HKN or National Health Day is commemorated every November 12th. The history of this date as HKN began with a simple but meaningful event. That day, November 12, 58 years ago, President Soekarno was on his way home from Solo to Jakarta, via Adi Sutjipto Airport in Yogyakarta.
Why did he stop in Yogyakarta? He was scheduled to stop by at the home of a primary school teacher named Darsono, in Kringin Village, Kalasan Subdistrict, Sleman Regency, Special Region of Yogyakarta (DIY). He was there to instruct National Command for the Eradication of Malaria (KNPPM). After a short rest at Tirtomartani Village Hall, President Soekarno walked to Darsono’s house. The President then sprayed DDT liquid into the inner chamber wall of Darsono’s house made of gedek (woven bamboo).
DIY province was chosen as the location for the launching of the national malaria eradication command, as DIY with the Provinces of Central Java and Lampung are areas with relatively high rates of malaria. KNPPM itself was contained in Presidential Decree No. 118 of 1959 which was declared by President Soekarno a few days after it was issued.
Malaria disease transmitted by Anopheles mosquitoes at that time was the main enemy of Indonesian society. This disease caused a lot of misery and death, so if it was not eradicated nationally, said Bung Karno, “It will be able to reduce the power of nation”.
As a follow up for the Keppres and KNPPM, the State Committee for Malaria Eradication Affairs, chaired by the Minister of Health and comprised of inter-sectoral departments, such as Department of Home Affairs, Defense, Information, Sea Transportation, Finance, National Design Bureau and universities . The implementation of KNPPM was done in the regions.
Current Health Conditions
Currently, the health condition of Indonesian society is very different compared to 58 years ago. Epidemiological transition from infectious diseases to non-communicable diseases in Indonesia is significant. In the past, infectious diseases such as malaria, dengue fever, diarrhea, respiratory infection, tuberculosis, and other infectious diseases dominated the disease in Indonesia. Non-communicable diseases such as coronary heart disease, stroke, cancer and kidney failure are major health problems in Indonesia.
There are many factors regarding the issue. One of them is the lifestyle change of the community toward unhealthy lifestyle, such as smoking habit, lack of physical activity, less consumption of vegetables and fruit, and so on.
Another thing that is different from 58 years ago is the National Health Insurance (JKN). If in the past, the community paid their own fee for service, then starting in 2014 the government launched JKN program which was organized through the national health insurance mechanism which is mandatory based on Law Number 40 Year 2004 regarding National Social Security System (SJSN). The objective is to meet the basic needs of a society that is eligible to people who have paid contributions or fees paid to the government.
We must admit, since its inception in 2014, the JKN program has provided tremendous benefits to the people of Indonesia. During 2014-2016, Rp 168 trillion was spent by BPJS Health for health care costs with 416.8 million of the utilization of this JKN-KIS program.
Myriad Research Comitted survey results were special. The result shows the satisfaction index of BPJS participants reached 81%. This exceeds the government’s target of only 75%. However, the current “trending topic” is BPJS deficit that continues to swell from year to year, unresolved care provider complaints, and public complaints about the quality of BPJS services. The question arises, whether patient satisfaction can be a benchmark for assessing health services?
The World Economic Forum Competitiveness Index Report 2017-2018 shows that the quality of health care and basic education in Indonesia is in an alarming condition, being in 94th position from 137 countries. Indonesia’s health levels is far behind other ASEAN countries such as Singapore (3), Malaysia (30), Vietnam (67), and Thailand (90).
This position is indeed increased by six ratings compared to the previous year 2016-2017 (100), but had dropped 20 ratings from 2015-2016 (80). This data shows that other ASEAN countries have invested in human development appropriately, while we still have not found the right “formula”.
Human development is the most important investment of a country. History has shown, HR is the key to the state success in building its future, not from natural resources. Many countries do not have as much natural resources as Indonesia, but nowadays it is a developed country and has a better index of competitiveness from Indonesia.
It is not right if we look at the health field from the health care services alone. Health is clearly closely related to the national resilience of a nation. Will Indonesia’s health policy system decline from year to year?
It all depends on the government. At that time Soekarno’s government understood about this condition, so he himself intervened in maintaining Indonesia’s health sovereignty, what about now? (*)
Editor: Bambang Bes
*) The author, Jagaddhito Probokusumo , is a general practitioner graduated from the Faculty of Medicine, Universitas Airlangga. IDI Board member of Surabaya City , Deputy of General Secretary of External Division, Indonesian Medical Student Senate 2014/2015 , and Head of BEM FK Unair 2013.