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"Maternal mortality rate in Indonesia is still very high with a very slow reduction from year to year. Some intensive efforts to reduce maternal mortality rate have been done, one of which is deployment of village midwives. However, the deployment of midwife in the village in Tasikmalaya regency has not shown desirable results.

This research has a purpose as to find information on the result of maternal and child health service and implementation of maternal and child health program management by midwife village and to know correlation between implementation of maternal and child health program management by midwife village and its results. This research uses cross sectional method and quantitative descriptive analysis with village midwife as unit analysis. The sample in this research is village midwife who has worked minimal one year in the village.

The sampling method is random sampling. Independent variable consist of needed data collection, plan of action, action book, infant and mother cohort, visit to integrated post, home visit, guidance to traditional mid wife, guidance of interested person child and safe motherhood, village coordination meeting and locally region monitoring of child and safe motherhood. Whereas dependent variabel is the result of maternal and child health services. To Test of chi square showed that plan of action was correlated with the result of maternal and child health service. In general midwife village had done maternal and child health program management from planning, actuating, controlling, and evaluation. Quality of implementation of program management by midwife in the village has not been optimal, may be bacause of title guaodance and controll from the health centre or regency health departement.;Maternal mortality rate in Indonesia is still very high with a very slow reduction from year to year. Some intensive efforts to reduce maternal mortality rate have been done, one of which is deployment of village midwives. However, the deployment of midwife in the village in Tasikmalaya regency has not shown desirable results.

This research has a purpose as to find information on the result of maternal and child health service and implementation of maternal and child health program management by midwife village and to know correlation between implementation of maternal and child health program management by midwife village and its results. This research uses cross sectional method and quantitative descriptive analysis with village midwife as unit analysis. The sample in this research is village midwife who has worked minimal one year in the village.

The sampling method is random sampling. Independent variable consist of needed data collection, plan of action, action book, infant and mother cohort, visit to integrated post, home visit, guidance to traditional mid wife, guidance of interested person child and safe motherhood, village coordination meeting and locally region monitoring of child and safe motherhood. Whereas dependent variabel is the result of maternal and child health services. To Test of chi square showed that plan of action was correlated with the result of maternal and child health service. In general midwife village had done maternal and child health program management from planning, actuating, controlling, and evaluation. Quality of implementation of program management by midwife in the village has not been optimal, may be bacause of title guaodance and controll from the health centre or regency health departement."

"Angka kematian bayi dan ibu bersalin yang masih tinggi merupakan salah satu masalah kesehatan, di negara kita dewasa ini, bahkan di negara-negara sedang berkembang umumnya. Melalui peningkatan dan pemerataan jangkauan pelayanan kesehatan khususnya upaya pelayanan program KIA, diharapkan akan dapat menekan angka kematian bayi dan angka kematian ibu bersalin yang masih tinggi ini.Pencapaian target cakupan program KIA Puskesmas yang masih rendah khususnya di daerah Kabupaten Nias, menjadi permasalahan dalam penelitian ini, sehingga timbul keinginan peneliti untuk mengetahui kemungkinan faktor-faktor apa yang berhubungan dengan pencapaian target cakupan program KIA Puskesmas yang masih rendah tersebut di daerah Kabupaten Nias.Variabel penelitian dibatasi pada faktor ketenagaan pelaksana program KIA Puskesmas (mencakup umur, lama kerja, penghasilan, kemampuan, motivasi, persepsi peran) dan faktor organisasi Puskesmas (mencakup kepemimpinan, sumber daya, imbalan, struktur, desain pekerjaan) terhadap prestasi kerja tenaga pelaksana program KIA dalamm pencapaian target cakupan program KIA Puskesmas.Penelitian ini merupakan penelitian deskriptif analitik yang dilakukan dengan pendekatan cross-sectional, melalui pengumpulan data primer untuk variabel babas dan data sekunder untuk variabel terikat. Responden penelitian adalah tenaga pelaksana program KIA Puskesmas yang kesemuanya berjumlah 26 orang dari 8 Puskesmas sebagai unit sekaligus sebagai sampel penelitian yang dipilih secara purposive dari total populasi sebanyak 19 Puskesmas di wilayah Kabupaten Nias. Analisa data dilakukan secara univariat melalui distribusi frekuensi dari responden, kemudian secara bivariat melalui uji statistik nonparametrik dengan mempergunakan Uji Korelasi Spearman untuk mengetahui hubungan antara variabel bebas dengan variabel terikat.Hasil analisa didapatkan bahwa hubungan antara variabel bebas dengan variabel terikat tidak bermakna secara statistik. Hasil pengamatan peneliti menunjukkan bahwa keadaan geografis wilayah kerja Puskesmas yang relatif mudah terjangkau memegang peranan dalam pencapaian target cakupan program KIA Puskesmas yang lebih baik.Disarankan agar kemampuan tenaga pelaksana program KIA Puskesmas dapat ditingkatkan melalui pelatihan/penataran yang berkaitan dengan program KIA, terutama para bidan di desa yang masih miskin pengalaman dan pengetahuan teknis dilapangan. Perlu dibina dan ditingkatkan koordinasi dengan lintas sektoral terutama dalam pemanfaatan kesempatan pelaksanaan kegiatan keterpaduan (kegiatan safari) KB - Kesehatan yang dapat meningkatkan pencapaian cakupan/kinerja Puskesmas. Akhirnya dirasa perlu untuk dilakukan penelitian lebih lanjut untuk menggali lebih dalam faktor-faktor yang berhubungan dengan prestasi kerja tenaga pelaksana program KIA Puskesmas, dengan mempergunakan sampel yang lebih besar dan variabel penelitian yang lebih lengkap.

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The high prevalence of Maternal and Infant Mortality Rate is one of the many health problems in Indonesia, as such commonly in developing countries. As to decrease Maternal and Infant Mortality Rate in Nias, many programs have been carried out, such as increasing the coverage and equity of Maternal Child Health Care (HCHC).

The low coverage target of HCHC program is the main issue of the study and the question is what factors related to low coverage target of MCHC program in Nias.

The independent variables of the study are: Health Han Power in MCHC in Health Centres (age, working period (experience), income, ability, motivation, role perception) and Organization of Health Centre (leadership, resources, incentive, organization structure, job description). The dependent variables are: performance of MCHC workers regarding to coverage target of HCHC program in Health Centres.

The design of the study is descriptive analytic with cross sectional. Data were generated from primary (independent variables) and secondary (dependent variable) data. The respondents are 26 HCHC workers from 6 Health Centres was selected purposively from 19 Health Centres in Nias. The data were analyzed with Nonparametric Statistics (Spearman Correlation Test) as to assess the association between independent and dependent variables.

From the study, it was found that there is no association between independent variables and dependent variables. Through geographically observation it coned be seen that the working area of Health Centres is relatively accessible. With this condition, it is visible to increase the coverage target of the HCHC program in Health Centres.

It was recommended to train HCHC workers, especially village midwife, intersectoral coordination (Health - Family Planning activities) as to increase the coverage target of HCHC program in Health Centres. To have more information of factors related to the performance of HCHC workers, it was also recommended to conduct study with larger sample size and more variables."

"ABSTRAKMasalah Kesehatan Ibu dan Anak (KIA) masih merupakan masalah utama yang perlu ditanggulangi diantara program-program kesehatan lainnya pada saat ini di Indonesia. Usaha akselerasi penurunan Angka Kematian Ibu (AKI) memerlukan data dan informasi yang akurat dan tepat waktu dalam menentukan arah pencapaian tujuan program yang dikehendaki. Namun beberapa data dan informasi KIA di kabupaten Purwakarta diragukan keakuratannya.Data dan inforrnasi memegang peranan sentral dalam pengambilan keputusan untuk perencanaan, monitoring dan evaluasi. Disisi lain banyak hambatan yang ditemukan dalam mengumpulkan data, menganalisa, dan merubah data menjadi inforrnasi yang dapat digunakan secara maksimal. Sedangkan kecenderungan yang sering terjadi adalah ketidak sesuaian antara kebutuhan informasi yang diminta dengan ketersediaan data yang masuk, diolah dan didesiminasikan. Menyadari hal tersebut di atas perlu usaha-usaha untuk mengetahui pemanfaatan data dan informasi program KIA yang dikumpulkan di tingkat bawah dalam hal ini kabupaten Purwakarta dalam mendukung perencanaan di tingkat pusat.Penelitian ini bertujuan untuk memperoleh informasi tentang pemanfaatan data dan informasi KIA yang dikumpulkan di kabupaten Purwakarta dalam mendukung perencanaan program KIA di tingkat pusat, serta faktor-faktor penghambat pemanfaatan data tersebut. Penelitian ini bersifat kualitatif, data diperoleh dari observasi kelengkapan data KIA tingkat kabupaten, pemeriksaan dokumen yang dipakai untuk memilah data serta jenis indikator-indikator yang dilaporkan ke propinsi dan pusat, dan wawancara mendalam untuk menggali penyebab rendahnya pemanfaatan. Responden adalah beberapa orang yang terlibat mengumpulkan, mengolah, mengkaji, dan memanfaatkan data KIA di kabupaten Purwakarta, propinsi Jabar, dan pusat.Hasil penelitian menemukan bahwa penyusunan rencana program KIA di tingkat pusat lebih banyak nienggunakan angka-angka nasional dari pada data dan informasi kabupaten. Selain itu pemanfaatan data dan informasi KIA belum optimal di propinsi maupun kabupaten. Disamping itu dualisme sumber data, anggapan kurang baik tentang bekerja di pengelolaan data, kurang pengetahuan, lama bekerja yang relatif singkat, dan ketersediaan dana yang tidak mencukupi untuk pemeliharaan komputer merupakan faktor-faktor penghambat pemanfaatan data KIA.Dalam mengoptimalkan pemanfaatan data dan informasi KIA di setiap tingkat administrasi kesehatan perlu dikembangkan penyusunan profil kesehatan ibu dan anak termasuk penyajian informasi dalam bentuk pemetaan. Penggalangan kerja sama antara unit teknis, unit pengelola informasi, Kantor Statistik, pihak ketiga (peneliti) akan membangun suatu jaringan kerja yang baik di bidang sistem informasi menghadapi faktor-faktor penghambat pemanfaatan data dan informasi KIA.

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ABSTRACT

Evaluation of the Making Use of Data and Information of Maternal and Child Health (MCH) Collected in Purwakarta District in supporting the Program Planning of MCH in CentralThe issue of MCH is still a main problem which needs to be coped with among other health problems today in Indonesia. Efforts to accelerate the decline of mother's death rate (MMR) require accurate date and information and punctuality in deciding the ways to reach the program objectives required. There is however, some doubt about several data and information of MCH in Purwakarta District.

Data and information play an important part in making decisions for planning, monitoring, and doing evaluation. On another side, there are many constraints encountered in collecting data, analyzing, and changing data into ones which is applicable at maximum. Whereas the trand which often occurs is that there is incongruency between information required and the availability of data-input which is processed and disseminated. Considering the matter, it is necessary to put efforts to know the making use of data and information of MCH program which is collected in lower level, in this case Purwakarta District, in supporting the planning in central.

This research has the objective to obtain the information about the using of data and information of MCH which is collected in Purwakarta District in supporting the planning of MCH program in central, and the constraints of the using of the data. The research is qualitative, in which the data is obtained from observation of data completion of MCH in district level, verification of documents used to select data, kinds of indicators reported to province and central, and profounding interview to dig out the cause of poor application. Respondents are several people involved in collecting, processing, analyzing and applying data in Purwakarta District, West Java Province and central.

The findings of research indicate that the setting of the planning MCH Program in central applied more national figures than the data and information in distret. Besides that, the ambiguity of data sources, bad assumptions of working in data processing, lack of knowledge, relatively short work and the availability of funds which was not enough for computer maintenance were the constraints of data application of MCH.

In making of the optimum use of data and information of MCH in every level of health administration, it is necessary to develop the setting of the profile of Maternal and Child Health including the presentation of information in the form of mapping. The promoting of cooperation among technical unit, information administration unit, Statistics Office, and the third hand (researchers) will build good networks in the field of information system to cope with the constraints encountered in the making use of data and information of KIA."

"Salah satu upaya menurunkan angka kesakitan dan kematian ibu adalah melalui pemberian pelayanan yang berkualitas. Cakupan pertolongan persalinan yang di tolong oleh tenaga kesehatan di Kabupaten Agam dari tahun 2008 sampai tahun 2010 masih rendah dan cendrung turun. Sejak bulan April tahun 2011 di Kabupaten Agam sudah diterapkan Jampersal, hal ini mendorong peneliti untuk mengetahui bagaimana cakupan pertolongan persalinan oleh bidan di desa pada bulan Juli-Desember 2011 sejak diterapkannya Jampersal.Penelitian ini dilakukan bulan April-Mei tahun 2012. Sampel pada penelitian ini adalah seluruh bidan desa yang berada di dua belas puskesmas yang berjumlah 102 orang. Jenis penelitian cross sectional dengan analisis menggunakan chi square. Untuk melihat perbandingan cakupan tahun 2010 dan tahun 2011. Perbandingan tersebut 2,5 kali, dengan p. value Mc.Nemar = 0.008 (OR 2.322) bermakna secara statistic. Selain itu dianalisa juga perbedaan rata-rata cakupan sebelum Jampersal (Juli-Desember 2010) dan setelah diterapkannya Jampersal (Juli-Desember 2011) yang dihitung dengan paired t-test, hasil analisis menunjukkan p value = 0,003 secara statistik bermakna, jadi terbukti terjadi penurunan cakupan persalinan oleh bidan di desa sejak diterapkannya Jampersal, disarankan kepada Dinas Kesehatan agar melakukan supervisi melalui pendekatan secara individu kepada bidan karena semakin setuju bidan dengan Jampersal semakin kecil penurunan cakupan persalinannya.

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An act that can be done to reduce maternal morbidity and mortality is through provision of healthcare services. In Agam Residency, the number of baby delivery that helped by health care worker between 2008 until 2010 was low and tended to fall. Jampersal had been implemented in Agam Regency since April 2011. This had encouraged researcher to know how the coverage of baby delivery with village?s midwife was on July-December 2011 after Jampersal implementation.

This research was conducted on april-may 2012. The samples were all village?s midwifes in 12 Public Health Center, there were 102 peoples. This was a cross sectional study with chi square analysis to compare between 2010 and 2012 coverage. The comparison was 2,5 times with p value Mc.Nemar = 0.008 (OR 2.322) and this was statistically significant. It was also being analyzed the coverage mean difference between before and after jampersal implementation (Juli-December 2010 and Juli-December 2011) by paired t-test. The result showed that p value = 0,003 and it was statistically significant, so it was being proved that the coverage of baby delivery with village?s midwife help was declined after jampersal implementation. The suggestion for Health Department is by supervising an individual approach to the midwife because the agreements of midwife to Jampersal will reduce the decline in coverage of baby delivery with help."

"Kesehatan ibu dan anak adalah salah satu indikator derajat kesehatan yang dapat dinilai sebagai keberhasilan pelayanan kesehatan dan menjadi komponen indeks pembangunan dan indeks kualitas hidup. Namun, masalah kematian dan kesakitan Ibu dan anak di Indonesia masih merupakan masalah besar. Dengan demikian, pelayanan kesehatan ibu dan anak menjadi prioritas utama dalam pembangunan kesehatan di Indonesia. Upaya penurunan angka kematian ibu dan anak diperlukan sistem pencatatan dan pelaporan yang memiliki kualitas data dan utilitas data yang baik. Pelaporan dan pencatatan kesehatan ibu dan anak digunakan untuk melihat dan memantau faktor-faktor resiko dan non resiko selama proses kehamilan normal maupun tidak normal dalam melakukan intervensi segera. Puskesmas Berastagi dan Puskesmas Tiga Panah merupakan beberapa dari Puskesmas yang ditemukan ketidaksambungan data, tidak kredibel di Kabupaten Karo. Risiko dari data yang tidak kredibel adalah tidak bisa mengetahui besarnya masalah yang sesungguhnya sehingga tidak bisa memonitor, mengevaluasi keberhasilan atau kegagalan program. Pukesmas Berastagi dan Tiga Panah menerima pelaporan KIA dari Bidan di Desa. Oleh karena itu diperlukan adanya evaluasi sistem pencatatan dan pelaporan kesehatan ibu dan anak untuk melihat data kesehatan ibu dan anak yang ada di Puskesmas Berastagi dan Tiga Panah terutama pelaporan data dari Bidan di Desa. Penelitian ini merupakan peneltian kualitatif dengan pengambilan data melalui wawancara, observasi dan studi dokumentasi. Hasil penelitian menunjukkan bahwa Puskesmas Berastagi memiliki kualitas data yang lebih baik dibandingkan dengan Puskesmas Tiga Panah namun masih terdapat desa yang harus diperbaiki dalam kualitas data; Penilaian lima komponen fungsi manajemen data, Puskesmas Berastagi memiliki pemanfaatan data dan informasi nilai yang paling rendah sedangkan untuk Puskesmas Tiga Panah dimana Pengolahan dan analisis data serta pemanfaatan data dan informasi memiliki nilai paling rendah ; Puskesmas Berastagi memiliki e-puskesmas namun belum mendukung pencatatan dan pelaporan KIA sedangkan Puskesmas Tiga Panah tidak memiliki e-puskesmas/SIMPUS; tidak terdapat SOP ; Formulir yang tidak tersedia secara rutin untuk Bidan di Desa di Puskesmas Berastagi sedangkan Puskesmas Tiga Panah tersedia secara rutin namun masih ditemukan Bidan di Desa mengirimkan dengan selembar kertas; tidak terdapat kebijakan secara tertulis terkait pencatatan dan pelaporan KIA; tidak pernah dilakukan pre dan post test di Puskesamas Berastagi dan Tiga Panah; Puskesmas Berastagi tidak memiliki dana khusus pencatatan dan pelaporan KIA.

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Maternal and child health is one indicator of health status that can be assessed as the success of health services and is a component of the development index and quality of life index. However, the problem of maternal and child mortality and morbidity in Indonesia is still a big problem. Thus, maternal and child health services are a top priority in health development in Indonesia. Efforts to reduce maternal and child mortality require a recording and reporting system that has good data quality and data utility.Maternal and child health reporting and records are used to view and monitor risk and non-risk factors during normal and abnormal pregnancy processes in carrying out immediate interventions. Puskesmas Berastagi and Puskesmas Tiga Panah are some of the Puskesmas that were found to be data disconnected, not credible in Karo District. The risk of data that is not credible is not being able to know the true magnitude of the problem and so being unable to monitor, evaluate the success or failure of the program. Pukesmas Berastagi and Tiga Panah receive MCH reports from the village midwife. Therefore, it is necessary to have an evaluation of the recording and reporting system for maternal and child health to see the data on maternal and child health at the Berastagi and Tiga Panah Puskesmas, especially the reporting of data from village midwives. This research is a qualitative research by collecting data through observation interviews and documentation studies. The results showed that Puskesmas Berastagi has better data quality than Tiga Panah Puskesmas but there are still villages that need improvement in data quality; b. The assessment of the five components of the data management function, Puskesmas Berastagi has the lowest value data and information utilization, while for Tiga Panah Puskesmas that data processing and analysis as well as data and information utilization has the lowest value; Berastagi Puskesmas has an e-puskesmas but it does not yet support MCH recording and reporting, while the Tiga Panah Puskesmas does not have an e-puskesmas / SIMPUS; there isn’t standard operating procedures; Forms that were not regularly available for Village Midwives at Puskesmas Berastagi while Puskesmas Tiga Panah were available regularly but were still found. Village midwives sent them with a sheet of paper; there is no written policy regarding MCH recording and reporting; never done pre and post test at Puskesamas Berastagi and Tiga Panah; Berastagi Puskesmas does not have special funds for recording and reporting MCH."

"Kewaspadaan universal dipandang sangat strategis untuk mengendalikan infeksi HIV/AIDS di sarana pelayanan kesehatan (Depkes, 2010). Berdasarkan wawancara dan observasi penulis pada 10 bidan di Kabupaten Badung, penulis menemukan bahwa 80% bidan belum menerapkan kewaspadaan universal dengan baik. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan perilaku penerapan kewaspadaan universal pada pertolongan persalinan oleh bidan di puskesmas wilayah kerja Dinas Kesehatan Kabupaten Badung pada tahun 2012. Penelitian ini adalah penelitian kuantitatif dengan desain cross sectional, dengan sampel adalah bidan yang melaksanakan persalinan yang berjumlah 86 orang. Data dianalisis dengan uji chi square dengan tingkat kepercayaan 95% sehingga α = 5%. Hasil penelitian didapatkan proporsi responden yang berperilaku menerapkan kewaspadaan universal dengan baik pada saat pertolongan persalinan adalah sebesar 18,6%, ada hubungan antara faktor predisposisi yaitu pengetahuan (p=0,000,OR=20,40) dan sikap (p = 0,000, OR = 21,207), faktor pemungkin yaitu ketersediaan sarana prasarana (p=0,000) terhadap perilaku penerapan kewaspadaan universal. Dari penelitian ini disarankan untuk melakukan refreshing training, melengkapi fasilitas, sarana dan prasarana, dibuat kebijakan kewaspadaan universal yang disosialisasikan pada seluruh tenaga kesehatan serta selanjutnya dilaksanakan pengawasan dan pemberian sanksi yang tegas dalam penerapan kewaspadaan universal.

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Universal precautions is deemed strategic for the control of HIV / AIDS in health care facilities (MOH, 2010). Based on interviews and observations of the author on 10 midwives in Badung regency, the authors found that 80% of midwives have not implemented universal precautions as well.

This study aims to determine the factors associated with the behavior of the application of universal precautions to help labor by a midwife at the health center working area Badung Health Agency in 2012.

The study was a quantitative study with cross sectional design, the sample is a midwife who perform labor, amounting to 86 people. Data were analyzed with chi square test with 95% confidence level so that α = 5%.

The study found the proportion of respondents that is behaving properly implement universal precautions at the time of delivery assistance amounted to 18.6%, there is a relationship between predisposing factors, namely knowledge (p = 0.000, OR = 20.40) and attitude (p = 0.000, OR = 21.207), enabling factors, namely the availability of infrastructure facilities (p = 0.000) on the behavior of the application of universal precautions.

From this study it is advisable to conduct refresher training, complete amenities, facilities and infrastructure, created a policy that promoted universal precautions in all health personnel and subsequently conducted surveillance and sanctions in the strict application of universal precautions."

"Indonesia masih dihantui Angka Kematian Ibu AKI yang relatif tinggi dibandingkan dengan negara-negara Region Asia Tenggara, yaitu 190 per 100.000 kelahiran hidup. AKI dapat direduksi dengan persalinan dengan perawatan yang terampil. Kementerian Kesehatan RI sejak tahun 2015 menetapkan persalinan yang aman adalah persalinan yang dilakukan oleh tenaga kesehatan nakes di fasilitas pelayanan kesehatan fasyankes. Meskipun cakupan pertolongan persalinan oleh nakes dan persalinan di fasyankes di Indonesia sudah tinggi, tetapi masih terdapat perbedaan cakupan menurut umur ibu, tingkat pendidikan ibu, status ekonomi, wilayah tempat tinggal, dan provinsi. Untuk memudahkan penghitungan ketidakmerataan kesehatan antar negara dan mengetahui daerah mana yang tertinggal, WHO mengeluarkan aplikasi bernama Health Equity Assessment Toolkit HEAT dan Health Equity Assessment Toolkit HEAT Plus, aplikasi ini mampu mengidentifikasi perbedaan dalam indikator kesehatan antar subkelompok populasi. Peneliti dapat memasukkan data sendiri ke dalam aplikasi HEAT Plus, dalam penelitian ini peneliti menggunakan data SDKI. Hasil analisis menunjukkan cakupan persalinan oleh nakes dan persalinan di fasyankes meningkat dari tahun 1994-2012. Cakupan tersebut terkonsentrasi pada ibu berumur 25-39 tahun, ibu dengan tingkat pendidikan SMP, ibu dengan kuintil kekayaan terkaya, ibu yang tinggal di daerah perkotaan, dan ibu yang tinggal di wilayah Sumatera dan Jawa. Ukuran ketidakmerataan yang mengalami penurunan tertinggi adalah Population Attributable Risk PAR dan Population Attributable Fraction PAF. Ketidakmerataan cakupan persalinan oleh nakes cenderung mengalami penurunan pada semua dimensi, sedangkan ketidakmerataan cakupan persalinan di fasyankes mengalami peningkatan pada dimensi provinsi.

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Indonesia is still haunted by a relatively high Maternal Mortality Rate MMR compared to the Southeast Asian Region countries, which is 190 per 100,000 live births. MMR can be reduced by delivery with skilled care. The Ministry of Health of Indonesia since 2015 established a safe delivery is the delivery done by Skilled Birth Attendants SBA in health service facilities. Although coverage of delivery assistance by SBA and delivery in health service facilities in Indonesia is high, but there are still coverage differences based on age, education level, economic status, residence, and province.

To facilitate the calculation of health inequalities between countries and to know which areas are left behind, WHO issued an application called Health Equity Assessment Toolkit HEAT and Health Equity Assessment Toolkit HEAT Plus, this application is able to identify differences in health indicators among subgroups of the population. Researchers can enter their own data into HEAT Plus application, in this research the researcher use SDKI data.

The results showed that the coverage of delivery by SBA and childbirth in health service facilities increased from 1994 to 2012. The coverage was concentrated in mothers aged 25 39, mothers with secondary and above educational level, mothers with richest quintiles, mothers living in urban areas, and mothers who live in Sumatra and Java. The highest decreasing inequality size is Population Attributable Risk PAR and Population Attributable Fraction PAF. Inequality of delivery coverage by SBA tends to decrease in all dimensions, whereas the inequality of delivery coverage in health service facilities has increased in the provincial dimension."

"Puskesmas adalah organisasi kesehatan fungsional yang merupakan pusat pengembangan kesehatan masyarakat yang juga membina peran serta masyarakat disamping memberikan pelayanan secara menyeluruh dan terpadu kepada masyarakat di wilayah kerjanya dalam bentuk program pokok. Program kesehatan ibu dan anak (IQA) merupakan salah satu program pokok di puskesmas yang mendapat prioritas tinggi, mengingat kelompok ibu hamil, menyusui , bayi dan anak merupakan kelompok yang sangat rentan terhadap kesakitan dan kematian (Departemen Kesehatan, 1992). Dalam mengayomi kelompok rentan ini banyak kegiatan yang dilakukan oleh puskesmas dalam upaya menurunkan angka kesakitan dan kematian, salah satunya melalui kegiatan antenatal care (ANC) yang adekuat. ANC yang adekuat ditunjukkan dengan salah satu indikator yang terdapat dalam suatu sistem pemantauan wilayah setempat program KIA yaitu indikator K4 ibu hamil.Diduga rendahnya cakupan K4 ibu hamil ini mungkin dipengaruhi oleh somber daya yang tersedia di puskesmas, peran lintas sektor, luas wilayah kerja, status puskesmas, jumlah penduduk, rencana kerja tahunan (POA) puskesmas, rencana kerja petugas pelaksana program, pemantauan dan penilaian. Oleh karena itu peneliti ingin mengetahui bagaimana gambaran karakteristik puskesmas yang berhubungan dengan cakupan K4 ibu hamil. Penelitian ini dilakukan di Kabupaten Aceh Besar tahun 1999 dengan menggunakan pendekatan kualitatif. Pengumpulan data diperoleh melalui wawancara mendalam terhadap pimpinan puskesmas dan bidan pengelola KIA di 6 (enam) puskesmas terpilih dalam Kabupaten Aceh Besar. Selain itu informasi dari bidan di desa sebagai pengelola MA di pedesaan diperoleh melalui diskusi kelompok terarah. Dengan demikian, untuk meningkatkan validitas data peneliti telah melakukan triangulasi sumber data, triangulasi metode.Hasil penelitian menunjukkan bahwa karakteristik puskesmas ternyata mempunyai peran terhadap pencapaian cakupan K4 ibu hamil antara lain tenaga pelaksana ANC, baik jumlah maupun mutunya masih kurang, ketersediaan sarana pelayanan yang belum memadai, dukungan/peran lintas sektor belum berjalan, serta rencana kerja petugas pelaksana program puskesmas yang belum dibuat (tidak ada). Berdasarkan hasil yang didapat pada penelitian ini, maka disimpulkan bahwa puskesmas dengan karakteristik sumber daya dan dukungan lintas sektoral yang memadai mempunyai cakupan K4=60%. Berdasarkan simpulan tersebut pula, peneliti menyarankan antara lain diperlukan upaya peningkatan mutu tenaga pelaksana program melalui pelatihan teknis fungsional, pemanfaatan sumber daya yang tersedia di puskesmas secara optimal, membuat rencana kerja puskesmas secara menyeluruh serta pimpinan puskesmas harus lebih bersifat proaktif untuk mendapatkan dukungan peran lintas sektor. Sebagai alat manajerial program MA, pemantauan wilayah setempat-kesehatan ibu dan anak (PWS-KIA) hendaknya terus dapat, digunakan dalam upaya melakukan pemantauan dan evaluasi program.

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Health center is a functional health organization designed as a development center for public health, aimed to build community participation in addition to delivering comprehensive and integrated community services in its region in the form of basic health services. Maternal and child health is one of basic services in health center, with a high priority. It is to say that pregnant and lactating mothers, babies and children are high-risk groups of morbidity and mortality (MOH, 1992). In order to protect these mothers and their coming babies, mothers should adequately do antenatal care. Adequate antenatal care is pointed out by an indicator, in a local visit area monitoring system of maternal and child health program (MCH), namely K4. K4 is the fourth ANC visit with a certain criteria.By hypothesis, a low coverage of K4 of pregnant mothers maybe influenced by the available power resources of health center, participation of inter-sector, working area, health center status, public population, plan of action of health center, plan of action officer program, monitoring and evaluation. Therefore, the researcher want to know how health center characteristics influence K4 coverage of pregnant mothers. This study was conducted in Aceh Besar District in 1999 using qualitative approach. The data was collected through in depth interviews to the chief of health center and senior midwives of 6 (six) selected health centers in Aceh Besar District. While information from midwives in village was obtained through focus group discussions (FGDs). In order to get valid data, the researcher applied triangulation on data resources and data collection method. Through the method the data were rechecked not only once.The results of this study show that the health center characteristics actually have roles toward K4 coverage of pregnant mothers, ANC staff lack off in number and quality, the availability of service facility is not sufficient, the role of inter-sector is not well run yet, and the plan of action of health center program of officer is not produced. Thus it can be concluded that health centers with sufficient resources and inter-sector support have K4 coverage more than 60 %. Based on the conclusion, the author suggests some improvement effort of through a functional technique training, the available optimal utilization of resource of the health center, production and improvement of the plan of action of health center more proactive action of and the chief of health center to have inter-sector support. As managerial tools of maternal and child health program, local area monitoring-maternal and child health (LAM-MCH) should be permanently used in monitoring and evaluating the program."