Whom is Health Development in Papua Directed to?

Andawat – Health is one of the basic needs for people development in Papua, even though people would ignore how important health is as a result of their poor awareness of health and the way they have been conditioned with traditional health care. Here, government should be there to provide health care to the remote areas. Government provides health facilities and cares based on the need in the field.

In the light of government institution in charge of providing public health care at Distrik level (an administrative region under a regency), Community Health Center (Puskesmas) has been actively involved, compared to how Distrik government presents itself to the community. However, these efforts have not been maintened maximally as a result of lack of medical practitioners, funding and coordination with Distrik government as well as other causes.

Health problems found at remote areas are different to problems in educational sector. If in education the main problem is lack of teachers and classrooms, in health sector the problem focused on lack of medical practitioners and budget management. In other places health building facilities are already available at any level ranging from Kampong Health Post (Poskeskam), Auxiliary Community Health Center (Puskesmas Pembantu) even Community Health Center at Distrik level.

According to data from the Office of Health of Papua in 2011, there are 230 Puskesmas in 2006 and the number increased to 314 in 2011. About 700s Pustu established around 2006-2011. An increase is also seen in the number of delivery hut. 454 delivery huts in 2007 increased to 497 in 2009.

Head of Papua Office of Health, Yosep Rinta Riatmaka, during meeting with stakeholders of health and NGOs in Jayapura (6/03/2012) says increasing number of health facilities aims to get friendly health care closer to the people in 385 distriks and 3.565 kampongs in 28 Kabupatens and a city spread throughout Papua.

Unfortunately, the office noted also that 40% of the Puskesmas have operated without permanent physicians, but temporary assigned physician hired for short period. Besides, 7% of the distriks even do not have Puskesmas. 27% of Pustu operates without medical practitioners and 41% of the delivery huts do not have midwives.

As a result of the lack of medical practitioners, although good buildings have permanently been built for health care, they are not able to satisfy people’s basic needs of health. Take an example of Kampong Sekori and Kampong Aimbe, Distrik Kemtuk, Kabupaten Jayapura or Distrik Tor, Distrik Pantai Barat and Apawer Kabupaten Sarmi which have experienced the problem.

In several Pustu, there are no more than 2 medical practitioners who have to serve many people living in some kampongs. They have to travel between the kampongs which are quite far like Pustu Bupul in Kabupaten Merauke or Pustu Yuruf in Kabupaten Keerom.

Distribution of health practitioners by local office of health at times does not take into account of the real needs in the field and without appropriate qualification. For example, the distribution does not consider supplying midwives to help delivery which places shamans as priority. Government campaigns clearly oppose the use of shaman to carry the delivery since it causes higher rate in postnatal death.

Besides, government policy to locate Public Health Bachelors (SKM) at Puskesmas at times bears another problem. The bachelors theoretically are not taught about handling patients. The people would only want to know that anybody works in health care and dress in white attire can perform medical help.”If it is not taken care well, we could be in trouble with the people,”says Yulius Peday, nurse in Puskesmas Distrik Tor, Kabupaten Sarmi.

According to Nurse Welly, Senior Nurse in Kabupaten Sarmi, it is important to place those with the degree in Public Health to take care of matters pertaining to management so a physician in a Puskesmas will only work with patients.

Lack of medical practitioners can have its effect on quality of a hospital. For example, the main Puskesmas in Kota Sarmi still operates as a Puskesmas rather than a hospital because it does not have sufficient number of general physicians and medical specialists.

Beside medical practitioners, supports for health care also serve another problem. For example, in Kampong Towe Hitam, Capital of Distrik Towe, Kab Keerom, aids under Special Autonomy program such as sticky rice (beras ketan), green beans, milk, vitamins and baby foods of different brands piled up and went out of date at Puskesmas Towe. It is argued that no one available to deliver the food stuffs to the kampongs reached in 6-7 hours or 2 days.

Funds for different kinds of health care have been budgeted at Puskesmas ranging from Health Operational Funds (BOK), mobile health care from kampong to kampong, funds for medicines delivery, porter costs and Puskesmas sanitation. Office of health only take care of administrational matters and the funds should have to be rendered to Puskesmas account.

In general, there are various sources of health funds. For example, it may cover APBN (national development budget that includes BOK, DAK (Funds allotted to a regency), Social Aid Fund, Community Health Insurance and Medical Delivery Insurance) and APBD (regional development budget), beside 15% of special autonomy fund as well as DAU and PAD (Regional Gross Income). Particular funds are also provided by UNICEF to Kabupaten Jayapura and Jayawijaya and GF ATM focused on Lungs TB, Malaria and HIV/AIDS. In short, there is a significant increase in health funding every year. For example, in terms of Special Autonomy fund, 80 billion rupiahs were allocated in 2002 and it increased to 600 billion rupiahs in 2011.

Other complaint comes around limited standard transport facilities and poor distribution of transport particularly to areas hard to reach with poor road condition. For example, there is no public transport to Distrik Tor, Kab Sarmi that requires medical practitioners to hitch private company’s cars or to pay motorcyclist Rp.250 thousand for 3 hour one way trip. Puskesmas cars are often in bad condition. Puskesmas Ubrub, Kab Keerom once rented military vehicles posted nearby to bring the practitioners from City of Arso to Puskesmas Ubrub Rp. 14 million for one way trip.

Despite these conditions, the Puskesmas and Pustu still keep certain ways to ensure maximum works in health care. For example, a physician in Puskesmas Bonggo, Kab. Sarmi asks the people to actively check their health especially pregnant women. The Puskesmas pay transport costs for pregnant women. Puskesmas Bonggo work for serving 16 kampongs and there are only 4 kampongs provided with Pustu. In one side of wall of Pustu Betaf, the work hours are posted covering the whole wall size. In Genyem and Waris there is an announcement board saying “Suster ada” or “Suster sedang keluar” (Nurse in or Nurse out) in one of the windows where the nurses stay’.

Having been aware of the problems, recruitment and distribution of medical practitioners should be organized properly. This also includes responding to problems they face and accommodating their needs in the field. Besides, it is necessary to monitor and impose firm proper sanction to how transport facilities are distributed and the budget use. If necessary sea transport have to be provided to services at coastal as in the case of Kab Sarmi and Kab Yapen. Along with it, it is also necessary to review the policy on ‘flying health care’ using airplanes as planned in 2012 for 3 Distriks in Kab. Jayapura.

Since certain diseases are visibly detected to medical care such as skin diseases, malaria, respiratory infection (ISPA) and particular diseases like “kaki gajah” (elephant feet) and leprosy, it is necessary to recruit health workers and nurse specialists as what in the past was done during Dutch colonial: there is nurse specialist for malaria, kaki gajah, etc.

Moreover, it is essential to review on health fund allocation to every government health care unit at either kampong, distrik, kabupaten or province level. If these government units can not maintain their work properly, government should work together with private health cre units to assure better health care service to the people, particularly native Papuans. (Andawat/ALDP)