Development Of Perinatologi Reduce Neonatal of Mortality in RSUD Lasinrang Pinrang
lasinrang general hospital

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Maternal and infant’s mortality rate in Indonesia is high compared to that of another developing countries. In 2012, the rate was estimated at 32 deaths per 1.000 success deliveries, way higher than the 24 deaths per 1.000 success deliveries targeted for 2014. For 2015 & 2016, we set to reduce the number to 23 deaths per 1.000 success delivery. Lasinrang Public Hospital in Pinrang Regency South Sulawesi is the only tertiarry medication center in the regency and serves 12 districts. The total population in the regency is 360.019 individuals. Its geographic conditions limits the access to get medical attention located in the regency capital. Perinatal mortality rate in Pinrang Regency was registered at 60 deaths per 522 deliveries, a staggering 11.5%. Key factors causing the severity of the problems are: a.Poor commitment of civil servant in providing services.The civil servants are unaware of the need to the right attitude in delivering service, to the point that hospitalities were nearly absent. b.Overdue medical emergency. Most maternal cases that were transferred to Perinatology Unit in Pinrang Public Hospital have high severity and were overdue. Procedural barriers and incoordination between Community Health Centers, Maternity Centers and individual midwives contribute significantly to the problem. c.The lack of information centers to communicate public’s need and to socialize our services. d.The Standard Operating Procedure that we had was not tied nor consolidated with the need of the service users. e.The limitation of infrastructures. f.The lack of competence human resources.

B. Strategic Approach

 2. What was the solution?
As its respond to the high mortality rate, Pinrang Public Hospital’s management initiated the development of the perinatology unit. We coordinated with vertical government units in Regency, Provincial and National levels as well as NGOs and community members.

 3. How did the initiative solve the problem and improve people’s lives?
The steps taken to put the initiative forward are: a.Consolidating ideas and perception regarding the matter at hand. All staffs and various supporting government units are involved in this process though series of meetings and discussion. The consolidation processes encourage the employees to be committed in providing better services. Such commitment is conceptualized in a series of motivating statements by all hospital’s staffs. b.Reorganization of referral system: we provide an Internet-based referral system that connects the hospital with community health centers, sub-centers and municipal midwives. This referral system facilitates immediate respond for any medical emergencies. I has successfully increase the timeliness of our respond towards emergency maternities. c.Providing call center: this step opens broader access for the society communicate with our staffs. It eliminates the need for complicated bureaucratic procedure thus increasing the quality of our responds. d.Constructing new Standard Operating Procedures: the SOP dictates the formation of several teams (red, green, yellow) to respond different level of medical emergency. It also regulates the execution of kangaroo care for infants. e.The improvement of hospital’s infrastructures: this step is part of our business and strategic planning and allocated in our annual budget. It comprises the construction of new perinatology ward, new medical equipment and other infrastructure to fulfill the service standard. This strategy accelerates the improvement of our service to the public as adequate rooms and facilities means more flexibility in delivering services. f.Improving the competence and skills of the human resources: Perinatology Unit of Lasinrang Public Hospital has a cooperation program with USAID in providing trainings and workshops for all administration and medical staffs.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Perinatology Unit of Lasinrang Public Hospital provides medical care for neonatals (0-28 days) with high medical risks. It is innovative in at least four different aspects: a.Online referral system as a product of our cooperation with USAID: this system is superior to conventional system because it integrates the services given by other medical center across Pinrang Regency. It helps the identification of maternity patients with high risk thus allowing better preparation when the patients and their infants are referred to Lasinrang Hospital. b.The improvement public’s accessibility: our call center provides various information such as medical advice and infant status information, thus helping the society in obtaining immediate and proper health care. c.Free transportation for patients from poor family. d.The existence of public complaints and reporting center through complaint box, text message of phone calls.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The Director Lasinrang Public Hospital, Management Board and all staffs who continuously develop new methods of service betterment. The impact of this innovation can be felt especially by the public Pinrang districts with a total population of approximately 360,000 inhabitants
 6. How was the strategy implemented and what resources were mobilized?
Our Perinatology Unit is an effort to optimize the care for neonatals. The forms of its development are 1) online referral system; 2) service information access; 3) special service methods; and 4) ease of service administration. It is aimed at increasing public’s access to perinatology services, especially for infants with high risks. The referral system prioritizes the management of information regarding maternity patients who will be potentially referred to our unit, i.e. patients with high medical risks. It opens intensive communication between care givers across Pinrang so that immediate actions can be taken with proper preparations. With this system, information such as patient social information, list of diagnosis and action already taken by care givers can be obtained in due time. Online referral system provides clear instructions for medical staffs and midwives on the proper steps to be taken. To ease the public’s access towards the information that we have, our unit provides a call center special for mobile phones. This information access is a channel for the society to get direct reference, service information, medical consultation, and the status of infants being cared in Perinatology Unit. Another type of care that we provide is kangaroo care for infants with low body weight. It benefits the infant because during the procedure its body temperature is maintained by a direct contact with its mother. This type of infant care helps increase its body weight, and accelerate its recovery and creates bonds with its mother. The procedure is only taken if the parents are willing and in healthy condition. Our unit forms special teams to respond to different types of medical emergencies. Red team attends infants with breathing problems and takes actions such as oxygen therapy or if needed positive pressure ventilation. Yellow team is responsible for the preparation of emergency trolley, prepares fluid infusion and other medications as instructed by the physician, monitors blood circulation and assists in CPRs. Green team controls oxygen supply, emergency trolley and suction, assists in patient’s fixation, contacts the physician, documents every medical actions taken, administers medicine intakes and delivers samples to laboratory.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The stakeholders are as follows: a.Pinrang Regent who authorized budget allocation for the formation of the unit. The Regent is committed to provide high quality service for its people and regulates that poor patients will receive free medication in Lasinrang Public Hospital. b.The Health Affairs Agency of Pinrang Regency as the coordinating body in the public’s health care service provided by both state and private sectors. c.NGOs especially Madani Society Forum that monitor and evaluate our performance in delivering public service. d.USAID that assists the management in training and assessment programs for the development of our human resources e.Ministry of Health Affairs of Indonesia

 8. What were the most successful outputs and why was the initiative effective?
Since 2012, infants mortality rate has been reduced significantly. From 11.5% to 5.1% (46 out of 935) in 2013 and 3,75% (53 out of 1.411) in 2014, 3,86% in 2015 (46 out of 1.189), 3,97% in 2016 (38 out of 956). The details are: a.Immediate actions can be taken thanks to online referral system and information obtained from (and given by) our call center. b.The improvements of staff’s commitment and motivation thanks to simpler mechanism of patient’s referral system. c.Reducing the cases where patients are transferred in an already critical conditions or if it’s critical, preparations can be made to accommodate immediate actions. d.Ease of communications between hospital’s staffs, medical personnel outside the hospital i.e. community health centers and midwives, and between the hospital and the public. It has directly improve the speed of our responds toward various emergency situations and thus reducing infants mortality rate. e.Eliminating financial barriers for maternity patients who come from poor family because our hospital provides free medications for them.

 9. What were the main obstacles encountered and how were they overcome?
The obstacles encountered are as follows: a.The need to procure high-tech equipment due to the uniqueness of medical cases and need in perinatology. b.Social taboo on separating infants and their mother after birth The solutions taken are: a.Improving the allocation of Regency and National budget for the hospitals as well as optimizing the increasing independency of Lasinrang Hospital in managing its own fund. b.Personal approaches in providing information for the family before, during and after hospitalization.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
a.From infants mortality rate perspective, the publics are benefited through: 1)reducing neonatal mortality rate 2)broadening the scope of service on neonatal with risks 3)increasing coordination between medical centers b.The impacts on public’s access towards health care services: The increase in the number and quality of infrastructures also increases public’s confidence in our unit: 1) 2010 - 376 Patients 2) 2011 - 458 Patients 3) 2012 - 522 Patients 4) 2013 - 935 Patients 5) 2014 - 1.013 Patients 6) 2015 - 1.189 Patients 7) 2016 - 956 Patients Ease of access for Pinrang people to care for their neonatal in their own region. In some instances, our unit even handles patients from outside Pinrang Regency. Patients referred to the Perinatology Unit of Lasinrang Hospital are increasing each year: 1) 33 referrals out of 458 patients in 2011 (6%) 2) 36 referrals out of 522 patients in 2012 (7%) 3) 153 referrals out of 935 patients in 2013 (16%)

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
This innovation encourages active participation of communities through the assessment of the quality and the quality of service is supported through interaction facilities either directly or through the media that has been provided either manually or electronically. accountability ratings that society can be measured through satisfaction surveys and public complaints. a.Public satisfaction index is increasing: 1) 69.52 (Good) in First Semester of 2013 2) 72.56 (Good) in Second Semester of 2013 3) 74.68 (Good) in First Semester 2013 b.Public participation as the result of public complaints and reports center: 1) 25, 50 and 6 reports through text message/phone, complaints box and report counter respectively in 2013 (a total of 81 reports) 2) 22, 7 and 1 reports through text message/phone, complaints box and report counter respectively in 2014 (a total of 30 reports)

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Especially against neonatal intensive care is a service with high costs. This high cost is a major obstacle faced by people, particularly the poor and vulnerable. but with the involvement of all parties improve service processes in an integrated manner, the whole society is no longer concerned to ensure that they see themselves able to receive the service without charge is plagued with problems. for the general public they are covered by national insurance BPJS, while vulnerable people who have not been covered in the insurance in the form of local government to provide facilities Description Disadvantaged.

Contact Information

Institution Name:   lasinrang general hospital
Institution Type:   Local Government  
Contact Person:   Suryadi Suryadi
Title:   Internal Auditor Lasinrang Hospital  
Telephone/ Fax:   +62421921298
Institution's / Project's Website:  
Address:   Macan street 22
Postal Code:   912-12
City:   Pinrang
State/Province:   South Sulawesi

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