Analisis Implementasi Program Deteksi Dini Kehamilan Risiko Tinggi dalam Pelayanan Antenatal oleh Bidan di Puskesmas Wilayah Kerja Dinas Kesehatan Kota Semarang Tahun 2014

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Magister Ilmu Kesehatan Masyarakat Konsentrasi Kesehatan Ibu dan Anak 2014 ABSTRAK Dian Nintyasari Mustika Analisis Implementasi Program Deteksi Dini Kehamilan Risiko Tinggi dalam Pelayanan Antenatal oleh Bidan di Puskesmas Wilayah Kerja Dinas Kesehatan Kota Semarang Tahun 2014 xv + 124 hal + 7 tabel + 3 gambar + 21 lampiran Kematian ibu dapat dicegah melalui pemeriksaan ANC secara rutin. Sesuai standar di Indonesia, ANC pada ibu hamil dilakukan minimal 4 kali. Hal ini bertujuan untuk mendeteksi bila ada kelainan atau komplikasi pada ibu secara dini. Ibu hamil risiko tinggi akan mendapatkan pengawasan atau pendampingan lebih ketat sehingga diharapkan akan mendapatkan penanganan yang tepat ketika bersalin. AKI di Kota Semarang tahun 2013 sebanyak 27 dengan jumlah ibu hamil adalah 28.399 orang, cakupan K4 27.889 dan jumlah ibu hamil risiko tinggi sebanyak 478 orang. Tujuan penelitian adalah menganalisis implementasi program deteksi dini kehamilan risiko tinggi dalam pelayanan antenatal oleh bidan di Puskesmas wilayah kerja Dinas Kesehatan Kota Semarang dan faktor – faktor yang berhubungan dengan implementasi tersebut. Jenis penelitian ini adalah observasional dengan rancangan kualitatif yang disajikan secara deskriptif melalui pengamatan observasional dan wawancara mendalam yang dilakukan pada 6 informan utama yaitu Bidan Puskesmas, informan triangulasi yaitu 6 Bidan Koordinator Puskesmas, Kepala Seksi Kesehatan Ibu Dinas Kesehatan Kota Semarang, dan 6 ibu hamil risiko tinggi yang memeriksakan kehamilannya di Puskesmas tersebut. Analisis data pada penelitian ini dilakukan dengan metoda analisis isi. Hasil penelitian menunjukkan bahwa semua informan utama berpendidikan Diploma III, dengan masa kerja berkisar 5-25 tahun, dan rata-rata usia 39 tahun. Pada umumnya bidan sudah melaksanakan program deteksi dini kehamilan risiko tinggi sesuai prosedur. Komunikasi berjalan dengan baik, konsisten, jelas dan mudah dipahami. Motivasi bidan dalam melakukan pelacakan dan pemantauan ibu hamil risiko tinggi karena sudah menjadi tugas bidan, dan program Puskesmas juga dikarenakan alasan kemanusiaan, tetapi komitmen bidan dalam hal ini masih kurang dikarenakan tenaga yang kurang. Belum ada SOP untuk kegiatan ini. Pembagian kerja, kerjasama dan laporan pertanggungjawaban sudah berjalan dengan baik dan lancar. Ada sebagian Puskesmas yang masih membutuhkan kelengkapan sarana prasarana. DKK dan Puskesmas koordinasi tentang keberadaan SOP untuk pelaksanaan deteksi dini kehamilan risiko tinggi. Motivasi bidan agar dapat mencapai sasaran untuk melakukan pelayanan secara komprehensif. Perlu peningkatan transportasi sehingga memudahkan dalam penanganan rujukan darurat pada ibu hamil risiko tinggi. Kata Kunci : Implementasi, Program Deteksi Dini Kehamilan Risiko Tinggi, Antenatal. Referensi : 35 (1995-2013) Diponegoro University Faculty of Public Health Master’s Program in Public Health Majoring in Maternal and Child Health 2014 ABSTRACT Dian Nintyasari Mustika Implementation Analysis of High-Risk Pregnancy Early Detection Program in Antenatal Services by Midwives at Health Centers in Work Area of Semarang City Health Office in 2014 xv + 124 pages + 7 tables + 3 figures + 21 enclosures Maternal mortality can be prevented by ANC examinations routinely. Based on a standard in Indonesia, ANC examinations on pregnant women are done at least 4 times. The examination aimed to detect abnormal condition or complication on pregnant women immediately. High-risk pregnant women will be monitored tightly in order to obtain appropriate treatment during delivery process. Infant Mortality Rate (IMR) in Semarang City in 2013 was 27. Meanwhile, number of pregnant woman was 28,399 persons, coverage of K4 was 27,889, and number of high-risk pregnant woman was 478 persons. This research aimed to analyze the implementation of early detection program of high-risk pregnancy in antenatal services conducted by midwives at health centers in work area of Semarang City Health Office (CHO) and to identify factors relating to the implementation. This was observational-qualitative research with descriptive method. Data were collected by observing and conducting indepth interview. Main informants consisted of 6 midwives worked at health centers. Meanwhile, 6 coordinator midwives at the health centers, Head of Maternal Health Section at Semarang CHO, and 6 high-risk pregnant women who visited their pregnancies at the health centers were as informants for triangulation purpose. Furthermore, data were analyzed using content analysis. The results of this research showed that all main informants had Diploma III degree, work period ranging from 5 to 25 years, average age equal to 39 years old. Generally, midwives had implemented early detection program of high-risk pregnancy in accordance with a procedure. Communication was good, consistent, clear, and easy to understand. They also had good motivation in tracing and monitoring high-risk pregnant women because they thought it was their main jobs, health center’s program, and humanity reason. Job sharing, cooperating, and reporting had been well done and smoothly. On the other hand, their commitments were still low due to lack of human resources. In addition, there was no Standard Operating Procedure (SOP) for this activity. Some health centers needed means. As suggestions, CHO and health centers need to make coordination about SOP to implement the program. Midwives need to motivate their selves in order to achieve goals to provide the services comprehensively. Transportation needs to be improved to assist emergency referral for high-risk pregnant women. Key Words : Implementation, Early Detection Program of High-Risk Pregnancy, Antenatal Bibliography : 35 (1995-2013