ANALISIS PENANGANAN RUJUKAN IBU HAMIL BERBASIS MANUAL RUJUKAN DI JAKARTA TIMUR

DINA NURDJANNAH, Prof Laksono Trisantoro, M.Sc., Ph.D

2018 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Latar Belakang : Untuk menggambarkan tingkat kemajuan suatu bangsa, WHO dan lembaga-lembaga internasional menggunakan alat ukur yaitu Angka Kematian Ibu (AKI). Millenium Development Goals (MDGs) atau Tujuan Pembangunan Millenium pada tahun 2000 menetapkan target penurunan angka kematian ibu di Indonesia dari 390 per 100.000 kelahiran hidup pada tahun 1990 menjadi 102 per 100.000 kelahiran hidup pada tahun 2015. Melalui hasil Survey Penduduk Antar Sensus tahun 2015 menunjukan Angka Kematian Ibu yaitu 305 per 100.000 kelahiran hidup. Sehingga dapat disimpulkan bahwa target MDGs ke-5 tidak tercapai. Melalui pelayanan kesehatan primer yang baik, AKI dapat diturunkan 20% dan bila ditunjang dengan sistem rujukan yang efektif, maka AKI dapat ditekan hingga 80 %. Jakarta Timur merupakan kota dengan penyumbang jumlah kematian ibu terbanyak di DKI Jakarta dengan jumlah kematian pada tahun 2015 sebanyak 29 orang, tahun 2016 sebanyak 21 orang, 2017 sebanyak 29 orang. Manual rujukan tersusun dari kejadian yang dapat dialami oleh ibu dan bayi dalam proses hamil dan persalinan, dan bagimana proses tersebut dapat didanai. Sistem rujukan dalam manual rujukan ini mensinergikan 5 sub system yaitu system manajemen/ program, system pelayanan klinis (SDM, SOP, sarana prasarana, rujuk balik), system pembiayaan, system informasi/komunikasi (SPGDT), dan transportasi Tujuan : Menganalisis penanganan rujukan ibu hamil berbasis manual rujukan dilihat dari pelaksanaan sistem manajemen, system pelayanan klinis (SDM, SOP, sarana prasarana, rujuk balik), system pembiayaan, system informasi (SPGDT) dan system transportasi di BPM, Puskesmas PONED, RS Non PONEK dan RS PONEK di Jakarta Timur; Mendeskripsikan peran Suku Dinas Kesehatan Jakarta Timur dalam penanganan rujukan ibu hamil di Jakarta timur serta menganalisis sebaran RS PONEK dan mendeskripsikan kelayakan RS PONEK di Jakarta Timur Metode : penelitian deskriptif analitik dengan rancangan studi kasus, teknik pengambilan data adalah data primer dan sekunder. Data primer dilakukan melalui wawancara mendalam kepada BPM, bidan koordinator Puskesmas PONED, dan dokter spesialis Obsgyn RS PONEK dan Non PONEK Hasil : Puskesmas sudah mampu melengkapi kebutuhan SDM, dan sarana prasarana PONED. Peranan suku Dinas Kesehatan perlu ditingkatkan sehubungan dengan koordinasi rujukan yang masih simpang siur sehingga banyak terjadi rujukan yang terlambat ditangani. Sebaran RS PONEK tidak berimbang terutama di kecamatan yang mempunyai sasaran ibu hamil tinggi. Hanya RSUP Persahabatan yang bisa memenuhi standar PONEK. Kesimpulan : pelaksanaan penanganan rujukan kasus ibu hamil belum maksimal dilaksanakan di Jakarta timur, sehingga diperlukan penguatan sistem pelayanan klinis di FKTP maupun FKRTL, dan penguatan sistem informasi rujukan yang didukung oleh pembuatan manual rujukan di Jakarta Timur.

Background: To illustrate the level of progress of a nation, WHO and international institutions use a measure of the Maternal Mortality Rate (MMR). The Millennium Development Goals (MDGs) in 2000 set a target of reducing maternal mortality in Indonesia from 390 per 100,000 live births in 1990 to 102 per 100,000 live births in 2015. Through the results of the 2015 Intercensal Population Survey showed figures Maternal mortality is 305 per 100,000 live births. So it can be concluded that the 5th MDGs target is not achieved. Through good primary health services, AKI can be reduced by 20% and if supported by an effective referral system, AKI can be reduced by up to 80%. East Jakarta is the city with the largest number of maternal deaths in Jakarta with the number of deaths in 2015 as many as 29 people, in 2016 there were 21 people, 2017 as many as 29 people. The reference manual is composed of events that can be experienced by mothers and babies in the process of pregnancy and childbirth, and how the process can be funded. The referral system in this reference manual synergizes 5 sub-systems, namely the management system / program, clinical service system (HR, SOP, facilities and infrastructure, referral feedback), financing system, information / communication system (SPGDT), and transportation Objective: Analyzing the handling of referral based maternal manual referral seen from the implementation of management systems, clinical service systems (HR, SOP, facilities and infrastructure, referrals), financing systems, information systems (SPGDT) and transportation systems at BPM, PONED Puskesmas, Non PONEK hospitals and PONEK Hospital in East Jakarta; Describing the role of the East Jakarta Health Office in handling the referral of pregnant women in East Jakarta and analyzing the distribution of PONEK Hospitals and describing the feasibility of PONEK Hospital in East Jakarta Method: Analytic descriptive study with a case study design, data collection techniques are primary and secondary data. Primary data was conducted through in- depth interviews with BPM, Puskesmas PONED, midwives coordinator in Puskesmas PONED, and Obsgyn specialists at PONEK Hospital and Non PONEK hospital. Results: Puskesmas has been able to complete the HR needs, and PONED infrastructure facilities. The role of the Suku Dinas Kesehatan tribe needs to be improved in connection with coordinating referrals that are still confusing so that many referrals are handled late. The distribution of PONEK Hospital is not balanced, especially in sub-districts that have high target mothers. Only RSUP Persahabatan can meet PONEK standards. Conclusion: The implementation of referral handling of cases of pregnant women has not been maximally implemented in East Jakarta, so that the strengthening of the clinical service system in FKTP and FKRTL is needed, and strengthening the referral information system supported by the making of reference manuals in East Jakarta.

Kata Kunci : analisis, rujukan, ibu hamil, manual rujukan, analysis, referral, pregnant women, reference manual