Buletin Penelitian Sistem Kesehatan

1-9

Authors: Joko Irianto and Suharjo

Backgroud: The health problems can be described on the number of Maternal Mortality (MMR), the higher of MMR to indication of so many health problems. Maternal mortality is closely related to access of quality health care. Quality access will provide opportunities for mothers to get prenatal care, aid delivery, and good treatment. Public health care is health facilities early referral of maternal care in villages, and then Public health care will be referred to a PONEK hospital if necessary. Objective: To knows the difference that maternal health services are carried out in PONED and non PONED Public health centers. Methods: To combine datas of Village Potential 2011, Maternal Mortality Follow-Up Study of Population Census 2012 and Research Health Facilities 2011 for analysis. Field confi rmation in two health centers and two hospitals in Bekasi and Bogor cities for cases maternal death of during pregnancy, during childbirth, miscarriage, and after birth (postnatal). Results: The hospitals can prevent maternal death during pregnancy or during childbirth. At public health care, the risk for maternal death during childbirth is higher than postnatal OR = 1.9 (CI: 1.22 to 3.0), maternal death during pregnancy and miscarriage in PONED is higher than Non PONED but not signifi cant (p > 0.05). At public health care not PONED, birth attendants is a factor in the recommendation to referral (p < 0.05). Conclution: The hospital facilities are able to PONEK the best services for mothers who need obstetric treatment. The midwives are important to reducing maternal mortality, they should be closer access to birth attendants and to perform appropriate referrals. Recommendation: The hospitals are need to be reinforced services capable PONEK and within easy reach from public health centers.

21-31

Authors: Aryo Ginanjar, Arih Diyaning Intiasari, and A. R Siswanto Budi Wiyoto

Background: Implementation of Puskesmas function as the center of society empowerment was done through the development of UKBM in work region of Puskesmas. This research aims to know the role of Puskesmas leader in Purbalingga District, Central Java Province in the implementation of Puskesmas function as the the center of society empowerment through development of UKBM. Role of Puskesmas leader that were analyzed in this research were role of motivation, communication, leadership, guidance, observation and supervision. Methods: The mainsubject of this research were 7 leaders of Puskesmas in Purbalingga District. The supporting subject were 7 people worked as Health Promotor in 7 Puskesmas and 1 person worked as Head of Society Empowerment and Health Promotion Divition Purbalingga District. Research type is descriptive with qualitative approach. Results of indepth interview, observation, and document analysis showed that the knowledgeof the Puskesmas leader in Purbalingga District concerning Puskesmas function as the center of society empowrement represent the Health Paradigm through facilities in the form of UKBM as the active participation from society to increase health degree of Indonesian society. Results: The role of Puskesmas leader in aspects of motivation, communication, guidance, supervise, and development of UKBM had been done well. The leadership role was applied by the combination of Democratic and Autoritary style of leadership. The difference of the role between Puskesmas leaders from medical background and nonmedical background was found insupervision aspect. Conclusion: Department of Health needs to undertake human resource development in the health center which has a dual leadership with the workload so that the role of supervision has not run optimally.

41-53

Authors: Muhammad Agus Mikrajab and Tety Rachmawati

Backgrounds: Integrated antenatal care as one of key program in screening maternal and child health services is started antenatal to puerperium phase and it is essential to protect complications during both antenatal and postnatal phases. Access to antenatal care (fi rst ANC to fourth ANC) has became providers key strategies in order to decrease missed opportunities of pregnant women that it can be implicated toward services quality and caused by increasing MMR and IMR in Blitar City. The purpose of this study was to analize of policy implementation for Integrated Antenatal Care services at Sananwetan, Kepanjen kidul, and Sukorejo Public Health Centers. Methods: A qualitative study with purposive design. Method for policy analysis used “a health policy triangle framework” (Walt & Gilson, 1994). Results: Lack of the role of policy actors in fi elds to bridge among integrated antenatal care services program, midwives, lab analyst and provider. Integrated Antenatal care Services are concerned with physical examinations conducted by Midwives and are concerned with laboratorium test both routine and medical indications conducted by laboratory analyst. Lack of technical training for midwives and lab analyst. Conclusion: Inter Sectoral partnership for policy actors in implementing integrated antenatal care of Health Centers were lack and ranning partially. Lack of availability of laboratory facilities and USG to exam pregnant womens. Local Government Regulation regarding general services retributions are concerned routine lab and medical indications examinations is not yet for the poor peoples. Recommendation: The masive role of policy actors in Blitar City through inter sectoral partnership involving policy review, monitoring, and evaluation of integrated antenatal care for health centers are sustainable. Budgetting in APBD and other sources to enhance laboratorium facilities and USG at three Health Centers based on types of laboratory and medical devices. Integrated antenatal care strengthening through technicals training are especially midwives and laborium analysts in developing midwives in obstetrics and medical examination competencies. We need a limited revision of regulation clauses. It is clauses of routine lab examination and medical indications free for every poor womens that conduct lab examinations.

63-73

Authors: Made Asri B and Setia Pranata

Background: Islamic boarding school system has long story in indonesia, they covered as much 14.798 student who are teenager between 9–15 year old. Problems encountered with adolescent sexuality and reproductive health. Methods: An explorative research implemented in 3 provinces ie East Java, Nusa Tenggara Barat (NTB), East Kalimantan and six Islamic boarding schools. Data were collected through questionnaires about reproductive health. Results: It showed 48,5% of respondents didn’t have enough knowledge, attitudes and behavior about reproductive health, 40% of respondents knew very little about puberty, menstruation and wet dream, 71% of respondents had little knowledge about the risk of pregnancy; 49% of respondents had not enough knowledge about sexually transmited diseases. 88% respondents said that they had fall in love, 76% of respondents had positive courtship behavior. Conclusion: The information about reproductive health in islamic boarding school for adolescents is still in adequate and only refer to yellow book. Health worker did not provide adequqte information. We still found student who have sex while when they were engaged still datting. Suggestion: The need of additional and up to date reproductive health information and the risks of sexual intercourse marriage it maybe delivery on interesting media, such as one social networking. A health reproductive modules consist of scientic material and some knowledge has to be developed and should be delivery health worker. Reproductive health syllabus and training for trainers for teachers of boarding school is needed.

83-90

Authors: Siti Isfandari

Background: The 2007 National Health Report, Riskesdas 2007 showed that female leads male almost in all morbidity of chronic diseases. Differences in health and illness patterns of men and women are not primarily technical or medical in nature, but also attributable to social factors such as powerlessness, access to resources, and constrained roles. Using the latest data of Riskesdas 2013, this analysis intends to use gender approach analyzing and interpreting health status difference between female and male to get inputs for the appropriate measures to reduce the gap between female and male morbidity on NCD. Methods: Riskesdas 2013 data was analyzed using gender framework which stressed the importance of socio economic factors on health status defi ned as prevalence of chronic diseases. Results: With the exception of younger age, women have higher prevalence of non communicable/chronic diseases. High education appears to benefi t only middle age women to achieve equal health status with men. Conclusion: Education, access to information is important factors to reduce the gap of female and male health status, however biological factor remains as primary factor. Recommendation: Since improving health status of women needs comprehensive approach, government policy should facilitate access to education and economic resources to women. Gender approach should be implemented for analysing health data.

99-107

Authors: Yurika Fauzia Wardhani and Astridya Paramita

Background: Health is a state of body, soul, and socially to enable more people to live socially and economically productive. In 2007 and 2013 Research and Development of the Ministry of Health conducted research which includes basic health morbidity, disability, mental health and lifestyle. This study aims to get an overview of community disability that affects their ability to perform economic and social measures. We hope this research may result in a recommendation for decision makers about mental kesehatan services. Methods: This study is a further analysis of secondary data from the Riskesdas 2007 and 2013. Data were analyzed by descriptive and analytical / comparative. The population in this analysis are all household members in Indonesia, with large and sampling techniques follow Riskesdas samples which household members aged > 15 years. Results: There is a percentage increase (5.8%) of respondents mental health status category of ’Healthy’ (no emotional mental disorder) and the percentage decrease in all categories of mental disorders around 50.0 percent in 2013. The highest severe emotional Mental Disorders in 2007 and 2013 were in women, who have divorced marital status dead / alive, residing in rural areas, or the end of the adult age group (> 60 years). Data processing results also show that: 1) the higher the degree of disability and, 2) the more unfavorable lifestyle, the more severe mental disorders experienced emotional. This is supported by the results of tests Kendalls tau-b that there is a signifi cant association between disability and mental disorder (α = 0.000 < 0.5) and lifestyle with mental disorders (α = 0.000 < 0.5).Conclusion: Public mental health status in the year 2013 has been better than in 2007. There has been an increase in mental health status, and there is a relationship between disability, lifestyle, mental health status. Recommendation: Promotion of mental disorders and persons with disabilities should be further improved and include the wider community, not only in cities but to remote perdesaan. Perlu provision of primary health care (health centers ODGJ care and disabilities and actively invites the public to maintain a healthy lifestyle through preventive-promotive activities