Problems in government response to bird flu outbreak

Problems in government response to bird flu outbreak

While the central government's moves in dealing with the first
human deaths from avian influenza (bird flu) won appreciation
from many, including the World Health Organization (WHO), many
have expressed concern over the way that local governments are
dealing with the matter. The Jakarta Post's Sri Wahyuni talked to
public health observer Mubasysyir Hasanbasri, who is also
director of Gadjah Mada University's Health Policy and Service
Management Program about the issue. The following is an excerpt
from the interview.

Question: How do you see the bird flu issue?

Answer: The government's response is okay, especially the
Minister of Health's quick move in placing herself as the
spokesperson in the case. In fact, in this era of
decentralization, the (head of the) local health office should
(be the spokesperson). Yet it shows she considers the case as a
kind of national crisis, which is good.

What is concerning is the way the local governments are
responding. However, it is understandable because when dealing
with such cases it is indeed the central government that have the
resources. Local governments mostly lack such resources. Even in
the U.S. it is usually the federal communicable disease control
body in Atlanta that takes over whenever an infectious disease
outbreak occurs.

Another concerning thing is our dependence on the
international community, especially in dealing with virology
tests. It would be much better if (the government's) good
response was also supported with good laboratory infrastructure.
But again, this is also understandable especially because it
deals with a new disease.

What is the implication of such a situation?

It slows down the policymaking process. Just to clarify
whether the deaths were due to bird flu, for example, we have to
await the results of tests from abroad.

In the case of bird flu, a veterinary laboratory is essential.
Unfortunately most veterinarians here are not paying strong
attention to the matter. There seems to be no cooperation between
the health office and the veterinary office.

I get the impression here that everything is directly taken to
the WHO for consultation. It seems that there is no institution
here that is prepared for such a situation. Our scientists, too,
do not seem to have the eagerness to do such examination (for the
virus) here. It is as if they want to let other people take care
of it. The supposedly centers of excellence here are weak. Even
tertiary education institutions do not seem to be organized to
have a center of excellence in this particular field.

What is the reason behind the problem?

Among others, is the limited budget for the development of
relatively expensive infrastructure as well as the slow pace in
the development of advanced research and technology in this
particular field. These are mostly because the development of
infrastructure so far has been more project-oriented. We never
plan seriously.

It needs an extraordinary political commitment to speed up our
health sector, especially regarding the investigation of
infectious diseases. Indonesia is very weak in terms of emergency
preparedness. We need to improve its management. The last two
years have been promising, in which the government has placed
doctors in particular hospitals to deal with emergency
situations. Yet, not all hospitals enjoy such a program.

Further, the role of related government institutions is often
confusing. When anthrax broke out several months ago in
Yogyakarta, the local veterinary office, which was supposed to be
in charge of the outbreak, did not have the data but the health
office did. The lack of policymakers who really care about such
cases also accounts for the slow response from the bureaucrats.

That's why it was a surprise to learn how the present
government was very quick in deciding to disburse funds to
finance the bird flu case that some, including local governments,
might consider as an overreaction.

What about the culling of the animals suspected of infection?

Ideally, such culling has to be done to all animals without
exception. However, in a country like Indonesia, where we deal
with poor farmers, it's impossible to do so. The government does
not have the funds to pay compensation. So (the policy) is the
trade-off between public health and economic interests. We just
cannot require all farmers to kill their poultry.

This is what makes us different from developed countries that
have huge amounts of emergency funds, meaning that a total cull
of animals (identified as carriers of the virus) can be done
without difficulty.

What can we do with all the limitations we have in dealing
with possible future outbreaks of infectious diseases?

What we have to develop is the management aspects, the way we
make decisions. To realize this, good gatekeepers are needed. In
this case, the press has been acting as a very good gatekeeper.
It is the press that has caught the information in the first
place and conveyed it to the public, so that the government can
also act properly.