Implementasi Program Pengendalian Penyakit Demam Berdarah Dengue (P2DBD) di Wilayah Kota Medan

Abstract

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi Kebijakan Kesehatan 2015 ABSTRAK Rapotan Hasibuan Implementasi Program Pengendalian Penyakit Demam Berdarah (P2DBD) di Wilayah Kota Medan. xvii + 136 halaman + 24 tabel + 10 gambar + 19 lampiran Kejadian kasus, incidence rate (IR) dan case fatality rate (CFR) penyakit DBD di Kota Medan berada dalam tren naik sejak tahun 2012 lalu. Hal ini mungkin disebabkan oleh adanya masalah dalam implementasi program P2DBD. Tujuan penelitian adalah untuk menganalisis pengaruh faktor komunikasi, sikap, karakteristik puskesmas, pemahaman standar dan sasaran, sumber daya, serta lingkungan terhadap keberhasilan implementasi program P2DBD di Kota Medan. Penelitian ini menggunakan rancangan penelitian observasional dengan pendekatan cross sectional. Pengumpulan data dilakukan dengan wawancara menggunakan kuesioner terstruktur dan observasi, dilengkapi wawancara mendalam untuk data kualitatif. Jumlah responden 39 petugas DBD di seluruh Puskesmas induk Kota Medan. Analisis dilakukan dengan teknik structural equation modeling (SEM) menggunakan software visual partial least square (VPLS). Hasil penelitian menunjukkan komunikasi 66,7% sangat baik, sikap petugas 82,1% positif mendukung program, karakteristik puskesmas 84,6% baik, pemahaman akan standar dan sasaran program 66,7% baik, sumber daya 74,4% baik, lingkungan 76,9% kondusif, sementara implementasi P2DBD 51,3% baik (level moderat). Hasil analisis bivariat, komunikasi dan lingkungan berpengaruh terhadap implementasi. Hasil analisis multivariat menunjukkan keragaman implementasi dapat dijelaskan secara bersama-sama oleh komunikasi, sikap, karakteristik puskesmas, standar dan sasaran, sumber daya, serta lingkungan sebesar 67,4%. Nilai R2 tersebut termasuk dalam kategori substansial, dimana faktor yang paling berpengaruh adalah lingkungan. Dinas Kesehatan disarankan agar membuat pelatihan berkala mengenai tatalaksana kasus DBD, supervisi program ke puskesmas, dan menginisiasi keberadaan kader jumantik. Bagi petugas agar memotivasi dan melakukan pendekatan persuasif pada masyarakat serta mengkoordinasikan revitalisasi Pokjanal DBD. Kata kunci : Program P2DBD, Implementasi kebijakan, Puskesmas. Kepustakaan : 60 (1980 – 2015) Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Administration and Health Policy 2015 ABSTRACT Rapotan Hasibuan Implementation of Dengue Haemorrhagic Fever Disease Control Program (P2DBD) in Medan City xvii + 136 pages + 24 tables + 10 figures + 19 appendices An incidence rate (IR) and a case fatality rate (CFR) of Dengue Haemorrhagic Fever (DHF) in Medan City tended to increase since 2012. This might be due to a problem in implementing DHF Disease Control Program (P2DBD). The aim of this study was to analyse the influence of factors of communication, attitude, health centres’ characteristics, understanding of a standard and a target, resource, and environment towards the success of the P2DBD implementation program in Medan City. This was an observational study using a cross-sectional approach. Data were collected using a structured questionnaire and observation followed by conducting indepth interview for qualitative data. Number of respondents were 39 DHF officers working at all main health centres in Medan City. Furthermore, data were analysed using a technique of structural equation model (SEM) processed by a software of visual partial least square (VPLS). The results of this research showed that most of the respondents had very good communication (66.7%), positive attitude in supporting the program (82.1%), good characteristics of health centres (84.6%), good understanding of a standard and a target (66.7%), good resource (74.4%), conducive environment (76.9%), and good implementation of P2DBD (51.3%), a moderate level. Bivariate analysis demonstrated that communication and environment influenced the implementation. Furthermore, multivariate analysis showed that the implementation could be explained by the factors of communication, attitude, health centres’ characteristics, standard and target, resource, and environment equal to 67.4%. The R2 value was included as a substantial category in which the most influenced factor was the environment. District Health Office needs to regularly conduct training of DHF case management, to supervise a program at health centres, and to initiate the existence of cadres for monitoring mosquito wrigglers. Health workers need to motivate, to persuasively ask a community, and to coordinate revitalisation of a DHF working group. Keywords : P2DBD Program, Policy Implementation, Health Centre Bibliography: 60 (1980-2015)