Health Minister: Emphasize Promotion and Prevention

KOMPAS/LASTI KURNIA

Health Minister Terawan Agus Putranto

JAKARTA, KOMPAS — Public health plays a crucial part in the development of human resources. This has prompted the government of President Joko “Jokowi” Widodo and Vice President Ma\'ruf Amin to push for an overall improvement of the health system in Indonesia.

In addition to reforming the National Health Insurance system, the President also wants a significant reduction in the rate of stunting, which is marked by a child\'s height being lower than normal due to malnutrition, as well as reducing maternal and infant mortality rates. The following is an interview by Kompas daily with Health Minister Terawan Agus Putranto at the Health Ministry Office in Jakarta on Tuesday (26/11/2019).

What are the health development priorities for the President?

Bapak President\'s vision and mission is to prepare superior human resources for an advanced Indonesia in 2045. In the health sector, the emphasis is on overcoming problems of the Health Care and Social Security Agency (BPJS Kesehatan), stunting, high rates of maternal and infant mortality as well as high drug prices and [the low] use of domestically produced medical devices.

According to you, what are the basic problems in health care development?

I see the health situation in Indonesia as a workable opportunity, and that motivates me. If we see it as a problem, then we will be dispirited. For example, if the BPJS Kesehatan’s deficit can be overcome, health services will automatically improve. Another opportunity concerns stunting. Many areas have not been well covered, this is my chance to check on the regions to identify shortcomings, whether the problem is related to the availability of food, spending capacity or a lack of education. Each region has its own local wisdom, so there is an opportunity to solve it.

Kompas/Heru Sri Kumoro

Health Minister Terawan Agus Putranto

Indonesia faces a double burden of infectious and noncommunicable diseases. What steps will you take?

Infectious diseases are threats of newly emerging or reemerging diseases. Based on Presidential Instruction (Inpres) No. 4 of 2019 on national health resilience, it is [tackled] through detection, handling and surveillance. All ministries have authorities.

Other than lifestyle issues, noncommunicable diseases are also related to knowledge. The most important thing is promotive and preventive measures; educating the public on preventing noncommunicable diseases, for example, by not consuming excessive sugar or salt. Prevention and promotion are badly needed to maintain health, especially to prevent noncommunicable diseases.

Extraordinary savings can be achieved if preventive and promotive efforts are increased. Therefore, those in charge of the first-level health facilities (FKTP) must be willing to go down to the community.

If the community health centers (Puskesmas) continue to pursue preventive and promotive measures, [the need for] curative action will diminish and residents will become healthier. With rising preventive and promotive measures, curative services at healthcare centers go down automatically. Extraordinary savings can be achieved if preventive and promotive efforts are increased. Therefore, those in charge of the first-level health facilities (FKTP) must be willing to go down to the community.

What are the challenges in dealing with stunting?

The biggest challenge is related to education. There is a matter of parenting, starting from preparing for pregnancy until the child is born. It needs good education and it takes time. The problem of stunting is also faced in urban areas, because both parents work for a living so that sometimes the child is not well looked after.

Kompas

Health Minister Terawan Agus Putranto

What are the strategies to dealing with stunting?

We want to reduce the stunting rate to below 20 percent. The method is through direct intervention by the Health Ministry and indirect intervention by other ministries. The Health Ministry can only influence 30 percent, while 70 percent [is to be done] by other ministries and institutions, such as environmental sanitation matters under the Public Works and Housing Ministry; then, the National Population and Family Planning Board (BKKBN) implements the Prosperous Family Card program. Puskesmas and integrated health service posts (Posyandu) are mobilized, and they are owned by the regional governments.

How to reduce the maternal mortality rate?

Looking at the BPJS Kesehatan report, the ratio of normal childbirth and cesarean section is 45 percent, higher than the WHO limit, 20 percent. This means that the high maternal mortality rate is not a matter of medical treatment, but support for pregnant women is not utilized optimally and antenatal care is not optimal. This is the role of the Puskesmas to reach pregnant women in the early stage.

How to overcome the BPJS Kesehatan deficit?

Increasing participants’ premiums only adds to BPJS Kesehatan revenue. If the leak is bigger, it will be the same. Leakage is seen from the excessive use of services or [treatment] not in accordance with the diagnosis. That must be addressed.

How about traditional medical treatment?

I used to constantly resort to kerokan (rubbing an oiled coin over the skin repeatedly until it turns bright red) and consume herbs, and I am healthy until now. If the risk is low, there is no need for regulation (medical proof).

How to maintain harmonious relations with professional medical organizations?

We are bound by a doctor\'s oath that fellow doctors are siblings. If the siblings are sometimes involved in a quarrel, that happens peacefully. Now I understand the will (of the Indonesian Doctors Association), so I have the opportunity to develop national health care for the community. (TAN/EVY)