Along with the increasingly complete infrastructure development in Papua, health services for Papuans are also getting better. We can see the improvement by the declining mortality rate in the province. What is the primary driver of the rising health services in Papua? There was a breakthrough launched by the Papua Province Government called the Kartu Papua Sehat Program.
Special Health Service only for Papuans
Health services as part of a country infrastructure have indeed received more attention from the Government of President Joko Widodo. Through the power of the Special Autonomous Region of Papua and West Papua, the Kartu Papua Sehat (KPS or Healthy Papuan Card Program) which is part of the national program of Jaminan Kesehatan Nasional (JKN or State Health Insurance) was launched. This program provides health care assistance for Orang Asli Papua (OAP or Indigenous Papuan) and reaches various regions in Papua, even in remote locations.
The main feature of this program is that all OAPs can use the services provided; even if they do not have an ID card number. Also, KPS does not set the ceiling for funds usage. This feature cannot be obtained from the JKN system of Badan Penyelenggara Jaminan Sosial (BPJS or Social Security Organizing Body) which requires an ID card number and also has a loan ceiling limit.
Different Financing Systems from BPJS
Director of the Merauke Regional General Hospital (Rumah Sakit Daerah or RSUD), dr. Nevil Muskita, explained that the Papua Healthy Card Program was a priority of the regional general hospital. This program will continue, whether there is or there is not any Papua Healthy Card fund from the Papua Provincial Government. “Health services for indigenous Papuans in Merauke Hospital will continue. [This applies] both for referral services and health services in regional hospitals,” he said.
Although there is already a budget for the Healthy Papua Card Program, the regional hospitals hope the Government can provide funds for the purchase of medicines and medical consumables. The average amount of funds provided by the Government is seven to eight billion rupiahs (USD 462,000-USD 528,000; exchange rate by October 4, 2018) every year. Of these funds, 50% is used for services while the rest is for referrals, drugs, medical consumables, and blood services specifically for OAPs.
Head of the Papua Provincial Health Office, drg. Aloysius Giyai, M.Kes., said that the service for OAPs went well. “Health services with KPS have increased dramatically in three years. From 80%, it increased to 98%, and now it is 100% in the leadership of Governor Lukas Enembe,” he said. Although his side still received reports that the services were still not evenly distributed, Giyai told that this was generally due to a lack of medicines and a referral service system.
The KPS financing system is a separate system from BPJS. It means that there is a special allocation of funds given by the Government for KPS. Although there have been attempts to integrate KPS and BPJS, the Papuan Health Office said that there are many obstacles and integration is very complicated to do. The reason is that there are still many Papuans, who live in remote areas, do not have an ID Card Number. However, the allocation of KPS funds is already sufficient to meet all the needs of hospitals in Papua.
Hundreds of Billion Rupiahs in Fund Allocation
Giyai said that the Health Service had spent a total of IDR 800 billion (USD 52,800,000) on KPS in 2014-2016. In 2016 alone, KPS received funds of IDR 300 billion (USD 19,800,000). Hundreds of billions of rupiah are used for Class III inpatient care in all hospitals and clinics in Papua. The Health Service also provides four airlines to transport patients in remote areas. “In addition to the costs of hospitalization and hospital services, KPS funds are also used to finance patient admission from remote areas using four pioneer airlines,” Giyai added.
In September 2017, the fund allocation for Jayapura Regional Hospital was IDR 70 billion (USD 4,620,000); while the funding allocation for Abepura Hospital is IDR 40 billion (USD 2,640,000) and IDR 10 billion (USD 660,000) for Abepura Regional Mental Hospital. For RSUDs in smaller districts/cities, the allocation of funds can vary from IDR 3 billion (USD 198,000) to IDR 10 billion. The size of the distribution of funds given depends on the classification of the hospital and the number of people it serves.
For patients who are tough to handle by local hospitals, referral services can help them get services at the biggest RSUD in Papua, Jayapura Hospital. If special treatment is needed, patients can be referred outside of Papua, namely to Jakarta Cipto Mangunkusumo Hospital, Makassar Wahidin Hospital, and Surabaya Dr. Soetomo Hospital.
Significant Decline in Papua’s Mortality Rate
All kinds of Provincial Government efforts to improve health services turned out to be sweet. In October 2018, Giyai mentioned a decline in the Maternal Mortality Rate, from 575 per 100,000 live births to 380 per 100,000 live births. The under-five mortality rate experienced a drastic decrease, from 54 per 1,000 live births to 13 per 1,000 live births.
Poor nutrition patients decreased from 21.6% to 7.7%. Immunization coverage increased from 57.5% to 67%. Treatment of new tuberculosis patients increases from 48% to 100%. Malaria incidence decreases from 70 cases per 1,000 people to 34 cases per 1,000 people. The number of Human Immuno Deficiency Virus (HIV) cases that took part in the Voluntary Counseling Test also increased from 3,713 cases to 4,155 cases. The use of Artemisinin-based Combination Therapy (ACT) for Malaria also reduced the cases from 142,306 to 100,410 cases.
Indonesia commits to improving the living standards of its people, especially in Papua and West Papua. The government continues to strive for easy access to various types of modern infrastructure for all people; which then increases the welfare of all Indonesians.