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Kata kunci: Kualitas Penyedia Layanan Keluarga Berencana, Putus Pakai Kontrasepsi Modern
The continued use of contraception is one indicator of the success of the family planning program. The rate of discontinuation using modern contraceptives in Indonesia is still quite high at 25%. This figure is still above the national target of 24.6%. Contraceptive discontinuation in the group of women who still need it will be classified as unmet need and potential for unwanted pregnancy. The occurrence of contraceptive discontinuation can be influenced by suboptimal services provided by family planning service providers. This research is a descriptive analytic study using cross sectional research design. This study analyzes data of the 2018 Population and Family Development Population Program Performance and Accountability Survey to determine the relationship between the quality of family planning service providers with modern contraceptive discontinuation using the chi-square test and logistic regression. This study found that there was a significant relationship between the quality of family planning service providers with modern contraceptive discontinuation after being adjusted by parity and the interaction between the quality of family planning service providers with parity. Women who received poor quality of family planning services had a 2.2 higher risk of discontinuing use of modern contraceptives compared to women who received good quality of service. Therefore, it is necessary to improve the quality of services evenly in all family planning service facilities to be able to increase the continuity of contraceptive use and increase the coverage of new contraceptive users.
Keywords: Modern contraceptive discontinuation, Quality of family planning service providers
In the reproductive cycle, the increasing age, number of children and health conditions lead to the need for more rational types of new contraceptives. Switching contraception to irrational methods may cause unintended pregnancies. High knowledge and perceptions of the effectiveness and efficiency of contraceptive use are related to the rational switching method pattern. Therefore, this study aims to evaluate the pattern of switching contraceptive methods, and to prove the difference association of knowledge and perception of contraceptive use with the pattern of rational switching contraceptive methods among women of Family Planning FP acceptors in East Java and West Nusa Tenggara.This study used a quantitative approach with Cross Sectional study design. Research subjects were women of reproductive age with 4616 women in East Java and 4819 women in West Nusa Tenggara. Changes in types of contraceptives were reviewed from the different types of contraceptives with the previous one during the timeframe of the FP program. Assessment of rationality was reviewed from the compatibility of the last method of contraception with age, number of children and family planning motivation. Knowledge was measured related to Long Term Contraceptive Method LTCM . While, perception rsquo s measurement was related to the effectiveness side effects and mode of use and efficiency cost and ease of obtaining of contraceptives. Data were analyzed using Multilevel Multiple Logistic Regression analysis to prove the research hypothesis.The switching pattern of contraceptive methods was dominated by changing from non LTCM to other non LTCM. Only a small proportion of high risk women switched to use rational contraception both in West Nusa Tenggara and East Java. Perceptions of side effect was associated with rational patterns of switching method in women in East Java, and perceptions of the use of contraceptives had relationship with patterns of rational contraceptive methods for women in West Nusa Tenggara. Perceptions of the cost of contraceptives was foundto be related withrational switching pattern of contraceptive methods among women in East Java and West Nusa Tenggara.In conclusion, there was a difference relationship of perceptionon contraception use and switching contraceptive method between East Java and West Nusa Tenggara. Therefore, it is recommended that Communication, Information and Education CIE strategies for women in East Java should focus on solving perceptual problems related to side effect while in West Nusa Tenggara women more focus on solving perception problems about how to use contraceptives. To solve the problems related to perception of contraceptive cost among women in East Java and West Nusa Tenggara, it is necessary to support the continuity of contraceptive application program for the poor and other categories through the Social Insurance Administration Organization Badan Penyelenggara Jaminan Sosial BPJS program.
ABSTRAK
Latar Belakang: Tingginya angka kematian ibu dan neonatus di Indonesia dipengaruhi oleh berbagai faktor, termasuk kualitas pelayanan kesehatan ibu dan anak (KIA) yang belum mencapai target. Kinerja bidan desa, sebagai ujung tombak pelayanan, dipandang sebagai salah satu faktor krusial yang dapat ditingkatkan melalui supervisi dari bidan koordinator puskesmas. Meskipun demikian, data menunjukkan pelaksanaan supervisi fasilitatif KIA di provinsi Jambi pada tahun 2022 dan 2023 baru mencapai 10.86% dan 17.38% dari target 90%. Khususnya di kabupaten Muaro Jambi, capaiannya lebih rendah lagi, yaitu 11.64% (2022) dan 15.07% (2023). Kesenjangan ini menunjukkan perlunya intervensi strategis untuk meningkatkan kualitas supervisi demi mengoptimalkan kinerja bidan dalam pelayanan KIA.
Tujuan: Mengetahui pengaruh model integrasi midwifery opinion leader dan supervisi fasilitatif terhadap kinerja bidan dan dampaknya pada cakupan pelayanan kesehatan ibu dan anak di Provinsi Jambi tahun 2025.
Metode Penelitian: Penelitian ini merupakan penelitian mixed methods exploratory sequential design terdiri dari 3 tahap yaitu tahap I diawali scoping review, studi pendahuluan dan uji coba instrumen dilanjutkan identifikasi kebutuhan model menggunakan metode kualitatif dengan desain phenomenology. Tahap II meliputi pengembangan model, panel expert, pelatihan dan uji coba model. Tahap III dilakukan uji model terhadap kinerja bidan dengan indikator standar kompetensi kinerja (SKK) dan cakupan pelayanan KIA dengan penelitian quasi experiment pretest-posttest with control designs. Populasi adalah seluruh bidan desa/pustu di provinsi Jambi. Sampel yaitu kelompok intervensi sebanyak 60 responden (di kabupaten Muaro Jambi) dilakukan intervensi model integrasi MOL dan supervisi fasilitatif, sedangkan kelompok kontrol 60 responden (di kota Jambi) dilakukan hanya supervisi fasilitatif. Waktu penelitian pada bulan Mei 2024 hingga Agustus 2025, analisis data dengan univariat, bivariat dan multivariat (Difference in Difference).
Hasil: Berdasarkan identifikasi kebutuhan ditemukan subtema: kinerja bidan, kebutuhan supervisi dan model supervisi. Selanjutnya dilakukan pengembangan model supervisi dengan pendekatan teori COM-B, supportif supervision, midwifery leadership dan coaching sehingga diperoleh model midwifery opinion leader (MOL) yang dapat diintegrasikan dengan program supervisi fasilitatif KIA puskesmas. Hasil uji penerimaan model diperoleh hasil skor tertinggi yaitu sikap terhadap penggunaan rata-rata 4.9 dan terendah yaitu persepsi manfaat dengan skor 4.71. Hasil analisis diff in diff diketahui pada 2 kelompok sebelum dan sesudah intervensi terhadap skor standar kompetensi kerja: penataan pelayanan 1.36(0.24-1.60), asuhan bayi baru lahir 2.36(0.75-3.12) pemeriksaan kehamilan 1.33(0.48-1.82), pemeriksaan ibu bersalin 1.93(1.72-3.65) dan asuhan ibu nifas 1.43(0.30-1.74).Uji dampak model terhadap cakupan KIA yaitu: kunjungan ibu hamil ke-4 (K4)18.25(3.83-22.08), persalinan nakes (PN) 15.53(3.47-19.00), kunjungan nifas (KNF) 15.59(3.41-19.00), kunjungan neonatal lengkap (KNL) 14.35(9.97-24.33), kunjungan bayi (KBY) 19.08 (7.26-26.35) dan kunjungan balita (KBAL) 5.81 (16.14-21.95).
Kesimpulan dan Saran: Model integrasi Midwifery Opinion Leader (MOL) dan supervisi fasilitatif berpengaruh dalam meningkatkan kinerja bidan dalam pelayanan KIA. Disarankan mempertimbangkan model ini dalam kegiatan program supervisi kesehatan ibu dan anak di Puskesmas.
ABSTRACT
Background: The high maternal and neonatal mortality rates in Indonesia are influenced by various factors, including the quality of maternal and child health (MCH) services, which have not yet reached their targets. The performance of village midwives, as the frontline of service delivery, is seen as a crucial factor that can be improved through supervision by health center coordinator midwives. However, data shows that the implementation of facilitative MCH supervision in Jambi province in 2022 and 2023 has only reached 10.86% and 17.38% of the 90% target. In Muaro Jambi district, in particular, the achievement was even lower, at 11.64% (2022) and 15.07% (2023). This gap indicates the need for strategic interventions to improve the quality of supervision in order to optimize the performance of midwives in MCH services.
Objective: To determine the effect of the midwifery opinion leader integration model and facilitative supervision on midwives' performance and its impact on the coverage of maternal and child health services in Jambi Province in 2025.
Research Method: This research is a mixed methods exploratory sequential design consisting of 3 stages, namely stage I, which begins with a scoping review, preliminary study, and instrument testing, followed by the identification of model requirements using a qualitative method with a phenomenology design. Stage II includes model development, expert panel, training, and model testing. Phase III involved testing the model on midwives' performance using standard competency performance (SKK) indicators and MCH service coverage using a quasi-experimental pretest-posttest with control designs. The population consisted of all village midwives/health workers in Jambi Province. The sample consisted of an intervention group of 60 respondents (in Muaro Jambi district) who underwent the MOL integration model intervention and facilitative supervision, while the control group of 60 respondents (in Jambi city) only underwent facilitative supervision. The research period was from May 2024 to August 2025, with data analysis using univariate, bivariate, and multivariate (Difference in Difference) methods.
Results: Based on the identification of needs, the following sub-themes were found: midwife performance, supervision needs, and supervision models. Subsequently, a supervision model was developed using the COM-B theory, supportive supervision, midwifery leadership, and coaching approaches, resulting in a midwifery opinion leader (MOL) model that can be integrated with the KIA puskesmas facilitative supervision program. The model acceptance test results showed the highest score for attitude toward use, with an average of 4.9, and the lowest score for perceived benefits, with a score of 4.71. The results of the diff in diff analysis showed that in the two groups before and after the intervention, the standard work competency scores were: service management 1.36 (0.24-1.60), newborn care 2.36 (0.75-3.12), pregnancy check-ups 1.33 (0.48-1.82), maternity check-ups 1.93 (1.72-3.65), and postpartum care 1.43 (0.30-1.74). The model's impact on MCH coverage was as follows: fourth antenatal visit (K4) 18.25 (3.83-22.08), skilled birth attendance (PN) 15.53 (3.47-19.00), postnatal visit (KNF) 15.59 (3.41-19. 00), complete neonatal visits (KNL) 14.35 (9.97-24.33), infant visits (KBY) 19.08 (7.26-26.35), and toddler visits (KBAL) 5.81 (16.14-21.95).
Conclusion and Recommendations: The integration model of Midwifery Opinion Leader (MOL) and facilitative supervision has an impact on improving midwives' performance in maternal and child health services. It is recommended to consider this model in maternal and child health supervision program activities at health centers.