Implementasi Sistem Rujukan Persalinan dengan Komplikasi oleh Bidan di Puskesmas Siwuluh (PONED) Kabupaten Brebes Tahun 2016

Abstract

Universitas Diponegoro Fakultas Kesehatan Masyarakat Program Studi Magister Ilmu Kesehatan Masyarakat Konsentrasi Kesehatan Ibu dan Anak 2016 ABSTRAK Rosmalia Kamil Implementasi Sistem Rujukan Persalinan dengan Komplikasi oleh Bidan di Puskesmas Siwuluh (PONED) Kabupaten Brebes Tahun 2016 x + 129 halaman + 3 tabel + 4 gambar + 6 lampiran Berdasarkan data dari Dinas Kesehatan Kabupaten Brebes jumlah ibu bersalin yang ditolong oleh tenaga kesehatan 33.062 (92,64%). Namun berbanding terbalik dengan peningkatan kematian ibu dari tahun 2013 sampai 2015 dengan tenaga kesehatan sebagai penolong persalinan. Hal ini menunjukkan bahwa pelayanan kesehatan yang belum optimal, dari jumlah kematian tersebut paling banyak meninggal karena keterlambatan penanganan di Rumah Sakit sekitar 80,8%. Melihat tingginya angka tersebut maka perlu dilakukan evaluasi terhadap sistem layanan rujukan di RS. Metode penelitian yang digunakan adalah kualitatif. Jumlah informan utama 8 orang, yaitu 4 Bidan Desa dan 4 Bidan Praktik Mandiri. Informan triangulasi 3 orang, yaitu 1 orang Kepala Puskesmas, 1 Orang Bidan Koordinator dan 1 orang bidan RS. Data dikumpulkan dengan wawancara mendalam. Pengolahan dan analisis data menggunakan analisis isi. Hasil penelitian menunjukkan bahwa sosialisasi sistem rujukan sudah berjalan dengan baik. IBI belum berperan sepenuhnya dalam pelaksanaan sistem rujukan hanya sebatas memberikan sosialisasi saja. Belum semua bidan melakukan rujukan persalinan ke Poned. Dalam persiapan alat dan obat masih terbatas belum sesuai dengan standar Poned. Masih ada bidan yang tidak membawa surat rujukan dan alat transportasi untuk merujuk hanya menggunakan mobil PUSLING, Desa siaga belum di aktifkan kembali disetiap desa. Menentukan kegawatdaruratan sesuai dengan standar operasional prosedur, jika ada yang melanggar akan diberi sanksi. Menentukan tempat rujukan sudah ada peraturan yaitu dengan mengirim pasien ketempat rujukan terdekat. Dokter kebidanan tidak selalu siap di RS, jadi jika ada pasien kegawatdaruratan tidak langsung ditangani. Keluarga pasien tidak bisa menerima informasi yang diberikan oleh bidan dalam menjelaskan tentang rujukan. Sistem Sijari Emas yang sering error dan pasien belum mempersiapkan segala sesuatu yang dibutuhkan seperti dokumen (KK, KTP, Kartu BPJS) dan biaya. Disarankan kepada Dinas Kesehatan Kabupaten Brebes untuk memberikan penyuluhan secara berkala tentang sistem rujukan, bekerjasama dengan Organisasi Profesi (IBI) untuk memperbaiki sistem rujukan, mengaktifkan kembali Desa Siaga di setiap desa, mempertegas kebijakan dalam pertolongan persalinan di Puskesmas Poned, berkoordinasi dengan RS agar dokter kebidanan selalu siap di RS jika ada pasien kegawatdaruratan. Kata kunci : Implementasi, Sistem Rujukan, Persalinan, Komplikasi, Bidan Kepustakaan : 41 (1975-2014) Diponegoro University Faculty of Public Health Master’s Study Program in Public Health Majoring in Maternal and Child Health 2016 ABSTRACT Rosmalia Kamil The Implementation of Delivery Referral System with Complication by Midwives at Siwuluh Health Centre (PONED) in District of Brebes in 2016 x + 129 pages + 3 tables + 4 figures + 6 appendices Based on data from Brebes District Health Office (DHO), number of mothers who were helped by health workers during their delivery processes were 33.062 persons (92.64%). This number was inversely proportional with maternal mortality rates who were helped by health workers during the period of 2013-2015. This situation indicated that providing health service was not optimal. The most of the mortality was due to lateness in handling at a hospital (80.8%). Therefore, there needed to evaluate the referral service system at a hospital. This was a qualitative study. Number of main informants were 8 persons consisted of 4 village midwives and 4 independent practice midwives. Number of triangulation purpose was three persons consisted of a head of a health centre, a coordinator midwife, and a midwife of a hospital. Data were collected by conducting indepth interview and analysed using content analysis. The results of this research showed that the referral system had been well socialised. Indonesian Midwives Association (IMA) had not fully involved in the implementation of the referral system. It just socialised the system. Not all midwives referred deliveries to PONED. Preparedness equipment and medicines were limited and not in accordance with the PONED standard. There were any midwives who did not bring a referral letter and just used a PUSLING car. Alert village had not been reactivated in every village. Determination of emergency was in accordance with SOP and there was any punishment for offenders. There was any regulation to determine a referral place, namely by referring patients to a nearest referral place. Obstetricians were often not available at a hospital. Therefore, there was any delay in handling patients. Family’s patients could not receive information of referral system provided by midwives. Gold Sijari system was often error. In addition, patients had not prepared required documents (i.e. a family card, an identity card, and a health insurance (BPJS) card) and money. Brebes DHO needs to provide information periodically about the referral system cooperated with IMA to improve the referral system, to reactivate alert village in every village, to confirm a policy in assisting a delivery process at PONED health centres, and to make coordination with a hospital to task obstetricians in order to be ready anytime at a hospital when they are any emergency patients. Keywords : Implementation, Referral System, Delivery, Complication, Midwife Bibliography: 41 (1975-2014)