Welcoming a medical education law
Ihsan was a promising student from South Halmahera, North Maluku, who once dreamt of becoming a doctor.
It was a noble wish given that almost 80 percent of general practitioners in South Halmahera were contract doctors and the local government relied on this program every year.
However, Ihsan failed to pass the admission test for a state medical school. To study medicine at a private university is very expensive; his family could not afford to pay his tuition.
The financial constraints facing Ihsan are one reason why Indonesia produces few doctors. The Constitution ensures that every citizen has the right to good healthcare but the perennial problem facing us is a lack of access to doctors due to their unequal distribution in Indonesia.
This would not happen if there was easy access to medical education in every region in the country.
Every province that falls short in general practitioners should be allowed to open its own medical school to fill the gap. Of course there will be a lot of questions regarding budgets, lecturers, curricula and availability of teaching hospitals.
Therefore, the House of Representatives made a good decision when it proposed a medical education bill to balance the distribution of doctors and provide equal access to healthcare for all.
The low quality of the country’s healthcare sector reflects the poor quality of its medical education and deficit of doctors.
Indonesia’s population is currently 238 million. Indonesia needs 95,000 general practitioners; it is 23,000 general practitioners short of that goal. With only 5,000 new doctors graduating a year, Indonesia will only be able to meet its current demand in five years.
There is also an uneven distribution of doctors between Java and the rest of Indonesia. Over 80 percent of the nation’s general practitioners reside in Java.
Over 70 percent of Indonesia’s medical schools are located on the country’s most populous island. Sadly, there is no longer a regulation that requires recently graduated doctors to serve in remote areas.
To address the shortage, some regional governments have provided scholarships to medical students who sign a contract to serve in the region after graduation.
Another solution is to build a school of medicine in every province. Under the medical education bill, the central government would allocate money to build a medical school in each region that is underserved by doctors.
At the same time the National Education Ministry could provide scholarships to recently graduated GPs to pursue specialist studies to entice them to teach at local medical schools. Or else local governments could offer good salaries to graduating doctors.
The government can play its part by forcing state universities who have an A accreditation to support the opening of new medical schools, which might in turn ask local government hospitals to serve as teaching hospitals. Those hospitals would be accredited as part of a network of teaching hospitals.
For a long time there has been no clarity about whether teaching hospitals fall under the supervision of the National Education Ministry or the Health Ministry.
The fact is most teaching hospitals do not function properly as they are not managed by medical schools. The government must put an end to this uncertainty and allocate more money for teaching hospitals to improve their quality.
We know that most teaching hospitals in Indonesia serve the poor only, reducing their status to second-class, and hence poor quality, hospitals. In contrast, most of the best hospitals in the United States are teaching hospitals.
In terms of quality, however, medical school graduates are facing a serious problem of a lack of recognition overseas. Indonesian doctors find it difficult to pursue specialist programs outside the country.
The problem rests with the curriculum here, which is old fashioned. Indonesian medical schools have to cooperate with the world’s top universities to improve their curriculum and secure international acknowledgement.
Another obstacle to promoting medical education is money. According to Rohmani a legislator on the House of Representative’s Commission X overseeing education, the cost of a medical education ranges from Rp 300 million (US$35,000) to Rp 400 million, which certainly is elusive for students from lower income families.
A solution lies perhaps in differentiating the medical education fees. The “have” students can pay in full, while those from lower income families can have their tuition paid for by the central or local governments under contract or scholarship schemes.
Now what is the government’s responsibility in medical education? We know that medical education is classified as a public good that falls under the government’s auspices. The government cannot just give half of the burden to private sector because medical education is not a subject of privatization.
The high cost of a medical education will result in expensive healthcare services, therefore limiting access. The medical education bill should address this long-standing issue.
The writer is a physician in Jakarta.
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