Ignasius Luti(1*), Mubasysyir Hasanbasri(2), Lutfan Lazuardi(3)

(*) Corresponding Author


Ignasius Luti1, Mubasysyir Hasanbasri2, Lutfan Lazuardi2
1 Dinas Kesehatan Kabupaten Lingga, Kepulauan Riau
2 Program Studi Ilmu Kesehatan Masyarakat, Fakultas Kedokteran,
Universitas Gadjah Mada, Yogyakarta
Background: One of the critical issues in the development of
national health care is the limited accessibility to health services.
Such problems also occur in Linga District of Kepulauan
Riau Province. It is caused by many factors, such as geographical
location, cost, number of health personnel and condition
of health care facilities, such as health centers and their
networks which are not accessible to the public. Several attempts
have been made, for example, by improving the status
of sub-health centers to be health centers, health centers to
be treatment centers, assinging health workers both medical
and paramedical, improving health financing and making budget
policies. However, its implementation has not been maximal.
In accordance with the above background, it would require
a study on the role of local government policy in improving
the referral system which is useful to know the problems
in the field, so that in the future a variety of improvement can
be done.
Objective: To determine the referral system in the islands
area of Linga District.
Methods: This was a case-study research. The research
subjects were head of health centers / health center doctors,
nurses/midwife assistants, ambulance drivers/sea ambulance
drivers, patient families, community figures, jamkesmas/
Jamkesda managers, head of health care section/head of
health office, director of local hospital/mobile hospital and emergency
room nurses. The variables in this study were independent
variable (referral system) and dependent variable (ambulance
service). The research location was in Linga District
of Kepualauan Riau Province.
Results: The results showed that policy efforts of the Linga
Government District in improving the referral system had existed.
The existing financing policy had encompassed two
aspects both from the demand side (medical expenses) and
from the supply side (a system that supported health care).
The process of referral from primary care to advanced services
had been going well although there was still lack as the
unavailability and completeness of services. Most of the health
workers had received training; there were also specialist doctors
(in collaboration with the faculty of medicine), but networking
in the referral process was done partially and not
Conclusion: The health referral system in Linga District had
run pretty well, but did not fully involve community participation
in an integrated service system. The local government in this
case Linga District Health Office needs to revitalize as well as
accelerate the development of Desa Siaga (alert villages) readiness
to increase community participation in the development
of a referral system.
Keywords: policy, referral systems, islands, ambulance service

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