Questions/Answers

Anti-discrimination health service is an original initiative implemented in Pontianak Sultan Syarif Alkadrie Public Hospital since 2012 and proposed by the Mayor of Pontianak, Sutarmidji. This innovation offers the entire level of Pontianak people to acquire easy accessible and impartial health service. Many hospitals in Indonesia, formerly known performing discrimination in health service based on patient’s status or financial ability. The discrimination includes service delivery and facility service. Such issue somehow prevents poor people from getting adequate and gratifying health service. Many poor people get neglected in acquiring health services. In fact, all people is entitled to get proper public service similarly health service. Hence Sultan Syarif Alkadrie Hospital since its establishment has implemented this innovation which provides equality in the services. Recently poor people in Pontianak either hospitalizing or doing outpatient treatment in this hospital can get the same facilities and health services as previously high level society get (comfortable rooms facilitated with AC, medical actions based on the type and severity of illness, patent and generic drugs, etc). Since the implementation of this innovation, the number of visit to the hospital has been increasing. Almost above 95% of visit, the patients use health insurance card, it has proven the ease of accessing health services. Moreover, this phenomenon leads people especially poor people to the improvement of lives. By acquiring healthy lives, they can perform better labor productivity therefore the poverty rate comes to decrease. It is shown by the data of impoverished population in Pontianak in 2016 and 2017 has decreased from 3.175 to 2.913. Eventually, the innovation achieved awards from the Ministry of Administrative and Bureaucratic Reforms as The Best Public Service Role Model in 2017 and 2018 as well as has given satisfaction to the people of Pontianak, specially the poor in accessing health services.

Our main objective is to provide a single standard of quality and excellence for all patients in health service, regardless of the income, ethnicity, geographic location, or any other detail. Everyone has equal access for health service and equity of health treatment. The poor as the most vulnerable in ill health maintain feel secure and not being afraid to be refused by the hospital nor given unappropriated health service. Nowadays’ complex situation of hospital institution requires adequate funds to function. It triggers the service given to the patients is based on patients’ financial capability that is usually shown by the difference of room classes afforded. The more expensive the room, the better service patients get. Those who can afford the upper class would get better treatment and service in all terms, from doctor visit to nurse care. Those who pay for the lower class – most are poor family – would be less prioritized even being abandoned. However, single standard of quality service in Sultan Syarif Mohamad AlKadrie hospital guarantees that everyone has equal excellence in health service. The treatment and service given are based on the type of illness, diseases, and age group instead of room classes or patients’ economic background.

The Anti-discrimination service implemented by Sultan Syarif Alkadrie Regional Public Hospital of Pontianak City provides the poor people with easy accessible and gratifying service. The implementation of health service for poor people defines an essential meaning because people’s health ensures the social justice compliance thus the health service for poor people is inevitable considering the mortality rate of infant and toddler is 3 (three) upto 5 (five) times higher than not poor family. In addition, the implementation of good health service for poor people can avert the mortality rate by 8 (eight) million each year. In accordance with the global commitment to reduce poverty rate through the improvement of health service for poor people. In our hospital, everyone is welcome for health service, the poor family will no longer be neglected and richer patients will no longer get more priority because of their wealth. As government, we can make sure that we are doing our job properly in providing the best and equal public service to all people, especially the poor. They can rely on the Pontianak Public Hospital to get a sufficient healthcare service. This condition also helps government to provide a better life quality for the poor.

The anti-discrimination or non-class hospital service of Sultan Syarif Alkadrie Regional Public Hospital is a government’s effort of Pontianak to eradicate poverty through the enhancement of hospital public service as 2030 sustainable development agenda pursuant to 17 objectives of SDGs. The initiative of pontianak city government is through Anti-discrimination service by providing poor people the easily accessible health service. Poverty and disease are very closely related thus an intervention is necessary to overcome such issues. Poverty affects health, therefore poor people becomes vulnerable to various diseases for they may suffer from: Malnutrition; Poor information about health; Unhealthy and unclean behavior; inadequate residential environment; and Unavailability of health expense. By contrast, health affects poverty. Healthy people can reduce poverty rate because they possess such conditions as: High labor productivity; Low expenditure of medical treatment; More chance to invest and save the money; Quality education improvement; fertility and mortality rate; economic stability. (http://sapa.or.id)

Recently we often hear or read about unfolding issues related to public services such as high poor people rate who suffer from diseases dealing with digestion thus it triggers high number of patient visit. Besides a number of poor people are yet to receive health insurance financed by the government. There is a discrimination in drug distribution between people who possess national health insurance and pay generally, however all people hospitalizing in our Hospital is entitled to get patent and generic drugs. Health service is extremely necessary for the entire society. Yet in our country, the government still discriminates the society level in providing hospital services based on financial status. The rooms for high level society are more well-prepared whereas health service is an essential need that should be provided and well-prepared for the entire society. In some hospitals, the availability of room for high level society is greater than for middle and lower level society. Including the facility like AC available for high level society and fan for middle to lower level society. Anti-discrimination service implemented by our Hospital is easily accessible by the entire society. AC is available in all rooms and health service is equal.

The initiative of Anti-discrimination service has impacted positively upon poor people in Pontianak City. Previously they were unable to access adequate health service. In Pontianak, there are 11 hospitals with government ownership, private, Indonesian Army and Indonesian National Police. Hospitals in Pontianak implement discriminatory services among high class and middle to lower class. Since the establishment of Pontianak Sultan Syarif Alkadrie Regional Public Hospital, the anti-discrimination concept has been implemented therefore poor people can easily access the health service and it become a breath of a fresh air to the people in accessing healthcare. The impact of Anti-discrimination service can be viewed through the data of outpatient visit number. In 2013, the visit number of 446, 2014 as many as 34.156, an increase in 2015 of 49.635 and in 2016 the number of 46.934 visits. The number of inpatient in 2014 as many as 5.160 patients, then an increase of 6.393 in 2015 and it reached by 5.685 patients in 2016. Emergency room visit in 2014 as many as 11.497, by 2015 an increase of 15.662 and in 2016 it reached as many as 17.055. Almost above 95% of the visit, the patients used health insurance card.

Anti-discrimination service is an innovation of Pontianak Sultan Syarif Mohamad Alkadrie Regional Public Hospital that specifically stands up for poor people in obtaining public service in health sector without class service discrimination. This innovation allows poor people in Pontianak City to access hospital services easily. The policy has given a positive impact, the more secured poor people’s health, the more increasing their productivity thus the poverty rate in Pontianak City is decreasing. Such issue can be reviewed through the data of impoverished population in Pontianak when in 2016 it reached 3.175% and a decrease in 2017 of 2.913%. Anti-discrimination health service is specific because Sultan Syarif Mohamad Alkadrie Pontianak Regional Public Hospital is the sole hospital that provides equal service facility for middle to lower level as for high level society. Besides, our public hospital building is mostly look like the private standard. The buildings, the medical instruments, the doctors and nurses and the equal healthcare treatment are the best we can provide. We seriously add more values for the hospital every year. To this effort, our 5 years old hospital has been the role model for the hospitals in Indonesia.

The innovation of anti-discrimination service in Sultan Syarif Mohamad Alkadrie Hospital offers such service concept as –equal, anti-discrimination, fair and effective in giving priority to the patient pursuant to professional standard, -fast, easy and affordable. This innovation is original; it has been implemented since the hospital establishment in 2012, an idea proposed by the Mayor of Pontianak, Sutarmidji in the context of realizing the vision of Pontianak City namely “Pontianak, the Equatorial City, leading environmentally sound in improving human resource and public service.” This vision corresponds to the vision of Sultan Syarif Mohamad Alkadrie Hospital: “embodying a single standard of quality and excellence health service, efficient, affordable and impartial hospital.” This initiative is for supporting Pontianak as the capital city of West Kalimantan Province, located in Borneo Island Indonesia with 620.000 population that categorized as a big city. During these past 8 years, we develop the infrastructures for triggering economic growth and reducing development disparity. The result is a more livable city with the increase of economic growth. However our 5,5% citizen or around 35 thousand people are still living under poverty line, or when the average expenditure per-capita is below $32/month that is vulnerable to health problem.

The implementation of anti-discrimination service in Sultan Syarif Mohamad Alkadrie Hospital requires support in form of health service outlay comprehensively from local Budget and State Budget. In 2012, the local budget was allocated for building the hospital, something rarely done by local government as most will rely from the state because of the big amount of budget. The state allocated for the health instruments and totally our local and central budget was much as 1,461,538 USD. In 2013 is by 2,458,649 USD, in 2014 by 4,393,087 USD, in 2015 of 5,323,934.49 USD and in 2016 of 6,307,641,837 USD. It increases every year as the increasing number of patients The number of hospital bed in providing anti-discrimination service was 100 beds in 2012 and turn into 250 beds in 2016. The number of human resource in hospital in the context of providing anti-discrimination service is currently 58 persons in the management, 42 medical workers, 216 nursing paramedics and 56 non-medical workers, the total is 372 persons. We require all staffs to have improved professional knowledge. The training of human resource for specialist doctors is conducted once a year while for the paramedics conduct in house training and training in competent institution.

Yes

Yes, our anti-discrimination concept is very possible to be replicated and implemented by other hospitals especially the public ones. Before we became the the Indonesian role model public hospitals, there has been many other cities conducting the imitative study to our hospital. And the number increases as we become Top 5 Indonesian Public Service Hospital. More cities coming, from the surrounding of Pontianak to the further part of Indonesia, Jayapura, the Papua Province. They learn about how we conduct anti-discrimination on healthcare service with limited resources and it have been proven that the initiative is able to and will be transferred to other contexts. Most imitate study visitors from other cities surprise with our buildings and facilities that do not look like the old fashion public hospital in Indonesia. Ours is more like a private owned one. This inspires other cities to have at least representative building followed by medical instruments along with the staffs. Nowadays, Jayapura regency is building their representative public hospital inspired from their Pontianak visit, than we also informed that our neighbor regency is also doing the same effort to found the representative and anti-discrimination healthcare service.

The initiative will be sustainable since it brings benefit to both people and the government. The government can serve healthcare and improve its people’s life as one of our city’s vision. Then all the people can feel secure for healthcare service, especially the poor. Of all, commitment from the Pontianak government plays an important role in keeping this hospital running by legal foundation support and financial support since the public hospital operated on a non-profit orientation concept. Thus, the initiative concerning anti-discrimination service will also be sustained continuously in Sultan Syarif Alkadrie Hospital for some reasons: 1. The commitment of Pontianak City government stated in the vision of Pontianak City namely “Pontianak, the Equatorial City, leading environmentally sound in improving human resource and public service.” The vision of Pontianak City corresponds to the vision of Sultan Syarif Mohamad Alkadrie Public Hospital i.e. “embodying a single standard of quality and excellence health service, efficient, affordable and impartial hospital.” 2. The constantly increase of funding support from Regional and Central Government for the improvement of healthcare especially the anti-discrimination service in Sultan Syarif Mohamad Alkadrie Hospital through City and State Budget. 3. The support from the legislature namely Regional People's Representative Assembly of Pontianak City. 4. The support from the Central Government Policy in which anti-discriminatory service corresponds to the National Health Insurance and 2030 sustainable development goals i.e. the implementation of system national and measurement of social insurance equitable for all people including the poorest and in 2030 reaches a wide range over poor and vulnerable population. 5. The support from the community for sustaining the anti-discrimination service for the people, specially the poor ones 6. The support from all employees, commitment of the medical staff, and good awareness from the people

Anti-discrimination service or equal / non-class hospital is an initiative that is continuously conducted by Sultan Syarif Mohamad Alkadrie Hospital since the anti-discriminatory service is the main vision of the hospital. The vision is namely “embodying a single standard of quality and excellence health service, efficient, affordable and impartial hospital.” Moreover, the commitment of Pontianak City Government especially the Mayor of Pontianak to sustain and continue this hospital service concept has been our crucial capital. The regulation has been drawn up in the form of regional and mayor regulation in order to possess strong foundation in its implementation. The existence of these legal regulations, also make easier in future planning and allocating human resources. Sultan Syarif Mohamad Alkadrie Pontianak Public Hospital was built on the purpose of making sure the government do their obligation especially in healthcare service for the people. The government is responsible for providing a good healthcare service, an equal and effective system, with no discrimination against all people. The patients should be the number one concern and priority based on the hospital standard. By implementing this concept, Pontianak Public Hospital brought back the nature of public hospital service, which is social service and non-profit orientation. Concerning our obligation as government not to differentiate our people based on the economic condition, the implementation of anti-discrimination healthcare service will be sustainable and implemented as long as the government system exists

Yes

Anti-discrimination service has been evaluated through periodical surveys of people satisfaction index, which is one of the indicators to measure the service in the hospital and find out the index of satisfaction of the patients. Firstly conducted in 2014 resulting of 75,58 satisfaction data, then in 2015 of 77,26 satisfaction data and in 2016 of 81,90 satisfaction data. This people satisfaction index is tend to increase every year. Based on the standard of Ministry of Administrative and Bureaucratic Reform the service of Sultan Syarif Alkadrie Regional Public Hospital has included into good category. Internal monitoring and evaluation are also crucial in operating this concept. These two activities are necessary in order to create innovation, solve problems and obstacles, and to bring betterment to the hospital. These are some evaluated activities done by the hospital: - Monthly meeting – “Monday Morning Coffee”. The participants are the managements, heads of room, and heads of medical installation. - Meeting between hospital management and medical committee. - Internal management meeting, the participants are director, heads of department, and heads of section. - Patients complains and suggestions mechanism (suggestion box). - Monthly financial report, to find out details about financial condition.

Sultan Syarif Alkadrie Hospital has successfully became one of top-35 public service innovations held by Ministry of Administrative and Bureaucratic Reform in 2016. This is a yearly evaluation for all public service entities in Indonesia that conduct innovation and improvement in providing public service. At the age of 5 years, our hospital has encompass this prestigious achievement as the result of our hard work. In 2017, the Ministry of Administrative and Bureaucratic Reform made our achievement moved forward as the hospital has been stipulated as the Best Public Service Role Model in 2017 and continued to 2018. However, this proudly outcome is not our final goal because for us, the success of providing the best healthcare service to all the people, especially the poor one, equally with a single standard excellent is our heartwarming success. The initiative has rise our patients number because the poor can easily access the health service and the increasing hope to our hospital. In 2013, the visit number is 446, 2014 is 34.156, an increase in 2015 of 49.635 and in 2016 the number of 46.934 visits. Almost above 95% of the visit, the patients use national health insurance card.

The indicator used for evaluating the initiative is the people’s satisfaction in obtaining anti-discrimination service providing by Sultan Syarif Alkadrie Hospital of Pontianak. The Indicator of people’s satisfaction that is used based on the regulation of Ministry of Administrative of Indonesia No. 16 in 2014 concerning survey guideline of people’s satisfaction towards the provision of public service. Other indicator is the increasing number patients every year to the hospital as a result of more people have access to healthcare service in Pontianak City. The increasing budget is also one of our indicator because the more patients using national health insurance, the more returns from social security administrator for healthcare (BPJS) to the hospital. This budget is then used back for the hospital's operational funding.

The idea of anti discrimination healthcare service or more known by non-class service / a single standard of quality and excellence for all patients in health service were fully supported 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 commitment of Pontianak City Government to sustain and continue the hospital service concept is one of our crucial capitals as it is also committees to give sufficient support to the 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. Other important stakeholder is the Regional People's Representative Assembly of Pontianak City. This institution involves in guarantee that the local budget is allocate for the hospital properly and continuously for public service specially the poor ones. 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.

There are some lessons that can be learned from the implementation of anti-discrimination healthcare service by Sultan Syarif Mohamad Alkadrie Pontianak Hospital. Firstly, all patients have the equal right to accept a single standard quality of excellent healthcare service without any discrimination regarding the economic condition. Secondly, Since most of the patients come from poor family or 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, and administration staff. All of them have to realize that even though the patients are coming from a low economic background, they do have to give an optimal service without any discrimination. Thirdly, a strong commitment has to be shown by the Pontianak city government since the hospital implements a non profit mechanism. Therefore, a financial support from the city government is very necessary to cover the cost of the hospital and additional payment support for the medical staff. Last, the patients’ feeling secure of don’t have to worry about preparing funds before getting any kind of medical treatments is an important factor for the cure process.