The Polemic of RUU Kesehatan: Between Inefficiency and Politicization
RUU Kesehatan is one of Indonesia’s momentum to reflect back upon the national health regulation as well as identifying aspects that needs to be improved. Picture: Unsplash
The recent “Bill of Health '' (RUU Kesehatan) was passed in the plenary meeting of DPR led by Puan Maharani on Tuesday, 11th of July 2023. It consisted of several aspects of the previous bills which merged into “The Omnibus Law'', among them are UU Nomor 4 Tahun 1984 terkait Wabah Penyakit Menular, UU Nomor 44 Tahun 2009 tentang Rumah Sakit, UU Nomor 36 Tahun 2014 tentang Tenaga Kesehatan, serta UU Nomor 20 Tahun 2013 tentang Pendidikan Kedokteran (Apa Urgensi RUU Kesehatan?, 2023). What is highlighted, stated by Health Minister of Indonesia, Budi Gunadi Sadikin was the redefinition of efforts to uphold health from treating to prevent and set it as a foundation in improving the nation’s overall health system (Ini Isi Lengkap UU Kesehatan Yang Disahkan DPR, 2023). It is meant to support the enhancement of health infrastructure and improving the delivery of public health services to address problems across the nation such as, inadequate quality of buildings and equipment across hospitals and health centers and deficit of doctors, specifically specialists. This issue has great implications that involve both health and economic sectors. One of the most noticeable changes is the enlargement of authority under Indonesia’s health ministry where most administerial decisions such as medical licenses (Surat Tanda Registrasi) are passed upon them which made their power more concentrated—allowing them to set any standards in the medical field (Kontroversi RUU Kesehatan, 2023). Formerly, the health councils are to decide whether or not a medical personnel (nakes) is fit to proceed with their medical practices that also involves “organisasi profesi” (OP) and collegiums from different kinds of medical personnel. In the new bill, both OP and collegiums have been removed from their responsibility to give out licenses since the councils are now directly responsible towards the ministry of health. The new structure is not foreign to countries like Thailand, Malaysia, and Singapore where regulation is in the hands of the government while the organization acts as the medium and facilitator to support the ministry of health (Justam, 2023).
Although the government aims to reform the health system entirely, there are points of opposition found in the creation of RUU Kesehatan. First, is the regulation towards foreign doctors or specialists as Indonesia is facing a human resource crisis in this specific sector where BPS recorded in 2022, there are only 176,100 doctors in Indonesia, including specialist and general practitioners (Jumlah Dokter Di Indonesia (2018-2022), 2022). They are allowed to enter Indonesia by going through a portfolio evaluation if they suffice the criteria given and would be allowed to start their practices without the need to possess temporary STR and Medical Practice License (SIP). Third, is the criminalization of nakes found in Pasal 462 ayat 1 which actually has the same content with the previous bill of UU No. 36 Tahun 2014 and have raised questions as to why it was sent as a complaint. Fourth is the erasure of mandatory spending where the government previously was required to allocate 5% and 10% of APBD and APBN respectively by following the suggestion of WHO from Budget Allocation for Health (MSK) measured by a country’s economic power from low, middle, to high income countries where they respectively should put aside 5,5%, 6,8%, and 8,8% from their GDP. The reason behind is due to the unproductive spending of the remaining fund from the budget as what the ministry has observed—deciding that it could be used for more urgent and impactful programs. Comparing to the neighboring countries such as Malaysia, Thailand, and Singapore, they spent 3-5% of their GDP for the health sector although Thailand had 2.2% from their overall GDP yet they managed to be anointed as one from six best countries on “Public Spending on Health for Their Given Capita”, thus explaining why they have high HDI number which could be a learning point for Indonesia that ranked 112 (Spending Targets for Health: No Magic Number, 2016).
With this weight of expectation, the Ministry of Health will face big challenges with their new owned power. Tracing back to their track record, they managed to send 1.213 specialists across the whole country through their “Wajib Kerja Dokter Spesialis” (WDKS) program in 2017 to address the human resource crisis (Menkes Bahas Keberhasilan Dan Tantangan Satu Tahun Penyelenggaraan WKDS, 2018) as well as succeeding to vaccinate 70.38% or 146.577.207 dose from 208.265.720 civilians and the number is steadily growing over time (Vaksinasi Dosis 2 Telah Mencapai 70,38% Dari Target Sasaran Vaksinasi Nasional, 2022). Although there are great achievements, critiques also came in place where Suharso Monoarfa, the Ministry of National Development Planning/Bappennas mentioned that 9 out of 10 indicators from the National Medium Term Development Plan (RPJMN) are suspected will miss its targets even though receiving MSK of 5%. One of its manifestations can be seen through Chasan Boesoirie Public Hospital, Ternate case where they were unable to pay Additional Employee Income (TPP) for 15 months for 700 PNS health workers, 200 non-PNS employees, and 20 doctors even from the 10% MSK state budget.
RUU Kesehatan is one of Indonesia’s momentum to reflect back upon the national health regulation as well as identifying aspects that needs to be improved. Seeing how complex the dynamics of drafting the bill up until its legalization were, it came to a realization of how bumpy the road is in enhancing the nation’s health sector as it is also engraved with political elements inside—considering the enlargement of authority from Kemenkes. Therefore, the public becomes weary with frequent corruption, collusion, and nepotism (KKN) that is rampant within those institutions. With the target of efficiency through ease of medical licensing and erasing mandatory spending, it seems like a far-fetched ideal as they have reversed outcomes. The promise to have more specialists should have improved the public’s well-being, especially in rural areas yet it has become more unclear with MSK being removed from the bill and would influence the quality of public health service as TPP might not be fulfilled.
References
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