Susilo's new government must focus on grassroots health
Susilo's new government must focus on grassroots health
Hananto Wiryo, Mataram, West Nusa Tenggara
The Cabinet of president-elect Susilo Bambang Yudhoyono must
ensure that in designing its health programs focuses on servicing
and reaching grassroots by truly optimizing existing health
infrastructures, improving affordability and awareness of health
services, and also eliminating malpractice.
In order to optimize and maximize health services, there needs
to be an improvement in the quality of health centers, from the
simplest level up to the hospital level.
While new infrastructures are important, the upcoming health
minister must be someone who truly understands and is capable of
optimizing the supply and distribution of medicines to the
Puskesmas, or local health centers.
The availability of basic health service through health
centers is urgent, especially in rural areas. Remote areas should
not be abandoned and only be reached through mobile health
services.
Aside from improving health infrastructure, the discipline and
dedication of health personnel must be improved as well. There is
an urgent need, and should receive priority within the first 100-
days of Susilo's administration.
Another point that needs to be solved immediately is to
improve the affordability of health services. The cost of health
care should be trimmed down further to utilize the health
insurance network. This system would allow health services be
provided to all segments of society. Such things as the
intensification of the service quality of PT Askes -- the
national health insurance program -- as well as establishing a
community insurance scheme are things that should be looked at in
the immediate future.
Additional funds acquired by the government from cuts in fuel
subsidies, for example, goods channeled toward the urgent health
service needs of the country. But, in order to do this, the
government must first ensure that it has created a transparent
system in the use and allocation of these funds.
If necessary, and if possible, through this money, community
health insurance for the poor should be free of charge by clearly
identifying criteria of poverty.
Another issue often overlooked, yet a potential problem in
Indonesia, is the growing concern over the number of malpractice
cases. It is an issue that has rarely been touched in the past,
and all but neglected by past governments. Unfortunately, there
is a tendency to keep things quiet especially if the victims are
poor. This only causes the incidence of malpractice to go from
bad to worse.
To reduce costs and the incidence of malpractice, a better
regulatory framework should be put in place by making regulations
on the matter clear. The health minister should set an example by
asserting a strict health code and direct hospitals and community
health centers to set up Protap, or Standard Service and
Management Procedures. The Protap could be both national and
local levels established by respective health centers and
hospitals.
For example, if a patient is diagnosed with typhus, it is
common practice for doctors to prescribe ampicillin (generic
antibiotics) and chloramphenicol. In fact, it is also common
knowledge among medical personnel that in most cases,
chloramphenicol, is sufficient.
The additional prescription of ampicillin is often due to
urging and sponsorship of pharmaceutical companies. The setting
of a Standard Service Procedure could help prevent such residual
prescriptions.
The aim of having Standard Service and Management Procedures
is to reduce the risk of malpractice. It will help cover the
rational limit of prescriptions given by a medical doctor. It
should also include coverage of surgical procedures that are
clearly needed. This is to prevent occurrences, such as a general
anesthesia for such a simple surgical process for someone who has
a five-centimeter elbow wound.
If there is a general standard procedure, we can easily pursue
who is responsible for making such decisions. It is, thus
desirable that every health service institution should have and
apply Protap.
These standard procedures do not have to be complicated and
the new health minister should be able to instruct local
officials to draft them individually or collectively. If there is
a hospital director who is unable to draft such procedures, then
the simple fact is that he or she is not fit to run a hospital.
The writer is head of pediatrics at Mataram General Hospital.
Apart from being a lecturer at Mataram and Udayana Universities,
he also serves as an expert staff on health affairs for the
governor of West Nusa Tenggara, and is a member of the Democratic
Party.