One Stop Eye Healthcare Systems “None people shall suffer a blindness due to incapable to pay”
South Sumatera province’s eye specialized hospital

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
There are more than 285 million of world inhabitants who suffer vision disorder. More less about 39 million person are suffering blindness, while 246 million amongst them are suffering the vision disorder. Meanwhile there are about 90% of persons with these vision disorder and blindness are remaining in the lower income countries. If such situation is just ignored without any action, the numbers will be doubled in 2020. In line with the abovementioned, the Ministry of Health by 2005 has compiled the Strategic National for Overcoming the Vision Disorder and Blindness. This effort in line with the 2020’s Vision Global Commitment: The Right to Sight as announced by WHO, that in 2020 is expected any inhabitant owns a right to vision optimally, By promoting the commitment the government shall be responsible to provide for any citizen to obtain optimal vision in 2020. Meanwhile, the condition in South Sumatera from 7,450,394 inhabitants lives concerning with vision disorder, namely, 5% are having pterygium disorder, 3.9% keratopathy, 1.7% cataract, 0.4% blindness and 4.5% wear glasses (corrected refraction) by age ranges 14-45 years, then the refraction disorder is registered on school students amounts to 1,546,611 and 87,5% are incapable to buy glasses. From 1.7% of cataract patients do not recognize if they’re having the said disease, namely about 42.1% and incapable to finance it about 9%. By the high of suffering the vision disorder, it shall be social problems needs to be solved in coordinately, because commonly the vision disorder is not only harming the patient’s productivity, but also it causes the social-economic impact to the community, which enable to reduce all community life quality and its turn will impair the rapid of economic development in South Sumatera. Besides, it happens the increase of health care cost due to the implementation of high-technology, direct cash payment pattern to the healthcare provider, also inflation, thus government must seek an appropriate solution to solve this healthcare financing problems. Based on the above mentioned, then before this initiative is conducted, the primary issues occur as follow; a. The lack of health means is the lack of eye healthcare facilities, the optic devices are not distributed evenly and eye healthcare facilities aren’t particularly concentrated at one healthcare facility also having commercial nature by the high rate like LASIK surgery is highly expensive, in addition to that due to the cataract surgery’s cost is not cheap causing the publics, particularly the poor are difficult to gain the cataract surgery healthcare. b. Total participants of National Health Security (NHS) until September 30th, 2015 reaches 3,858,084 lives of total inhabitant, it means there are remaining 4 millions of inhabitant have no health insurance, then Statistic Central Agency counts a total poor per September 2015 about 13.77% of total inhabitant. c. South Sumatera Province owns region area of 87,017.41 km² by 17 city regencies and total villages are 3,232, the distribution for community desires to perform eye health examination so much, then it causes backlog (cataract patient’s accumulation) at remote rural areas.

B. Strategic Approach

 2. What was the solution?
Eyes are sensitive organs, which obviously requiring a high-tech to treat them and the high-tech is identically with high cost too. A political will of Governor is done by establishing a well-organized system through the integrated and comprehensively eye health care. This initiative project is promoted by South Sumatra eye specialized hospital is relied upon a dogma that the health is supposed to be held entirely, integrated, evenly, reachable until to the remote areas by good qualities also acceptable and felt by all community levels with affordable cost.

 3. How did the initiative solve the problem and improve people’s lives?
This initiative constitutes facilities for entire public wish to gain the integrated, comprehensive, comfortable, low-cost and affordable eye healthcare. The comprehensive means in-building care with completed means and infrastructures by 10 (ten) subspecialist healthcare, sustained by the supporting infrastructures also located the self-owned optic facilities. Medical record data indicates that total patient visits from 2013 until 2015 is averagely increasing about 1.4-2% annually, for the latest 2 years are 2014 & 2015 having a visit increase about 2.3% and from such data indicates the cataract patient dominates a visit by the amount, which is relatively similar within two years consecutively, namely about 2,450 patients. Recalling the blindness caused by cataract disease contributes the largest proportion to the national blindness rate, then blindness overcome strategy is caused by the said cataract disease constituting one of medical intervention is most possibly conducted, namely cataract surgery, then by One Stop Service-Eye Healthcare System (SILAMSAT), the cataract surgery is intensively conducted whether in-building or out-building by affordable rates and covered by National Health Security (NHS), Jaminan Kesehatan Nasional (JKN) even free cost where will impact to the significantly decrease of South Sumatra’s blindness rate and will basically decrease the nationally blindness rate due to cataract. Afterward the basis of retribution levy as stipulated in the Affordable Cost Local Regulation, so that public will not be burdened by expensive cost’s assumption, for example LASIK surgery constitutes one of the most superior healthcare compares with other hospital throughout Indonesia, LASIK surgery with materials and output, which are similar with other healthcare facilities but cheaper cost. By using the Local Health Insurance program, namely Health Social Security South Sumatera (HSS - Jamsoskes) “Sumsel Semesta”, through this program, then all poor will be automatically covered by Jamsoskes if not yet joint with National Health Security (NHS) program, then it may joint this program by using South Sumatera’s Citizen Identity Card (KTP). The poor’s easiness is to gain healthcare by clear path and prioritizes the equality principle without differs in providing healthcare for poor who desires to gain eye healthcare due to mostly action as medically indicated covered by HSS. With a broad reach, about 17 Regencies in South Sumatera province concerning with the blindness level is mostly contributed by rural areas, thus it causes a Backlog (cataract patient’s accumulation), then in order to reach this initiative requires the other in-building activities, namely, filtering system/Eye Camp means the mass-roving eye healthcare held routinely every year throughout remote areas of regencies/cities of South Sumatera.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The hospital been established as leading refractive center under the Decree of Head of Eye Specialized Hospital on June 2013. This initiative owns a superior service, namely Lasik surgery, which is only US$450 up to US#977 for one and two eyes, a low cost is earned by cutting-off Return Of Investment system’s. Those strategies then affect this hospital as the only hospital which provides the cheapest LASIK surgery in Indonesia. thus it may indirectly block the loss of state foreign, the fact shows the much Indonesian people are going aboard to perform eye surgery. Then this initiative also has a big role in overcoming the mass vision disorder in South Sumatera namely by eye camp program using wheel radius system, to reach a public requires healthcare throughout South Sumatera, focusses it’s service at healthcare center and cooperates with the public health center (Puskesmas) at the remote areas, where this Puskesmas will capture patient then it’s will be held a surgery at the nearest Puskesmas. This coordination also reduced the patient numbers significantly and create the specialist personnel due to they will work in highly volume as for the impact it will create the skillful and expertise’s increase for those specialist.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
South Sumatera’s Governor has stipulated the Establishment for South Sumatera Province’s Blindness Disorder Overcoming Committee in 2012 through Governor Decree No 813/KPTS/DINKES/2012. Concerning with the said Governor Decree, the eye specialized hospital becomes the reference throughout South Sumatera in case of South Sumatera Province’s blindness overcome. This initiative is done by South Sumatera Province’s eye-specialized hospital by involving all civil servants as their duties and functions also related elements, particularly within implementation of initiative elements such as the one stop solution – completed service by affordable cost, the similar treatment for poor with easy and clear financing service’s procedure also optimizing organization’s roles like Indonesian Ophthalmologists Association/ Persatuan Dokter Mata Indonesia (Perdami) of South Sumatera as the provider institution of medical personal assistance for in-building and out-building activities, which are motorized by Hospital. There are positive impacts of this initiative, namely, Based upon the medical record data indicates that patient visit from 2013until 2015 averagely raises about 1.4-2% annually, for the latest 2 years, 2014 and 2015 are having a visit increase about 2.3 %, this data indicates this hospital (SILAM-SAT) becomes a public target to gain eye healthcare facilities. Regarding Eye camps are held evenly in South Sumatera Province’s Regencies in 2014 – 2015 occurs the decrease of surgery realization is about 33% by the surgery quantity to 1,260 patients by 2014 and 680 patients by 2015 (Eye Camp report data). It means the Eye camp program is significantly reducing backlog (cataract patient’s accumulation) in South Sumatera.
 6. How was the strategy implemented and what resources were mobilized?
This initiative’s core constitutes routine activities of all civil servants are namely, providing primary service to public without any difference such initiative shall be facilitative to all publics wish to gain the integrated and comprehensive eye healthcare, which are easy and low-cost even free. To sustain the service fluency on this initiative program shall be done at several stages: 1. Performance review Its function as the unit reporting of each activity whether may be held in synergy, well-coordinated, appropriate with the available funds, and according to the field condition and situation. 2. Planning For compiling the planning shall be done through activities: 1) Technical coordination meeting comprises of management and planning division 2) The making of Capacity building plan for human resources gradually 3) It is held an expert meeting with the discussed topics. 3. Organizing It is done a role sharing amongst related units to achieve the stipulated objectives. 4. Implementation 1) Implementation is conducted by all units are appropriate with respective duties (in-building) 2) The fund allocation making for eye camp program, sets a target and realization of the backlog reduce (cataract patient’s accumulation) 5. Supervision It is done monitoring and evaluation to supervise the healthcare activities. Resources are used in this initiative namely, 1. Human Resources : The main motor is all Eye-Specialized Hospital’s employees, appropriate with organization structure and respective duties and functions, namely a Head assisted by 1 person of Administration Sub Division Head, 2 persons of Division Head who synergize with functional groups like medical personal, nursery paramedic and non-nursery also administration personnel. The latest data in December 2016, total employees are 168 persons comprises of 54 males and 114 females, particularly for specialist personnel from totally are 12 persons, 8 persons of them are females and the rest are males, the employment equity aspects of this initiative shall be applied and female aspect to this initiative has a bigger roles as the initiative main motor. SILAM-SAT’s healthcare basically constitutes the provider for public service’s means and facilities, therefore since it has been optimized a SILAM-SAT services (one stop-eye healthcare system /Sistem Pelayanan Kesehatan Mata Satu Atap), inter unit human resources’ role shall be better with supported by hospital management that makes SILAM-SAT as process for more increasing the public health quality. 2. Financial Resources : this initiative operation is mostly tuned into : 1. Budget business plan (RBA)-BLUD (Public Service Agency) South Sumatera Province’s eye-specialized hospital are following routine goods/service procurement process to meet technical-operational requirements of SILAM-SAT and The budget from Public Service Agency also used for payroll of Non Civil Servant’s human resources at eye-specialized hospital. 2. National Budget and Local Budget’s subsidization, 3. Utilizing Corporate Social Responsibility (CSR), which constitutes the Company accountability to the public social-economic environment. Such as the free glasses distribution for students, social services, etc. The above funds management shall be done transparently and orderly by continuously facilitation by Finance and Development Supervisory Agency (BPKP) of South Sumatera Province.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
In the beginning for making the low-rate tariff is the idea of South Sumatra Province’s Governor of which in accordance with the visions of South Sumatra Province’s are namely, SOUTH SUMATERA IS MORE ADVANCE, AND INTERNATIONALLY COMPETITION”. Then the said idea is elaborated by the hospital management by proposing the unit cost calculation. The SILAM-SAT’s initiator is South Sumatera Province’s eye-specialized hospital. Those are main motors; • South Sumatra Province’s Governor (related agencies) • Management (Hospital Head, Administration Sub Division Head, Medical Service Section Head and Medical and Nursery Supporting Section Head) • Hospital’s human resources (medical, non-medical and administration personnel) • National Health Security (NHS) • Third Parties, NGO, Organization, Private, State-owned enterprise, education Parties. As cooperated within Cooperation Agreement. The shareholder’s involvements are namely as follow: 1. Governor serves as stakeholder being the policy director through South Sumatra Province’s Local Secretary and Local Financial and Asset Management Agency has implemented the laws mandate is namely forming South Sumatera Province’s eye-specialized hospital being Financial Management Pattern for Local Public Service Agencies (PPK BLUD). 2. Governor serves as regulator (Jamsoskes regulation, Tariff Local Regulation, Organization Structure) Task Force’s Involvements: 1. Department of Health, as supervision and referral Technical Implementation Unit. 2. Local Financial and Asset Management Agency (BPKAD), budget allocation making support and asset management for Local Public Service Agency (BLUD) 3. Financial and Development Monitoring Agency (BPKP), serves as facilitator for BLUD’s financial management. Organization and the related technical Parties’ involvements: 1. Perdami, serves as partner that jointly assists the South Sumatra Province region’s blindness overcome program. 2. Education firms, human resources supply of medical personnel. 3. State-owned enterprise, local-owned enterprise, have roles through corporate social responsibility to assist finance in overcoming the eye health disorder. 4. NHS, serves as facilitator for financing the service user public.

 8. What were the most successful outputs and why was the initiative effective?
Some outputs of this initiative; 1. The high of public satisfaction serves as the comprehensive eye healthcare user ( one stop solution ) 2. Affordable/low-tariff pattern 3. Poor gains a health insurance facilities beyond JKN (NHS) 4. Reduces a backlog numbers (cataract patient’s accumulation) with routine eye camp throughout areas of South Sumatera. Such outputs provide effectively achievement as follow; Based upon the public satisfaction index (IKM)’s survey result as conducted by this initiative from 2013 until 2015, it ranges about 62.51 – 81.25 that means a good category, public satisfies with the integrated eye healthcare facility (one stop service) because it insures public to gain the easiness of eye healthcare with preventable and curable, also rehabilitative comprehensively in one stop solution. In order the eye healthcare at SILAM-SAT may reach all public levels, South Sumatera local government provides means and infrastructures and the eye-specialized hospital only provides operational activities without counting unit cost of means purchasing therefore the given healthcare tariff shall be affordable/cheap to the public. Health Social Security South Sumatera (HSS - Jamsoskes) Sumsel Semesta program is designated only for public have no other health insurance, particularly for poor, because the health issues is basic service shall be fulfilled by the government. The eye amp activities, which conducted routinely each year may reduce the blindness and other eye disorder’s rate by shortening a time realization target, instead of just waiting the patient visits to healthcare center due to such activities have been spread over entire region of South Sumatera’s regencies / cities.

 9. What were the main obstacles encountered and how were they overcome?
1. National Health Security system’s application of current healthcare center is more complex caused by the Indonesia health security will be more structured and centralized (Universal Coverage), which enable all Local Health Security must joint with NHS not later than 2019, which the obligation serves as the Laws mandate. Here the problems arise by the swelling of provincial budget if the integration with NHS caused by the paid premium difference will be bigger. Public’s assumption is regarding NHS also remaining much constraints such as inpatient cases by the limited time and so many procedural chains shall be carried out by the public and it is quite different with HSS-Jamsoskes by sufficiently attaching their citizen identity card/family card to the hospitals can have provided a public service. The solution is the Governor shall direct the related Parties remains carrying out HSS-Jamsoskes program as the NHS facilitator until the integration of NHS participants has gradually completed entirely. 2. In case of institution, this hospital still constitutes Agency Technical Executor Unit (UPTD) of South Sumatera Province Health Agency, recalling all matters shall be coordinated to the agency, the complicated bureaucracy flows shall be initially submitted to the agency, although there are many sciences and technologies located in the eye specialized hospital makes it becomes science intensive, technology intensive and capital intensive’s organization. The much types of functional personnel with their varied expertise and competencies make the hospital happens work intensive then it will finally happen an interest intensive, problem intensive and conflict intensive. As for the solution, it has been done any effort to improve the status from Agency Technical Executor Unit (UPTD) becomes Central unit agency (SKPD) itself is more independently, by making the academic script and other terms for the intended status improvement.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Based on the monitoring to the user public reveals the following benefits: - The lower of sickness, vision disorder and cataract blindness’s rate of South Sumatera Province dues to this initiative is implemented by local government-owned hospital and non-profit oriented through the comprehensive eye healthcare, which is efficiently and effectively - In 2015, the medical record data shows the patient visit’s increase for medical treatment at hospital by totally visit is 51,546 patients from the said amount is more less about 75 % of the disadvantaged public using the finance facility (insurance). Then the increase also happens at Lasik division by 2015 and Lasik surgery raises about 2% of previous year (Lasik divisions’ reporting diagram). Thus this initiative may fulfill the public requirement upon the eye health’s importance also the higher of inhabitant efforts to gain optimally life quality, includes having better vision. - The increasing of public awareness, particularly family, upon the diagnose significant at eye healthcare by routine socialization is held by eye health promotion unit at hospital - The awakening of cross-sector’s awareness within an effort to assist eye health disorder by cooperating with third Parties in case of financing utilization for students’ free glasses, social service of free cataract surgery for the disadvantaged public and they all are held routinely annually.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
This initiative shall be UPTD, thus for LAKIP (Accountability report) still depend on South Sumatera Province’s Health Agency, but due to that hospital has a unique and highly specific natures, it is kind all-round intensive institution and has highly problem complexities, dynamic and activities then carrying out services fully integrity. The hospital refers to Hospital by Law (HBL) and Hospital Management Pattern. management manages the hospital governance by implementing hospital governance (services) and clinical governance (patient treatment) in parallel and synergy. This hospital also has a benchmark towards the criteria achievement as stipulated for each type of services through Minimum Service Standard.

 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)
There is no special valuation/evaluation used in this initiative, but this initiative uses Public Satisfaction’s survey index towards one activity is conducted to measure the successful within the implementation of Public Service Quality Improvement Program. The Satisfaction measurement indicator constitutes a significant element within performance evaluation process where the final objective wish to be achieved is to provide better service, more efficiently and more effectively based on public needs. IKM’s survey result is done by this initiative from 2013 until 2015 ranges about 62.51 – 81.25, which means Good Category (the category is appropriate with Minister Decree of State Apparatus Empowerment No. 25 Year 2004)

Contact Information

Institution Name:   South Sumatera province’s eye specialized hospital
Institution Type:   Local Government  
Contact Person:   Anang Tribowo
Title:   High Level Official  
Telephone/ Fax:   +627115612838 (Tel) / +627115612841 (Fax)
Institution's / Project's Website:  
Address:   Jalan Kolonel H Burlian KM 6
Postal Code:   30152
City:   Palembang
State/Province:   South Sumatera

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