Tuesday, December 3, 2013

1) Free healthcare overwhelming Indonesia's Papua

1) Free healthcare overwhelming Indonesia's Papua
2) Churches join fight against HIV in Indonesia’s Papua



1) Free healthcare overwhelming Indonesia's Papua

JAYAPURA, 3 December 2013 (IRIN) - As more people sign up for health insurance offered to indigenous people in Indonesia's Papua province, a public health system already struggling with too few health workers and substandard services is coming under greater strain.

“People in the mountains and in coastal areas have flocked to the hospitals seeking treatment, even for diseases that can be handled by local clinics… People go straight to hospitals because they want to be treated by specialists,” said Aloysius Giay, director of the state-run Abepura Hospital near Jayapura, the provincial capital.

Yusmina Wakum pays around US$50 and travels 350km for eight hours by bus to reach the main hospital in Jayapura, to receive treatment for gout. “Where we live there's a hospital, but medicines are not good,” said Yusmina's 19-year-old sister, Miriam Wakum, as her elder sibling sat slumped in a wheelchair. “She got worse and couldn't sleep, so we decided to take her here.”

The health scheme was intended for use only in the province’s 34 tertiary referral hospitals, but residents have largely refused to seek care for non-emergency complaints in more than 300 public health clinics known as Puskesmas – citing poor service and lack of specialists – even though those services are also free, Giay said.

About 52 percent of Papua’s 2.8-million population are indigenous. In the past two years overcrowding has increased and patient queues have grown longer as more people joined the scheme, launched in 2009. The problem may worsen, health officials say, with the government’s plans to launch a universal healthcare scheme for all Papuans, indigenous and non-indigenous.
Health posts vacant

In Keerom district, near the border with Papua New Guinea, where violence from a low-level but long-running separatist conflict in Papua has fuelled security concerns, a local Catholic priest, Roni Guntur, said health posts are mostly vacant. “In some places the government has built community clinics, but there are hardly any health workers. Some of them left because they said there were no supporting facilities or because they did not feel safe.”

In 2012 Papua had a ratio of two doctors and 17 nurses per 10,000 people, above the national average of 1.4 doctors and five nurses, but Health Ministry data show that health personnel are not evenly distributed.

Some Papuan districts have less than one doctor and five nurses per 10,000 people, according to the Health Ministry, whereas the World Health Organization recommends a minimum of 23 health workers per 10,000 residents to provide basic care.

While reference hospitals in main towns like Jayapura and Abepura struggle to cope with the patient surge, many indigenous Papuans are still unaware of the health plan that is almost free of charge. “People in villages are still dying because they don't get treatment and aren't aware of their rights,” said Giay.

“Those who suffer more serious illness still have to pay for drugs because they are not covered by the insurance,” said the priest, Guntur, who noted that there was also confusion over what is covered by the insurance scheme.

Health consultations for indigenous communities are provided at no cost, as well as hospitalization in the cheapest, third-class ward and most medicines. Residents still bear transportation and some treatment costs.


To cope with growing pressure on the health system, the provincial government has announced it will build four new referral hospitals in 2014. Officials said there are also plans to establish more schools for health workers, and to offer free training via the internet.

Most indigenous communities live in underserved remote areas, so in 2012 the Health Ministry started flying provincial health workers to these areas, where they stay for several months at time to treat villagers and train local health workers.

“Because of the limited budget, the provincial government can only provide [training] modules for the health staff, not for the local cadres, but by their own initiative the [provincial] staff developed very modest modules in the local language,” said Ratih Woelandaroe, a UN Children’s Fund (UNICEF) health officer in Papua.

The rugged jungle-clad landscape is the biggest challenge to accessing health services, said Sudhir Khanal, UNICEF’s child survival and development specialist in Papua.

Papuan Governor Lukas Enembe, installed in April 2013, has made improving healthcare a priority, and set up a Unit for the Acceleration of Health Care Development, which is headed by Giay.

"We are aware that all this time, monitoring and supervision has been poor, and that's why there's a need to make a move and improve things," Giay acknowledged.

Theme (s)Health & Nutrition,
[This report does not necessarily reflect the views of the United Nations]


2) Churches join fight against HIV in Indonesia’s Papua

YOKA, 2 December 2013 (IRIN) - Churches in Indonesia’s Papua province, a Christian pocket in a mainly Muslim country, are seeking to play a bigger role in the fight against HIV and AIDS in Indonesia's most affected region, despite tensions with the government over funding, as well as philosophical differences on how to prevent the spread of HIV. 

Seven years ago, Sunarsih, 30, (who has only one name, as is customary in parts of Indonesia), sought out a church-run shelter for people living with HIV after she was diagnosed positive. “I heard that people who had HIV would die in a few years. I was ashamed and afraid,” she said, but did not know how she had contracted the virus.

Sunarsih is one of the growing number of people living with HIV and AIDS in Indonesia’s Papua region, composed of Papua and West Papua provinces, which have a predominantly ethnic-Melanesian population and make up half of New Guinea island. Despite abundant natural resources, including the world'slargest known gold deposit, the area struggles with an underdeveloped healthcare system.

Under an autonomy scheme granted to Papua as part of the central government's efforts to pacify separatists’ clamour for independence, every village gets up to one billion rupiah (US$83,000) in development money annually, but critics say the cash has benefited local communities little.

Referred by a friend, Sunarsih sought treatment at Yayasan Pengembangan Kesehatan Masyarakat (Public Health Advocacy Foundation), a non-profit, Christian-run shelter for people with HIV and AIDS in Abepura town near Jayapura, the provincial capital of Papua. The local state-run hospital provides free antiretroviral (ARV) treatment.

“The organization has supported me all these years and provided me with nutritious food,” she said. “Now I’m back on my feet again.”

Simon Wospakrik, head of the community service department for congregants of the Evangelical Christian Church (GKI) in Papua, said its preachers have helped spread awareness about HIV and AIDS to 1,500 congregations across Papua and West Papua.

GKI, one of the largest of Papua's 45 or so denominations, has also worked with local authorities, NGOs and foreign Christian missionaries to educate the public about HIV prevention and provide health services.

“The church has to play an instrumental role in fighting HIV and AIDS,” Wospakrik told IRIN. “We can't just stand idle. We have to move fast and use all our resources to stop the spread of the virus,” he said.

GKI runs the ‘Walihole’ (Life Preserver) HIV/AIDS clinic in Yoka, a village on the outskirts of Jayapura, where ARVs and tuberculosis (TB) drugs are available at no cost. 

Korry, 33, began treatment at the clinic in December 2012 after she tested positive for both HIV and tuberculosis (TB), which health workers say are common co-infections in patients seen at the clinic.

She completed a six-month course of TB therapy and is still on ARVs. “I feel healthy again, just like I used to be,” said Korry, whose young daughter is also HIV positive and is receiving counselling from the same organization. 

“Many of them [TB patients] had dropped out of [taking their] TB medications before, so we have to make sure it’s [the illness] under control,” said Rumboi Werimon, the clinic’s secretary. 

The Health Ministry said a generalized HIV epidemic, lack of health funding and a “high” number of patients who do not comply with their treatment regimens are among major challenges in the fight against TB in Papua.

Health system challenges

Papua and West Papua, home to 3.8 million people, have limited road networks, as much of the region is covered by jungle. With many places reachable only by aircraft or on foot, the government and NGOs have struggled to boost access to healthcare. 

In 2012 the region had a ratio of two doctors and 17 nurses per 10,000 people, which is higher than the national average of 1.4 doctors and five nurses, but health personnel are not evenly distributed, Health Ministry data show. The World Health Organization recommends a minimum of 23 health workers per 10,000 residents to provide basic care.

The provinces, known collectively as Tanah Papua, accounted for 15 percent of Indonesia's new HIV cases in 2011, the highest burden among the country’s 34 provinces, even though the region is home to only 1.5 percent of the country's 237 million (2010 census) population, according to the UN Children’s Fund (UNICEF).

There were an estimated 7,600 people in Papua living with HIV in 2010, but the number rose to 13,000 in 2012, according to the National AIDS commission, which estimates an average of some 3,000 newly diagnosed cases annually. 

The Joint UN Programme on HIV/AIDS (UNAIDS) 2013 epidemiology report [ http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf ] puts the estimated number of Indonesians living with HIV nationally in 2012 at 400,000, with an estimated 44,000 new infections.

The epidemic in Tanah Papua is driven almost completely by unsafe sexual intercourse, say experts. “There's lack of knowledge and sex education, and no formal sex education in schools,” said Sudhir Khanal, a UNICEF health specialist in Papua. “Sex is always seen as a very taboo subject to talk about.” 

The Evangelical Church’s Wospakrik says another obstacle in the fight against HIV and AIDS is the stigma and discrimination suffered by people who are positive.

Lipiyus Biniluk, head of the Union of Churches in Papua, which includes around 45 denominations, said despite their best efforts, services provided by the churches are limited to what their congregants can fund.

Theology meets medicine
“It seems to me the government has no desire to empower the people of religion in their anti-HIV effort. We need information, data and funding, but the authorities are only giving us lip service. They are not working seriously,” said Biniluk.

The provincial government says it has earmarked 11 billion rupiah ($950,000) in HIV/AIDS funding this year. Donors, including the Global Fund to Fight AIDS, Tuberculosis and Malaria, are winding down assistance as middle-income countries like Indonesia reduce their reliance on external funding.

Aloysius Giay, chairman of the province’s Unit for the Acceleration of Health Care Development, a body set up by newly elected governor Lukas Enembe, said health workers and churches are “sometimes at odds” over approaches on how best to deal with the HIV epidemic.

“Christians consider circumcision to be a taboo, while health workers recommend it as an effective measure to prevent HIV infection,” he said. “Health officials are calling for the use of condoms, but religious people accuse us of encouraging promiscuity.”

“People [in the church] have this holier-than-thou attitude,” he said. “With money flowing in, and people having new-found wealth, it’s inevitable they engage in risky behaviour.” 

But Wospakrik said that while the church’s key message on HIV prevention is abstinence, it is not opposed to promoting condom use among those engaged in medically risky behaviour, such as men having sex with sex workers, he said. 

Long-held traditional beliefs – some rooted in religion – also get in the way, Giay said. “Many tribespeople believe diseases are caused by evil spirits, God’s punishment or black magic, and refuse to be treated medically. That’s the issue that the church should tackle [in addition to HIV].” 

Theme (s)HIV/AIDS (PlusNews),
[This report does not necessarily reflect the views of the United Nations

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