Senin, 04 Maret 2013

The need to improve Jakarta’s healthcare system


The need to improve Jakarta’s healthcare system
Tommy Dharmawan and Tiara Bunga Mayang Permata ;  
Tommy Dharmawan is a physician; Tiara Bunga Mayang Permata is a graduate of the School of Hospital Administration, University of Indonesia
JAKARTA POST, 02 Maret 2013


Dera, a premature baby, was born without an oesophagus, the first part of the human digestive system. Dera needed special treatment in the Neonatal Intensive Care Unit (NICU).

But, her parents could not find her a place because all 10 NICU hospitals in Jakarta were full at that time. Unfortunately, Dera died before she received proper treatment.

The Jakarta Health Agency clarified that it was true that all NICU facilities in the 10 hospitals were really full and that none of them refused Dera due to financial reasons.

The agency’s clarification was a response to some media reports that public hospitals in Jakarta refused Dera as her parents only had a Jakarta Health Card (KJS) and that hospitals had turned into profit-oriented companies.

The deputy governor of Jakarta, Basuki Tjahaja “Ahok” Purnama, even said that the health service in Jakarta public hospitals had become worse and that he would order an audit on doctors in public hospitals.

Ahok’s statement is only a political statement. He should see the service in public hospitals for himself. He should know that since KJS was launched in November last year, more Jakartans have been directly to public hospitals, even with only a minor illness.

Most Jakartans do not want to go to the community healthcare center (puskesmas) first before going to hospitals because they think that the quality of service in puskesmas is very bad.

So, health officials in public hospitals are serving so many patients that their quality of service will surely be decreasing.

His statement about having an audit on doctors in public hospitals was apparently based on unconfirmed reports that doctors in Jakarta steal money from poor people.

The deputy governor should know that most state doctors in Jakarta have a basic salary of only Rp1.2 million (US$123.5) per month. It is far below the labor wage of Rp 2.2 million per month.
He should remember that to be a doctor, one needs six years of study at a cost of hundreds of millions of rupiah in tuition fees, only to be paid a state doctor’s salary of Rp1.2 million. Thank god there have never been street rallies by doctors in Jakarta.

One Jakarta councilor said that there should be a NICU in every puskesmas. It is once again only a political statement. For sure, she does not know the real facts about NICU. A NICU should have well-trained health officials such as neonatologist doctors and specialist nurses.

There are only a few neonatologists right now in Indonesia and they mostly work in Type A public hospitals. To be a neonatologist, a doctor should be a pediatrician first for five years and then take a fellowship in neonatology for almost two years. It is not that simple.

Also, it would be very expensive to build NICU in all 341 puskesmas across Jakarta.

Jakartans should know that it is easy to blame bureaucracy, but it is very hard to implement change. If Governor Joko “Jokowi” Widodo wants a free health care service for every Jakartan, he should change first the referral system.

People with only a minor illness should not go directly to public hospitals, but to puskesmas first. Every puskesmas should have an emergency and inpatient ward.

So, every minor illness could be handled by puskesmas staff. Also, government should prepare to improve the quality of health officials in puskesmas, as well as their quantity.

Public hospitals should reject non-emergency patients who do not have a referral card from puskesmas.

There should be an online system set up by the Jakarta health agency that will connect puskesmas with hospitals and among hospitals themselves. So that every puskesmas and hospital in Jakarta could see the availability of facilities in the hospital that they want to refer the patient to.

There are also tales of hospitals that are reluctant to provide full healthcare services to the poor. Many KJS-card holders are usually put at the bottom of operating waiting lists.

In this case, Indonesia needs more regulations and concrete action to protect the rights of low-income people to healthcare. Assigning more class III wards in hospitals for impoverished people could be one solution.

The Health Ministry should increase its ratio of beds for the poor to more than 50 percent.

The public view about this issue also needs to be changed. A typical Indonesian wants a quick service, but does not want to wait until the system works.

If they think a health service is not very smooth, they immediately assume that the hospital official wants some money. They think that they do not get quick service because they do not have money or only have KJS cards.

Jakartans should know that there are a lot of patients in Jakarta public hospitals, whether they use KJS cards or not, thus creating a long queue for service.

The media should have a balanced view about this sensitive health issue, while politicians should not make statements without knowing the real facts. If they want to talk about health issues, they should first see the real implementation of health programs in the hospitals. Do not just blame the hospitals and their staff.

Meanwhile, for every hospital official, they must give the best service even though there are minor problems outside.

Just give the very best of yourself to the patients. For doctors and hospital staff, they should learn how to communicate well, so that patients and their families can understand the diagnosis and proper treatment.

Jakarta, despite having hundreds of hospitals, 341 puskesmases and more than 4,000 integrated health service posts (posyandu), is still battling with health issues. We need more improvement in the health system so that every Jakartan will be able to access health care services properly. ●

Tidak ada komentar:

Posting Komentar