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Journal : Jurnal Manajemen Kesehatan Indonesia

Implementation ff Midwive-Traditional Birth Attendants Partnership by Midwives in Buton District, Southeast Sulawesi, (A Case Study on Wakaokili Primary Healthcare Center) Hermawati, Hermawati; Kuntjoro, Tjahjono; Sriatmi, Ayun
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 1 (2013): April 2013
Publisher : S2 IKM FKM UNDIP

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1091.872 KB) | DOI: 10.14710/jmki1110310

Abstract

The limited knowledge on the importance of health workers deliveries, together with someother factors such as economies, social and culture, made traditional birth attendants becamea choice of delivery services. This condition resulted in the increase of Maternal MortalityRate in Buton District. The coverage of health workers deliveries in Wakaokili was still low. Itwas marked by the low rate of traditional birth attendance-midwives’ partnership anddeliveries referral to the midwives, as well as high rates of traditional birth attendancedeliveries. This study was a descriptive qualitative study. Data were collected by in depthinterviews on 4 village midwives and 9 traditional birth attendants as the main informants.Data were analyzed by content analysis method. Results showed that the goals and programsuccess indicators were not understood well. Dissemination was only an introduction and thereport was not discussed. There was no coaching or internship program. The attitude tendedto be ambivalent and the resources were not supportive. It is proven that economic, social andpolitical environment influence the program results.
Factors Affecting Village Midwives Work Performance in Conducting Early Detection of High Risk Pregnancy in the Antenatal Care in South Bengkulu District Yunita, Harlen; Kuntjoro, Tjahjono; Purnami, Cahya Tri
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 2 (2013): Agustus 2013
Publisher : S2 IKM FKM UNDIP

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (672.887 KB) | DOI: 10.14710/jmki1210320

Abstract

Antenatal care provided health service for pregnant women and their fetuses according to theminimum standard of 7T, and minimum of four examinations during pregnancy. These standardswere intended to assure protection to pregnant women, such as risk factors early detection,complication prevention and management. Based on the coverage of maternal and children localarea monitoring (PWS-KIA), maternal and infant mortality rates, and preliminary survey tovillage midwives, it was concluded that work performance of village midwives was stillinadequate. Objective of this study was to identify factors affecting work performance of villagemidwives in conducting early detection of high risk pregnancy in the antenatal care. This was anexplanatory research with cross sectional approach. Data were collected using structuredquestionnaire and observation. Study population was village midwives. Samples consisted of 93respondents who were selected using simple random sampling technique. Results of the studyshowed that 73.1% of village midwives’ age were in the range of 25-35 years old, and 37.6% ofvillage midwifes duration of work were in the range of 36-60 months. Bivariate analysis withcross tabulation and Pearson Product Moment test indicated that variables related to workperformance were knowledge (p= 0.000), motivation (p= 0.004), perception on supervision ofcoordinator midwives (p= 0.016), and perception on workload (p= 0.047). Multivariate analysisusing multivariate logistic regression test indicated common effect of knowledge and facilitiesvariables with significance value of 0.000 and r 2 = 0.394; it meant that 39.4% of workperformance variable could be explained by variation of those two variables. District healthoffice is expected to provide training, to complete facilities for village midwives before startingto work in the village; to form team or committee as a consultation place. Puskesmas is expectedto complete documentation facilities; head of puskesmas and coordinator midwives are advisedto actively doing supervision.
Evaluation of the Implementation of Posyandu (Integrated Service Center) Development Policy by Operasional Working Group (Pokjanal) City of Banjarmasin South Kalimantan Province (Case Study in The District of East Banjarmasin) Sari, Anggrita; Kartika, Lucia Ratna; Kuntjoro, Tjahjono
Jurnal Manajemen Kesehatan Indonesia Vol 1, No 3 (2013): Desember 2013
Publisher : S2 IKM FKM UNDIP

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (344.068 KB) | DOI: 10.14710/jmki1310339

Abstract

Since 2010, in East Banjarmasin sub-district, members of sub-district operational team work(pokjanal) had been established based on the decree no. 10/2010 regarding sub-district Pokjanalboard member. The role and function of this pokjanal was not maximal. Objective of this study wasto evaluate the implementation of posyandu supervision by pokjanal based on supervision output,input, and process aspects.This was a descriptive-qualitative study with cross sectional approach. Data collection was doneusing in-depth interview technique on four sub-district pokjanal board members as main informants.Triangulation informants consisted of ten people. Content analysis was applied in the data analysis.Results of the study showed that sub-district pokjanal was established. However, based on evaluationon output aspect, it was found that completeness of data and information were insufficient; problemanalysis and intervention were not done; annual planning and supervision activity scheduleformulation were not performed; coordination activity and report of activities results were notdone. Input aspect: human resource, facilities, and funding were not provided according to the roleand function of pokjanal in implementing the supervision. Process aspect: data collection,information, and problem analysis were not done. Annual plan formulation, monitoring and activityevaluation were not implemented according to pokjanal function. This was caused by no socializationand technical guidance that could assist the work of pokjanal; therefore, no pokjanal activity reportdocuments were found.Conclusion of this study was that Pokjanal organization did not function properly. Reasons for thiscondition could be viewed from output aspect: posyandu supervision activity was not done; inputaspect: Pokjanal did not function according to their role; process aspect was not implementedaccording to the pokjanal guideline.It is suggested that stakeholder commitment and clarity are needed; cross sectors and cross programscoordination and communication should be optimized
Implementation on the Referral System of High Risk Pregnant Women from Villages Midwives to Primary Healthcare Center with Basic Obstetric and Neonatal Emergency Care in Banjar District, South Kalimantan (a Case Study in Sungkai Primary Healthcare Center) Palimbo, Adriana; Sriatmi, Ayun; Kuntjoro, Tjahjono
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 1 (2015): April 2015
Publisher : S2 IKM FKM UNDIP

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (419.291 KB) | DOI: 10.14710/jmki3110435

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Quality of obstetrical referral service could not be separated from referral system done byvillage midwives as a front health service post in the community. Obstetric case managementthat was not fully follow a basic principle of referral, delays to identify signs of dangerouspregnancy condition, delay to make decision, and delay to obtain services in the health facilitywere factors related to the quality of obstetrical referral service. The objective of this study wasto explain the implementation of high risk pregnancy referral system by village midwives to PONED primary healthcare center Banjar district, 2011. This was an observational study usingdescriptive qualitative design. This study was in the form of a case study to describe and tocomprehend related phenomena using cross sectional approach. Study instrument was villagemidwives from Sungkai primary healthcare center who referred high risk pregnant women toPONED primary healthcare center. Data were collected by conducting in-depth interview.Qualitative technique was applied to analyze the data. Results of the study showed that villagemidwives still performed stabilization beyond their authority. Majority of people in thecommunity used Jamkesmas (community health insurance) funding; however, funding andtransportation or village ambulance availability and other needs were insufficient forJamkesmas patients. During midwives accompaniment, most of them only accompanied when thepatient was referred to the private hospital, and they did not do that for Jamkesmas patients.Midwives did not bring reference letter to PONED primary healthcare centers when they werereferring pregnant women; it was also done when they were referring pregnant women toprivate hospitals. Midwives included a letter and KIA book as an enclosure when they referredthe patient to the general hospital for Jamkesmas claim purpose. Based on the study results,suggestions given to the head of district health office were to provide additional number ofvillage midwives with its qualification; to assure the availability and sufficiency of instrument,medicine and materials in Polindes or Poskesdes; Suggestions for primary healthcare officewere to conduct guidance and supervision for village midwives, to distribute clearly the jobassignments to village midwives in their work areas.
Analysis of Factors Associates to the Incidence of Pulmonary TB Patients Drop Out in Primary Healthcare Centers in Sorong Papua Barat Octovianus, Lopulalan; Suhartono, Suhartono; Kuntjoro, Tjahjono
Jurnal Manajemen Kesehatan Indonesia Vol 3, No 3 (2015): Desember 2015
Publisher : S2 IKM FKM UNDIP

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (376.049 KB) | DOI: 10.14710/jmki3310458

Abstract

Data from health office of West Papua province regarding new cases of tuberculosis (TB) indicatedthat the number of cases increased although lung TB control program was improved. Data from BP2PL of West Papua health office in 2009 showed that 2462 new cases of positive fast acid bacilli(BTA) were found; among them, 337 patients were dropout. In 2010, 2476 cases with positive BTAwere found, and among them 441 patients were dropout. Based on preliminary survey done inSorong city primary healthcare centers, in 2008, 87 new lung TB cases with positive BTA werefound. Among them, 20 patients were treated and cured, 64 patients were dropout. In 2009, therewas an increase in the number of new cases, which were 108 patients. Among them, 28 patientswere cured, and 61 patients were dropout. In 2010, 103 new cases with positive BTA were found;among them, 27 patients were cured, and 55 patients were dropout. The objective of this study wasto identify factors related to the occurrence of drop out among lung TB patients who were in thetreatment program.This was a quantitative study with cross sectional approach. Data were collected using interviewmethod supported by structured questionnaire. Study population was all patients visited in theSorong city primary healthcare centers. Study samples were 50 dropout patients and 50 patientswho sought for medication regularly and cured in primary healthcare centers in Sorong city.Frequency distributions were presented for univariate analysis, and chi square test was applied forbivariate analysis.Results of the study showed that there was association between knowledge and dropout occurrence(p= 0.001).Motivation was associated with dropout occurrence (p= 0.001). The role of PMO wasassociated with drop out occurrence (p= 0.001). Accessibility was associated with dropoutoccurrence (p= 0.001). Family support was associated with dropout occurrence (p= 0.001). Noassociation between age and dropout occurrence (p= 0.356), between sex and dropout occurrence(p= 0.156), between education and dropout occurrence (p= 0.453).In conclusion, variables related to dropout occurrence are knowledge, motivation, roles of PMO,accessibility, and family support. Suggestions for district health office are to increase educationfrequency, playing documentary movies about infectious diseases. Long term suggestions are tobuild supporting primary health care center, and to reactivate village health cadres.
Analisis Penyusunan Draf Panduan Praktik Klinis Pelayanan Radiologi di RRSUD Ajibarang Kabupaten Banyumas Aryani, Asri Indah; Jati, Sutopo Patria; Kuntjoro, Tjahjono
Jurnal Manajemen Kesehatan Indonesia Vol 4, No 1 (2016): April 2016
Publisher : Prodi Magister Ilmu Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat Undip

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (41.79 KB) | DOI: 10.14710/jmki.4.1.2016.1-10

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Panduan Praktik Klinis adalah prosedur yang dilaksanakan oleh sekelompok profesi yang mengacu pada Pedoman Nasional Pelayanan Kedokteran yang dibuat oleh organisasi profesi dan disyahkan oleh Pimpinan Rumah Sakit.Dalam memberikan pelayanan kesehatan kepada pasien maka pelayanan radiologi harus berdasarkan pada Panduan Praktik Klinis yang ada pada pelayanan tersebut. Tujuan dari penelitian ini yaitu menjelaskan proses penyusunan draf Panduan Praktik Klinis Pelayanan Radiologi di RSUD Ajibarang Kabupaten Banyumas. Metode penelitian yang digunakan adalah penelitian kualitatif dengan tujuan ingin menggali lebih dalam dari berbagai sumber dan informan mengenai proses penyusunan panduan praktik klinik pelayanan radiologi di RSUD Ajibarang Kabupaten Banyumas. Pengumpulan data dengan menggunakan metode wawancara mendalam, observasi dan telaah dokumen. Metode pengolahan data dengan contens analisys (analisis isi ) . Data dalam penelitian ini disajikan dalam bentuk narasi dan dilengkapi dengan matriks hasil wawancara.Penyajian data didukung dengan hasil observasi lapangan dan telaah dokumen. Hasil penelitian menunjukan bahwa dari aspek sumber daya terdapat hambatan, yaitu dokter spesialis radiologi belum berperan dalam proses penyusunan,dan kurang terjalinnya komunikasi antara pelaksana radiologii dengan tim penyusun panduan praktik klinis rumah sakit. Aspek pola tarif tidak terdapat hambatan, tarif INA-CBGs sudah digunakan pada program Jaminan Kesehatan Nasional (JKN) dan diberlakukan per 1 Januari 2014. Pada aspek ketersediaan bukti, panduan praktik klinis yang tersusun sudah berdasarkan literature dan textbook. Format draf panduan praktik klinis yang tersusun meliputi, judul prosedur tindakan, pengertian, indikasi, kontra indikasi, persiapan, prosedur tindakan , pasca prosedur tindakan, tingkat evidens, tingkat rekomendasi, penelaah kritis, indikator prosedur tidakan penata radiologi, kepustakaan Kesimpulan bahwa proses penyusunan panduan praktik klinis sudah berjalan dengan baik, tetapi dokter spesialis radiologi belum berperan. Direkomendasikan agar surat keputusan direktur tentang Tim Penyusun Panduan Praktik Klinis RSUD Ajibarang direvisi. Pelayanan radiologi untuk menyelesaikan dan menetapkan draf panduan praktik Panduan Praktik Klinis yang sudah final.A clinical practice guideline is a procedure implemented by group of a profession referred to National Guideline of Medical Service made by organisation of profession and approved by Director of a hospital. In providing health services to patients, radiology service must refer to the clinical practice guideline that is available in its service. The aim of this study was to explain the process of draft arrangement of the clinical practice guideline of radiology service at Ajibarang Public Hospital in Banyumas District. This was qualitative research aimed at investigating the arrangement process of the clinical practice guideline of radiology service collected from various sources and informants at Ajibarang Public Hospital in Banyumas District. Data were collected using methods of indepth interview, observation, and literature review, analysed using content analysis, and presented descriptively combined with matrix of interview results. In addition, data presentation was supported by results of field observation and literature review. The results of this research showed that viewed from aspects of resources, there were any barriers as follows: radiologist did not involve in the arrangement process and there was lack of communication between radiographer and an arrangement team of the clinical practice guideline of hospital. On the other hand, there was no barrier in the aspect of tariff pattern. Tariff of INA- CBGs have been used in a program of National Health Insurance and implemented since 1 January 2014. In the aspect of evidence availability, arranged clinical practice guideline was based on literature and textbook. A format of arranged clinical practice guideline draft consisted of title of action procedure, definition, indication, contra-indication, preparation, action procedure, post action procedure, levels of evidence, levels of recommendation, reviewers, indicators of action procedure of radiographer, and references. In conclusion, the arrangement process of the clinical practice guideline had been well implemented. However, radiologist had not involved. Director’s decree about arrangement team of the clinical practice guideline at Ajibarang Public Hospital needs to be revised. Radiology service needs to accomplish and determine final draft of the clinical practice guideline.
Kebutuhan Perawat Puskesmas Berbasis Analisis Beban Kerja Laraswatie, Harisa; Kuntjoro, Tjahjono; Jati, Sutopo Patria
Jurnal Manajemen Kesehatan Indonesia Vol 4, No 2 (2016): Agustus 2016
Publisher : Prodi Magister Ilmu Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat Undip

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (171.062 KB) | DOI: 10.14710/jmki.4.2.2016.118-122

Abstract

Kebutuhan Perawat Puskesmas ditinjau dari analisis beban kerja sangat diperlukan untuk mengetahui jumlah kebutuhan perawat yang disesuaikan dengan standar-standar pelayanan serta keadaan riil di Puskesmas, terlebih dengan akan ditingkatkannya pelayanan Puskemas rawat jalan menjadi Puskesmas rawat inap dimana pembangunan infrastruktur harus sejalan dengan pembangunan SDM. Desain penelitian kualitatif dengan pendekatan studi kasus mulai dari pengambilan data, FGD, NGT, Work Sampling sampai wawancara mendalam dengan stakeholder yang berpengalaman terhadap penghitungan kebutuhan pegawai berbasis ABK dan perwakilan perawat itu sendiri. Analisis data dengan menggunakan formulir penghitungan kebutuhan pegawai dari BKN. Hasil penghitungan kebutuhan perawat untuk rawat inap 9 orang, sebanding dengan perencanaan jumlah tempat tidur yakni 9 (1:1), dimana dibutuhkan 5 perawat terampil dan 4 perawat ahli. Kebutuhan perawat di rawat jalan yang meliputi BP, UKM dan Pustu jumlahnya lebih besar yakni 26 orang dengan rincian perawat terampil 16 orang dan perawat ahli 10 orang atau 1 perawat melayani 1.458 jiwa atau 456 keluarga. Saran yang disampaikan kepada Puskesmas Rembang 2 adalah dipenuhinya kebutuhan perawat dengan mempertimbangkan inovasi pelayanan keperawatan untuk mengurangi beban SDM yang besar, dibentuknya komite keperawatan oleh DKK sebagai instansi pembina jabatan fungsional, penetapan diagnosa keperawatan baku dan sistem informasi pelayanan asuhan keperawatan untuk menggambarkan tingkat kemandirian individu, keluarga, kelompok dan masyarakat di Kabupaten Rembang dalam perawatan dirinya serta saran untuk para akademisi untuk menggali lebih banyak lagi tentang beban kerja fungsional lain dibidang kesehatan sehingga tujuan pembangunan kesehatan nasional bisa tercapai. A nurse’s necessity at a health centre viewed from workload analysis is required to identify a nurse’s necessities adjusted with service standards and real condition at a health centre. This requirement is in accordance with the change of an outpatient health centre status to be an inpatient health centre in which infrastructure and human resource need to be improved. This was a qualitative study using case study approach started from data collection, FGD, NGT, work sampling, to indepth interview with stakeholders who had experiences in calculating an employee’s necessities based on ABK and nurse representative. Furthermore, data were analysed using a form to calculate an employee’s necessities obtained from BKN. The results of calculation of a nurse’s necessities showed that number of nurses required for an inpatient unit were nine persons consisted of five skilled nurses and four expert nurses. This number was equal to nine beds that were required (1:1). On the other hand, number of nurses required for an outpatient unit including BP, UKM, and Pustu were 26 persons (16 skilled nurses and 10 expert nurses) or 1 nurse served 1,458 people or 456 families. Rembang 2 Health Centre needs to fulfil a nurse’s necessities by considering innovation of nursing services to reduce burden of human resource. A nursing committee needs to be formed by District Health Office as an institution that is responsible to supervise functional positions. Standards of nursing diagnosis and an information system of nursing care services need to be determined in order to describe an autonomy level of individual, family, group, and community in District of Rembang in terms of self-care. In addition, academics need to conduct further research regarding workload of other functional positions in health in order to achieve goals of national health development.
Analisis Kepuasan Pasien Dilihat dari Minat untuk Dirawat Kembali Terhadap Pelayanan Dokter dan Perawat Masruron, Lailil; Kuntjoro, Tjahjono; Kartasurya, Martha Irene
Jurnal Manajemen Kesehatan Indonesia Vol 7, No 2 (2019): Agustus 2019
Publisher : Prodi Magister Ilmu Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat Undip

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (263.188 KB) | DOI: 10.14710/jmki.7.2.2019.81-87

Abstract

Title :Patient Satisfaction To Doctor’s And Nurse’s Care Associated To The Interest To Be Rehospitalized (A study at RSUD Dolopo, Madiun Regency). AbstractBed Occupancy Rate (BOR) at Dolopo Public Hospital had decreased from 56.16% in 2013 to 35.86% in 2104 and 35.2% in 2015, and the average ALOS (Average Length of Stay) and Turn over Interval (TOI) increased. The preliminary study on patients of Social Security Agency (BPJS Non PBI) showed a dissatisfaction to nurse’s and doctor’s services. The aim of this study was to analyze the associations between patient satisfaction toward doctor’s & nurse’s services to the interest to be rehospitalized.This study was conducted in a cross sectional design. The subjects were 95 patients of  BPJS with Non PBI in inpatient room for class I, II, III, which was choosen by using accidental sampling. Data were gathered through interviews using structured questionnaires. Data analysis was conducted by Chi-square tests and logistic regression.Results showed that the patient satisfaction based on aspects of tangibles, reliability, responsiveness, assurance, and empathy were lower than the expectations. Most of the subjects have positive attitudes, negative subjective norms and perceptions of behavior control and had a poor accesibility to the hospital. However 75.8% of the respondents were interested to be rehospitalized at Dolopo Hospital. There were correlations between patient satisfaction (p=0.009), attitude (p=0.000), subjective norm (p=0.002) with the interest to be rehospitalized. There was no correlation between control perception behavior (p=0.103), and access (p = 0.454) with the interest to be rehospitalized. After controlled for the attitude toward doctors’ and nurses’ services, the patients who were satisfied to the doctor’ and nurses’ services had 3.84 times to be interested to be rehospitalized than the patients who were not satifsfied (OR = 3.84 ; CI 95% : 0.98-15.12, p=0.054).Keywords       : Patient Satisfaction, Rehospitalized, BPJS.