Evaluasi Input dan Proses Pelaksanaan Pengawasan Fasilitatif oleh Bidan Koordinator terkait Program Kesehatan Ibu dan Anak di Kabupaten Lumajang

Abstract

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Kesehatan Ibu dan Anak 2015 ABSTRAK Diana Noor Fatmawati Evaluasi Input dan Proses Pelaksanaan Pengawasan Fasilitatif oleh Bidan Koordinator terkait Program Kesehatan Ibu dan Anak di Kabupaten Lumajang xvi + 131 halaman + 3 tabel + 5 gambar + 20 lampiran Kasus kematian ibu dan bayi di Kabupaten Lumajang pada lima tahun terakhir menunjukkan kecenderungan peningkatan. Hal tersebut salah satunya dapat disebabkan karena lemahnya pengawasan fasilitatif program KIA oleh bidan koordinator sehingga permasalahan yang melatar belakangi belum terpantau akibatnya usaha perbaikan belum maksimal. Tujuan penelitian ini menganalisis input dan proses pelaksanaan pengawasan fasilitatif oleh bidan koordinator terkait program kesehatan ibu dan anak di kabupaten lumajang. Jenis penelitian adalah observasional dengan metode kualitatif. Informan utama adalah bidan koordinator Puskesmas 4 orang. Informan triangulasi bidan desa 8 orang, kepala Puskesmas 4 orang dan 1 orang kabid Kesga. Data dikumpulkan dengan wawancara mendalam. Pengolahan dan analisis data menggunakan analisis isi. Hasil penelitian menunjukkan bahwa pelaksanaan manajemen fasilitatif program KIA belum berjalan dengan baik. Beberapa masalah pada aspek input: bidan koordinator belum dilatih, keterbatasan dan keterlambatan pencairan dana, buku pedoman tidak dibagi ke bidan desa. Masalah pada proses: urutan prioritas sasaran belum sesuai ketentuan, pembahasan orientasi kegiatan pengawasan dan pengisian daftar tilik tidak rutin, daftar tilik diisi bidan koordinator. Penilaian prosedur keterampilan klinis bagi bidan desa sulit dilaksanakan karena tidak selalu ada pasien, wawancara prosedur dan peragaan keterampilan klinis jarang dilaksanakan. Masalah pada pengorganisasian belum ada SK tim maupun pembagian tugas, Masalah pada monitoring dan evaluasi yaitu masih ada Puskesmas yang belum menyerahkan laporan kegiatan ke Dinas Disarankan kepada Dinas Kesehatan untuk melakukan refreshing kegiatan pengawasan fasilitatif, melakukan pendampingan, melakukan monitoring dan evaluasi secara rutin. Bagi puskesmas disarankan untuk menerbitan SK kegiatan dan pembagian tupoksi, meningkatkan keterampilan petugas pelaksana pengawasan, mengadakan simulasi kasus untuk meningkatkan keterampilan. Kata Kunci : Pengawasan Fasilitatif, Program KIA Pustaka : 54 (1993-2015) Diponegoro University Faculty of Public Health Master’s Program in Public Health Majoring in Maternal and Child Health 2015 ABSTRACT Diana Noor Fatmawati Evaluation of Input and Process of Implementing the Facilitative Monitoring by Coordinator Midwives relating to the Program of Maternal and Child Health in District of Lumajang xvi + 131 pages + 3 tables + 5 figures + 20 enclosures Maternal and infant mortality cases in District of Lumajang in the past five years were prone to increase. These problems were due to weaknesses in conducting the facilitative monitoring of a maternal and child health program by coordinator midwives. The aim of this study was to analyse input and process of implementing the facilitative monitoring by coordinator midwives relating to the maternal and child program in District of Lumajang. This was an observational study using qualitative approach. Main informants consisted of four coordinator midwives working at health centres. Meanwhile, informants for triangulation purpose consisted of eight village midwives, four heads of health centres, and a head of family health department. Data were collected by conducting indepth interview. Furthermore, data were analysed using content analysis. The results of this study showed that the facilitative monitoring had not been well implemented. Some problems occurred in input aspects were: coordinator midwives were untrained; disbursement of funds was limited and late; and a guidance book was not provided to a village midwife. Some problems happened in process aspects were: sequence of target priorities was not in accordance with a standard; discussing activity orientation for monitoring and filling a checklist was irregular; and coordinator midwives filled checklist. Procedure assessment of clinical skills for village midwives was difficult to implement because there was no sufficient number of patients. In addition, procedures of interview and practically clinical skills were rarely conducted. In organising aspects, there was no decree for either a team or job descriptions. In aspects of monitoring and evaluating, some health centres had not reported their activities to District Health Office (DHO). DHO needs to refresh activities of facilitative monitoring, to supervise, to monitor, and to evaluate regularly. Health centres need to release decrees for activities and job descriptions, to improve skills of monitoring officers, to conduct case simulation to improve skills. Key Words : Facilitative Monitoring, Program of Maternal and Child Health Bibliography : 54 (1993-2015)