Pencegahan keterlambatan rujukan maternal di Kabupaten Majene

Abstract

Background: The geography, distances and infrastructures
factors are highly affecting community accessibility to modern
transportation. In general, obstetric emergency cases failed to
be managed because of the low accuracy in routine pregnancy
follow up and delay in referral. One limiting factor 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 obstetric 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
dif ficult 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 helping 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.
Keywords: maternal referral delay, traditional referral, service
regionalization