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"ABSTRAKKematian Ibu dan Anga Kematian Neonatal di Indonesia masih tinggi. Indonesia tercatat sebagai negara yang belum berhasil mencapai target MDGs keempat dan kelima di tahun 2015 Puskesmas PONED didirikan dalam rangka untuk mencapai target keempat dan kelima MDGS tersebut. Namun sayang penelitian mengenai kinerja puskesmastersebut masih sangat jarang dilakukan. Desain penelitian ini adalah potong lintang dengan pengambilan sampel menggunakan metode consecutive sampling. Sampel penelitian adalah seluruh puskesmas PONED yang telah aktif berjalan lebih dari 1 tahun di Kota Bekasi.Pada 9 sampel yang ada, didapatkan bahwa kinerja puskesmas tersebut masuk dalam kategori sedang. Penentuan kinerja ini berdasarkan skor Penilaian Kinerja Rumah Sakit dalam Pelayanan Maternal - Perinatal dari Supervisi Fasilitatif (OJT) JNPK-KR tahun 2009. Sebagian besar Puskesmas PONED di Kota Bekasi yang diteliti mendapatkan nilai kurang pada bagian penilaian proses, terutama mengenai pelayanan post natal, dimana pelayanan ini meliputi kemampuan dalampelayanan bayi < 2000 gram, pelayanan rawat gabung 24 jam, ASI penuh dan resusitasi neonatus. Hal ini juga disebabkan oleh kurang lengkapnya prasarana pendukung pada Puskesmas PONED, seperti alat vakum, obat resusitasi, fasilitas penanganan bayi preterm

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ABSTRACTIndonesia?s maternal mortality rate remains high that the country did not succeed to achieve the target of Millenium Development Goals 4 and 5 in 2015. Basic Emergency Obstetrik and Newborn Care service program at public health care (BEmONC PHC) was established in order to achieve the goals. Unfortunately, study on performance of public health care in executing the program is rarely performed.The design of this study was cross-sectional with consecutive sampling as the subject selection method. The subjects were BEmONC PHC that had run the program actively more than one year in Bekasi.Performance of nine BEmONC PHC was categorized as moderate by using Penilaian Kinerja Rumah Sakit dalam Pelayanan Maternal-Perinatal scoring from facilitative supervision (on the job training) JNPK-KR in 2009. Most of all BEmONC PHC in Bekasi were rated below average in ?process? as one of the appraisal parts, especially postnatal service which included capability in infants less than 2000 grams born management, 24 hour rooming-in service, breastfeeding, and neonatal resuscitation. The cause was lack of supporting infrastructures at BEmONC PHC i.e vacuum, resuscitation drugs, and pretermneonatal management facility."

"Tesis ini membahas mengenai determinan pemilihan lokasi bersalin pada pasien obstetri di unit rawat jalan RSK Azzahra, yaitu faktor predisposisi, faktor pemungkin, faktor pendorong, dan faktor kebutuhan. Penelitian ini bersifat analitik kuantitatif dengan desain penelitian survei cross sectional. Dari hasil penelitian terlihat bahwa determinan yang terbukti signifikan secara statistic dengan pemilihan lokasi bersalin pada pasien obstetri RSK Azzahra adalah waktu tempuh dari rumah ke RSK Azzahra (p=0,011), sumber biaya perawatan (p=0,023), persepsi responden terhadap tarif bersalin RSK Azzahra (p=0,000), persepsi responden terhadap pelayanan dokter (p=0,026), persepsi responden terhadap pelayanan perawat (p=0,02l), serta rekomendasi dari dokter untuk bersalin di RSK Azzahra (p=0,0i 1). Faktor yang secara statistik terbukti paling dominan adalah faktor persepsi terhadap tarif bersalin. Diharapkan pada pihak manajerial RSK Azzahra memberlakukan fasilitas ambulance on-call untuk menangkap pasien yang bertempat tinggal jauh, peninjauan terhadap strategi penetapan tarif pemberian reward dan evaluasi kinerja untuk meningkatkan kinerja dokter dan perawat, membuat kebijakan terkait rekomendasi bersalin dari dokter, membuat penelitian lebih lanjut mengenai analisis tarif dari RS dan RSK sekitar RSK Azzahra dan penelitian mengenai pilihan bersalin pada pasien yang telah bersalin di Azzahra dapat dilakukan untuk menambah dan mempertajam dari hasil yang telah dilaksanakan.

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This thesis describes determinants of obstetric outpatient’s choice for delivery location in Azzahra Hospital, which is predisposing, enabling, reinforcing, and need factor. This study is an analytical quantitative study with cross sectional survey. Based on the result, there are 29,6% patients that choose not to give birth in Azzahra Hospital. Determinants which proven signiticant statistically affect the choice of delivery location are time needed to Azzahra Hospital (p=0,0ll), source of payment (p=0,023), perception to delivery tariff (p=0,000), perception to doctors service (p=0,026), perception to nurse service (p=0,021), and doctor’s recommendation (p=0,0l 1). Multivariate analysis result shows that the most influence factor is perception to delivery tariff It is recommended to Azzahra Hospital Management to initiate on-call ambulance service to serve farther patients, conducting evaluation on pricing strategy, applying reward system and performance evaluation to maintain and increase doctors and nurses performance, assembling hospital policy regarding doctors recommendation system, it is advised to later study to carry out pricing analysis and tirrther study regarding delivery location selection on inpatients to enhance, intensify, and to be compared with the result existed."

"ABSTRAK Latar belakang : Robekan perineum tingkat III dan IV dapat menimbulkan berbagaimorbiditias seperti disfungsi organ panggul, dispareni, nyeri kronik, dan masalahpsikososial yang mengganggu kualitas hidup perempuan. Audit terhadap tatalaksanarobekan perineum perlu dilakukan sebagai dasar perbaikan panduan pelayanan klinisdan pelayanan di rumah sakit. Tujuan : mengetahui insidensi dan mengaudit tatalaksana robekan perineum tingkatIII dan IV di Rumah Sakit Cipto Mangunkusumo pada tahun 2011-2014 berdasakanpanduan Royal College of Obstetricians and Gynecologist (RCOG) tahun 2015. Metode : Studi deskriptif dengan desain potong lintang dilakukan denganmenggunakan data persalinan di RSUPN Cipto Mangunkusumo dari tahun 2011sampai dengan 2014. Kesesuaian tatalaksana robekan perineum tingkat III dan IVdinilai berdasarkan kehadiran konsulen, tempat memperbaiki, penggunaan anestesi,metode jahitan, bahan jahitan, antibiotik pasca operasi, kateter 1 kali 24 jam,penggunaan analgetik dan laksantia. Subjek yang memenuhi minimal 7 dari 9kriteria, dianggap mendapatkan tatalaksana yang sesuai dengan panduan RCOG. Hasil : Dari tahun 2011 sampai dengan 2014, insidensi robekan perineum berturutturutadalah sebesar 3,54; 4,34; 3,95; dan 1,77%. Tatalaksana robekan perineumtingkat III dan IV pada studi ini didapatkan sesuai pada 57,8% subjek. Ketidaksesuaian ditemukan pada komponen tempat operasi, operator oleh ahli, danpenggunaan kateter urin 1 kali 24 jam pasca tindakanKesimpulan : Insidensi robekan perineum derajat 3 dan 4 didapatkan masih tinggi.Masih terdapat tatalaksana robekan perineum derajat III dan IV yang belum sesuai dengan standar RCOG. ABSTRACT Background : OASIS may lead to several morbidities i.e pelvic organ dysfunction,dysparenia, chronic pain, and psychosocial problems leading to impaired quality oflife of women. Audit of OASIS management is needed to improve the clinicalguideline and practice of OASIS management in a hospital. Objective : To determine the incidence of OASIS and assess the case management atCipto Mangunkusumo National Hospital during 2011-2014 using the criteria statedin the Royal College of Obstetricians and Gynecologist (RCOG) guideline 2015. Methods : A cross-sectional descriptive study was conducted using the deliverydatabase in Cipto Mangunkusumo Hospital, a tertiary referral university hosptal inJakarta, Indonesia during 2011-2014. The OASIS management of each subjectswere assessed based on 9 items listed at RCOG 2015 guideline of OASISmanagement (consultant presence during repair, place of repair, use of anesthesia,methods of suturing, suturing material, use of post-operative antibiotic, use ofurinary catheter 24 hour after surgery, use of laxative agent.Result : During 2011-2014, the incidence of OASIS were respectively 3,54; 4,34;3,95; and. 1,77%. As many as 57,8% subjects with OASIS were approproatelymanaged according to RCOG guideline. Surgery performed at delivery suite, surgeryperformed by resident (not an expert), and not using postoperative foley catheterwere the items that frequently missed in the management. Conclusion : We found a relatively high incidence of OASIS in our hospital. There was several items included in RCOG guideline that should improved in our hospital.;Background : OASIS may lead to several morbidities i.e pelvic organ dysfunction,dysparenia, chronic pain, and psychosocial problems leading to impaired quality oflife of women. Audit of OASIS management is needed to improve the clinicalguideline and practice of OASIS management in a hospital. Objective : To determine the incidence of OASIS and assess the case management atCipto Mangunkusumo National Hospital during 2011-2014 using the criteria statedin the Royal College of Obstetricians and Gynecologist (RCOG) guideline 2015. Methods : A cross-sectional descriptive study was conducted using the deliverydatabase in Cipto Mangunkusumo Hospital, a tertiary referral university hosptal inJakarta, Indonesia during 2011-2014. The OASIS management of each subjectswere assessed based on 9 items listed at RCOG 2015 guideline of OASISmanagement (consultant presence during repair, place of repair, use of anesthesia,methods of suturing, suturing material, use of post-operative antibiotic, use ofurinary catheter 24 hour after surgery, use of laxative agent.Result : During 2011-2014, the incidence of OASIS were respectively 3,54; 4,34;3,95; and. 1,77%. As many as 57,8% subjects with OASIS were approproatelymanaged according to RCOG guideline. Surgery performed at delivery suite, surgeryperformed by resident (not an expert), and not using postoperative foley catheterwere the items that frequently missed in the management. Conclusion : We found a relatively high incidence of OASIS in our hospital. There was several items included in RCOG guideline that should improved in our hospital.;Background : OASIS may lead to several morbidities i.e pelvic organ dysfunction,dysparenia, chronic pain, and psychosocial problems leading to impaired quality oflife of women. Audit of OASIS management is needed to improve the clinicalguideline and practice of OASIS management in a hospital. Objective : To determine the incidence of OASIS and assess the case management atCipto Mangunkusumo National Hospital during 2011-2014 using the criteria statedin the Royal College of Obstetricians and Gynecologist (RCOG) guideline 2015. Methods : A cross-sectional descriptive study was conducted using the deliverydatabase in Cipto Mangunkusumo Hospital, a tertiary referral university hosptal inJakarta, Indonesia during 2011-2014. The OASIS management of each subjectswere assessed based on 9 items listed at RCOG 2015 guideline of OASISmanagement (consultant presence during repair, place of repair, use of anesthesia,methods of suturing, suturing material, use of post-operative antibiotic, use ofurinary catheter 24 hour after surgery, use of laxative agent.Result : During 2011-2014, the incidence of OASIS were respectively 3,54; 4,34;3,95; and. 1,77%. As many as 57,8% subjects with OASIS were approproatelymanaged according to RCOG guideline. Surgery performed at delivery suite, surgeryperformed by resident (not an expert), and not using postoperative foley catheterwere the items that frequently missed in the management. Conclusion : We found a relatively high incidence of OASIS in our hospital. There was several items included in RCOG guideline that should improved in our hospital."

"Kejadian Komplikasi Obstetri merupakan masalah kesehatan masyarakat, karena prevalensinya yang tinggi dan merupakan salah satu faktor utama penyebab kematian ibu. Secara holistik, kejadian komplikasi obstetri dapat disebabkan oleh faktor medis (kualitas program dan layanan kesehatan ibu) dan faktor-faktor lain yang ada dalam konteks kewilayahan (kebijakan desentralisasi, pertumbuhan ekonomi, faktor lingkungan). Oleh karena itu, diperlukan studi/analisa lebih lanjut untuk mengetahui determinan yang berpengaruh terhadap kejadian komplikasi obstetri baik dari aspek individu maupun aspek kontekstual.Penelitian ini bertujuan untuk mengetahui peranan dari faktor komposisional (level individu) serta determinan kontekstual (level kabupaten/kota) terhadap kejadian komplikasi obstetri di 20 Kabupaten. Penelitian ini menggunakan desain potong lintang dengan pendekatan analisis multilevel untuk mengestimasi efek kontekstual, sehingga dapat ditentukan prioritas intervensi program terhadap kejadian komplikasi obstetri. Penelitian dilakukan dengan memanfaatkan data sekunder Riskesdas 2013, Studi Kualitas Pelayanan Kesehatan Ibu di 100 Fasilitas Kesehatan tahun 2012 dan data BPS Tinjauan Regional berdasarkan PDRB Kabupaten/Kota tahun 2010-2013, dengan melibatkan 2066 orang Wanita Usia Subur berusia 15-49 tahun) yang memiliki riwayat kehamilan, persalinan dan nifas.Hasil penelitian menunjukkan bahwa prevalensi Kejadian Komplikasi Obstetri di 20 Kabupaten adalah 30,1%. Tampak adanya perbedaan peranan di level individu dan level kabupaten/kota. Pada level individu, variabel yang berperan cukup besar terhadap kejadian komplikasi obstetri di 20 Kabupaten adalah kunjungan ANC (aOR: 3,17, 95% CI 1,29-7,76). Pada level Kabupaten, variabel yang berperan adalah kualitas pelayanan antenatal di rumah sakit (IOR: 0,291-1,287), kualitas pelayanan pascasalin di rumah sakit (IOR: 0,610-2,776), dan pertumbuhan ekonomi (IOR: 0,759-3,916). Namun determinan kejadian komplikasi obstetri masih didominasi oleh peran faktor risiko di level individu.Intervensi program kesehatan ibu dilakukan dengan memfokuskan pada perubahan perilaku sehat di tingkat individu, namun sejalan dengan peningkatan kualitas pelayanan kesehatan ibu di tingkat Kabupaten sehingga secara otomatis menarik minat dan kesadaran masyarakat untuk datang ke fasilitas kesehatan dalam mencari pelayanan KIA yang bermutu.

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Obstetric complications is a public health problem, because of its high prevalence and one of the main factors that caused maternal mortality. Holistically, obstetric complications caused by medical factors (quality programs and maternal health services) and other factors that exist within the territorial context (decentralization policy, economic growth, environmental factors). Therefore, a further analysis was needed to find the determinants that affects obstetric complications from the aspect of individual and contextual level.

The aims of this study was to search the role of compositional factors (individual level) as well as contextual determinants (districts level) in determine obstetric complications in 20 districts. This study used a cross-sectional design with multilevel analysis approach to estimate the effects of contextual factors, so it can determined intervention programa of obstetric complications. The study was conducted by using secondary data of Riskesdas 2013, the Quality of Maternal Health Care Assessment in 100 health facilities in 2012, and Regional Review based on Districts GDP in 2010-2013, involving 2066 Woman at Reproductive Age (15-49) who already have their history on pregnancy, childbirth and post-partum.

The results showed that the prevalence of Obstetric Complications in 20 districts is 30.1%. There was a different role from the individual level and the districts level that influence an obstetric complications. At the individual level, the variable that contribute greatly to the prevalence of obstetric complications in 20 districts is antenatal care (aOR: 3,17, 95% CI 1,29-7,76). At the district level, the variable that played role was the quality of antenatal care in hospitals (IOR: 0,291-1,287), the quality of postnatal care in hospitals (IOR: 0,610-2,776), and economic growth (IOR: 0,759-3,916). However, determinants of obstetric complications were still dominated by the role of individual level risk factors.

Intervention on maternal health programmes must be carried out by focusing on healthy behavior changes at the individual level, but in line with the improvement of the quality of maternal health services at the district level so that automatically can attract the interest and awareness of the community to obtain the better quality of maternal health services in health facilities."

"Tesis ini membahas rujukan kasus kegawatdaruratan Obstetri Neonatal oleh Bidan Desa ke Puskesmas mampu PONED di Kabupaten Bogor. Penelitian ini adalah penelitian kualitatif. Hasil Penelitian menyarankan bahwa setiap bidan desa harus tinggal di desa dan mendapatkan pelatihan APN dan PPGDON; puskesmas harus membuat sosialisasi dan pembinaan khusus untuk kegiatan PONED; Dinas Kesehatan harus memenuhi kebutuhan Sumber Daya Manusia (SDM) khusus untuk petugas PONED melalui mutasi dan promosi yang tepat; memenuhi kebutuhan sarana dan pembinaan terjadwal secara rutin; membuat penilaian kinerja Puskesmas mampu PONED sebagai tolak ukur keberhasilan kegiatan PONED di Kabupaten Bogor; memberikan bantuan biaya transportasi kepada masyarakat miskin yang akan dirujuk.

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The focus of this study is the referral case of an obstetric and neonatal emergency by villagel midwives to the PONED preliminary health Center in Bogor District. This research is a qualitative study. This study results come up with some suggestions. Every midwife need to stay in the rural district and get the training PPGDON and training APN; PHC should make some socialization and coaching program related to PONED activities; Health Department in Bogor must fulfill the need of PONED human resources by some mutation and promotion; in addition, the supervision facility and observation need to be scheduled regulary; some indicator of success have to be developed in order to measure the PONED performance effectively; besides, the cost of transportation also should be allocated to protect the poor."

"Rujukan kebidanan merupakan sistem penting dalam menangani komplikasi dan kegawatdaruratan kehamilan dan persalinan dan diharapkan dapat mengantarkan ibu melewati masa kehamilan dan persalinannya dengan aman. Penelitian ini bertujuan melihat gambaran pasien rawat inap di RSUD Cibinong yang meliputi karakteristik, pola rujukan, tindakan, kondisi ibu saat datang di RS dan kondisi neonatal. Penelitan ini menggunakan desain studi cross-sectional yang dilakukan pada pasien rawat inap kebidanan kebidanan di RSUD Cibinong pada tanggal 7 April - 19 Mei 2011 sebanyak 218 sampel. Pengumpulan dan pengambilan sampel dilakukan dengan wawancara menggunakan kuesioner terstruktur dan menggunakan data status pasien. Pada penelitian ini menunjukan bahwa mayoritas ibu berusia 20-35 tahun (77.52%), dengan tingkat pendidikan ibu rendah (65.1%), ibu tidak bekerja (85.8%). Kasus rujukan pada RSUD Cibinong sebanyak 79.8% dengan asal rujukan terbanyak dari bidan (39.0%), rantai rujukan terbanyak adalah 2 mata rantai (54.6%). Didapatkan bahwa ibu yang melahirkan dengan seksio sesarea sebanyak 45% dari seluruh persalinan, kondisi ibu yang tiba dalam kondisi menghawatirkan sebanyak 25.7% dan bayi lahir mati 6%.

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Obstetric referral system is particularly important in pregnancy care and handling emergencies and complications of pregnancy and childbirth delivery. it is expected to help the mother through pregnancy and birth safely. This research aims to see the descriptions of the hospitalized obstetric patient in Cibinong General Hospital which include characteristics, referral patterns, treatment, maternal condition when arrived at the hospital and neonatal conditions. This research is a cross-sectional study at hospitalized obstetric patients in Cibinong General Hospital on April 7 - May 19 2011. The data was collected with interview bay using questioners to 218 respondent and use the patient status. This research show that the majority samples of aged 20-35 years (77.52%), and with low levels of maternal education (65.1%). The referral cases in Cibinong General Hospital as much as 79.8% with reference to the origin of most of the midwives (39.0%), referral chain was 2 chain (54.6%). Found that mothers who gave birth by caesarean section as much as 45% of all deliveries, the condition of the mother who arrives in a worrying condition as much as 25.7% and 6% stillbirth."

"Salah satu upaya percepatan penurunan AKI yaitu meningkatkan kualitas pelayanan persalinan oleh nakes di fasyankes. Pemanfaatan layanan persalinan di fasyankes dipengaruhi oleh pelayanan antenatal yang diterima oleh ibu hamil. Penelitian ini bertujuan mengetahui efek pelayanan antenatal terhadap pemanfaatan layanan persalinan di Indonesia. Penelitian ini menggunakan desain cross sectional dengan analisis regresi logistik multinomial menggunakan sampel penelitian 15.142 wanita usia subur yang melahirkan anak terakhir lima tahun sebelum survei dan terpilih dalam sampel SDKI 2012. Hasil penelitian menunjukkan bahwa pemanfaatan layanan persalinan di fasyankes 64,63%. Pemeriksaan fisik umum dan obstetri, risiko terjadinya persalinan di rumah baik dengan penolong persalinan nakes maupun dukun 3,64 kali lebih besar terhadap persalinan di fasyankes pada ibu yang hanya mendapat 1 pemeriksaan dibandingkan ibu yang mendapat 4 pemeriksaan. Pemeriksaan penunjang, risiko terjadinya persalinan di rumah dengan penolong persalinan nakes 1,39 kali lebih besar terhadap persalinan di fasyankes pada ibu yang tidak mendapat pemeriksaan dibandingkan ibu yang mendapat pemeriksaan darah dan urin, serta risiko terjadinya persalinan di rumah dengan dukun 1,25 kali lebih besar pada ibu yang hanya mendapat pemeriksaan darah atau urin dibandingkan dengan ibu yang mendapat kedua pemeriksaan. Komponen suplemen tablet zat besi dan imunisasi TT, risiko terjadinya persalinan di rumah dengan penolong persalinan nakes 1,92 kali lebih besar terhadap persalinan di fasyankes pada ibu yang tidak mendapat tablet zat besi dan imunisasi TT dibandingkan ibu yang mendapat kedua pemeriksaan. Sedangkan risiko terbesar terjadinya persalinan di rumah dengan penolong persalinan dukun 2,16 kali lebih besar pada ibu yang tidak mendapat tablet zat besi dan imunisasi TT dibandingkan ibu yang mendapat keduanya. Semakin sedikit pemeriksaan yang dilakukan, maka risiko menjadi lebih besar untuk terjadinya persalinan di rumah. Oleh karena itu, sangat perlu untuk memberikan penyuluhan tentang pentingnya pemeriksaan kehamilan agar ibu cenderung melakukan persalinan di fasilitas pelayanan kesehatan, sehingga menekan risiko kematian ibu dan bayi.

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One of the efforts to accelerate reduction of MMR by improving the quality of delivery care by skilled birth attendant in health facility. Utilization of delivery care at health facilities is influenced by antenatal care received by the pregnant mother. This study aims to determine the effect of antenatal care on the utilization of delivery care in Indonesia. This study used a cross sectional design with multinomial logistic regression analysis, using 15,142 women aged 15-49 years with a delivery in five years prior to survey selected in the sample IDHS 2012.

The results showed that the utilization of delivery care in health facilities 64.63%. General physical checkup and obstetrics, the risk of delivery in home both with skilled birth attendant and traditional birth attendant more than 3.64 times to deliver in health facility, mothers who only receive one checkup compared to mothers who received 4 checkup. Supporting chekup, the risk of delivery in home with skilled birth attendant were 1.39 times more likely to the delivery in health facility, mother who did not received checkup compared mother who did blood and urine test, as well as the risk of delivery in home with traditional birth attendant were 1.25 times more likely, mothers who only checkup blood or urine test compared with mothers who received 2 checks.

For component of iron tablet supplement and TT immunization, the risk of delivery in home with skilled birth attendant were 1.92 times more likely to delivery in health facility, women who did not receive iron tableet and TT immunization compared to mothers who received both. While the greatest risk of birth at home with traditional birth attendant was 2.16 times more likely mothers who did not receive iron tablet and TT immunization than mothers who received both. Lack of checkup, the risk increase for delivery in home. Therefore, it is very important to promote about the importance of pregnancy checkup so that mothers tend to delivery in health facilities, thus reducing the risk of maternal and infant deaths."

"Penggunaan Alat Pelindung Diri pada waktu melakukan pertolongan persalinan di rumah sangat penting karena dapat mencegah bidan tertular dari penyakit infeksi akibat kerja terutama hepatitis dan HIV/AIDS. Tujuan penelitian ini untuk mengetahui gambaran dan faktor apa saja yang berhubungan dengan penggunaan APD pada waktu melakukan pertolongan persalinan di rumah. Desain ini adalah cross sectional. Popolasi penelitian adalah seluruh bidan di desa dengan total sampel yang memenuhi criteria inklusi 96 orang. Hasil penelitian menunjukkan bahwa pengetahuan, pendidikan, ketersedian dan pengawasan adalah faktor yang berhubungan dengan penggunaan Alat Pelindung Diri oleh bidan di desa.

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The use of self safety tool by midwife at the time of delivering natal assistance in home is very important because it can prevent the midwife of being infected by infection illness because of working especially hepatitis and HIV/AIDS. The purpose of this research is to recognize the description and the factors of anything that connect with the use of APD at the time of delivering natal assistance in home. This research design is cross sectional. The population of the research is all the entire midwives in the village with total sample that covers the inclusive criteria of 96 people. The research shows that knowledge, education, availability and supervision are the factors that connect with the use of self safety tool by midwife in the village."

"Pelayanan Obstetri dan Neonatal Emergensi Dasar (PONED) merupakan salah satu pelayanan Puskesmas yang diharapkan dapat memberikan kontribusi untuk penurunan AKI dan AKB. Angka Kematian Ibu (AKI), Angka Kematian Bayi (AKB) dan Angka Kematian Balita (AKABA) di Indonesia tertinggi dibandingkan negara-negara ASEAN lainnya. Kabupaten Administrasi Kepulauan Seribu memiliki 2 Puskesmas Kecamatan yang memiliki rawat inap yang berfungsi PONED dan 4 Puskesmas Kelurahan yang mempunyai perawatan 24 jam. Namun demikian indikator pelayanan Program PONED masih belum mencapai target, salah satunya angka Kematian Bayi dan Rujukan Ibu Melahirkan yang masih sangat tinggi. Penelitian ini merupakan penelitian analitik kualitatif. Informan ditentukan dengan menggunakan purposive sampling. Informan penelitian antara lain masyarakat, Pemerintah Daerah, Tim PONED Puskesmas, Para Kepala Puskesmas PONED, penanggung jawab program PONED Sudinkes Pulau Seribu, dan Penanggung Jawab SDM Kesehatan Sudinkes Kepulauan Seribu. Data yang dikumpulkan berupa data primer dan data sekunder berupa hasil wawancara mendalam dan telaah dokumen. Hasil penelitian diperoleh data bahwa pada standar dan ukuran kebijakan telah dipahami oleh pelaksana kebijakan. Pemahaman ini didukung komunikasi yang jelas dan berkelanjutan antara Dinas Kesehatan, puskesmas dan stakeholder, kejelasan informasi dan konsistensi informasi. Ketersediaan anggaran, sarana dan prasarana sudah mencukupi tetapi terkendala masalah pemeliharaan alat karena faktor air asin yang menyebabkan peralatan mudah berkarat dan rusak. Struktur birokrasi sudah terdapat Keputusan Bupati mengenai tim PONED, namun belum ada struktur khusus PONED di Suku Dinas Kesehatan Kepulauan Seribu Disposisi ditunjukan dengan sikap positif berupa komitmen bersama Pemerintah Daerah dan Puskesmas dalam penanganan ibu hamil, penanganan kasus rujukan ibu melahirkan dengan penyulit. Peran serta masyarakat dalam pelaksanaan PONED sudah ditunjukan dengan pemanfaatan Puskesmas PONED dalam pemeriksaan kehamilan dan proses melahirkan, Output pelaksanaan program PONED sudah dilakukan pencatatan dan pelaporan capaian program kepada penanggung jawab di Sudinkes, belum ada format pelaporan khusus PONED dan belum dilakukan analisa pelaporan PONED serta feedbacak pelaporan belum dilaksanakan. Implementasi pelayanan PONED di Puskesmas Kepulauan Seribu Selatan dan Puskesmas Pulau Seribu Utara sudah berjalan tapi belum optimal dengan adanya hambatan dan kendala di komponen input, proses maupun output yang harus diatasi sehingga pelayana PONED di Kepulauan Seribu bisa berjalan dengan baik.

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Basic Emergency Obstetric and Neonatal Care (PONED) is one of the Primary Health Care services that is expected to contribute to the reduction of MMR and IMR. Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR) and Toddler Mortality Rate in Indonesia are the highest compared to other ASEAN countries. The Seribu Islands Administrative Regency has 2 sub-district health centers that have PONED inpatient care and 4 sub-district health centers that have 24-hour care. However, the service indicators of the PONED program have not yet reached the target, one of which is the very high infant mortality rate and maternal referral. This study was a qualitative analytic study. Informants were determined using purposive sampling. The research informants included the community, local government, Primary Health Care PONED team, Heads of Primary Health Care PONED, the person in charge of the Thousand Island sub-district PONED program, and the person in charge of the Thousand Islands sub-district health human resources. The research results show that the policy standards and measures have been understood by implementers. This understanding is supported by clear and continuous communication between the Health Service, community health centers and stakeholders, clarity of information and consistency of information. The availability of budget, facilities and infrastructure is sufficient but is hampered by equipment maintenance problems due to the salt water factor which causes the equipment to rust easily and cause damage. The bureaucratic structure already has a Regent's Decree regarding the poned team, but there is no special PONED structure in the Seribu Islands Health Sub-Department. The disposition is shown by a positive attitude in the form of a joint commitment between the Regional Government and the Community Health Center in handling pregnant women, handling referral cases of mothers giving birth with complications. Community participation in the implementation of PONED has been demonstrated by the use of PONED Community Health Centers in pregnancy checks and the birthing process. The output of the implementation of the PONED program has been recorded and reported on program achievements to the person in charge at the Health Sub-Department. reporting has not been implemented. The implementation of PONED services at the South Seribu Islands Community Health Center and North Thousand Islands Health Center is already underway but is not yet optimal due to the existence of barriers and obstacles in the input, process and output components that must be overcome so that PONED services in the Thousand Islands can run well."

"RSUD Kota Bekasi sebagai Badan Layanan Umum (BLU) harus meningkatkan daya saing RS di era globalisasi dengan melakukan refonnasi manajemen yang diharapkan dapat menyelesaikan berbagai masalah manajemen dalam efisiensi. produktivitas, kualitas dan patient responsiveness. BLU mempakan suatu badan kuasi Pemerintah yang tidak bertujuan mencari laba, meningkatkan kualitas dan memberikan fleksihilitas manajemen RS.RSUD Kota Bekasi merupakan satu dari beberapa RS yang beberapa RS yang berada di perbatasan dengan DKI Jakarta, sehingga tingkat persaingan sangat tinggi, dengan demikian diperlukan pengembangan strategi yang jelas dan penjabarannya sampai ke tingkat operasional. Untuk itu peneliti berusaha untuk membantu penerapan strategi dengan menggunakan Balanced Scorecard di IGD scbagai he frontliner RSUD Kota Bekasi.Balanced Scorecard (BSC) merupakan a1at manajemen untuk menttansfonnasikan strategi menjadi aksi. BSC mampu menje1askan dan rnenerjemahkan strategi secara komprehensif dan dapat dijatankan dalam kegiatan operasional sehari-bari. Kinetja ditetjemahkan ke dalam sasaran dan tolok ukur yang jelas dan spesifik melalui keempat perspektif : keuangan, pelangganproses bisnis internal. serta pembelajaran dan pertumbuhan sehingga kinelja dapat dimonitor dan dievaluasi secara berkafa untuk mengetahui kemajuannya dalam pencapaian strategi. (Kaplan dan Norton, 1996).Penelitian yang dilakukan merupakan pcnclhian operasional (Riset Operasional), yaitu penelitian yang berhubungan dengan penernpan suatu metode yang sesuai dengan somber daya yang tersedia. Dalam tahap pengembangan BSC, dibagi kinerja yang didasarkan pada uraian jabalan belum pemah dilakukan, tidak ada evaluasi terhadap kinerja setiap individu yang bertugas di IGD, yang ada hanya mengukur jumlah kunjunganjumiah pendapatan, dan survei kepuasan pelanggan.4) Penilaian kinerja di Instalasi Gawat Darurat beJum memiiiki aJat ukur dan basil akur. Penilaian kine!ja yang ada hanya berdasarkan indikator (SPM) IGD yang dltetapkan DepKes. 5) Media komunikasi dilakukan sebulan sekali, namun jika ada pennasaiaban mendadak seperti keluhan pasien atau keluban dokter spesiatis, maka rapat bisa dilakukan sewaktu-waktu. namun belum dioptimatkan sebagai media monitoring: dan evaluasL Fase II Proses Cascading Strategi RS yaitu : 1) strategi IGD yang sesuai visi dan misi didapatkan melalui wawancam dan FGD rnengbasilkan pengembangan strategi yang disepakati bersarna. 2} Pengembangan strategi juga dituronkan dari renstra RSUD, 3) Pela Strategi IGD dibuat melalui dua iterasi, melalui FGD dan CDMG, 4) Membangun BSC dengan empat perspektif di dapat perspektif pelanggan 25%, proses bisnis internal 35o/o, pembelajaran dan pertumbuhan 25%, keuangan 15%.Berdasarkan penelitian ini, dapat diketahui bahwa sangat diperlukan suaut penjabaran KPI yang jelas untuk masing-masing pemegang jabatan dan individu yang disesuaikan dengan tugas dan tanggung jawab. Sistem Pelapon:rn dan review KPI perlu dijalankan secara berkala agar dapat diketahui kemajuan dalam pencapaian strategi melalui pencapaian KPJ. Eva1uasi kinerja hendaknya didasrakan pada pencapaian KPI pada masing-masing individu.

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RSUD Kota Bekasi as a Public Service Board have to well-develop to face hospital competition as global by reforming management to manage all those management's complexity in such efficient. productivity, quality and patient responsiveness. Public Service Board becoming a government institution which is a Non-Profitable entity, up grading the quality and giving hospital's management to more flexible way.RSUD Kota Bekasi is one from those hospitals which is located at the border from DKI Jakarta. This means the degree of competition is very high, therefore need a clear strategy development in all sectors, especially at operational sector. Research and Development people has to help out to implement all strategies by using Balanced Scorecard at Emergency Department as the front/iner RSUD Kota Bekasi.Balanced Scorecard (BSC) is a management tool in transforming all strategy into action. BSC can explain and translating in such comprehensive way and can be implemented as a daily operational. Productiveness can be translated and can became a clear specific measurement through 4 perspective such as financial, customer, internal business and learning procedure and growth which all these can be monitored and being evaluated into several steps to know whether the growth still in corridor of strategy achievement. (Kaplan dan Norton, 1996).Any research taken is an Operational Research which is related in implementation a method with all provided internal resources. There are 2 phases in BSC's development step. Phase I is Analyzing Current Performance system to review the system that already implemented, then Phase II is Cascading Process of satisfaction survey.4) The productivity measurement at Emergency Department of performance appraisal is not clear. 5) Regular meeting is taken monthly. however if there is an urgent incident such complaints the meeting an optimized as media monitoring dan evaluation. Phase II Cascading Process of Hospital's Strategy are : 1) AU Emergency Department's strategy relating with hospital's vision and mission which obtained through interview and FGD resulting strategy development to all members 2) planning also giving several feedback for strategy development.3) Emergency Department Strategy Map is made through two iteration, which are through FGD and CDMG, 4) Developing BSC with four perspectives are consists of 25% of Customers perspective, 35% of Internal Business. 25% of learning and growing then J 5% of financial.Through this research, we can make a conclusion that a very clear of KPl s cascading is really a crucial part to aU hospitat?s members and to every person to aU their duties and responsible. System report and review of KPI need to be done step by step so can be noticed on the strategic achievement Productivity evaluation must base on the achievement to each person individu."