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

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eimbursement to pharmacy level for referrals and perhaps eventually DOTS administration/follow-upcould provide the needed incentive for more active participation by private providers.36
9. ROLE OF PROFESSIONALASSOCIATIONS IN MONITORINGAND IMPROVING QUALITY9.1 RELATIONSHIP BETWEEN PUBLIC HEALTH OFFICIALSAND PROFESSIONAL ASSOCIATIONSThere is a proliferation of associations in Indonesia. The health professions all have their ownassociation, and some have sub-associations. For example, all physicians are members of the IMA, butthere are also associations for each of the medical specialties (obstetrics, pediatrics, etc.). Someassociations admit there is overlap in issues of interest – for example ISFI, which represents pharmacists,and GP Farmasi, which represents the pharmaceutical industry, including distributors and pharmacies.Except for the IMA, which is legislatively mandated to oversee the quality of the profession, the officialrole of various associations in quality assurance is unclear. Generally, the associations have not played asignificant role in enforcing practice norms or quality standards.It is difficult for associations to collect dues – the Hospital Association (PERSI) estimatesthat only 10 percent of its members pay dues. Even IMA reports difficulty collecting membershipfees of Rp 10,000 per month, even though physicians are required to be IMA members, and they do nothave income constraints. Health professionals do not always see value from membership in theirprofessional association, and the associations have limited budgets to undertake activities. Most relyexclusively on volunteers to manage operations and have limited capacity to take on large-scale projects.In this environment, it is difficult to define who its members are and to maintain membership lists.Health officials generally realize the importance of involving the professional associationsin discussions of new activities. While there is mutual respect, there is less understanding ofconcrete ways to work together. Lastly, there may be some degree of mutual interest among publichealth officials and professional associations in maintaining some of the ambiguity around theresponsibility for provider quality, as no one wants to be fully responsible for provider quality.9.2 INDONESIAN MIDWIVES ASSOCIATION (IBI)IBI is making the slow transition from being a volunteer organization to being aprofessional organization. They currently have 13 salaried staff at headquarters, while all other staffare volunteers. Members pay membership fees of approximately US$ 6 a year. Additional funds areraised through training fees, sales of technical manuals, and donations from pharmaceutical and productgroups.IBI is piloting a competency exam for midwives. It is under review by the Ministries of Healthand Education who are considering national implementation. Included in the discussion is how to trainassessors at province or district level. It appears that some districts are independently requiring thecompetency exam, even though it is not yet a national standard. In Yogyakarta district, midwives do not37
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PRIVATE SECTOR HEALTHCARE IN INDONE
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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 36 and 37: • Pharmacists and drugsellers - A
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: district provides TB drugs to priva
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
Page 92 and 93: Muhammadiyah is a 226 bed hospital
Page 94 and 95: Dinas Yogyakarta31. Mardiningsih, S
Page 96 and 97: 2.1 Provincial InformationThe popul
Page 98 and 99: How can services provided at privat
Page 100 and 101: The Provincial Health Office meets
Page 102 and 103: from multiple sources: 40 percent f
Page 104 and 105: 2.9 Licensing and Oversight of Phar
Page 106 and 107: As per IMA Propinsi, they meet with
Page 108 and 109:
It was mentioned that the budget fo
Page 110 and 111:
• Private midwives are willing to
Page 112 and 113:
etween PKBI and the District Health
Page 114 and 115:
Cahya Kawaluyan Hospital has adapte
Page 116 and 117:
the midwife to charge a slightly hi
Page 118 and 119:
Involving Physicians in DOTS. A sig
Page 120 and 121:
Ikatan Bidan Indonesia (IBI) West J
Page 122 and 123:
Indicator DKI West Jakarta Data Sou
Page 124 and 125:
visited an average of over 60 perce
Page 126 and 127:
3.9 Potential role of professional
Page 128 and 129:
members who pay membership fees. Th
Page 130 and 131:
emainder paying out of pocket. Reve
Page 132 and 133:
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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