ANALISIS PEMANFAATAN PEDOMAN KERJA BIDAN DALAM PENGELOLAAN PROGRAM KIA-KB DI PUSKESMAS KOTA PONTIANAK (Analysis of Using the Midwife’s Work Guide in Management of Family Planning – Maternal and Child Health Program at Health Centers in Pontianak City)

Abstract

Di Kalimantan Barat Angka Kematian Ibu pada tahun 2006 sebesar 403,13/100.000 per kelahiran hidup, dan Angka Kematian Bayi 44,12 /1000 kelahiran hidup. Sedangkan Angka Kematian Ibu dan Angka Kematian Bayi di Kota Pontianak didapatkan bahwa angka kematian ibu dari tahun 2005 sampai tahun 2006 mengalami peningkatan dan pada tahun 2007 mengalami penurunan, sedangkan angka kematian neonatal dari tahun 2005 sampai tahun 2007 mengalami peningkatan. Berdasarkan laporan Profil Dinas Kesehatan Kota Pontianak didapatkan data bahwa cakupan K1 dan K4 secara kuantitatif hasilnya mencapai diatas 90%, namun secara kualitatif dinyatakan bahwa hampir semua daerah terjadi perbedaan dimana didapatkan puskesmas yang memiliki target K1 paling rendah adalah Siantan Hilir, K4 paling rendah adalah Banjar Serasan , cakupan Neonatus paling rendah adalah Kampung Dalam. Meskipun Dinas Kesehatan Kota Pontianak telah berupaya memenuhi sarana, prasarana dan sumber daya lainnya termasuk adanya pedoman kerja bidan , namun masih ditemukan 3 puskesmas yang memiliki cakupan K1, K4 dan neonatus rendah. Dari studi pendahuluan didapatkan bahwa bidan belum bekerja sesuai dengan pedoman sehingga target yang diharapkan belum tercapai. Untuk mengetahui permasalahan tersebut dilakukan penelitian tentang pemanfaatan pedoman kerja bidan dalam pengelolaan program KIAKB di Puskesmas di Kota Pontianak. Tujuan penelitian ini adalah untuk menganalisis pemanfaatan pedoman kerja bidan dalam pengelolaan program KIA-KB di Puskesmas Kota Pontianak Jenis penelitian observasional yang bersifat kualitatif dengan pendekatan crossectional. Metode pengumpulan data diperoleh melalui wawancara mendalam sebanyak 9 (sembilan) orang, antara lain pimpinan puskesmas, bidan koordinator dan bidang pelaksana di 3 (tiga) puskesmas masing-masing 1 orang. Hasil penelitian didapatkan bahwa puskesmas dalam memberikan pelayanan menggunakan pedoman pelayanan dari pusat dan pedoman dari Dinas Kesehatan Kota Pontianak namun pada pelaksanaannya adanya dua pedoman membebani bidan, kepatuhan bidan didapatkan bahwa puskesmas yang sudah melaksanakan kedua pedoman tersebut adalah puskesmas Kampung Dalam, bidan mengetahui pedoman pengelolaan KIA-KB, tetapi pada tahap pelaksanaan ada beberapa yang belum dikerjakan seperti asuhan kebidanan kespro- remaja, prasekolah dan askeb lansia, kegiatan monitoring, hanya puskesmas Kampung Dalam yang rutin menyelenggarakan, supervisi telah dilaksanakan oleh ketiga puskesmas, tindakan koreksi dilaksanakan di tiga puskesmas tersebut setelah melalui evaluasi 3 bulan, agar pedoman kerja dapat dijadikan acuan dalam bekerja, Puskesmas Kampung Dalam menerbitkan kebijakan tertulis tentang pemanfaatan pedoman kerja, namun pada puskesmas laiinya tidak ditemukan kebijakan tertulis. sosialiasi sebelum kebijakan sudah dilaksanakan, bidan belum memiliki persepsi yang sama tentang kewajiban implementasi pedoman baik pedoman pusat maupun dari Dinas. Disarankan agar pemanfaatan pedoman dapat maksimal dan tidak membebani bidan, Pimpinan puskesmas dapat membagi tugas bidan baik untuk pelayanan maupun kegiatan administrasi, sosialiasasi kembali tentang pedoman kerja bidan, diadakan pelatihan, kegiatan monitoring diaktifkan, supervisi dilaksanakan, pemerataan tenaga dan perlunya kebijakan tertulis tentang pemanfaatan pedoman. In West Borneo, Maternal Mortality Rate (MMR) in 2006 was 403.13/100.000 life births and Infant Mortality Rate (IMR) was 44.12/1000 life births. MMR and IMR in Pontianak City from year 2005 to 2006 were increasing but in year 2007, those rates decreased. Neonatal Mortality Rate from year 2005 to 2007 was increasing. According to the Profile of Pontianak City Health Office, coverage of Visit-1 and Visit-4 quantitatively was upper than 90%, otherwise, qualitatively there showed that most of the areas vary in terms of the coverage. Siantan Hilir Health Center has the lowest coverage of Visit-1 in Pontianak. Banjar Serasan Health Center has the lowest coverage of Visit-4. Kampung Dalam Health Center has the lowest coverage of Neonatal. Even though Pontianak City Health Office had tried to fulfill means and other resources including midwife’s work guide, three health centers had a low coverage of Visit-1, Visit-4, and Neonatal. Based on previous study, midwives had not worked in accordance with the guide that accounted for unreached target. To identify its problem, there needs to perform a research about the use of midwife’s work guide in management of Family Planning – Maternal and Child Health Program at Health Centers in Pontianak City. Aim of this research was to analyze the use of midwife’s work guide in management of Family Planning – Maternal and Child Health Program at Health Centers in Pontianak City. This was observational research using a qualitative method and cross sectional approach. Data were carried out from in-depth interview towards 9 persons namely Head of Health Centers, Coordinator of Midwife, and Midwives at three health centers. The result of this research shows that in providing services, health centers use two guides of services namely from Health Department of Indonesia and from Pontianak City Health Office in which this condition burdens midwives. The Health Center that has already implemented these guides is Kampung Dalam Health Center. Midwives have understood the guide in management of Family Planning – Maternal and Child Health Program, but in the implementation, there are some activities that have not been done well namely midwifery care of reproductive health for adolescent, pre-school, and older group, monitoring activity (there is only Kampung Dalam Health Center that performs monitoring routinely), supervision (this activity has been conducted by three health centers), and correction activity (this activity has been performed by three health centers after quarterly evaluation). Kampung Dalam Health Center has published a written policy about the use of work guide. Socialization of the policy has been done. Midwives have not had a same perception about the duty for implementing the guides. It is suggested to use the guides maximally and it does not burden midwives. Head of Health Centers could share the midwife’s tasks in terms of the services and administrative affairs. Head of Health Centers should resocialize the guide, conduct training, activate monitoring activity, perform supervision, distribute health workers, and publish a written policy about the use of the guide.