Many in dark over right to healthcare under bylaw

Many in dark over right to healthcare under bylaw

Muninggar Sri Saraswati, The Jakarta Post, Jakarta

Many patients at public health centers in the city are unaware
that they are entitled to receive basic medical treatment,
including medicine, for only Rp 2,000 (about 19 US cents),
according to Article 8 of City Bylaw No. 3/1999.

"I didn't know anything about it. I usually pay Rp 7,000 per
visit," said Turmina, who was seeing a doctor at a health center
in Petamburan, Central Jakarta.

Turmina, whose husband is a street vendor in the nearby Tanah
Abang market, and her family prefer to use the public health
center because of the affordable fees.

"It would be better if the center only charged us Rp 2,000 per
visit, including medicine, as stated in the bylaw," she said,
adding that she always paid additional fees for medicine.

According to data, many centers in the city charge patients
more than Rp 2,000 just for the administrative fees, which
excludes medical treatment and medicine. Some people pay up to Rp
15,000, or 750 percent higher than the official fee, each time
they visit a center.

The public health centers say they have to charge people more
to cover their operating costs.

However, each center in the city receives monthly operational
funds of at least Rp 5 million from the City Health Agency. They
amount received depends on the size of the center, the number of
patients seen each month and the types of illnesses the center
treats. Each center also receives a supply of subsidized generic
medicine.

Dr. Susy, who works at a public health center in Central
Jakarta, said most centers in the city had not been obeying the
bylaw for the past two years.

"So far, we haven't had any complaints from our patients or
the agency," said the doctor, who asked that the precise location
of her center not be given.

"Most of the money paid by patients is used to pay the
salaries of several part-time workers here, whose monthly
salaries are below the provincial minimum wage."

The part-time workers -- from janitors to administration staff
-- receive monthly salaries of between Rp 150,000 and Rp 500,000.
The minimum wage in Jakarta is Rp 590,000.

Doctors at the centers, who are classified as public servants,
receive a monthly salary of about Rp 1.5 million from the
government.

The health center where Susy works makes between Rp 2.5 and Rp
4 million each month from about 300 patients. This money is used
to pay the salaries of five employees and to maintain the
center's building.

Responding to reports that many health centers were in
violation of the bylaw, Dr. Marius Widjajarta of the Indonesian
Health Consumer Empowerment Foundation said the agency had failed
to enforce the bylaw.

Marius, who at one time worked at public health center in East
Java, said he believed the centers would be able to cover their
operating costs by charging patients Rp 2,000 per visit, as the
centers received funding and medicine from the government.

A reliable source at the agency confirmed that many public
health centers were in violation of the bylaw.

"We (the agency) expect the health centers will be able to
finance themselves in the future. We can tolerate (the violation
of the bylaw) because we believe the public can still afford the
fees," the source said.

Given the situation at the centers, it seems unlikely that the
government will be able to realize plans to have public health
centers provide medical treatment free of charge. The government
has said it hopes to implement this policy in 2006.