Prevention the best medicine for Jokowi

Shortly after his inauguration on Oct. 20, president-elect Joko "Jokowi" Widodo will have to deal with the many health problems besetting Indonesia, one of the largest archipelagic countries in the world and home to 250 million people.

First, there is the problem of the unequal distribution of health workers between Java and the rest of the country. According to Health Ministry data, there were 95,976 registered doctors in the country as of March 2014, but sadly none of them were available for assignment at the 938 community health centers (Puskesmas) located outside of Java. Worse, of nearly 9,600 Puskesmas nationwide, 30.8 percent of them have no sanitarian, 30.2 percent have no dietician and 55 percent are without a laboratory analyst.

Second, there is a high prevalence of preventable diseases, including malaria. Although the incidence of malaria has already declined from 2.9 percent in 2007 to 1.9 percent in 2013, the number of cases remains high in several provinces. As of 2010, malaria-prone regions were West Nusa Tenggara with 20 cases per 1,000 citizens, East Nusa Tenggara with 20-50 and Maluku and Papua with over 50.

Preventable diseases are not just seen in rural areas. Jakarta is also struggling to eradicate preventable diseases, especially dengue hemorrhagic fever (DHF). The capital city is the region with the second-highest dengue prevalence rate with 220 per 100,000 people.

Degenerative diseases are also rising in number. Health Ministry data said that the mortality rate from degenerative diseases had climbed from 49.9 percent in 2001 to 59.5 percent in 2007. Common life-threatening degenerative diseases are stroke, hypertension, diabetes and cancer.

For people with degenerative diseases, curative treatments take a long time and incur high costs. For the government, it will require a bigger health budget, as the majority of patients come from low-income families, which means that their health expenditures must be covered by the government.

Considering disease incidence rates and the budget needed to cure illnesses, Jokowi's government's health program should prioritize prevention. People need to adopt healthy lifestyles and the government could help promote healthy lifestyles by transforming parks into comfortable places to jog, revamping slum areas, increasing taxes imposed on fast food and cigarettes, tightening non-smoking regulations and promoting health screenings for high-risk people.

According to the 2013 National Basic Health Survey, 36 percent of Indonesians smoke, with most of them in the early productive age of 15-19 years old. The survey also found only 26 percent of Indonesians regularly exercised.

With the rise of degenerative and preventable infectious diseases, Indonesia needs more preventive health programs. One solution would be for the government to widen the role of general physicians in Puskesmas by appointing them as family doctors who take care of several families in an area and receive government grants to implement preventive programs at the health centers.

Such a program would allow family doctors to reach out to the grass roots to implement a variety of preventive measures such as immunizations, health screenings and environmental health.

With regard to healthcare costs, all Indonesians should join a health insurance program. President Susilo Bambang Yudhoyono launched social security insurance for all under the Social Security Management Agency (BPJS) earlier this year and his successor Jokowi should follow up and improve it through his Indonesian health card program.

To boost prevention and strengthen BPJS coverage, Jokowi needs to raise the health budget from the current Rp 70 trillion (US$5.78 billion) per year, or 3.7 percent of the total budget. The Health Law mandates that the health budget should account for at least 5 percent of the total budget.

According to the World Health Organization (WHO), 22 of 36 low-income nations allocate 11 percent of their national budget to the health sector.

Jokowi is therefore right to ask the provinces to help the central government meet the minimum health budget and increase the equity of the BPJS.

The current health budget for preventive measures has been set at only Rp 150 billion, which is far lower than curative health spending. Indonesians are waiting for Jokowi to change the orientation of national health care toward prevention, which would not only improve the health standards of Indonesians but also control health spending.

As Jokowi once stated, Indonesia should have a self-supporting economy that provides its people with their basic needs, including education and health. We hope Jokowi fulfills his promises.

source: http://www.thejakartapost.com