EVALUASI KINERJA PELAYANAN ANTENATAL ANTARA PUSKESMAS CAKUPAN TINGGI DENGAN PUSKESMAS CAKUPAN RENDAH MENGGUNAKAN PENDEKATAN BALANCED SCORECARD

Abstract

Background: Community Health Center (CHC) is hoped to
give quality antenatal care. However, maternal and child health
coverage in Bekasi District has not achieved the targeted
standard yet. First visit of pregnant mothers in 2006 was 87.5%
and fourth visit coverage was 77.8%. There were 21 cases
of maternal mortality in 2005 and only four out of 34 CHCs
achieved the target of maternal and child coverage. These
show that maternal and child health care performance is not
optimal; therefore, improvement should be made. One of
performance measurements is balanced scorecard which
includes four perspectives, namely finance, costumers’
satisfaction, internal business, and learning and growth.
Objective: To evaluate antenatal care performance between
high coverage CHC and low coverage CHC using balanced
scorecard approach in Bekasi District.
Method: This was an observational study with cross sectional
study design. Qualitative data were used in this study. The
subjects were the head of CHCs, the midwives responsible
for the implementation of antenatal care in maternal and child
health room, and all pregnant mothers receiving forth visit care.
The study was performed in Mekarmukti and Cibarusah CHCs.
Study instruments were questionnaire, checklist, and interview
guide. Univariate analysis and bivariate analysis with chi-square
test and stratification were used.
Results: There was an association between providers’
education/training and antenatal coverage (χ² = 10.015; p =
0.002; PR = 4.026; CI 95% = 1.667-9.724), and patients’
satisfaction (χ2 = 4.607; p = 0.032; PR = 2.516; CI 95% = 1.080-
6.348), while standardized care was not related to antenatal
care coverage. Stratification analysis showed that antenatal
care coverage in Mekarmukti CHC was better than that in
Cibarusah CHC (χ2 = 5.662; p = 0.017; PR = 4.407; CI 95% =
1.082-18.789), patients’ satisfaction in Mekarmukti CHC was
better than that in Cibarusah CHC (χ2 = 6.935; p = 0.008; PR =
8; CI 95% = 1.256-84.624). Based on the qualitative data, there
was no difference in finance performance in both CHCs.
Conclusions: There is a difference between providers’
education/training and the level of patients’ satisfaction in
Mekarmukti and Cibarusah CHCs. There is no difference in
Mekarmukti and Cibarusah CHCs operational fund and standard
antenatal care.
Keywords: balanced scorecard, performance, antenatal
coverage