Pencegahan Keterlambatan Rujukan Maternal di Kabupaten Majene

SANTY, Gufria Darma Ira, Prof. dr. M. Hakimi, SpOG, PhD

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Faktor geografis, jarak dan infrastruktur sangat mempengaruhi akses masyarakat terhadap kemudahan memperoleh sarana transportasi modern. Kedaruratan obstetri umumnya gagal ditangani karena ketidaktelitian dalam memfollowup kehamilan dan keterlambatan rujukan. Salah satu faktor penyulit untuk melakukan rujukan maternal adalah keterbatasan sarana transportasi modern untuk mencapai pemukiman penduduk didaerah terpencil. Otonomi klinik dan kesukarelaan dari tenaga kesehatan merupakan faktor kunci dalam sistem rujukan medik. Unsur transportasi antara komunitas dan fasilitas kesehatan serta antar fasilitas kesehatan sayangnya belum menjadi bagian dari keterpaduan sistem rujukan profesionalisme. Penelitian ini mempelajari strategi dalam mengatasi keterlambatan pertolongan persalinan di daerah yang jauh dari fasilitas kesehatan. Ia ingin membuktikan apakah manajemen rujukan menjadi perhatian dan agenda pemerintah. Metode: Penelitian ini menggunakan desain studi kasus. Data diperoleh dari bidan desa, tokoh masyarakat, kepala puskesmas, kepala dinas kesehatan, direktur rumah sakit, kepala unit gawat darurat, kepala Palang Merah Indonesia, koordinator lapangan PMI dan pasien kegawatdaruratan obstetri di Kabupaten Majene. Penelitian dilakukan bulan Agustus-Desember 2007. Hasil: Keluarga dan pasien memegang peran utama dalam berurusan dengan kedaruratan persalinan. Kemampuan keluarga dan jarak merupakan kondisi yang menyulitkan pengelolaan persalinan darurat bagi penduduk yang jauh dari fasilitas kesehatan. Upaya mengatasi masalah itu masih diserahkan pada masingmasing pihak provider dan unit layanan kesehatan. Ia sangat tergantung pada kemampuan pasien dan keluarganya. Pasien yang mampu bisa mengatasi persoalan mereka. Sebagian besar keluarga yang tinggal di daerah yang jauh dari fasilitas kesehatan berhadapan dengan pilihan yang sulit yang paling tidak memberikan keamanan. Ambulans oleh puskesmas, rumah sakit dan PMI dikoordinir langsung oleh kepala instansi masing-masing. Rumah sakit memiliki layanan ambulans yang terpisah dari paket gawat darurat. Kesimpulan: Meskipun telah menjadi agenda dinas kesehatan dan pemerintah, pengelolaan sarana transportasi masih diserahkan pada sektor informal. Masyarakat membantu menyediakan layanan transportasi secara spontanitas. Pengelolaan sarana transportasi masih dilakukan secara mandiri dan sederhana oleh masingmasing fasilitas kesehatan. Saran: Inisiatif untuk mengelola ambulans secara terpadu menjadi keharusan pengembangan sistem kesehatan daerah. Upaya itu bisa didukung oleh unsur-unsur ambulans yang tersedia di tiap fasilitas kesehatan. Kehadiran manajemen yang mengelola kerjasama dari unsur provider pelayanan persalinan yang dikelola sebagai suatu satuan rujukan regional menjadi agenda utama.

Background: The Geography, distances and infrastructures factors are highly affecting community accessibility to modern transportation. In general, obstetric emergency cases are failed to be managed because of the low accuracy in routine pregnancy follow up and delay in referral. One of the limiting factors in obstetric referral is the unavailability of an effective mode of modern transportation to reach remote residential area. Autonomy of the clinics and willingness of health staff are the key factors in medical referral system. Unfortunately, the transportation which connects between community and health facilities and among facilities has not become parts of a professional integrated referral system. This research studies the strategies to overcome delay in delivery assistance in remote areas which are far from health facilities. It tries to prove that referral management should become a focus and a part of government agenda. Method: This research uses case study design. Data were obtained from village midwives, important public figures, heads of community health service, the head of health department, the director of public hospital, the head of hospital emergency unit, the local head of Indonesia Red Cross Organization, local field coordinator of Red Cross Organization and the patients of obstectric emergency units in Kabupaten Majene. This research was conducted from August to December 2007. Result: The patients and their family play the main role in managing the emergency of obstetric problems. Family financial capability and distances are some of the problems in managing the obstetric emergency for patients who live far from health facilities. The efforts to overcome those problems are still in the hand of service providers and health service units. They heavily depend on the patient and family financial capability. The patients who can afford to pay the services will be able to overcome their problems. Most of the families who live in rural area which are far from health facilities will face unsecured difficult situation. Every ambulance which is owned by community health services, hospital and Red Cross Organization are managed by the head of their units. The hospital itself has a special ambulance service unit which is separated from its emergency unit. Conclusion: Even though the management of transportation mode has already become a part of health department and government agenda, it is still hand over informal sectors. Community is nhelping in providing transportation service spontaneously. The management of transportation mode is still simple and undertaken by each health facility. Suggestion: The initiatives to manage ambulance in integrated way become a must to develop local health system. These efforts could be supported by all available ambulance in every health service. The presence of units which manage the cooperation between every available obstetric service in one regional integrated system should become the main agenda.

Kata Kunci : Keterlambatan Rujukan Maternal,Manajemen Rujukan,Rujukan Tradisional,Maternal referral delay, traditional referral, service regionalization