DETERMINAN KINERJA PELAYANAN KESEHATAN IBU DAN ANAK DI RUMAH SAKIT PEMERINTAH INDONESIA (ANALISIS DATA RIFASKES 2011)

Abstract

Background: The hospital has quite an important role in
reducing IMR and MMR because hospitals as providers of
plenary personal health services including maternal and child
health (MCH). However, until now the IMR and MMR Indonesia
is still high compared to other ASEAN countries. The main
causes of maternal mortality are obstetric complications or
disease as a complication that arises during pregnancy, childbirth
and postpartum. This factor was experienced by approximately
20% of all pregnant women, while complication cases that
were treated well are less than 10%.
Objective: The research aims to identify the effect of hospital
characteristics, management of MCH services, human
resources for MCH, MCH services, and MCH equipment on the
performance of MCH services in government hospitals in
Indonesia.
Methods:Research is using secondary data of Health Facilities
Research 2011 (RIFASKES) with a cross sectional study.
Population and sample is the entire Indonesian government
hospitals (685 hospitals). The research variables were
identified from the available variables in the questionnaire
RIFASKES. Performance measurement of the composite
variable proportion of maternal deaths due to hemorhage d”
1%, d” 10% pre-eclampsia, sepsis d” 0.2%, d” 20% secaria
section, the proportion of stillborn d” 4%, and the proportion of
LBW handling 100% based SPM hospital. Multivariate logistic
regression was used to obtain a model determinants of
performance MCH services.
Results: The majority (66.3%) government hospitals in
Indonesian has less than optimal performance. As the
determinant is unaccredited status (OR = 2.99: 1.43 to 6.28),
the hospital is not a vehicle of education (OR = 1.78; 1.11 to
2.85), team PONEK is incomplete (OR = 1.89; 1.27 to 2.82),
there is no PONEK-trained doctor in the ER (OR = 1.89; 1.27 to
2.82), there is no team ready to perform the operation or task
though on call (OR = 2.16; 1.32 to 3.53). The most dominant
factor is the unaccredited status.
Conclusions: Suboptimal performances of MCH at Indonesian
government hospitals are influenced by the low hospital service
characteristics and incomplete of human resources. The
Ministry of Health needs to support improvement in all types of
services to complete an accredited hospitals (16 types of
services), not just 5 or 12 services. They also need to make
the government hospital as a vehicle of education, increase
the quantity and quality of human resources are trained in
PONEK-skill, ensure availability of PONEK-trained doctor in
emergency, provide the team that are ready to perform the
operation or task though on call, and increase organizational
commitment to overall performance improvement.
Keywords: Performance, Maternal and Child Health Services,
Government Hospital