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

admitted that her pharmacist only comes once a month to take her salary. Another pharmacy in Cianjur wasreported to sell narcotics without prescription.It is important to realize that few of the private providers are only “private.” The vast majority of healthpersonnel working in the private sector are, in fact, government employees who work in public facilitiesduring the morning and private facilities in the afternoon. For example over 80 percent of publicmidwives are in private practice. In theory, some of the supervision and regulation of the private sectoroccurs through public sector supervision, since it is the same person. Most of the “pure” private providersare retired from the public sector or newly graduated.There is some supervision and monitoring through IBI. For example, IBI representatives provide trainingin the district training center for midwives. After the training, the District Health Office staff follows upthe training to ensure it is being implemented. Also, the Midwife Coordinator in the District Health Officeprovides supportive supervision using a self-assessment tool. This system exists in both Bandung andCianjur districts due to support from the USAID Health Service Program. There is also widespreadsupervision of midwives through the Bidan Delima program. The Representatives from IBI regularly visitall Bidan Delima as part of their supervisory program.District government officials may have a full map of the health care system but they concentrate almostexclusively on the public sector, which limits their responsiveness to monitoring needs within the privatesector. Unlike Yogyakarta, Bandung District does not have an independent monitoring agency (BadanMutu Pelayanan Kesehatan), which is contributing significantly to the evaluation of quality issues inYogyakarta.2.4 DinKes Experience with Public-Private PartnershipThe District Health Office in Bandung claims that it has a good relationship with individual private healthsector partners (e.g., IBI, ISFI, etc). However, there is no regular meeting where the District Health Officemeets with the various private sector partners in health care to discuss collaboration. The Head of theProvincial Health Office claimed that there is no collaboration at all between government and privatehospitals. One gets the overall impression that the government health offices do not regard the privatesector as part of their responsibility except for licensing and issues on malpractice.A priority activity of the newly installed Head of the Provincial Health Office is to establish a good workingrelationship with the Districts by working with them as a team rather than the traditional hierarchicalmanner. She wants to move forward as a community with common interests. However, when she invitedofficials from the District Health Offices to get together, only 50 percent attended. She is determined tomake progress and she is convinced that there can be closer collaboration between public and private healthsectors. She is currently communicating with IMA, IBI, ISFI, GP Farmasi, and other stakeholders tostrengthen links among all the players in the health care arena.There are regular meetings between the government and professional associations. The Provincial IMAmet quarterly with the Provincial Health Office on government health programs to discuss areas ofcollaboration. They describe their relationship with the Provincial Health Office as close. The ProvincialHealth Office is providing IMA Province an office space at the former’s new office building free of rentalcharges. This move will likewise ensure more interaction and collaboration between IMA and theProvincial Health Office. Currently, the officers of IMA are volunteers and IMA sustains its SecretariatOffices.77