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Equitable System of Health Workers in Indonesia

The need for health services is one of the most basic and fundamental needs for human beings. The right of all citizens of Indonesia to receive quality health services in a fair and equitable is explicitly outlined in the 1945 opening of aline IV of the state's goals to promote the general welfare and in greater detail in article 28 paragraph 1 H, that every person is entitled to health service. But in fact, equitable health services in Indonesia, is still far from expectations. Not only the service gap between the poor and middle class and above, as we always hear, but also inter-regional disparities in health services. Data from the Ministry of Health said in 2008, the ratio of the number of doctors per population in Papua around 0.28 versus 5.9 in the Jakarta area.

In fact, equitable health care for a nation is an important asset for investment as well as the achievement of quality development of quality human resources. Without equitable distribution of health services, it is very difficult to hope for an increase in Indonesia's human development index is still perched at position 118. Health care disparities also have the potential to cause symptoms of social jealousy, one of the factors that can cause symptoms of national disintegration. There are many things that cause the uneven distribution of health personnel in Indonesia. Cost of education is heavy and expensive, making the most of the health workers who have passed the education think twice to serve in the "dry". In addition, the lack of binding regulations to distribute health personnel throughout the country such as the PTT obligation for doctors, after removal of the obligation PTT since 4 years ago also led to more health professionals feel comfortable working in large cities. So far, the efforts made by government to ensure equal distribution a health power limited to attempts to provide incentives for health personnel in order to work in remote areas, but these efforts are less effective seprtinya. This makes us have to think more deeply about how to address the health inequalities of income that is so striking between the big cities compared to the lagging regions, which became the main reasons why most health professionals are not interested to work in the area. One effort that could be implemented to cover the gap that is the implementation of the health care system family doctor. System of family doctor services Before we discuss about what's many family physicians, we need first to know about the mechanisms and levels should how public health services conducted by health personnel. Actually or ideally, there are three stages of health services needed by the community. The third phase of health care are as follows: first, Primary Rate Service. Service here was held by General Practice Physician or which is known as General Practitioners. This stage is the first contact of patients with a doctor who is usually

located in the Private Clinic, Doctors Joint Clinic, Health Center, Medical Clinic, Clinic Company, or the General Polyclinic hospital, etc..Secondly, `Service Secondary Level. If considered necessary, the patient will be referred to a Secondary Level Service. For that general practice physicians will write a consultation or referral to a more skilled health personnel, in this case a specialist. Third, the Service Level Tertiary. If the problem also can not or will not be resolved by the service at the secondary level, the patient will be sent to a higher level, ie the patient will be referred to a consultant or subspesialis. Each patient should have the first primary health care for all health problems it faces. Exceptions of course exist, for example, to cases of severe emergencies, patients can be directly to the nearest emergency room anywhere. If the problem the patient has been treated in secondary or tertiary level, then the patient will generally be returned to the doctor to get further treatment. Basically, a family physician is a general practice physician in charge of organizing primary care. Some countries still use the term general practice physicians, because doctors who graduate out of medical education has indeed been a family physician has special skills, and family doctor services system has been used as a whole in the country. are a few countries including Indonesia have yet to implement this system of family doctor services. Physician graduates from various institutions of medical education diIndonesia also do not have a family physician competence. The basic principle of family doctor services are health services to the family as a unit, where doctors responsible for health services is not limited by age or gender group of patients is also not limited by the organs of the body or certain types of diseases, like secondary health services that are already specialized. The family doctor is a doctor who can provide community-oriented health services with emphasis on family, he does not regard the patient as a sick individual but as part of the family unit and environment soasialnya. Besides family doctors are not only responsible for the curative and rehabilitative health services (dating to the doctor's patient waiting passively) but also actively prevent families / communities suffering from the disease (promotive and preventive). There are two basic things needed in the implementation of a consistent family doctor, ie mechanism tiered health care, and insurance-based health financing system. Without the implementation of a tiered health care mechanism is very difficult to educate the public on the role and benefits of family physicians. Without insurance-based health financing equitable, will also remain very difficult for the community to access family doctor services. In many countries, the implementation of family doctor services have been integrated with an insurance-based health financing mechanisms and the mechanism of a tiered health care. There are many benefits to be gained in excution system of family doctor services. Some of the benefits of it, among them: First, will be held the handling of cases of disease as a whole person, not just to lodge complaints. Second, will be held and disease prevention services are guaranteed continuity of health services. Thirdly, If it takes a specialist service, setting it would be better and focused, especially in the midst of the complexity of health care today. Fourth, will be held so the transaction integrated health services that a health problem does not

pose various other problems. Fifth, if all family members participate in services then all the information about the family, good health information or explanation of social conditions can be utilized in addressing health problems at hand. Sixth, will be taken into account various factors that influence the occurrence of disease, including social and psychological factors. Seventh, will be held the handling of cases of disease with a more simple procedure and not so expensive and because it will ease the cost of healthcare. Application of family doctor services system also provides a positive influence for the equity of health workers in Indonesia. As we know, one reason why many (most) health workers are reluctant to work in the area because so senjangnya income received by health professionals practicing in large cities than in remote areas. But if the family doctor services can be applied as a whole, then the income received by doctors in big cities is not too much different from the income received by income received by a doctor in the area. Why? Due to a family physician health care system, each family physician to cover certain areas and populations with a rational ratio, so that doctors no longer accumulate in large cities. Of course the area of consideration that should be covered must be taken into account. However, there are many things that become obstacles to the implementation of a comprehensive system of family doctor services. Most people still do not understand the role of the health care system denagn family doctor, and the mechanism of tiered health care. As a result, some communities still come to the secondary health care for the working area must able to be handled by primary care. This, of course, causes health costs by masyarat dikelurkan become much more expensive. In addition, insurance-based health financing system that still could not yet be maximal also inhibit the implementation of the health care system family doctor. One other thing that is also important to be fixed if we want to implement this system of family doctor services consistently is our paradigm in health development. All interested parties, ranging from the government in charge of health care, hospital, PKM, and other health care providers, health workers, and society must be able to change our paradigm in health care. "The paradigm of the sick" which we use, which resulted in us more direct funding and health efforts for the treatment and posthospital care, must be changed towards a healthy paradigm is a paradigm of trying to direct the efforts and funding toward preventive public health of diseases and health education for the community to be able to maintain their health independently. With health paradigm, the authors believe the implementation of family doctor based health services can be realized in the near future.