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

IMA is involved in any allegations of malpractice or patient dissatisfaction. IMA investigatesthe claims and often mediates the disputes. It is unclear who else is involved in settlement of suchdisputes, as IMA may arguably favor the physician.One of the primary issues at district level discussions is physicians’ income. The issuesinclude setting customary fees (often with younger specialists seeking higher fees) and appropriate splitbetween physician and hospital for fees reimbursed through insurance plans. The IMA branch in WestJava Province reported that of the 1,100 Puskesmas in the province, 500 do not have physicians,primarily because the salary offered at Puskesmas is too low.One of the concerns of IMA at headquarters level is the role of GPs in a system that isbecoming increasingly specialist-centered. IMA wants to improve the quality of primary care, andthe image of the primary care doctor. IMA is a partner in a World Bank funded program in Bontang,East Kalimantan to establish a district health system centered around nine family practice clinics, eachstaffed by three GPs. All curative care should be centered around these clinics, leaving the Puskesmasfree to focus on public health activities.IMA could be a good partner for improving quality of care, as it views this responsibility asan important part of its mandate. It has a broad branch network, and has more legal authority tomonitor and supervise its members than do the other professional associations. Working with IMA todisseminate treatment protocols as part of its CPD offerings would be one potential intervention. IMAis also looking for ways to be more pro-active in quality assurance, so may be willing to take onresponsibilities such as monitoring practice patterns, particularly if done in a supportive manner.9.4 INDONESIAN PHARMACISTS ASSOCIATION (ISFI)ISFI estimates that it has approximately 5,400 members from an estimated 27,000registered pharmacists in Indonesia. ISFI has been trying to promote the TATAP concept or “nopharmacist, no service” as part of its national recommendations. ISFI considers the current regulationsaround pharmacy ownership, which allows non-pharmacists to own pharmacies, a major impediment topromoting professional operations.ISFI participated in a pilot program with the National TB Control Program (NTP) incooperation with Depkes. This project was implemented with the General Directorate of Pharmacyand Medical Supplies (Binfar) in three provinces included developing a pharmacy medical record to referpatients for early detection. The motivation for the pharmacists was the possibility of added salesthrough increased status in the community for undertaking public health works and increased shopvisits. The program largely collapsed when GFATM funding to NTP was suspended.While ISFI involvement would be critical in any projects with pharmacists, their role inimproving the quality of the pharmacist profession is less clear. Given little local or centralgovernment interest in enforcing the regulations related to the profession, and the relatively weakorganizational capacity within ISFI, it is unlikely they could lead major improvements.9.5 GP FARMASIGP Farmasi represents all the parts of the pharmaceutical industry, from themanufacturer through the distribution chain to the end providers. Its members include 210manufacturers, wholesalers or distributors, apoteks, and toko obat. While the pharmacist is a member39