Anti Discrimination Health Service
Sultan Sy. Mohamad Alkadrie Hospital of Pontianak City Government

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
1. Healthcare service through hospital nowadays is problematic. The service given to the patients is based on financial capability of the patients. It is shown by the difference of room classes in hospital, and these classes determine the quality of service given to the patients. The more expensive the room, the better service patients get. The classes are ranged from Super VIP, VIP, First Class, Second Class and Third Class. This condition creates discrimination of healthcare service given to the people. Those who can afford the upper room class would get better treatment and service in all terms, from doctor visit to nurse care. Those who pay for the lower class – most of the time are poor family – would be less prioritized even being abandoned by the hospital. The discrimination of the hospital healthcare service appears because service fee that received by the hospital are based on the room class. The more expensive the room class, the more money hospital would get. This condition is not only happen in private hospital but also public hospital. The whole purpose of public hospital is to provide healthcare service to all people despite their economic capability and background. Unfortunately, the purpose of public hospital deviates to a new direction, from social oriented to profit oriented. Even some public hospitals are used as a source of income for the local government. The people are the one who suffer from the existence of this discrimination in the public hospital, especially the poor people. Thus, it appears become one of the main problem faced by the government. On one side, they are the one who have the responsible to provide public service to their people including healthcare. On the other side, government also needs to get some revenue. The poor people are the one who suffer the most. They cannot get a sufficient healthcare service from their government. Discrimination, unfairness until abandonment are felt by the poor people because of the existence of room classes in public hospitals. They cannot afford higher room classes. Thus, they would get a lower quality of service because the amount of money they paid only contributes a small amount of income to the hospital. They get less priority compare to those who pay for the upper room classes. They get less attention from the doctors and nurses because the medical workers are more focused on the patients who stay in upper room classes since the upper class patients are the one who contribute more money to the income of the public hospitals. This condition is not supposed to happen because it shows that the governments are not fair in giving public service to the people. Moreover, the discrimination also against the constitution number 44 year 2009 about public service. More and more people are disappointed with the service of the public hospitals and their government. This disappointment leads to the lack of trust from the people to the government, and this is a big loss for the government.

B. Strategic Approach

 2. What was the solution?
2. Pontianak city government came up with an idea to built the city owned Public Hospital named Sultan Syarif Mohammad Alkadrie-Pontianak Public Hospital. The hospital implements a non-discrimination healthcare service, which means the treatment and service given are based on the type of illness, diseases, gender and age group instead of room classes or their economic background. The city public hospital also assigned its nurses and other medical staff into two different groups according to the type of disease and treatment rooms of patients and expertise of the staff.

 3. How did the initiative solve the problem and improve people’s lives?
3. Pontianak Public Hospital currently only has rooms with third class standard for all patients. The rooms are divided according to the type of disease, treatment, gender, and age group. It does not matter if patients are coming from wealthy or poor family, they all get the same quality of service. No more discrimination, no more inequality. By implementing this system of service in public service hospital, all patients are guaranteed in getting a proper and sufficient treatment and service. The poor family will no longer be neglected and richer patients will no longer get more priority. Thus, the government can make sure that they are doing their job properly in providing the best and equal public service to the people, especially the poor people who suffer the most from the previous hospital system. They can rely on the Pontianak Public Hospital to get a sufficient healthcare service. The healthcare for poor family are covered by the government through an universal healthcare. They can access the universal healthcare through public hospital. The existence of the new Pontianak Public Hospital provide a huge benefit to the people. First, they have an additional healthcare facility where they can access the service using the universal healthcare. It means that they have a guarantee of healthcare service provided by the city government. Thus, it will give the poor people a better life quality. Second, This initiative provide a safe feeling for the poor as their health services is guaranteed by the government.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
4. The core innovation done by Pontianak Public Hospital is through its service mechanism. It implements a breakthrough mechanism that classified patients regardless their economic and social status, which is known as an anti discrimination or a non class service. The explanation of the service classification will be done based on the current condition and the future development of the Sultan Syarif Mohamad Alkadrie Pontianak Public Hospital. Current condition – a non-class hospital service. The hospital does not distinguish the rooms facility. So at the moment, all rooms are using the third class room standard. Regarding the medical treatments, all treatments are classified by the diseases and the severity of patients’ condition instead of financial condition of the patients. There is no difference in the service quality, the use of equipment and service for medical treatments or operation, and other supporting check up. All patients also get a proportional medical treatment based on the standard operational procedure of the service. By implementing a non discrimination service, Sultan Syarif Mohamad Alkadrie Pontianak Public Hospital are able to deliver a non discrimination and effective services by prioritizing and facilitating the patients’ importance based on standard, professional, on-time and fast, easy and affordable.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
5. The initiator of Non Discrimination Public Hospital idea is the Mayor of Pontianak, Sutarmidji. He came up with the idea to support Pontianak City’s Vision as an Environmentally Oriented Equator City, leading in human resources development and public service. The city government is the one who runs the hospital under a unit called Sultan Syarif Mohamad Alkadrie Hospital supervised by Health Department of Pontianak City. Even though it is a city owned public hospital, but it does not limit the service only for the Pontianak people that is around 600.000 people but also the surrounding area. The healthcare service is open for all people. People in Pontianak and the neighbor city next to it get a lot of benefit with the existence of the new public hospital. Before, there was only one public hospital in Pontianak, Sudarso Public Hospital that owned by the province government. Sudarso Public hospital is also the biggest hospital in West Kalimantan, so it becomes a reference hospital for all smaller public hospital all over West Kalimantan. Therefore, Soedarso Public Hospital always has an over capacity of patients that they need to be taken care of. The existence of Pontianak Public Hospital becomes a breath of a fresh air to the people in accessing healthcare. Pontianak Public Hospital becomes a new option for people especially those who are under the universal healthcare. An additional healthcare facility will help the government in providing healthcare service to its people, and help to overcome the problem of patients over-load. When the quantity of over-load patients are lowered, public hospital can give a better healthcare service to the patients.
 6. How was the strategy implemented and what resources were mobilized?
6. The strategy to successfully implement an anti discrimination hospital service are, the making of policy, the development of a clear program operation manual, supporting activities to maintain organizational resources and steps to overcome the environmental change with more detail explanations below. A strong commitment shown by the Mayor of Pontianak and the entire officials represents the core purpose of this hospital which is to provide a qualified service to all people especially those who were being marginalized overtime –the poor. Hence, the mayor decided to convey his idea into reality. His idea of policies serve as the foundation of service and medical treatment price in the hospital. Since the hospital has no class discrimination, there is only one set of prize for all treatments and services. To embody the policies into reality, a set of ground rules need to be made to act as a guidance for the brand new policy. Besides, ground rules also need to be established in order to set standard of services. Then, some rules were made to establish a system of standardized service throughout the entire hospital. Some rules are Medical Service standard, standard operating procedure for all services, clinical pathway, until service procedures. The ground rules also regulate the hospital rooms. The rooms are divided into some categories, which are children room, male room, female room, contagious disease, maternity room. The nurses also categorized in two groups based on the disease and rooms. It is important for all staffs to understand their roles, responsibility and job characterization. They are also responsible to make improvements in the healthcare service they provide to all patients. The service characteristic all employee needs to obey is that the healthcare should be equal, economical accessible, appropriate and acceptable for all. To improve the ability of the employee, the capacity building improvement for all staffs is very important. In house training for the medical staffs are often conducted. To achieve certain level of competence, the staffs need to enroll the educational and training process related to their expertise held by health professional institution. In management level, strategies to implement the non discrimination healthcare services are establishing policies and operational programs and activities by taking into account the organization’s resources and environmental conditions encountered, as follows: 1. A strong commitment by the mayor, the board of management and staffs; 2. Determining the Medical Service Standards, Standard Operating Procedures, and Clinical Pathway 3. Treatment rooms assignment based on the type of disease, gender and age group. 4. Nurse group assignment into two groups, responsible for the care of patients according to the type of disease and treatment rooms. For evaluating all staffs and management commitments, services and staff encouragements, the hospital regularly conduct monitoring in such ways: 1. Conduct a regular monthly meeting; 2. Conduct a meeting between management and the medical committee; 3. Conduct an internal meeting of management, with directors, health of division and the heads of section /sub-division; 4. Apply a mechanism of costumer complains and suggestions (suggestion box) and 5. The monthly report of financial section. 6. Conduct the customer satisfaction index Pontianak city government also committed to give sufficient support to the public hospital, since the public hospital operated on a non-profit orientation. Therefore, the financial support from the Pontianak city government plays an important role in the running of Pontianak Public Hospital. The other funding for Pontianak Public Hospital are BLUD financial system from National insurances. The hospital also gets financial support from central government, West Kalimantan Provincial government.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
7. The idea of anti discrimination service or more known by non-class service was initiated by the mayor of Pontianak, Mr. Sutarmidji, in order to actualize the big vision of Pontianak to become an environment oriented equator city, the front row of human resources development and public service. The successful implementation of the concept of anti discrimination service needs a holistic support and awareness of multiple important stakeholders, which are management of the hospital, medical crew, nurses, and all supporting staff members. Since most of the patients come from low economic and social background, the implementation of anti discrimination service requires a total change of point of view of all employees from doctors, nurses, other medical staff, until administration staff. All of them have to realize that even though the patients are coming from a low economic background they have to give an optimal service without any discrimination. The working culture of the whole hospital has to be based on the basic value, belief and commitment to give service that can satisfied all patients despite their background. Pontianak city government also committed to give sufficient support to the public hospital, since the public hospital operated on a non-profit orientation. Therefore, the financial support from the Pontianak city government plays an important role in the running of Pontianak Public Hospital.

 8. What were the most successful outputs and why was the initiative effective?
The results and the impact that can be reported are the increase in the number of patient (walk-in and hospitalized patients) and also community satisfaction index. Increase in the number of patients and the use of emergency room has proved that the hospital has been used well and in accordance with the needs of society in Pontianak and outside Pontianak. It also represent the increasing level of trust to the hospital Based on the Community Satisfaction Index Surveys in the hospital, the services in Sultan Sharif Mohamad Alkadrie Hospital of Pontianak is categorized as good.

 9. What were the main obstacles encountered and how were they overcome?
Along the way, the implementation of this brand new concept comes with some obstacles. First problem, nurses as the front row of hospital service in the medical treatment have not yet master all specialty in medical work such as surgery, internal disease, pediatric, neurology, sight and hearing. Therefore, to overcome this problem, nurses are categorized to two groups, surgical and non surgical patients. Furthermore, the hospital also held some in-house training to increase the capability of the nurses, general practitioners are assigned as inpatient doctor for 24 hours (divided in three work shifts). Second problem, the implementation of non class based service influences the income of the staffs. Employees get less take-home pay since there is no cross-subsidy like a regular hospital. In class based hospital system, the income from the upper class patients are distributed to all staff member. Pontianak city government stepped in to solve this condition by giving an extra intensives other than regular payment for all employees and for the medical specialists, the government provides houses and cars to support their activity

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Sultan Syarif Mohamad Alkadrie Pontianak Public Hospital is considered as a new hospital, which started in October 2012. The hospital started with a concept of anti discrimination service. By using this approach, the patients are getting an equal treatment and only be classified by the severity of the illness, type of diseases regardless the financial ability. The anti discrimination concept is the pioneer in Indonesia, so it can not be compared to the past condition. Even in the constitution and regulation about hospital in Indonesia, there is no clause about non-class hospital. Republic of Indonesia Ministry of Health, Nafsiah Mboi stated when she officially started the operation of Pontianak Public Hospital that “There is only a few non class hospitals in Indonesia, and this policy is very good to be implemented because we can give health care service without considering economic and social status, religion, ethnicity, and race of the patients.” The result and impacts that can be reflected in the increase of the number of patients, and society satisfaction index. The increase of the patients number from all categories, walk-in patients, hospitalized patients, and emergency room patients shows that Pontianak Public Hospital is used well by the people, and meet the needs of people in Pontianak and the city around. Based on the official hospital report, in 2013 there were 446 visits for walk-in patients. Then the amount went up immensely to 34.156 in 2014. In 2015, the number rose again to 49.635 patients. In 2016, the number rose again to 52.227 patients. Let’s move on to the number of hospitalized patients, the trend is also show an increase. In 2014 there were 5.160 hospitalized patients, and there was approximately 25% increase in 2015 to 6.393 patients and decrease in number in 2016 into 5.685 patients because the more curative effort conducted by the Pontianak City Public Health department. About the emergency room patients, there were 11.497 patients, and in 2015 there were 15.662 patients who got medical treatments from Pontianak Public Hospital. Moving on to the survey about Society Satisfaction Index, Pontianak Public Hospital done in 2014 got 75,58 marking. In 2016, the marking got higher to 77,26. Based on these marking, Sultan Syarif Mohamad Alkadrie is considered as the good category.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Yes, this initiative has improve the integrity and accountability in public services. Firstly for the integrity, since most of the patients come from low economic and social background, the implementation of anti discrimination service has create a total change of point of view of all employees from doctors, nurses, other medical staff, until administration staff from profit to service oriented to everyone equally or non discrimination services principle. All of them has realize that even though the patients are coming from a low economic background they have to give an optimal service without any discrimination. The working culture of the whole hospital staffs has been based on this basic value. They have belief and commitment to give service that can satisfy all patients despite their background but based on the equity, accessible, appropriate and acceptable for all. Secondly, for the accountability of the public services, all staffs understand their roles, responsibility and job characterization. They also try hard to make improvements in the healthcare service they provide to all patients. Thirdly, Pontianak city government also committed to give sufficient support to the public hospital for everyone equally even the public hospital operated on a non-profit orientation. Therefore, the financial support from the Pontianak city government committed to play important role in the running of Pontianak Public Hospital.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
. Yes, this initiative benefits for women and girls and improve the situation of the poorest and most vulnerable. Previously the poor are the one who suffer from the existence of health service discrimination. This condition creates discrimination of healthcare service given to the people. Those who can afford the upper room class would get better treatment and service in all terms, from doctor visit to nurse care. Those who pay for the lower class – most of the time are poor family – would be less prioritized even being abandoned by the hospital. This condition is on and on that more people are disappointed with the service of the public hospitals and their government. This disappointment leads to the lack of trust from the people to the government, and this is a big loss for the government. But nowadays in Pontianak City, everyone can have health service even they are poor. Patients don’t have to worry about preparing funds before getting any kind of medical treatment like the current other hospitals mechanism. In Pontianak Public Hospital, the payment can be done at the end of the treatments with a very reasonable price.

Contact Information

Institution Name:   Sultan Sy. Mohamad Alkadrie Hospital of Pontianak City Government
Institution Type:   Local Government  
Contact Person:   Yuliastuti Saripawan
Title:   Mrs  
Telephone/ Fax:   +6281250149158
Institution's / Project's Website:  
E-mail:   risfadona@gmail.com  
Address:   Komodor Yos Sudarso Street
Postal Code:   78113
City:   pontianak
State/Province:   West Kalimantan
Country:  

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