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

clients to Dinkes. The private providers only reported activities related to drugs or funding they receivedfrom the local government.The consistency of reporting depends on the type of private provider. A discussion with private practicemidwives found that all were reporting information on services provided to both the peskesmas and to theIBI district chapter. They all used a standard form for reporting, and as a rule, there are few lapses inreporting. However, it is not clear whether Sudinkes uses this information for planning or decisionmaking. The midwives report that they never receive any feedback related to these reports. The teamalso visited a private practice midwife and small group practice of General Physicians. The midwifestated that she was seeing less than 10 clients per month for contraceptive injection, but her license hadexpired and she was not reporting to Sudinkes. The doctor who was interviewed in a small group practicedid not know whether service reports were sent to Sudinkes.At present pharmacies do not undertake any reporting for most medicines and are only required to providereports for narcotics and psychotropic preparations which few shops handle.3.6 Dinkes experience with PUBLIC-PRIVATE PARTNERSHIPSDinkes (?) has a program supported by the GFATM and USAID to conduct DOTS treatment, whichincludes private doctors, but very few doctors participate in this scheme. The doctors are also required toprovide reports to Dinkes, if they participated. Further, this program is closing down as they are nolonger receiving TB medicine and funding from GFATM. Although there were programs in the past toprovide TB medications, vaccines, and contraceptives through private providers, they are no longeroperating.St Carolus Hospital, a not for profit Catholic hospital, has been active in TB control and treatment for 26years. Its activities include training for community members in DOTS, distribution of treatment kits, andpublic health promotion. It treatment success rate is over 90 percent. If there is a shortage of drugs, thehospital procures from its own funds. St Carolus also provides public health services includingimmunization, and school-based health programs through its health center, with little support fromgovernment, except for medicines. Depkes had also provided rice to supplement the nutrition of lowincome patients, but that program has also ended.The not-for-profit hospitals we visited believed it is unfair for the government to treat not-for-profithospitals the same as for-profit hospitals, particularly with regard to tax treatment and utilities rates.These hospitals believed they have contributed to public health, and provide a high proportion of theirservices for low-income clients which should be government responsibility, often with limitedgovernment support.What can be done to rationalize the use of medications, as part of anintegrated provider quality improvement approach?3.7 Sources of medications for private providersBy far the main source of medicines for private hospitals is through national pharmaceutical distributors.Most hospitals report using six to eight main distributors and report the ready availability of all medicinesrequired. Private hospitals report that they can obtain significant price discounts from the distributerswith a general 10 percent reduction on brand name medicines and 30 percent reduction on genericmedicines, and under ASKES schemes a general 20 percent discount from the distributers. Privatehospitals reported using a combination of generic and brand name products, but at the pharmacy sections101