Untuk meningkatkan pelayanan kesehatan yang bermutu salah satu hal yang dinilai dalam Quality assurance adalah tingkat kepatuhan petugas. Tingkat kepatuhan petugas terhadap standar pemeriksaan pasien ISPA merupakan penilaian terhadap kinerja petugas. Kota Bandar Lampung merupakan salah satu daerah proyek penerapan QA. Dan Laporan Puskesmas uji coba tingkat kepatuhan petugas terhadap standar pemeriksaan masih rendah yaitu 56,0 %. Tujuan penelitian ini adalah memperoleh informasi tentang faktor-faktor yang berhubungan dengan tingkat kepatuhan petugas standar pemeriksaan ISPA di Puskesmas Kota Bandar Lampung tahun 2002. Penelitian ini menggunakan disain cross-sectional dengan pendekatan kualitatif dan kuantitatif dengan jumlah sampel total populasi sebanyak 102 petugas pemeriksa di Balai Pengobatan. Pengumpulan data untuk memperoleh gambaran faktor yang berhubungan dengan kepatuhan, petugas diminta mengisi kuesioner, sedangkan untuk memperoleh tingkat kepatuhan petugas dengan mengamati petugas selama memeriksa pasien ISPA dengan menggunakan daftar tilik. Hasil penelitian memperlihatkan dari 102 petugas pemeriksa pasien di BP yang diteliti maka hanya 30,4 % petugas yang patuh, pendidikan berlatar belakang medis 28,4 %, yang memiliki beban kerja ringan hanya 19,6 %, kepala Puskesmas yang mempunyai kepemimpinan kondusif hanya 59,8 %, pengetahuan tentang program ISPA 55,9 % pengetahuan baik, 62,7 % petugas mempunyai motivasi baik, 40,2 % pernah mengikuti pelatihan, 40,2 % petugas mengatakan pernah memperoleh pembinaan dan sarana minimal pemeriksaan dipuskesmas yang lengkap 27,5 %. Dari 8 variabel yang diuji stastististik dengan kai kuadrat diperoleh hubungan yang bermakna antara kepatuhan dengan kepemimpinan, pengetahuan petugas, motivasi, pelatihan, pembinaan dan sarana minimal dengan nilai P < 0,05. Sedangkan untuk analisis multivariat dengan regresi logistik ganda hanya tiga variabel yang secara signifikan berhubungan dengan kepatuhan yaitu kepemimpinan, pelatihan dan sarana minimal, dengan nilai P<0,05. Kepemimpinan merupakan variabel yang paling dominan dengan OR 19,8361 kali. Untuk uji interaksi antara ketiga variabel dipemleh hasil yaitu tidak ada hubungan interaksi antara ketiga variabel tersebut. Kesimpulan secara umum kepatuhan petugas terhadap standar pemeriksaan pasien ISPA di Puskesmas Seluruh Kota Bandar Lampung masih rendah, disarankan kepada Depkes untuk menyederhanakan daftar tilik agar dalam penerapan dilapangan lebih operasional. Kepada Dinas Kesehatan hendaknya dalam penempatan kepala puskesmas harus benar-benar kepala puskesmas mempunyai visi untuk kemajuan puskesmas dan dalam melakukan pembinaan kepada puskesmas secara rutin dan terstruktur dan untuk semua petugas harus membudayakan budaya mutu dalam setiap kegiatannya.

In order to improve the quality of health service the one that should be examined in quality assurance is the level of the health worker compliance. The level of health worker compliance to the examining standard of ARI patient is assessment to health worker?s performance. Lampung City is one of the rural projects in implementing the QA. Based on the report of Health Center model to the standard of examining is still low, that was 56,0%. The objective of this study is to obtain the information on the factors that related with the level compliance of the health worker, who giving the examining standard of ARI patient at the Health Center of Bandar Lampung in 2002. This study design used cross-sectional, with qualitative and quantitative approaches. The number of sample and population was 102 examiner workers at the Health Center. The data were collected to obtain the description of factor that related with the compliance, the worker asked to fill-out the questionnaire, while to obtain the level of worker compliance by observation to the worker during the examining of ARI patient, the observation used checklist. The result of this study shows that out of 102 patients who examining by the workers at the Health Center which studied, it was only 30,4% whose compliance. Their education background in medical was 28.4%. The ones who having light work loading are 19,6%. Head of the Health Center who's having conducive leadership only 59.8%, the knowledge on ARI program was good 55,9%. The workers who having good motivation was 62,7%, 40,2% ever followed the training, 40,2% workers said that they ever obtained the development and minimal utility of full examining at the Health Center was 27,5%. Four variables, that are education, staffs knowledge, the facility of examining, leadership, work load, supervision, training, and motivation statistically significant associated with compliance, and minimum equipment with p<0,05. While for multivariate analysis by double logistic regression, only three variables that significantly having relationship to compliance, i.e. leadership, training and minimal utility, with p<0,05. The leadership was variable those the most dominant with OR 19,8361 times. For interaction test among the three variables, it obtained the result; i.e. there was not any relation among those three variables. The conclusion in general, the health worker compliance to the examining standard of ARI patient at the Health Center throughout Bandar Lampung City was still low, It is suggested to the MOH to make simple the examining list in order the implementation at the field more professional. To Local Health Office, when he placed the head of Health Center should be the real of head of Health Center who's having vision to the development of the Health Center and in doing the development to Health Center routinely and structurally. For entire of the health workers should be socialized the quality in each activity.

Dalam kurun waktu lima tahun terakhir ISPA terutama pneumonia masih merupakan penyumbang terbesar dalam kejadian kematian bayi di Indonesia pada umumnya dan di Kabupaten Sumedang khususnya. Hasil penelitian Depkes tahun 1997 menunjukkan penatalaksanaan kasus ISPA yang tepat dapat mencegah secara efektif sekitar 60-80 % kematian akibat pneumonia. Keadaan ini menjadi titik tolak Depkes untuk mengintensifkan program penanggulangan penyakit ISPA dengan salah satu program prioritasnya adalah meningkatkan kemampuan petugas dalam manajemen penatalaksanaan penyakit ISPA pada bayi yang dititikberatkan pada kepatuhan dalam pelaksanaan SOP ISPA. Tujuan penelitian ini adalah mengkaji pengaruh pelatihan terhadap tingkat kepatuhan petugas dalam pelaksanaan SOP ISPA dan dampaknya kepada kepuasan ibu bayi setelah memperoleh pelayanan oleh bidan di puskesmas.Pendekatan penelitian adalah quasi experimental dan panel survey non equivalent group design. Ada dua sampel penelitian. Kelompok pertama yaitu 10 orang bidan puskesmas di wilayah bekas Pembantu Bupati Darmaraja dan Tanjungsari Kabupaten Sumedang yang diukur kepatuhan dalam pelaksanaan SOP ISPA sebelum dan sesudah pelatihan. Kelompok kedua adalah 110 ibu bayi yang membawa bayinya berobat ke puskesmas di lokasi yang sama dengan keluhan batuk/sesak. Tingkat kepuasannya diukur setelah memperoleh pelayanan. Kelompok kontrol dengan jumlah bidan dan ibu bayi yang sama di 10 puskesmas pada wilayah bekas Pembantu Bupati Kota dan Congeang di Kabupaten Sumedang. Tingkat kepatuhan bidan dalam pelaksanaan SOP ISPA dianalisa secara univariat untuk menilai distribusi frekuensi dan besarnya proporsi diantara sampel. Sedangkan Mc Nemar test dipergunakan untuk menilai pengaruh pelatihan terhadap tingkat kepatuhan.Hasil analisa statistik menunjukkan rata-rata skor kepatuhan Bidan dalam pelaksanaan SOP ISPA dan skor kepuasan ibu bayi sebelum pelatihan pada kedua kelompok dalam keadaan setara. Dengan uji Mc Nemar menunjukkan bahwa kepatuhan sesudah pelatihan meningkat pada kelompok intervensi (p = 0,0001 dan OR = 5,8). Terdapat perbedaan proporsi tingkat kepuasan ibu bayi sebelum dan sesudah Bidan mendapat pelatihan (p = 0,028) dan ada hubungan yang bermakna antara tingkat kepatuhan Bidan dengan kepuasan ibu bayi (p = 0,018). Kesimpulan yang didapat, Bidan pada kelompok intervensi yang mendapat pelatihan manajemen penatalaksanaan ISPA mempunyai peningkatan skor kepatuhan lebih tinggi dibandingkan dengan kelompok yang tidak mendapat pelatihan. Ibu bayi yang dilayani oleh Bidan pada kelompok intervensi mempunyai skor kepuasan lebih tinggi dibandingkan ibu bayi yang dilayani Bidan yang tidak mendapat pelatihan manajemen penatalaksanaan ISPA.

The Influence or Acute Respiratory Infection Management Training for Midwives of Community Health Centers and Its Impact on Baby Mothers' Satisfaction in Sumedang District, 2001/2002In the last five years acute respiratory infection (ARI) disease especially pneumonia has been the main contributor for the death of babies in Indonesia in general and in Sumedang District in particular. Data of Indonesian Ministry of Health research in 1997 showed that the appropriate management to handle ARI cases could effectively reduce the death of babies from pneumonia by 60 to 80 %. This data has been assigned as a basis to intensify the program of preventing AFT. One of the priorities of the program is to improve the capability of health providers in managing ARI prevention for babies emphasized on the health providers' compliance with conducting SOP of ARI.This research is aimed to investigate the influence of training on the degree of health providers' compliance with conducting SOP of ARI and its impact on baby mothers' satisfaction on the quality of services from the community health centers' midwives.This research employs quasi experimental and panel survey non equivalent group design. There were two groups of samples. The first group was 10 community health centers' midwives in the former region of Darmaraja and Tanjungsari Regent Assistant in Sumedang District who were measured their degree of compliance with managing ARI before and after they had been trained. The second group was 110 baby mothers who visited community health centers in the same place with coughs and short-winded complaints. Their satisfactions of the service quality were measured. The control group samples were the same number of midwives and baby mothers in 10 community health centers in the former regions of Sumedang City dan Congeang Regent Assistant in Sumedang District. The midwives' compliance with ARI management was subjected to univariate analysis to determine frequency distribution and proportion compliance among them. Further, Mc Nemar test was applied to determine whether or not the training influenced the degree of compliance.Statistical analysis showed that, before the training, the average score of both midwives' compliance with conducting SOP of ARI and the baby mothers' satisfaction was equal. By Mc Nemar test, the data revealed that the degree of compliance had improved after they had been trained in the experimental group (p = 0.0001 and OR = 5.8). Furthermore, there was a different proportion of the degree of baby mothers' satisfaction before and after the midwives had been trained (p = 0.028). The degree of midwives' compliance is significant associated with the baby mothers' satisfaction (p = 0.018). It is concluded that the midwives from the experimental group who had been trained on ARI management have higher score of compliance than those who had not been trained. Accordingly, the baby mothers who received health services from the trained midwives have higher score of satisfaction than those who were served by the untrained midwives on ARI management.