Jakarta Globe – IRIN, December 7, 2013
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| Malaria victims under treatment at a small clinic in Timika, Papua. (JG Photo/Jurnasyanto Sukarno) |
As more
people sign up for health insurance offered to indigenous people in Papua, a
public health system already struggling with too few health workers and
substandard services is coming under greater strain.
“People in
the mountains and in coastal areas have flocked to the hospitals seeking
treatment, even for diseases that can be handled by local clinics… People go
straight to hospitals because they want to be treated by specialists,” said
Aloysius Giay, director of the state-run Abepura Hospital near Jayapura, the
provincial capital.
Yusmina
Wakum pays around US$50 and travels 350km for eight hours by bus to reach the
main hospital in Jayapura, to receive treatment for gout. “Where we live
there’s a hospital, but medicines are not good,” said Yusmina’s 19-year-old
sister, Miriam Wakum, as her elder sibling sat slumped in a wheelchair.
“She got
worse and couldn’t sleep, so we decided to take her here.”
The health
scheme was intended for use only in the province’s 34 tertiary referral
hospitals, but residents have largely refused to seek care for non-emergency
complaints in more than 300 public health clinics known as Puskesmas — citing
poor service and lack of specialists — even though those services are also
free, Aloysius said.
About 52
percent of Papua’s 2.8-million population are indigenous. In the past two years
overcrowding has increased and patient queues have grown longer as more people
joined the scheme, launched in 2009. The problem may worsen, health officials
say, with the government’s plans to launch a universal healthcare scheme for
all Papuans, indigenous and non-indigenous.
Health
posts vacant
In Keerom
district, near the border with Papua New Guinea, where violence from a
low-level but long-running separatist conflict in Papua has fueled security
concerns, a local Catholic priest, Roni Guntur, said health posts are mostly
vacant. “In some places the government has built community clinics, but there
are hardly any health workers. Some of them left because they said there were
no supporting facilities or because they did not feel safe.”
In 2012
Papua had a ratio of two doctors and 17 nurses per 10,000 people, above the
national average of 1.4 doctors and five nurses, but Health Ministry data show
that health personnel are not evenly distributed.
Some Papuan
districts have less than one doctor and five nurses per 10,000 people,
according to the Health Ministry, whereas the World Health Organization
recommends a minimum of 23 health workers per 10,000 residents to provide basic
care.
While
reference hospitals in main towns like Jayapura and Abepura struggle to cope
with the patient surge, many indigenous Papuans are still unaware of the health
plan that is almost free of charge. “People in villages are still dying because
they don’t get treatment and aren’t aware of their rights,” said Aloysius.
“Those who
suffer more serious illness still have to pay for drugs because they are not
covered by the insurance,” said the priest, Roni, who noted that there was also
confusion over what is covered by the insurance scheme.
Health
consultations for indigenous communities are provided at no cost, as well as hospitalization
in the cheapest, third-class ward and most medicines. Residents still bear
transportation and some treatment costs.
Solutions
To cope
with growing pressure on the health system, the provincial government has
announced it will build four new referral hospitals in 2014. Officials said
there are also plans to establish more schools for health workers, and to offer
free training via the Internet.
Most
indigenous communities live in underserved remote areas, so in 2012 the Health
Ministry started flying provincial health workers to these areas, where they
stay for several months at time to treat villagers and train local health
workers.
“Because of
the limited budget, the provincial government can only provide [training]
modules for the health staff, not for the local cadres, but by their own
initiative the [provincial] staff developed very modest modules in the local
language,” said Ratih Woelandaroe, a UN Children’s Fund (Unicef) health officer
in Papua.
The rugged
jungle-clad landscape is the biggest challenge to accessing health services,
said Sudhir Khanal, Unicef’s child survival and development specialist in
Papua.
Papuan
Governor Lukas Enembe, installed in April 2013, has made improving healthcare a
priority, and set up a Unit for the Acceleration of Health Care Development,
which is headed by Aloysius.
“We are
aware that all this time, monitoring and supervision has been poor, and that’s
why there’s a need to make a move and improve things,” Aloysius acknowledged.
