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

How can services provided at private facilities be better integrated into thehealth system to ensure better delivery and monitoring of private healthservices (e.g. TB, ANC)?2.2 Reporting on private providers to the District Health OfficeThe District Health Office keeps records of all private providers by category. There are 26 categoriesincluding private hospitals, clinics, midwives, pharmacies. There are a total of 3,603 private providersincluding 458 private midwives. They update private providers every year and private providers need torenew their license every 5 years. In Bandung district, they had data from 2003. In Cianjur district, theyhad less information at the district level because they have fewer private providers. For example, there areno private hospitals. However, the Provincial Health Office has data on all private providers in theprovince, since they are ultimately responsible for licensing.It is unlikely that official data is reliable due to non-compliance by private providers to submit updatedinformation. There is currently no real incentive to comply. For example, many of the private hospitalsdo not report data on the treatment of tuberculosis and yet they provide treatment. Only those hospitalsthat receive drugs from the health office submit data on TB. To the end of 2008, the Provincial HealthOffice Head reported that only 10 percent of private hospitals submitted their reports despite the fact thatthere is an existing regulation for hospital compliance with regards to submission of reports.In terms of MCH services, there is regular reporting to the District Health Office from private midwives.There is much better compliance from Bidan Delima compared to other midwives. However, there isvirtually no reporting from private hospitals.Private providers are not required to provide any information on their fees to the Provincial or District HealthOffice. The government health offices only know whether the private providers are licensed.2.3 Role of DinKes in supervision and monitoring of private providers and ensuring theiroverall qualityThe primary role of the District Health Office regarding the private sector is to license private providers.For midwives, the initial license is issued by the District Health Office upon recommendation by IBI.The renewal license after 5 years is issued by the District Health Office upon recommendation by IBI.According to IBI Province, there is no competency test conducted for midwives prior to initial or renewalof license. They plan to conduct it this year.Beyond this, they see their role as very limited. Even in Bandung District, which is more active thanCianjur and has more private providers, they play a limited role in monitoring the quality of providers.They check the clinic facilities such as equipment rather than the quality of care. They also have a limitedrole in supervision because of limited budgets. Given the large number of private providers in BandungDistrict, they have limited staffing and therefore cannot visit private providers regularly.As an example, private pharmacies are supposed to have a pharmacist present. The District Health Office alsoconducts inspection of the various pharmacies. Pharmacists should only have one practice. It is, however, aknown fact that pharmacists practice in multiple sites making their license available to pharmacy owners fortheir facilities to comply with business permit requirements. The Balai POM at the provincial level coordinatesclosely with the District Health Office. Inspections are supposed to be conducted twice a year. However, this isdifficult to enforce, as per the Bandung District Health Office. In fact, in Cianjur district, a pharmacy owner76