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

that there was no management of the geographical location where pharmacies could open, so that somelarge pharmacies opened very close to smaller pharmacies, which had a negative impact on the revenuegeneration of the smaller pharmacy.In terms of quality, Yogyakarta is examining some different options. They have established anindependent monitoring agency, entitled Badan Mutu Pelayanan Kesehatan, which is contributingsignificantly to the evaluation of quality issues. This Council for Quality in Health Care has as a missionto help health care providers and authorities offer comprehensive, continuous, professional, and highquality services. They are also providing a link between licensing, health worker monitoring and healthfacility management. They do customer satisfaction surveys and report back to health authorities onlicensing and management. Three examples of their work include:• The Pharmacists Association made a proposal to BMPK that it was necessary to have twoapothecaries at each pharmacy. This is in order to have 24 hour coverage and professionalservices that could offer counseling on drug interaction, effectiveness and dosage. As a result ofthis, 53 percent of the Yogyakarta apothecaries now have two pharmacists on duty.• An assessment of a private hospital that had an unacceptably high case fatality rate in thetreatment of Dengue Hemorrhagic Fever. This resulted in a letter from Dinas to the hospitaldetailing what were the necessary improvements 13 that needed to be undertaken or there wouldbe sanctions forthcoming, including the potential to close the hospital.• An assessment of 10 hospitals that were considered the referral hospital of choice foremergency obstetric treatment. This assessment found SOP not in use, key staff such asanesthetists not in place, midwives not present in the emergency room, and non-functioningblood banks among other key findings (BMPK, March 2009 Evaluation of PONEK).1.3.3 Reporting Practices of Private ProvidersPrivate providers fill in data information sheets and send them up to the Dinkes level. However, they feelthat reporting is a one-way street and that they do not receive sufficient feedback from Dinkes as to theaggregate analysis of the reports. They use established Dinas formats to capture their service deliverydata. The midwives interviewed say they send data to three different places: their local community healthcenter, with carbon copies to Dinas and IBI. The BMPK found in its review of emergency obstetricsystems of 10 hospitals that there were no reporting systems in place for the hospital to send informationto Dinas.In doing interviews with midwives, the team heard of other reporting practices. One informant who is aBidan Delima, a D4 14 prepared midwife, and a Maternal Child Health Program Analyst with the BantulDistrict Office, shared her recent experience. She compiles data from all providers and then does trendanalysis. In the 2006 and 2007 there were declining trends in maternal mortality, with only 6-8 casesbeing reported a year. In 2008, 18 cases of maternal death were reported and in the first quarter of 2009,they have already had seven maternal deaths. The majority of the deaths were attributable to eclampsia.Of the 25 deaths that have occurred most recently, only three were attributable to poor management bymidwives. The other 22 deaths were in the hospital and resulted from either late referral or pooradherence to standard protocols.13 The results of this inquiry will be presented at a workshop in Jakarta on June 4 th . The workshop is focusing ondecentralization and district governance process.14 Similar to Bidan Delima, D4 is a certification process that was previously supported to improve midwife quality.59