| Summary: | Background: Strengthening referral system is a method to accelerate decrease of
maternal mortality rate. The main factors affecting referral system are facilities,
staff, team work, and budget that need seroius attention from all stakeholders
involved in the program of maternal health.
Objective: The study aimed to evaluate referral system of maternal health at
District of Karimun Province of Kepulauan Riau.
Method: This was a qualitative case study undertaken at Karimun Hospital and 2
health centers with high maternal and infant mortality rate, i.e. Meral and Moro
Health Center that were located at both urban and rural areas. Data were obtained
through in-depth interview, focus group discussion, observation, checklist and
document study.
Result: The result of the study showed there was limitation of resources at
primary health service such as facilities and equipments and hospital able to
provide comprehensive emergency neonatal and obstetric management despite 24
hours service availability. There were lack of team coordication across referral
levels involving district health office, hospital and health centers, incomplete
standard operating procedures, weak infrormation system and emergence of by
pass referral procedure. Community participation in referral system was very high
though some labour was assisted by traditional childbirth assistants. The condition
was mainly due to cultural factors.
Conclusion: Maternal health referral system at primary health service as well as
in hospital was not yet effective. Community had actively participated in referral
process but participation was not yet integrated in the system.
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