Main informants were the head of GFK and two GFK workers. Data werecollected by conducting in-depth interview and observation. Content analysis was applied in thedata management.Results of the study showed that drug planning at GFK Gunung Mas was inadequate. This wascaused by insufficient number of workers with adequate abilities, and the obedience of workers inimplementing planning guideline was insufficient. Workers' education level was suitable with therequirement namely pharmaceutical school. Majority of workers' knowledge was limited to definitionand drug criteria; majority of GFK workers' workload was overload. All workers did not get trainingon drug planning. Supervision by their superior was not done periodically. Obedience of workersto drug planning guideline was insufficient.Suggestions for district health office are to conduct training on integrated drug planning technique,to improve periodic supervision to GFK workers. Suggestions to GFK Gunung Mas are to formulatestandard operating procedure for drug planning, to do right drug calculation, to do ABC/ VEN analysis