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ABSTRAK
Angka Kematian Ibu (AKI) dan Angka Kematian Bayi (AKB) merupakan indikator yang lazim digunakan untuk menentukan derajat kesehatan masyarakat. Salah satu kebijakan Departemen Kesehatan dalam akselerasi penurunan AKI dan AKB antara lain dengan merintis pembentukan puskesmas PONED. Terdapat 21 Puskesmas PONED di Kabupaten Deli Serdang dan telah mendapat intervensi program EMAS sejak tahun 2012, tetapi AKI masih tinggi. Di Puskesmas Talun Kenas yang telah diintervensi EMAS dilaporkan AKI sebesar 125/100.000 kelahiran hidup dan Puskesmas Hamparan Perak yang belum diintervensi EMAS dilaporkan AKI sebesar 39/100.000 kelahiran hidup.
Tujuan penelitian ini adalah melakukan analisis mutu pelayanan bagi ibu bersalin di puskesmas PONED, Kabupaten Deli Serdang. Penelitian ini dilakukan dengan metode kualitatif melalui wawancara mendalam. Tempat penelitian yaitu Puskesmas Talun Kenas dan Puskesmas Hamparan Perak. Informan dalam penelitian ini adalah kepala bidang kesehatan keluarga Dinas Kesehatan Kabupaten Deli Serdang, kepala puskesmas, bidan koordinator, petugas terlatih PONED dan masyarakat pengguna layanan PONED di dua puskesmas tersebut.
Dari hasil penelitian didapatkan bahwa sosialisasi program PONED masih belum dilakukan dengan baik, jumlah tenaga terlatih PONED masih kurang, kualitasnya juga masih kurang, pelatihan PONED masih kurang. Sarana dan prasarana pendukung PONED masih belum memadai untuk puskesmas yang belum diintervensi oleh EMAS. Pembinaan khusus dari dinas kesehatan kabupaten mengenai pelaksanaan PONED masih kurang. Prosedur rujukan pasien kegawatdaruratan belum dilakukan dengan baik. Tidak adanya alokasi dana khusus untuk pelaksanaan PONED di puskesmas. Sementara itu untuk Puskesmas Talun Kenas telah memenuhi semua aspek mutu pelayanan sedangkan Puskesmas Hamparan Perak mutu pelayanannya masih kurang baik.
Saran agar Dinas Kesehatan Kabupaten lebih memperhatikan pembinaan ke puskesmas PONED yang ada di Kabupaten Deli Serdang termasuk mengadakan pelatihan, menambah sarana dan prasarana PONED serta mengadakan evaluasi untuk perbaikan mutu pelayanan selanjutnya. Untuk program EMAS sebaiknya direplikasikan ke seluruh puskesmas PONED yang ada di Kabupaten Deli Serdang sehingga tidak ada kesenjangan mutu pelayanan yang diberikan oleh semua puskesmas PONED
Kata Kunci : Puskesmas, Pelayanan Obstetri Neonatal Emergensi Dasar, Mutu Pelayanan
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ABSTRACT
Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) is an indicator which is commonly used to determine public health standard. One of the policies of the Department of Health in accelerating the decrease in MMR and IMR is, among others, by pioneered the establishment of PONED puskesmas (public health center). There are 21 PONED Puskesmas in Deli Serdang District and 10 of them which had been intervened by EMAS program since 2012 but MMR is still high. Talun Kenas Puskesmas which had been intervened by EMAS program and reported 125/100.000 live births for MMR, while Hamparan Perak which had not yet intervened by EMAS program reported 39/100.000 live births for MMR.
The objective of the research was to analyze the service quality for mothers who give birth at PONED Puskesmas, Deli Serdang District. The research used qualitative method by conducting in-depth interviews. It was conducted at both Talun Kenas Puskesmas and Hamparan Perak Puskesmas. The informants were the head of family health of the health service of Deli Serdang District, the head of puskesmas, midwife coordinators, trained personnel of PONED, and those who used PONED service at both puskesmas.
The result of the research showed that the socialization of PONED program was not conducted properly, the number of trained PONED personnel was inadequate, its quality was also inadequate, and PONED training was inadequate. The supporting equipment and infrastructure of PONED was inadequate for puskesmas which had not yet intervened by EMAS. Special guidance by the District Health Office about the implementation of PONED was inadequate. The procedure of the reference for emergency patients was not done adequately. There was no special grant for the implementation of PONED at puskesmas. Talun Kenas Puskesmas had had all of the quality aspects, while Hamparan Perak Puskesmas had not had quality aspects.
It is recommended that the District Health Service pay more attention to the development of PONED puskesmas in Deli Serdang District by conducting training, adding equipment and infrastructure of PONED, and evaluating the next service quality improvement. Besides that, EMAS program should be replicated to all PONED puskesmas in Deli Serdang District so that there will be no discrepancy in service quality given by all PONED puskesmas.
Keywords: Puskesmas, Service in Basic Emergency of Obstetrics and Neonatal, Service Quality
