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Healthcare focus ‘should shift to NCDs’
The government and private sector should start working together in addressing the significantly increasing prevalence of noncommunicable diseases, an executive at the World Bank’s private-sector arm, the International Finance Corporation (IFC), has said
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span>The government and private sector should start working together in addressing the significantly increasing prevalence of noncommunicable diseases, an executive at the World Bank’s private-sector arm, the International Finance Corporation (IFC), has said.
IFC’s global head of health and education, Elena Sterlin, said governments around the world, including in Indonesia, should take the leading role in shifting the healthcare focus from communicable diseases to noncommunicable diseases, such as diabetes and cancer, which have raised serious concerns in recent years.
Indonesia has seen a growing prevalence of noninfectious chronic illnesses, as revealed by the 2018 Basic Health Research (Riskesdas) report.
According to the report, the prevalence of cancer increased to 1.8 percent in 2018 from 1.4 percent in 2013, diabetes mellitus to 8.5 percent from 6.9 percent, strokes to 10.9 percent from 7 percent and chronic kidney disease to 8.5 percent from 6.9. Adult obesity, one of the risk factors of noncommunicable diseases, has also doubled in 10 years, affecting about 20 percent of the population aged over 18.
“Treating chronic diseases is not necessarily just about building more hospitals. A lot of chronic diseases are treated with outpatient treatments. If these people have diabetes, they need to have regular monitoring [...] The most important thing is to set up outpatient clinics,” Elena said in a closed interview session in Jakarta on Friday.
She said the clinics needed to be specialized for a certain disease only, which aimed to prevent patients from entering the complication state or from being hospitalized. “Sugar clinics” emerging in foreign countries were one example, she said, referring to clinics specialized in controlling diabetes. Such specialization would also help healthcare facilities reduce their costs, Elena said.
“There needs to be a system created for ongoing diagnosis and monitoring, and then you create basic hospitals and more complex ones, so it’s more like a ‘feeder system’ [...] It’s a very nice way of channeling the patients to the right level of care,” she added.
She acknowledged that Indonesia had implemented such a system, in which the Health Care and Social Security Agency (BPJS Kesehatan) required National Health Insurance (JKN) participants to, in some cases, obtain referrals from community health centers (Puskesmas) or clinics to be eligible for hospital checkups.
Data from the Health Ministry showed that as of 2018, Indonesia had 924 private clinics with at least one specialist doctor. The data, however, did not provide details on the doctors’ specializations.
It showed that out of all 34 provinces, four did not have such clinics, namely North Maluku, Southeast Sulawesi, West Sulawesi and North Kalimantan. Thirteen provinces only have between three and nine clinics.
There were 7,917 private clinics across the country with no specialist doctors, the data revealed.
The Health Ministry’s noninfectious disease prevention and control director, Cut Putri Arianie, concurred that the private sector’s involvement in providing primary healthcare facilities should be emphasized by local administrations.
However, she noted that funding might remain a problem. BPJS Kesehatan recorded a Rp 16.5 trillion (US$1.17 billion) budget deficit in 2018, which it attributed to low premiums charged to participants.
Arianie said that so far, the government had been encouraging community-based services, called the integrated health counseling posts (Posbindu), to offer free, early checkup. Health Ministry data showed that out of 81,403 villages in the country, only 43.9 percent or 35,749 villages have offered Posbindu services.
The BPJS also required Puskesmas and clinics to conduct supervision programs for diabetes and hypertension patients, which include routine monitoring and reminding patients to do checkups through the SMS gateway.
“The most important thing is for people to adopt healthy lifestyles. The number of healthcare facilities won’t matter much if we don’t get to the source of the problem,” Arianie told The Jakarta Post on Saturday.
She said the three common risk factors of noncommunicable diseases were smoking, unhealthy diet and minimal physical activities. Cross-sector efforts would be the key to discouraging people from these factors, she added, noting for example the imposing of high excise on tobacco products as well as sugary food and drink products.
“We have required that products put information about their sugar, salt and fat content on their packaging, but some don’t comply. It’s beyond our authority […] The industry should also innovate by making less sugary products, for example, as some brands have done,” Arianie said.
