Kebijakan Pemerintah Daerah Dalam Meningkatkan Sistem Rujukan Kesehatan Daerah Kepulauan Di Kabupaten Lingga Provinsi Kepulauan Riau

Abstract

Background: One of the critical issues in the development of national health care is the limited accessibility to health ser- vices. Such problems also occur in Linga District of Kepulauan Riau Province. It is caused by many factors, such as geo- graphical location, cost, number of health personnel and con- dition of health care facilities, such as health centers and their networks which are not accessible to the public. Several at- tempts have been made, for example, by improving the status of sub-health centers to be health centers, health centers to be treatment centers, assinging health workers both medical and paramedical, improving health financing and making bud- get policies. However, its implementation has not been maxi- mal. In accordance with the above background, it would re- quire a study on the role of local government policy in improv- ing the referral system which is useful to know the problems in the field, so that in the future a variety of improvement can be done. Objective: To determine the referral system in the islands area of Linga District. Methods: This was a case-study research. The research subjects were head of health centers / health center doctors, nurses/midwife assistants, ambulance drivers/sea ambulance drivers, patient families, community figures, jamkesmas/ Jamkesda managers, head of health care section/head of health office, director of local hospital/mobile hospital and emer- gency room nurses. The variables in this study were indepen- dent variable (referral system) and dependent variable (ambulance service). The research location was in Linga District of Kepualauan Riau Province. Results: The results showed that policy efforts of the Linga Government District in improving the referral system had existed. The existing financing policy had encompassed two aspects both from the demand side (medical expenses) and from the supply side (a system that supported health care). The process of referral from primary care to advanced services had been going well although there was still lack as the unavailability and completeness of services. Most of the health workers had received training; there were also specialist doctors (in collaboration with the faculty of medicine), but networking in the referral process was done partially and not integrated. Conclusion: The health referral system in Linga District had run pretty well, but did not fully involve community participation in an integrated service system. The local government in this case Linga District Health Office needs to revitalize as well as accelerate the development of Desa Siaga (alert villages) readi- ness to increase community participation in the development of a referral system.