PROBLEM DAN TANTANGAN PUSKESMAS DAN RUMAH SAKIT UMUM DAERAH DALAM MENDUKUNG SISTEM RUJUKAN MATERNAL DI KABUPATEN KARIMUN PROVINSI KEPRI TAHUN 2012

Abstract

Background: Strengthening referral system is a method to
accelerate decrease of maternal mortality rate. The main factors
affecting referral system are facilities, staff, team work, and
budget that need seroius attention from all stakeholders
involved in the program of maternal health. By strengthening
the system of maternal health the problem and the challenge of
health center to support of maternal referral can be addressed.
Objective: The study aimed to evaluate referral system of
maternal health at District of Karimun Province of Kepulauan
Riau.
Method: This was a qualitative case study undertaken at
Karimun Hospital and 2 health centers with high maternal and
infant mortality rate, i.e. Meral and Moro Health Center that
were located at both urban and rural areas. Data were obtained
through in-depth interview, focus group discussion,
observation, checklist and document study.
Result: The result of the study showed there was limitation of
resources at primary health service such as facilities and
equipments and hospital limited ability to provide comprehensive
emergency neonatal and obstetric management despite being
operated 24 hours. There were lack of team coordication
across referral levels involving district health office, hospital
and health centers, incomplete standard operating procedures,
weak information system and bypassing referral procedure.
Community participation in referral system was very high
though some labor was assisted by traditional childbirth
attendants. This condition was mainly due to cultural factors/
reasons.
Conclusion: There are some problems and challenges in both
primary health service and hospitals to support maternal
referral system in Karimun District. Some policies are required
as a first step toward better referral system in Karimun District,
for instance accelerating a functioning CMOC hospital,
strengthening the teamwork across referral system, and
establishing SOP for maternal cases including its referral
procedures.
Keywords: Problem, Challenge, Maternal referral system,
Health Center, Distric Goverment Hospital.