Implementasi Pelayanan Neonatal Emergensi Komprehensif di Rumah Sakit PONEK di Indonesia

Abstract

Abstrak
 Angka kematian neonatal dan angka kematian balita di Indonesia masih tinggi. Kasus kegawatdaruratan merupakan penyebab tingginya angka kematian tersebut. Rumah sakit Pelayanan Obstetrik dan Neonatal Emergensi Komprehensif (PONEK) 24 jam merupakan rumah sakit rujukan dengan visi mempercepat penurunan angka kematian neonatus dan angka kematian balita. Penelitian ini bertujuan untuk mengetahui implementasi pelayanan neonatal emergensi pada rumah sakit PONEK 24 jam di Indonesia. Penelitian didesain dengan pendekatan mix method yaitu pembauran antara studi kuantitatif dan kualitatif. Studi kuantitatif adalah cross sectional dan studi kualitatif adalah Rapid Assesment Procedure yang dilakukan pada tahun 2014. Penelitian dilakukan di rumah sakit di Indonesia dengan kriteria rumah sakit PONEK 24 jam, telah menerima sosialisasi tentang PONEK, dipilih secara random di 7 provinsi di Indonesia masing-masing 2 rumah sakit tiap provinsi. Berdasarkan kriteria tersebut sebanyak 14 rumah sakit diobservasi dalam penelitian ini. Data kuantitatif yang dikumpulkan meliputi pelayanan klinis, manajemen, sarana dan prasarana, ketenagaan dan pendanaan. Data dikumpulkan dengan cara observasi, telaah dokumen dan wawancara. Data kualitatif yang dikumpulkan meliputi proses, hambatan, dan keberhasilan PONEK dengan cara indepth interview dengan informan kunci direktur rumah sakit, ketua komite medik dan dokter spesialis. Hasil penelitian menunjukkan bahwa sebagian besar rumah sakit telah melaksanakan pelayanan neonatal emergensi 24 jam, KMC dan aksesibilitas darah yang memadai. Pelayanan neonatal emergensi telah didukung dengan jenis tenaga profesional, komitmen direktur rumah sakit yang tinggi, MoU dengan IDI, kerjasama dengan NGO serta ruangan, sarana dan prasarana yang memadai. Keberhasilan rumah sakit PONEK 24 jam didukung oleh kesadaran masyarakat untuk memanfaatkan layanan rumahsakit. Namun di beberapa rumah sakit kurangnya tenaga terlatih, jumlah tenaga, tidak ada tim, sarana dan prasarana serta ruangan menjadi alasan rumah sakit tidak melaksanakan PONEK. Kesimpulan: beberapa rumah sakit telah melaksanakan pelayanan neonatal emergensi komprehensif 24 jam, namun masih perlu mendapat perhatian dalam hal pelatihan dan jumlah tenaga, biaya, sarana dan prasarana serta ruangan yang memadai.
 Kata kunci: neonatal, emergensi, rumah sakit, rujukan
 Abstract
 Neonatal under-five mortality rate in Indonesia was still high, while the emergency cases were the most of its causes. Emergency neonatal care (EmNC) hospital was a referral provider to accelerate decline in neonatal and under-five mortality. This research aimed to observe the implementation of emergency neonatal services at referal hospitals in Indonesia. This study was a cross sectional study with quantitative and qualitative design. The study was conducted in all of referal hospital in Indonesia with criterian socialized emergency neonatal care. Based on these criteria as many as 14 hospitals in 7 provinces were observed in this study. The quantitative data collected includes clinical services, management, facilities and infrastructure, manpower and funding. Data were collected by observation, document review and interview. The qualitative were collected including the process, constraints, and attainment of emergencies services by indepth interviews to directors, medical committee heads, and specialists as informants. The results show that most hospitals provided 24-hour emergency neonatal services, KMC and adequate blood accessibility. Emergency neonatal care has been supported by professionals (i.e doctor, obsgyn, anaesthetician, etc), commitment of hospital director, MoU with IDI and NGOs. The attainment of emergency neonatal care was supported by public awareness to utilize hospital services. Skilled physician, room, essensial supplies and equipment for performing certain emergency neonatal care functions were not available in several surveyed hospital. Some hospitals have implemented comprehensive emergency neonatal care, but still need number of skilled pshycisian, budget facilities, supplies and equipment.
 Keywords: neonatal, emergency, hospital, referal system

Implementation of comprehensive emergency obstetric neonatal care (ponek) in Indonesia Hospitals: a literature review

“…As well as in the research of Herdarwan et al further explained that there are 2 types of PONEK room separate PONEK rooms. First it is separated from the ER room and second one is still integrated with the ER (29). Then in the research of Pratama et al it is known that there are delivery rooms, operating rooms, and neonatal rooms and supporting facilities are available, but facilities and infrastructure are still considered insufficient both in terms of quantity and condition (17).…”

“…Increasing health worker motivation can be done by strengthening management capacity in health services such as management competence, social support in the workplace, treating employees fairly, as well as monitoring and evaluating performance. (38) Afieina Maulida Mulyono, Ayu Khoirotul Umaroh Implementation of comprehensive emergency obstetric neonatal care (ponek) in Indonesia hospitals: a literature review Then in the research of Herdarwan et al (2017) mentioned that the existing obstacles are the lack of funding sources, the number and competence of trained personnel is still lacking, the facilities and infrastructure are not adequate, the incubator room is still lacking based on the number of needs, the specifications of the equipment are not in accordance with the needs, limited drugs, cross-sector cooperation is not optimal, there is still a lack of communication with health care facilities from the origin of referrals, specialists cannot be on site 24 hours, and the cooperation mechanism between the health department and the hospital with the Integrated Emergency Management System (SPGDT) has not run optimally (29). These barriers can be overcome by the availability of adequate funding and its optimal absorption.…”

Effectiveness of the Kangaroo Method as a Treatment for Low Birth Weight Baby (Lbwb)

“…The kangaroo method of care is a special way of caring for low birth weight babies using the kangaroo method, namely making direct contact between the baby's skin and the mother's skin to help the baby's healthy development through increasing temperature control, breastfeeding and preventing infection (Proverawati, 2012). The kangaroo method can prevent heat loss in babies through skin-to-skin contact between mother and baby by conduction and radiation (Indrasanto, 2013).…”

“…Continuous interaction between the mother and the baby will influence the mother's feelings of confidence in caring for her baby. The kangaroo method of care makes it easier to provide breast milk and the mother is more confident in caring for the baby and has better bonding attachment which has a positive impact on the psychology of the mother and family (Indrasanto, 2013).…”

Factors to improve the quality of comprehensive emergency obstetric and newborn care

“…The findings of this qualitative study also indicate that adequate facilities and appropriate infrastructure of a tertiary hospital are one of the influencing factors of the CEmONC services. Although the health workers who provide the CEmONC services are sufficient and competent according to standards, the service can run ineffectively if the supporting facilities are below the standard [28]. In the tertiary referral hospital, hospital managers should periodically monitor and evaluate the availability of ICU and NICU to optimize the function of providing subspecialty care for high-risk pregnant women and newborns [29].…”