Referral exchange system: Facing challenges in use of technology to improve referral efficiency and quality

As the biggest archipelagos developed middle income country, Indonesia facing challenges to put the most appropriate quality national referral system in place. At provinces level, it have existing foundations for safe and efficient emergency obstetric and neonatal care services and referrals: primary, secondary, and tertiary care facilities exist, trained health providers are in place, supportive policies are in place, and many districts have sufficient financial resources available to ensure efficient referrals. Yet, throughout the provinces, quality of emergency obstetric and neonatal care services is poor, and few referral systems function optimally, resulting in far too many maternal and newborn death.

EMAS-Expanding Maternal and Neonatal Survival, a five year USAID funding project in Indonesia (2011-2016) introducing the referral exchange serves as a mechanism to improve efficiency within the referral system. This innovative SMS-based “Referral Exchange” was developed as a more efficient mechanism for identification of the appropriate referral destination, referral notification, referral acknowledgement and referral disposition. The platform for the referral exchange will also enable community health center staff to receive phone advice, if needed, from the hospital staff prior to sending the patient to the hospital. The Referral Exchange will only be as effective as the referral system itself. Its success is entirely dependent on the success of the other EMAS approaches aimed at improving quality of emergency obstetric and neonatal care services, increasing coordination amongst facilities, integrating private sector facilities, increasing accountability, and minimizing financial barriers. In the first three months of introduction in Cirebon district, the use of referral exchange information system is gradually increase, from 151 cases in November 2012, to 288 in December and 193 in January (per January 14, 2013). All those 632 referral cases were successfully safely delivered and resulting healthy mother and baby.