Analisis Faktor-Faktor yang Mempengaruhi Kinerja Bidan dalam Pelayanan Antenatal Terpadu di Puskesmas Kota Manado

Abstract

Universitas Diponegoro Program Pascasarjana Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan Minat Manajemen Kesehatan Ibu dan Anak 2012 ABSTRAK Els Ivi Kulas Analisis Faktor-Faktor yang Mempengaruhi Kinerja Bidan dalam Pelayanan Antenatal Terpadu di Puskesmas Kota Manado xiv + 118 halaman + 26 tabel + 3 gambar + 18 lampiran Pelayanan antenatal terpadu adalah pelayanan antenatal komprehensif dan berkualitas, diberikan kepada semua ibu hamil di fasilitas kesehatan mencakup upaya promotif, preventif sekaligus kuratif dan rehabilitatif. Pelayanan antenatal terpadu oleh bidan di puskesmas Kota Manado pelaksanaannya kurang maksimal, dibuktikan dengan cakupan pelayanan antenatal masih dibawah target dan cenderung mengalami penurunan. Tahun 2009, cakupan K1 90,8% menurun menjadi 86% tahun 2010 (target 95%) dan cakupan K4 tahun 2009 mencapai 82,2% menurun menjadi 78% tahun 2010 (target 84%), serta masih terdapat 2 kasus kematian ibu hamil. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi kinerja bidan dalam pelayanan antenatal terpadu di Puskesmas Kota Manado. Jenis penelitian adalah observasional analitik dengan disain cross sectional. Populasi adalah semua bidan di puskesmas kota Manado berjumlah 90 orang. Subjek sejumlah 65 orang dipilih dengan metode purposive sampling. Pengumpulan data primer melalui wawancara dengan menggunakan kuesioner terstruktur dan pengamatan dengan menggunakan lembar observasi. Analisis yang digunakan Chi-Square dan Regresi Logistik. Hasil penelitian menunjukkan pengetahuan baik (75,4%), persepsi supervisi baik (50,8%), sarana prasarana lengkap (53,8%), persepsi beban kerja tinggi (58,5%), motivasi tinggi (53,8%) dan kinerja bidan dalam pelayanan antenatal terpadu baik (55,4%). Hasil analisis bivariat menunjukkan ada hubungan yang signifikan antara pengetahuan (p=0,002), persepsi supervisi (p=0,035), persepsi beban kerja (p=0,001), motivasi (p=0,010) dengan kinerja bidan. Hasil analisis multivariat menunjukkan adanya pengaruh secara bersama-sama variabel persepsi beban kerja (p=0,025) dan motivasi (p=0,033) terhadap kinerja bidan dalam pelayanan antenatal terpadu. Puskesmas hendaknya mengurangi tugas tambahan administrasi bidan, meningkatkan motivasi bidan dalam pendokumentasian hasil kegiatan, adanya koordinasi antara bidan dengan bidan koordinator dan kepala puskesmas dalam pelaksanaan kegiatan pelayanan antenatal terpadu. Dinas Kesehatan hendaknya menyelenggarakan pelatihan, memperbaiki teknik supervisi, memberikan alternatif solusi bagi masalah yang ditemui dan penyediaan sarana prasarana yang belum tersedia. Kata Kunci : Kinerja Bidan, Pelayanan Antenatal Terpadu, Puskesmas Kepustakaan : 42 (1993-2010) Diponegoro University Postgraduate Program Master’s Program in Public Health Majoring in Health Policy Administration Sub Majoring in Maternal and Child Health Management 2012 ABSTRACT Els Ivi Kulas Analysis on Factors Related to the Performance of Midwives in Integrated Antenatal Care Service in Primary Healthcare Centers in Manado xiv + 118 pages + 26 tables + 3 figures + 18 enclosures An integrated antenatal service was a qualified comprehensive antenatal service given to all pregnant women in the health facility. It included promotive, preventive, curative, and rehabilitative services. The implementation of an integrated antenatal service by primary healthcare midwives in Manado municipality was not maximal. This was supported by evidences such as antenatal service coverage that was still below the target and tended to decrease; the K1 coverage in 2009 was 90.8%, and it was 86% in 2010 (the target was 95%); the K4 coverage in 2009 was 82.2%, and it was 78% in 2010 (the target was 84%); and there were two pregnant women death cases. The study objective was to identify factors affecting work performance of midwives in the integrated antenatal service in the primary healthcare centers (puskesmas) of Manado municipality. This was an observational analytic study with cross sectional approach. Study population was all 90 primary healthcare center midwives. Study samples were 65 midwives selected using purposive sampling method. Collection of primary data was done through interview guided by structured questionnaire, and observation using observation sheet. Chi-square and logistic regression were applied in the analysis. Results of the study showed that the majority of respondents had good knowledge (75.4%), good perception on supervision (50.8%), complete facilities (53.8%), high workload (58.5%), high motivation (53.8%), and good work performance of midwives on the integrated antenatal service (55.4%). Results of a bivariate analysis showed an association between work performance of midwives and knowledge (p= 0.002), perception on supervision (p= 0.035), perception on workload (p= 0.001), motivation (p= 0.010). Result of multivariate analysis showed joint effect of workload perception (p= 0.025) and motivation (p= 0.033) variables toward work performance of midwives in the integrated antenatal service. Suggestions for primary healthcare center are to reduce additional administrative task for midwives; to improve motivation of midwives in making documentation of activities; to create coordination among midwives, midwives coordinator, and the head of puskesmas. Suggestions for district health office are to provide trainings, to improve supervision technique, to provide alternative solution for problems faced in the field, and to provide facilities. Key words : Work performance of midwives, integrated antenatal service, Primary healthcare centers Bibliography : 42 (1993-2010)