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Indonesia

Assessing the Private Sector's Contribution to Improved Health Outcomes

The role of the private sector in the Indonesian health care system has grown dramatically over the past decade. Today, the majority of health care professionals engage in the delivery of both public and private services. Notwithstanding the progress made in expanding the public health care system, access to and the quality of services remain low and the poor in particular rely heavily on private-sector provision of health care systems. Despite the importance of private providers, little is known about them, where they are, and what services they provide.

Development partners came to agreement in late 2008 that a review and assessment of the private health care sector in Indonesia would make a significant contribution by identifying key issues and options for discussion. In-depth understanding of key private health care sector issues would provide information that USAID, development partners, and the Government of Indonesia could use to plan future interventions that better engage private sector health providers to achieve health sector goals and objectives. USAID/Indonesia is particularly interested in using the private sector assessment to inform the Mission’s future strategic planning to improve MCH services and to prevent and control infectious diseases in Indonesia.

Health Systems 20/20, with support from the Strengthening Pharmaceutical Systems and Private Sector Partnerships-One projects, conducted a desk review and in-country assessment to summarize what is currently known about the private health sector in Indonesia and develop recommendations for interventions that could strengthen the role private health care providers can play in achieving health sector objectives. The assessment concluded that if Indonesia is to achieve its priority health objectives, more attention must be paid to engage private sector providers.

To improve the quality of private providers and to ensure that they contribute to priority health objectives, general recommendations of the assessment included:

• Improve district and province capacity to manage an integrated public-private health system
• Through existing financing schemes, adjust payment policies to provide financial incentives for providers to improve quality and adhere to standards
• Create partnerships with private sector to address public health priorities such as MCH, TB, and malaria
• Support independent oversight boards and consumer education initiatives
• Support the NGOs that are new recipients of Global Fund grants
• Revitalize and support promotion of high quality branded generics

In line with USAID/Indonesia’s current health strategy, the assessment team offered three options for potential programs to strengthen MCH services and control of infectious diseases:

1) INTEGRATED APPROACH TO IMPROVE MCH SERVICES – There is significant potential to improve the quality of MCH services, and thereby reduce maternal mortality, with a multi-component approach including creating financial incentives through public insurance schemes to follow treatment protocols, strengthening districts to engage with private midwives and hospitals to improve MCH, supporting independent oversight boards, and working with the Indonesian Midwives Association (IBI) to ensure the quality of the Bidan Delima network of private sector midwives.

2) COLLABORATION WITH THE PRIVATE SECTOR IN TB CONTROL – Given the data on health-seeking behavior, the first health professional in contact with TB patients may well be the local pharmacist or drugseller. The TB program could be strengthened significantly through a three-pronged intervention that includes training for private pharmacists and drugsellers to improve quality of case detection and treatment, creating incentives for these providers to follow standard protocols for detection, diagnosis, and treatment, complemented by stronger coordination between district health officials and the national TB program.

3) SUPPORT NEW GFATM RECIPIENTS TO CONTROL INFECTIOUS DISEASES – Several local faith-based and non-governmental service delivery organizations will soon become new Global Fund recipients for TB, HIV/AIDS, and malaria, respectively. Supporting these organizations to successfully manage, monitor, and evaluate their Global Fund grants would represent big improvements in these programs. Improvements in management capacity would not only benefit the Global Fund funded programs, but would have benefits for the overall organization bringing improved efficiency in service delivery.