Faktor-Faktor yang Mempengaruhi Tidak Terlaksananya Manajemen Terpadu Balita Sakit di Puskesmas Sentani Kota Kabupaten Jayapura Tahun 2013

Abstract

Background: According to Riset Kesehatan Dasar (Riskesdas) year 2010, the infant mortality rate per 1,000 live births was 36-41 and under five mortality rate per 1,000 live births was amounted at 62-64 . Based on the profile of Jayapura District Health Office in 2009 , the infant mortality rate per 1,000 live births was 12.99 and the maternal mortality rate per 1,000 live births was 6 and the prevalence of malnutrition among children under five years was 3.20 % . Based on the data collected from the regular reports done by Provincial Health Offices throughout Indonesia in the National Summit of Child Health Programs in 2010 , the number of health centers implementing integrated management of childhood illness (IMCI) until the end of 2009 was amounted to 51.55 % , but not all health centers were able to implement IMCI approach for various reasons , among others : lack of health personnel having trained IMCI; the health personnel has been trained but the infrastructure was not yet ready; lack of commitment or policy of the leadership of the health center , and others. Objective: The objectives of the research were to analyze further the factors affecting the implementation failure of Integrated Management of Childhood Illness ( IMCI ) in Sentani Health Center, Jayapura. Method: The research was qualitative method. The research population were the DHO officers and health center staff who have been involved in IMCI service, while the samples taken were 5 informants . The sampling technique was non- random purposive sampling. Result: The results showed that IMCI was not implemented in Sentani health centers due to the unbalance number of officers who deal with infants / toddlers; due to double jobs done by IMCI-trained personnel, the trained personnel were moved to different health centers; or the trained personnel continued their education. IMCI failed to be implemented in the health center was also due to the termination of procuring IMCI supporting facilities at Sentani health center by Jayapura District Health Office, and lack of quality of the facilities for handling infants / toddlers provided by Jayapura District Health Office . IMCI was failed to be implemented in the health center which is also caused by the absence of Sentani policy (implementation guidance and technical advice) regarding the implementation of IMCI in health centers . Others factor for IMCI not being implemented in Sentani health center was due to the limited funds from the local budget which could not support all activities of the organization of IMCI such as training , supervision and evaluation to the officers . Conclusion: IMCI in health centers Sentani is not implemented due to the factors of human resources, infrastructure , policies , budgets , officers’ habits, patient satisfaction towards the conventional methods (non IMCI), as well as the lack of supervision by District Health Office on the IMCI implementation in the health center.

Latar belakang: Menurut Riset Kesehatan Dasar (Riskesdas) tahun 2010, angka kematian bayi per 1000 kelahiran hidup adalah sebesar 36-41 dan angka kematian balita per 1000 kelahiran hidup adalah sebesar 62-64. Berdasar profil Dinas Kesehatan Kabupaten Jayapura tahun 2009, angka kematian bayi per 1000 kelahiran hidup adalah sebesar 12,99 dan angka kematian ibu per 1000 kelahiran hidup adalah sebesar 6 serta prevalensi gizi kurang pada anak balita adalah 3,20%. Menurut data laporan rutin yang dihimpun dari Dinas Kesehatan Propinsi seluruh Indonesia melalui pertemuan nasional program kesehatan anak tahun 2010, jumlah Puskesmas yang melaksanakan MTBS hingga akhir tahun 2009 sebesar 51,55%, namun belum seluruh Puskesmas mampu menerapkan pendekatan MTBS karena berbagai sebab, antara lain : belum adanya tenaga kesehatan yang sudah terlatih MTBS, sudah ada tenaga kesehatan terlatih tetapi sarana dan prasarana belum siap, belum adanya komitmen atau kebijakan dari pimpinan Puskesmas, dan lain-lain. Tujuan: untuk menganalisis faktor-faktor yang mempengaruhi tidak terlaksananya Manajemen Terpadu Balita Sakit (MTBS) di Puskesmas Sentani Kabupaten Jayapura Metode: adalah metode kualitatif. Populasi dalam penelitian adalah petugas Dinas Kesehatan Kabupaten dan petugas Puskesmas yang pernah terlibat dalam pelayanan MTBS, sedangkan sampel yang diambil adalah sebanyak 5 orang informan. Cara pengambilan sampel yang digunakan adalah Non random sampling dengan teknik purposive sample. Hasil: penelitian menunjukkan bahwa tidak terlaksananya MTBS di Puskesmas Sentani dikarenakan tidak seimbangnya jumlah petugas yang menangani bayi/balita sakit dikarenakan petugas terlatih MTBS melaksanakan tugas rangkap, petugas terlatih pindah tugas dan atau petugas terlatih melanjutkan pendidikan. Tidak terlaksananya MTBS di Puskesmas Sentani dikarenakan terhentinya pengadaan sarana penunjang pelaksanaan MTBS dari Dinas Kesehatan Kabupaten Jayapura kepada Puskesmas Sentani dan tidak berkualitasnya sarana/fasilitas penanganan bayi/balita yang diberikan oleh Dinas Kesehatan Kabupaten Jayapura. Tidak terlaksananya MTBS di Puskesmas Sentani dikarenakan tidak adanya kebijakan (petunjuk pelaksanaan dan petunjuk teknis) mengenai pelaksanaan MTBS di Puskesmas. Tidak terlaksananya MTBS di Puskesmas Sentani dikarenakan dana yang bersumber dari dana APBD tidak dapat menunjang seluruh kegiatan MTBS berupa penyelenggaraan pelatihan, supervisi hingga evaluasi terhadap petugas. Kesimpulan: MTBS di Puskesmas Sentani tidak terlaksana dikarenakan faktor SDM, sarana prasarana, kebijakan, anggaran, kebiasaan petugas, kepuasan pasien terhadap metode konvensional, serta terhentinya supervisi dari Dinas Kesehatan Kabupaten terhadap pelaksanaan MTBS di Puskesmas.