Improving Implementation of 10 STSB (Steps to Successful Breastfeeding) through BENEFIT (Breastfeeding Exclusively in Health Facility) Intervention in East Java, Indonesia
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ABSTRAK
Latar Belakang: Peningkatan cakupan ASI eksklusif dapat dilakukan dengan menerapkan 10 LMKM di fasilitas kesehatan. Berdasarkan hasil penilaian program 10 LMKM tahap 1 menunjukkan perlunya penguatan 10 LMKM terutama langkah 1 dan 2 sebagai prosedur pengelolaan kritis (Critical Management Procedural). Untuk menindaklanjuti temuan tersebut maka dijalankan Project BENEFIT untuk meningkatkan penerapan dari langkah-langkah tersebut. Proyek tersebut dilaksanakan pada tahun 2019 hingga 2020 di 5 kabupaten/kota di Jawa Timur yaitu Bondowoso, Jember, Probolinggo, Trenggalek dan Surabaya.
Tujuan: Penelitian ini bertujuan untuk mengevaluasi implementasi penguatan 10 LMKM yang dilakukan melalui proyek BENEFIT
yang berfokus pada penguatan langkah 1 dan 2 di fasilitas kesehatan di Provinsi Jawa Timur dan bagaimana pengaruhnya terhadap penerapan langkah lainnya serta pencapaian dalam indikator menyusui.
Metode: Studi crossectional dilakukan pada 720 responden yang terdiri dari 143 pimpinan fasilitas kesehatan dan 577 ibu nifas (untuk validasi data). Pengumpulan data dilakukan dengan menggunakan kuesioner yang diadaptasi dari BFHI Unicef/WHO yang mengevaluasi penerapan keseluruhan langkah dalam 10 LMKM menggunakan aplikasi KoBo ToolBox pada periode Juli-September 2020.
Hasil: Terdapat peningkatan dalam penerapan 10 LMKM terutama langkah 1 dan 2. Langkah 1 yaitu tersedianya kebijakan tertulis pemberian ASI eksklusif menunjukkan peningkatan kepatuhan yang signifikan (66,4 menjadi 72,82; α= 0,015). Sedangkan untuk tahap 2 (pelatihan dukungan menyusui bagi petugas kesehatan dan non-kesehatan) menunjukkan peningkatan yang signifikan dalam pelaksanaannya (69,5 menjadi 77; α = 0,015). Prosedur manajemen kritis berperan sebagai landasan yang mempengaruhi praktik dukungan menyusui di fasilitas kesehatan. Berdasarkan hasil monitoring dan evaluasi menunjukkan adanya perbaikan pada praktik dukungan menyusui selama perawatan ibu di fasilitas kesehatan seperti cakupan IMD (71,2%) baik pada persalinan normal maupun seksio sesarea, rawat gabung (69,1%) dan praktik menyusui bayi baru lahir. (73,5%).
Kesimpulan: Intervensi BENEFIT yang berfokus pada penguatan langkah 1 dan 2 dalam 10 LMKM sebagai prosedur manajemen kritis mampu meningkatkan kepatuhan implementasi keseluruhan langkah 10 LMKM. Sebagai landasan untuk melaksanakan langkah-langkah lainnya, penguatan 10 LMKM terutama langkah 1 dan 2 terbukti dapat meningkatkan praktik dukungan menyusui di fasilitas kesehatan oleh seluruh staf.
Kata Kunci: Menyusui, 10 LMKM, BENEFIT
ABSTRACT
Background: 10 Steps to Successful Breastfeeding (STSB) was implemented as an attempt to improve the coverage of exclusive breastfeeding in healthcare facilities. Results of the phase 1 Baby-Friendly Hospital Initiative (BFHI) assessment necessitated further strengthening for steps 1 which is the availability of an exclusive breastfeeding policy and step 2 which entails training provision for maternal and child health officer. These two steps are regarded as critical management procedures which act as a foundation for the implementation of subsequent steps. To follow up on these findings, Project BENEFIT was implemented to improve steps 1 and 2. The project was carried out between 2019 and 2020 in 5 districts in East Java, namely Bondowoso, Jember, Probolinggo, Trenggalek and Surabaya.
Objectives: This objective of this study is to evaluate the implementation of the BENEFIT project and how it affects the implementation of other steps as well as how it impacts breastfeeding indicators.
Methods: This cross-sectional study was conducted on 720 respondents consisting of 143 health facility leaders and 577 post-partum mothers to validate response. Data was collected using a questionnaire adapted from Baby Friendly Hospital Initiation (BFHI) guidelines by World Health organization (WHO) and United Nations Children Emergency Fund (UNICEF) using the KoBo ToolBox application between July and October 2020.
Results: There was an improvement in the implementation of steps 1 and 2. A significant increase in compliance was found for Step 1 (66.4 to 72.82 α = 0.015) and step 2 (69.5 to 77.9, α = 0.15). Subsequent monitoring and evaluation also showed moderate improvement on breastfeeding support practice in health facilities such as coverage of skin-to-skin contact (71.2%) both on normal and section-caesarean delivery, rooming-in (69.1%) and the practice of breastfeeding newborn (73.5 %).
Conclusion: The BENEFIT project assisted in the increased compliance for steps 1 and 2 STSB, which further improved breastfeeding support practices by all healthcare facility staff members for other steps.
Keywords: Breastfeeding, 10 STSB, BENEFIT
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