Managing Early Detectionof Mothers with High-Risk Pregnancy by Health Surveillance Workers for Mater

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International Journal of English, Literature and Social Science (IJELS) https://dx.doi.org/10.22161/ijels.4440Vo l-4, Issue-4, Jul – Aug 2019 ISSN:…
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International Journal of English, Literature and Social Science (IJELS) https://dx.doi.org/10.22161/ijels.4440Vo l-4, Issue-4, Jul – Aug 2019 ISSN: 2456-7620Managing Early Detectionof Mothers with HighRisk Pregnancy by Health Surveillance Workers for Maternal and Child Health in Declining Maternal Mortality in Semarang City Nur Asia Hapsari Pratiwi, Sri Achadi Nugraheni, Apoina Kartini Master of P ublic Health, Diponegoro University Semarang, Indonesia Email: nurpratiwi2013@gmail.comAbstract— Health Surveillance Workers for Mother and Child or Tenaga Surveilans Kesehatan (Gasurkes) KIA are mandated to decrease the number of maternal mortalities and increase the coverage for early detection of high-risk pregnancy. It was found that Gasurkes KIA can decline Maternal Mortality Rate and uplift the coverage for early detection of high-risk pregnancy in Semarang City. A good management practice may result in well-organized Gasurkes KIA. This study aimed to analyze the management of early detection conducted by Gasurkes KI Aamong mothers with high-risk pregnancy seen from the coverage for early detection practices. This study was a quantitative study using a cross-sectional design. The population is all Gasurkes KIAs in Semarang City, which then were retrieved to be 93 respondents as samples using total sampling technique. The inclusion criteria for the Gasurkes KIAs are that they have worked since 2008 and have not face validity test for questionnaires. Data from questionnaires were analyzed using Chi-Square test. The findings explain that 66Gasurkes KIA(71%) in the community village level have achieved the coverage for early detection of high-risk pregnancy. There is a relationship between early detection planning conducted by Gasurkes KIA among mothers with high-risk pregnancy and the coverage for early detection of high-risk pregnancy(p=0.024).Also, there is a relationship between organizationand coverage for early detection of high-risk pregnancy (p=0.010). It was found that encouragingearly detection of mothers with high-risk pregnancy conducted by Gasurkes KIArelates to the coverage for early detection for high-risk pregnancy (p=0.008). Furthermore, supervision on early detection of mothers with high-risk pregnancy and the coverage for early detection of high-risk pregnancy (p=0.039). Hence, Gasurkes KIAshould improve the functions of management. Keywords— Management, Gasurkes KIA, Coverage for Early Detection of High-Risk Pregnancy. I. INTRODUCTION The decline of Maternal Mortality Rate (MMR) is one of Sustainable Development Goals in Indonesia. The Semarang District Health Office mentioned in 2014, Semarang City still has high MMR of 33 cases, while 35 cases in 2015.1 The maternal mortality usually occurs to mothers with high-risk pregnancy. High-risk pregnancy is pathology pregnancy, which can influence mother and infant condition. To face high-risk pregnancy, health workers and mothers should be proactive, have promotive and preventive actions as well as decide succinctly and quickly to save mothers and infants.2 Seen from the coverage for early detection for highwww.ijels.comrisk pregnancy as health workers observed around Semarang City is below national target at 20% and 10% in 2014.3 Health workers should put attention on what they have done for early detection of high-risk pregnancy. In 2016, Semarang District Health Office recruited health surveillance workers for maternal and child health orTenaga Surveilans Kesehatan KIA (Gasurkes KIA).4 The analysis of maternal and infant mortality data from Semarang District Health Office from 2016 to 2018 conclude that indicators for maternal and child health moderately achieved targetsmainly because the MMR in Semarang City declined up to32 cases in 2016, 23 cases in 2017, and 19 cases in 2018. Moreover, the coverage for high-risk pregnancy Page | 1167International Journal of English, Literature and Social Science (IJELS) https://dx.doi.org/10.22161/ijels.4440 achieved the national targets at 20% (25.8% in 2016, 28% in 2017, and 32% in 2018).56 In 2018, Semarang Government was awarded by indoHCF innovation Awards for Maternal and Child Health category since they initiated healthy mother and child movementor Gerakan Ibu dan Anak Sehat (GIAT) and Gasurkes KIA programs.7 The decline of MMR and the improvement of coverage for early detection of mothers with high-risk pregnancy which exceed the national target (30%) raise questions on how Gasurkes KIAmanages their activities to achieve the targets. Early detection of pregnancy aims to identify mothers with risks and complications in labor.8The early detection of mothers with high-risk pregnancy is to discover abnormal condition and pregnancy complications that should be treated, so mothers will not get hurt or jeopardized . 9 George R Terry mentions functions of management in four different manners, such as planning, organizing, encouraging, and supervising.10 To diminish the MMR, Semarang Government launched a recruitment for health surveillance workers (Gasurkes) by allocation a huge amount of Regional Development Budget II. Thus, it is expected that Gasurkes KIAas the motors for declining the MMRcan perform optimallysince their performance will determine the effectiveness of budget spent. In taking decisions and actions, Gasurkes KIA need a systematic work system which requires a good management.11 Looking into other studies in this field, Triana Widiastuti conducted a studyin 2014 about managing early detection of mothers with high-risk pregnancy in antenatal care provided by primary healthcare centers in Jepara. Triana’s study concludesthat managing early detection of mothers with high-risk pregnancy is influenced by the functions of management onhow it is planned, guided, and supervised.12 This study aimed to analyze the management of early detection of mothers with high-risk pregnancy, which was conducted by Gasurkes KIAto pursue the coverage of early detection of mothers with high-risk pregnancy in Semarang. II. METHOD This quantitative study employs a cross -sectional design with independent variables, including planning, organizing, encouraging, and supervising. The dependent variable includes the coverage of early detection of mothers with high-risk pregnancy in Semarang. The population is 173 Gasurkes KIAs in Semarang City who have worked since www.ijels.comVo l-4, Issue-4, Jul – Aug 2019 ISSN: 2456-76202018 in 177community villages.11 As samples, only 93 respondents selected by using total sampling technique participated in this study and met the inclusion criteria. The respondents have worked since 2018 and not faced questionnaires for validity test. Primary data were collected using valid and reliable structured questionnaires which were distributed to all respondents. Meanwhile, secondary data include data of early detection coverage for high-risk pregnancy in community village level and supporting reports from direct records of primary healthcare centers in Semarang and Semarang District Health Office. The primary data and secondary data were analyzed using chi-square test to identify the relationship among independent variables and dependent variable. This study was conducted in primary healthcare centers of Semarang in February 2019. III. RESULTS AND DISCUSSION 3.1 Characteristics ofGasurkes KIA Table 1 shows the analysis to describe respondent characteristics, which consist of age, latest education, and work period in Gasurkes KIA. There arethreeage categories, but most of the respondents (55.9%) are 21-25 years old. Most of them (91.4%) have diploma III degree, and nearly 50.5% of them have worked as Gasurkes KIA for t2-3 years. (Tabel 1). Table 1. Frequency Distribution of Respondent Characteristics Respondent Characteristics Age Category:  21-25 years  26-30 years  >30 years Latest Education:  D3 Nursing  D4 Midwifery  S1 Medical  Doctor Work P eriod:  1 year  2-3 years  >3 yearsN%52 37 455.9 39.8 4.385 8 0 091.4 8.6 0 038 47 840.9 50.5 8.6Source: Primary Data, 2018 1. Frequency of Respondents based on Achieved Coverage for Early Detection of High-Risk Pregnancy in Community Village Level It can be seen from Table 2 that the achieved coverage of early detection for high-risk pregnancy occurs in Page | 1168International Journal of English, Literature and Social Science (IJELS) https://dx.doi.org/10.22161/ijels.4440 66 Community Villages (71%), but there are 27 Community Villages that did not achieve the target coverage (29%). ( Tabel 2). Table 2. Frequency of Respondents based on Achieved Coverage for Early Detection of High-Risk Pregnancy in Community Village Level No 1 2Fulfilled Not Fulfilled TotalAchieved Coverage F % 66 71,0 27 29,0 93100Source: Primary Data, 2018 Chi-Square Test on the Relationship between Management of Early Detection of Mothers with HighRisk Pregnancy in Semarang In Table 3, 45 respondents (100%) said that the relationship between planning and coverage for high-risk pregnancy in community level is deficient. There are 18 respondents (40%) who stated that the coverage target has not been achieved, but 27 respondents (60%)mentioned the opposite. In terms of planning for early detection of highrisk, 48 respondents (100%) argued that early detection planning has been run well. According to 9 respondents (18.75%), the coverage for early detection of high-risk pregnancy has not met targets, but 39 respondents (81.25%) stated that the coverage is achieved. Thesquaretest shows pvalue of 0.024, which is less than α value (0.05), meaning there is a relationship between plan made by the Gasurkes KIA and the coverage for early detection of high -risk pregnancy (Table 3). Moreover, 50 respondents (100%) thought that the relationship of organization and coverage for early detection of high-risk pregnancy is not good in community village level. There are 21 respondents (42%) who have not met the target of coverage for early detection of high-risk pregnancy in community village level while 29 respondents (58%) have achieved the target. Out of 43 respondents (100%) who gave good response about the organizaiton of early detection of high-risk pregnancy, there are 6 respondents (13.95%) who have not attained the target coverage in the community village level, but 37 respondents (86.05%) achieved the target. The square testfinds p-value of 0.10,which is less than α value (0.05), meaning that there is a relationship between organization and coverage for early detection of high-risk pregnancy (Table 3).www.ijels.comVo l-4, Issue-4, Jul – Aug 2019 ISSN: 2456-7620In terms of organizing function, there are 46 respondents (100%) who stated that theGasurkes KIAdid not organize early detection of high-risk pregnancy well. There are 19 respondents (41.3%) who have not completed the coverage target, but 27 respondents (58.7%) attained the target. Out of 47 respondents (100%) who mentioned good organization done by the Gasurkes KIA in early detection of high-risk pregnancy, 8 respondents (17.0%) have not achieved the coverage target while 39 respondents (83.0%) have already fulfilled the target. From the square test, it was found that p-value is 0.008 which is less than α value (0.05), meaning there is a relationship between encouraging and coverage for early detection of high-risk pregnancy (Table3). In terms of supervision, 43 respondents (100%) thought that theGasurkes KIAdid not supervise early detection of high-risk pregnancy well. There are 17 respondents (39.53%) who did not fulfill the target. Whereas 26 respondents (60,47%) had good coverage. On the other hand, 50 respondents (100%) mentioned good supervision done by the Gasurkes KIA. Out of this total, only 10 respondents (20%) who have not completed the coverage target, but 40 of them (80%) gave good coverage. The square test also mentions p-value of 0.039, which is less than α value (0.05). It means supervision has a relation with the coverage for early detection of high-risk pregnancy (Table 3). Table.3: Bivariate Analysis of the Relationship among Independent Variables and Dependent Variable Independent VariablesA.B.C.D.Coverage Target Not Achieved Achieved N % n %TotalPValueP lanning Not Good Good18 940 18.7527 3960 81.2545 480.024Organizing Not Good Good19 841.3 17.027 3958.7 83.046 470.01018 942.86 17.6524 4257.14 82.3542 510.00817 1039.53 2026 4060.47 8043 500.039Encouraging Not Good Good Supervising Not Good GoodSource: Primary data, 2018 Page | 1169International Journal of English, Literature and Social Science (IJELS) https://dx.doi.org/10.22161/ijels.4440 3.1.1 Planning The results show that planning has a good relationship with coverage for early detection of high -risk pregnancy in community village level of Semarang City. It happens because the respondents have planned the number of target society, target coverage, and supporting resources for the first time. These findings are relevant to the previous qualitative research which found the relationship between planning as the functions of management and coverage for early detection of high-risk pregnancy. Planning contributes vitally to the management because it becomes a basic fundamental function for other functions of management.4 Effective planning needs experience, creative thinking, understanding, and feeling on activities that the health surveillance workers have planned. They need to concern about tangible (concrete) and intangible (unconcreted) factors which affect the planning. Planning helps them to make a decision on actions for now and future.10 It also supports program to achieve effective and efficient goals.13 Planning for early detection of high-risk pregnancy attempts to determine the number of target society, target coverage, and resources (work, funding, and time) efficiently, so the target coverage can be achieved gradually. In 2018, the target coverage for early detection of high -risk pregnancy per community village should be fully fulfilled as primary healthcare centers and District Health Office have determined in a year program. As expected that this target can identify the minimum intensity of optimal maternal class in periodically controlling maternal condition at leastfour times classes. The implementation of optimal maternal class can decrease the MMR as the 5N program and the SDGs target. In planning early detection of high-risk pregnancy, theGasurkes KIAperform and form functions of management well, such as determining the number of target society, target coverage, and resources. Nevertheless, it was still found that some of them do not have proper functions of management. 3.1.2 Organizing The relationship between organization and coverage for early detection of high-risk pregnancyshows that 46 respondents thought that organizing function carried out by the Gasurkes KIAis not good. There are 19 respondents (41.3%) who did not meet the coverage target for community village level, but 27 respondents (58.7%) achieved the target. Out of 47 respondents (100%) who gave good evaluation on www.ijels.comVo l-4, Issue-4, Jul – Aug 2019 ISSN: 2456-7620organizingfunction, there are 8 respondents (17.0%) who did not achieve the targeted coverage. Instead,39 respondents (83.0%) fulfilled the target. Organizing early detection of high-risk pregnancy is done by collecting primary resources effectively and efficiently and manage people in a system to execute planned activities and achieve goals. Organization can connect people whose tasks are interrelated.1014 Organizing is defined as involving variety of work and activities as efficiently as possible, so they can cooperate in doing tasks in a particular environment to achieve specific goals. In other words, organizing tunes different groups and various visions, as well as lead them to the same goal.10 Organization can give positive effects in encouraging and supervising early detection of high -risk pregnancy. Several hindering factors in achieving the target are that Gasurkes KIA rarely communicate each other, cooperate with regional cadres and village stakeholders,and lack of knowledge and attitude. External hindering factors are the far and elite domicile, lack of information, and reluctance of maternal check. If mothers live in elite housing area, Gasurkes KIA often get difficulties to visit them. Sometimes, some cadres lack of information about new laboring mother. If mothers live far away and cannot access where antenatal care is conducted. Also, mothers never do maternal check-up in primary healthcare centers or the nearest hospital. The previous study also shows the same that there is a relationship between knowledge and encouragement from the health workers towards early detection of high-risk pregnancy.8 The success of early detection of high-risk pregnancy is influenced by mother’s behavior, individual willingness to health objects , family support, availability of information about health, freedom for decision-making, and situation that makes them act or not. A mother does not want to undergo early pregnancy detection because maybe they do not have intention and expect them pregnant (behavior intention). It happens because there is no family support nor social support. The third reasonis lack of accessibility of information.15 The findings of this study show that the Gasurkes KIA who manage early detection of high-risk pregnancy makes the function of organization run better. It can be seen that the Gasurkes KIA, and other people in the program have known the goals of early detection of mothers with high -risk pregnancy. One of the goals is to prevent maternal complications and mortality which have unknown causes by having contact and visit mothers at least four times in a Page | 1170International Journal of English, Literature and Social Science (IJELS) https://dx.doi.org/10.22161/ijels.4440 month. Hence, the coverage for early detection of high -risk pregnancy is achieved. Besides, the Gasurkes KIA have job division for themselves, cadres, other healthworkers, and village stakeholders in implementing early detection of mothers with high-risk pregnancy. The Gasurkes KIA delegate necessary authority to decide because the process of early detection passes several steps that different people get involved. 3.1.3 Encouraging In this encouraging function, 42 respondents (100%) mentioned that the Gasurkes KIAhave not encouraged early detection of high-risk pregnancy well. There are 18 respondents (42.86%) who have not achieved the targeted coverage, but 24 respondents (57.14%) have completed the target. Whereas, out of 51 respondents (100%) who have good response on their encouragement, 9 respondents (17.65%) did not achieve the target, but 42 respondents (82.35%) fulfilled it. Encouragement is action to encourage team members to achieve a target. Encouragement comes from self-motivation to cooperate in the same line and harmony with other stakeholders so that they can develop and achieve goals.14 Encouragement is expected to make team members cooperate efficiently, be keen on their work, develop skills and abilities to be good team member so that team goals can be achieved.1617 Encouragement in health sector nowadays applies to internal organization environment, but also cross -sectoral stakeholders to support health programs. Early detection of high-risk pregnancy requires team to collaborate with other stakeholders. The Gasurkes KIAneed to maintain team motivation to do their tas k wholeheartedly and have strong responsibility to achieve the goals. The results in this study show that the Gasurkes KIAhave encouraged the team members well. They have been able to cooperate with cadres, village stakeholders, and other sectors efficiently and effectively in implementing early detection. Function of management is related to the functions of planning and encouraging, which also are associated with the coverage target for early detection of high -risk
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