Berdasarkan SDKI 1997, Angka Kematian Ibu (AKI) di Indonesia masih tinggi yaitu 334 per 100.000 kelahiran hidup (target nasional: 125 per 100.000 kelahiran hidup pada tahun 2010) dan Angka Kematian Bayi (AKB) sebesar 25 per 1000 kelahiran hidup (target nasional adalah 15 per 1000 kelahiran hidup), ini menggambarkan tingkat kesejahteraan masyarakat serta arus terhadap pelayanan kesehatan masih rendah, khususnya kesehatan ibu dan anak. Untuk menurunkan AKI dan AKB telah dilakukan berbagai upaya diantaranya adalah memudahkan pelayanan kesehatan yang dapat menjangkau seluruh lapisan masyarakat dengan menempatkan bidan di desa. Penelitian ini bertujuan untuk memperoleh gambaran tentang kinerja bidan di desa dalam pelayanan kesehatan ibu dan neonatal dan faktor-faktor yang berhubungan dengan kinerja serta faktor yang paling dominan. Dengan memakai indikator K1, K4, linakes, KNI dan KN2. Kinerja baik bila cakupan K1 > 95%, K4 > 90%, Linakes 85%, KNI > 80% dan KN2 7 80%. Penelitian ini dilakukan di Kabupaten Lampung Barat dengan menggunakan rancangan penelitian Cross Sectional. Sampel penelitian adalah seluruh bidan di desa yang bertugas di Kabupaten Lampung Barat yang berjumlah 94 orang. Analisis data meliputi analisis univariat, analisis bivariat dengan uji Chi Square untuk melihat hubungan antara variabel bebas dengan variabel terikat dan analisis multivariat dengan uji regresi logistik untuk melihat faktor yang paling dominan berhubungan dengan kinerja bidan di desa Hasil penelitian menunjukkan bahwa proporsi kelompok bidan di desa yang memiliki kinerja kurang lebih besar dibandingkan bidan di desa yang memiliki kinerja baik. Hasil analisis bivariat menunjukkan bahwa variabel pengetahuan, sarana, penghasilan tambahan dan supervisi mempunyai hubungan bermakna dengan kinerja bidan di desa dan yang tidak mempunyai hubungan bermakna adalah umur, status perkawinan, masa kerja, dukungan pimpinan dan dukungan masyarakat. Hasil analisis multivariat menunjukkan bahwa variabel pengetahuan, penghasilan tambahan dan supervisi merupakan faktor dominan yang dapat menentukan hubungan variabel independen dengan kinerja bidan di desa. Variabel yang paling dominan berhubungan dengan kinerja bidan di desa adalah variabel pengetahuan. Setelah diketahui faktor faktor yang berhubungan dengan kinerja bidan di desa, maka dapat diformulasikan berupa saran saran sebagai berikut: Bagi Pemerintah Daerah Kabupaten Lampung Barat yaitu membuat kebijakan memberikan insentif kepada bidan di desa dan bidan PTT yang berprestasi dapat diangkat sebagai pegawai negeri sipil. Bagi Dinas Kesehatan mengadakan pelatihan fungsional dan manajemen sosial approach, merencanakan supervisi yang berkualitas, mempermudah pemberian lain praktek bidan, mengusulkan penambahan tenaga bidan di desa sesuai kebutuhan, bidan di desa yang berprestasi diusulkan sebagai bidan di desa teladan. Bagi Puskesmas memberikan pembinaan secara periodik dan intensif serta mengadakan monitor dan evaluasi. Bagi bidan sendiri mengadakan pendekatan kepada masyarakat, memanfaatkan peran aktif dukun bayi, melaksanakan kerja sama lintas sektoral dan berusaha untuk meningkatkan pengetahuan dan ketrampilannya.

The Factors Related to Village Midwife Performance in Health Service for Maternal and Neonatal in West Lampung Regency 2002Based on the SDKI 1997, Maternal Mortality Rate (MMR) in Indonesia is still high, which is 334 per 100.000 living birth (national target: 125 per 100.000 living birth) and Infant Mortality Rate (IMR) is 25 per 1.000 living birth (national target is 15 per 1.000 living birth). These describe the level of public prosperity and access to health service is still low, especially for the health of mothers and children. To decrease the MMR and 1MR various efforts have been undertaken. One of them is to facilitate health service that could reach the public through placement of midwives in villages. The objective of this study is to get a description regarding the operation of midwives in villages concerning the health service for mothers and neonatal, and the factors which relate to the operation and the most dominant factor, using K I , K4, l inakes, KN1 and KN2 indicators. The operation is good when the scoop is 1(1 y 95%, K4 ? 90%, Linakes ? 85%, KN1 ? 80%, and KN2 ? 80%. This study is carried out in West Lampung Regency using a cross sectional study plan. The samples of the study are every villages midwives who are in duty in West lampung Regency which consist of 94 people. The analysis consist of univariat analysis, biovariat analysis with chi Square test to find out the relationship between the independent variable with the dependent variable and multivariate analysis with logistic regression test to find out the most dominant factor which is related to the operation of midwives in villages. The result of the study shows that the midwives group proportion in villages which has less operation is higher compared to midwives in villages which has good operation. The result of bivariat analysis shows that the variable of knowledge, facilities, additional income, and supervision has significant relationship with the midwives operation in villages; and variables which have no significant relationships are age, marital status, work period, support from the superior or the public. The result of multivariate analysis shows that the variables of knowledge, additional income, and supervision are the dominant factors which could determine the relationship between the independent variable with the operation of midwives in villages. The most dominant variable related to the operation of midwives in villages is knowledge. Once the factors which are related to the operation of midwives in villages have been identified, then the following suggestions could be formulated: For the District Government of West Lampung Regency is to make a policy that would give incentive for the village midwives and PTT midwives who have good track record could be raised as civilian government officers. For the Health Board is to make social approach management training and functional training, plans a good supervision, facilitate midwives working permit, proposes to increase the midwives according to the needs, village midwives who have good track records is proposed as the best midwife. For the Public Health Centers are to give education periodically and intensively and also to monitor and evaluate their progress. As for the midwives themselves are to make an approach to the public, using the active role of traditional midwives, undertake cross sector cooperation and try to improve their own knowledge.

Di Indonesia angka kematian ibu secara Nasional berdasarkan Survey Demografi Kesehatan Indonesia (SKDI) tahun 1995 adalah 390 per 100.000 kelahiran hidup, yang merupakan angka tertinggi di antara negara-negara ASEAN (Dep. Kes. RI 1998). Berbagai upaya untuk menurunkan angka kematian ibu dan bayi telah banyak dilakukan, salah satu diantaranya adalah peningkatan upaya pelayanan kesehatan dengan jalan mengikutsertakan oraganisasi/sektor terkait serta lembaga swadaya masyarakat dalam menunjang kesejahteraan ibu dan anak. Disamping itu, pemerintah telah menyebarkan bidan ke desa untuk membantu akselerasi penurunan angka kematian ibu dan bayi serta memperluas jangkauan pelayanan yang telah ada sekaligus meningkatkan cakupan program kesehatan ibu dan anak (KIA). Penelitian bertujuan untuk memperoleh gambaran kinerja bidan di desa dalam pelayanan antenatal (ANC) dan faktor-faktor yang berhubungan dengan kinerja bidan desa. Kinerja bidan di desa diukur dengan hasil cakupan K4. Kinerja baik bila cakupan K4 > 80% dan kinerja kurang bila cakupan K4 < 80%. Penelitian ini dilakukan di Kabupaten Agam dengan menggunakan rancangan penelitian Cross Sectional. Sampel penelitian adalah bidan di desa yang bertugas di Kabupaten Agam dan pengambilan sampel dilakukan dengan cara sistematik random sampling sebanyak 100 orang, Hasil penelitian menunjukkan 78% kinerja bidan di desa di Kabupaten Agam masih kurang dan 22% dengan kinerja baik. Penelitian menunjukkan bahwa kinerja bidan di desa di Kabupaten Agam masih kurang. Faktor-faktor berikut ini, umur, status perkawinan, penghasilan, supervise Dinas Kesehatan Kabupaten dan kondisi kerja (gedung), mempunyai hubungan yang bermakna terhadap kinerja bidan di desa. Sedangkan faktor jumlah anak, pelatihan, masa kerja, rasa aman, dan perlengkapan kerja tidak mempunyai hubungan yang bermakna dengan kinerja bidan di desa. Penelitian ini menyarankan agar : 1. Pemerintah daerah menyediakan biaya operasional untuk pelatihan daiam rangka meningkatkan profesionalisme bidan di desa sehingga cakupan K4 meningkat. 2. Bagi Dinas Kesehatan Kabupaten Agam : a. Melakukan upaya dalam bentuk penegasan kepada Kepala Puskesmas tentang tugas dan wewenang bidan di desa agar cakupan K4 meningkat. b. Meningkatkan profesionalisme bidan di desa melalui kegiatan : -Pertemuan sekali tiga bulan di tingkat Kabupaten. -Pertemuan bulanan di Puskesmas. -Pemberdayaan belajar melalui Kalakarya dan Gugus Kendali Mutu. -Memberikan pelayanan prima kepada ibu hamil.

Analysis on Factors Which are Related to the Performance Villages Mid Wives in Antenatal Care Services (ANC) In Agam District, West Sumatera, October - December 2000Based on Indonesian Demographic Survey (1995), the Maternal Mortality Rate (MMR), in Indonesia were 390 per 100,000 life birth, which is the highest number of the ASEAN countries (Indonesian Department of Health, 1998). There are some programs to decrease number of Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR). One of the programs is to increase of health services by following the relevant sector and non government organization. Also the government has been already spread the village mid wives to decrease Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) number and to widening the health services. The purpose of this research is to know how the performance of the village mid wives in the Antenatal Care services and some related factors. The performance of the village mid wives is measures by four times health services visits. Good performance can be measures if the four times health services visits is 80% or more. Bad performance can be measures if the four times health services visits is less 80%. The research had already done in Agam district, West Sumatera Province by using Cross Sectional Random Sample. The sample of this research is village mid wives which were working in Agam district and by using Systematic Random Sampling method for 100 villages mid wives. The result of the research showed that 78% performance of the villages mid wives in Agam district still bad and 22% are good. There are some factors related to this performance such as age, marital status, salary, upper level health offices, supervision and working facilities. The unrelated factors to this performance are number of children, working duration, training, the mid wives feels of secure and nurse working kit. This research suggested that: 1. For District Government, is to provide the operational costs for trainings in order to increase the professionalism of mid wives at villages to increase K4. 2. For Agam District Health Department: a. Stressing the Head of Health Center about job and responsibility of mid wives at villages to increase K4. b. Increasing mid wife professionalism, through activities such as: -Once in three months meeting at District Level. -Monthly meeting at the Health Center. -Empowerment through Kalakarya learning and Total Quality Management. -Give prime quality services to pregnant mother.

Angka kematian ibu (AKD di Indonesia masih relatif tinggi bila dibandingkan dengan negara-negara ASEAN yaitu sebesar 3901100000 kelahiran hidup (SDKL,1994). Hasil Assesment Safe Matherhood di Indonesia menyebutkan bahwa yang mempengamhi AKI antara lain kualitas pelayanan antenatal masih rendah. Upaya untuk menurunkan AKI sampai ke tingkat paling rendah telah dilakukan dengan penempatan bidan di desa, tujuannya lebih menel-cankan pada pelayanan kesehatan dasar dan meningkatkan cakupan program kesehatan ibu dan anak, antara lain pelayanan antenatal yang indikator pemantauannya adalah K1 dan K4. Cakupan pelayauan antenatal di Provinsi Daerah Istimewa Aceh telah mulai meningkat, narnun bila dilihat pada Daerah Tingkat II Kabupaten Aceh Barat, merupakan urutan keclua terendah dari 11 Kabupaten yang ada, yaitu K1 77.04% dan K4 66.68 % bila dibandingkan dengan target Nasional K1 90 % dan K4 85%. Sehubungan dengan hal tersebut, peneliti tertarik untuk memperoleh informasi tentang gambaran pencapaian cakupan K4 oleh bidan di desa yang dilihat dari faktor internal dan faktor ekstemal bidan di desa. Penelitian ini merupakan penelitian deskriptif dengan pendekatan Cross Sectional, pengumpulan data dilakukan di Kabupaten Aceh Barat dengan jumlah sampel 123 responden dari 26 Puskesmas, yang dilaksanalcan mulai tanggal 5 - 28 Februari 2001 dengan cara Systimatic Random Sampling. Untuk mengetahui distribusi frekwensi dilakukan analisis_univariat, proporsi pencapaian cakupan K4 yang baik 17.9 % dan perkiraan di popdlasi dengan CI 95% adalah antara 11.9 sampai 23.9. Untuk mengetahui hubungan antara variabel dilakukan analisis bivariat dengan menggunakan uji Chi Square dengan P = 0.05. Hasil menunjukkan ada hubungan bem1ak:na antara lain sikap, pelatihan, sarana dengan penoapaian cakupan K4 dengan masing-masing nilai P = 0033, P = 0.01, P = 0.O13. Kemudian dilal-cukan analisis multivariat dengan uji Regresi Logistik, yang masuk dalam model lcandidat yang nilai P = < 0.25 yaitu pengetahuan, sikap, pelatihan, sarana, prasarana, tempat tugas, dau dukungan masyaralcat. Hasil akhir uji Regresi Logistik didapat 3 variabel yang masuk dalam model yaitu sikap pelatihan, sarana, kemudian dilakukan uji intraksi dan akhimya ketiga variabel ini tidak masuk dalam model (P>0.05). Hasil penelitian ini menunjukkan perkiraan kemungldnan pencapaian cakupan K4 oleh bidan di desa berkisar antara 50 % sampai 99 %. Memperhatikan hasil penelitian yang diperoleh, penulis menyarankan agar dapat membuat reuoana perbaikan dan peningkatan cakupan K4 melalui upaya- upaya khusus terhadap bidan di desa.

The Martenal Mortality Rate (MMR) in Indonesia is relatively still high compare to other ASEAN countries that is 3901100000 life births (SDKI, 1994). The result of Assesment Safe Motherhood in Indonesia mentioned thad one factor which affects MMR is the poor quality of antenatal care. Efforts to decrease MMR up to the lowest level have been done such as by providing the midwives in the villages. The aim was emphasized on the basic health care and increasing the coverage of mothers and children health program such as antenatal care with K1 and K4 as the controlling indicator. Antenatal care coverage in D.I Aceh Province has been increased recently, but if we see from the case in Aceh Barat District which is the second lowest from 11 Districts that are K1 77.04 % and_K4 % 66.68 % from the national target of 90 % and K4 85 %. Due to the fact in the field the researcher is interested in gaining information about the description of K4 coverage by the midwifes in the villages from the internal and external factors point of view. This research is a descriptive research with Cross Sectional approach. Data survey was done in Aceh Barat District to 123 sample from 26 Public Health Centre. This was done from 5 up to 28 February 2001 by Systimatic Random Sampling Method. Univariat analysis was done in order to End out the frequency distribution with coverage of the best K4 17.9 %, in population estimated for a 95 % confined interval is between 11.9 % up to 23.9 %. Bivariat analysis figure out the relationship among the variables by the Chi Square test with P = 0.05. The outcome shows a significant relationship between attitude, training and fasility in one side and the achievement of K4 coverage in the other side with each of their P = 0.033, P = 0.013 and P = 0.0l3. After those multivariat analysis and logistic regression were done with the result that knowledge, attitude, training, facility, infrastructure, workplace, and public support have P < 0.25, so they can be considered as candidate model. Final result of logistic regression test indicates that 3 variables (attitude, training and facility) considered as model, alter that interaction test shows that cannot be considered as model (P > 0.05). Result of the research indicates that Estimated Probabilities coverage of K4 by the midwife village about 50 % up to 99 %. Based on this result, researcher suggests that institution in charge of this matter in Aceh Barat District shall make planning to increase the coverage of K4 through the breakthrough and special effort for the midwife village.