Analysis on Determinants of Pulmonary Tuberculosis Officer Motivations In Tuberculosis Case Invention in Semarang Regency (A Case Study in Several Primary Health Care Centers)

Abstract

Penderita Tuberkulosis dengan status Basil Tahan Asam (BTA) positif dapat menularkan ke 1015 orang lain setiap tahunnya, sehingga penemuan kasus penting dilaksanakan. Cakupan penemuan kasus tuberkulosis dengan BTA positif di Kabupaten Semarang tahun 2009 jauh di bawah cakupan nasional. Rendahnya disebabkan karena motivasi petugas yang kurang. Tujuan penelitian ini untuk menganalisis faktor yang dapat menurunkan motivasi petugas TB dalam  penemuan kasus di Kabupaten Semarang. Penelitian dilakukan dengan metode kualitatif.  Pengumpulan data primer dilakukan dengan wawancara mendalam, dan data sekunder dengantelaah dokumentasi. Subjek penelitian adalah petugas Tuberkulosis Paru di Puskesmas.  Pemilihan subjek dilakukan secara purposive. Informan utama berjumlah 18 orang, terdiri dari 6 orang perawat, 6 orang Analis dan 6 orang dokter kepala Puskesmas. Informan triangulasi adalah 6 orang petugas BP, dan satu orang Kasie P2M Dinkes Kabupaten Semarang. Analisis data dilakukan dengan content analysis. Hasil penelitian menunjukkan bahwa motivasi  petugas rendah karena pekerjaannya merupakan penunjukkan pimpinan Puskesmas dan membutuhkan waktu yang lama serta berisiko tertular oleh penderita. Tanggung jawab dalam menyelesaikan pekerjaan kurang karena beban pekerjaan yang banyak, bekerja tanpa target dan motivasi. Petugas tidak mendapatkan kompensasi, membutuhkan dukungan dari pimpinan untuk mengeluarkan ide dan gagasan dalam penemuan kasus. Sarana transportasi untuk penemuan kasus tidak ada. Puskemas tidak memiliki rencana implementasi kebijakan program penemuan kasus, dan sistem supervisi terhadap cakupan penemuan kasus belum optimal. Disimpulkan bahwa motivasi petugas Tuberculosis Paru dalam penemuan kasus masih rendah, karena belum ada dukungan dan tanggung jawab masih kurang serta sistem kompensasi dan supervisi yang belum ada.

Tuberculosis patients with positive acid fast bacilli (BTA) were able to infect 10-15 other people every year; therefore case detection was important to be implemented. Detection coverage of tuberculosis cases with positive BTA in Semarang district was far below national coverage. This low coverage could be caused by low motivation of tuberculosis (TB) health workers. Objective of this study was to analyze factors that decreased motivation of TB workers in conducting case detection in Semarang district. This was a qualitative study. Primary data collection was done by conducting in-depth interview; secondary data collection was done by conducting documentation review. Study subjects were lung tuberculosis workers in the primary healthcare centers. Subjects were purposively selected. The number of main informants was 18 people. The main informants were six nurses, 6 analysts, and six heads of primary health care centers. Triangulation informants were six polyclinic health workers, and one head of communicable disease control unit of Semarang district health office. Content analysis method was applied in the data analysis. Results of the study showed that motivation of TB workers was low due to the works were assigned by the primary healthcare centers leader, the work took longer time, and workers were at risk to get infection from patients. Responsibility to finish the works was low due to high amount of workload, work without target and motivation. TB workers did not get compensation; they needed support from the leader to express their ideas in the case detection. Transportation facility for case detection was not provided. The primary healthcare centers did not have planning to implement case detection program policy. Supervision system on case detection coverage was not optimal. In conclusion, motivation of lung tuberculosis workers in case detection was low. It was caused by no supports, insufficient responsibility, and no compensation and supervision.