Abstrak: Realisasi dana Bantuan Operasional Kesehatan (BOK) di Puskesmas Kota Serang dari tahun 2014-2016 selalu mencapai 100% setiap tahun dan 30% digunakan untuk kegiatan KIA. Namun, capaian cakupan pelayanan kesehatan ibu dan anak khususnya kunjungan antenatal K4 menunjukkan penurunan dan belum mencapai target (75%). Penelitian kualitatif ini dilakukan di Dinas Kesehatan, 2 (dua) Puskesmas dengan cakupan K4 tinggi dan 2 (dua) Puskesmas dengan cakupan K4 rendah. Hasil penelitian menunjukkan bahwa Puskesmas kekurangan sumber daya manusia dan sarana prasarana untuk program KIA, dana operasional untuk kegiatan preventif dan promotif hanya mengandalkan dana BOK, pengawasan pencatatan pelaporan bidan masih lemah, serta frekuensi pergantian kader yang relatif tinggi. Kata Kunci: Bantuan Operasional Kesehatan, Puskesmas, Kunjungan Antenatal K4 The Health Operational Aid Fund (BOK) has been 100% absorped during 2014- 2016 in health centers in Serang city. Out of the total fund, 30% has been used for KIA program activities. However, coverage of maternal and child health services especially K4 antenatal visit tend to decrease and has not reached the target (75%). This qualitative research was conducted in District Health Office, 2 (two) health centers with high K4 coverage and 2 (two) Puskesmas with low K4 coverage. The result showed that Puskesmas has shortage in human resources and infrastructure facilities for KIA program, while funding to support preventive and promotive activities was only rely on BOK funds. In addition, midwife reporting was found insufficient, and high turn over of cadres has lead to poor performance. Key words : community health centre, health operational fund, K4 antenatal visit