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

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capacity and resources to provide effective planning and oversight. There is little coordination withprivate providers to involve them in critical public health programs, such as TB or malaria, or to includethem as referral points. District officials do not have a good understanding of how to interact withprivate providers, and mostly focus on their role as licensor. Improving capacity of district andprovincial health officials to engage with the private sector is critical to improving health services. Usingthe area of maternal health as an example, the data shows that only 9.7 percent of deliveries take placein public facilities – all other deliveries are in private facilities, or at home assisted by a private midwifeor TBA. It is unlikely that maternal mortality objectives can be met without fully engaging the privatesector.There are a variety of potential private sector partners including professional associationsand private provider networks. Many have not traditionally been partners in public healthprograms, but represent important channels for reaching large numbers of consumers. Two groups thatare seldom even considered health providers are pharmacists and drugsellers – however, they must beengaged because for half of all Indonesians who choose to self-medicate, this is their first contact at theonset of illness. Also increasingly important partners are the faith-based NGOs that are new recipientsof GFATM grants. These NGOs recognize their increasing responsibilities and have taken small steps tostrengthen management, but will require additional support to implement their grants and to meet GFreporting requirements.These potential partners have central level coordinating boards, and varying degrees oforganizational structure at province and district level. In addition, government counterpartssuch as Depkes and Bappenas have staff at central level committed to improving health services. Whilecentral-level government officials and other partners are critical to ensuring support and providingavenues for expansion, initial implementation should be based at district and province level in order toensure operational feasibility. The proposed interventions do not represent major policy changes, butrather fine-tuning of implementation details that must be carefully designed and evaluated at anoperational level. Working through all levels of partner organizations, along with engaging otherorganizations such as the Association of District <strong>Health</strong> Offices (Asosiasi Dinas Kesehatan/Adinkes), wouldmaximize the likelihood of dissemination when appropriate.Interventions that incorporate financial incentives to drive provider quality have highpotential for replicability, as Jamkesmas is fully implemented in all districts. Models atdistrict level that demonstrate operational feasibility and document positive health outcomes couldeasily be adopted by other districts, as the Jamkesmas administrative systems are already in place.Investments in technical assistance to Jamkesmas within Depkes also may create potential for changes tobe adopted as national recommendations.In order to demonstrate the effectiveness of a coordinated effort that includes changingprovider incentives, partnership with private providers, and support to district andprovincial health officials, initial efforts should focus on a limited set of critical healthpriorities. Officials at all levels identify MCH and TB treatment and control as among their healthpriorities, there is information on appropriate treatment standards, and enforcing effective treatmentsdo not require significant additional funding.42
If Indonesia is to achieve its priority health objectives, more attention must be paid toengage private sector providers. To improve the quality of private providers and to ensure thatthey contribute to priority health objectives, general recommendations are:• Improve district and province capacity to manage an integrated public-private health system;• Through existing financing schemes, adjust payment policies to provide financial incentives forproviders to improve quality and adhere to standards;• Create partnerships with private sector to address public health priorities such as MCH, TB,and malaria;• Support independent oversight boards and consumer education initiatives;• Support the new NGOs that are recipients of GFATM grants; and• Revitalize and support promotion of high quality branded generics.43
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PRIVATE SECTOR HEALTHCARE IN INDONE
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PRIVATE SECTOR HEALTH CAREIN INDONE
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7. Rationalizing Use of Medications
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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 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: 10. CONCLUSIONS ANDRECOMMENDATIONSI
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
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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
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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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