High Pressure, High Stakes: Why Proper Primary Health Care Is Vital in Indonesia

By Deborah Muirhead on 11:28 am Apr 10, 2013
Category Columns, Opinion
Preventative measures for high blood pressure are far cheaper than later treatment options. (Reuters Photo/Beawiharta)

Preventative measures for high blood pressure are far cheaper than later treatment options. (Reuters Photo/Beawiharta)

Sunday was World Health Day and the global theme was, appropriately, “high blood pressure.”

Rates of non-communicable diseases in Asia are rapidly rising with cardiovascular problems including high blood pressure near the top of the list.

Indonesia is no exception, with deaths due to non-communicable diseases now outweighing those from communicable diseases nearly three to two.

The 2007 Basic Health Care Survey, Riskesdas, suggested around one in three adults in Indonesia have hypertension. Problems related to hypertension in pregnancy (eclampsia and pre-eclampsia) are responsible for a high and increasing proportion of maternal death in the country.

In Indonesia, rates of NCDs are not as starkly associated with socioeconomic status as they are in many other countries, though they still affect those in higher income groups slightly more than poorer populations.

This appears to be due to similar risk behaviors across socioeconomic quintiles, including high rates of smoking — especially in men — as well as lack of balanced diet and physical exercise.

The recent Global Adult Tobacco Survey suggested 67 percent of men smoke in Indonesia (and less than 3 percent of women) despite four in five people understanding that smoking can cause serious illness.

Rates of diagnosis of hypertension, however, are low with only around one in four people having hypertension being aware of it, according to Riskesdas 2007.

The Indonesian Ministry of Health says an efficient and effective primary health care system is crucial to support improved screening, diagnosis and early treatment of hypertension.

This will in turn reduce impacts of hypertension and other NCDs on the social and economic well-being of Indonesians and the cost of health care. This is particularly important given Indonesia’s development of national health insurance scheme (Jaminan Kesehatan Nasional, or Jamkesmas), due to begin next January.

While this will signify an increased investment in health, with more people covered for health care each year, controlling rising costs of health care associated with the rapid rise in NCDs is crucial.

Protecting the health of Indonesians while controlling health care costs will necessarily include extending the coverage and quality of preventative services including health promotion, screening and early detection.

Prevention and early treatment, particularly of NCDs, is far cheaper than ongoing and often costly treatment required.

Lessons from other countries pursuing similar universal coverage goals show implementation of such schemes can cause greater increases in spending in hospitals rather than in primary care, including primary health care centers such as Puskesmas (community health centers).

Financing for broad-based preventative public health programs is generally not covered under national health schemes, necessarily based on individual care and claims. It is essential therefore that financing for public health programs is protected separately to contributions under Jamkesmas.

As well as partnerships in HIV and maternal and newborn health, the Australia-Indonesia partnership for Health Systems Strengthening aims to contribute to improved primary health systems, access and quality, particularly for poorer Indonesians.

Ensuring primary health care receives adequate financial and human resources to play its important role as gatekeeper to the rest of the health system is essential.

Ways to motivate communities to use services provided by Puskesmas, their networks and other primary health care providers, need to be considered in structuring and financing of health services.

As Indonesia embarks on reforms to a national health scheme it is important to ensure continued and increased support for public health prevention and promotion programs and to protect the important role of primary health care.

This is essential not only to meet public health goals, including prevention of high blood pressure and other non-communicable diseases, but also to guard against rapidly rising costs in the health system that can result from too great a focus on hospital-based curative care.

Deborah Muirhead is a senior health analyst at the Australian Agency for International Development (AusAID) .