Strengthening maternal referral systems during public health emergencies: insights from Indonesia’s covid-19 response
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Introduction: This study assesses hospital readiness in maternal referral hospitals six months after the onset of the pandemic, aiming to inform future public health emergency responses.
Methods: A descriptive and exploratory mixed-methods design was employed. Surveys and focus group discussions were conducted with 127 hospitals in the COVID-19 maternal referral hospitals by the East Java Provincial Government using the modified WHO hospital readiness checklist for COVID-19 2020. Quantitative data were analyzed descriptively, and qualitative data from focus group discussions were thematically analyzed to get deeper insights into the challenges faced by hospitals.
Results: A total of 105 hospitals (83%) responded to the survey. While PPE supplies were largely adequate, gaps in infrastructure, including negative-pressure rooms, isolation areas, and diagnostic capacity, persisted. Financial constraints, particularly delays in the National Health Insurance Scheme (BPJS Kesehatan) claims, further strained hospital operations. FGDs revealed that PCR delays, staffing shortages, and underdeveloped referral coordination systems hindered the delivery of maternal services.
Conclusions: Strengthening maternal referral systems requires improving diagnostic capabilities, investing in essential infrastructure, and ensuring timely financial reimbursement. Collaborative efforts among the Ministry of Health, BPJS Kesehatan, and healthcare facilities are crucial to enhancing maternal healthcare resilience during future public health emergencies.
Akbar, M. I. A. et al. (2022). Clinical manifestations and pregnancy outcomes of COVID-19 in indonesian referral hospital in central pandemic area. Obstetrics & gynecology science, 65(1), 29–36. https://doi.org/10.5468/ogs.21135
Alabi, Q. K. et al. (2023). Impact of COVID-19 pandemic on mother and child health in Sub-Saharan Africa - a review. Pediatric research, 94(4), 1278–1283. https://doi.org/10.1038/s41390-023-02651-w
Bahrami-Motlagh H. et al. Performance of Low-Dose Chest CT Scan for Initial Triage of COVID-19. Iranian Journal of Radiology 2020 17:4 [Internet]. 2020 Oct 31 [cited 2024 Jul 15];17(4):1–10. Available from: https://brieflands.com/articles/ijradiology-104950
Brazier JF. et al. Examination of Staffing Shortages at US Nursing Homes During the COVID-19 Pandemic. JAMA Netw Open [Internet]. 2023 Jul 3 [cited 2024 Jul 15];6(7):e2325993–e2325993. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807662
Cordey S, Moncrieff G, Cull J, Sarian A. ‘There’s only so much you can be pushed’: Magnification of the maternity staffing crisis by the 2020/21 COVID-19 pandemic. BJOG [Internet]. 2022 Jul 1 [cited 2024 Jul 15];129(8):1408–9. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.17203
Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020. MMWR Morb Mortal Wkly Rep [Internet]. 2022 Jun 26 [cited 2024 Jul 15];69(25):769–75. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/mm6925a1.htm
Heltiani N, Nababan L, Nababan L, Putri L. Completeness of Delivery and Accuracy of Delivery Diagnosis Code On The Smooth Verification of BPJS Claims in Hospital. Greenation International Journal of Tourism and Management [Internet]. 2023 Sep 12 [cited 2024 Jul 15];1(3):276–85. Available from: https://research.e-greenation.org/GIJTM/article/view/98
Hirshberg MJ, Davidson RJ, Goldberg SB. Educators Are Not Alright: Mental Health During COVID-19. Educational Researcher [Internet]. 2023 Jan 1 [cited 2024 Jul 15];52(1):48–52. Available from: https://journals.sagepub.com/doi/10.3102/0013189X221142595
Kamara J, Moses F, Thekkur P et al. The effect of the COVID-19 pandemic on emergency maternal and under-five referrals in Sierra Leone: A cohort study [version 1; peer review: peer review discontinued]. F1000Research 2024, 13:703 (https://doi.org/10.12688/f1000research.149455.1)
Kartiningrum, E., Notobroto, H., Salim, L., & Otok, B. (2023). Spatial determinants affected maternal mortality of East Java province during the COVID-19 pandemic era, in 2020-2021. Journal of Public Health in Africa, 14(2), 5. doi:https://doi.org/10.4081/jphia.2023.2545
Kim M, Lee KJ, Kim HJ, Han JH, Kim CK. Impact of in-hospital COVID-19 quarantine policy changes on quality of acute stroke care: A single center experience. 2024 Mar 5 [cited 2024 Jul 15]; Available from: https://www.researchsquare.com
Lestari AW, Tahlil T, Darmawati. Determinants of Preparedness Management and Nurses’ Response to COVID-19 Prevention Measures at a Government-Owned General Hospital in Indonesia. International Journal of Nursing Education [Internet]. 2022 Oct 17 [cited 2024 Jul 15];14(4):14–9. Available from: https://medicopublication.com/index.php/ijone/article/view/18676
Mahendradhata, Y., Andayani, N. L. P. E., Hasri, E. T., Arifi, M. D., Siahaan, R. G. M., Solikha, D. A., & Ali, P. B. (2021). The Capacity of the Indonesian Healthcare System to Respond to COVID-19. Frontiers in public health, 9, 649819. https://doi.org/10.3389/fpubh.2021.649819
Melo Mendes IC, Martins de Oliveira AL, Martins Pinheiro Trindade P, Mendes da Silva W, Pontes Frankel P, Carvalho Mocarzel C, et al. Severe Covid-19 in pregnant and postpartum women admitted to an intensive care unit: A retrospective cohort study. PLoS One [Internet]. 2023 [cited 2024 Jul 15];18(12):e0295444. Available from: /pmc/articles/PMC10721012/
Muchsam Y, Tanjung R, Hidayat MR, Kautsar MZ, Fauzan I, Juhaeri SH, et al. Review of BPJS claim requirements for service efficiency in RS X. Int J Health Sci (Qassim) [Internet]. 2022 Sep 30 [cited 2024 Jul 15];6(3):1492–500. Available from: https://sciencescholar.us/journal/index.php/ijhs/article/view/13130
Perez AO, Domingo-Palaoag T, Werner GR, Uzdensky DA, Ristiantri YRA, Susiloningtyas D, et al. Multi-criteria Decision Analysis for Readiness of COVID-19 Referral Hospital in Jakarta. IOP Conf Ser Earth Environ Sci [Internet]. 2022 Sep 1 [cited 2024 Jul 15];1039(1):012022. Available from: https://iopscience.iop.org/article/10.1088/1755-1315/1039/1/012022
Seif Rabiei MA, Keramat F, Sedighi I, Jalili E, Nikooseresht M, Talebi SS, et al. Evaluation of the Response Rates of Hospitals in the Prevention and Control of COVID-19 in Hamadan Province of Iran. https://doi.org/101177/11786329231187825 [Internet]. 2023 Jul 21 [cited 2024 Jul 15];16. Available from: https://journals.sagepub.com/doi/10.1177/11786329231187825
Suhargono MH. Emergency maternal referral worksheet as a clinical decision-making tool. Majalah Obstetri & Ginekologi [Internet]. 2021 Apr 28 [cited 2024 Jul 15];29(1):7–13. Available from: https://e-journal.unair.ac.id/MOG/article/view/26564
Syairaji, M., Nurdiati, D., Wiratama, B.S. et al. Trends and causes of maternal mortality in Indonesia: a systematic review. BMC Pregnancy Childbirth 24, 515 (2024). https://doi.org/10.1186/s12884-024-06687-6
The Government of East Java Province, 2020. COVID-19 Data in East Java Province and Surabaya [WWW Document]. Jatim Tanggap COVID-19. URL http://infocovid19.jatimprov.go.id
Valera E, Jankelow A, Lim J, Kindratenko V, Ganguli A, White K, et al. COVID-19 Point-of-Care Diagnostics: Present and Future. ACS Nano [Internet]. 2021 May 25 [cited 2024 Jul 15];15(5):7899–906. Available from: https://pubs.acs.org/doi/full/10.1021/acsnano.1c02981
Wallace AS, Raaum SE, Johnson EP, Presson AP, Allen CM, Elliott M, et al. Impact of COVID-19 Visitation Policies and Hospital Capacity on Discharge Readiness in Medicine Patients. 2023 Sep 30 [cited 2024 Jul 15]; Available from: https://www.researchsquare.com
WHO. 2021. Living Guidance for Clinical Management of COVID-19 Available online at: https://iris.who.int/bitstream/handle/10665/349321/WHO-2019-nCoV-clinical-2021.2-eng.pdf?sequence=1
WHO. WHO Coronavirus Disease (COVID-19) Dashboard. (2021). Available online at: https://covid19.who.int/
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