Analisis Implementasi Manajemen Terpadu Balita Sakit (MTBS) di Puskesmas Kota Surabaya

Universitas Diponegoro Program Pascasarjana Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Administrasi dan Kebijakan Kesehatan Minat Manajemen Kesehatan Ibu dan Anak 2011 ABSTRAK Rekawati Susilaningrum Analisis Implementasi Manajemen Terpadu Balita Sakit (MTBS) di Puskesmas Kota Surabaya xvii +132 halaman +23 tabel+8 gambar+ 11 lampiran MTBS merupakan pendekatan yang komprehensif untuk balita sakit dan salah satu solusi mengurangi angka kematian/kesakitan bayi dan balita serta sangat sesuai diterapkan di Puskesmas. Dalam kenyataannya, MTBS belum berjalan sesuai yang diharapkan. Tahun 2009, persentase balita sakit di Surabaya yang ditangani dengan MTBS baru sekitar 30,4%. Tujuan penelitian ini menjelaskan implementasi MTBS ditinjau dari teori Van Meter dan Van Horn yaitu ukuran dasar dan tujuan kebijakan, sumber kebijakan, komunikasi, karakteristik badan pelaksana, lingkungan ekonomi, sosial dan politik serta kecenderungan pelaksana. Penelitian dilaksanakan bulan Desember 2010 April 2011. Penelitian ini merupakan penelitian kualitatif. Pengumpulan data dilakukan dengan metode wawancara mendalam. Subyek penelitian adalah bidan atau perawat penanggung jawab MTBS sebanyak 6 orang, yang diambil secara purposive sampling. Informan triangulasi adalah kepala puskesmas dan Ka. Bid. Yankes. Analisis data dengan content analysis. Hasil penelitian menunjukkan bahwa ukuran dasar dan tujuan kebijakan belum ada secara tertulis.Sumber kebijakan terdiri dari petugas dan fasilitas. Untuk petugas, jumlah sementara cukup, mempunyai kompetensi yang memadai dan beban kerja lebih dari 3 jenis. Untuk fasilitas, ruangan belum tersedia, pengadaan formulir sulit, peralatan dan obat tersedia cukup serta tidak ada dana khusus. Komunikasi tentang MTBS dilakukan oleh fasilitator MTBS saat pelatihan saja. Karakteristik badan pelaksana (SOP) meliputi persiapan, pelaksanaan, pencatatan dan pelaporan. Persiapan, tidak ada secara khusus, hanya ada diseminasi yang sifatnya pengenalan. Pelaksanaan belum sesuai dengan modul dan MTBS belum digunakan lagi. Pencatatan dan pelaporan berdasarkan jumlah balita yang diperiksa dokter. Masyarakat minta dilayani dengan cepat. Petugas cenderung enggan melaksanakan MTBS. Kesimpulan penelitian adalah penerapan MTBS kurang mendapatkan perhatian dari petugas, kurang dukungan dari puskesmas maupun DKK. Saran yang perlu adalah komitmen dari DKK dan puskesmas untuk bersama-sama mengkaji penerapan MTBS di Surabaya. Kata Kunci : Manajemen Terpadu Balita Sakit, puskesmas Jumlah Pustaka : 39 Diponegoro University Postgraduate Program Master’s Program in Public Health Majoring in Health Policy Administration Sub Majoring in Maternal and Child Health Management 2011 ABSTRACT Rekawati Susilaningrum Analysis on the Implementation of Integrated Management of Childhood Illness (IMCI) at Primary Healthcare Centers in Surabaya xvii +132 pages +23 tables +8 figures + 11 enclosures Integrated management of childhood illness (IMCI) was a comprehensive approach to childhood illness and as one of solutions to reduce infant and childhood mortality/morbidity rates. It was appropriately applied to puskesmas. In fact, IMCI had not run as expected. In 2009, percentage of childhood illness in Surabaya which was covered by IMCI was about 30.4%. The study objective was to explain IMCI implementation viewed from Van Meter and Van Horn theories that included basic measurement and policy goal, policy resources, communication, characteristics of executing institution, economic environment, social and politics and executor tendency. This study was conducted in December 2010 – April 2011. This was a qualitative study. Data were collected using in-depth interview method. Study subjects were 6 midwives or nurses responsible for IMCI. They were selected using purposive sampling method. Triangulation informants were head of puskesmas and chief of health service unit. Data analysis was done by applying content analysis. Results of the study showed that basic measurement and policy goal did not exist in written form. Policy resources consisted of workers and facilities. In term of workers, the number of workers was conditionally sufficient, they had appropriate competency and had more than 3 types of workload. In term of facilities, no room available, difficulty in supplying forms, sufficient instruments and medication, no special funding. Communication regarding IMCI was done by IMCI facilitators only in the training. Characteristics of executing institution (SOP) included preparation, implementation, recording and reporting. Preparation: No special preparation, only dissemination that was only an introduction. Implementation had not been done according the modules and IMCI had not been used again. Recording and reporting were based on the number of children under-five that were examined by physician. Community wanted to be served immediately. Workers tended not to implement IMCI. The conclusion of this study was that application of IMCI received less attention from workers, less support from puskesmas or district health office. It was suggested to have commitment from district health office and puskesmas to joint in evaluating IMCI implementation in Surabaya. Key words : Integrated management of childhood illness, puskesmas Bibliography : 3