Struggle to continue for access to health, despite budget

Desy Nurhayati, The Jakarta Post, Jakarta

Minister Siti Fadilah Supari recently reaffirmed the Health Ministry's commitment to continuing to improve the Indonesian people's access to health facilities despite its limited budget.

Although the 2007 health budget of Rp 19.2 trillion (US$2.03 billion) was an increase on the previous year's Rp 13.6 trillion, the money was unable to cover the people's ideal healthcare needs.

The government's inability to provide people with proper health services was also admitted by President Susilo Bambang Yudhoyono, who said that the country's economic situation was not strong enough to provide an adequate budget for the health sector. Health is not one of the top three priorities in the state budget.

Schemes for poor people, like the health insurance program Askeskin, have not been well managed, with many weaknesses in their monitoring systems.

Running Askeskin to target has been a problem for the government. There were people who should not have been included in the program, but poor management has resulted in them receiving things such as free hospital treatment, while those who really need the facilities were not covered by the scheme.

Weak supervision also resulted in some hospital workers marking up their expenditures so as to receive larger reimbursements from the government.

Amid this lack of funding, diseases and other problems continue to hit the country.

Bird flu remained a serious threat in 2007 although Indonesia saw a 20 percent decrease in the number of bird flu infections in humans over the whole year.

Indonesia reported 44 fatalities and 54 confirmed cases in 2006, while as of mid-December 2007 there were 35 fatalities and 41 confirmed cases.

Indonesia has been the hardest hit by the H5N1 virus, with 93 fatalities reported out of a total of 115 infections since 2003. Worldwide, the virus has infected at least 340 people in 13 countries, a December report from the World Health Organization said.

Efforts to fight the deadly disease across the country have been hampered by ignorance of the threat posed by the virus. A lack of coordination among stakeholders as well as budget constraints have also posed obstacles.

Indonesia has succeeded in fighting for an equitable and more transparent virus sharing mechanism.

In front of the Inter-Governmental Meeting on Pandemic Influenza Preparedness in Geneva, Switzerland, last November, the Indonesian minister argued that developing countries had always been victimized because the WHO's system on virus sharing was unfair for them and sided with developed countries.

"Capitalists do not only exploit the third world countries' natural resources, but also their biological resources," Siti said.

She maintained that Indonesia had full intellectual property rights to its virus strain and to decide who should develop the vaccine, and that it would not share samples with those who would use the samples for commercial purposes.

Earlier this year, Indonesia decided to stop sending virus samples to the WHO after it discovered an Australia-based pharmaceutical company had developed a vaccine based on Indonesia's bird flu strain without the country's permission.

However, the WHO said Indonesia's refusal to share the samples had jeopardized the global fight against bird flu.

Instead, Indonesia made an agreement with a Swiss-based Baxter Healthcare to jointly develop a human vaccine based on the Indonesian strain.

During the November meeting, it was acknowledged that the current international system of virus sharing had been unfair for the origin countries. It was agreed that a more transparent mechanism would be developed based on policies in respective countries, meaning that virus-sharing transactions would require a material transfer agreement.

The dispute over sharing bird flu virus samples between the Indonesian Health Ministry and the WHO, however, was finally settled in a recent meeting between both sides.

To guarantee that the system will be fairer, a trace mechanism will be applied to track down the whereabouts of Indonesia's samples throughout the world.

The year also saw the government issue new policies on drugs, including the establishment of the People's Pharmacy and the Rp 1,000 over-the-counter drug program.

The People's Pharmacy was aimed at providing people with affordable medicine, and was part of the government's efforts to protect the public from expired and counterfeit drugs.

The scheme, which is also expected to empower pharmacists nationwide, has managed to give drugs sellers confidence because people have put more trust in them.

Meanwhile, the introduction of cheap drugs had resulted in a scarcity of medicines on the market, due to alleged large-scale purchases by pharmaceutical companies, which are afraid of business competition. But the minister said such matters have been settled since more companies are willing to produce the drugs with a per-strip sale price of Rp 1,000.

In 2007, the government also wrapped up the massive national measles immunization drive targeted at some 23 million children aged between six months and five years.

The two-year measles campaign was hoped to reduce the child fatality rate of around 30,000 nationwide caused by the disease and its complications. Along with the measles shots, the children were also given polio vaccines and vitamin A.

The massive campaign, however, was still hampered by parents' low awareness concerning the disease, as well as by the country's geographical nature.

After years of negligence toward ocular health, the ministry has said it will focus on reducing the number of visually impaired children in an attempt to join a global eye health movement. The movement, dubbedThe Right to Sight", is hoping to reduce the number of people with impaired vision to 25 million in 2020.

Ophthalmologists, however, have said that the government had yet to prioritize eye health in its programs, causing a high prevalence of blindness nationwide.

The limited number of ophthalmologists in the country and their uneven distribution is also an issue.

Currently, there are only around 1,300 ophthalmologists nationwide, 80 percent of which reside on Java. Meanwhile, rural areas are lacking eye specialists due to limited facilities.

With a smaller budget of Rp 17.6 trillion allocated for the health sector next year, the government and all related stakeholders still have to work hard to fulfill the public's basic healthcare needs, so that a healthy nation can be achieved.

In a move toward providing better health services for people, a new bill on hospitals and protection for patients is currently being deliberated by the House of Representatives.