EVALUASI PELAKSANAAN RUJUKAN MATERNAL DAN NEONATAL DI KABUPATEN BANTUL

INDRA KOMALA R.N, Prof. dr. Laksono Trisnantoro, M.Sc., Ph.D.

2015 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Angka kematian ibu di DIY pada tahun 2012 sebanyak 40 kasus, kemudian pada 2013 naik menjadi 46 kasus. Sedangkan kematian neonatal pada tahun 2012 sebanyak 400 kasus, sementara pada tahun 2013 naik menjadi 448 kasus. Hal yang sama terjadi di salah satu kabupaten di DIY, angka kematian ibu tertinggi di Kabupaten Bantul. Angka kematian maternal di Kabupaten Bantul pada tahun 2012 sebanyak 7 kasus, pada tahun 2013 naik sebanyak 13 kasus. Sedangkan angka kematian neonatal pada tahun 2012 sebanyak 116 kasus, pada tahun 2013 naik menjadi 165 kasus. Penyebab kematian maternal adalah pendarahan, eklamsi, dan penyakit lain. Sedangkan penyebab kematian neonatal adalah kelainan koginetal, asikfia dan BBLR. Meskipun sumber daya manusia, fasilitas, SOP, sarana dan prasarana dari Puskesmas PONED Srandakan, RSKIA Ummi Khasanah maupun RS PONEK Panembahan Senopati telah tersedia di Kabupaten Bantul, namun jumlah angka kematian di Kabupaten Bantul sangat tinggi. Tujuan: Mengevaluasi pelaksanaan rujukan maternal dan neonatal di Kabupaten Bantul. Metode: Penelitian ini menggunakan rancangan studi kasus dengan metode dan analisis exploratory. Subjek penelitian ini orang-orang yang mengetahui informasi tentang kesehatan ibu dan anak di Kabupaten Bantul yang berkaitan langsung dengan sistem rujukan, pengambilan sampel secara purposive. Instrumen penelitian menggunakan panduan wawancara mendalam (indepth interview) dengan bantuan alat perekam elektronik, kamera dan buku catatan. Analisa data kualitantif dapat dijelaskan ke dalam tiga proses yang saling terkait yaitu reduksi data, penyajian data dan pengambilan keputusan. Hasil: Penelitian ini menemukan fakta yaitu, ketersediaan SDM, peralatan, obatobatan belum semua sesuai dengan standar PONEK dan PONED. Komunikasi anatr level rujukan belum ideal. Munculnya BPJS kesehatan, menyebabkan jasa medis terlambat diklaim. Kurangnya kerjasama antar level rujukan melibatkan dinas kesehatan. Jejaring rujukan yang merupakan Koordinasi anatar level rujukan PONED, PONEK dan dinas kesehatan belum berjalan. Sementara, pengawasan yang dilakukan oleh dinas kesehatan belum optimal. Kesimpulan: Petugas kesehatan di rumah sakit PONEK Panembahan Senopati dan RSKIA Ummi Khasanah belum semua mengikuti pelatihan PONEK. Dan RSKIA terdapat kekurangan petugas kesehatan tetap. Jasa medis petugas kesehatan terlambat. Proses rujukan antar level rujukan belum berjalan baik. Proses rujukan balik belum berjalan dengan baik karena keterbatasan waktu petugas kesehatan dan menganggap rumah sakit sudah dapat menyelesaikan masalah. Dalam manual rujukan, dinas kesehatan tidak menyerahkan data ibu yang mengalami resiko tinggi ke RS PONEK. Kata Kunci:

Background: There were 46 cases of maternal mortality rate in Yogyakarta in 2013. While neonatal mortality increased to 448 cases. The highest maternal mortality rate in the Bantu district, Yogyakarta is 13 cases while neonatal mortality 165 cases. Human resources, facilities, standard of operations process, infrastructure, EmOC Health Center, RSKIA, and comprehensive EmOC hospital, have been available in Bantul district, but there is still high number of mortality. Therefore, the researcher wanted to evaluate the implementation of maternal and neonatal referral which is one of the government programs to reduce MMR and IMR in Bantul. Objective: To evaluate the implementation of maternal and neonatal referral in Bantul district. Method: This research is a qualitative research which uses case-studies with exploratory analysis and method. Subjects of this study the people who know the information about maternal and child health in Bantul directly related to the referral system and purposive sampling. Research instruments used is in-depth interview guide with the help of electronic recording devices, cameras and notebooks. Qualitative data analysis can be described into three interrelated processes they are first, data reduction; second, data presentation and third decision-making. Results: The availability of human resources, equipment, medicines do not conform to the standard yet. Bantul district already has a means of transportation in the form of the health department budget BESS. Communication tool used in health facilities is a phone. Funding used in the referral system Jamkesmas, Jamkesda and BPJS. Standard of operations process related to maternal and child health services are available and are in accordance with standards established by the Department of Health/health depertement, governor regulation, WHO and referral guidelines. There lack of cooperation between the levels of referrals wich involves the health department. Coordination between the reference level basic EmOC, comprehensive EmOC and the health department are form of referral network handling report of cases about obstetrik complications and neonatal cohort each month. Supervision by health department such as maternal and neonatal mortality but has not touched his medical techniques yet. Conclusions: (1) The implementation of the referral system of human resources, equipment, financing, transportation, availability of tools, communication and standard of operations process have not bee bused on the standards set; (2) Referral process between the reference level is not running optimally; (3) Return referral process is not going well because of time limitation, beside health workers assume the hospital has been able to solve the problem; (4) In the manual reference, the health department does not submit data of mothers with high complications to hospital comprehensive EmOC.

Kata Kunci : Evaluasi, rujukan, maternal dan neonatal