Maximizing Mobile Technology to Strengthen Referral Systems for MNH Emergencies in Indonesia

Presenter: Yayuk Sri Rahayu, Expanding Maternal and Neonatal Survival

Background: Karawang is a district with 2.2 million population. In 2012, there were 55 maternal deaths, increasing to 64 in 2013. Factors such as uncertainty of referral destination, lack of hospitals preparedness, and poor communication cause delays in providing adequate MNH emergency care.

Methodology: The District Health Office established the Emergency MNH Call Center as the first line of contact for midwives referring MNH complications to hospitals. The call center runs 24/7 and is operated by 8 trained midwives. The call center uses short code 119 and can be called from any phone free of charge. During an MNH emergency, the midwife dials 119 and is immediately connected to the operators. After validating the midwife data, the operators ask standard questions such as patient data, complication, diagnosis, and pre-treatment. Operators input data into the computer-based referral exchange system called SijariEMAS. Through SijariEMAS, the patient information will be automatically routed to the most appropriate referral hospital in the network, and the hospital will respond. If a hospital does not respond promptly then the operators will manually contact the hospital by phone. Through SijariEMAS, the health center midwife will receive SMS notification on where to refer and what treatment to provide before/during referral. Call center also monitors and ensures all referrals are accepted and processed timely by hospitals. The district government fully funds the call center.

Results: Emergency MNH Call Center is a premier innovation of Karawang District. It has being used by more 1200 health providers and linked over 50 health centers and 20 hospitals in Karawang. It has facilitated over 5000 referrals since September 2013. In 2014, maternal deaths declined by 10%.

Conclusions: The Karawang MNH Call Center demonstrates that strong commitment and ownership from local government can lead to effective and sustainable mobile technology innovations.