Analisis Implementasi Program Kelas Ibu Hamil oleh Bidan Puskesmas di Kota Malang

Abstract

Universitas Diponegoro Program Pascasarjana Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan Minat Manajemen Kesehatan Ibu dan Anak 2013 ABSTRAK Jiarti Kusbandiyah Analisis Implementasi Program Kelas Ibu Hamil oleh Bidan Puskesmas di Kota Malang v + 84 halaman + 22 tabel + 3 gambar + 5 lampiran Angka Kematian Ibu (AKI) di Kota Malang (90,4 per 100 rb KH) lebih tinggi dari Jawa Timur (79,4 per 100 rb KH) pada tahun 2010. Cakupan K4 juga menurun dari 98,7% pada tahun 2009 menjadi 87,1% pada tahun 2011 dan masih di bawah target (95%). Upaya peningkatan cakupan K4 sudah dilaksanakan sejak tahun 2009 melalui kelas ibu hamil. Hasil studi pendahuluan menunjukkan bahwa pelaksanaan kelas ibu hamil belum berjalan dengan baik. Tujuan penelitian ini adalah menganalisis faktor-faktor yang berpengaruh terhadap implementasi kelas ibu hamil oleh bidan puskesmas di Kota Malang. Jenis penelitian ini adalah observasional analitik dengan pendekatan cross sectional. Subjek penelitian adalah 25 bidan yang menyelenggarakan kelas ibu hamil. Data dikumpulkan dengan angket terstruktur dan lembar observasi. Analisis dilakukan dengan uji korelasi Fisher Exact dan regresi logistik. Hasil penelitian menunjukkan baru 30% kelas ibu hamil yang sudah dilaksanakan dengan baik, 20% belum baik dan 50% sudah tidak menyelenggarakan kelas ibu hamil. Dari responden yang menyelenggarakan kelas ibu hamil, didapatkan hasil standar dan tujuan kebijakan belum jelas bagi 32% responden, sumberdaya belum memadai bagi 36% responden, komunikasi antar organisasi belum berjalan baik bagi 60% responden, karakteristik badan pelaksana belum baik bagi 72% responden dan disposisi belum baik oleh 32% responden. Ada hubungan bersama-sama antara disposisi/sikap implementor serta standar dan tujuan kebijakan dengan implementasi program kelas ibu hamil. Untuk memperbaiki implementasi kelas ibu hamil perlu dilakukan sosialisasi lebih intensif tentang pedoman kelas ibu hamil, menyertakan bidan praktek mandiri untuk menyelenggarakan kelas ibu hamil serta motivasi untuk peningkatan sikap bidan terhadap kelas ibu hamil supaya lebih positif. Kata Kunci : Implementasi, Kelas Ibu Hamil, Bidan Puskesmas Jumlah Pustaka : 35 (1975 – 2011) Diponegoro University Postgraduate Program Master’s Program in Public Health Majoring in Health Policy Administration Sub Majoring in Maternal and Child Health Management 2013 ABSTRACT Jiarti Kusbandiyah Analysis on the Implementation of Maternity Class Program by Primary Healthcare Center's Midwives in Malang City v + 84 pages + 22 tables + 3 figures + 5 enclosure Maternal mortality rate (AKI) in Malang city (90.4 per 100000 live births) was higher than in the East Java province (79.4 per 100000 live births) in 2010. Coverage of K4 also decreased from 98.7% in 2009 to 87.1% in 2011; it was still below the target (95%). Efforts to increase K4 coverage had been done since 2009 by conducting antenatal classes. Results of a preliminary study indicated that the implementation of antenatal classes did not run smoothly. Objective of this study was to analyze factors related to the implementation of antenatal class by primary healthcare center midwives in Malang city. This was an observational-analytical study with cross sectional approach. Study subjects were 25 midwives who run antenatal classes. Data were collected through structured questionnaire and observation list. Fisher Exact correlation test and logistic regression were applied in the data analysis. Results of the study showed that only 30% of antenatal classes run well, 20% of antenatal classes were not good, and 50% of antenatal classes were closed. Respondents who run antenatal classes reported that standard and the purpose of a policy were not clear for 30% of them; resources were inadequate for 36% of respondents; communication among organization was inadequate for 60% of respondents; characteristics of the executive board were unsatisfactory for 72% of respondents; and disposition was unsatisfactory for 32% of respondents. There was a common association between implementation of antenatal class program and disposition or attitude of implementers, standard or purpose of policy composite. Several activities need to do to improve the antenatal classes. Those activities were to do intensive socialization regarding antenatal class program guidelines; to involve private practice midwives in running the antenatal class; to give motivation to midwives to have more positive attitude to antenatal class. Key words : implementation, antenatal class, primary healthcare center midwives Bibliography : 35 (1975-2011)