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Health facilities at the district level in Indonesia

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At Independence the Government of Indonesia inherited a weak and unevenly distributed health system to which much of the population had only limited access. In response, the government decided to increase the number of facilities and to locate them closer to the people. To staff these health facilities the government introduced obligatory government service for all new graduates in medicine, nursing and midwifery. Most of these staff also established private practices in the areas in which they were located. The health information system contains little information on the health care facilities established for private practice by these staff. This article reports on the results of enumerating all health facilities in 15 districts in Java. Methods We enumerated all healthcare facilities, public and private, by type in each of 15 districts in Java. Results The enumeration showed a much higher number of healthcare facilities in each district than is shown in most reports and in the health information system which concentrates on public, multi-provider facilities. Across the 15 districts: 86% of facilities were solo-provider facilities for outpatient services; 13% were multi-provider facilities for outpatient services; and 1% were multi-provider facilities offering both outpatient and inpatient services. Conclusion The relatively good distribution of health facilities in Indonesia was achieved through establishing public health centers at the sub-district level and staffing them through a system of compulsory service for doctors, nurses and midwives. Subsequently, these public sector staff also established solo-provider facilities for their own private practice; these solo-provider facilities, of which those for nurses are almost half, comprise the largest category of outpatient care facilities, most are not included in official statistics. Now that Indonesia no longer has mandatory service for newly graduated doctors, nurses and midwives, it will have difficulty maintaining the distribution of facilities and providers established through the 1980s. The current challenge is to envision a new health system that responds to the changing disease patterns as well as the changes in distribution of health facilities.

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Published by
Published 01 January 2009
Reads 6
Language English
Australia and New Zealand Health Policy
Research Health facilities at the district level in Indonesia †1 †2 Peter Heywood*and Nida P Harahap
BioMedCentral
Open Access
1 2 Address: MenziesCentre for Health Policy, University of Sydney, NSW, Australia andJalan Bukit Dago Selatan, Bandung. West Java Province, Indonesia Email: Peter Heywood*  pfheywood@gmail.com; Nida P Harahap  nidaph@bdg.centrin.net.id * Corresponding author†Equal contributors
Published: 18 May 2009Received: 16 December 2008 Accepted: 18 May 2009 Australia and New Zealand Health Policy2009,6:13 doi:10.1186/1743-8462-6-13 This article is available from: http://www.anzhealthpolicy.com/content/6/1/13 © 2009 Heywood and Harahap; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background:At Independence the Government of Indonesia inherited a weak and unevenly distributed health system to which much of the population had only limited access. In response, the government decided to increase the number of facilities and to locate them closer to the people. To staff these health facilities the government introduced obligatory government service for all new graduates in medicine, nursing and midwifery. Most of these staff also established private practices in the areas in which they were located. The health information system contains little information on the health care facilities established for private practice by these staff. This article reports on the results of enumerating all health facilities in 15 districts in Java. Methods:We enumerated all healthcare facilities, public and private, by type in each of 15 districts in Java. Results:The enumeration showed a much higher number of healthcare facilities in each district than is shown in most reports and in the health information system which concentrates on public, multi-provider facilities. Across the 15 districts: 86% of facilities were solo-provider facilities for outpatient services; 13% were multi-provider facilities for outpatient services; and 1% were multi-provider facilities offering both outpatient and inpatient services. Conclusion:The relatively good distribution of health facilities in Indonesia was achieved through establishing public health centers at the sub-district level and staffing them through a system of compulsory service for doctors, nurses and midwives. Subsequently, these public sector staff also established solo-provider facilities for their own private practice; these solo-provider facilities, of which those for nurses are almost half, comprise the largest category of outpatient care facilities, most are not included in official statistics. Now that Indonesia no longer has mandatory service for newly graduated doctors, nurses and midwives, it will have difficulty maintaining the distribution of facilities and providers established through the 1980s. The current challenge is to envision a new health system that responds to the changing disease patterns as well as the changes in distribution of health facilities.
Background At Independence the Government of Indonesia inherited a weak and unevenly distributed health system to which
much of the population had only limited access. In response, the government decided to increase the number of facilities and to locate them closer to the people. In
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