Analisis Implementasi Program Jaminan Persalinan oleh Bidan Desa di Kabupaten Lumajang

Abstract

Universitas Diponegoro Program Pascasarjana Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan Minat Manajemen Kesehatan Ibu dan Anak 2012 ABSTRAK Warih Respitowati Analisis Implementasi Program Jaminan Persalinan oleh Bidan Desa di Kabupaten Lumajang xii + 123 halaman + 9 tabel + 3 gambar + 10 lampiran Implementasi jaminan persalinan di Kabupaten Lumajang masih belum sesuai petunjuk teknis seperti pelaksanaan KB pasca salin. Tujuan dari penelitian ini adalah menjelaskan implementasi program jaminan persalinan oleh bidan desa di Kabupaten Lumajang. Jenis penelitian ini adalah penelitian eksplanatif. Informan utama yaitu 2 orang bidan desa dari puskesmas PONED dan non PONED dengan cakupan persalinan tertinggi dan 2 orang bidan desa dengan cakupan persalinan terendah dari masing-masing puskesmas. Informan triangulasi berjumlah 12 orang yang terdiri dari 1 orang pengelola jampersal Dinas Kesehatan, 1 orang verifikator jampersal, 2 orang kepala puskesmas dan 8 orang pasien jampersal. Data didapatkan melalui indepth interview serta menggunakan metode observasi terhadap sarana dan prasarana polindes. Analisis data penelitian ini menggunakan content analysis. Hasil penelitian menunjukkan bahwa kegiatan pelayanan jaminan persalinan dilaksanakan menggunakan standar pelayanan minimal. Kebijakan jaminan persalinan merupakan kebijakan yang tepat dalam mengatasi masalah pembiayaan kesehatan. Pelaksana kebijakan adalah bidan desa yang memiliki kompetensi sesuai tujuan program. Target dan lingkungan juga mendukung terhadap pelaksanaan program. Ukuran dasar dan tujuan kebijakan telah jelas dan dapat dipahami bidan desa, namun pendanaan masih belum maksimal sehingga banyak keluhan dari bidan. Komunikasi dan koordinasi berjalan dengan baik namun kondisi sosial dan ekonomi masyarakat belum sepenuhnya mendukung terkait pelaksanaan KB pasca salin. Dana kebijakan jampersal dinilai terlalu kecil baik bagi penolong maupun bahan habis pakai sehingga kondisi tersebut mengakibatkan pelaksanaan program hanya sebagai kewajiban yang harus dijalankan. Saran yang direkomendasikan bagi Dinas Kesehatan Lumajang adalah perlunya peraturan terkait KB pasca salin dan perencanaan yang baik tentang kebutuhan sumber daya sehingga menunjang pelaksanaan pelayanan. Monitoring penggunaan buku KIA harus diupayakan oleh puskesmas agar meminimalkan permasalahan teknis seperti adanya double claim akibat penggunaan buku KIA ganda. Kata Kunci : Implementasi, Jaminan Persalinan, Bidan Desa. 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 Warih Respitowati Analysis on the Implementation of Delivery Assurance Programme by Village Midwives in Lumajang District xii + 123 pages + 9 tables + 3 figures + 10 enclosures Implementation of delivery assurance (Jampersal) program in Lumajang district was not done according to the technical guideline; it was not done by way of the implementation of KB after delivery program was done. Objective of this study was to explain the implementation of delivery assurance program by village midwives in Lumajang district. This was an explanatory study. Main informants were two village midwives from PONED and non PONED primary healthcare centers (puskesmas) with the highest delivery coverage, and two village midwives from each puskesmas with the lowest delivery coverage. Triangulation informants were 12 people. Those people were one jampersal manager from district health office, one jampersal verification person, two heads of puskesmas, and 8 jampersal patients. Data were collected through in-depth interview and observation to polindes (village polyclinic) facility. Content analysis method was applied in the data analysis. Results of the study showed that activities of delivery assurance service were conducted using minimal standard service. Delivery assurance policy was a right policy to solve health cost problems. Executors of the policy were village midwives who had competency that suited with program purposes. Target and environment supported the program implementation. Basic indicator and purpose of the policy were clear and understandable for village midwives. However, funding was not maximal, and it caused many complaints from midwives. Communication and coordination were adequate; however social condition and community economy did not completely support the implementation of post-delivery KB (family planning). Funding for jampersal was very small for both delivery assistance and consumable materials. This condition made the implementation of program was only for fulfilling the responsibility. Recommended suggestions for Lumajang district health office are to provide regulations related to post-delivery KB, to do proper planning regarding resources requirement to support service implementation. Monitoring on the usage of KIA book should be done by puskesmas to minimize technical problems such as double claim due to using double KIA book. Key words : implementation, delivery assurance, village midwives