On strategies employed during the Covid-19 pandemic and adaptations for the future of health care
What were the main challenges your organisation encountered in scaling up treatment facilities for Covid-19 at public hospitals, and how were they overcome?
FATHEMA DJAN RACHMAT: Covid-19 is a health crisis like no country has experienced before, and for which no country had a well-established mitigation or response plan – including Indonesia. We first aimed to understand the behaviour of the virus and then promptly develop strategies to prevent its spread, while also identifying effective solutions for patients. Collaboration was key in enabling us to overcome the challenges we faced throughout the process.
To understand the nature of the virus, we established 18 polymerase chain reaction labs across Indonesia, with 14 in public hospitals. We worked with other state-owned enterprises (SOEs) to procure sufficient medical equipment to meet potential demand, and collaborated with top Indonesian universities such as the University of Indonesia and Airlangga University to recruit and train lab analysts. All laboratories were operational by May 2020 and have conducted over 200,000 tests in total, with 3000-4000 tests conducted daily.
In addition, we installed a dedicated Covid-19 wing in all public hospitals and allocated the wing a specified portion of the hospital’s non-ICU beds. Meanwhile, we built our first modular hospital dedicated to Covid-19 that housed around 160 beds. This provided a steep learning curve on the treatment of critical Covid-19 patients. We then shared the knowledge we gained across all of our hospitals.
How did collaboration between public hospitals and private telemedicine firms boost the response to Covid-19, and in which ways do you expect this relationship to evolve in the future?
RACHMAT: Our policy during the Covid-19 period is that patients should minimise going to appointments in person unless it is absolutely necessary. Even outside times of crisis, telemedicine is a key tool to alleviate pressure on the health system and provide health services to communities. We provide our own telemedicine service using video-conferencing technologies such as Zoom, and have also begun to explore collaborate with private telemedicine firms. One example of this is Halodoc: we provide Covid-19 test services to their subscribers and, in turn, we use their platform to offer our services to the public.
These partnerships could continue to play an important role after the pandemic has subsided. We expect that patients will continue to minimise physical interaction with doctors over safety concerns, and this market will be captured through telemedicine systems developed either by SOEs or private firms. These platforms can provide additional services as well, such as educating patients on their medication.
However, Indonesia has a unique health operating environment that could slow growth in this area. The current legal framework regulates a number of key operations: how medical records can be kept and by whom; who can provide consultation or medical services; and how drugs can be procured for patients. Private telemedicine firms will therefore need to collaborate with hospitals in order to deliver the services expected by patients.
Telemedicine continues to deliver benefits beyond patient consultation and related services. Technological advancement can enable the sharing of expertise among medical professionals, which can be particularly important to staff in remote areas who may not have a robust team of medical specialists or technicians. We expect these services to play a greater role as we move towards increased digitalisation as part of the national Health Care 4.0 strategy.
To what extent has the Covid-19 pandemic influenced your future vision for Health Care 4.0 and digital health services in Indonesia?
RACHMAT: Integrating technological innovation into our systems – including cloud services for the secure storage of patient data – was already part of our IT roadmap before the pandemic. We expect that Covid-19 will accelerate the realisation of these digital services as part of Health Care 4.0 in Indonesia. Crucially, the pandemic period has shifted consumer behaviour: many Indonesians now rely on digital services for health care. However, this has only helped to kick-start the early stages of implementation.
There remains much more work to be done, particularly in terms of integrating big data and a relevant security framework; adopting and implementing the internet of things for digital health services; and developing a lean management approach, while also changing public behaviour to align with digitalisation. Driving progress in this area could help to offset the rising costs of health care and therefore play a key role in Indonesia’s economic growth.