PERSPEKTIF BIDAN TERHADAP IMPLEMENTASI KEBIJAKAN PELAYANAN PERSALINAN PESERTA JAMINAN KESEHATAN NASIONAL (JKN) DI PUSKESMAS DI KABUPATEN CIAMIS TAHUN 2026

Abstract

ABSTRAK

PERSPEKTIF BIDAN TERHADAP IMPLEMENTASI KEBIJAKAN PELAYANAN PERSALINAN PESERTA JAMINAN KESEHATAN NASIONAL (JKN) DI PUSKESMAS DI KABUPATEN CIAMIS TAHUN 2026

Oleh : ITA PUSPITA NIM 1520125072

Angka Kematian Ibu (AKI) masih menjadi permasalahan di Kabupaten Ciamis, dengan 21 kasus kematian ibu pada tahun 2023. Kebijakan Jaminan Kesehatan Nasional (JKN) yang mengarahkan pelayanan persalinan ke Puskesmas turut berdampak pada penurunan jumlah persalinan yang ditangani Praktik Mandiri Bidan (PMB). Penelitian ini bertujuan mengeksplorasi secara mendalam perspektif bidan terhadap implementasi kebijakan pelayanan persalinan peserta JKN di Puskesmas Kabupaten Ciamis, meliputi persepsi, pengalaman, kendala, dampak, dan strategi adaptasi. Penelitian ini menggunakan metode kualitatif dengan pendekatan fenomenologi. Informan dipilih secara purposive sampling, berjumlah delapan orang, terdiri atas lima bidan PMB, Kepala Puskesmas, Kepala Bidang Pelayanan Kesehatan Dinas Kesehatan Kabupaten Ciamis, dan Ketua Ikatan Bidan Indonesia (IBI) Kabupaten Ciamis. Data dikumpulkan melalui wawancara mendalam dan observasi, kemudian dianalisis menggunakan metode Colaizzi tujuh tahap dengan triangulasi sumber. Hasil penelitian menunjukkan bahwa persepsi PMB terhadap kebijakan bersifat ambivalen. JKN diakui bermanfaat dalam meringankan biaya persalinan, tetapi implementasinya dinilai mendiskriminasi PMB dan membatasi hak pilih pasien. Bidan PMB mengalami tekanan akibat misinformasi, dilema relasional, dan tuntutan mengembangkan strategi kompromi. Kendala utama bersifat struktural, terutama sistem klaim BPJS (Badan Penyelenggara Jaminan Sosial) yang dinilai tidak adil dan lambat. Dampak kebijakan meliputi penurunan kunjungan persalinan hampir 90%, pengikisan peran sosial profesional bidan, dan tekanan psikologis. Strategi adaptasi PMB meliputi diversifikasi layanan komplementer kebidanan, peningkatan kompetensi melalui pendidikan berkelanjutan, serta penguatan hubungan berbasis kepercayaan dengan pasien. Penelitian merekomendasikan perbaikan sistem kemitraan klaim antara Puskesmas dan PMB yang lebih adil dan responsif untuk mendukung optimalisasi jejaring pelayanan persalinan dan penurunan AKI.

Kata Kunci : Fenomenologi, Implementasi Kebijakan, JKN, Perspektif Bidan, Praktik Mandiri Bidan

ABSTRACT

MIDWIVES' PERSPECTIVES ON THE IMPLEMENTATION OF THE NATIONAL HEALTH INSURANCE (JKN) CHILDBIRTH SERVICE POLICY AT PUSKESMAS IN CIAMIS REGENCY IN 2026

Written by : ITA PUSPITA NIM. 1520125072

Maternal Mortality Rate (MMR) remains a public health concern in Ciamis Regency, with 21 maternal deaths recorded in 2023. The National Health Insurance (JKN) policy, which directs childbirth services to Community Health Centers (Puskesmas), has affected deliveries managed by Independent Midwifery Practices (PMB). This study aimed to explore midwives’ perspectives on implementing JKN childbirth service policies at Puskesmas in Ciamis Regency. This qualitative study used a phenomenological approach. Informants were selected using purposive sampling and consisted of eight participants: five PMB midwives, one Puskesmas Head, one Head of the Health Service Division of the Ciamis Regency Health Office, and one Chairperson of the Indonesian Midwives Association (IBI). Data were collected through in-depth interviews and observation, then analyzed using Colaizzi’s seven-stage method with source triangulation. The findings showed that PMBs’ perceptions of the policy were ambivalent. JKN was considered beneficial in reducing childbirth costs; however, implementation was perceived as discriminatory toward PMBs and restrictive of patients’ right to choose. PMB midwives experienced pressure due to misinformation, relational dilemmas, and compromise demands. The main barriers were structural, particularly the BPJS (Social Security Administering Body) claims system, which was considered unfair and slow. Policy impacts included an almost 90% decline in childbirth visits, erosion of midwives’ professional roles, and psychological pressure. PMBs adapted by diversifying complementary midwifery services, improving competencies through continuing education, and strengthening trust-based relationships with patients. This study recommends a fairer and more responsive claims partnership system between Puskesmas and PMBs to optimize childbirth service networks and reduce MMR.

Keywords: phenomenology, policy implementation, JKN, midwives' perspective, Independent Midwifery Practice