Healthcare providers’ perception of the referral system in maternal care facilities in Aceh, Indonesia: a cross-sectional study

Abstract

ObjectivesOur study investigates the barriers perceived by staff in the referral systems in maternal healthcare facilities across Aceh province in Indonesia.DesignWith a cross-sectional approach, two sets of surveys were administered during September to October 2016 in 32 sampling units of our study. We also collected referral data in the form of the frequency of ingoing and outgoing referral cases per facility.SettingIn three districts, Aceh Besar, Banda Aceh and Bireuen, a total of 32 facilities including hospitals, community health centres, and private midwife clinics that met the criteria of providing at least basic emergency obstetric and neonatal care (BEonC) were covered.ParticipantsAcross the 32 healthcare centres, 149 members of staff (mainly midwives) agreed to participate in our surveys.Primary and secondary outcome measuresThe first survey consisted of 65 items focusing on organisational measures as well as case numbers for example, patient counts, mortality rate and complications. The second survey with 68 items asked healthcare providers about a range of factors including attitudes towards the referral process in their facility and potential barriers to a well-functioning system in their district.ResultsOverall, mothers’/families’ consent as well as the complex administration process were found to be the main barriers (36% and 12%, respectively). Healthcare providers noted that information about other facilities has the biggest room for improvement (37%) rather than transport, timely referral of mothers and babies, or the availability of referral facilities.ConclusionsThe largest barrier perceived by healthcare providers in our study was noted to be family consent and administrative burden. Moreover, lack of information about the referral system itself and other facilities seemed to be affecting healthcare providers and mothers/families alike and improvements perhaps through a shared information system is needed.

Successes, Challenges and Opportunities Towards Universal Health Coverage for Maternal and Child Health in South East Asian Countries: A Systematic Review

“…Among studies included in the review, a majority was from India (n=30, 48 %) . There were 11 studies from Nepal (42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52) , 10 from Bangladesh (53)(54)(55)(56)(57)(58)(59)(60)(61)(62) , six from Indonesia (63)(64)(65)(66)(67)(68) and two from Timor-Leste 69,70 . From Bhutan 71 , Thailand 72 , and Myanmar 73 one from each was identi ed.…”

“…A study conducted among Nepal women has identi ed family support, transport availability and nearby birthing center as facilitators for institutional deliveries 52 . In Indonesia, a research revealed that all private and public hospitals in a province provide full coverage of Comprehensive Emergency Obstetric and New-born Care 64 . Support from friends, family and co-workers and male participation in accessing antenatal clinics are identi ed as enablers for early ANC booking in Bhutan 71 .…”

“…They further provide contracting in EmOC specialists in private sector as a measure to reduce maternal mortality 29 . In Nepal, Bangladesh and Indonesia, there are similar programmes to facilitate maternal care including institutional delivery 42,43,52,57,59,63,64,66,67 . For the improvement of access to needy mothers and children, government of India has provided accreditation of private sector health providers in government-led schemes for maternity services.…”

“…It acts as a challenge for community management of them. Health service responses for postpartum care are identi ed as poor and non-patient-centered in a study done in Indonesia 64 . Postnatal care at village level is identi ed as non-patient-centered care practices in Klaten district, central Java Province, Indonesia 68 .…”

“…Poor governance in birthing centers 45 , lack of support from hospital administration 51 and less priority given on primary health care 50 are the barriers identi ed in Nepal for good quality delivery and postpartum care. In Indonesia, decentralization of the health sector which created confusion regarding roles and responsibilities as well as complex administration process were identi ed as important factors which impede the quality care 64,65 . Vogel et al has identi ed that the de ciencies in policies and political context and de ciencies with accountability and monitoring as the barriers to implement WHO Maternal and perinatal health recommendations in Myanmar 73 .…”