Poor people need more access to health services

JAKARTA (JP): The Group of Women Against Violence (Gabungan Perempuan Anti Kekerasan) demanded yesterday that information on low cost, quality health services be more accessible to the poor.

They also urged yesterday that the government and hospitals be more sensitive to people's shame of admitting to be poor and the fear of poor quality service if they do.

"The inadequate information for consumers, especially about health services provided by hospitals to the poor, lead to them becoming health care consumers without any bargaining power," read the group's statement. The group is comprised of 17 non- governmental organizations.

Nine representatives of the group placed posters around the main entrance of the state-owned Cipto Mangunkusumo General Hospital (RSCM) in Central Jakarta, before meeting with the hospital management yesterday.

Patients going in and out of the entrance crowded around the posters, including the largest which cited a clause from the 1992 Health Law: "Each citizen has an equal right to acquire the highest standard of health."

The group's protest was triggered by the case of a Tanjung Priok resident who came to the hospital to pick up her baby on Sept. 19, only to find the baby had died on Feb. 24.

The baby had been taken by his father, a newspaper vendor, to RSCM shortly after a midwife delivered it on Feb. 10. The midwife said the baby had no rectum.

The mother, Suni, told reporters she came after receiving a notice from the hospital on Aug. 8 that they owed Rp 317,500 (US$139.56).

Suni said they didn't get notification of their child's death. The management, who insisted they could not locate her address to convey the news, could not explain why she received the bill but not the death notification.

Suni's husband was quoted by the Kompas daily as saying that since taking the baby to RSCM in February, they were scared to visit their baby because he had been informed treatment cost Rp 50,000 a day.

Suni then got an official note stating he was poor. The note is required to obtain free or low cost health services.

The hospital's Deputy Director for Medical Services, Hermansyur Kartowisastro, said the management regrets that the family did not inquire about free or low cost services.

"People can ask the doctors, the nurses, the administrative staff... but somebody has got to ask," said Hermansyur.

He also explained that the management and staff had gone through all mandatory procedures in the absence of a patient's family.

"If we put up signs on the procedures (to gain low cost or free services) people would be more ashamed to ask," he said.

Tati Krisnawaty of the Solidaritas Perempuan Association, urged that hospitals must be more active in educating the poor about access to low-cost or free services.

"The poor may either be ashamed to admit being poor, or they may fear low quality service and discrimination if hospital staff know they are poor," Krisnawaty said, citing a number of cases.

The women's group also demanded lower medical costs and higher subsidies for state-owned hospitals to serve the poor. They said money spent on unnecessary and expensive medication could be better put toward subsidizing the poor. They also protested the "explicit and implicit forms of commercialization of health services."

The Director General of Medical Services at the Ministry of Health, whom they met later, said efforts at providing services for the poor are constrained by the ministry's Rp 946.3 billion budget. Health care is only allotted 2.5 percent of the state budget.

Hospitals, he said, must undertake their social function "but must also be managed economically". (anr)