Management of High Risk Pregnancy Early Detection on Antenatal Care at Primary Health Care in Jepara District

Abstract

Angka Kematian Ibu di Jepara tahun 2012 menduduki peringkat ke 10 di Jawa Tengah sebesar 21 per 100.000 kelahiran hidup. Penyebab terbanyak preeklamsi berat 8 orang (30%). Data PWS KIA menunjukkan cakupan deteksi dini risiko tinggi oleh tenaga kesehatan tahun 2012 sebesar 19,01%, belum mencapai target nasional. Tujuan penelitian ini untuk mengetahui manajemen deteksi dini ibu hamil risiko tinggi pada pelayanan antenatal di tingkat puskesmas Kabupaten Jepara. Jenis penelitian ini adalah kualitatif. Variabel pada penelitian ini adalah input (SDM, dana, sarana, SOP), Proses (perencanaan, pembinaan, supervisi dan monitoring) dan Output. Informan utama adalah kepala Puskesmas dan Bidan koordinator. Informan triangulasi adalah Kasi Kesga (kepala seksi kesehatan keluarga) dari DKK (Dinas Kesehatan Kabupaten) dan 16 bidan desa. Pengumpulan data dilakukan melalui wawancara mendalam dan Focus Group Discussion. Pengolahan data dilakukan dengan metode analsis isi (content analysis). Hasil penelitian menunjukkan bahwa Puskesmas dengan cakupan rendah mempunyai rasio bidan per penduduk yang rendah, SOP belum ditempel, perencanaa dilaksanakan per tahun, pembinaan dilakukan setiap 6 bulan dan umpan balik hasil supervisi disampaikan secara lisan. Puskesmas dengan cakupan tinggi juga mempunyai rasio bidan per penduduk masih rendah, perencanaan dilaksanakan per bulan melalui lokakarya mini, pembinaan dilakukan per bulan, umpan balik supervisi disampaikan secara tertulis serta ada sangsi apabila laporan terlambat. Disimpulkan bahwa manajemen deteksi dini ibu hamil risiko tinggi dipengaruhi oleh perencanaan, pembinaan, dan supervisi/ monitoring. Disarankan kepada puskesmas untuk melakukan perencanaan dan pembinaan per bulan serta supervisi dan monitoring secara lebih intensif.

Maternal Mortality Rate in Jepara District in 2012 placed the 10 th rank in Central Java, namely 21 per 100.000 live births. Severe preeclampsia was the most common cause, namely 8 persons (30%). Data of Local Area Monitoring in 2012 showed that coverage of high risk early detection by health workers was only 19.01% and had not achieved the national target yet. This research aimed to identify early detection management of a high risk pregnant woman on Antenatal Care services at health center in District of Jepara. This was qualitative research. Research variables were Input (human resources, funds, means, and Standard Operating Procedure), Process (planning, actuating, supervising, and monitoring), and Output. Main informants were head of health center and midwife coordinator. In addition, informants for triangulation purpose were head of family health section at District Health Office and 16 village midwives. Data were collected by conducting indepth interview and Focus Group Discussion. Furthermore, data were analyzed using a method of content analysis. The result of this research revealed that at health centers with low coverage, ratio between midwife and population was low, Standard Operating Procedure had not been displayed, planning was arranged annually, actuating was done every six month, and feedback of supervision results was informed verbally. In contrast, health centers with high coverage indicated that ratio between midwife and population was low, planning was arranged monthly through mini workshop, actuating was done every month, feedback of supervision results was informed in writing, and there also was any punishment if a report was late to submit. As a conclusion, early detection management of a high risk pregnant woman was influenced by planning, actuating, and supervising/monitoring. As a suggestion, head of health center needs to make a plan and actuate every month, and also supervise and monitoring intensively.