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Adri Akhyani; Pembimbing: Anhari Achadi; Penguji: Ascobat Gani, Herwin Meifendy, Ilmi Tri Indiarto
Abstrak:
Pelayanan Obstetri dan Neonatal Emergensi Dasar (PONED) merupakan salah satu pelayanan Puskesmas yang diharapkan dapat memberikan kontribusi untuk penurunan AKI dan AKB. Angka Kematian Ibu (AKI), Angka Kematian Bayi (AKB) dan Angka Kematian Balita (AKABA) di Indonesia tertinggi dibandingkan negara-negara ASEAN lainnya. Kabupaten Administrasi Kepulauan Seribu memiliki 2 Puskesmas Kecamatan yang memiliki rawat inap yang berfungsi PONED dan 4 Puskesmas Kelurahan yang mempunyai perawatan 24 jam. Namun demikian indikator pelayanan Program PONED masih belum mencapai target, salah satunya angka Kematian Bayi dan Rujukan Ibu Melahirkan yang masih sangat tinggi. Penelitian ini merupakan penelitian analitik kualitatif. Informan ditentukan dengan menggunakan purposive sampling. Informan penelitian antara lain masyarakat, Pemerintah Daerah, Tim PONED Puskesmas, Para Kepala Puskesmas PONED, penanggung jawab program PONED Sudinkes Pulau Seribu, dan Penanggung Jawab SDM Kesehatan Sudinkes Kepulauan Seribu. Data yang dikumpulkan berupa data primer dan data sekunder berupa hasil wawancara mendalam dan telaah dokumen. Hasil penelitian diperoleh data bahwa pada standar dan ukuran kebijakan telah dipahami oleh pelaksana kebijakan. Pemahaman ini didukung komunikasi yang jelas dan berkelanjutan antara Dinas Kesehatan, puskesmas dan stakeholder, kejelasan informasi dan konsistensi informasi. Ketersediaan anggaran, sarana dan prasarana sudah mencukupi tetapi terkendala masalah pemeliharaan alat karena faktor air asin yang menyebabkan peralatan mudah berkarat dan rusak. Struktur birokrasi sudah terdapat Keputusan Bupati mengenai tim PONED, namun belum ada struktur khusus PONED di Suku Dinas Kesehatan Kepulauan Seribu Disposisi ditunjukan dengan sikap positif berupa komitmen bersama Pemerintah Daerah dan Puskesmas dalam penanganan ibu hamil, penanganan kasus rujukan ibu melahirkan dengan penyulit. Peran serta masyarakat dalam pelaksanaan PONED sudah ditunjukan dengan pemanfaatan Puskesmas PONED dalam pemeriksaan kehamilan dan proses melahirkan, Output pelaksanaan program PONED sudah dilakukan pencatatan dan pelaporan capaian program kepada penanggung jawab di Sudinkes, belum ada format pelaporan khusus PONED dan belum dilakukan analisa pelaporan PONED serta feedbacak pelaporan belum dilaksanakan. Implementasi pelayanan PONED di Puskesmas Kepulauan Seribu Selatan dan Puskesmas Pulau Seribu Utara sudah berjalan tapi belum optimal dengan adanya hambatan dan kendala di komponen input, proses maupun output yang harus diatasi sehingga pelayana PONED di Kepulauan Seribu bisa berjalan dengan baik.
Basic Emergency Obstetric and Neonatal Care (PONED) is one of the Primary Health Care services that is expected to contribute to the reduction of MMR and IMR. Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR) and Toddler Mortality Rate in Indonesia are the highest compared to other ASEAN countries. The Seribu Islands Administrative Regency has 2 sub-district health centers that have PONED inpatient care and 4 sub-district health centers that have 24-hour care. However, the service indicators of the PONED program have not yet reached the target, one of which is the very high infant mortality rate and maternal referral. This study was a qualitative analytic study. Informants were determined using purposive sampling. The research informants included the community, local government, Primary Health Care PONED team, Heads of Primary Health Care PONED, the person in charge of the Thousand Island sub-district PONED program, and the person in charge of the Thousand Islands sub-district health human resources. The research results show that the policy standards and measures have been understood by implementers. This understanding is supported by clear and continuous communication between the Health Service, community health centers and stakeholders, clarity of information and consistency of information. The availability of budget, facilities and infrastructure is sufficient but is hampered by equipment maintenance problems due to the salt water factor which causes the equipment to rust easily and cause damage. The bureaucratic structure already has a Regent's Decree regarding the poned team, but there is no special PONED structure in the Seribu Islands Health Sub-Department. The disposition is shown by a positive attitude in the form of a joint commitment between the Regional Government and the Community Health Center in handling pregnant women, handling referral cases of mothers giving birth with complications. Community participation in the implementation of PONED has been demonstrated by the use of PONED Community Health Centers in pregnancy checks and the birthing process. The output of the implementation of the PONED program has been recorded and reported on program achievements to the person in charge at the Health Sub-Department. reporting has not been implemented. The implementation of PONED services at the South Seribu Islands Community Health Center and North Thousand Islands Health Center is already underway but is not yet optimal due to the existence of barriers and obstacles in the input, process and output components that must be overcome so that PONED services in the Thousand Islands can run well.
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Pelayanan Obstetri dan Neonatal Emergensi Dasar (PONED) merupakan salah satu pelayanan Puskesmas yang diharapkan dapat memberikan kontribusi untuk penurunan AKI dan AKB. Angka Kematian Ibu (AKI), Angka Kematian Bayi (AKB) dan Angka Kematian Balita (AKABA) di Indonesia tertinggi dibandingkan negara-negara ASEAN lainnya. Kabupaten Administrasi Kepulauan Seribu memiliki 2 Puskesmas Kecamatan yang memiliki rawat inap yang berfungsi PONED dan 4 Puskesmas Kelurahan yang mempunyai perawatan 24 jam. Namun demikian indikator pelayanan Program PONED masih belum mencapai target, salah satunya angka Kematian Bayi dan Rujukan Ibu Melahirkan yang masih sangat tinggi. Penelitian ini merupakan penelitian analitik kualitatif. Informan ditentukan dengan menggunakan purposive sampling. Informan penelitian antara lain masyarakat, Pemerintah Daerah, Tim PONED Puskesmas, Para Kepala Puskesmas PONED, penanggung jawab program PONED Sudinkes Pulau Seribu, dan Penanggung Jawab SDM Kesehatan Sudinkes Kepulauan Seribu. Data yang dikumpulkan berupa data primer dan data sekunder berupa hasil wawancara mendalam dan telaah dokumen. Hasil penelitian diperoleh data bahwa pada standar dan ukuran kebijakan telah dipahami oleh pelaksana kebijakan. Pemahaman ini didukung komunikasi yang jelas dan berkelanjutan antara Dinas Kesehatan, puskesmas dan stakeholder, kejelasan informasi dan konsistensi informasi. Ketersediaan anggaran, sarana dan prasarana sudah mencukupi tetapi terkendala masalah pemeliharaan alat karena faktor air asin yang menyebabkan peralatan mudah berkarat dan rusak. Struktur birokrasi sudah terdapat Keputusan Bupati mengenai tim PONED, namun belum ada struktur khusus PONED di Suku Dinas Kesehatan Kepulauan Seribu Disposisi ditunjukan dengan sikap positif berupa komitmen bersama Pemerintah Daerah dan Puskesmas dalam penanganan ibu hamil, penanganan kasus rujukan ibu melahirkan dengan penyulit. Peran serta masyarakat dalam pelaksanaan PONED sudah ditunjukan dengan pemanfaatan Puskesmas PONED dalam pemeriksaan kehamilan dan proses melahirkan, Output pelaksanaan program PONED sudah dilakukan pencatatan dan pelaporan capaian program kepada penanggung jawab di Sudinkes, belum ada format pelaporan khusus PONED dan belum dilakukan analisa pelaporan PONED serta feedbacak pelaporan belum dilaksanakan. Implementasi pelayanan PONED di Puskesmas Kepulauan Seribu Selatan dan Puskesmas Pulau Seribu Utara sudah berjalan tapi belum optimal dengan adanya hambatan dan kendala di komponen input, proses maupun output yang harus diatasi sehingga pelayana PONED di Kepulauan Seribu bisa berjalan dengan baik.
Basic Emergency Obstetric and Neonatal Care (PONED) is one of the Primary Health Care services that is expected to contribute to the reduction of MMR and IMR. Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR) and Toddler Mortality Rate in Indonesia are the highest compared to other ASEAN countries. The Seribu Islands Administrative Regency has 2 sub-district health centers that have PONED inpatient care and 4 sub-district health centers that have 24-hour care. However, the service indicators of the PONED program have not yet reached the target, one of which is the very high infant mortality rate and maternal referral. This study was a qualitative analytic study. Informants were determined using purposive sampling. The research informants included the community, local government, Primary Health Care PONED team, Heads of Primary Health Care PONED, the person in charge of the Thousand Island sub-district PONED program, and the person in charge of the Thousand Islands sub-district health human resources. The research results show that the policy standards and measures have been understood by implementers. This understanding is supported by clear and continuous communication between the Health Service, community health centers and stakeholders, clarity of information and consistency of information. The availability of budget, facilities and infrastructure is sufficient but is hampered by equipment maintenance problems due to the salt water factor which causes the equipment to rust easily and cause damage. The bureaucratic structure already has a Regent's Decree regarding the poned team, but there is no special PONED structure in the Seribu Islands Health Sub-Department. The disposition is shown by a positive attitude in the form of a joint commitment between the Regional Government and the Community Health Center in handling pregnant women, handling referral cases of mothers giving birth with complications. Community participation in the implementation of PONED has been demonstrated by the use of PONED Community Health Centers in pregnancy checks and the birthing process. The output of the implementation of the PONED program has been recorded and reported on program achievements to the person in charge at the Health Sub-Department. reporting has not been implemented. The implementation of PONED services at the South Seribu Islands Community Health Center and North Thousand Islands Health Center is already underway but is not yet optimal due to the existence of barriers and obstacles in the input, process and output components that must be overcome so that PONED services in the Thousand Islands can run well.
T-6982
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Dyan Handayani; Pembimbing: Anhari Achadi; Penguji: Purnawan Junadi, Amal Chalik Sjaaf, Enny Ekasari, Elis Rohmawati
T-5125
Depok : FKM-UI, 2018
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Nurmala Meilasari; Pembimbing: Wiku Bakti Bawono Adisasmito; Penguji: Dumilah Ayuningtyas, Purnawan Junadi, Lysbeth Regina Pandjaitan, Sri Puji Wahyuni
Abstrak:
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Stunting merupakan permasalahan serius di seluruh dunia. Prevalensi stunting di Indonesia tahun 2023 sebesar 21,5% menurun 0,1% dari tahun 2022. Prevalensi stunting di DKI Jakarta sebesar 17,6% meningkat 2,8% dari tahun 2022 sedangkan Jakarta utara memiliki kenaikan prevalensi stunting terendah dari 4 Kota Administrasi di DKI Jakarta yaitu 1,3% dari tahun 2022 dengan prevalensi stunting sebesar 19,8%. Jakarta utara memiliki kebijakan berupa modul aksi cegah stunting yaitu Jakarta Utara menuju Zero Stunting. Berdasarkan data BPS tahun 2023, terdapat 13,33% perempuan usia 10 tahun ketas di Jakarta Utara yang tidak menyelesaikan pendidikannya dan terdapat 7,24% penduduk miskin di Jakarta Utara. Berdasarkan Perpres RI No. 72 Tahun 2021 tentang Percepatan Penurunan Stunting, target prevalensi stunting tahun 2024 sebesar 14%. Jakarta Utara masih memiliki gap sebesar 5,8% untuk mencapai target 14% prevalensi stunting di tahun 2024. Oleh karena itu dilakukan penelitian mengenai analisis implementasi kebijakan stunting di Jakarta Utara dari aspek ekonomi berupa program pemberian susu, telur untuk balita bermasalah gizi, makanan tambahan bagi ibu hamil Kurang Energi Kronik (KEK) dan aspek pendidikan melalui edukasi stunting kepada ibu hamil dan orang tua balita sebagai upaya pencegahan dan penanggulangan stunting. Model implemntasi kebijakan yang digunakan adalah model Van Meter Van Horn. Penelitian ini adalah penelitian kualitatif dengan pendekatan studi kasus. Pengambilan data melalui wawancara mendalam kepada 15 informan dari instansi pemerintah, orang tua balita dan ibu hamil serta FGD kepada kader posyandu di wilayah Cilincing dan Tanjung priok sebagai lokasi penelitian. Hasil penelitian dari aspek ekonomi pemberian susu dan telur bagi balita bermasalah gizi pada tahun 2023 berkontribusi terhadap pencegahan dan penanganan balita stunting di Jakarta Utara. Hal ini dapat dilihat dari 72,11% balita weight faltering mengalami kenaikan berat badan, 59,01% balita under weight sudah tidak under weight, 54,9% balita gizi kurang sudah tidak gizi kurang dan 45,34% gizi buruk sudah tidak menjadi gizi buruk serta 149 balita stunting sudah tidak menjadi stunting berdasarkan status gizi. Dari aspek pendidikan pemberian edukasi mengenai stunting kepada ibu hamil kurang optimal karena hanya 9,93% ibu hamil mendapatkan edukasi melalui kelas ibu yang dianggarkan oleh puskesmas di Jakarta Utara, namun semua orang tua balita bermasalah gizi sudah mendapatkan edukasi mengenai stunting. Diperlukan edukasi mengenai pencegahan dan penanganan stunting secara masif kepada ibu hamil dan orang tua balita serta perlu adanya regulasi mengenai pemberian pangan tinggi protein hewani bagi ibu hamil dan balita bermasalah gizi dan bagi balita dari keluarga dengan penghasilan di bawah UMP
Stunting is a serious problem throughout the world. The prevalence of stunting in Indonesia in 2023 is 21.5%, a decrease of 0.1% from 2022. The prevalence of stunting in DKI Jakarta is 17.6%, an increase of 2.8% from 2022, while North Jakarta has the lowest increase in stunting prevalence of the 4 Administrative Cities in DKI Jakarta, namely 1.3% from 2022 with a stunting prevalence of 19.8%. North Jakarta has a policy in the form of an action module to prevent stunting, namely North Jakarta towards Zero Stunting. Based on BPS data for 2023, there are 13.33% of women aged 10 years and above in North Jakarta who have not completed their education and there are 7.24% of poor people in North Jakarta. Based on RI Presidential Decree No. 72 of 2021 concerning the Acceleration of Reducing Stunting, the target for stunting prevalence in 2024 is 14%. North Jakarta still has a gap of 5.8% to achieve the target of 14% stunting prevalence in 2024. Therefore research was conducted regarding the analysis of the implementation of stunting policies in North Jakarta from an economic aspect in the form of programs providing milk, eggs for toddlers with nutritional problems, additional food. for pregnant women with Chronic Energy Deficiency (KEK) and educational aspects through stunting education for pregnant women and parents of toddlers as an effort to prevent and overcome stunting. The policy implementation model used is the Van Meter Van Horn model. This research is qualitative research with a case study approach. Data were collected through in-depth interviews with 15 informants from government agencies, parents of toddlers and pregnant women as well as FGDs with posyandu cadres in the Cilincing and Tanjung Priok areas as research locations. The results of research from the economic aspect of providing milk and eggs to toddlers with nutritional problems in 2023 will contribute to the prevention and handling of stunting toddlers in North Jakarta. This can be seen from 72.11% of underweight toddlers experiencing weight gain, 59.01% of underweight toddlers are no longer underweight, 54.9% of underweight toddlers are no longer underweight and 45.34% of underweight toddlers are no longer underweight. malnutrition and 149 stunted toddlers were no longer stunted based on nutritional status. From an educational aspect, providing education about stunting to pregnant women is less than optimal because only 9.93% of pregnant women receive education through maternal classes budgeted for by the community health center in North Jakarta, but all parents of toddlers with nutritional problems have received education about stunting. Massive education regarding the prevention and handling of stunting is needed for pregnant women and parents of toddlers and there is a need for regulations regarding providing food high in animal protein for pregnant women and toddlers with nutritional problems and for toddlers from families with incomes below the UMP
T-7135
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Willyana Syafriyanti/ Pembimbing: Anhari Achadi/ Penguji: Prastuti Soewondo, Pujiyanto, Titin Eka Sugiatini, Titi Suniarti
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Kabupaten Lampung Utara menjadi salah satu kabupaten penyumbang AKI tertinggi di Provinsi Lampung. Laporan profil kesehatan Lampung Utara menyebutkan bahwa terjadi trend kenaikan AKI pada 5 tahun terakhir yaitu dari tahun 2017-2021. Kementerian Kesehatan telah mengeluarkan Permenkes Nomor 21 Tahun 2021 sebagai upaya penguatan dalam pelayanan kesehatan ibu guna mencegah kematian ibu maupun bayi, termasuk didalamnya mengatur terkait pelayanan kesehatan masa hamil (antenatal). Disisi lain, Puskesmas sebagai layanan primer diharapkan mampu melaksanakan pelayanan antenatal tersebut sesuai standar sebagai penguatan upaya preventif. Dinas Kesehatan Lampung Utara telah mendistribusikan alat USG kepada Puskesmas di Kabupaten Lampung Utara, guna mendukung pelakanaan pelayanan antenatal di Puskesmas. Tujuan penelitian ini untuk mengetahui implementasi kebijakan pelayanan antenatal di Puskesmas Negara Ratu dan Puskesmas Cempaka. Penelitian ini merupakan penelitian kualitatif. Pengambilan data dilakukan melalui wawancara mendalam, observasi dan telaah dokumen. Hasil penelitian menunjukkan bahwa implementasi kebijakan pelayanan antenatal sudah berjalan, namun pelayanan antenatal terpadu dengan program kesehatan jiwa serta pencatatan dan pelaporan belum optimal dilaksanakan. Komunikasi sudah dilakukan dengan baik. SDM dan fasilitas masih kurang. Para pelaksana kebijakan bersikap mendukung namun belum terdapat mekanisme pemberian reward yang diberikan. Sudah terdapat SOP terkait pelayanan antenatal dan koordinasi antar Puskesmas dengan BPM sudah berjalan dengan baik. Mayoritas ibu hamil mendukung dan ikut berpartisipasi dalam melakukan pelayanan antenatal, namun masih ditemukan kendala dan tantangan dalam mendorong partisipasi ibu hamil dalam melakukan pelayanan antenatal. Kesimpulannya, implementasi kebijakan pelayanan antenatal sudah berjalan, namun belum optimal. Diperlukan upaya optimaliasi pada implementasi kebijakan pelayanan antenatal dan juga peningkatan pada sumber daya dan dukungan masyarakat guna mendukung proses impelementasi. Kata Kunci: Implementasi, Kebijakan, Antenatal, Puskesmas.
Lampung Utara Regency is one of the districts with the highest MMR contribution in Lampung Province. Lampung Utara health profile report states that there has been an increasing trend of MMR in the last 5 years, namely from 2017-2021. The Ministry of Health has issued Permenkes Number 21 of 2021 as an effort to strengthen maternal health services to prevent maternal and infant deaths, including regulating health services during pregnancy (antenatal). On the other hand, the Public Health Center as the primary service is expected to be able to carry out the antenatal service according to standards as a strengthening of preventive efforts. Lampung Utara Health Office has distributed ultrasound kits to Public Health Center in Lampung Utara Regency, to support the implementation of antenatal care at the Public Health Center. The purpose of this study was to determine the implementation of antenatal care policies at the Public Health Center of Negara Ratu and Public Health Center of Cempaka. This research was a qualitative research. Data collection was carried out through in-depth interviews, observation and document review. The results of the study showed that the implementation of antenatal care policies has been running, but integrated antenatal care with mental health programs and recording and reporting have not been optimally implemented. Communication has been done well. Human resources and facilities were still lacking. Policy implementers were supportive but there was no reward mechanism yet. There were already SOPs related to antenatal care and coordination was going well. The majority of pregnant women support and participate in conducting antenatal care, but there were still obstacles and challenges in encouraging the participation of pregnant women in conducting antenatal care. In conclusion, the implementation of antenatal care policies has been running, but not optimal. Efforts are needed to optimize the implementation of antenatal care policies and also increase the resources and community support for support the implementation process.
T-6605
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Yessi Febriana; Pembimbing: Puput Oktamianti; Penguji: Ede Surya Darmawan, Wachyu Sulistiadi, H. Zamhir Setiawan, Monika Yaniwati PM
Abstrak:
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Permenkes Nomor 21 Tahun 2021 bertujuan mengurangi angka kematian ibu dan bayi baru lahir dimana salah satu upaya yang dilakukan melalui menjamin kualitas pelayanan kontrasepsi termasuk tubektomi. Permenkes ini merupakan acuan dalam pelayanan kontrasepsi termasuk tubektomi. Untuk itu perlu dianalisis bagaimana pelaksanaan pelayanan tubektomi dari sisi supply side agar mempermudah PUS dalam mendapatkan layanan tubektomi. Penelitian ini bertujuan untuk menganalisis kesesuaian implementasi Permenkes Nomor 21 Tahun 2021 pada pelayanan tubektomi di Kota Administratif Jakarta Selatan dan Jakarta Timur agar dapat memberikan saran perbaikan kepada stakeholder terkait sehingga dapat meningkatkan cakupan peserta KB tubektomi. Penelitian ini merupakan penelitian kualitatif dengan menggunakan model implementasi kebijakan Van Meter Van Horn seperti tujuan kebijakan, sumber daya, komunikasi, karakteristik lembaga, disposisi, dan lingkungan ekonomi, sosial dan politik. Pengambilan data dilakukan melalui wawancara mendalam dan menggunakan telaah dokumen. Informan pada penelitian ini adalah Sudinkes, Sudin PPAPP, Rumah Sakit, Penyuluh KB, kader, peserta KB di Jakarta Selatan dan Jakarta Timur. Penelitian dilakukan pada bulan Desember 2022 sampai dengan Februari 2023. Hasil penelitian menunjukkan bahwa implementasi kebijakan telah dilakukan namun belum sepenuhnya sesuai dengan Permenkes No.21/2021 terutama untuk KIE dan konseling. Standar dan tujuan kebijakan sudah dipahami dan dilakukan oleh pelaksana. Komunikasi dilakukan secara berjenjang melalui what’s up grup masih belum optimal. Variabel disposisi pelaksana kebijakan sudah baik. Variabel sumber daya masih terkendala dengan pendanaan yang terbatas dan insentif rutin bagi kader yang belum tersedia. Karakteristik badan pelaksana sudah cukup baik dimana SDM hampir tercukupi dan sudah tersedia SOP atau pedoman. Lingkungan ekonomi dan sosial peserta KB kurang mendukung, serta masih membutuhkan dukungan politik dari pimpinan daerah terkait pembiayaan layanan tubektomi.
The aim of Minister of Health Regulation number 21 of 2021 is to reduce maternal and newborn mortality. One of the efforts is ensuring the quality of contraceptive services including tubectomy. This Policy is a reference in contraception services including tubectomy. So it is necessary to analyze how the implementation of tubectomy services is carried out from the supply side in order to make it easier for women to get tubectomy services. The purpose of this study to analyze the implementation of Minister of Health Regulation number 21 of 2021 on decision making using the tubectomy contraception method by family planning participants in of South Jakarta and East Jakarta. The study can provide suggestions for improvements to relevant stakeholders for increasing the coverage of tubectomy family planning participants. This study is a qualitative research which using the policy implementation model of Van Meter and Van Horn 1975 with variables of size and objectives, resources, implementing agencies, communication, dispositions, along the economic, social, and political environment. Data collection was carried out through in-depth interviews and using document review. Research informants were Sub-Department for Health, Sub-department for Empowerment, Child Protection and Population Control (PPAPP), Hospitals, Family Planning Counselors, cadres, Family Planning participants in South Jakarta and East Jakarta. The study was conducted from December 2022 to February 2023. The results showed that that policy implementation has been carried out but is not fully in accordance with Minister of Health Regulation number 21 of 2021, especially for IEC and counseling. Policy measures and objectives have been understood and carried out by implementers. Communication is carried out in stages through what's up groups is not optimal yet. The disposition variable of policy implementers is good. The resource variable is still constrained by limited funding and none of routine incentives for cadres. The characteristics of the implementing agency are good enough where human resources are nearly sufficient and SOPs or guidelines are already available. The economic and social environment for family planning participants is not supportive, and they still need political support from regional leaders regarding the financing of tubectomy services.
T-6693
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Riandi Verdi; Pembimbing: Anhari Achadi; Penguji: Mardiati Nadjib, Wachyu Sulistiadi, Doddy Izwardy, Indra Rachmad Dharmawan
Abstrak:
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Prevalensi karies gigi anak masih sangat tinggi di Kota Bekasi. Hal ini sangat memprihantinkan karena anak-anak merupakan salah satu modal utama dalam membangun masa depan bangsa. Salah satu cara dalam membantu mengatasi masalah tersebut adalah melalui program UKGS. Program UKGS di Kota Bekasi dilaksanakan oleh semua Puskesmas, termasuk Puskesmas Mustikajaya. Tujuan dari penelitian ini adalah untuk mengetahui hasil implementasi program UKGS pada masa adaptasi kebiasaan baru di Puskesmas Kecamatan Mustikajaya pada tahun 2023. Penelitian ini dilakukan dengan metode penelitian kualitatif melalui wawancara mendalam dengan pihak-pihak yang terlibat dalam program UKGS di Mustikajaya. Tidak ada perbedaan komponen hasil implementasi antara masa sebelum pandemi dengan setelah pandemi. Hasil penelitian menunjukkan bahwa sosialisasi dilakukan oleh Dinas Kesehatan Kota Bekasi kepada Puskesmas Mustikajaya dan dilanjutkan ke sekolah. Terdapat SOP pelaksanaan program UKGS yang bersumber dari Kementerian Kesehatan. Sumber daya manusia dirasakan masih kurang tercukupi, fasilitas dan pendanaan berasal dari BLUD dan BOK. Terdapat SK penunjukkan penanggung jawab program UKGS. Para responden menyatakan berkomitmen penuh pada program UKGS. Paket I dan II Program UKGS Puskesmas Mustikajaya memiliki nilai sebesar 99,8% dan Paket III memiliki nilai 26,9%. Hal ini menandakan program UKGS belum berjalan dengan maksimal dan perlu ada perbaikan dan peningkatan pelayanan UKGS lebih lanjut.
Dental caries children’s prevalence in Bekasi City is still very high. This is a concerning matter since children are one of the main assets to build the nation’s future. UKGS become one of the solutions to overcome the problem. The UKGS program in Bekasi city is implemented by all Community Health Centers (CHC), including Mustikajaya CHC. The aim of the research is to determine the results of the implementation of UKGS program during the adaptation of new habit period at the Mustikajaya CHC in 2023. There is no difference in the components of implementation results between the prepandemic and post-pandemic periods. Qualitative methods was conducted in the research by using depth interview method through the parties that involved in the UKGS program in Mustikaya PHC. The results showed that the socialization was carried by the Bekasi Public Health Office to Mustikajaya CHC and continued to schools. There is an SOP for the UKGS program that made by Ministry of Health. Human resources are still inadequate, facilites and funds come from BLUD and BOK. A decree was appointed to the people in charge of the program. The respondents were fully commited to the UKGS program. The value of UKGS Package I and II are 99,8% while the Package III is 26,9%. This indicates that the UKGS program is not running optimally and need a further improvement and enhancement of UKGS services.
T-6951
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Yohani Satya Putri Liman; Pembimbing: Purnawan Junadi; Penguji: Dumilah Ayuningtyas, Pujiyanto, Muhammad Rais Haru, Hidayat Nuh Ghazali Djadjuli
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Filariasis limfatik masih menjadi tantangan kesehatan masyarakat di Indonesia, khususnya di wilayah endemis seperti Kecamatan Membalong, Kabupaten Belitung, yang telah memperoleh sertifikat eliminasi namun, angka mikrofilaria rate di beberapa wilayahnya tetap berada di atas ambang batas nasional. Penelitian ini bertujuan untuk menganalisis implementasi Pemberian Obat Pencegahan Massal (POPM) filariasis tahun 2023 di Kecamatan Membalong dengan menggunakan pendekatan kualitatif dan desain studi kasus. Data dikumpulkan melalui wawancara mendalam, dan telaah dokumen terhadap pelaksana program di dua Puskesmas serta Dinas Kesehatan. Analisis menggunakan model Donabedian diperkuat dengan pendekatan Indeks Kualitas Kebijakan (IKK) dari LAN, dan model Van Meter dan Van Horn untuk mengevaluasi aspek structure, process, serta output dan outcome berupa dampak. Hasil penelitian pada aspek structure menunjukkan bahwa kebijakan POPM filariasis di Kecamatan Membalong tergolong efektif sebagai dasar pelaksanaan program dan telah memenuhi indikator kualitas kebijakan menurut pendekatan IKK. Strategi pelaksanaan dinilai adaptif, ditunjukkan melalui penyesuaian waktu, pelaksanaan, sweeping serta pelibatan lintas sektor. Namun, terdapat kendala keterbatasan jumlah sumber daya manusia dan pencatatan logistik yang masih manual sehingga menimbulkan potensi risiko. Sarana prasarana dinilai memadai, dan dana kegiatan juga mencukupi kebutuhan, meskipun terdapat perbedaan dalam sistem penganggaran antar Puskesmas. Pada aspek process, Komunikasi dan koordinasi antar pemangku kepentingan sudah berjalan, namun perlu ditingkatkan sebab penting dalam dimensi process IKK yang turut menentukan kualitas implementasi kebijakan pelaksanaan POPM. Pendataan sasaran telah dilakukan secara detail, namun akurasinya masih dipengaruhi oleh mobilitas penduduk. Sosialisasi telah dilaksanakan, namun belum sepenuhnya menjangkau seluruh lapisan masyarakat. Pemberian obat telah mengikuti petunjuk teknis, namun belum seluruh sasaran hadir dan mengonsumsi obat di pos pelayanan. Sweeping efektif meningkatkan cakupan, namun keterbatasan SDM dan waktu membuat pelaksanaannya belum optimal. Fleksibilitas sweeping menjadi indikator penting dalam proses IKK untuk menilai efektivitas kebijakan. Kejadian ikutan pasca POPM umumnya bersifat ringan dan telah tertangani, tetapi pelaporan dan pemantauan masih bersifat pasif. Monitoring dan evaluasi POPM sudah terstruktur, namun masih terkendala kepatuhan, pelaporan manual, dan kurangnya integrasi. Hal ini menunjukkan perlunya penguatan indikator IKK, terutama dalam aspek efektivitas, efisiensi, dan umpan balik pelaksanaan kebijakan. Dari aspek Output, Cakupan obat di Kecamatan Membalong tinggi, namun prevalensi mikrofilaria masih >1% di beberapa wilayah. Dalam IKK, keberhasilan dinilai dari konsumsi obat yang valid serta dampaknya, bukan hanya capaian angka. Jumlah obat yang digunakan telah sesuai dengan sasaran, tetapi ditemukan selisih antara obat yang didistribusikan dengan yang benar-benar dikonsumsi oleh masyarakat. Hasil survei darah jari menunjukkan angka MF rate di wilayah Puskesmas Simpang Rusa masih di atas 1%. Pada aspek Outcome menunjukkan bahwa POPM filariasis menurunkan kasus namun eliminasi belum tercapai di seluruh kecamatan. Kesimpulan penelitian ini menegaskan bahwa Implementasi POPM filariasis di Kecamatan Membalong didukung kebijakan yang kuat dan strategi adaptif, namun masih terkendala kekurangan SDM, pencatatan logistik manual, dan pemantauan minum obat yang belum optimal. Cakupan pemberian obat tinggi, tetapi eliminasi belum tercapai karena masih ada wilayah dengan MF rate di atas ambang batas. Temuan ini menegaskan perlunya penguatan SDM, sistem pencatatan, dan kolaborasi lintas sektor. Dalam IKK, hal ini menunjukkan efektivitas kebijakan masih perlu evaluasi dan penyesuaian strategi agar eliminasi filariasis dapat dicapai secara berkelanjutan.
Lymphatic filariasis remains a public health challenge in Indonesia, especially in endemic areas such as Membalong Subdistrict, Belitung Regency, which has received elimination certification; however, the microfilaria rate in several regions still exceeds the national threshold. This study aims to analyze the implementation of the Mass Drug Administration (MDA) program for filariasis prevention in Membalong Subdistrict in 2023 using a qualitative approach and case study design. Data were collected through in-depth interviews and document reviews involving program implementers at two primary health centers (Puskesmas) and the District Health Office. The analysis applied the Donabedian model, reinforced with the Policy Quality Index (IKK) from LAN, and Van Meter and Van Horn’s implementation model to evaluate aspects of structure, process, as well as output and outcome in terms of program impact. The findings on the structural aspect indicate that the filariasis MDA policy in Membalong is effective as the program’s foundation and fulfills policy quality indicators according to the IKK approach. The implementation strategy is considered adaptive, shown by schedule adjustments, door-to-door sweeping, and cross-sectoral involvement. However, challenges remain, such as limited human resources and manual logistic recording, which pose potential risks. Facilities and infrastructure are generally adequate, and funding meets the needs, although there are differences in budgeting systems between health centers. In terms of process, communication and coordination among stakeholders are established, but need strengthening, as these are essential in the IKK process dimension, which also determines the quality of policy implementation. Target population data collection has been conducted in detail, though its accuracy is still affected by population mobility. Socialization activities have been carried out, but have not fully reached all community groups. Medicine distribution has followed technical guidelines, but not all targets have attended and consumed the drugs at service posts. Sweeping has effectively increased coverage, but human resource and time constraints have hindered optimal implementation. The flexibility of sweeping is an important indicator in the IKK process dimension for assessing policy effectiveness. Adverse events after MDA were mostly mild and well managed, but reporting and monitoring remain passive. Monitoring and evaluation are structured but still hampered by compliance issues, manual reporting, and lack of integration. This highlights the need to strengthen IKK indicators, especially in effectiveness, efficiency, and feedback in policy implementation. In terms of output, drug coverage in Membalong is high, but microfilaria prevalence remains above 1% in some areas. According to the IKK, success is measured not just by coverage numbers, but by valid drug consumption and real impact. The number of drugs used matches the target, but discrepancies remain between drugs distributed and those actually consumed. Blood survey results show that the MF rate in the Simpang Rusa health center area is still above 1%. The outcome aspect indicates that the MDA program has reduced cases but elimination has not yet been achieved throughout the subdistrict. The study concludes that MDA implementation in Membalong is supported by strong policy and adaptive strategies, but still faces barriers such as limited human resources, manual logistics recording, and suboptimal drug consumption monitoring. Coverage is high, but elimination has not been achieved, as some areas still have MF rates above the threshold. These findings underscore the need to strengthen human resources, data recording systems, and cross-sector collaboration. According to the IKK, this suggests that policy effectiveness still requires evaluation and strategic adjustment to achieve sustainable filariasis elimination.
T-7304
Depok : FKM UI, 2025
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Isnawati; Pembimbing: Wachyu Sulistiadi; Penguji: Ascobat Gani, Prof. Dr. drg. Yaslis Ilyas, MPH., Intan Widayati, Doni Aria Candra
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Penelitian ini adalah untuk mengetahui upaya pencegahan kematian ibu melalui kebijakan program ANC. Hal ini dilakukan dengan menganalisis komponen masukan yang terdiri dari pedoman antenatal care, sumber daya manusia, sarana prasarana dan dana. Komponen proses di lihat dari proses pelaksanaan program antenatal care dan komponen keluaran adalah upaya penguatan kebijakan program untuk pencapaian indikator dan standar pelayanan dalam pencegahan kematian ibu yang dilakukan di Puskesmas Pamijahan Kabupaten Bogor. Penelitian ini adalah penelitian kualitatif dengan menggunakan metode studi kasus, dimana data primer diperoleh dari hasil wawancara mendalam dan data skunder diperoleh dari hasil telaah dokumen. Hasil yang diperoleh dari penelitian ini adalah sebagai berikut: 1.Kesenjangan antara kebijakan daerah dengan standar nasional, 2. Keterbatasan SDM, 3. Kurang Optimalnya sarana prasarana, 4. Penyerapan dan penggunaan dana program belum optimal, 5. Belum tercapainya target program dan masih adanya kasus kematian ibu, 6. Perlu adanya upaya penguatan program dalam mendukung kebijakan program kesehatan ibu khususnya antenatal care. Di usulkan adanya penguatan kelembagaan, SDM, fasilitas dan teknologi, akses dan layanan, pembiayaan, edukasi dan promosi kesehatan serta penguatan partisipasi dan keterlibatan publik
This research aims to understand the efforts to prevent maternal deaths through ANC program policies. It involves analyzing input components such as antenatal care guidelines, human resources, infrastructure, and funding. The process component is viewed from the implementation of the antenatal care program, and the output component includes efforts to strengthen program policies in achieving indicators and service standards for preventing maternal deaths conducted at Puskesmas Pamijahan, Bogor Regency. This qualitative research uses a case study method, where primary data is obtained from in-depth interviews and secondary data is obtained from document reviews. The results of this research are as follows: 1. Discrepancy between local policies and national standards, 2. Limited human resources, 3. Suboptimal infrastructure, 4. Inefficient absorption and use of program funds, 5. Failure to meet program targets and persistent maternal deaths, 6. There is a need for program reinforcement to support maternal health policies, particularly antenatal care. It is proposed to strengthen institutions, human resources, facilities and technology, access and services, financing, health education, promotion, and public participation and involvement
T-7042
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Renta Yulfa Zaini; Pembimbing: Wachyu Sulistiadi; Penguji: Ascobat Gani, Dumilah Ayuningtyas, Upik Rukmini, Anita Dianawati
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Untuk mewujudkan seluruh program prioritas yang menjadi tanggung jawabnya, Puskesmas melakukan kolaborasi dengan jejaring Fasilitas Kesehatan Tingkat Pertama lain di wilayah kerjanya melalui integrasi pelayanan kesehatan. Kementerian Kesehatan telah menerbitkan Pedoman Penyelenggaraan Integrasi Pelayanan Kesehatan di Puskesmas dengan FKTP lain dalam pelaksanaan Program Prioritas. Penelitian ini bertujuan untuk menganalisis implementasi kebijakan Integrasi Pelayanan Kesehatan di Puskesmas dengan FKTP Lain di Kabupaten Kendal Jawa Tengah. Penelitian merupakan analisis kebijakan, menggunakan pendekatan kualitatif dengan disain penelitian menggunakan model implementasi kebijakan Edward III yang dikombinasikan dengan kerangka kerja dari WHO dan segitiga analisis kebijakan dari Walt & Gilson untuk memetakan variabel-variabelnya. Pengambilan data dilakukan melalui wawancara mendalam dan telaah dokumen yang dilaksanakan pada bulan April – Mei 2024. Hasil penelitian menunjukkan bahwa kebijakan sudah mulai berjalan akan tetapi belum semua kebijakan terlaksana. Sikap pelaksana sudah baik tetapi belum didukung pemahaman kebijakan yang utuh. Dukungan sumber daya belum optimal dalam hal anggaran dan pemanfaatan teknologi digital untuk pelaporan. Komunikasi belum efektif dalam kejelasan kebijakan. Struktur birokrasi di tingkat FKTP masih kurang, pemahaman pedoman kurang sehingga peran dan pembagian wewenang di FKTP belum berjalan dengan baik. Monitoring dan evaluasi belum berjalan optimal, serta keterlibatan swasta perlu didorong dalam integrasi pelayanan kesehatan. Oleh karena itu, upaya-upaya peningkatan efektivitas implementasi memerlukan penguatan kebijakan, peningkatan komunikasi, penatalaksanaan sumber daya, serta monitoring dan evaluasi
To implement all priority programs for which they are responsible, Puskesmas collaborates with other First Level Health Facility networks in their working areas through health service integration. The Ministry of Health has issued Guidelines for the Implementation of Health Service Integration at Puskesmas with other primary health care facilities in the implementation of Priority Programs. This study aims to analyze the implementation of the Health Service Integration policy at Puskesmas with other FKTPs in Kendal District, Central Java. The research is a policy analysis using a qualitative approach with a research design using the Edward III policy implementation model combined with the WHO framework and the policy analysis triangle from Walt & Gilson to map the variables. Data collection was carried out through in-depth interviews and document reviews conducted in April - May 2024. The results showed that the policy has started to run but not all policies have been implemented. The attitude of the implementers is good but has not been supported by a complete understanding of the policy. Resource support has not been optimal in terms of budget and utilization of digital technology in reporting. Communication has not been effective in policy clarity. Bureaucratic structure at the FKTP level is still lacking, and understanding of the guidelines is lacking so the role and division of authority at FKTP has not gone well. Monitoring and evaluation have not run optimally, and the involvement of the private sector needs to be encouraged in the integration of health services. Therefore, efforts to improve implementation effectiveness require strengthening policies, improving communication, managing resources, as well as monitoring and evaluation.
T-6972
Depok : FKM UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Maya Masita; Pembimbing: Helen Andriani; Penguji: Adang Bachtiar, Ascobat Gani, Sito Hatmoko, Pitut Aprilia Savitri
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Tuberkulosis masih menjadi ancaman bagi kesehatan masyarakat. Pelaksanaan program terus dilakukan demi tercapainya Eliminasi Tuberkulosis tahun 2030. Namun demikian indikator program masih belum mencapai target, salah satunya angka tuberkulosis resistensi obat. Peraturan Menteri Kesehatan Nomor 67 Tahun 2016 dan Peraturan Presiden Nomor 67 Tahun 2021 tentang Penanggulangan Tuberkulosis menyebutkan bahwa Strategi Nasional Penanggulangan Tuberkulosis salah satunya dengan pelibatan masyarakat dan komunitas. Penelitian bertujuan untuk menganalisis implementasi kebijakan penanggulangan Tuberkulosis di Kabupaten Banyumas dalam pengendalian Tuberkulosis Resisten Obat melalui peran kader dan organisasi kemasyarakatan pegiat tuberkulosis yang ditinjau menggunakan teori implementasi kebijakan Van Meter dan Van Horn (1975). Penelitian ini merupakan penelitian analitik kualitatif. Informan ditentukan dengan menggunakan purposive sampling. Informan penelitian antara lain kader puskesmas, kader tuberkulosis resisten obat (patient support), penanggung jawab program tuberkulosis puskesmas, koordinator bidang P2PM Dinas Kesehatan dan komunitas Yayasan Mentari Sehat Indonesia (MSI). Data yang dikumpulkan berupa data primer dan data sekunder berupa hasil wawancara mendalam dan telaah dokumen. Diperoleh hasil penelitian bahwa pada standar dan ukuran kebijakan telah dipahami oleh pelaksana. Pemahaman ini didukung komunikasi yang jelas dan berkelanjutan antara Dinas Kesehatan, puskesmas dan komunitas MSI. Disposisi ditunjukan dengan sikap positif berupa komitmen bersama dan Rencana Aksi Daerah. Kader dan komunitas berkontribusi dalam penemuan kasus, pendampingan pengobatan, edukasi dalam upaya pencegahan, dan dukungan sosial ekonomi serta mengurangi stigma. Implementasi kebijakan program penanggulangan tuberkulosis telah berjalan, namun belum didukung anggaran yang memadai, terbatasnya jumlah kader, kurangnya komitmen antar organisasi perangkat daerah serta masih adanya stigma di masyarakat.
Tuberculosis remains a threat to public health. Program implementation continues in order to achieve Tuberculosis Elimination in 2030. However, the program indicators still have not reached the target, one of which is the rate of drug-resistant tuberculosis. Regulation of the Minister of Health No. 67/2016 and Presidential Regulation No. 67/2021 on Tuberculosis Control states that the National Strategy for Tuberculosis Control includes community involvement. The study aims to analyze the implementation of the Tuberculosis Control Policy in Banyumas Regency in controlling drug-resistant tuberculosis through the role of cadres and community organizations of tuberculosis activists using Van Meter and Van Horn's (1975) policy implementation theory. This research is a qualitative analytic research. Informants were determined using purposive sampling. The research informants included primary health care cadres, drug-resistant tuberculosis cadres (patient support), the person in charge of the primary health care tuberculosis program, the coordinator of the P2PM field of the Health Office and the Mentari Sehat Indonesia Foundation (MSI) community. The data collected were primary data and secondary data in the form of in-depth interviews and document review. The results showed that the policy standards and measures were understood by the implementers. This understanding is supported by clear and continuous communication between the Health Office, primary health care and the MSI community. Disposition is shown by positive attitudes in the form of joint commitments and Regional Action Plans. Cadres and communities contribute to case finding, treatment assistance, education in prevention efforts, and socioeconomic support and reduce stigma. Implementation of the TB control program policy has been running, but has not been supported by an adequate budget, limited number of cadres, lack of commitment among regional apparatus organizations, and the persistence of stigma in the community
T-6861
Depok : FKM-UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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