Antenatal Care Policy and Management

Antenatal Service Policies

Antenatal Care Policy and Management

For village midwives in the Municipality of Banda Aceh

ABSTRACT

Antenatal Care Policy and Management For Village Midwife In anda Aceh Municipality Wahyu Zulfansyah1, Mubasysyir Hasanbasri2, Cahya Purnama3 Background: In order to obtain qualified human resources, early prevention is needed even before born. Optimal antenatal care will affect on woman who deliver healthy and qualified baby. In Banda Aceh municipality, the first and fourth visit coverage of pregnant mother and delivery process that was assisted by health care provider is still beyond the target.

Objective: This research was aimed to find out antenatal policy and management for village midwife in Banda Aceh municipality. Method: This was a descriptive research that used case study design. Qualitative method was used to find out problem and obstacle in antenatal service by village midwife. Case study approach was used to investigate the contemporary phenomenon in the real life context whenever the border between phenomenon and the context was not clearly understood, the utilization of multi source and multi proof could be used for organizational and management studies. The data was collected by using interview, observation and document utilization.

Result: The coverage of antenatal service in Banda Aceh municipality this time still beyond the target which was stated by Ministry of Health Republic of Indonesia. The conducted effort to achieve the coverage target was by improving human resources through training, monitoring and evaluation, continuous supervision, giving incentive for village midwife, antenatal care socialization and the providence of facility and infrastructure in collaboration with cadre in the village.

Conclusion: Support was needed from every stakeholder in order to support the implementation of antenatal care. Keyword: antenatal care, village midwife.

1 District Health Office of Aceh Besar

2 Health Service Management, Gadjah Mada University

3 District Health Office of Sleman

1.      Background

Condition of health development in Nanggroe Aceh Darussalam years 2005 was a very favorable development conditions when than 30 years of previous health and development is the first year after a natural disaster earthquake / tsunami and post-signing of MOU between GAM and the peace GoI will, in the previous year For the year the NAD is areas that are highly prone to security. Almost all sectors can said to be extremely difficult to develop due to an atmosphere of security is not conducive so that does not support the

pembangunan1. It is also felt in the health sector, many construction of facilities and infrastructure can not be done and supervised well. Placement of midwives in villages also have problems sufficient means remembering can not do the work entirely due to the conflict between GAM and GoI that vulnerable to security threats, so it is very disturbing the performance of health services. Maternal and child health programs is one of the priorities.

The main health development in Indonesia. this program responsible for health services for pregnant women, maternal, neonatal and infant. One program of Maternal Health and Child Health (MCH) is a lower incidence of death and illness in among mothers, and to accelerate the decline in death rates Mother and Son is to improve service quality and maintain the continuity of maternal and perinatal health services in level of basic services and referral services primer.
 

Reproductive health is an important issue because it is very affect the public welfare. In situations of life normal course (without any conflicts and disasters) reproductive health is an issue that is relatively vulnerable to neglect, especially in post-conflict and disaster situation Aceh province today. Women and children are the group vulnerable who need special attention. History has proved that almost every affected country, women and children find it harder complex due to their specific needs such as reproductive mensturasi, pregnancy, breastfeeding and parenting anak.

One indicator to assess the health of the Figures Maternal Mortality and Infant Mortality. Decrease in mortality mother still feels very slow, the problem of maternal mortality was first discussed by international forum in Nairobi, Kenya in October 1987. As a follow-up, on 29 June 1988 in Indonesia was held workshop Welfare mothers involving 17 sectors and stakeholders to support the efforts of the Safe Motherhood. In lokarya the president of RI has provided instructions to suppress the maternal mortality rate (MMR) 50% of AKI 1986 (450/100.000 live births) to the birth 225/100.000 alive at the end of 2000. The activity was initiated by the department of health, BKKBN and the Office of State Minister in cooperation with POGI4 UPW. 

Maternal mortality rates for the Province of Nanggroe Aceh Darussalam 2005 was 354/100.000 live births, while in National was 307/100.000. Antenatal care coverage monitored through a new visit pregnant women in 2005 to K1 NAD is 83.12% while the coverage of K4 2005 was 71.92%.

1. Maternal and child health situation in the Municipality of Banda Aceh: 1) coverage of the visit of pregnant women is still lacking, 2) detection of high risk mothers pregnancy by skilled health is low, 4) supervision and feedback by skilled obstetric care have not gone well, 5) training of midwives in villages are still very lacking so that K1 and K4 are still below the national target and the target Province of Nanggroe Aceh Darussalam. Efforts to reduce mortality and maternal morbidity demands a close relationship between the various levels health care system that starts from the level of service basic health centers (primary) includes the prevention, detection Early complications of pregnancy, safe and clean delivery and referral into a more baik2 facilities. Method This type of research is a descriptive case study design. 

Qualitative methods used to determine the problems and barriers barriers to antenatal care by a midwife in the village. Case study approach is used to investigate the phenomenon of contemporary in the context of real life, when the boundary between phenomenon in the context does not appear explicitly, the utilization multi-source and multi-proof, can be used for organizational studies and manajemen5. Data collection methods used are interviews, observation and utilization dokumen6.

This research unit is a unit of Banda Municipal Health Office Aceh. The subject of this study is the Chief Medical Officer of Municipality Banda Aceh, Municipal Health Office Head of MCH Banda Aceh, the Head of Puskesmas, and village midwives.

Results and Discussion Policy of the City Health Office in Banda Aceh targets antenatal care coverage is to increase the ability of midwives in villages through training, meetings with the midwife coordinator periodically, the provision of facilities, provision of incentives, promotions midwife in the village became a civil servant civil, socialization programs to the community through antenatal care means of mass media, monitoring, done by 

Tiered at the City Health Office through the Head of Maternal Health and Children to a midwife in the clinic coordinator who performed scheduled and implemented for all midwives in villages.

To accelerate the achievement of targets in the search for targets mothers pregnant, the midwife in the village working with the people who are volunteered to help and carry out post Yandu. Usually The society has received training in running duties such as cadres. 

Table 1. Coverage of K1 and K4 in the Municipality of Banda Aceh. COVERAGE INDICATORS SERVICE 2004 2005 2006 TARGET K1 75.68 67.7% 86.2% 95% K4 68.17 67.31% 77% 95% Antenatal care coverage for the Municipality of Banda Aceh to K1 2004, amounting to 75.68 percent and 68.17 percent K4nya, for K1nya 2005, 67.7 percent and 67.31 percent for the year K4nya 2006 K1nya K4nya 86.2 percent and was 77 percent and labor by health workers at 69.8 percent, the lowest Jaya is a new health center with K1 and K4 31 percent 19 percent while the highest 97.2 percent Puskesmas Meuraxa K1 and K4 91.3 percent. Achieving this target is actually less than that set by the government by 95 percent is due to them midwives do not live in the village because of the unavailability of places midwives lived in the village provided by local governments and villagers, not like a village health clinic as a residence, unavailability of vehicles for transportation as well as the difficulty good transport facilities and road vehicles to the public midwives working in village locations.