Akses dalam sistem rujukan Puskesmas daerah terpencil di Kabupaten Majene Sulawesi Barat

BUNDA, Suryana Mulya, Prof.dr. Laksono Trisnantoro, M.Sc.,Ph.D

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebij. dan Manaj. Pe

Latar belakang : Penyebaran penduduk yang tidak merata berakibat pada pelayanan kesehatan, khususnya di daerah terpencil. Puskesmas Tammerodo di Kabupaten Majene merupakan salah satu puskesmas dengan 2 daerah terpencil, dimana terdapat 3 ibu hamil meninggal pada tahun 2006 dan 2 ibu hamil meninggal pada tahun 2007 akibat perdarahan dan tidak tertolong pada saat menuju puskesmas. Hal ini terjadi akibat keterbatasan akses baik keadaan geografis maupun sarana kesehatan sehingga petugas kesehatan enggan memberikan pelayanan. Tujuan : Tujuan penelitian ini adalah untuk mengetahui aksesibilitas pelaksanaan sistem rujukan di Kabupaten Majene. Metode : Metode yang digunakan adalah metode kualitatif dengan rancangan penelitian studi kasus yang bersifat deskriptif. Data dikumpulkan melalui wawancara mendalam, observasi dan dokumentasi. Hasil : Alat transportasi utama rujukan yang digunakan oleh masyarakat di daerah terpencil adalah bulle yaitu dengan cara digotong menggunakan sarung. Dukun memegang peranan penting dalam pelayanan kesehatan namun hal ini mulai mengalami perubahan sejak adanya kerjasama yang dilakukan puskesmas sehingga perannya semakin besar. Puskesmas Tammerodo telah melaksanakan proses rujukan walaupun terdapat berbagai kekurangan yaitu tidak adanya aturan secara tertulis mengenai pelaksanaan rujukan di puskesmas baik yang berasal dari Pusat maupun Pemerintah Daerah sehingga dalam pelaksanaan sehari-hari tidak terdapat acuan baik dalam pengaturan transportasi, pembiayaan maupun pengembalian pasien. Kesimpulan : Sarana transportasi yang tersedia telah mendukung proses rujukan walaupun masih ditemukan keterlambatan rujukan dan dukun terlatih telah bekerja sama dengan petugas kesehatan dan berperan aktif dalam sistem rujukan walaupun peran suami dalam sistem rujukan belum terlihat. Pengalokasian anggaran rujukan oleh dinas kesehatan tanpa mengikutsertakan puskesmas mengakibatkan tidak terpenuhinya kebutuhan sarana dan prasarana rujukan. Usulan contracting out, desa siaga, mengikut sertakan dukun dan suami serta pengelolaan anggaran rujukan oleh puskesmas diharapkan dapat memperbaiki pelaksanaan rujukan di daerah terpencil.

Background : Unequally population disporsement caused matter in health services, especially at remote area. Tammerodo community health centre at Majene District were one of community health centre that had two remote areas, which three of pregnant mothers had died at 2006 and two pregnant mothers also died at 2007 because of bleeding and couldn’t be help when they were to community health centre. All of these happened because of limited access such as geographical and health equipment and made health officer refused to give health services. Objective : The objective of the study was to find out implementation accessibility of reference system at Majene District. Method : The study used qualitative method with descriptive case study design. Data was collected through depth interview, observation and documentation. Result : The main reference transportation used by people at remote area was bulle, which carried by using a sarong. Shaman held an important role in health services, but it begun to change since there was cooperation with community health centre. Tammerodo community health centre had been implementing reference process even there had a lot of shortcoming, such as no written direction for reference implementation at the community health centre, both Central nor District Government so there were no guidelines in transportation in daily implementation arrangement, financing and patient’s return. Conclusion : The transportation vehicle were already supported reference process even there were late arriving that still found and shamans worked together and involved in reference system eventhough husbands didn’t have roled yet. Reference budgeting alocated by health division and caused some of reference instruments were not fulfilled. We hope that the proposal of contracting out, Desa Siaga, shamans and husbands took part in reference system also community health centre were the one for managing reference budget could improved implementation of remote area reference.

Kata Kunci : Puskesmas,Sistem Rujukan,Akses, Access, Reference, Remote Area, Community Health Centre