Strengthening maternal referral systems during public health emergencies: insights from Indonesia’s COVID-19 response
Dublin Core
Title
Strengthening maternal referral systems during public health emergencies: insights from Indonesia’s COVID-19 response
Subject
COVID-19, emergency management, hospital readiness, indonesia, maternal health
Description
Introduction: Despite the World Health Organization (WHO) declaring the end of the Coronavirus Disease (COVID-19)
Public Health Emergency of International Concern (PHEIC) in May 2023, the pandemic highlighted critical gaps in
hospital emergency preparedness, particularly in maternal healthcare. East Java, Indonesia, was among the most
severely affected provinces, reporting an 11.02% increase in maternal deaths. 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.
Public Health Emergency of International Concern (PHEIC) in May 2023, the pandemic highlighted critical gaps in
hospital emergency preparedness, particularly in maternal healthcare. East Java, Indonesia, was among the most
severely affected provinces, reporting an 11.02% increase in maternal deaths. 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.
Creator
Muhammad Ardian Cahya Laksana1,2,3
, Nyoman Anita Damayanti3,4* , Pandu Hanindito
Habibie2
, Mochammad Hud Suhargono5
, Erni Rosita Dewi6
, Budi Santoso2
, Waritsyah
Sukarjiyah7
, Alifina Izza2,6
, and Nurani Zulfa Zakiya6
, Nyoman Anita Damayanti3,4* , Pandu Hanindito
Habibie2
, Mochammad Hud Suhargono5
, Erni Rosita Dewi6
, Budi Santoso2
, Waritsyah
Sukarjiyah7
, Alifina Izza2,6
, and Nurani Zulfa Zakiya6
Source
http://dx.doi.org/10.20473/jn.v20i2.70589
Date
21 May 2025
Contributor
peri irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Muhammad Ardian Cahya Laksana1,2,3
, Nyoman Anita Damayanti3,4* , Pandu Hanindito
Habibie2
, Mochammad Hud Suhargono5
, Erni Rosita Dewi6
, Budi Santoso2
, Waritsyah
Sukarjiyah7
, Alifina Izza2,6
, and Nurani Zulfa Zakiya6, “Strengthening maternal referral systems during public health emergencies: insights from Indonesia’s COVID-19 response,” Repository Horizon University Indonesia, accessed February 21, 2026, https://repository.horizon.ac.id/items/show/11124.