Back to School

 Tempo English Magazine, February 15-21, 2016

In Search of Healthcare for All

The age-old saying that health is better than wealth is undeniable, which is why places where people still find difficulty in accessing health services are classified as poor and under-developed. In line with President Joko Widodo’s 2015-2019 National Mid-Term Development Plan, the Health Ministry has drawn up a strategic health plan, calling for a total overhaul of the public health care system. It will focus on upgrading the quality of community health centers and their medical personnel. The plan is an uphill battle, particularly in provinces where facilities and qualified manpower are lacking. Yet, in regions such as East Nusa Tenggara, local governments collaborating with civil society are on their way to achieving the goal of an effective health care system for their communities. Tempo English reports from East Flores and North Central Timor regencies.


A new long-distance work study program in East Nusa Tenggara is helping nurses and midwives build crucial skills.

pjj with caption

ELISABETH Wiliam is thrilled to be back in the classroom. In front of her hangs a large flat screen television connected to a small modem. A camera sits on top.

The scene likely bears little resemblance to the rooms she satin 28 years ago when she was studying at her vocational nursing school (SPK). “But now, we learn through video conferences and use laptops to go online,” the 53-year-old woman said.

Elisabeth is a nurse at a community health center in Larantuka, East Flores regency, East Nusa Tenggara (NTT). Squeezed into her busy work schedule, twice a month she visits the public hospital in the regency capital to take part in classes and to hone her medical skills. Last year, Elisabeth enrolled in the long distance education (PJJ—Pendidikan Jarak Jauh) program, hoping to earn her diploma.

As a vocational school graduate, her current level of certification is equivalent to a high school diploma. All SPK programs were ended by the Health Ministry in 1999, but certificate-holders remain free to practice as nurses or midwives.

With almost 30 years of experience, there is no doubt Elisabeth is a skilled nurse. However, new professional regulations mean that in order to continue working, she must obtain a three-year diploma (D3).

“I’ve always wanted to go back to school, even before the government issued the law, but it was not feasible because of economic constraints,” she said. “I want to learn more and give my patients the best service,” Elisabeth said. When she got the call from the local health office to join the PJJ program, she did not think twice.

Ikhsan Klakelau, 43, faces a similar situation. How- ever, his mobility is hampered by the responsibilities he holds as a father—he cannot travel far, and whenever he does, he cannot stay for long.

Ikhsan works in a Puskesmas in Adonara Island. To reach Larantuka to take the course, he needs approximately three hours.

“With the PJJ Program, I only need to stay for two days in Larantuka every time we have classes,” he said.

Ikhsan admitted he was initially sceptical about the benefits of the program. As the family’s primary earner, he was worried about any drop in pay. But because the program requires him to travel only twice a month, he said he was able to manage.

Nevertheless, Elisabeth and Ikhsan now have to divide their time between study, family and work. Elisabeth said that with good time management, it could be done. “For me, as long as I can get my diploma when this ends, I will strive to do my best.”

Time, however, is only one of the concerns. Another is the demands of the new technology. Ikhsan said that because he lived on a small island, it was difficult for him to get a strong Internet signal, and coursework includes online assignments that must be completed from home. So, every Saturday, he travels to a separate Puskemas in Adonara with a sufficiently strong Internet connection to do the work.

Despite these difficulties, all 39 nurses enrolled in the D3 program in East Flores Regency are determined to finish their study and earn their diploma. “I hope to continue working as a nurse even after my retirement age, I wouldn’t be able to do so without a D3 certificate,” said Elisabeth.

The long distance learning PJJ program is an initiative launched by the Health Ministry in conjunction with the Australia Indonesia Partnership for Health System Strengthening (AIPHSS). It was first started in July 2014 to address skills deficit among healthcare personnel in NTT.

Pilot projects were set up in East Flores Regency and Southwest Sumba Regency that targeted 87 nurses. East Flores health office chief Yosep Usep Aman said that many of the nurses and midwives in the regency were graduates of the 1970s and 1980s vocational nursing schools. “With the law on healthcare personnel, in a couple of years, they will no longer be considered competent in the medical field,” he told Tempo English three weeks ago.

This threatens to trigger a shortage of trained personnel in a region where need remains high. Yosep explained that because most of the healthcare professionals were in their 40s, they were hesitant to travel for more education. Thus, Yosep said a balance had to be found whereby nurses and midwives could continue to work while pursuing their diplomas. “They must still be able to work,” he said.

The Health Ministry and AIPHSS cooperated with the Kupang Health Technology Polytechnic (Poltekes) to design such a program.  Jefrin Sambara, the Kupang Poltekes director, said that the Healthcare Human Resources Development and Empowerment Agency (PPSDM) helped create the curriculum.

“We wanted it to be 60 percent practice and 40 per- cent theory, to achieve the competency they need at work,” he said.

It took a few months of discussion, but in June 2014, Jefrin and his team completed the academic plan. They travelled to Jakarta to present it to officials at the Directorate-General of Higher Education (Dikti) in Jakarta. After the presentation, they received a number of suggestions and made some adjustments.

According to Jefrin, program designers were ad- vised to incorporate the Learning Management Sys- tem (LMS) into the curriculum. The LMS is a software that allows students to complete assignments online. “We weren’t familiar with the LMS, so the experts at Dikti helped us with it,” he explained.

In July 2014, the previous health minister, Nafsiah Mboi, inaugurated the PJJ program in Kupang, after which the students received a week of orientation in the city. The orientation week was also aimed at familiarizing enrolees with laptops and the online system. Each was given a modem for use at home.

Elisabeth said that at first she did not even know how to turn on the laptop. “I asked the tutors to teach me how to use it during the orientation,” she said, adding that she was proud of her newfound proficiency.

The its of the course go beyond mere technical know-how, however. Elisabeth said the medium helped teach her procedural standards that she never knew before. For example, she said she had never be- fore considered a patient’s body position prior to measuring their blood pressure. “Now I know that their feet must be flat on the floor so that their body can relax,” she said.

Head of nursing at the Kupang Poltekkes, Margaretha Ulemadja Wedho, said after three semesters, enrolees had already come a long way. She admitted the first six months were a struggle. “Many of them have more than 20 years of experience, but they tend to forget some of the simplest medical procedures, so the practical classes were not so easy for them,” said Margaretha.

When the law takes effect in a few years, these nurses will have a diploma and will be able to continue working as healthcare professionals. Yosep said that with- out a D3 certificate, they could be charged with malpractice. “There’s a criminal repercussion for that, as written in the law on healthcare,” he added.

This year, the East Flores regency has allocated Rp900 million to support 83 midwives enrolled in the PJJ program. Yosep said the local government was committed to ensuring the sustainability of the PJJ even after the Australian government program ends.

The PJJ program was replicated in North Central Timor Regency in January 2016, with 39 midwives and 20 nurses enrolling. Zakarias Eduardus Fernandez, the regency health office chief, said there were currently 140 medical staff who lacked the required D3 certificate.

Beatrix Seran, 49, a midwife at a Puskesmas in the regency said she was thrilled about the new program. Beatrix complained that despite her 25 years of experience, she had never personally delivered a baby, as that job always went to a staff member with a higher level of training. “But now that I’ve been given the chance, I’m determined to study hard and provide better services for my patients,” she said.



Photos by Amanda Siddharta (TEMPO)

Source: Tempo English Magazine