Analisis Manajemen Sistem Pelayanan Kegawatdaruratan Obstetri di Puskesmas PONED Wilayah Kabupaten Kupang Tahun 2011

Abstract

Universitas Diponegoro Program Pascasarjana Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan Minat Manajemen Kesehatan Ibu dan Anak 2011 ABSTRAK Tirza Vivianri Isabela Tabelak Analisis Manajemen Sistem Pelayanan Kegawatdaruratan Obstetri di Puskesmas PONED Wilayah Kabupaten Kupang Tahun 2011 xvi, 173 halaman + 39 tabel + 5 gambar + 14 lampiran Puskesmas PONED merupakan puskesmas yang memiliki fasilitas dan kemampuan memberikan pelayanan untuk menanggulangi kasus kegawatdaruratan obstetri dan neonatal selama 24 jam. Kabupaten Kupang telah memiliki 5 Puskesmas mampu PONED. Secara umum penelitian ini bertujuan untuk menjelaskan tentang manajemen sistem pelayanan kegawatdaruratan obstetri di Puskesmas PONED wilayah Kabupaten Kupang tahun 2011. Metode penelitian ini adalah kualitatif. Subyek penelitian adalah dokter PONED, Kepala Puskesmas, Kepala Bidang Penyehatan Lingkungan dan ibu nifas patologi. Pengumpulan data dilakukan melalui wawancara mendalam, pengamatan menggunakan chek list dan studi dokumentasi. Hasil penelitian menunjukkan bahwa manajemen sistem pelayanan kegawatdaruratan obstetri dari perencanaan, pengorganisasian, pelaksanaan dan evaluasi belum berjalan dengan baik karena masih terdapat keterbatasan aspek input meliputi SDM, keuangan, sarana prasarana, dasar hukum, SOP atau protap, juklak, juknis, serta stakeholder. SDM atau tim PONED tidak tinggal di Puskesmas, tugas belajar, dokter yang ada berasal dari Puskesmas lain, bahkan ada Puskesmas yang tidak memiliki dokter. Keuangan yang diperuntukkan khusus bagi kegiatan PONED belum ada. Sarana prasarana sebagian besar belum memenuhi standar. Dasar hukum berupa SK yang melegalkan tim PONED melaksanakan tindakan belum ada, yang tersedia hanya SOP atau protap yang wajib dijalankan setiap tim dalam pelayanan. Dukungan Pemda belum optimal. LSM atau donor agency juga terbatas. DKK yang senantiasa mendukung Puskesmas sehingga terkesan jajaran kesehatan yang lebih banyak bekerja. Namun demikian kebijakan tentang Puskesmas PONED sudah tertuang dalam Peraturan Gubernur Nomor 42 Tahun 2009 Tentang Revolusi KIA. Manajemen sistem pelayanan kegawatdaruratan obstetri di Puskesmas PONED wilayah Kabupaten Kupang dapat berjalan baik dengan cara menyiapkan SDM sesuai kebutuhan jumlah, kompetensi dan kualifikasi, ada dana peruntukkan khusus bagi pelayanan PONED, ada Surat Keputusan yang melegalkan tim PONED untuk memberikan pelayanan di Puskesmas, adanya job description yang jelas, koordinasi, bimbingan, penggerakkan dan evaluasi dengan melibatkan Pemerintah Daerah dan penataan kembali kebijakan tentang revolusi KIA menyangkut SDM, keuangan dan sarana prasarana serta membuat peraturan daerah mengenai penyelenggaraan program revolusi KIA. Kata kunci : Pelayanan PONED, Puskesmas, Manajemen Kepustakaan : 52, 1985-2010. Diponegoro University Postgraduate Program Master’s Program in Public Health Majoring in Health Policy Administration Sub Majoring in Maternal and Child Health Management 2011 ABSTRACT Tirza Vivianri Isabela Tabelak Analysis on Obstetric Emergency System Management of Primary Healthcare Center with Obstetric and Neonatal Essential Care in Kupang, 2011 xvi, 173 pages + 39 tables + 5 figures + 14 enclosures PONED puskesmas was a puskesmas that had facilities and ability to give service to control obstetrical and neonatal emergency cases for 24 hours. Kupang district had 5 PONED puskesmas. In general, the objective of this study was to explain about management of an obstetrical emergency service system in PONED puskesmas in Kupang district, 2011. This was a qualitative study. The study subjects were PONED physicians, heads of puskesmas, heads of environmental sanitation unit and pathological post partum mothers. Data was collected through in-depth interview, observation using check list and documentation study. Results of this study showed that management of obstetrical emergency service system, including planning, organizing, implementation and evaluation, had not run well due to limitation in the input aspects. Input aspects included human resource, finance, facilities, law basis, standard operating procedure (SOP) or ‘protap’, operating guidance, technical manual and stakeholder. Human resource or PONED team did not live in puskesmas due to he/she was still taking advanced study. The physician was from other puskesmas. There was puskesmas without physician. No special budget allocation for PONED activities. Facilities were still under the standard level. There was no legal basis but only SOP or ‘protap’ that should be followed by each team in their service. Legal basis was a decree that legalized PONED team to do actions. Local government support was not optimal. There was limited non government organization or donor agency that gave support. District health office was the only one that always supported puskesmas and it created image that health officers were doing more works. Fortunately, the policy regarding PONED puskesmas had been included in the Governor regulation number 42, 2009 on KIA revolution. Management of obstetrical emergency service system in PONED puskesmas in Kupang district will run well by preparing human resource according to the number of people needed, competence and qualification; providing funding for PONED service; providing decree to legalize PONED team to implement the service in puskesmas; providing good job description, coordination, assistance, actuating and evaluation by involving local government; restructuring policy on KIA revolution that involving human resource, finance and facilities; making regional regulation regarding implementation of KIA revolution program. Key words : PONED service, puskesmas, management Bibliography : 52, 1985 - 2010