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

practice, however, limited resources make it difficult for district authorities to maintain oversight overprivate providers. Some professions have been more pro-active in ensuring that members are meetingset competency standards.For physicians, the Medical Practitioners Act of 2004 makes it clear that the IndonesianMedical Association (IMA) is responsible for ensuring the quality of the profession andsetting practice standards. IMA, at branch level 7 , provides a recommendation for licensing, which alldistricts require before a doctor can be licensed. IMA introduced a competency exam in 2007 for allnew doctors. Upon passing the competency exam, physicians are licensed for five years. At renewal,the physician must document at least 250 continuing professional development (CPD) credits or re-takethe competency exam. Licensing requirements, however, are only a first step in ensuring quality. IMAadmits that it is still working to define how to fulfill its responsibilities for ensuring quality more fully.Currently, neither IMA nor Dinkes has the resources to conduct supervision visits or to monitor privatepractices in other ways.The Indonesian Midwives Association (IBI) follows a similar practice to IMA for itsmembers. IBI has just introduced a competency test for its members, required for licensing. Unlikeother professional associations, IBI is more active in supervision of its members. In all four assessmentdistricts, private midwives reported supervision visits by the District Midwife Coordinator or anotherIBI leader in the district. In Yogyakarta, midwives reported receiving visits from the head of thePuskesmas.The situation on licensing of pharmacists and pharmacy outlets is more confused. Thedistricts have responsibility for licensing pharmacists, and issue licenses for a period of five years.Generally, the local branch of ISFI (Pharmacists Association) provides a recommendation letter to thedistrict. However, ISFI reported that not all districts consider this letter a requirement for licensing.The licenses for pharmacy shops/outlets are issued at province level, but with the bulk of theapplications being received and processed at district level and a final recommendation made to provincelevel. Again, given resource constraints, it is not possible for districts or ISFI to monitor pharmacyoperations once licensed.The process for licensing new hospitals is first to receive a temporary operating license.Once the hospital is operational, they would request Hospital Accreditation Commission (KARS)accreditation, and upon successful accreditation, a standard operating license would be issued. KARS isan independent institution that accredits hospitals on 16 service standards, such as operating theater,pharmacy, emergency unit, etc. Regulations require that hospitals be accredited every three years.KARS reported that of the 1300 hospitals in Indonesia, 560 are accredited for all 16 standards. Clearly,the accreditation requirement is not enforced, and there appears to be minimal oversight of privatehospitals once they are licensed.Once private hospitals, individual practices or pharmacies are licensed, there is generallylittle further interaction with public health officials. Although there are some exceptions, privatehealth providers, pharmacies, and hospitals generally do not provide any regular reports to the districthealth officials. Some hospitals and private practices that receive medicines and supplies from verticalprograms such as TB medicines, vaccines, and malaria medication provide reports to the Dinkes, butonly related to those programs for which they have received free medicines.7 There are currently 343 IMA branches, nearly one in every district in Indonesia.18