Symbols of medical field, lab coat and stethoscope. (Photo: By Courtesy)
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The era of Asian Free Trade Area (AFTA) has commenced. South East Asian countries are going to have a trade liberalization. One of the points from AFTA is that ASEAN Economic Community (AEC) to conduct liberation in the field of services.

In health, there will be three professions to be liberated, doctors, dentists and nurses. People are worried that the field of services will follow the market mechanism and Indonesia trapped in this situation as our workforce quality is not very competitive.

The participation of Indonesia in AFTA has forced the country to follow the market mechanism in the field of services. The competition becomes fiercer. High quality service will dominate the market. Weak competitions will not last and left behind. Indonesian healthcare service is threatened by other competitions such as Singapore, Malaysia and Thailand.

The quality and quantity of Indonesian healthcare service still needs improvements. The ratio of medical specialists in Indonesia is lower than other ASEAN countries. It can be seen from many middle-class men to get treatments abroad. Our country’s healthcare services are not ready for the competition with ASEAN countries.

There are other challenges faced by the Indonesian healthcare service. What are they? Communication and coordination among elements is not very good. The implementation is also poorly executed. The healthcare achievement is then lower than expected.

Curative treatment also dominates over preventive one and the uneven doctor distribution even causes new challenges on the growing cases of infectious diseases and diseases from unhealthy lifestyles.

In the upstream, medical education also has important roles. Unfortunately, this education has not been fully supported by the government. It should produce more complete doctors, but it is still stained with commercialization practice.

The latest case, education process in Faculty of Medicine Universitas Papua (Unipa) has finally reopened after ten months closed for the lack of fund.  The re-opening was done after an agreement on the education development in Ministry of Research, Technology and Higher Education between the government of West Papua, UNipa and Indonesia University on July 25, 2017.

Prior to the re-opening, 102 FK Unipa students since October 2016 have not been able to continue their study because there was no funds from Sorong government to invite lecturers from UI.  Moreover, there are more Faculty of Medicine establishment by Ministry of Research, Technology and Higher Education without going through assessment of evaluation team.

Even students of FK Universitas Bosowa, Sulawesi Selatan, which was established in 2016 had to conduct their study in Faculty of Medicine Universitas Airlangga, not in their own place.

The medical education quality is uneven or it is still low. It was marked by only 17 of 83 Medicine programs accredited A.

The low quality of education will affect to the readiness of doctors to compete in AFTA. Those problems were caused by the lack of communication, coordination and implementation between stakeholders in healthcare service.

We cannot only blame the doctors and Ministry of Health. I calculated that at least there are 20 stakeholders or more involved in this healthcare services, such as doctors, dentists, nurses, midwives, IDI, KKI, DPR, KKI, BPJS, Kemenristekdikti, Pemprov, Pemkot, BPK, KPK, BPOM, Jaksa, Polri, media also patients. They are all the stakeholders and communication, coordination, implementation monitoring are needed from them.

Therefore, the government should reform the medical education and improve the technology based quality. The reformation should cover financing strategy, student admission and distribution of graduates so doctors can be an important factor of national security once again.

It is very important as health is a part of national security and we cannot just let it follow the market mechanism. Financing should be given entirely to the government. Students should no longer be burdened with costly tuition fees.

The admission should be even tighter, so the students selected really have the quality. The government must also distribute the doctors to the regions which really need them. Those three strategies are expected to improve the quality of doctors and fulfill the need for independent healthcare service.

The technology based medicine mastery should be also improved. It will improve the quality of healthcare service so the people trust to domestic healthcare service will improve.

The effort to improve the technology mastery is made by sending medical staffs abroad to study or inviting the experts to share knowledge. The government should lead the effort by improving the policy on sophisticated devices, the infrastructure and incentives for the science and technology development. (*)

*) Author is a doctor graduated from FK UNAIR, Official of IDI Surabaya 2017-2020. He has been the Vice President External of Indonesian Medical Student Senate Association (ISMKI) 2014 and Head of Student Executive Board (BEM) Faculty of Medicine UNAIR 2013. He can be contacted

Editor: Bambang Bes

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Media komunikasi dan informasi seputar kampus Universitas Airlangga (Unair).