Implementasi Program Manajemen Terpadu Balita Sakit (MTBS) Puskesmas Wilayah Kabupaten Pasuruan

Abstract

Pada tahun 2006 sosialisasi program MTBS dan pelatihan kepada petugas puskesmas telah dilakukan, dimana masing-masing Puskesmas diwakili oleh 1 orang tenaga medis (dokter) dan 2 orang tenaga paramedis(bidan, perawat). Akan tetapi kematian balita di kabupaten Pasuruan mengalami kenaikan, yaitu tahun 2007 sebesar 5,2/1000 kelahiran hidup, tahun 2008 sebesar 5,4/1000 kelahiran hidup dan tahun 2009 sebesar 6,1/1000 kelahiran hidup. Darikematian tersebut diketahui penyebabnya antara lain karena gizi buruk, pneumonia, DBD,diare serta infeksi. Oleh karena itu perlu dilakukan analisis terhadap faktor faktor dalam implementasi program MTBS di Puskesmas Kabupaten Pasuruan. Jenis penelitian adalah deskriptif kualitatif, metode sampling yang digunakan adalah purposive sampling. Sebagai informan utama adalah petugas MTBS (dokter, bidan, perawat) di Puskesmas wilayah
perkotaan dan pinggiran kota yang melakukan MTBS, berjumlah 12 orang. Sedangkan sebagai informan triangulasi adalah 4 kepala Puskesmas, satu Kasie Kesga Dinas Kesehatan Kabupaten Pasuruan. Variabel dalam penelitian ini adalah faktor komunikasi, faktor sumber daya, faktor disposisi, serta faktor struktur birokrasi. Penelitian memberikan hasil sosialisasi dan pelatihan program MTBS sudah dilakukan. Petugas yang melayani balita sakit belum menunjang keberhasilan pencapaian tujuan MTBS oleh karena belum semua petugas mendapatkan pelatihan MTBS, jumlah petugas tidak sebanding dengan jumlah balita sakit
yang berkunjung. Seluruh petugas MTBS mempunyai sikap positif untuk mendukung program MTBS. Meskipun sudah tersedia SOP namun tidak semua petugas menggunakannya dalam melayani MTBS. Pembinaan dari DKK belum dilakukan rutin, supervisi masih bersifat umum, serta tidak ada tindak lanjut yang diberikan. Agar pelayanan MTBS terlaksana dengan baik maka perlu ditingkatkan sosialisasi SOP yang disertai pelatihan yang merata
untuk semua petugas serta supervisi yang spesifik pada MTBS.

Data in 2007-2010 showed that integrated management of childhood illness (IMCI) activities increased. However, IMCI coverage had not reached the target established by Pasuruan district health office, which was 80%. Preliminary study indicated that not all under-five children who visited health centers received IMCI services. It was caused by no availability of IMCI facilities, unscheduled supervision, and no feedback. The objective of this study was to explain IMCI program implementation from policy aspect in primary healthcare centers in Pasuruan district.
    This was an observational qualitative study with cross sectional approach. Study population was all primary healthcare centers that performed IMCI in Pasuruan district. Main informants were IMCI team that consisted of physicians, midwives, nurses. Triangulation informants were policy makers such as head of primary healthcare center, head of family health section, and consumers.
    Results of the study showed that in 4 primary healthcare centers with high IMCI coverage, communication had been performed (socialization and marketing); however, there was no specific organizational structure (unstructured). Viewed from resources side, not all human resource received IMCI training; not all facilities of IMCI were fulfilled; specific funding for IMCI program was not allocated. In relation to disposition, all workers had positive attitude in supporting IMCI program. Bureaucracy structure was not optimal; there was a standard operating procedure, but it was not implemented correctly in practice.  There was recording and reporting, but routine supervision and feedback was not performed.
    Based on the results of study, it was suggested and recommended to keep doing IMCI program socialization, human resource improvement, facility fulfillment, improvement of workers by conducting IMCI training, implementing arrangement for reporting and recording to district health office, improvement in supervision quality by giving feedback to district health office.