Interview: Nafsiah Mboi

Is health tourism a threat to local service providers?

NAFSIAH MBOI: While I know this issue has many people concerned, my priority is to ensure the quality of the health care services we have in Indonesia. These will cater to the majority, for whom health tourism is not an option. The chief focus is on addressing quality concerns across primary and secondary care and on ensuring sufficient staffing and medication. In theory, if we improve domestic care, people will remain in Indonesia to receive treatment. We are therefore urging hospitals to obtain national accreditation. At present 50-60% of hospitals are accredited, and we are proud to have 11 internationally accredited hospitals (nine private, two public), with the number increasing every year.

Indonesia’s universal health system will present an unprecedented challenge for the government in terms of quality and capacity. How can this be met?

MBOI: The system is now nearly 10 years in the making. Over the last five, we have focused on ensuring primary care by preparing manpower and equipment, and securing access to water, electricity and internet. As for doctor numbers, we are nearing the World Health Organisation (WHO) standard of 40 per 100,000 people: we currently have 38 and, with 7000 doctors graduating every year from our medical schools, will achieve that standard by the end of 2014.

My main concern, however, is not numbers but quality and distribution. At some medical schools, disappointingly, only 10% of students graduate as doctors. We have therefore developed a new law that sets standards for medical education and caps faculty intake to ensure that students get better attention. As for distribution, we are using affirmative action to provide doctors to isolated areas – a system being extended to nurses and dentists. We publicly list hospitals and clinics with shortages, and have received good responses from young medical professionals willing to serve in remote areas. Even so, there is a shortage of specialists, and our plan must focus on supplying district hospitals first.

In which areas could the domestic sector benefit most from foreign investment and knowledge?

MBOI: My immediate answer is research for the development of our medicinal and pharmaceutical industries. Indonesia has incredible biodiversity, yet we import most of the raw materials the sector uses. We should seek help from foreign experts who can help us use our plants and resources effectively for the medicines we need. Using biodiversity to serve our people is a duty.

Technical assistance and targeted investments in research and development can help us do so. We need countries with highly developed medical technology to help us develop our own. We also have the potential to increase health exports, having achieved expertise in producing medical vaccines over the last decade. By collaborating with other countries, this capacity could be significantly strengthened.

What steps is the ministry taking to address the prevalence of smoking in Indonesia?

MBOI: Fortunately, we are not alone here: many civil society organisations are already active in this area. We also now have Regulation 109 of 2012, which is helping us tackle the problem more practically. Some argue that tobacco growers will suffer, and some companies are already importing tobacco from Brazil as it is more cost effective. What I suggest is, first, that we impose high taxes on these imports, and second, that we work to improve our own tobacco production. Finally, we must open a dialogue with tobacco farmers to make them aware of other beneficial ways to use their land.

We recently did a review of the diseases that are costing the government the most money. The results were cancer, stroke, renal failure and high blood pressure – all closely related to smoking. The suffering caused by such diseases affects not only the infirm person but also their family. We are seeing increases in the levels of these non-communicable diseases, and are therefore making extensive efforts to raise awareness not only about smoking but also about healthy living.