Analisis Faktor-Faktor yang Mempengaruhi Implementasi Program Perencanaan Persalinan dan Pencegahan Komplikasi oleh Bidan Desa di Kabupaten Demak

Abstract

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Kesehatan Ibu dan Anak 2015 ABSTRAK Sumiyarni Analisis Faktor-Faktor yang Mempengaruhi Implementasi Program Perencanaan Persalinan dan Pencegahan Komplikasi oleh Bidan Desa di Kabupaten Demak xvi + 101 halaman + 6 tabel + 3 gambar + 5 lampiran Program Perencanaan Persalinan dan Pencegahan Komplikasi (P4K) sebagai salah satu bentuk pemberdayaan masyarakat yang kegiatannya di fasilitasi oleh Bidan di Desa dalam rangka peningkatan peran aktif suami, keluarga dan masyarakat dalam merencanakan persalinan yang aman dan persiapan menghadapi komplikasi bagi ibu hamil, termasuk perencanaan dan penggunaan KB Pasca salin. Program ini dilaksanakan bidan dengan kontak langsung ke ibu hamil, suami, keluarga sepakat dalam pengisian stiker termasuk memberi konseling dan memberikan pelayanan saat itu juga sehingga bisa meningkatkan cakupan dan mutu pelayanan kesehatan ibu dan anak. Dalam pelaksanaannya Program P4K SOP belum dibuat, sumber daya tidak berjalan baik,bidan bersikap malas, ibu hamil keluarga tidak jelas mengenai manfaat dari program P4K. Tujuan penelitian menjelaskan Faktor-faktor yang mempengaruhi implementasi P4k oleh Bidan Desa di Kabupaten Demak. Merupakan penelitian deskriptif dengan metode kualitatif. Subyek penelitian 4 ibu hamil. Informan utama Bidan Desa 4 orang, informan triangulasi Bidan Koordinator 1 orang . Faktor faktor yang mempengaruhi Implementasi P4K meliputi Struktur Birokrasi, Sumber Daya, Komunikasi dan Disposisi. Data dikumpulkan dengan wawancara mendalam dan dianalisis dengan analisis isi. Struktur birokrasi dalam implementasi program P4K tidak ada pendelegasian dalam bentuk surat keputusan Puskesmas dan Dinas Kesehatan Kabupaten,telah dibentuk tim di desa, petunjuk teknis pelaksanaan tidak diberikan kepada Bidan Desa, koordinasi dilakukan melalui rapat. Sumber daya dalam implementasi P4K tidak ada dana operasional dari Puskesmas atau Dinas Kesehatan Kabupaten, sarana prasarana telah disediakan, pelaksanaan oleh Bidan Desa dibantu tim Desa. Komunikasi dilakukan penyampaian kepada ibu hamil saat periksa kehamilan di Bidan, PKD dan Puskesmas. Disposisi dalam implementasi P4K sikap dan kemauan yang baik dari bidan Desa, namun masih ada bidan desa yang memiliki momitmen kurang baik Dinas Kesehatan perlu koordinasi dengan Puskesmas terkait penerbitan surat pendelegasian sebagai dasar pelaksanaan tugas bagi Bidan Desa dan Tim P4K,menyusun petunjuk pelaksanaan, merencanakan dan mengalokasikan anggaran untuk pelaksanaan P4K.Komitmen Bidan desa ditingkatkan dalam pemahaman dan motivasi Kata kunci : Implementasi Progam Perencanaan Persalinan Dan Pencegahan Komplikasi,Bidan Desa Kepustakaan : 40 (1974-2013) Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Maternal and Child Health 2015 ABSTRACT Sumiyarni Analysis of Factors Influencing the Implementation of Delivery Planning and Complication Prevention Program by Village Midwives in District of Demak xvi + 101 pages + 6 tables + 3 figures + 5 appendices A Delivery Planning and Complication Prevention Program (P4K) is one of the community empowerment forms conducted by village midwives to increase a role of a husband, a family, and a community in planning safe delivery and preparing the occurrence of complication for pregnant women including planning and being Family Planning acceptors after birth. This program were implemented by midwives through direct contact to pregnant women, husbands, families to make agreement in filling sticker including providing counseling and services to increase a coverage and to improve maternal and child health service quality. In fact, Standard Operating Procedure of the P4K program had not been made yet, resource had not been utilised, midwives tended to be lazy, pregnant women’s families did not understand the benefits of the P4K program. The aim of this study was to explain factors influencing the implementation of P4K by village midwives in District of Demak. This was a descriptive study using a qualitative method. Number of subjects were four pregnant women. Main informants consisted of four village midwives, whereas informant for triangulation purpose was a Coordinator Midwife (one person). Factors influencing the implementation of P4K encompassed structure of bureaucracy, resource, communication, and disposition. Data were collected using indepth interview and analysed using a method of content analysis. Regarding structure of bureaucracy in implementing the P4K program, there was no delegation such as a decree of Health Centre and District Health Office (DHO). On the other hand, a team at a village had been formed. A techical implementation guidance was not provided to village midwives. Coordination was made by meeting. Regarding resource, there was no operational budget from Health Centre or DHO. In addition, means had been provided. The implementation by village midwives was assisted by a village’s team. Communication was done to pregnant women during antenatal care visit at midwives, Village Health Post, or Health Centre. Regarding disposition of the P4K implementation, village midwives had good attitude and good willingness. However, there were any midwives who did not have good commitment. DHO needs to make coordination with Health Centres relating to issuing decree of delegation as a regulation to implement tasks for village midwives and P4K team. In addition, DHO needs to arrange a technical guidance, plan, and allocate budget to implement P4K. Commitment of village midwives in understanding and motivation needs to improved. Keywords : Implementation of Delivery Planning and Complication Prevention Program, Village Midwife Bibliography: 40 (1974-2013)