Feb. 15, 2018


Prof. Dr. Nila F. Moeloek

Indonesia

Prof. Dr. Nila F. Moeloek

Minister of Health, Indonesia

"In November 2017, JKN membership has reached 183,579,086 people, and the JKN scheme had reached approximately 73% of the population."

BIO

Prof. Dr. Nila F. Moeloek is currently serving as Minister of Health, Republic of Indonesia, a position which she has been trusted to hold since 2014, when she was appointed to the Working Cabinet of President Joko Widodo. Born in Jakarta on April 11, 1949, she completed her medical education at the Faculty of Medicine, University of Indonesia, in 1974. She then pursued her medical specialty in ophthalmology, and in 2003 she earned her PhD degree in ophthalmology at the Faculty of Medicine, University of Indonesia.

How would you evaluate the implementation of the national healthcare scheme in Indonesia?

Indonesia has taken significant steps towards universal health coverage through the development of an integrated national health scheme. One in particular is the social health insurance scheme called National Health Insurance (JKN) launched in 2014. The aim of JKN is to provide all citizens with access to quality health services, including prevention, promotion, treatment, and rehabilitation, while also protecting them from health-related financial hardships. The evaluation of the implementation of JKN includes issues such as membership coverage, healthcare providers, the financial aspect, healthcare utilization, and healthcare quality improvement. Indonesia has committed to achieving universal health coverage in 2019. In November 2017, JKN membership has reached 183,579,086 people, and the JKN scheme had reached approximately 73% of the population. Of this, 59.9% are from lower-income groups, 16.1% are informal workers and the unemployed, and 24% are formal workers. JKN involves public healthcare providers—community clinics and public hospitals—and private healthcare providers—private clinics and specialist clinics, individual physician practices, and private hospitals—as they are contracted by the Healthcare and Social Security Agency (BPJS Kesehatan). As of November 2017, BPJS Kesehatan has contracted 21,771 healthcare providers across the country, consisting of 5,900 primary healthcare providers and 2,261 referral healthcare providers. In 2016, there were up to 192.9 million visits using JKN, which is an almost 100% increase compared to 2014. In 1H2017, BPJS Kesehatan reported that the number of healthcare visits under JKN reached 106.2 million, which demonstrates that JKN has succeeded in improving access to healthcare for citizens. In terms of quality improvement, the Ministry of Health has implemented a healthcare referral system to ensure that all healthcare providers have a national standard. All referral healthcare providers must be accredited by 2019 and all primary healthcare providers—public health centers—must accredited by 2021. The Ministry of Health also set national clinical practice guidelines for both primary healthcare and referral healthcare.

How has BPJS Kesehatan contributed to a more inclusive healthcare landscape?

JKN is integrating the many fragmented insurance programs and covering the poor and near poor, civil servants, military personnel, police, pensioners, state enterprises, informal workers, and private formal workers; it is ensuring that the entire population will be covered under a single national health insurance program and brings Indonesia closer to achieving universal health coverage. BPJS Kesehatan is responsible for managing the national health insurance program. It has been operating as a “single payer" across the country and its role is recruiting the members, collecting premiums, accrediting healthcare providers, making payments to contracted healthcare providers, and handling complaints. The Ministry of Health, as the regulator, is responsible for setting regulations related to the implementation of JKN. In addition, the ministry is also responsible for ensuring healthcare provider availability, including health facilities, health workforce, medical equipment, and medication, by working together with local governments and the private sector.

How do you envision the role of the ministry in attracting investment into the medical equipment and pharmaceutical sectors?

The Ministry of Health aims for Indonesia to be more self-reliant in the field of pharmaceuticals and medical devices in order to meet healthcare needs at a more affordable price. High levels of imports of pharmaceutical raw materials and medical devices may affect the cost of health services in the event of economic fluctuations at a global level. Indonesia's pharmaceutical industry is promising for both domestic players and foreign investors. The Ministry of Health aims to accelerate the development of the pharmaceutical and medical devices industry. We released an Action Plan for the Development of Pharmaceutical and Medical Device Industry that was established by Regulation of the Minister of Health in 2017. According to the Presidential Decree No. 44/2016, pharmaceutical foreign industries that produce patented medication or high technology can use up to 85% of FDI while those that produce pharma raw materials as well as high-tech medical devices can use up to 100% FDI. This investment policy is expected to attract more investment to produce pharmaceutical raw materials and high-tech medical devices as well as reduce dependence on imports. Since 2016, there have been several new foreign investments in pharma and medical devices. Furthermore, the ministry has developed certain policies to attract investors, both from local and overseas, such as accelerating the licensing service, facilitating technical regulations, and promoting local medical products through exhibitions and workshops.

How do you strive for inclusive healthcare and address public health issues given the sheer size of the country?

The geography of the country is a big challenge for us. Therefore, our strategy is to address this challenge by improving coverage and community access to comprehensive and quality healthcare services and achieving the highest levels of community health. For this purpose, we have established a system which provides a health center for every 20,000 people. At present, there are 9,274 health centers across the country. Every health center provides public health services and medical services served by a team of doctors, nurses, nutritionists, sanitarians, pharmacists, and other health professionals and administrative staff. There are between 20-30 staff in each health center. Additionally, each center has its own satellites comprising Sub-Health Centers (Puskesmas Pembantu), Village Health Posts (Poskesdes), Village Midwives (Bidan Desa) and Village Health Posts (Posyandu). As the working area of a Health Center can be very large, mobile health centers are provided for outreach activities. The mobile clinics can be in the form of vans or small boats in the case of people that live on remote islands. Currently, we are strengthening the outreach activities of health centers by introducing the Family Health Approach (PIS-PK) whereby Puskesmas staff are carrying out home visits to detect health problems in the family, controlling health risk factors of the household, and referring patients to the health center should there be any family members who get sick. Recently, we are also starting to develop “Flying Health Care" for remote areas unaccesible by land or sea. To address the the financial constraints of healthcare access we have started the Social Health Insurance Scheme (JKN) since 2014 and we are now working toward universal healthcare. With regard to primary public health issues, Indonesia is now facing the double burden of communicable diseases and increasing rates of non-communicable disease. We are also still working on improving nutritional status and environmental health status in some parts of the country. Finally, I should mention that the Ministry of Health is intensifying promotional and preventive efforts such that the burden of healthcare for curative and rehabilative efforts can be reduced and health financing can become more efficient. We do this through the “Healthy Life Style" (Germas) program, which encourages physical exercise for 30 minutes per day, enough fruit and vegetables each day, and a medical check up every six months.

How do you strive for synergies between public and private healthcare facilities?

Private investment is essential to ensure access to and quality of healthcare. In order to optimize the referral system, the Ministry of Health has assigned 14 national referral hospitals, 20 provincial referral hospitals, and 110 regional referral hospitals, all of them public hospitals. Synergies between 948 public hospitals and 1,847 private hospitals can be seen in the provision of healthcare services under JKN to achieve universal health coverage by 2019. Private hospitals contribute by increasing access to healthcare and providing more beds and specialists.

What are your primary ambitions for the healthcare sector?

Under the flagship of Healthy Indonesia Program, and in line with the President's vision and missions, we have invested those priorities in the Ministry of Health Strategic Planning Year 2015–2019. The plan includes accelerating, synergizing, and advancing preventive efforts for a healthy lifestyle using the Family Approach technique. Additionally, we encourage other sectors to support us through the Healthy Lifestyle Movement that emphasizes initiatives to improve the quality of life. We empower the central and regional governments, as well as community groups to promote a healthy lifestyle. We are also improving health access for the community, especially in term of infrastructures in remote isolated and border-line areas as well as islands

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