Digital health is a burgeoning field, with incredible potential in Indonesia. Indeed, a number of digital health platforms already exist, providing a range of services to their users – from online consultations with a doctor, to prescriptions delivered to your front door. Aiming to grow faster, some platforms have developed innovative partnerships with existing digital giants; KlikDokter with KMK Online and Halodoc with Go-Jek, while Alodokter replicates the success of e-commerce king, Lazada.
In big cities like Jakarta, where undertaking any pursuit can be prohibitive due to traffic, these platforms are revolutionary. In the same way that you can order dinner from the comfort of your home, you can now seek high quality medical advice from there too. Yet, a key refrain that emerged from discussions was how these platforms could help make healthcare all over Indonesia, not just the big cities, more efficient, effective and accessible.
For a country with over 17,000 islands, digital health could be the answer to achieving these things, and to providing high quality health to all. The current digital health space however, feels like it is aimed at middle and upper-class city folk. Data from commercial web traffic data and analytics site, Alexa.com, shows that the majority of users are city-based with a college level education. As such, we need to start rethinking how digital health can be used to help those who need high quality healthcare the most.
As of September 2017, over 180 million Indonesians have registered with National Health Security (JKN), the world’s largest national health insurance scheme aiming to achieve universal health coverage (UHC). The JKN requires members to go through primary healthcare before referral to secondary or tertiary care. So, for the majority of Indonesians, health begins not through an app, but at the primary health care level, the Puskesmas, and it is here that we must look to create a digital health revolution.
The World Health Organization’s most recent Global Observatory for eHealth report emphasizes that there is a close association between eHealth, strengthening health information systems, and achieving UHC. We must harness digital health to strengthen our healthcare system, and in doing so, find ways in which it can help overcome serious ongoing issues in Indonesia, such as child stunting or maternal mortality. It is imperative that digital health works across all levels of the healthcare system, and does not become exclusionary to those outside major cities, or those without consistent personal connectivity. While it should continue to exist as a patient-driven, app-based means of accessing high quality healthcare, it must also be embedded as a strong foundation that underpins healthcare service delivery at the systems level, in order to effect sustainable change at a population level.
Projects implemented at the Puskesmas level, underpinned by digital technologies, can both strengthen the foundations of the healthcare system and re-shape the delivery of healthcare. A project called SIMPUS aims to do just this, through the application of an improved system to manage patient registry data in a number of Puskesmas. The platform helps Puskesmas management staff to better coordinate with Health Security Agency (BPJS), and health workers to understand disease trends of patients that could be synthesized with surveillance data.
Another key message of discussions at the conference was that effective collaboration across sectors and countries will be imperative in moving towards using digital health to strengthen the delivery of healthcare services in Indonesia. There has already been some success; a collaboration between international health technology company, Philips, Telkom and the local government has created a Mobile Obstetrics Monitoring system in Papua. This system tracks the health status of pregnant women who visit the Puskesmas, and ensures women do not fall through the cracks in referral or follow-ups. Should the system flag any irregularities in the pregnancy, midwives can also be connected to a doctor in an urban area for further instruction, maximizing the efficiency, effectiveness and accessibility of healthcare.
There is no escaping that digital health is the way of the future in Indonesia. A “mobile-first” country, data from global management consulting firm, McKinsey & Company, shows that Indonesians spend on average, 3.5 hours a day using the internet on a mobile device, with 50 million more internet users expected between 2015 and 2020. To create real change in the healthcare system however, we must not just see digital health as an end goal, or as a marketing gimmick, but rather as one component of many, which will ultimately create a stronger health system for all.
This does not mean we should move away from the incredible health platforms we already have, but we need to allow room for multiple paradigms in digital health to coexist, and must correctly tailor our application of digital health platforms to specific contexts and purposes. Strong government support and a willingness to work with bilateral partners, as well as the private sector, will be the way forward to ensuring that digital health is tailored to maximize the potential for high quality, accessible healthcare at all levels of society.
This article has been published on The Jakarta Post, February 24, 2018.
Randell is a public health researcher from Australia and Fadjar Wibowo is a former Chief Editor and Medical Operation of a leading Digital Health Platform in Indonesia. Both currently serve Center for Indonesia’s Strategic Development Initiatives (CISDI). The opinion is solely theirs.