Future Health Services

Indonesia as an archipelagic country with a population of more than 260 million must be able to adapt and take advantage of the opportunities as well as challenges for improving access and quality of health services. At present, Indonesia has around 15,000 first-level health facilities spread across the country, 160,000 general practitioners and specialists and 230 million residents who have been registered at the National Health Insurance (JKN) system.

Indonesia\'s maternal and infant mortality rates are 305 per 100,000 live births and 27 per 1,000 live births, respectively — still the highest in ASEAN, even though these two variables include indicators of the progress of a nation in the world. In 2019, Indonesia\'s human development index of 0.694 (including medium classification), ranked 116th along with Vietnam from 189 countries. The parameters that determine this index are the level of education and health. Therefore, the health and education sectors must be our priority.

The independence of drugs and medical devices is a major problem because 90-94 percent are still in the form of imported products. This is ironic for a large country with extraordinary wealth and biodiversity as well as ethnicities. How should Indonesia develop a national health system that is friendly, protective, productive and able to compete in the world? We must be able to manage and empower all potentials for the maximum welfare of society. Indonesia has no less than 600 ethnic groups as well as extraordinary genetic wealth, followed by the richest biodiversity in the world. This hidden treasure must be utilized for the development of research and innovation in the health sector. We should be able to provide medicines, health technology and independent treatment protocols based on the character of Indonesian people that are different from Caucasian races or other nations in the world.

At present, there are more than 3,200 universities in Indonesia, with 85 medical schools that have become incubators of science and technology and can be utilized for the development of resilience and independence in the health sector.

At present, there are more than 3,200 universities in Indonesia, with 85 medical schools that have become incubators of science and technology and can be utilized for the development of resilience and independence in the health sector.

It is time for us to lead innovations in the health sector by mapping the potential of universities in developing drug research, technology and medical devices with a focus on primary prevention efforts. Researches and innovation on developing Indonesia\'s biodiversity potential and genetic diversity enable us to be a master in its own country. About 90-95 percent of the needs of drugs and medical devices in Indonesia so far are still imported.

Data from the Trade Ministry shows that in 2014, imports of medical equipment reached US$750 million with an export value of only $165 million. The average growth of the medical device industry reaches 12.8 percent per year.

More or less the same data is seen in the drug industry. After the JKN implementation, the generic drug market in 2015 increased by 12.5 percent in value and 16 percent in real terms. Ironically, 90 percent of pharmaceutical raw materials are still imported. This shows that the structure of the pharmaceutical industry has not been optimal.

The main suppliers of Indonesia\'s pharmaceutical raw materials are China (60 percent) and India (30 percent), with an import value of around $1.3 billion. Indonesia has 11 Legal Entity State Universities (PTN-BH) that have great potential to develop knowledge-based economic regions. We must be smart to see opportunities in the midst of many shortcomings; in short, the entrepreneurship spirit.

Adaptation and adoption of technology

We must accommodate technological advances and be able to adjust to the needs of the vast Indonesian state and have a large population. Tele-medicine technology becomes a necessity for more than 17,000 islands, from Sabang to Merauke. Learn from the United Kingdom by using virtual GP technology (Now GP) on the use of a tele-medicine devices in improving access to health services. This can simultaneously reduce the level of patient lines at healthcare facilities every day. To reduce the JKN financing deficit, the use of tele-medicine in domestic products is an alternative that can be applied in health services in all regions of Indonesia.

Entering the era of disruption, the use of AI plays an equally important role in early detection of diseases. The processing of the big data on clinical and genomic things is the basis for the development of promotive and preventive models, especially for degenerative diseases, which so far require the largest proportion of costs in JKN. The government must be able to direct all research and innovation in genetics through the establishment of the Indonesian Genome Institute and Studies (INA-GENIUS) so that all universities and research institutions in our country are able to formulate simultaneously and in synergy the genetic prediction model of Indonesian patients.

AI is also useful to improve the optimization of the use of diagnostic tools in the laboratory, helping to convert doctor-patient interviews into big data that is ready to be analyzed. AI is also a basis for the development of wearable devices that are beneficial to society in terms of health promotion.

Robotics technology in the health field will immediately shift the evidence-based medicine paradigm into algorithm-based medicine that can increase speed and accuracy in the diagnostic and therapeutic fields. The combination of the use of big data, AI, robotics and internet of things (IOT) will undoubtedly have a disruptive innovation impact on the development of Indonesian health services, especially in terms of preventive medicine and precision medicine.

Fulfilling the SDG promise

The third and fifth Sustainable Development Goals (SDGs) are development in the fields of health, education and gender equality. One of the most important bases in achieving these two goals is reproductive health. The World Health Organization’s (WHO) definition of reproductive health clearly states that an individual is declared healthy if his reproductive organs and functions are good. As is stated explicitly, this explains the importance of a couple to bear offspring. Reproductive health describes the life cycle that starts from the baby in the mother\'s womb until it is born, childhood, adolescence, adulthood, old age and then death.

Family planning and reproductive health education must be done from adolescence with the aim of raising awareness of the "prospective parents" about the importance of having a picture and target to foster a healthy and prosperous family in the future. This policy must be spearheaded and led by the National Population and Family Planning Agency (BKKBN) by adopting local wisdom in every region throughout Indonesia.

In fact, the essence of family planning is that each pregnancy must be planned, prepared and maintained properly, or in ancestral language, we must prepare bibit (sperm and egg = genotype), bobot (quality) and bebet (appearance = phenotype). Government policies regarding cervical cancer vaccination and measles, mumps, rubella (MMR) need to be pushed on a wider scale to protect expectant mothers from the dangers of infectious diseases that can interfere with the growth of babies in the womb.

Thirty-five percent of healthy pregnancies are also determined by good sperm quality. Therefore, it is important to change the paradigm in reproductive health that men play a major role in the occurrence of a healthy pregnancy. The issue of gender in reproductive health is no longer the primary domain of women, but must be supported by each of the pair.

The advancement of digital technology, IoT and AI is an extraordinary potential that can be utilized to improve the quality of reproductive health services. Early detection and development of non-invasive biomarkers are believed to have a significant impact on reproductive health services. The number of cellphone users in Indonesia today (280 million) and internet users (83 million) is the basic capital for us to develop "technology-based national reproductive health program". We can make examples of simple things by requiring all secondary school female students to record their menstrual cycle and the accompanying complaints into the national reproductive health information system.

The menstrual cycle can be used to detect biological age and possible diseases of women that can interfere with the quality of pregnancy, such as disorders of egg maturation (usually characterized by irregular menstrual cycles) and brown cysts that are generally accompanied by complaints of extreme pain during menstruation. This information can be very valuable in developing a family planning program for the realization of Indonesia\'s golden generation. At present, we have the Indonesian Oocytes Calculator (IKO), developed based on data from more than 2,000 Indonesian women to predict the biological age of women, which is positively correlated with the quality of their oocytes. This calculator is available at Playstore and Apple Store, so it can help Indonesian women plan and prepare for pregnancy appropriately.

Disruptive ideas and thoughts must be translated with technological sophistication so as to facilitate access while encouraging community participation to create a healthy Indonesia and fulfill the promise of SDGs. This is in line with the concept of precision medicine, which is the four Ps — Preventive, Predictive, Personalized, and Participatory — and is believed to accelerate the healthy reproduction of Indonesia toward the golden generation in 2045.

KOMPAS/LARASWATI ARIADNE ANWAR

Budi Wiweko.

Budi Wiweko, Professor at the School of Medicine, University of Indonesia; chairman of Commission 2 of Academic Senate, University of Indonesia; deputy director of IMERI, the School of Medicine, University of Indonesia