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Jakarta Post

World Health Day: Puskesmas increasingly preferred place for medical treatment

Health matters: A doctor checks the health of a patient at Sawah Besar community health center (Puskesmas) in Central Jakarta

Sudibyo M. Wiradji (The Jakarta Post)
Jakarta
Tue, April 17, 2018

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World Health Day: Puskesmas increasingly preferred place for medical treatment

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span class="inline inline-center">Health matters: A doctor checks the health of a patient at Sawah Besar community health center (Puskesmas) in Central Jakarta.(JP/Seto Wardhana)

World Health Day is celebrated on April 17 annually across the world. This year’s celebration was themed “Universal health coverage: everyone, everywhere” with the slogan “Health for All”. To celebrate World Health Day, The Jakarta Post is running a special edition, addressing the issue of healthcare access, the Healthcare and Social Security Agency (BPJS Kesehatan) and life style-related diseases.

At dawn, when most people were getting ready for their daily activities at home, a crowd of patients swarmed a Puskesmas (community health center) in Limo subdistrict, Depok, even though the door of the center was tightly locked.

The sleepy-looking patients, some of whom were coughing and sneezing children, had to wait outside the facility ahead of time to avoid long waits.

“If I do not come much earlier, I will get a ‘high’ registration number, which means I’ll have to wait longer, maybe one or two hours or even more, before I receive medical treatment,” said Ryanto, a patient of the Puskesmas who suffered from a stomach ache.

He said he was a regular visitor to Puskesmas Limo, which is situated on the outskirts of Depok, part of the urbanized Greater Jakarta, and is easily accessible thanks to asphalt roads.

“I notice that visitors of the Puskesmas have increased in number over the last several years,” he said.

Among the new visitors are those who, in the past, had never set foot in a community health center but wanted to take advantage of the Health Care and Social Security Agency (BPJS Kesehatan) card.

Under the National Health Insurance – Healthy Indonesia (JKN-KIS) program, holders of the BPJS Kesehatan card are required to obtain a reference letter from a Puskesmas before seeking further treatment at a BPJS-affiliated hospital.

The jump in the number of visitors to Puskesmas is also a common sight in other similar medical facilities across the country, except for those located in deep hinterlands or in remote areas such as East Nusa Tenggara (NTT) and Papua, where geographic conditions, such as hills and mountains, and poor infrastructure have made health facilities difficult to access.

Indonesia is a vast country with more than 17,000 islands, so providing health care for all remains a big challenge. A case in point is the deaths of 67 children due to measles and malnutrition in Asmat regency, Papua province, in mid-January, which some consider “a jolting tragedy”.

As part of a government endeavor to improve public welfare and health, Puskesmas have been built in every subdistrict. The number of Puskesmas that provide free-of-charge medical services has continued to increase each year. Health Ministry data shows that as of 2017, the number of Puskesmas totals 9,825, compared to 9,767 in 2016 and 9,754 in 2015. Of the current 9,825 Puskesmas, 3,454 provide inpatient services.

In the past, Puskesmas were known for providing educational and preventives services, but some experts have said that there has been a slight change in focus, especially since the launch of the JKN-KIS in 2014.

Most of the centers are increasingly engaging more in handling individual health rather than carrying out their primary task to promote community health endeavors, including disease-prevention programs.

“When it comes to providing health services, the role of treating individual health and conducting community health endeavors should be balanced. But the current situation does not reflect the balanced role,” said University of Indonesia Center for Health Economics and Policy Studies (CHEPS) head Budi Hidayat as quoted by Media Indonesia.

A study by CHEPS based on the 2013-2015 National Survey on Social Issues and Economics shows that coverage in the immunization and baby’s breast milk (ASI) programs declined by 14 percent and 63 percent respectively following the launch of the JKN-KIS.

The unexpected spread of diphtheria, which was declared an “extraordinary” development in many regions, and several other diseases was partly caused by a decline in disease-prevention services at Puskesmas, according to Budi.

The challenges facing Puskesmas in carrying out its community-oriented preventive services include limited funds and operational issues. “This has been exacerbated by a lack of drugs, inadequate facilities, a lack of competent health personnel and a jump in the number of patients in need of treatment, especially since the JKN-KIS was launched, making the Puskesmas personnel “too busy” to carry out promotional and preventive programs.

“Puskesmas is the tip of the spear in performing its promotional and preventive health tasks,” he said.

He urged for concrete steps to be taken to return Puskesmas to their original role as community health providers to contain possible outbreaks of diseases caused by a lack of disease-prevention programs.

Improving service quality


BPJS Kesehatan director of law, communications and institution relations Bayu Wahyudi said he saw positive changes taking place in many Puskesmas following the launch of the JKN-KIS.

“In the past, people saw Puskesmas with one eye because Puskesmas were seen as a place for medical treatment for disadvantaged people. Now, the stereotype has slowly been fading away thanks to improved facilities and services,” he said, adding, “Puskesmas have become first-level health facilities (FKTP).”

The Indonesian Hospital Association (PERSI) highlighted the importance of ensuring the availability of physicians, specialists, health facilities and medicine in the effort to provide health care for all, including those living in remote areas.

PERSI says on its website pdpersi.co.id that it is no secret that the tough challenge facing Indonesia is the unequal distribution of physicians and specialists and lack of quality health facilities and medicine.

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