Factors that Affect the Performance of the Village Midwife in the Standard Implementation of Midwifery Birthing Mothers and Orphans in Semarang

Abstract

Abstrak

Salah satu indikator pelayanan kesehatan yang berkualitas dapat terlihat dari perbandingan AKI (Angka Kematian Ibu ) dan AKB ( Angka Kematian Bayi ). Di Kabupaten Semarang , AKI tahun 2010 mencapai 101, 92/ 100.000 kelahiran hidup,dan pada tahun 2011 naik menjadi 146,24/100.000 kelahiran hidup. Penyebab langsung kematian ibu 90 % disebabkan karena persalinan dan segera setelah persalinan. Penyebab kematian ibu diantara lain perdarahan (52%), ekalmasi (18 %), infeksi (15 %), persalinan lama (15 %). Untuk menurunkan angka kematian ibu, harus dilakukan pelayanan kesehatan maternal yang berkualitas sesuai dengan standar asuhan. Pelaksanaan standar asuhan di Kabupaten semarang belum dilaksanakan dengan baik. Tujuan penelitian adalah untuk menganalisis faktor-faktor yang mempengaruhi kinerja bidan desa dalam penerapan standar asuhan kebidanan ibu bersalin oleh bidan desa di Kabupaten Semarang. Jenis penelitian adalah observasional analitik dengan pendekatan crosssectional.

Cara pengambilan data dilakukan dengan wawancara menggunakan kuesioner. Populasi adalah 311 bidan desa di Kabupaten Semarang. Pengambilan sampel dipilih dengan tehnik proportional random sampling dari bidan desa yang memenuhi kriteria inklusi dan eksklusi pada tiap puskesmas. Analisis data dilakukan dengan uji product moment dan regresi linier.Hasil penelitian menunjukkan bahwa bahwa rerata umur responden 33 tahun, dengan rerata masa kerja 11 tahun, pendidikan responden sebagian besar D III kebidanan (72,36 %). Hasil analisis univariat menunjukkan bahwa kinerja bidan desa dalam penerapan standar asuhan kebidanan ibu bersalin fisiologis adalah kurang (83 %), kinerja bidan dalam penerapan standar asuhan kebidanan ibu bersalin patologi kurang (87%), pengetahuan kurang (57 %), motivasi tinggi (51%), persepsi supervisi kurang (55 %), persepsi beban kerja rendah (57 %), persepsi imbalan kurang (57 %), persepsi sanksi kurang (55 %). Faktor yang berhubungan dengan kinerja adalah pengetahuan (nilai p = 0,000), motivasi (nilai p =0,007), persepsi supervisi ( nilai p = 0,008), persepsi beban kerja (nilai p =0,012), persepsi imbalan (nilai p = 0,000), persepsi sanksi (nilai p = 0,000). Faktor yang berpengaruh terhadap kinerja bidan desa dalam penerapan standar asuhan kebidanan ibu bersalin adalah pengetahuan (p = 0,000), persepsi beban kerja (p = 0,027), persepsi sanksi (p = 0,000).

Saran bagi Dinas Kesehatan Semarang adalah sosialisasi tentang pelayanan ibu bersalin sesuai standar asuhan kebidanan kepada seluruh bidan desa, Memperbaiki teknik supervisi yang diterapkan antara lain dengan penyusunan jadwal supervisi dan kesepakatan waktu antara supervisor dan staf tentang pelaksanaan supervisi.

Abstract

In Semarang district, maternal mortality rate (AKI) increased from 101.92/ 100000 live-births in 2010 to 146.24/100000 live-births in 2011. The majority of death patients were caused by referral delay and a delay in detection of in labour emergency signs. This indicated that the implementation of obstetric standard care in Semarang district was not done properly. Objective of the study was to analyze factors affecting work performance of village midwives in the application of obstetric standard care for in labour mothers in Semarang district.

This was an observational analytical study with cross sectional approach. Data were collected through interview guided by questionnaire. Study population was 311 village midwives in Semarang district. The number of respondents was 76 midwives selected purposively according to inclusion and exclusion criteria in each primary healthcare center. Product moment test and linear regression were applied in the data analysis.

Results of the study showed that average age of respondents was 33 years old, average working period was 11 years old, majority of respondent’s education background was D III in midwifery (72.36%). Work performance of village midwives in the implementation of obstetric standard care for physiological mother in labour was insufficient (83%), work performance of village midwives in the implementation of obstetric standard care for pathological mother in labour was insufficient (87%), respondents with insufficient knowledge was 57%, respondents with high motivation was 51%, respondent’s perception on supervision was inadequate (55%), respondent’s perception on workload was low (57%), respondent’s perception on incentive was insufficient (57%), and respondent’s perception on sanction was inadequate (55%). Factors related to work performance of village midwives were knowledge (p= 0.000), motivation (p= 0.007), perception on supervision (p= 0.008), perception on workload (p= 0.012), perception on incentive (p= 0.000), perception on sanction (p= 0.000). Factors affecting work performance of village midwives in the implementation of obstetric standard care for in labour mothers were knowledge (p= 0.000), perception on workload (p= 0.027), perception on sanction (p= 0.000). Suggestions for Semarang district health office are to conduct refreshing on maternity services according to obstetric standard care to all village midwives, to improve supervision technique by implementing facilitative supervision.