Evaluation of Antenatal Care Implementation by Midwives at the Public Health Centers in Paniai Regency, Papua Province

Abstract

Background: The antenatal care (ANC) services in the working area of Puskemas in Paniai Regency are still less than optimal compared to the predetermined standards. This is due to the influence of the service system that includes input, process, output, supervision and feedback that are not optimal.

Research Objectives: To access the ANC service system that include of the input, process, output, supervision and feedback aspect at the Puskesmas in Paniai Regency, Papua Province. Research method: The research method used in this study was qualitative research using a case study approach. The study was conducted in April-May 2020 at five Public Health Centers in the work area of the Paniai Regency Health Department. A total of 11 informants were taken using a method of purposive sampling. The main methods of data collection are in-depth interviews and participatory observation. The data were qualitatively analyzed. Results: The overview of the input aspect: 1) Most health workers (midwives) in ANC services have not met the standards for the provision of the ANC services. There were still many midwives who did not have STR (Registration Certificate) as evidence of midwife competence. Many midwives also never attended ANC training to increase their competence.

There were 2 midwives who has followed the training, but it was 10 years ago. In addition, the placement of midwives in all public health centers (Puskesmas) services were still unequal; 2) Funds, the availability of budgets for ANC services at Puskesmas in Paniai Regency cannot support the operational services needed; 3) Inadequate and incomplete facilities and infrastructure make it impossible to operate the service as expected. The existing Standard Operating Procedures (SOP) can not therefore be followed by ANC services. The overview of the process aspect: the service flow system did not comply with the integrated guidelines of the Ministry of Health. The ANC service process has not been carried out by midwives according to the standards. The overview in the output aspect: inadequacy of ANC services according to the predetermined targets could be due to poor input, including: not good service due to insufficient number of staff / midwives in the Puskesmas, lack of adequate facilities, such as UGS, laboratory and others. The overview in the supervision aspect: The head of the Puskesmas from each Puskesmas did not supervise properly; he did not perform a workshop to evaluate every activity that had been carried out by each program. The overview in the feedback aspect: Many pregnant women in the work area of the Puskesmas prefer to go to other health services such as hospitals or Puskesmas. This is a benchmark for Puskesmas, both in terms of input, service process, and output itself, to improve the service system.