Is It Yes, Importing Foreign Doctors Makes The Quality Of Indonesian Public Health Services Increase?

The Ministry of Health's plan to import doctors has caused controversy because Indonesia has not yet entered into clear regulations. (Unsplash)

JAKARTA The government's plan to import foreign doctors to Indonesia has triggered pros and cons. The Indonesian Doctors Association (IDI) emphasized that it does not object to the presence of foreign doctors, as long as it is in accordance with regulations and competencies.

On several occasions, Minister of Health Budi Gunadi Sadikin revealed the discourse of bringing foreign doctors to Indonesia. The goal is to improve the quality of public health services.

Budi explained three problems in providing health human resources in Indonesia, namely total, distribution, and quality.

Reflecting on the referrals of the World Health Organization (WHO), each country ideally has a ratio of 1:1000 to meet the needs of doctors. This means that one doctor serves 1,000 residents.

Meanwhile, according to Budi Gunadi, the ratio of general practitioners in Indonesia is only 0.47 out of 1.000 population or below the standard. If the Indonesian population is 280 million, Budi Gunadi mentioned, it will take 140,000 more doctors and if a year of graduates from the medical faculty is 12,000 it will take 10 years to achieve that ratio.

In addition, Indonesia also lacks around 29,000 specialist doctors whose distribution is mostly concentrated on the island of Java. Then, will import foreign doctors to Indonesia answer this problem?

Bringing in foreign doctors is actually a practice that is commonly practiced by a country, one of which is to meet the shortage of doctors.

In the midst of a polemic regarding the government's plan to import foreign doctors, Moh. Adib Khumaidi, as General Chairperson of the Indonesian Doctors Association (PB IDI) emphasized that IDI did not reject the policy.

According to him, IDI should have responded to this policy with a broader perspective considering the current global developments. According to Adib, the policy of giving space for foreign doctors to come and practice in Indonesia is a necessity.

"The problem of foreign doctors is indeed a focus, meaning we are not in a position to agree or not, or reject or not," said Adib in the online PB IDI Media Briefing, Tuesday (9/7/2024).

The United States, Canada, Australia, New Zealand, and a number of countries in the Middle East are among those that allow foreign doctors to practice in their country. However, this is done with very clear regulations. That is why, Dr Adib emphasized the importance of regulatory clarity to protect citizens.

All countries make a domestic regulation to limit the practice of foreign doctors. All countries have an interest in protecting their citizens through doctors who meet administrative and competition requirements," he said.

And talking about ability, Dr. Adib believes doctors in Indonesia are equivalent to foreign doctors.

"When it comes to capacity, Indonesian doctors are very capable. Rest assured that Indonesian doctors are not inferior to foreign doctors," added Dr Adib.

The plan to bring in foreign doctors was also highlighted by the Chairman of the 2014-2019 Indonesian Medical Consil Education Standard Division, Sukman Tulus Putra. He emphasized that there was no rejection from Indonesian doctors against plans to import foreign doctors.

"Basically, Indonesian doctors receive as long as foreign doctors can provide temporary transfer of skills, knowledge, and properties. And this policy applies in every country," said Sukman.

However, of course, clear regulations are needed regarding the competence of the doctor to be brought in. He gave an example of how foreign doctors in Australia must follow the equalization or adaptation for approximately two years before they can practice in that country.

According to Sukman, regulations are important to protect the people.

"This is a good method, so they know for sure that health problems in every country are very different. I think this is a very natural thing and we can accept it," said Dr Sukman.

The discourse about bringing foreign doctors to Indonesia is not the first time this has happened. During the COVID-19 pandemic several years ago, this idea was also expressed by the Coordinating Minister for Maritime Affairs and Investment Luhut Binsar Panjaitan.

The reason is simple, so that the state foreign exchange worth trillions of rupiah does not run abroad because every year there are 600 thousand people from Indonesia who seek treatment in several neighboring countries.

The existence of foreign doctors in Indonesia is actually contained in Law Number 17 of 2023 concerning Health. Article 248 paragraph (1) states that Medical Workers and Health Workers of foreign graduates who can carry out practices in Indonesia only apply to specialist medical personnel and subspecialists and health workers at certain competency levels after participating in competency evaluations.

Although foreign programs are not new in a number of countries, including in developed countries, the Chairperson of the Medical and Health Cluster of the Indonesian International Scientist Association, Iqbal Mochtar emphasized that this program must have strict rules. Starting from educational qualifications, because foreign doctors have different systems and specializations.

In addition, language exams are also important because they have to communicate with other health workers and most importantly with patients. He gave an example of developed countries such as Germany and the US applying high requirements to foreign doctors regarding language skills.

And no less important, these countries also carry out competency tests and provide training to foreign doctors.

"So if there is an Indonesian doctor who is already a super specialist who loses abroad, he must repeat the residence from the start, he cannot immediately continue. There are additional training that must be done before entering," said Iqbal.

On the same occasion, Iqbal also mentioned that the plan for a foreign doctor program in Indonesia has a number of problems. Starting from an unclear basis, to a very high number of foreign doctor salaries.

Iqbal also mentioned the claim of Minister of Health Budi Gunadi Yang that the availability of doctors in Indonesia is still far below WHO standards. In fact, with the shortage of thousands of doctors, it means that the government must also spend a super large budget.

According to him, specialist doctors in the US can earn a salary of around Rp. 400 million to Rp. 600 million per month. At such a cost, Indonesia can pay around four to six domestic cardiologists.

"If the government wants to include thousands of doctors, where did the funds come from? Who paid this doctor? Does the government have special funds?" said Iqbal.

He is worried that if later the recitation of foreign doctors is only equated with the doctor's salary in Indonesia, it is unlikely that the government will bring in doctors who have high standards such as in the US, Canada.

"Then where do these doctors want to be placed? They should be placed in remote areas because the problems in Indonesia are uneven distribution of doctors. The question is whether they want it? " Iqbal said in the tone of a question.