PRIVATE SECTOR HEALTH CARE IN INDONESIA - Health Systems ...

The Provincial Health Office meets with the hospital group every three months. Muhammadiyahsuggested to the City Health Office in Bandung that there should be more collaboration with privatesector health providers and they should be involved in all the various training programs. They believe thatat least 25 percent of training slots should be reserved for private sector participants.One example of private-public partnership is between midwives and traditional birth attendants. InCianjur, there are 348 villages and 17 of these have no midwife. Twenty five villages have midwives butthese midwives are not residents of these villages. The District Health Office encouraged partnershipbetween the traditional birth attendants and the midwives. There are 2,000 traditional birth attendants inCianjur. In 2007, there were 85 maternal deaths and 84 of these were handled by traditional birthattendants. In 2008, 42 percent of deliveries were handled by traditional birth attendants. Currently, thereis a partnership between a midwife and traditional birth attendants whereby all deliveries are referred tomidwives. Traditional birth attendants handle the post-partum care and care of the infant. Rp 50-100,000is paid to the traditional birth attendant and the midwife is paid Rp 200-250,000. There are threeobstetrician/gynecologists in Cianjur, one of whom is retired.An example of an unsuccessful public-private partnership is in the area of TB. Two years ago, the CityHealth Office in Bandung initiated and conducted a DOTS Training involving 50 pharmacistsrepresenting ISFI, the hospital, industrial, community pharmacies. It was, in reality, only a seminar whereattendees were expected to cascade the learning to their constituents. The expected outcome was forpharmacists to identify TB symptomatics and refer them to the Puskesmas for proper diagnosis andtreatment, if found to be a TB case. However, the intervention was not successful and this was attributedto the following reasons:• Lack of follow-through on the part of the City Health Office in Bandung in terms of monitoringand evaluation;• The need to have involved the drugstore owners (GP Farmasi Group) to ensure buy-in;• Lack of follow-through on the part of ISFI to ensure dissemination and implementation of theintervention to its constituents and colleagues in the pharmacy – the assistant pharmacist andstore clerks;• No integration of the pharmacy sector with the DOTS system and lack of links to other players(e.g. physicians). There was no formal system for referral, nor a feedback system.Recently, there has been renewed interest in public-private partnerships for TB. The Provincial HealthOffice has had discussions with Muhammadiyah about involving them in their TB Program.Muhammadiyah has submitted a request to the City Health Office in Bandung to be part of the TB DOTSProgram. After having submitted statistics required by the District Health Office, Muhammadiyah is nowpart of the DOTS system and receives free TB drugs. However, the hospital’s pharmacy said the supplyof TB drugs from the District Health Office was insufficient. They only provided drugs for the poor, butthey were supposed to provide drugs for all confirmed cases. There have been stock-out problems leadingto patients not coming back for their treatment.78