Hananto Wiryo, Mataram – The Cabinet of president-elect Susilo Bambang Yudhoyono must ensure that in designing its health programs focuses on servicing and reaching grassroots by truly optimizing existing health infrastructures, improving affordability and awareness of health services, and also eliminating malpractice.
In order to optimize and maximize health services, there needs to be an improvement in the quality of health centers, from the simplest level up to the hospital level.
While new infrastructures are important, the upcoming health minister must be someone who truly understands and is capable of optimizing the supply and distribution of medicines to the Puskesmas, or local health centers. The availability of basic health service through health centers is urgent, especially in rural areas. Remote areas should not be abandoned and only be reached through mobile health services.
Aside from improving health infrastructure, the discipline and dedication of health personnel must be improved as well. There is an urgent need, and should receive priority within the first 100-days of Susilo's administration.
Another point that needs to be solved immediately is to improve the affordability of health services. The cost of health care should be trimmed down further to utilize the health insurance network. This system would allow health services be provided to all segments of society. Such things as the intensification of the service quality of PT Askes – the national health insurance program – as well as establishing a community insurance scheme are things that should be looked at in the immediate future.
Additional funds acquired by the government from cuts in fuel subsidies, for example, goods channeled toward the urgent health service needs of the country. But, in order to do this, the government must first ensure that it has created a transparent system in the use and allocation of these funds.
If necessary, and if possible, through this money, community health insurance for the poor should be free of charge by clearly identifying criteria of poverty.
Another issue often overlooked, yet a potential problem in Indonesia, is the growing concern over the number of malpractice cases. It is an issue that has rarely been touched in the past, and all but neglected by past governments. Unfortunately, there is a tendency to keep things quiet especially if the victims are poor. This only causes the incidence of malpractice to go from bad to worse.
To reduce costs and the incidence of malpractice, a better regulatory framework should be put in place by making regulations on the matter clear. The health minister should set an example by asserting a strict health code and direct hospitals and community health centers to set up Protap, or Standard Service and Management Procedures. The Protap could be both national and local levels established by respective health centers and hospitals.
For example, if a patient is diagnosed with typhus, it is common practice for doctors to prescribe ampicillin (generic antibiotics) and chloramphenicol. In fact, it is also common knowledge among medical personnel that in most cases, chloramphenicol, is sufficient.
The additional prescription of ampicillin is often due to urging and sponsorship of pharmaceutical companies. The setting of a Standard Service Procedure could help prevent such residual prescriptions.
The aim of having Standard Service and Management Procedures is to reduce the risk of malpractice. It will help cover the rational limit of prescriptions given by a medical doctor. It should also include coverage of surgical procedures that are clearly needed. This is to prevent occurrences, such as a general anesthesia for such a simple surgical process for someone who has a five-centimeter elbow wound.
If there is a general standard procedure, we can easily pursue who is responsible for making such decisions. It is, thus desirable that every health service institution should have and apply Protap.
These standard procedures do not have to be complicated and the new health minister should be able to instruct local officials to draft them individually or collectively. If there is a hospital director who is unable to draft such procedures, then the simple fact is that he or she is not fit to run a hospital.
The writer is head of pediatrics at Mataram General Hospital. Apart from being a lecturer at Mataram and Udayana Universities, he also serves as an expert staff on health affairs for the governor of West Nusa Tenggara, and is a member of the Democratic Party.