Implementasi Program Kemitraan Bidan dan Dukun oleh Bidan Desa di Kabupaten Buton Provinsi Sulawesi Tenggara Tahun 2012 (Studi Kasus di Puskesmas Wakaokili)

Abstract

Universitas Diponegoro Program Pascasarjana Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan Minat Manajemen Kesehatan Ibu dan Anak 2012 ABSTRAK Hermawati Implementasi Program Kemitraan Bidan dan Dukun oleh Bidan Desa di Kabupaten Buton Provinsi Sulawesi Tenggara Tahun 2012 (Studi Kasus di Puskesmas Wakaokili) xv + 198 halaman + 12 tabel + 4 gambar + 21 lampiran Terbatasnya pemahaman masyarakat tentang pentingnya pertolongan persalinan oleh Nakes terlatih sehingga dukun merupakan alternatif pemilihan penolong persalinan, disamping faktor sosial ekonomi, budaya, dan kinerja bidan, akibatnya AKI cenderung mengalami peningkatan dari tahun 2008 sampai tahun 2010 di Kabupaten Buton. Upaya peningkatan cakupan persalinan belum optimal ditandai rendahnya jumlah dukun bermitra mengakibatkan rendahnya rujukan kehamilan dan persalinan oleh dukun di wilayah Puskesmas Wakaokili. Hal ini berkaitan dengan implementasi Program Kemitraan Bidan dan Dukun oleh Bidan Desa di wilayah Puskesmas Wakaokili. Jenis penelitian ini adalah deskriptif kualitatif. Pengumpulan data dilakukan dengan teknik wawancara mendalam (Indepth Interview) pada 4 bidan desa dan 9 dukun bersalin sebagai informan utama. Bidan koordinator, kepala Puskesmas, Kabid Kesga DKK Buton, lintas sektor, Toma dan ibu bersalin sebagai informan triangulasi. Analisa data menggunakan metode analisis isi (content analysis). Hasil penelitian menunjukkan kurang dipahami tujuan dan indikator keberhasilan program dan belum ada aturan tertulis pelaksanaan program. Diseminasi program hanya bersifat pengenalan, dalam pelaksanaan kemitraan ada beberapa langkah yang belum dilaksanakan oleh pelaksana program, pencatatan khusus kemitraan bidan dan dukun belum tersedia, pelaporan dilakukan setiap bulan tetapi tidak didiskusikan dan SOP belum tersedia. Sosialisasi, evaluasi, supervisi, pembinaan dan magang dukun secara khusus belum pernah dilaksanakan. Sikap pelaksana terhadap kemitraan ada yang menerima dan menolak, penerapan program dengan pedoman belum sesuai. Ketersediaan sumber daya belum mendukung kegiatan program. Lingkungan ekonomi, sosial dan politik sangat mempengaruhi keberlangsungan program. Kesimpulan yang diperoleh dari penelitian adalah belum optimalnya implementasi Program Kemitraan Bidan dan Dukun di wilayah Puskesmas Wakaokili karena cakupan kegiatan Program KIA/KB masih jauh dari target, serta belum ada kebijakan yang mendukung pelaksanaan. Maka diharapkan kepada DKK Buton dan Puskesmas Wakaokili untuk mengupayakan tetap berlangsungnya kemitraan dengan dukungan seluruh aspek diantaranya ketersediaan sumber daya yang memadai, kejelasan ukuran dan tujuan kebijakan, peningkatan pengetahuan masyarakat, pembinaan dukun dan supervisi yang kontinyu. Kata Kunci : Implementasi, Program Kemitraan Bidan dan Dukun . Kepustakaan : 72 ( 1992 – 2011 ) 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 Hermawati The Implementation of Midwive and Traditional Birth Attendant Partnership Program in Buton District Southeast Sulawesi Province, 2012 (A Case Study at Wakaokili Primary Healthcare Center) xv + 198 pages + 12 tables + 4 figures + 21 enclosures Limitation of community understanding regarding the important of delivery assistance by trained health workers caused people chose traditional delivery assistants (dukun bayi) as an alternative worker for delivery assistance besides socio-economic, culture, and work performance of midwives. Therefore, maternal mortality rate (AKI) in Buton district was tended to increase in the period of 2008-2010. Efforts to increase delivery coverage were not optimal, and it was indicated by a low number of collaboration between dukun bayi and midwives. This resulted in a low number of pregnancy and delivery referral by dukun bayi in the work area of Wakaokili primary healthcare center (puskesmas). It was related to the implementation of dukun bayi and midwives collaboration program by village midwives in the work area of Wakaokili primary healthcare center. This was a descriptive qualitative study. Data were collected using in-depth interview technique to four village midwives and 9 dukun bayi as main informants. Coordinator midwives, a head of puskesmas, a head of family health department of Buton district health office, cross sectors, community leaders, and post-delivery women were included as triangulation informants. Content analysis was applied in the data analysis. Results of the study showed that understanding on the objective and program successfulness was insufficient; no written rule regarding program implementation was made. Content of program dissemination was only introductory materials. In the implementation of the collaboration, several steps were not done by program executors; no special recording on midwives and dukun bayi collaboration was provided. Reporting was conducted every month but it was not discussed, and no standard operating procedure (SOP) was provided. Special socialization, evaluation, supervision, assistance, and internship of traditional delivery assistants had been made. Positive and negative attitudes towards the collaboration were shown by the executors (midwives and dukun bayi). Suitability of program application and the guideline was insufficient. Availability of resources was insufficient to support program activities. Economy, social and political environment influenced strongly continuation of the program. In conclusion, implementation of collaboration between midwives and dukun bayi in the work area of Wakaokili primary healthcare center was not optimal; it is caused by activity coverage of KIA/KB program is still far below the target, and there is no supporting policy for the program implementation. It is expected that Buton district health office and Wakaokili primary healthcare center keep the continuity of the collaboration with support from all aspects such as adequate availability of resources, clear policy purpose and indicators, improvement of community knowledge, traditional delivery assistance and continual supervision. Key words : implementation, midwives and traditional delivery assistants collaboration program Bibliography : 72 (1992-2011)