Adisti Sukma Sawitri, Depok – Suci Islamiyah will never forget the fact that her mother died in one of the leading government hospitals in Central Jakarta, deprived of proper medical treatment.

Although she possessed a health insurance card that was supposed to ensure that her mother received treatment in a second-class ward at the hospital, her mother died of a stroke in a third-class ward, where five nurses had to take care of about 80 poor people with serious health problems.

"I felt terrible about what the hospital did to my mother, but what concerns me most is that the people who were hospitalized with my mother are still suffering today due to the corrupt hospital management," Suci said last week at the launching of a health advocacy center in Depok, West Java.

If such practices can happen in one of the best hospitals in the country, she said she could hardly imagine the condition of health services in the rest of Indonesia.

Low quality health care in government hospitals and clinics for people of the low-income bracket is one of many chronic public service problems in the country.

Although the government has allocated Rp 3.4 trillion (US$373.6 million) this year for health insurance for the poor (Askeskin), disbursement remains low due to the sluggish bureaucratic system and low commitment of health officials.

"We admit that our performance in disbursing and managing the budget is still poor. That is because we do not have a good system for coordination yet," said the deputy head of the Health Ministry's Finance and Insurance Center, Kalsum Komaryani.

She said that although the center had tried to cooperate with PT Asuransi Kesehatan (Askes) and state and private hospitals, problems still existed due to corrupt practices by individuals, such as the unauthorized collection of funds from patients or pushing them to buy expensive medicine.

Under the Askeskin program, poor people are supposed to get free treatment and medicine in hospitals that have an agreement with PT Askes, as long as they can show a letter from their neighborhood chief to prove that they do not have the means to pay for the treatment.

In fact, poor people find it hard to get such a letter, and hospitals often charge them for medicines and hospitalization.

"To tell you the truth, when it comes to such practices, I don't know what to do," Kalsum said.

The National Planning Agency's director of health and public nutrition, Arum Atmawikarta, said that community groups should actively participate in the provision of good health care and the improvement of hygiene to make up for the failure of the ministry's bureaucracy.

He cited as an example that Indonesia had been unable to battle Malaria because people depended on the government to battle the disease.

"We really support individuals or organizations who want to participate actively in providing health services," he said. Arum said that community-based public services had proven to be effective in providing clean water in several regions.

A World Bank-sponsored project, initiated in early 2000, has successfully provided community-based clean water facilities in several low-income areas in eight provinces.

Local residents covered 20 percent of the financing for the project, while the remainder was taken care of by the bank. A community group could get up to Rp 250 million for the project.

"The local people take care of the facilities because they financed them and were involved in planning the project. I think this kind of participation will also work in health services," Arum said.

However, he added that private institution's involvement in managing public services should be avoided because it may lead to the seeking of commercial gain.