Analisis Implementasi Pemeriksaan Kadar Hemoglobin dalam Pelayanan Antenatal di Puskesmas Kabupaten Jember Propinsi Jawa Timur

Abstract

Universitas Diponegoro Program Pascasarjana Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan Minat Manajemen Kesehatan Ibu dan Anak 2011 ABSTRAK Yuniasih Purwaningrum Analisis Implementasi Pemeriksaan Kadar Hemoglobin dalam Pelayanan Antenatal di Puskesmas Kabupaten Jember Propinsi Jawa Timur xv + 107 halaman +10 tabel + 5 gambar + 10 lampiran Hasil PWS KIA Dinas Kabupaten Jember tahun 2009 menunjukkan bahwa pemeriksaan kadar hemoglobin pada ibu hamil masih dibawah target yaitu hanya dilakukan pada 35,4% dari seluruh ibu hamil. Beberapa hal yang diduga sebagai penyebab permasalahan ini yaitu komunikasi, sumberdaya, disposisi dan struktur birokrasi. Tujuan penelitian adalah untuk menjelaskan implementasi pemeriksaan kadar hemoglobin dalam pelayanan antenatal di Puskesmas Kabupaten Jember. Selanjutnya dilakukan pembandingan antara puskesmas yang mempunyai cakupan tinggi dengan puskesmas yang mempunyai cakupan rendah. Penelitian ini adalah penelitian kualitatif dengan metode cross sectional. Data dikumpulkan dengan metode in depth interview. Informan utama adalah 4 orang bidan dan 2 orang petugas laboratorium. Informan triangulasi adalah 4 Kepala Puskesmas dan 1 Kepala Bidang Pelayanan Kesehatan Dinas Kesehatan Kabupaten Jember serta FGD terhadap 12 ibu hamil. Hasil penelitian menunjukkan bahwa dalam faktor komunikasi Dinas kesehatan Kabupaten Jember tidak memberikan informasi tentang pemeriksaan kadar Hb pada semua Puskesmas, sebagian kepala Puskesmas tidak memberikan informasi kepada bidan dan petugas laboratorium terkait dengan pelaksanaan kegiatan pemeriksaan kadar Hemoglobin serta bidan tidak memberikan informasi kepada ibu hamil tentang pemeriksaan kadar Hemoglobin. Ketersediaan sumber daya untuk sarana tersedia dengan baik didukung oleh sumber dana dari APBD dan untuk tenaganya, jumlah tenaga laboratorium hanya ada di 2 Puskesmas yang kebetulan memiliki fasilitas laboratorium. Pada faktor disposisi yaitu masih ada bidan yang menentukan pemeriksaan kadar hemoglobin sesuai dengan indikasi (sesuai kebutuhan) dengan alasan kejadian anemia bisa diperbaiki dengan memberikan informasi kebutuhan gizi ibu hamil. Faktor struktur birokrasi yaitu dari semua Puskesmas hanya ada satu yang memiliki SOP untuk pemeriksaan kadar hemoglobin . Disarankan kepada Dinas Kesehatan Kabupaten Jember untuk menyampaikan informasi mengenai kegiatan pemeriksaan kadar hemoglobin seharusnya menyeluruh pada tiap-tiap puskesmas, masing-masing Puskesmas melibatkan bidan dan tenaga laboratorium, bidan seharusnya membuat perencanaan kebutuhan bahan habis pakai sesuai dengan perkiraan jumlah ibu hamil dalam kurun waktu satu tahun dan memberikan informasi pentingnya pemeriksaan kadar hemoglobin pada ibu hamil meskipun biaya pemeriksaan dibebankan pada ibu hamil. Perlu menyusun SOP tentang pemeriksaan kadar hemoglobin dan kepala puskesmas perlu melakukan pengawasan secara langsung terhadap pelaksanaan pemeriksaan kadar hemoglobin. Kata kunci : Implementasi kebijakan, pemeriksaan kadar hemoglobin, pelayanan antenatal Kepustakaan : 35, 1991-2010 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 Yuniasih Purwaningrum Analysis on the Implementation of Hemoglobin Level Assessment in Antenatal Care at Primary Healthcare Centers in Jember District, Jawa Timur Province xv + 107 pages +10 tables + 5 figures + 10 enclosures Result of KIA local area monitoring (PWS) in Jember district health office in 2009 indicated that hemoglobin (Hb) concentration measurement on pregnant women was still below the target. It was only done on 35.4% of all pregnant women. Several suspected causing factors for this problem were communication, resources, disposition and bureaucracy structure. The objective of this study was to explain the implementation of hemoglobin concentration measurement in the antenatal care at primary healthcare centers (puskesmas) in Jember district. Moreover, puskesmas with high coverage and puskesmas with low coverage would be compared. This was a qualitative study using cross sectional method. Data was collected through in-depth interview. The main informants were 4 midwives and 2 laboratory workers. Triangulation informants were 4 heads of puskesmas and 1 head of health service unit of Jember district health office and FGD was conducted to 12 pregnant women. Results of the study showed that in relation to communication factor, Jember district health office did not give information regarding Hb measurement to all puskesmas. Several heads of puskesmas did not pass the information regarding to the implementation of Hb concentration measurement activity to midwives and laboratory workers. Midwives did not pass the information to pregnant women about Hb concentration measurement. In relation to the resources, the availability of facilities was good and it was supported by funding resource from APBD. Laboratory workers were only available in 2 puskesmas with laboratory facilities. In relation to disposition factor, there was still found that midwives were the one who decided to measure Hb concentration according to indication (according to the needs). The reason for that was the occurrence of anemia could be reduced by giving information about nutrition needs to pregnant women. In relation to bureaucracy structure factor, among all puskesmas, only one puskesmas that had a standard operating procedure (SOP) for Hb concentration measurement. It was suggested to the head of Jember district health office to pass the information regarding Hb concentration measurement activity to all puskesmas. Each puskesmas should involve midwives and laboratory workers. Midwives should make planning on the need of non reusable materials according to the estimation of the number of pregnant women in a year and should give information on the important of Hb concentration measurement to pregnant women even though the cost for the measurement was on pregnant women’s responsibility. It was important to formulate SOP about Hb concentration measurement and the head of puskesmas should monitor directly to the implementation of Hb concentration measurement. Key words : policy implementation, hemoglobin concentration measurement, Antenatal care Bibliography : 35, 1991 - 2010