Turbulence of the 2023 Health Program
Like a ship, the health sector will enter an area of turbulence. Health programs face the risk of slowing progress or stagnation. Program targets may not be fully achieved.
The gloomy condition of the global economy in 2023 could have an impact on national health programs. Indonesia health scene faces many big challenges in 2023.
The International Monetary Fund predicts global growth will weaken to just 2.7 percent in 2023, or even 1 percent. More than 30 countries are predicted to go into recession.
The health aspect is closely related to the economic aspect. There are concerns that this gloomy global outlook will disrupt the climate for health development, including in Indonesia. Various tough challenges stand in the way and have the potential to make health programs stagnate, even fail.
Crucial challenges
At least three major challenges will face Indonesian health in 2023. The first is limited pandemic funding. Pandemic funding is a determining factor in the success of health development because of the pandemic's link to various health issues.
For 2023, the government has allocated a health budget of Rp 170 trillion, down 20 percent from Rp 218 trillion in 2022. The reason for the decline is that the government no longer allocates a budget for the Covid-19 pandemic, whereas previously the Covid-19 budget was Rp 116 trillion. This is surprising. Pandemic funds have been eliminated, even though the world is still struggling with Covid-19 and WHO has not announced the end of the pandemic.
Indeed, after the peak of Omicron in December 2021, global case and death rates have greatly declined. Vaccination coverage has also been very broad. A number of countries have carried out maximum relaxation, including no longer requiring face masks, PCR checks or rapid antigen tests (RAT) when attending events. Even Qatar, at the World Cup with millions of spectators, no longer required people to wear face masks or undergo Covid-19 checks. This maximum relaxation gives a gesture as if the panic has passed or is coming to an end.
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In fact, this is not the case. Although globally the pandemic situation has improved, a number of countries are still struggling with high levels of cases and deaths. In the US, there are still more than 100,000 cases every day. At the same time, there are concerns that the current improvement in the Covid-19 profile is not entirely real.
The reason is that with the maximum relaxation carried out in a number of countries, detection and tracing efforts have been greatly reduced. Many people who have flu-like symptoms are no longer tested for Covid-19 status. It is considered a common cold and is immediately given flu medicines.
Even if tested, the method used is generally only RAT, which has limited sensitivity and specificity. This means that many Covid-19 cases go undetected. Not to mention the reluctance of people to seek medical treatment when suffering flu-like symptoms. Simply put, the numbers are potentially underreported.
Some experts believe that in 2023 it is likely that Covid-19 will not disappear, including in Indonesia. The most optimistic scenario is that the pandemic transforms into an endemic. Covid-19 still exists even though its magnitude is not as large as the pandemic. The decline in the number of cases and deaths does not mean that the load of disease has subsided. The pandemic will metamorphose into an endemic and automatically change the Covid-19 load from pandemic load to endemic load.
In endemic load, specific and serious management is still needed so that the endemic does not grow to peak or become a pandemic again. The programs needed during this endemic phase are various, including procuring regular vaccines, both self-produced and imported, and injecting them. This program certainly requires adequate funding.
Without adequate funding, endemic transformation and its management will not run smoothly. The omission of pandemic funds when a pandemic has not really ended is overconfidence and can pose a serious risk to health programs.
Second is the sequelae of the pandemic. The handling of the pandemic has had serious side effects on other health problems. The war and concentration against the pandemic for two years had to "forget for a moment" other health problems. This sparked a reemergence of health problems that were already under control.
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Since the pandemic, basic immunization coverage has dropped from 84.2 percent to 79.6 percent, even though the target is 93 percent. During the pandemic, more than 1.7 million babies have not received basic immunizations. If this deficiency is not immediately remedied, there could be an increase in cases of infection in children and a double load on health.
The pandemic caused a delay in achieving thestunting target. In the last few years, the prevalence of stunting has only decreased by 3.3 percent from 27.7 percent to 24.4 percent. At the end of 2021, the prevalence was still 24.4 percent, even though the 2024 target is 14 percent. It's not easy dropping 10 percent in two years.
In 2021, the number of tuberculosis cases in Indonesia exceeded 800,000 with more than 90,000 deaths. Only 270,000 tuberculosis cases were discovered in 2020, even though cases that year were estimated at more than 840,000.
These issues are basic health program issues which are important indicators of health achievement. Some of these issues are also targets for the Sustainable Development Goals (SDGs) that must be achieved. Failure to improve this profile paints a negative picture of the performance of the Health Ministry as well as the inability to achieve the SDGs. These are sequelae that need to be minimized.
Third is chronic health issues. There are many chronic health issues that need immediate improvement in 2023. The aim is to create adequate resilience against the emergence of another pandemic.
Of the10,000 puskesmas (community health centers) in Indonesia, more than 50 percent do not yet have standard health workers and nearly 600 puskesmas do not have doctors. In fact, these facilities are the backbone and important front line for public and individual health programs, including if an epidemic hits.
Indonesia's health data is also not solid. There are differences in data between institutions. The data on the number of doctors at the Health Ministry is different from that of the Indonesian Medical Council and the Indonesian Doctors Association. In fact, data elements are very important when dealing with outbreaks.
Heart disease, stroke and diabetes are the top killers with a high burden.
Non-communicable diseases also continue to be a scourge on health programs due to the high levels of morbidity, mortality and the burden they bring. Heart disease, stroke and diabetes are the top killers with a high burden. In fact, this disease is actually preventable. It can be avoided with adequate and continuous promotive and preventive efforts. Unfortunately, in this country there is no special program on a national scale that targets this issue.
In other countries, there are national obesity programs or national healthy lifestyle programs that consistently carry out promotive and preventive efforts to prevent non-communicable diseases.
Program turbulence
The government and experts are echoing a positive narrative that Indonesia will not experience a recession and may only experience an acceptable growth slowdown. The government is also said to have prepared an exit strategy if it turns out that a recession occurs in Indonesia. Even so, there is no guarantee that Indonesia's health program will run smoothly without a hitch.
The gloomy prospects for the global economy, the absence of special funds for a pandemic and the various health issues that must be resolved make 2023 full of challenges and risks. Like a ship, the health sector will enter an area of turbulence. Health programs face the risk of slowing progress or stagnation. Program targets may not be fully achieved.
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Given these conditions, the government needs to make a scale of program priorities. Programs that are prioritized and implemented must be those that are urgently needed and have a direct connection with the transition process from pandemic to endemic. Not all elements of the health transformation mentioned by the health minister must be implemented next year, some could be postponed.
A number of crucial programs that need immediate action are the handling and synchronization of population health metadata, a more even distribution of health workers, and the creation of a national Covid-19 vaccine that can be used as a regular vaccination. The Health Ministry must also build synergistic and participatory collaborations with all stakeholders in the health sector, including universities and professional organizations.
With the existing limitations, the Health Ministry cannot solve all of these problems without the support of various parties. Moreover, 2023 is getting closer to the year that national leaders will change. Many unexpected things could happen.
Iqbal Mochtar
Iqbal Mochtar,
Board member of PB IDI and PP IAKMI. Chairman of the Indonesian Doctors Association for the Middle East.
This article was translated by Kurniawan Siswo.
