Healthcare in Indonesia can be summed up in two words: organized disarray. It remains a decentralized system due to the difficulty of the country’s logistics. With over 13,000 islands covering 1.9 million km², approximately 134 million Indonesians live in remote and rural areas. On the ground floor, there are village health posts known as posyandu: these focus on providing primary care in villages and referring patients to the larger community healthcare centers called, puskesmas. With our partners, Khiri Campus student groups perform health check-ups at posyandus and puskesmas. Our groups observe, diagnose, and treat patients in distressed communities.
Village health posts rely heavily on kaders, community health volunteers, to engage with the rural communities and empower villagers to utilize modern healthcare services instead of local-homeopathic belief systems. Most health posts don’t have the equipment for inpatient care, so a big portion of their resources are devoted to preventative care. As most doctors that get stationed in rural areas do not stay there permanently, many health centers struggle to provide adequate treatment. Our local partners initially determine the root causes behind the health issues troubling their communities. Healthcare group can start assisting the local medical professionals in developing up-to-date treatment plans or continue with their current action plans.
During one of our nursing placement program in Dlingo Village, the most common issues local patients were suffering from were high blood pressure and lower back pain. We looked at each patient’s history to determine the causes responsible for their ailments. While build rapport with each villager, our groups found out that diet and lifestyle were responsible for their diseases. At the end of the program, we relayed this information to the local healthcare officers, so they could continue developing preventative programs with the local townspeople.
Even though the posyandus, village health posts, may focus on integrated health services, they still refer patients to larger district clinics, puskesmas, and regional hospitals for anything more involved, such as surgery. Many clinics must have four-wheel-drive vehicles and motorboats to provide urgent care and respond to emergencies. Each district clinic is supposed to be managed by a doctor and staffed with nurses, but only approximately 40-50% of the facilities are properly staffed. Even less puskesmas, around 12-15%, have all the necessary equipment to support an entire district.
As the kaders, the primary health care volunteers, are elected by local village committees, they often receive inadequate training to effectively fulfill their roles and duties. As volunteers, the system also has very little oversight and accountability. Health advocacy groups and various NGOs have research and data suggesting that properly trained kaders will have an immediate positive impact on rural communities.
With our future groups, we also build upon what was taught by past groups and further train the local volunteers. This will have a sustainable impact within the villages by equipping the local medical officers with more skills to address the issues that their patients struggle with. Having frameworks to develop preventative care and easily administer treatments is the most effective way to help frontline healthcare personnel in Indonesia. One previous group set up a training program for local health officers and volunteers to recommend dietary guidelines that aid in preventing high blood pressure. Afterward, they held seminars teaching massage techniques to promote circulation in patients with hypertension.
Indonesia’s lack of investment in human resources and medical equipment is due to the organizational philosophy behind public health facilities. The district health clinics, as well as the larger hospitals, must be self-supporting: it’s what Indonesians call the swadana principle. The central government only subsidizes a portion of the center’s salaries and operational costs: in the end, each center must cover the rest of their healthcare costs. As a result, these costs get transferred onto the consumer.
As the public sector was never set up to effectively manage themselves, the private sector took advantage of this market gap. This has led to making most diagnostic services and tests increasingly more expensive and financially out of reach for the poorer people in rural areas. As the private healthcare sector continues to grow bigger, nearly 66% of all medical services are now in the hands of the private medical industry.
At the local level, the volunteers remain vital to the operations of the posyandus as they offer immediate solutions to villagers. Most village health posts cannot recruit and train enough volunteers. With some officers serving as many as ten households, the level of care provided at these posyandus remain inadequate.
Our health and social care programs work with communities that do not have access to routine healthcare. Previously, we have invited the local health officers to update shared information on how to prevent malnutrition in babies and toddlers. They were challenged to creatively demonstrate how they will communicate the information to the parents in their community: the role-playing was hilarious and light-hearted.
This program is always enjoyable for our student groups, but more importantly, the local volunteers got the chance to enrich themselves and confidently push forward with their local healthcare programs through the experience. If your university is interested in our Indonesia healthcare programs, we’d love tohear from you.