Sistem Rujukan Dalam Sistem Pelayanan Kesehatan Maternal Perinatal Di Indonesia

Abstract

ABSTRAK
 Kasus keterlambatan rujukan merupakan salah satu permasalahan utama terjadinya kematian ibu dan bayi di Indonesia. Kematian ibu dan bayi dapat diakibatkan pelayanan di fasilitas kesehatan belum maksimal, terjadi keterlambatan pelayanan rujukan, mengakibatkan sangat terlambatnya pasien tiba di fasilitas pelayanan rujukan. Berbagai hambatan termasuk ketidakjelasan hubungan dengan BPJS Kesehatan dalam hal pengaturan sistem rujukan, terjadinya perbedaan pendapat rujukan dan perhatian terhadap pengembangan sistem rujukan di daerah yang masih kurang kuat. Tahun 2020 Kementerian Kesehatan RI mengeluarkan Permenkes No. 3/2020 yang mengatur Klasifikasi dan Perizinan Rumah sakit, yang tentunya mempengaruhi sistem rujukan. Dengan sistem rujukan diharapkan meningkatkan pelayanan kesehatan yang lebih bermutu. Metode yang diambil berdasarkan tinjauan literatur dan penelitian yang mencoba menggali lebih banyak informasi guna mengetahui sistem rujukan yang terjadi di Indonesia baik kabupaten, propinsi, Puskesmas dan Rumah Sakit.
 Sistem rujukan pelayanan kesehatan merupakan salah satu upaya meningkatkan mutu pelayanan kesehatan yang memberikan dampak penurunan Angka Kematian Ibu dan Bayi akibat keterlambatan penanganan kegawatdaruratan. Sistem rujukan merupakan sistem dimana kordinasi merupakan unsur utama yang bersifat multi sektor dan harus ada dukungan berbagai profesi multi disiplin dan multi profesi. Untuk mendukung hal tersebut seluruh sarana pelayanan kesehatan pemerintah maupun swasta agar melaksanakan prosedur rujukan kesehatan mengacu Petunjuk Teknis Sistem Rujukan Pelayanan Kesehatan. Setiap sarana pelayanan kesehatan di kabupaten/kota diharapkan membuat pemetaan alur rujukan pelayanan kesehatan disesuaikan dengan tingkat kemampuan fasilitas kesehatan, keberadaan jaringan transportasi dan keadaan geografis wilayah masing-masing.
 Simpulan penyediaan akses pelayanan kesehatan ibu dan anak yang berkualitas menjadi tantangan besar, pemerintah harus memiliki komitmen kuat meningkatkan status kesehatan ibu dan anak, untuk mewujudkan program Penurunan AKI dan AKB tersebut diperlukan perbaikan sistem rujukan yang efektif dan efisien dengan memperkuat sistem rujukan kesehatan diberbagai jenjang pelayanan kesehatan.
 Kata kunci : Sistem Rujukan, Pelayanan Kesehatan, Maternal Perinatal
 ABSTRACTLate of referral is one of the main problems in the occurrence of maternal and infant mortality in Indonesia. Maternal and infant deaths can be caused by services at health facilities not yet maximized, there is a delay in referral services, resulting in very late patients arriving at the referral service facility. Various obstacles include unclear relations with BPJS Health in terms of setting a referral system, the occurrence of differences of referral opinions and attention to the d The health service referral system is one of the efforts to improve the quality of health services which has the effect of reducing maternal and infant mortality rates due to delays in emergency handling. The referral system is a system where coordination evelopment of a referral system in regions that are still not strong enough. is the main element that is multi-sectoral and there must be support from various multi-disciplinary and multi-professional professions. To support this, 
 all public and private health service facilities should carry out health referral procedures referring to the Technical Guidelines for Health Services Referral Systems. Each health service facility in the district / city is expected to make a mapping of health service referral flow tailored to the level of ability of the health facility, the existence of the transportation network and the geographical situation of each region.Conclusion the provision of access to quality maternal and child health services is a big challenge, the government must have a strong commitment to improve maternal and child health status, to realize the MMR and IMR Reduction program, it is necessary to improve an effectiveand efficient referral system by strengthening the health referral system at various levels of service health.’ Keywords: Referral System, Health Services, Maternal Perinatal
 ABSTRAK
 Kasus keterlambatan rujukan merupakan salah satu permasalahan utama terjadinya kematian ibu dan bayi di Indonesia. Kematian ibu dan bayi dapat diakibatkan pelayanan di fasilitas kesehatan belum maksimal, terjadi keterlambatan pelayanan rujukan, mengakibatkan sangat terlambatnya pasien tiba di fasilitas pelayanan rujukan. Berbagai hambatan termasuk ketidakjelasan hubungan dengan BPJS Kesehatan dalam hal pengaturan sistem rujukan, terjadinya perbedaan pendapat rujukan dan perhatian terhadap pengembangan sistem rujukan di daerah yang masih kurang kuat. Tahun 2020 Kementerian Kesehatan RI mengeluarkan Permenkes No. 3/2020 yang mengatur Klasifikasi dan Perizinan Rumah sakit, yang tentunya mempengaruhi sistem rujukan. Dengan sistem rujukan diharapkan meningkatkan pelayanan kesehatan yang lebih bermutu. Metode yang diambil berdasarkan tinjauan literatur dan penelitian yang mencoba menggali lebih banyak informasi guna mengetahui sistem rujukan yang terjadi di Indonesia baik kabupaten, propinsi, Puskesmas dan Rumah Sakit.
 Sistem rujukan pelayanan kesehatan merupakan salah satu upaya meningkatkan mutu pelayanan kesehatan yang memberikan dampak penurunan Angka Kematian Ibu dan Bayi akibat keterlambatan penanganan kegawatdaruratan. Sistem rujukan merupakan sistem dimana kordinasi merupakan unsur utama yang bersifat multi sektor dan harus ada dukungan berbagai profesi multi disiplin dan multi profesi. Untuk mendukung hal tersebut seluruh sarana pelayanan kesehatan pemerintah maupun swasta agar melaksanakan prosedur rujukan kesehatan mengacu Petunjuk Teknis Sistem Rujukan Pelayanan Kesehatan. Setiap sarana pelayanan kesehatan di kabupaten/kota diharapkan membuat pemetaan alur rujukan pelayanan kesehatan disesuaikan dengan tingkat kemampuan fasilitas kesehatan, keberadaan jaringan transportasi dan keadaan geografis wilayah masing-masing.
 Simpulan penyediaan akses pelayanan kesehatan ibu dan anak yang berkualitas menjadi tantangan besar, pemerintah harus memiliki komitmen kuat meningkatkan status kesehatan ibu dan anak, untuk mewujudkan program Penurunan AKI dan AKB tersebut diperlukan perbaikan sistem rujukan yang efektif dan efisien dengan memperkuat sistem rujukan kesehatan diberbagai jenjang pelayanan kesehatan.
 
 Kata kunci : Sistem Rujukan, Pelayanan Kesehatan, Maternal Perinatal
 
 ABSTRACTLate of referral is one of the main problems in the occurrence of maternal and infant mortality in Indonesia. Maternal and infant deaths can be caused by services at health facilities not yet maximized, there is a delay in referral services, resulting in very late patients arriving at the referral service facility. Various obstacles include unclear relations with BPJS Health in terms of setting a referral system, the occurrence of differences of referral opinions and attention to the d The health service referral system is one of the efforts to improve the quality of health services which has the effect of reducing maternal and infant mortality rates due to delays in emergency handling. The referral system is a system where coordination evelopment of a referral system in regions that are still not strong enough. is the main element that is multi-sectoral and there must be support from various multi-disciplinary and multi-professional professions. To support this, 
 all public and private health service facilities should carry out health referral procedures referring to the Technical Guidelines for Health Services Referral Systems. Each health service facility in the district / city is expected to make a mapping of health service referral flow tailored to the level of ability of the health facility, the existence of the transportation network and the geographical situation of each region.Conclusion the provision of access to quality maternal and child health services is a big challenge, the government must have a strong commitment to improve maternal and child health status, to realize the MMR and IMR Reduction program, it is necessary to improve an effectiveand efficient referral system by strengthening the health referral system at various levels of service health.’ Keywords: Referral System, Health Services, Maternal Perinatal

Kartu Skor Poedji Rochyati in the Indonesian Maternal Referral System

“…This connection is manifested as an effective referral system, facilitating swift and coordinated response to maternal health challenges and ultimately contributing to the reduction of maternal mortality. 4,17,18 The Ministry of Health of the Republic of Indonesia through the Director of Maternal Health Development has established a National Action Plan to Accelerate the Reduction of Maternal Mortality Rate for 2013-2015, in which the fourth main program is the implementation of effective referrals for cases of maternal complications. This is based on the fact that one of the main obstacles to the slow decline in MMR in Indonesia is barriers to providing and accessing emergency obstetric services.…”

“…Each province will have a different map. 18,19 Referral is the transfer of responsibility from one health service to another. The referral system is a network of health services that allows for reciprocal delegation of responsibility for the emergence of problems from a case or public health problems both vertically and horizontally to those who are more competent, affordable, and carried out rationally.…”

“…Effective referrals require communication between facilities, the goal is that the referred facility knows the patient's condition and can prepare early the treatment needed by the patient as soon as the patient arrives at the hospital. 18,20 The aim of referral is to produce equal distribution of health efforts in the context of solving health problems in an efficient and effective manner. The aim of the referral system is to improve the quality, coverage, and efficiency of health services in an integrated manner.…”

“…The referral must obtain the consent of the patient and/or family, as well as the authorized health worker must provide an explanation to the patient regarding the diagnosis and therapy or medical action required by the patient, the reason and purpose for the referral, the risks that may arise if the referral is not made, referral transportation, and the risks or complications that may arise during referral mobilitation. 18 A safety referral system is a network system for health care facilities that allows for reciprocal delegation of responsibility for problems that arise both vertically (communication between equal units) and horizontally (higher core communication to lower units) to service facilities. more competent, rationally affordable, and not limited by administrative area.…”

“…The referral system according to the 2009 Indonesian Ministry of Health National Health System is a health service delivery system that carries out reciprocal delegation of responsibility for one/more cases of disease or health problems vertically from units with less ability to units that are more capable or horizontally between units that are level of ability in the field of maternal and perinatal health. 18 As outlined in Article 7 of the Minister of Health Regulation No. 001 of 2012 regarding the Referral System for Individual Health Services, the referral process can occur both vertically and horizontally.…”