Faktor-Faktor yang Berhubungan dengan Kinerja Bidan Desa dalam Pelaksanaan Rujukan Gawat Darurat Obstetri Persalinan di Kabupaten Kediri

Abstract

Universitas Diponegoro Program Pascasarjana Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan Minat Manajemen Kesehatan Ibu dan Anak 2012 ABSTRAK Endah Ernawati Faktor-Faktor yang Berhubungan dengan Kinerja Bidan Desa dalam Pelaksanaan Rujukan Gawat Darurat Obstetri Persalinan di Kabupaten Kediri xiv + 94 halaman + 28 tabel + 6 gambar + 7 lampiran Kematian ibu di Kabupaten Kediri dari tahun 2008 sampai dengan 2010 mengalami peningkatan dari 58/100.000 kelahiran hidup menjadi 135/100.000 kelahiran hidup. Faktor penyebab kematian terbesar adalah kasus preeklamsi/eklamsi, penolong persalinan pertama sebagian besar bidan dengan estafet rujukan lebih dua kali. Tujuan penelitian adalah untuk menganalisis faktor-faktor yang berhubungan dengan kinerja bidan desa dalam pelaksanaan rujukan gawat darurat obstetri persalinan di Kabupaten Kediri. Penelitian ini menggunakan rancangan penelitian observasional dengan pendekatan cross sectional. Pengumpulan data dilakukan dengan wawancara menggunakan kuesioner dan observasi. Populasi penelitian adalah 107 orang bidan desa dengan jumlah sampel 52 bidan desa yang tersebar di 37 puskesmas di Kabupaten Kediri dan dipilih secara proportional random sampling berdasarkan Puskesmas. Analisa data dilakukan dengan uji chi–square dan regresi logistik. Hasil penelitian menunjukkan bahwa median dan simpang baku umur bidan 36+5,4 tahun, bidan berpendidikan D3 sejumlah 73,1% dengan median dan simpang baku masa kerja 16+5,3 tahun. Bidan berpengetahuan kurang baik 86,5%, mempunyai persepsi baik terhadap sistem kompensasi 55,8%, persepsi terhadap supervisi baik 55,8%, motivasi tinggi 57,7%, sikap yang baik 51,9% tetapi mempunyai kinerja kurang baik 71,2%. Hasil analisis bivariat menunjukkan bahwa ada hubungan antara umur, pendidikan, masa kerja, motivasi dan sikap dengan kinerja bidan desa dalam pelaksanaan rujukan gawat darurat obstetri persalinan di Kabupaten Kediri. Hasil analisis multivariat menunjukkan bahwa faktor yang berpengaruh secara bersama-sama terhadap kinerja rujukan adalah masa kerja (p=0,011), pendidikan (p=0,029) dan sikap (p=0,019). Masa kerja merupakan faktor yang paling berpengaruh terhadap kinerja bidan dalam pelaksanaan rujukan. Disarankan kepada Dinas Kesehatan untuk meningkatkan pengetahuan dan ketrampilan bidan desa dalam penanganan gawat darurat obstetri, memberi kesempatan magang di Rumah Sakit dan melakukan monitoring dan evaluasi secara khusus pada rujukan. Kata Kunci : Rujukan, Gawat Darurat Obstetri, Kinerja, Bidan Desa Kepustakaan : 49, 1987 – 2009 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 Endah Ernawati Factors Associated to the Village Midwive's Work Performance in the Implementation of Obstetric Emergency Referral in Kediri District xiv + 94 pages + 28 tables + 6 figures + 7 enclosures Maternal mortality rate in Kediri district in the period of 2008-2010 increased from 58/100,000 live-birth to 135/ 100,000 live-birth. The main factors causing maternal death were pre-eclamsia or eclamsia case, the first delivery assistant was a midwife, and more than two referrals were done. The objective of this study was to analyze factors related to village midwives work performance in the implementation of obstetric emergency referral in Kediri district. This was an observational study with cross sectional approach. Data collection was done by conducting interview guided by questionnaire and doing observation. Study population was 107 village midwives. Study samples were 52 village midwives resided in 37 primary healthcare centers (puskesmas) in Kediri district. They were selected using proportional random sampling method based on puskesmas. Chi-square and logistic regression tests were applied in the data analysis. Results of the study showed that median and standard deviation of village midwives’ age were 36 ± 5.4 years old; 73.1% of midwives were in the D3 level of education; median and standard deviation of working duration were 16 ± 5.3 years. Proportion of midwives with insufficient knowledge was 86.5%, with good perception on compensation system was 55.8%, with good perception on supervision was 55.8%, with high motivation was 57.7%, with good attitude was 51.9%, and with inadequate work performance was 71.2%. Results of bivariate analysis showed associations between age, education, duration of working, motivation, attitude and work performance of village midwives in the implementation of obstetric emergency referral in Kediri district. Multivariate analysis showed factors that jointly affecting the work performance of midwives in implementing referral were duration of working ( p= 0.011), education (p= 0.029), and attitude (p= 0.019). Duration of working was the most influencing factor to the work performance of midwives in the implementation of referral. Suggestions for District Health Office were to improve knowledge and skills of village midwives in the implementation of obstetric emergency management; to provide an opportunity for midwives to do internship in the hospital, and to do special monitoring and evaluation on the referral. Key words : Referral, obstetric emergency, work performance, village midwives Bibliography : 49, 1987-2009