A well-functioning healthy system Nila Kusumawati Elison  ;   A researcher at Women’s Research Institute who graduated in health management and policy at the School of Public Health, Georgia State University, Atlanta, Georgia, US

JAKARTA POST,  12 Desember 2014

                                                                                                                       

Since the new President has launched another new brand of health reform, the Indonesia Health Card (KIS), it has been a burning theme of discourse. Of course, as many are still trying hard to figure out the universal health coverage, or Jaminan Kesehatan Nasional, which has been running for less than one year, KIS brings more bewilderment. But even so, providing sundry health reforms offers welfare and social protection for the people; regardless of underlying political motives, the health system has to function well to invigorate these health reform implementations. As such, there is a need to overview the national health system’s performance through its six building blocks: health financing, health services, health workers, health information, medicines and health products and governance. Health financing is important to ensure that people can access health services without incurring financial problems. To achieve merely one international target, such as the Millennium Development Goals, the world’s poorest countries require an average per capita expenditure of US$62. As a lower middle-income nation, Indonesia has gradually increased its health expenditure per capita, reaching $108 in 2012. Nonetheless, the general government expenditure on health as a percentage of total government expenditure, reflecting the government’s commitment to health for the people, remains low. According to WHO, by October 2013 it was still only between 5-8 percent, which makes Indonesia one of 70 countries that devotes less than 10 percent of general government expenditure to health. Health services refer to the way inputs, such as infrastructure, health workers, health equipment and medicines, are amalgamated to allow the provision of promotive, curative, rehabilitative and palliative intervention. According to the 2012 Social Protection Floors Recommendation of the International Labor Organization (ILO), health services should fulfill four interrelated criteria: availability, accessibility, acceptability and quality. Many studies reveal that health facilities and health services in Indonesia, mainly those in rural areas, are inaccessible by both health workers and people requiring the services. The availability of sufficient, competent, motivated and equally distributed health workers is indispensable. In 2010, the ILO set a global standard called the ILO’s staff-related Access Deficit Indicator benchmark. According to the benchmark, a density of 34.5 health workers (midwives, nurses and physicians) per 10,000 population is required to deliver quality health services. In 2012, the density of midwives and nurses in Indonesia was only 13.8/10,000 population, and that of physicians was even lower, 2.0/10,000 population, according to the WHO. Further, a great number of health workers prefer working in urban areas to rural ones. Thousands of skillful and competent health workers, mainly nurses, have migrated overseas and not returned. Shockingly, based on the latest report of Indonesia’s health information system review and assessment, only 25 percent of health workers were able to accurately diagnose patients’ diseases. A health information system offers a wide range of benefits for a country. A strong health information system can, but is not limited to, help stakeholders obtain updated and accurate prevailing and potential public health issues; make decisions; plan, monitor and evaluate country-specific public health programs and internationally collaborative health agenda. The benefits include making information available for policymakers to decide whether the nation needs to have multiple health reforms for the people. Further, an effective health information system provides donors and global partnerships a strong cornerstone for their support of public health programs. Unfortunately, health information systems in developing countries, including Indonesia, where many serious public health problems are rampant, are still largely inadequate. Essential medicines are those that meet people’s priority healthcare needs and have to be available at the health facilities. WHO indicated that almost 2 billion people in the world could not access essential medicines that they need. Sadly, 50 percent of them live in Africa and Asia. On top of that, when bleeding is the worst culprit of high maternal mortality in Indonesia, blood banks and blood products have been often inadequately available in health facilities. After all, governance plays a salient role in the health sector and agenda. Good governance does not only entail government and high-level policymakers’ commitment and political will, but also demands strong collaboration with other stakeholders. Without laudable governance in place, the other five building blocks of the health system will not make a difference to the health of the people. ●