EVALUASI SISTEM RUJUKAN PELAYANAN KESEHATAN IBU DI KABUPATEN KARIMUN PROVINSI KEPRI TAHUN 2012

Zulhadi, Prof. dr. Laksono Trisnantoro, MSc, PhD

2013 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Memperkuat sistem rujukan merupakan salah satu cara dalam mempercepat penurunan angka kematian ibu. Faktor utama yang mempengaruhi sistem rujukan seperti fasilitas, tenaga, SOP, kerjasama tim, transportasi, komunikasi, dan pendanaan perlu mendapatkan perhatian serius dari semua stakeholders yang terlibat dalam program kesehatan ibu. Tujuan: Penelitian ini bertujuan melakukan evaluasi sistem rujukan kesehatan ibu di Kabupaten Karimun Propinsi Kepri dan faktor-faktor yang mempengaruhinya. Metode: Penelitian ini bersifat kualitatif dengan desain studi kasus di RSUD Karimun dan di 2 wilayah puskesmas yang angka kematian ibu dan bayinya tinggi yaitu Puseksmas Meral dan Puskesmas Moro. Kedua puskesmas ini juga merupakan wilayah perkotaan dan perdesaan. Data diambil dengan cara wawancara mendalam (in-dept interview), focus grup discussion, pengamatan dan check list dan telaah berbagai dokumen. Hasil: Penelitian ini menemukan masih ada keterbatasan sumberdaya di pelayanan dasar seperti sarana dan peralatan dan belum disiapkannya RSUD sebagai rumah sakit mampu PONEK, walaupun aktifas pelayanan 24 jam sudah berjalan. Kurangnya kerjasama tim antar level rujukan yang melibatkan Dinas Kesehatan Kabupaten, RSUD dan puskesmas, belum lengkapnya SOP, lemahnya sistem informasi dan alur rujukan yang by pass masih ditemukan. Keterlibatan masyarakat dalam sistem rujukan sangat tinggi, walaupun persalinan dengan dukun masih ditemukan. Kondisi ini lebih disebabkan karena faktor budaya. Kesimpulan: Sistem rujukan kesehatan ibu di pelayanan dasar maupun di rumah sakit rujukan belum efektif. Masyarakat sudah berpartisipasi aktif dalam proses rujukan tetapi belum terkelola dalam suatu sistem.

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. 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, focus 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 able to provide comprehensive emergency neonatal and obstetric management despite 24 hours service availability. There were lack of team coordication across referral levels involving district health office, hospital and health centers, incomplete standard operating procedures, weak infrormation system and emergence of by pass referral procedure. Community participation in referral system was very high though some labour was assisted by traditional childbirth assistants. The condition was mainly due to cultural factors. Conclusion: Maternal health referral system at primary health service as well as in hospital was not yet effective. Community had actively participated in referral process but participation was not yet integrated in the system.

Kata Kunci : Sistem rujukan, kesehatan ibu, evaluasi, kematian ibu, layanan kesehatan pertama, Rumah sakit rujukan