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

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• Pharmacists and drugsellers – Approximately half of all Indonesians self-medicate withproducts purchased through pharmacists, drugsellers, and other retail outlets. These actorscan play an important role in rationalizing drug use, and providing referrals to health facilities.• Physicians (GPs) – It is estimated that 80 percent of all GPs, including those employed by thegovernment, also have private practices. They have been underutilized as partners inimproving MCH services, and controlling infectious diseases.14
4. METHODOLOGYThe in-country work was designed to answer the priority questions agreed upon with USAID/Indonesia:• How can services provided at private facilities be better integrated into the Dinkes monitoringand supervision system to ensure quality services?• How can financial incentives (such as performance-based payments, payment mechanisms) beused to improve access to services or quality of services among private providers (i.e.,midwives, GPs, Aisyiyah, etc.)?• What can be done to rationalize the use of medications, as part of an integrated providerquality improvement approach?• Can pharmacists and drugsellers be good partners for improving health services andrationalizing drug use?• What role can professional associations play in monitoring and improving quality of careamong private providers?4.1 DISTRICT SELECTIONThe following criteria were considered in district selection:• Existence of long-standing Bidan Delima program (network of high quality midwives);• Existence of district financing scheme (district commitment to health for the poor);• Existence of Muhammadiyah health facilities (network of non-governmental facilities); and• Experience in the district under USAID’s <strong>Health</strong> Services Program (HSP) project (availability ofpre-assessment data).These characteristics would allow more concrete options for improving quality by working with strongprovider networks, and using financial incentives to improve and ensure provider quality. Using thesecharacteristics, we also aimed to select four districts that were representative of different types ofdistricts in Indonesia. With input from USAID/Indonesia to focus on high population density urban andperi-urban areas, the four districts selected for field work were:• West Jakarta – very large urban district;• Kabupaten Bandung – peri-urban district;• Daerah Istimewa Yogyakarta (DIY) – smaller urban district; and• Cianjur – rural district.Findings from each of these districts are integrated into this consolidated report.15
Page 1: PRIVATE SECTOR HEALTHCARE IN INDONE
Page 5: PRIVATE SECTOR HEALTH CAREIN INDONE
Page 8 and 9: 7. Rationalizing Use of Medications
Page 11 and 12: ABBREVIATIONSANCAskesAskeskinAusAID
Page 13: THEUSAIDVATWHOTotal health expendit
Page 17 and 18: EXECUTIVE SUMMARYAs documented in I
Page 19 and 20: By using their power to select whic
Page 21: higher reimbursement for complex de
Page 25 and 26: 2. BACKGROUND2.1 GENERAL BACKGROUND
Page 27 and 28: While decentralization of the healt
Page 29: FIGURE 1: TOTAL EXPENDITURES ON HEA
Page 32 and 33: poor, which only allows use of publ
Page 34 and 35: Lack of overall investment in healt
Page 38 and 39: 4.2 ASSESSMENT APPROACHData collect
Page 40 and 41: practice, however, limited resource
Page 42 and 43: Dinas to the hospital detailing the
Page 44 and 45: Unlike Muhammadiyah and NU faciliti
Page 46 and 47: TABLE 3: POPULATION COVERAGE BY HEA
Page 48 and 49: customary fees. At the same time, i
Page 51 and 52: 7. RATIONALIZING USE OFMEDICATIONS7
Page 53 and 54: too few medicines to meet the publi
Page 55 and 56: 8. PHARMACISTS ANDDRUGSELLERS AS PA
Page 57 and 58: district provides TB drugs to priva
Page 59 and 60: 9. ROLE OF PROFESSIONALASSOCIATIONS
Page 61 and 62: IMA is involved in any allegations
Page 63 and 64: 10. CONCLUSIONS ANDRECOMMENDATIONSI
Page 65: If Indonesia is to achieve its prio
Page 68 and 69: • Supporting the mapping of all f
Page 71 and 72: ANNEX A: ASSESSMENT GUIDEIndonesia
Page 73 and 74: Key Informants at Provincial LevelK
Page 75: Key InformantsoooIBI, and memberrep
Page 78 and 79: Assessment Question Approach/Backgr
Page 80 and 81: Indicator Number Data Source and No
Page 82 and 83: 1.3.4 DinKes Experience with Privat
Page 84 and 85: The team interviewed a manager 16 a
Page 86 and 87:
They have used many different healt
Page 88 and 89:
In Yogyakarta Province, there are 1
Page 90 and 91:
graduates to work immediately in 24
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Muhammadiyah is a 226 bed hospital
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Dinas Yogyakarta31. Mardiningsih, S
Page 96 and 97:
2.1 Provincial InformationThe popul
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How can services provided at privat
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The Provincial Health Office meets
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from multiple sources: 40 percent f
Page 104 and 105:
2.9 Licensing and Oversight of Phar
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As per IMA Propinsi, they meet with
Page 108 and 109:
It was mentioned that the budget fo
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• Private midwives are willing to
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etween PKBI and the District Health
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Cahya Kawaluyan Hospital has adapte
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the midwife to charge a slightly hi
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Involving Physicians in DOTS. A sig
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Ikatan Bidan Indonesia (IBI) West J
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Indicator DKI West Jakarta Data Sou
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visited an average of over 60 perce
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3.9 Potential role of professional
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members who pay membership fees. Th
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emainder paying out of pocket. Reve
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3.20 Indonesian Pharmacists Associa
Page 134 and 135:
OtherApotek Gitamara, Jl. Kemanggis
Page 136 and 137:
13. Government of Indonesia, World
Page 138:
41. Thrabany, Hasbullah, et al. 200
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