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The high maternal mortality rate (346 per 100.000 live birth) in Indonesia is causedby several factors, one of it is that Indonesia has not been achieved the indicator ofaid deliveries in health facilities. This study aims to look at the influence and thecontribution of individual factors and province factor on deliveries in six provincesin Indonesia based on data from Demographic and Health Survey and healthprofiles of Indonesia in 2012. Based on the analysis of multilevel multinomiallogistic regression, the determinant of delivery aid is the individual factors includethe antenatal care, regions, health insurance, household wealth index, husband'soccupation, employment and education of women of childbearing age, parity andthe age of them. The determinant factor of the province covers the ratio of healthcenters, the ratio of beds and population density. Contextual variables (provincefactors) decrease 24.22% variation deliveries at six provinces in Indonesia.Keywords :Maternal mortality, Deliveries, individual factors, provinces factors, multilevellogistic regression multinomial.
Angka Kematian Ibu (AKI) di Indonesia masih cukup tinggi. Sebagian besar terjadi selama melahirkan dan periode postpartum langsung dengan penyebab utama akibat komplikasi obstetrik. Pertolongan persalinan oleh tenaga kesehatan telah dikaitkan dengan upaya menurunkan angka kematian ibu, pemanfaatan pelayanan ini masih relatif rendah. Penelitian ini bertujuan untuk mengidentifikasi determinan pemanfaatan pelayanan berdasarkan karateristik individu. Penelitian ini menggunakan pendekatan cross sectional, dengan data primer yang dikumpulkan melalui penyebaran angket kepada 203 responden. Hasilnya menunjukkan ada hubungan antara pendapatan keluarga, sikap terhadap pelayanan kesehatan dan persepsi kebutuhan kesehatan yang dirasakan dengan pemanfataan pertolongan persalinan oleh tenaga kesehatan. Sikap merupakan determinan paling dominan terhadap pertolongan persalinan oleh tenaga kesehatan (p=0,000 OR=19,292 CI 95%=8,337–44,644). Sedangkan umur, tingkat pendidikan, pekerjaan, kepemilikan jaminan kesehatan, persepsi jarak dan waktu tempuh ke fasilitas kesehatan tidak teridentifikasi berhubungan secara signifikan. Disarankan kepada pihak puskesmas untuk meningkatkan koordinasi dengan berbagai pihak terkait, mengintegrasikan program kesehatan ibu dengan program lain, melibatkan masyarakat dalam mengidentifikasi masalah kesehatan, dan menyebarkan informasi pentingnya pertolongan persalinan oleh tenaga kesehatan. Kata Kunci: Pertolongan persalinan oleh tenaga kesehatan, sikap, persepsi.
Maternal Mortality Rate (MMR) in Indonesia is still quite high. Mostly occurred during delivery and immediate postpartum period due to the major cause of obstetric complications. Delivery assistance by health professionals has been associated with reducing maternal mortality effort, this service utilization is still relatively low. The aim of this study is to identify the determinants of health service utilization based on individual characteristics. Cross sectional approach was used with primary data that is collected by spread out the questionaire to 203 respondents with . The results showed that there is a relationship between family income, attitudes toward health care and perceptions to the need of heath service with the utilization of delivery assistance by health professionals. Attitude is the most dominant determinant of delivery assistance by health professional (p = 0.000 OR = 19.292 95% CI = 8.337 to 44.644). As for age, education level, occupation, property insurance, the perception of distance and travel time to health facilities was not significantly associated. The recommendation for the Cijeruk Health centre is to enhance coordination with relevant stakeholders, integrating maternal health program with other programs, involving the community in identifying health problems, and disseminate important information delivery assistance by health professionals. v Universitas Indonesia Keywords: Delivery asisstance by health personnel, attitudes, perceptions.
Untuk mengatasi masalah kesehatan yang muncul sebagai dampak krisis ekonomi, pemerintah telah memberikan pelayanan kesehatan bagi Keluarga Miskin (Gakin) melalui program PKPS-BBM Bidkes diantaranya dengan memberikan biaya pertolongan persalinan oleh tenaga bidan sebesar Rp. 150.000. Pemanfaatan dana pertolongan persalinan masih rendah. Oleh sebab itu penulis ingin mengetahui berapa biaya satuan untuk pertolongan persalinan serta pemanfaatannya oleh Gakin. Penelitian ini merupakan penelitian kuantitatif dengan melakukan analisis ekonomi terhadap kebutuhan biaya pertolongan persalinan bagi Gakin serta melakukan Survey Cepat untuk mengetahui pemanfaatan pertolongan persalinan oleh keluarga miskin serta faktor - faktor yang berhubungan dengan pemanfaatan pertolongan persalinan. Penelitian kualitatif digunakan untuk memperoleh jawaban atau informasi mendalam yaitu: persepsi bidan desa dalam melaksanakan pertolongan persalinan, kecukupan biaya pertolongan persalinan dan mekanisme pencairan biaya pertolongan persalinan. Hasil penelitian menunjukkan bahwa biaya pertolongan persalinan yang sesuai dengan kebutuhan adalah sebesar Rp. 213.250. Adapun Gakin yang memanfaatkan pertolongan persalinan dengan bidan sebanyak 69, 9 %. Dan faktor bidan sebagai provider yang mempengaruhi pemanfaatan pertolongan persalinan adalah karena biaya pengganti untuk pertolongan persalinan gakin relatif kecil dan lamanya proses pencairan dana pertolongan persalinan. Dari faktor ibu bersalin Gakin, faktor yang mempengaruhi rendahnya pemanfaatan persalinan oleh bidan antara lain: ketidaktahuan Gakin bahwa persalinan dengan bidan tidak dipungut biaya dan khawatir bayar mahal kalau ditolong oleh bidan. Secara garis besar hasil dari penelitian ini adalah diperlukan upaya-upaya pemerintah dan masyarakat untuk meningkatkan akses pelayanan kesehatan bagi Gakin khususnya pelayanan pertolongan persalinan melalui penyesuaian kembali biaya pertolongan persalinan yang sesuai kebutuhan, memudahkan mekanisme pencairan dana pertolongan persalinan, sosialisasi tentang hak gakin memperoleh pelayanan kesehatan serta dengan peningkatan kinerja bidan di desa.
The government has given a health service for Poor Family (Gakin) by PIPS-BBM Bidkes program to overcome the health problem which emerges as an economic crisis impact, such as giving the expense of helping child birth by midwife is equal to 150.000 rupiahs. The used of helping child birth cost is still lower. Because of this, the writer wishes to know how much set cost of helping childbirth and also it?s used by Gakin. This research is a quantitative research by conducting an economic analysis of child birth cost requirement for Gakin and also conducting a Rapid Survey to know the used of helping child birth by poor family and also the factors that related to help child birth. A qualitative research is used to get an answer or deep information, such as countryside midwife perception in conducting child birth help, cost sufficiency of helping child birth and cost mechanism of helping child birth. The research result indicates that cost of helping child birth which is available with requirement is equal to 213.250 rupiahs. Gakin which has been used child birth help by a midwife is almost 69, %. From midwife factor as provider which affected the used of helping child birth because substitution cost for helping child birth of Gakin is low relatively and long duration of cost liquefaction process of helping childbirth. From child birth mother factor of Gakin, as a factor which affected the lower of using a child birth by midwife such as: ignorance of Gakin that child birth by midwife is not getting charge and they are worry to pay high cost if they are helped by a midwife. From marginal result of this research, it was suggested to government and society efforts to improve the health service access for Gakin, especially the service of helping child birth by adjustment return the cost of helping child birth which is available with requirement, facilitating the cost liquefaction mechanism of helping child birth, socialization concerning Gakin rights to get health service and also the improvement of midwife performing in countryside.