Bold and Initiating Collaboration

One of the reasons for ibu Naf’s popularity is her boldness to voice her views and make decisions. Her courage was also noticeable in the control of HIV, the field of health she has dedicated herself to for three decades

Kompas

Nafsiah Mboi

Nafsiah Mboi remains very active at her age; she will be 81 on July 14. She is a prolific speaker at online discussions and examines the latest health data to provide her expert advice to various stakeholders.

“I keep learning, following WhatsApp groups of young members with their fresh ideas. I favor evidence-based medicine,” Nafsiah said at an online conversation on Tuesday (15/6/2021).

The presence of Nafsiah at health meeting forums, offline as well as online, is always warmly welcomed by their audiences. Nafsiah, who is rarely without her smile, has been a teacher for many health workers. The hard work and innovations made by the former civil servant, activist and minister are sources of inspiration, including her persistent effort to control HIV in Indonesia in the last 30 years. Her performance earned her the 2021 Dedicated Intellectual Award from Kompas.

I keep learning, following WhatsApp groups of young members with their fresh ideas. I favor evidence-based medicine

She served as a doctor in Ende, Flores, East Nusa Tenggara (NTT), from 1964 until her retirement in 1997 before reaching a career peak as health minister in 2012-2014.

The journey of ibu Naf — as she is called by her peers — in the health sector began after she graduated from the University of Indonesia’s School of Medicine (FKUI) in 1964 and she was assigned to Ende as the first female doctor in the region. Her (late) husband, Brig. Gen (ret.) Benedictus Mboi MPH, became a regency doctor in Ende and Manggarai.

After working for three years, Nafsiah wanted to continue her study to become a specialist. Noticing that women in Ende preferred to be examined by a female doctor, she wished to study gynecology and obstetrics.

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However, she was not allowed to specialize in gynecology and obstetrics.

“There were many excuses. They said I wouldn’t be strong enough and couldn’t work on call. That’s all nonsense,” she said.

Finally, she studied pediatrics at FKUI, graduating in 1971 and majoring in child health at Rijksuniversiteit, Gent, Belgium, which she completed in 1972.

As a pediatrician, ibu Naf returned to NTT and finished her assignment in 1975. She further dedicated herself to NTT when her husband was elected governor of the province, a post he maintained from 1978 to 1988.

KOMPAS/PRAYOGI DWI SULISTYO

Nafsiah Mboi

At the time, she was actively involved in women’s empowerment. As the governor’s spouse, she was obliged to support his working program for the relief of poverty. She focused on the control of children’s diseases related to poverty.

“The provincial budget was very small. The people were very poor and health services were only curative. There was no drug supply,” she noted.

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Under such limitations, ibu Naf collaborated with various parties to start a campaign about health and disease prevention, particularly malaria, respiratory infection and diarrhea. NTT elders worked as motivators in local communities. A limited immunization program got a boost and mandatory immunization coverage reached 97 percent.

To be a good doctor, Nafsiah learned many things from her late husband. She said her husband had a humanistic approach and remarkable communication skills. He was able to communicate to the public as well as then-president Suharto. The skill was useful to persuade and convince various parties about important health issues.

“I met my future spouse at FKUI. He was chairman of the committee for new students, a kind man with a soft voice. Our families initially did not approve of our relationship because we come from different ethnic groups and religions. We broke up a thousand times but reconciled another thousand times. We shared the same feeling,” recalled ibu Naf.

Health development

In her view, health development in Indonesia from 1990 to 2019 made considerable progress. Life expectancy increased, infant and maternity death rates decreased. The healthcare system was also better arranged and now Indonesia even have a national health insurance program with 224 million participants.

Yet the epidemiologic transition in which noninfectious diseases were the dominant cause of mortality aroused her concern. Although the population’s life expectancy is higher, the rate of healthy life expectancy is worrying.

KOMPAS/AYU PRATIWI

Nafsiah Mboi

In 1990, Indonesia’s life expectancy rate (AHH) was 69.4 years while its healthy life expectancy rate (AHHS) was listed as 61.2 years. The gap between the AHH and AHHS widened in 2019, with the AHH reaching 73.5 years and AHHS 62.9 years. The disparity of quality of life and access to health service between regions was very steep.

Her interest in disease load data analysis made ibu Naf actively become engaged as a board member of the Institute for Health Metrics Evaluation (IHME) at the University of Washington in the United States.

She has also been requested to fill advisory council or consultative council positions by many organizations.

Bold

One of the reasons for ibu Naf’s popularity is her boldness to voice her views and make decisions. On tobacco control, for instance, she argued with tobacco farmers’ organizations and emphasized that cigarettes were hazardous and their production and distribution should be controlled.

Her courage was also noticeable in the control of HIV, the field of health she has dedicated herself to for three decades. Her expertise in this infectious disease began when she met with professor of epidemiology Jonathan Max Mann, when she was a research fellow at Harvard University.

“I had no precise idea of HIV at first and finally I was interested after meeting with the HIV program boss, Jonathan Mann,” Nafsiah said.

She also had the opportunity to study non-discriminative health policy formulation in Australia. The experience prompted ibu Naf to find a suitable formula to deal with HIV in Indonesia.

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Nafsiah’s boldness was evident when she offered free sterile syringes and methadone therapy to users of narcotic injections when she was secretary of the National AIDS Control Commission. It was a controversial decision at the time.

“Many people were afraid to handle this disease,” she said.

Her ability to collaborate with many parties, including high-risk groups, who are often overlooked in the control of HIV, also proves that her approach is uncommon in the country. But the approach has continued to be effective.

“HIV will remain a threat as long as the moral approach is given priority over public health,” she added.

Nafsiah Mboi

Born: Sengkang, South Sulawesi, July 14, 1940

Children: Three

Education:

- School of Medicine, University of Indonesia (FKUI), 1964

- Medical Specialist, FKUI, 1971

- Master of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium, 1990

Awards include:

- Ramon Magsaysay Foundation Award for Government Service from Magsaysay Foundation, Philippines (1986)

- Dedicated Intellectual Award, Kompas 2021

This article was translated by Aris Prawira