Pelayanan Manajemen Terpadu Balita Sakit (MTBS) pada Puskesmas di Regional Timur Indonesia

The decline in under-five mortality remains target of health development in Indonesia. One effort that can be done, among others, is to improve the skills of health workers in dealing with sick children through the Integrated management of Chilhood Illness (IMCI). This study aims to evaluate the implementation of IMCI in 10 selected districts/cities in Eastern Region of Indonesia with a sample of 20 puskesmas selected randomly. In total 40 under-five children were observed when receiving IMCI services at the puskesmas. In addition, an assessment of the completeness of filling out of 200 forms of IMCI under-five children who had come to the puskesmas a week before the survey was conducted. Information related to the availability of equipment to support IMCI services is collected through direct observation in 20 selected puskesmas assisted by a check list form. The results showed that 80% of puskesmas in the eastern region have implemented IMCI, but only 25% of puskesmas reaching all the under-five children. As many as 90% of puskesmas have been trained for IMCI, however only 15% have been monitored post training. Only 25% of puskesmas received supervision from the District Health Office in implementing IMCI. The observation results at the IMCI service for children under five showed that, the lowest score for compliance with IMCI was counseling (25.8%) and the highest was diarrhea assessment (73.8%). The results of observing the IMCI forms showed that the lowest score was feeding practice (30.4%) and repeat visits (30.8%). Meanwhile, oral rehydration facilities for diarrhea are reported to be inadequate, because they are only available at 50% of puskesmas. There needs to be monitoring and supervision of officer compliance and increasing the availability of supporting equipment and facilities/insfrastructure in the implementation of IMCI.  Abstrak Penurunan angka kematian balita masih menjadi target pembangunan kesehatan di Indonesia. Salah satu upaya yang dapat dilakukan antara lain meningkatkan keterampilan tenaga kesehatan dalam menangani balita sakit, melalui pendekatan Manajemen Terpadu Balita Sakit (MTBS). Penelitian ini bertujuan untuk mengevaluasi pelaksanaan MTBS di 10 Kabupaten/Kota terpilih di regional timur, dengan jumlah sampel 20 puskesmas yang dipilih secara acak. Secara total, 40 pasien balita diobservasi pada saat mendapatkan pelayanan MTBS di puskesmas. Selain itu, dilakukan asesmen kelengkapan pengisian dari 200 formulir MTBS balita yang pernah datang ke puskesmas dalam kurun waktu seminggu sebelum survei. Infomasi terkait dengan ketersediaan peralatan untuk mendukung pelayanan MTBS dikumpulkan melalui observasi secara langsung di 20 puskesmas terpilih dibantu dengan formulir check list. Hasil analisis menunjukkan bahwa 80% puskesmas di regional timur telah melaksanakan MTBS, namun hanya 25% puskesmas yang menjangkau seluruh balita. Sebesar 90% puskesmas telah terlatih MTBS, namun hanya 15% yang dilakukan monitoring pasca pelatihan. Hanya 25% puskesmas yang mendapatkan supervisi dari Dinas Kesehatan Kabupaten/Kota dalam pelaksanaan MTBS. Hasil observasi pada saat pelayanan MTBS pada balita menunjukkan, skor kepatuhan pelaksanaan MTBS yang terendah adalah konseling (25,8%) dan tertinggi adalah asesmen diare (73,8%). Hasil observasi pengisian formulir MTBS menunjukkan, skor terendah pada pengisian pemberian makan (30,4%) dan kunjungan ulang (30,8%). Sementara itu, fasilitas rehidrasi oral untuk diare dilaporkan belum memadai, karena hanya tersedia di 50% puskesmas. Perlu adanya monitoring dan supervisi terhadap kepatuhan petugas serta peningkatan ketersediaan peralatan dan sarana/prasarana pendukung dalam pelaksanaan MTBS.