Sistem Rujukan Maternal dan Neonatal di Daerah Kepulauan (Studi Kasus di Provinsi Papua dan Maluku)

Maternal and neonatal health services are aimed to produce a healthy and quality generation and reduce maternal mortality rate (MMR) and infant mortality (IMR). MMR and IMR in Indonesia tend not to improve. Targeted reduction of MMR and IMR will be difficult to achieve if not given appropriate intervention, both socially, economically and culturally, as well as stabilization of referral system. In 2015, research on maternal and neonatal referral system in Papua and Maluku provinces was conducted. Data were collected at selected health centers, District hospitals, provincial hospitals, and regional referral hospitals. Study design is cross sectional. Data collection was done by interview, document review, verbal autopsy, and survey to health facilities and infrastructure. The results show that both provinces already have Governor Decree related to health care system and regionalization policy, but have not translated into Mayor Decree in each selected district. Referral flow indicates that there are still many health workers / families who choose directly to the district hospital or provincial hospital or health worker who refers to other closer regency hospitals. The number of maternal and neonatal deaths is still high, the unavailability of OBGY and Pediatricians, low compliance of the BEONC and CEONC standards. Consumables and drugs are often depleted because of the lack of coordination, uncontrolled stock, and the late of drug requests. Event though maternal and neonatal referrals have been financed through National Health Insurance, however still many shortcomings, both in terms of funding flows and problems in administrative completeness, as well as unavailability of accommodation and transportation costs for families and midwives who will accompany mother. Abstrak Pelayanan kesehatan maternal dan neonatal ditujukan untuk menjaga kesehatan ibu sehingga mampu melahirkan generasi yang sehat dan berkualitas serta mengurangi Angka Kematian Ibu (AKI) dan Angka Kematian Bayi (AKB). AKI dan AKB di Indonesia cenderung tidak mengalami perbaikan. Target penurunan AKI dan AKB akan sulit dicapai jika tidak diberikan intervensi yang tepat, baik secara sosial, ekonomi dan budaya, serta pemantapan sistem rujukan. Pada tahun 2015 dilakukan penelitian sistem rujukan maternal dan neonatal di Provinsi Papua dan Maluku. Pengumpulan data dilakukan di puskesmas terpilih, RSUD Kabupaten, RSUP Provinsi, dan RSUP Rujukan Regional. Disain penelitian studi potong lintang. Pengumpulan data dilakukan dengan wawancara, penelusuran dokumen, autopsi verbal, dan check list kelengkapan sarana dan prasarana. Hasil penelitian menunjukkan kedua provinsi sudah memiliki PerGub terkait dengan sistem pelayanan kesehatan dan kebijakan regionalisasi, namun belum diterjemahkan ke dalam PerBup di masing – masing kabupaten terpilih. Alur rujukan menunjukkan masih banyak tenaga kesehatan/keluarga yang memilih langsung ke RS kabupaten/RS provinsi atau tenaga kesehatan yang merujuk ke RS kabupaten lain yang lebih dekat. Jumlah kematian maternal dan neonatal masih tinggi, tidak tersedianya DSOG dan DSA, sarana prasarana masih belum sesuai standar PONED dan PONEK, ketersediaan dan kecukupan alat di Provinsi Papua masih di bawah 50 persen. Bahan habis pakai dan obat sering habis karena tingkat koordinasi, pengontrolan stok, dan daftar permintaan obat kurang terkontrol. Pembiayaan rujukan maternal dan neonatal melalui sistem JKN dan Jamkesda, namun banyak mengalami kekurangan, baik dalam hal alur pembiayaan maupun permasalahan di kelengkapan administrasi, serta tidak tersedianya biaya akomodasi dan transportasi bagi keluarga dan bidan pendamping pasien.