Ailing 'Puskesmas' need treatment before they can curb outbreaks

Ailing 'Puskesmas' need treatment before they can curb outbreaks

The Jakarta Post, Jakarta

Prevention is better than cure, according to the popular axiom.

The government, however, seems to believe the opposite as the
Ministry of Health is allocating just 11 percent of its budget to
community health centers (puskesmas), while giving three times
that amount to hospitals.

Recent outbreaks of old diseases -- polio, dengue fever and
malnutrition -- have been blamed in part on the erosion of
puskesmas as the vanguard of community health care, due to a lack
of funds following decentralization.

Minister of Health Siti Fadilah Supari, speaking about the
polio outbreak and malnutrition cases, said many local
administrations failed to provide the necessary money to keep the
community health centers functioning healthily.

The central government appears to be following suit,
allocating only Rp 342 billion earlier this year to assist the
puskesmas, while setting aside Rp 901.7 billion for hospitals,
which mainly play a curative role.

In the revised 2005 state budget, Rp 698.9 billion is set
aside for puskesmas and Rp 3.256 trillion is earmarked for
hospitals.

This same pattern is being followed in the allocating of the
Rp 3.7 trillion health fund for the poor from the fuel subsidy
cut. Only Rp 1.08 trillion of this money is being allocated for
public health services at puskesmas, with the rest going to
hospitals. This despite the fact that in most villages across
Indonesia, distance is a serious barrier for people to get
treatment at a hospital.

"We strongly urge the ministry to put the priority in its
budget on taking preventive measures at the puskesmas level,
instead of on curative measures (through hospitals)," House of
Representatives Commission IX's health task force head, Mariani
Akib Baramuli, said on Tuesday.

Last year, House Commission VII, which also oversees health,
put preventive and educational measures at the top of its list of
recommendations to the health ministry.

Puskesmas, a concept developed decades ago, emphasize
preventive and educational measures. While hospitals are
responsible only for their patients, puskesmas are meant to
actively monitor health conditions in their respective areas,
which average more than 10,000 people.

Besides serving as health centers, puskesmas also help to
assure local development efforts encourage the populace to
maintain a healthy environment, or at least to maintain
conditions so they do not have a negative effect on the health of
the local community.

Currently, however, due to insufficient operational funds, the
7,277 puskesmas nationwide are not playing a preventive role.

Health centers in most regions, except for Jakarta, have to
pay money to local administrations, instead of receiving
assistance funds from them.

A community health center head in West Java confirmed recently
that the local administration, for which he works, demanded a
yearly fee of Rp 69 million from the center. Only about 30
percent of this money is returned to the health center, which is
barely enough to cover its operational costs.

The health center in question, located only a 30-minute drive
from Jakarta, is forced to branch out to make extra money,
including opening a telephone kiosk next to its building.

Puskesmas in remote areas face more problems than a lack of
funds. "There are not enough doctors and medical workers willing
to work at remote puskesmas," the health ministry's director
general of community health, Azrul Azwar, told The Jakarta Post
recently.

He said that because the government no longer made it
compulsory for new doctors to serve in puskesmas, the number of
volunteer doctors from Indonesia's 48 medical schools had
steadily declined from an estimated 3,500 annually.

"As a result only 40 percent of puskesmas in the country are
led by doctors. The rest are led by mantri (male nurses) or
worse, district officers," Azrul said.

He suggested that incentives be given to young doctors to
serve at puskesmas. In addition, the budget priorities of both
the central government and local administrations is necessary.

Unless these measures are taken, many doubt the government's
ability to create a "healthy Indonesia" by 2010.

If the puskesmas function as originally intended, fewer
burdens would be placed on hospitals.

And why cure if you can prevent?