Improving Quality Antenatal Care Services Used By Pregnant Women With The Client Oriented Provider Efficient Method Through Self Need Assessment,Client Right Assessment, Client Flow Analysis At Bojonegoro District Community Health Center

Abstract

The Maternal Mortality Rate (MMR) in Bojonegoro Regency has increased in the last 3 years, in 2019 the MMR was 157.23 per 100,000 live births (KH), in 2020 it reached 161.80 per 100,000 KH, in 2021 it reached 200.30 per 100,000 KH from the MMR target of 98.5 Per100,000 KH. The low coverage of antenatal care services, K1 in 2021 was 99.5%, K6 coverage was 82.99% of the target of 100%. To reduce MMR, quality health services are needed at the Health Center, namely improving the ability of midwives, it is hoped that they can provide health services that are oriented to the needs of their clients. The health service process that focuses on its clients is the Client Oriented Provider Efficiency (COPE) method which will have an impact on Customer Satisfaction. This study aims to improve the quality of maternal health services using the COPE method and analyze the commitment of midwives, the satisfaction of pregnant women at the Bojonegoro Regency Health Center. The research location was at the Ngumpak Dalem Health Center and the Dander Bojonegoro Health Center. The population was the Health Center, Midwives and Pregnant Women. The Health Center sample was by purposive sampling with an operational research design. The COPE method has 4 stages consisting of Stage I: Information gathering and analysis including 1) Self Need Assessment (SNA) 2) Client Right Assessment (CRA) 3) Client Flow Analysis (CFA). Stage II Action Plan Development and Priority including the USG Method, Fish Bone Diagram, CARL, MEER, 5W + 1H, Stage III Implementation Stage IV Follow Up and Evaluation. In Year I 2024, this research was implemented by applying the COPE Method in Stages I and II.

The results of the study showed that the commitment of midwives at the Ngumpak Dalem Inpatient Health Center and the Dander Non-Inpatient Health Center in Bojonegoro Regency was the Morally Committed commitment type, the Commitment During Later commitment stage, low commitment level. The COPE Stage I process at the SNA at the Ngumpak Dalem Health Center and at the Dander Health Center it was not fulfilled Information up date, training and development. CRA at both Health Centers on Information;Dignity, comfort, and expression of opinion; Continuity of care was not fulfilled. CFA showed that the Client waiting time at the Ngumpak Dalem Health Center was longer than the Dander Health Center. Stage II Action Plan and Priority through FGD discussing data from Stage I with the Health Center team consisting of Midwives and Heads of Health Centers obtained priority problems of the lack of fulfillment of midwives' rights to supervision by the Health Office, Information Up Date, Training and development and the lack of fulfillment of pregnant women's rights to information. The priority of the cause of the problem is the lack of understanding of Customer service. Alternative Priority of Problem Solving in Interpersonal Communication Training/Counseling, Improvement Activity Plan Low Fulfillment of Midwives' Needs for Updated Information, Training and Development. The satisfaction of pregnant women at the Ngumpak  Dalem  Health  Center  and  Dander  Health  Center  is mostly quite satisfied.  It is

recommended to improve the ability of midwives in the technical aspects of midwifery and interpersonal communication and counseling through training.