‘RI needs effective health worker management’

The delivery of decent healthcare services has been hampered by challenges including a lack of health workers and poor access to healthcare facilities, especially in remote areas. The Jakarta Post’s Elly Burhaini Faizal talked to World Health Organization (WHO) Representative to Indonesia Khanchit Limpakarnjanarat on the need to improve management of health workers in the country. Below are excerpts.

Question: Why do we need to ensure the competence and skills of community-based health workers?

Answer: In order to have quality healthcare, we need to have a sufficient number of health workers. Once you have scaled up that number, however, the focus of the [health] care is on the quality. That is why we have to adjust the balance between the number and also the quality. The World Health Organization (WHO) has provided, on many occasions, technical assistance in improving training — especially in curriculum and standardization — in order to ensure that we have it [the quality].

We also try to network with several professional associations, like medical councils or medical associations in the region in order to learn from each other about how to certify levels of competency. So, those are things that we can do on our part. But again, it’s not just the quality, but was also have to deal with the number of health workers and the distribution. How we can distribute the healthcare workforce to areas where they are most needed, especially in remote areas?

How effective is the current policy in improving the quality of healthcare services?

I think you have to think about it in a more meaningful way. Although we try to promote primary care, healthcare systems actually encompass a whole range. You’ve got to build links between primary care and services provided in secondary and tertiary levels. Even though we often hear about the promotion of primary care, it’s not just about primary care. You have to deal with secondary and tertiary care as well. They can’t stand alone. The system has to be a whole system, with a referral system. We may handle most illnesses at the primary care level. However, there will be few occasions in which you need higher, or more sophisticated health care services.

I think strengthening community-based healthcare services is one of best choices for big countries including Indonesia. Definitely, you cannot build sophisticated hospitals everywhere in such a big country. This is impossible, including in terms of resources needed. But, by having more primary care facilities, we may better deal with the majority of simple illnesses.

What benefits can we expect from an effective referral system?

People will get better care in terms of their illnesses. As sicknesses get more serious, primary care facilities run into limitations. You won’t have an improved sickness and death rate with primary care along. However, with a good referral system, it will improve.

Despite recent efforts, healthcare workers are still unevenly distributed. How can we deal with the problem?

We have to plan the distribution of [health workers] systematically. You’ve got to have a very good information system in order to reach any target you want to give special attention.

I think we can try to deal with that problem by providing appropriate incentives in order to draw the healthcare workforce to the areas that need more healthcare services, but currently have insufficient coverage. I think what [Health Minister Endang Rahayu Sedyaningsih]tries to convey to the public is she has tried in her capacity to more evenly distribute healthcare professionals in terms of coverage. With a lack of quality services, however, people still won’t use the service even though if you have good coverage. So, it should run together along these two dimensions.