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Angaka kematian ibu di Indonesia saat ini masih tinggi, pada tahun 1997 sebesar 373 per 100.000 kelahiran hidup, padahal pemerintah dalam hal ini Depkes ingin menurunkan angka kematian ibu. Untuk menurunkan angka kematian ibu (AKI) pemerintah telah menempatkan petugas kesehatan (Bidan di desa) dan fasilitas pelayanan kesehatan sampai kedaerah terpencil untuk ikut menjaga kesehatan ibu dan bayi selama masa kehamilan, persalinana, dan masa sesudah persalinan.Tujuan penelitian ini ingin mengetahui gambaran tingkat kepatuhan. bidan di desa terhadap standar pelayanan antenatal care (ANC) di Kabupaten Karawang, serta faktor-faktor apa saja yang berhubungan dengan kepatuhan bidan di desa terhadap standar pelayanan antenatal.Rancangan penelitian adalah cross sectional (potong lintang), populasi penelitian ini bidan di desa yang ada di Kabupaten Karawang, sebanyak 277 orang dengan jumlah sampel sebanyak 162 orang. Data di analisis secara univariat. bivariat, dan multivariat dengan menggunakan regresi logistik ganda. Perangkat lunak yang dipakai ialah program komputer di laboratorium Program Studi llmu Kesehatan Masyarakat Universitas Indonesia (PS-IKM).Hasil penelitian yang didapat adalah dari 162 responden, yang patuh terhadap standar pelayanan antenatal care (ANC) sebanyak 115 responden (71,0%), dan yang tidak patuh sebanyak 47 responden (29,0%). Faktor yang memiliki hubungan dengan kepatuhan bidan di desa terhadap standar pelayanan antenatal care (ANC) adalah.umur, pengalaman kerja, pengetahuan, sedangkan perkawinan, pelatihan, supervisi dan sarana tidak memiliki hubungan bermakna. Sedangkan hasil multivariat faktor yang paling dominan berhubungan dengan kepatuhan bidan di desa pada standar pelayanan antenatal adalah status perkawinan.Mempertimbangkan hasil penelitian ini, maka disarankan kepada semua pihak yang terkait (Dinas Kesehatan, Puskesmas) perlu pembinaan khusus terhadap bidan di desa terutama bidan di desa yang memiliki tingkat pengetahuan yang kurang, sedangkan untuk bidan perlu meningkatkan pengetahuannya melalui pelatihan dan banyak membaca.
The Factors that Related to Village Midwife Compliance on Antenatal Service Standard at Karawang District, 2002The Maternal Mortality Rate (MMR) in Indonesia is still high, it was 373 per 1000 live births, 1997, even the government, and MOH would like to reduce it. To reduce the MMR, the government has been placed Village Midwife and facility of health service up to Remote Areas to participate maintain the maternal health and infant during pregnancy, delivery, and post-natal.The objective this study is to determine the description of Village Midwife compliance rate to ANC standard at Karawang District, and also on what factors that influence to Village Midwife compliance to ANC standard. The study design used cross-sectional, the population of this study is Village-Midwife that available at Karawang District, and the number is 277 people, with the sample as 162 people.The data was analyzed by univariate, bivariate, and multivariate used logistic regression. The software is computer program at the Laboratory of the Faculty of Public Health, University of Indonesia (PS-IKM-UT).The result of this study obtained that out of 162 respondents who's having compliance to ANC standard as 115 respondents (71.0%), and was not compliance 47 respondents (29.0%). Result of bivariate prove have significant relationship to Village Midwife compliance to ANC standard are age, work experience, knowledge, while marital, training, supervision and facility is not having significant relationship. The specially vector to related wich compliance to ANC standard as married status.Considering to the result of this study, it is recommended to all related parties (Local Health Service, Health Center) need special guidance to Village Midwife, especially Village Midwife that having lower compliance, while for Midwife should increase her knowledge through training and a lot of reading.
Masih tingginya Angka Kematian Ibu (AKI) di Indonesia menunjukkan bahwa mutu pelayanan kesehatan khususnya layanan Antenatal (ANC) masih rendah. Secara umum kematian ibu dapat dicegah apabila adanya komplikasi kehamilan dan risiko tinggi terdeteksi secara dini dengan pelayanan ANC yang baik. Selain itu, pemanfaatan layanan ANC juga berdampak pada penurunan kejadian BBLR dan merupakan satu mata rantai yang tidak kalah pentingnya dalam upaya penurunan AKI. Kebijakan Depkes dalam upaya mempercepat penurunan AKI mengacu pada intervensi strategis "Empat Pilar Safe Motherhood' salah satunya adalah meningkatkan akses dan mutu layanan ANC dan strategi MPS (Making Pregnancy Safer) dimana bagi bidan di desa terfokus dengan melaksanakan Pelayanan Kebidanan Essensial dan Pertolongan Panama Gawat-darurat Obstetri dan Neonatal (PPGON) yang salah satu kegiatannya adalah deteksi dini kasus risiko tinggi melalui pelayanan ANC. Oleh karena itu, keberadaan bidan di desa sangat strategis dan mendukung kebijakan program pengembangan "Desa Siaga Tahun 2008". Tingkat kepatuhan (Compliance Rate) bidan terhadap standar layanan ANC di Kabupaten Muam Jambi sebagai gambaran mutu pelayanan kesehatan masih di bawah standar minimal Quality Assurance (80%) yaitu pada tahun 2005 sebesar 64,9% dan tahun 2006 sebesar 66,54%. Kondisi ini diduga turut berkontribusi terhadap cakupan KI dan K4 yang masih di bawah target Standar Pelayanan Minimal (SPM). Secara umum penelitian ini bertujuan untuk mendapatkan gambaran kepatuhan bidan di desa terhadap standar layanan ANC dan faktor-faktor yang berhubungan dengan kepatuhan bidan di desa terhadap standar layanan ANC yaitu faktor individu meliputi variabel umur, pendidikan, pengetahuan, masa kerja, lokasi kerja, lokasi tempat tinggal, status perkawinan, dan status kepegawaian; variabel kepuasan kerja; dan faktor organisasi meliputi variabel komitmen organisasi, kelengkapan saran, supervisi, dan pelatihan. Desain penelitian yang dipilih adalah analitik kuantitatif rancangan cross sectional dengan responden yaitu bidan di desa sebanyak 141 orang pada 18 Puskesmas dalam wilayah Kabupaten Muaro Jambi (total sampel). Pengumpulan data dilakukan dengan cara pengamatan (observasi) dan wawancara menggunakan daftar tilik, serta menggunakan kuesioner yang dijawab atau diisi sendiri oleh responden (self administered questionaire). Hasil penelitian memperlihatkan bahwa sebagian besar bidan di desa kurang patuh terhadap standar layanan ANC (62,4%). Rata-rata tingkat kepatuhan bidan di desa terhadap standar layanan ANC sebesar 74,62% yang bervariasi antara 41,16% - 99,30%. Hasil analisis penelitian membuktikan bahwa variabel pendidikan, pengetahuan, lokasi tempat tinggal, status kepegawaian, kepuasan kerja, komitmen organisasi, kelengkapan saran, dan supervisi merniliki hubungan signifikan dengan kepatuhan bidan di desa terhadap standar layanan ANC. Variabel supervisi merupakan faktor yang paling dominan berhubungan dengan kepatuhan bidan di desa terhadap standar layanan ANC di Kabupaten Muaro Jambi. Atas dasar basil analisis tersebut, dapat disarankan khususnya kepada Dinas Kesehatan Kabupaten Muaro Jambi dan Puskesmas untuk dapat melakukan upaya-upaya pengawasan dan pembanaan terhadap bidan di desa melalui kegiatan supervisi atau penyeliaan (pada program QA) yang efektif khususnya untuk meningkatkan kepatuhan bidan di desa terhadap standar layanan ANC. Supervisi dilakukan secara kontinyu dan komperhensif mulai dari pengumpulan data untuk mengukur tingkat kepatuhan petugas terhadap standar ANC, menemukan penyimpangan atau masalah terhadap standar yang telah ditetapkan, melakukan pembahasan tentang segala kegiatan dan permasalahan yang ditemukan, mencari penyebab masalah, dan merumuskan upaya perbaikan secara sederhana, dan melakukan upaya-upaya perbaikan serta memberikan umpan balik sehingga peningkatan mutu layanan ANC dapat ditingkatkan secara terus menerus.
The high quantity of Maternal Mortality Rate (MMR) in Indonesia shows that health service quality especially Antenatal Care (ANC) still low. Generally, maternal mortality could prohibit if pregnancy complication exist and high risk early detected with good ANC. Besides, ANC service utilization also influence BBLR issues reduction and one of the link that not less important in decreasing MMR. Department of Health policies in hastening MMR reduction is referring to strategic intervention of "Four Pillar Safe Motherhood", which one of it is improving access and quality of ANC services and MPS (Making Pregnancy Safer) strategy. Where midwife in village focused with implementing Essential Midwifery Assistance and First Aid Obstetric Emergency and Neonatal that one of the activity is early detection of high-risk cases through ANC services. Therefore, midwife in village existences are strategic and assist developing program policy of "Desa Siaga Tahun 2008". Midwife compliance rate toward ANC service standard at Muaro Jambi Regency as health service quality representation is still below minimal standard of Quality Assurance (80%) that is in the year of 2005 equal to 64,9% and 2006 equal to 66,54%. This condition estimated also giving contribution toward K1 and K4 exposure that still below target of Minimal Service Standard (SPM). Generally, this research intend to get midwife in village compliance representation toward ANC service standard and factors that related with midwife in village compliance toward ANC service standard that are individual factors covering variable of age, education, knowledge, work period, work location, residence location, marriage status, and employee status; work satisfactory variable; and organization factor that covering organization commitment variable, medium equipments, supervision, and training. Research design that selected is cross sectional quantitative analytical design with respondent that is midwife in village equal to 141 people in 18 Public Health Center at Muaro Jambi Regency area (total sample). Data gathering done by observation and interview using visit list, and using questioner that answered or self-filled by respondent (self-administrated questionnaire). Research result shows that most of midwife in village are less compliance toward ANC service standard (62,4%). Average rate of midwife in village compliance toward ANC service standard equal to 74,62% that varying from 41,16% - 99,30%. Research analysis result shows that variables of education, knowledge, residence location, employee status, work satisfactory, organization commitment, medium equipments, and supervision have significant relation with midwife in village compliance toward ANC service standard. Supervision variable is the most dominant factor that related with midwife in village compliance toward ANC service standard at Muaro Jambi Regency. Based on those analysis results, suggested especially to Muaro Jambi Regency Health Agency and Public Health Center to perform observation efforts and midwife in village comprehension through supervision activity or management (in QA program) that effective especially to improve midwife in village compliance toward ANC service standard. Supervision done continually and comprehensively started from data gathering to measure official compliance level toward ANC standard, finding deviation or problems toward settled standard, doing clarification about every activity and problems found, finding problems cause, abbreviating simple restoration effort, and doing restoration efforts along with giving feedback so that development of ANC service quality could be increased continually.
A good quality ANC can reduce maternal mortality.The background of this research is the unknown midwives compliance in Bruno health centers and the unavailability of the baseline data. This study aims to determine the factors that affect midmives compliance in Bruno health centers, Purworejo in 2013. This study used a cross sectional design and quantitative methods.Based on bivariate analysis, there is a significant association between longer working with midwives compliance, very strong association in variable attitudes, strong association in variable facilities and supervision While variable knowledge and training was moderate associaton.