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An evaluation of the referral systems at community health centres in remote, border and island regions of Indonesia: a research protocol

Year: 2025

Type: article

Abstract: INTRODUCTION: Indonesia comprises 16,771 islands, including 111 small islands and atolls. The Indonesian government has established community health centres, known as puskesmas in Indonesian, to provide health services to the entire populations of the country, including those in remote areas. In 2014, the Indonesian government introduced a national health insurance system with the goal of providing equitable access to health care for all citizens. However, not all health issues can be managed by these community health centres, necessitating a referral system to more advanced healthcare facilities. This study aims to evaluate the implementation of the referral system by community health centres in small island areas, with a view to addressing a research gap on this topic. METHODS: This implementation research explores the challenges associated with the referral system using the intervention mapping approach. This approach involves six stages: (1) needs assessment, (2) change matrix development, (3) devising strategies to optimise referrals based on practical theories, (4) program preparation, (5) adoption and implementation planning, and (6) evaluation planning. The target population will comprise patients, healthcare workers at community health centres and various other stakeholders. The study is to be conducted on three small islands in Sangihe Islands Regency, North Sulawesi Province: Nusa Tabukan, Marore and Kahakitang. RESULTS: The evaluation of the referral program addresses the gap in the implementation of referrals from community health centres on small islands, providing valuable information for the government and policymakers regarding healthcare delivery in hard-to-reach and remote areas. CONCLUSION: The study's results are expected to offer valuable insights into systematic research processes and provide recommendations for interventions designed to improve the referral system from community health centres to regional hospitals.

Source: Rural and Remote Health

DOI: 10.22605/rrh9763

Authors: Welembuntu, Kristanti, Mahendradhata

Institutions: Universitas Gadjah Mada, Politeknik Negeri Nusa Utara

Language: English

Topic: Healthcare Systems and Technology

Subfield: Organizational Behavior and Human Resource Management

Field: Business, Management and Accounting

Domain: Social Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: diamond

Funder: Universitas Gadjah Mada