Problem Dan Tantangan Puskesmas Dan Rumah Sakit Umum Daerah Dalam Mendukung Sistem Rujukan Maternal Di Kabupaten Karimun Provinsi Kepri Tahun 2012 Problem and Challenge of Primary Health Service and Distric Goverment Hospital To Support Maternity Referral

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, f ocus 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 ins tance accelerating a functioning CMOC hospital, strengthening the teamwork across referral system, and establishing SOP for maternal cases including its referral procedures.