Healthcare Delivery System in Indonesia

8/13/2019 Healthcare Delivery System in Indonesia

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The general objective of the National HealthDevelopment Program in Indonesia asstipulated in the National Health System is toprovide a healthy life for all Indonesians.

The specific objectives of the National HealthDevelopment Program in Indonesia are:

To enable people to maintain their own health andlive a healthy and productive life

To promote an environment conducive to the healthof the people To promote good nutrition among the people To decrease morbidity and mortality To promote a healthy and prosperous family life


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To achieve these objectives, varioushealthcare efforts have been

implemented, including among others,the strengthening of the healthcaredelivery system as part of an overallhealth development program.This is being carried out both bygovernment and the private sector.


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Due perhaps to the fact that Indonesia isstill a developing country, the presentcondition of Indonesian healthcare remainsunsatisfactory although there have beenmajor improvements compared to twodecades ago.

The primary cause of death in Indonesiasince 1995 is cardiovascular diseases thatnow overtake predominant infectiousdiseases, reflecting the double burdenfaced today.


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The pattern of death in Indonesia is still stronglyrelated to general poverty, low income percapita, high rates of illiteracy and various

socio-cultural factors. According to Household Health Surveys, the 10

leading diseases in the country are: acuterespiratory tract infection, diseases of skin,

diseases of teeth, mouth and gastro-intestinaltract, other infectious diseases, bronchitis-asthma and other disease of respiratory tract,malaria, nerve disorders, cardiovasculardisorders, diarrhoea and tuberculosis.


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INDICATOR/VARIABLE YEAR FIGURES

Infant mortality rate per 1000 live births 1993 58.0

Under five mortality rate per 1000 1993 81.0

Maternal mortality rate per 100.000 livebirths

1993 425

Crude death rate per 1000 1994 6.0Life expectancy : male 1993 60.8

- female 1993 64, 6

Low birth weight (%) 1993 15.0

Protein Calorie Deficiency per 100Underfives 1993 40.0

Clean water supply per 100 population 1986 30.0

Latrines per 100 population 1986 37.9

Percentage EPI coverage 1993 93.6


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The responsiblility for dealing with public healthproblem in Indonesia lies with the government.Following the basic principle of sound public health,public health services provision in Indonesia strongly

encourages community participation throughprimary health care services.

The main health body entrusted with carrying outpublic health services in Indonesia is the Community

Health Center (Puskesmas), situated at sub-districtlevel serving a population of about 30,000-40,000.There are over 7,000 such centers in the country bythe year 2000.


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The basic services are health promotion, Familyplanning, Nutrition, Environmental sanitation, Curativecare and various developmental services accordingto local areas need.

In most instances, a doctor, with a staffing between8-32, consisting of nurses, midwives and other auxiliarypersonnel, heads each Puskesmas.

In densely populated areas, there are Sub-Community Health Centers (Puskesmas Pembantu) at

the village level, generally headed by a senior nurseor midwife, and operated under the supervision of,and linked to, the Community Health Center. Atpresent, the total number of Puskesmas Pembantu inIndonesia is 19,977


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To serve people who live in very remoteareas, there are Mobile Community HealthCenter (Puskesmas Keliling), operated byand based at the local Puskesmas.

The staff of Puskesmas Keliling consist of onedoctor, assisted by two or three personnel,including nurses/midwives and a driver.

At present, there are about 6,024Puskesmas Keliling serving villages within thesub-district.


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To support the activities of the Puskesmas, the

community health effort is organized in theform of the Integrated Services Post(Posyandu), located at the hamlet level.

The responsible community institution toPosyandu is the village community resiliencecommittee. The activities of each Posyandu,assisted and supervised by local Puskesmasstaff, consist of five basic types of healthservices. These are: (i) MCH Services, (ii)Nutrition Services, (iii) Family Planning Services,(iv) Diarrhoeal Disease Control and (v)Immunization Services. At present, there areabout 251,459 Posyandu registered inIndonesia.


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To guarantee successful operation of thePuskesmas, a referral system has beenintroduced.

Any public health problem that cannot beovercome by the Puskesmas will be referredto higher health institutions/offices at thedistrict, provincial or even the national level.

In accordance with the principle ofdevolved autonomy, there are DistrictHealth Offices at the district level and theProvincial Health Office at the provinciallevel.


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The Ministry of Interior and the Ministry ofHealth at the national level coordinate thehealth offices that are directly under thecoordination of the local government.

The general rule is that the main function ofthe Ministry of Health is to provideconceptual guidance, technical guidanceand material, as well as financialcontribution and assistance to the localgovernment district and provincial healthoffices.


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The primary level personal/medical carefacility managed by the government isthe Puskesmas assisted by the PuskesmasPembantu and Puskesmas Keliling.

Besides the provision of medical personalcare, the Puskesmas also makesprovision for public healthcare services inthe community medical care facilities.


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The primary medical care facilitiesmanaged by the private sector vary.There are private midwives practitionersand private medical practitioners foundin almost every part of the country.

The number of private midwivespractitioners in Indonesia is estimated to

be approximately 34,000. Around 20% ofthe private medical practitioners arespecialists, while the rest are generalpractitioners.


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Since most of the midwives and doctors are

government employees, their private practiceis usually conducted in the afternoon after theclosing of government offices.

In some places, although it is illegal,paramedics also have their own privatepractices.

Most private medical practitioners in Indonesia

operate their practices as a sole practice,although in the big cities there is now anincreasing trend for group practices thatbecome more popular.


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Other types of primary medical care

facilities managed by the private sectorin Indonesia are the MCH clinic and thepolyclinic. These types of medicalfacilities are usually managed by

midwives or nurses, although theresponsible person for these facilities isstill the doctor.

Unfortunately, the actual number ofprivate MCH clinics and privatepolyclinics in Indonesia is not available.


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The secondary and tertiary medical carefacilities in Indonesia are located athospitals. There are around 1,200hospitals registered in the country, ofwhich 404 hospitals are government orlocal government hospitals.

The total number of beds available in allhospital is 111,460, which means that forevery 100,000 people there are around59.8 hospital beds available.


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Government hospitals are divided into fivecategories, namely the A, B, C, D and Etype.

Type D (with 25-100 beds) and type C (with100-400 beds) government hospitals areconsidered to be secondary level medicalcare facilities in Indonesia.

These hospitals are situated in the districtcapitals, of which there are 305 in thecountry.


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Type D hospitals are in transitional periodand ought to be promoted to a type Chospital.

Type C hospital are expected to be ableto provide at least six major specialtyservices, namely internal medicine,pediatrics, obstetric and gynecology,surgery, radiology and clinicalpathology.


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Type B (with 200-500 beds) and the type A(with 100-400 beds) government hospitalsare considered as secondary level medicalfacilities in Indonesia.

Type B hospitals are located in theprovincial capitals and are expected to becapable of providing a broad spectrum ofspecialist services, while type A hospitals areexpected to provide a broad spectrum ofsub-specialist services.

At present, the total number of type Bgovernment hospitals is 23 and the totalnumber type A government hospitals is 4.


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Annual health expenditure in Indonesia is still verylow. It is estimated to be around 2.5% of GNP or

about US$18 per capita, a level far under the WHOrecommended expenditure level of at least 5% GNP.

A big portion of total health expenditure in Indonesiacomes from the people, whereas the contribution of

government is only around 30%. The small contribution of government are utilized for

all-line subsidy that creates unfair health financing forthe poor.

Most of private spending on health care is out-of-pocket, because only around 20% are protected byvarious types of prepaid care.


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Indonesia still faces various health problems. Toovercome these challenges, Indonesia hasimplemented, since 1969, a series of Five YearNational Development Programs, including theNational Health Development program.

Significant progress has been achieved inhealth care sector, both in public healthservices as well as in medical services.

The management of the healthcare deliverysystem in Indonesia is carried out both bygovernment and the private sector, includingsome forms of public-private mix.


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The low level of health spending, themisdirection of government subsidies,

and the big portion of population without-of-pocket spending indicating lowproportion of people protected byprepaid care, are challenges in thatneeds to be reformed gradually towardsmore fairness in health financing.


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Documents

Healthcare Delivery System in Indonesia