Analysis on Low Rate Utilization of Delivery Services by Health Workers at Wakaokili Community Health Center in Buton Regency

Abstract

Pemanfaatan layanan persalinan tenaga kesehatan di Indonesia masih rendah terutama di daerah pedesaan. Kondisi ini juga terjadi pada masyarakat di wilayah kerja Puskesmas Wakaokili Kabupaten Buton, dimana pada saat hamil sebagian besar ibu memeriksakan diri ke bidan tetapi saat bersalin lebih memilih dukun. Pemerintah telah melakukan berbagai upaya meningkatkan minat masyarakat untuk bersalin pada tenaga kesehatan namun sampai saat ini belum mencapai hasil yang diinginkan. Untuk itu penelitian ini dirancangan dengan pendekatan kualitatif, metode studi kasus guna memahami alasan yang melatar belakangi rendahnya pemanfaatkan layanan persalinan oleh masyarakat. Pengumpulan data dengan wawancara menggunakan pedoman wawancara dan observasi langsung pada layanan kesehatan. Jumlah informan utama 36 orang terbagi dalam 2 kelompok yaitu kelompok sasaran langsung program meliputi ibu bersalin oleh bidan, dukun dan oleh keluarga beserta para suami. Serta kelompok sasaran tidak langsung program yaitu Toma/Toga dan kader kesehatan. Adapun informan triangulasi bidan, dukun dan kepala Puskesmas Wakaokili serta Kabid Kesga DKK Buton. Hasil penelitian diketahui bahwa alasan yang melatarbelakangi rendahnya pemanfaatkan layanan persalinan tenaga kesehatan yaitu karena mereka tidak mengenal bidan di desa, karena tidak memahami manfaat persalinan oleh tenaga kesehatan, biaya di dukun lebih terjangkau dan karena bidan tidak selalu ada saat dibutuhkan. Selain itu adanya kepercayaan masyarakat bahwa lancar tidaknya persalinan bukan ditentukan oleh penolong persalinan tetapi oleh perbuatan ibu semasa hamil. Juga adanya keyakinan terhadap doa-doa yang dimiliki oleh dukun atau suami menyebabkan masyarakat selalu menyertakan dukun dalam kehamilan dan persalinan guna kelancaran proses persalinan. Untuk itu diharapkan bidan lebih aktif melakukan pendekatan pada warga binaanya. Juga puskesmas dan kepada Dinas Kesehatan untuk melakukan upaya peningkatan pengetahuan masyarakat, kapasitasi dan pembinaan dukun dan juga mengkaji ulang insentif bagi bidan dalam rangka peningkatan kunjungan pada bumil baik di rumah maupun yang di kebun.

    Utilization of delivery service by health workers in Indonesia was still low especially in rural areas. This condition occurred in communities in the work area of Wakaokili primary healthcare center (puskesmas) Buton district. Most of pregnant women in this community did antenatal care to midwives, however they chose traditional delivery assistant (dukun bayi) to assist their delivery process. Government had done many efforts to increase community interest to give birth with health workers assistance. However, this effort had not reached what was expected. This was a case study with qualitative approach. Objective of the study was to understand the background for low utilization of delivery services by the community. Data were collected through interview guided by interview guideline, and direct observation in the health services. The number of main informants was 36 people. They were divided into 2 groups. Those groups were direct target program group that included post-delivery women assisted by midwives, dukun bayi, and house member including husbands; indirect target program group consisted of community leaders and cadres. Triangulation informants were midwives, dukun bayi, the head of Wakaokili primary healthcare center, and the head of family health department of Buton district health office. Results of the study showed that background for the low utilization of delivery services by health workers was that community did not know village midwives; community did not understand benefits of giving birth assisted by health workers; the cost of giving birth assisted by dukun bayi was affordable; midwives were not always ready when needed. In addition, there was a stigma that smoothness of delivery process was not determined by who assisted the delivery but by what had been done by the mothers during pregnancy. Furthermore, there was a belief towards praying words spoken by dukun bayi or husbands; this was one of reasons why dukun bayi was included in the delivery process. They believed that dukun would make the delivery process success. Midwives are expected to be more active to approach their supervised community. Primary healthcare center and district health office are suggested to do efforts to improve community knowledge, to train and assist dukun, and to review the incentive for midwives in order to be able increase the number of visits to pregnant women in their house or in the field.