Primary health care policy and vision for community pharmacy and pharmacists in Indonesia
Keywords:Pharmacies, Primary Health Care, Delivery of Health Care, Integrated, Ambulatory Care, Community Health Services, Pharmacists, Community Pharmacy Services, Professional Practice, Indonesia
The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the “Smart Use of Medicines” program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice.
Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Suparmi, Achadi EL, Taher A, Wirawan F, Sungkar S, Sudarmono P, Shankar AH, Thabrany H; Indonesian Health Systems Group. Universal health coverage in Indonesia: concept, progress, and challenges. Lancet. 2019;393(10166):75-102. https://doi.org/10.1016/s0140-6736(18)31647-7
Central Intelligence Agency. The World Factbook: Indonesia. Vol 2020. Washington DC: Central Intelligence Agency; 2020.
Ministry of Health Indonesia. Indonesia Health Profile 2018 (Profil Kesehatan Indonesia 2018). Jakarta: Ministry of Health Indonesia; 2018.
Tan M, Kusriastuti R, Savioli L, Hotez PJ. Indonesia: an emerging market economy beset by neglected tropical diseases (NTDs). PLoS Negl Trop Dis. 2014;8(2):e2449. https://doi.org/10.1371/journal.pntd.0002449
Schröders J, Wall S, Hakimi M, Dewi FST, Weinehall L, Nichter M, Nilsson M, Kusnanto H, Rahajeng E, Ng N. How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis. PLoS One. 2017 Jun 20;12(6):e0179186. https://doi.org/10.1371/journal.pone.0179186
Kristina SA, Endarti D, Wiedyaningsih C, Fahamsya A, Faizah N. Health Care Cost of Noncommunicable Diseases Related to Smoking in Indonesia, 2015. Asia Pac J Public Health. 2018;30(1):29-35. https://doi.org/10.1177/1010539517751311
Christiani Y, Dugdale P, Tavener M, Byles JE. The dynamic of non-communicable disease control policy in Indonesia. Aust Health Rev. 2017;41(2):207-213. https://doi.org/10.1071/ah15196
Mahendradhata Y, Trisnantoro L, Listyadewi S, Soewondo P, Marthias T, Harimurti P, Prawira P.The Republic of Indonesia Health System Review. Health Systems in Transition. New Delhi: WHO; 2017. Available at: https://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf?sequence=1&isAllowed=y (accessed (Jul 15, 2020).
Government of Indonesia. [The National Health Law Number 36 of 2009]. In: Indonesia Go. Vol 36/2009. Jakarta: Government of Indonesia; 2009.
Suryanto S, Plummer V, Boyle M. Financing healthcare in Indonesia. Asia Pacific J Health Manag. 2016;11(2):33-38. https://doi.org/10.24083/apjhm.v11i2.185
Ministry of Health Indonesia. [Data and Information: Indonesian Health Profile 2019]. Jakarta: Ministry of Health Indonesia; 2020.
World Health Organization. Primary health care systems (PRIMASYS): comprehensive case study from Indonesia. Geneva: World Health Organization; 2017.
Ministry of Health Indonesia. [The Minister of Health Regulation Number 46 of 2015 on Puskesmas Accreditation]. In: Indonesia MoH. Vol 46/2015. Jakarta: Ministry of Health Indonesia; 2015.
Limato R, Tumbelaka P, Ahmed R, Nasir S, Syafruddin D, Ormel H, Kumar MB, Taegtmeyer M, Kok M. What factors do make quality improvement work in primary health care? Experiences of maternal health quality improvement teams in three Puskesmas in Indonesia. PLoS One. 2019;14(12):e0226804. https://doi.org/10.1371/journal.pone.0226804
Holzhacker RL, Wittek R, Woltjer J, Decentralization and Governance in Indonesia. Cham: Springer; 2016. ISBN: 978-3-319-22433-6
Heywood P, Choi Y. Health system performance at the district level in Indonesia after decentralization. BMC Int Health Hum Rights. 2010;10:3. Published 2010 Mar 5. https://doi.org/10.1186/1472-698x-10-3
Aspinall E. Health care and democratization in Indonesia. Democratization. 2014;21(5):803-823. https://doi.org/10.1080/13510347.2013.873791
Fossati D. Beyond “Good Governance”: The multi-level politics of health insurance for the poor in Indonesia. World Development. 2016;87:291-306. https://doi.org/10.1016/j.worlddev.2016.06.020
Mboi N. Indonesia: On the Way to Universal Health Care. Health Systems & Reform. 2015;1(2):91-97. https://doi.org/10.1080/23288604.2015.1020642
Government of Indonesia. [The National Social Security System Law Number 40 of 2004]. In: Indonesia Go. Vol 40/2004. Jakarta: Government of Indonesia; 2004.
Suryahadi A, Febriany V, Yumna A. Expanding social security in Indonesia. In: Ilcheong Yi eds. Towards universal health care in emerging economies: London: Palgrave Macmillan; 2017. ISBN: 978-1-137-53376-0
Pisani E, Olivier Kok M, Nugroho K. Indonesia's road to universal health coverage: a political journey. Health Policy Plan. 2017;32(2):267-276. https://doi.org/10.1093/heapol/czw120
Hermansyah A, Sainsbury E, Krass I. Investigating the impact of the universal healthcare coverage programme on community pharmacy practice. Health Soc Care Community. 2018;26(2):e249-e260. https://doi.org/10.1111/hsc.12506
Dartanto T, Halimatussadiah A, Rezki JF, Nurhasana R, Siregar CH, Bintara H, Usman, Pramono W, Sholihah NK, Yuan EZW, Soeharno R. Why Do Informal Sector Workers Not Pay the Premium Regularly? Evidence from the National Health Insurance System in Indonesia. Appl Health Econ Health Policy. 2020;18(1):81-96. https://doi.org/10.1007/s40258-019-00518-y
Reuters. Indonesia to raise health insurance premiums amid coronavirus outbreak. Available at: https://es.reuters.com/article/asia/idUSL4N2CV2H5 (accessed Jul 15, 2020)
The Jakarta Post. Jokowi raises BPJS Kesehatan premiums, again. Jakarta: The Jakarta Post; 2020.
Athiyah U, Setiawan CD, Nugraheni G, Zairina E, Utami W, Hermansyah A. Assessment of pharmacists' knowledge, attitude and practice in chain community pharmacies towards their current function and performance in Indonesia. Pharm Pract (Granada). 2019;17(3):1518. https://doi.org/10.18549/pharmpract.2019.3.1518
Hermansyah A, Rahem A, Sukorini AI. Survey of Pharmacy Contribution and Excellence: Nationwide Survey Report. Surabaya: Faculty of Pharmacy Universitas Airlangga. Indonesian Pharmacist Association; 2019.
Hermansyah A, Athiyah U, Setiawan CD. Are patients willing to ask for generic drug substitutions? Int J Pharm Teach Pract. 2013;4(4):1-7.
Hermansyah A, Sukorini AI, Setiawan CD, Priyandani Y. The conflicts between professional and non professional work of community pharmacists in Indonesia. Pharm Pract (Granada). 2012;10(1):33-39. https://doi.org/10.4321/s1886-36552012000100006
Smith F. Private local pharmacies in low- and middle-income countries: a review of interventions to enhance their role in public health. Trop Med Int Health. 2009;14(3):362-372. https://doi.org/10.1111/j.1365-3156.2009.02232.x
Hermansyah A, Sainsbury E, Krass I. Community pharmacy and emerging public health initiatives in developing Southeast Asian countries: a systematic review. Health Soc Care Community. 2016;24(5):e11-e22. https://doi.org/10.1111/hsc.12289
Wibowo Y, Parsons R, Sunderland B, Hughes J. Evaluation of community pharmacy-based services for type-2 diabetes in an Indonesian setting: pharmacist survey. Int J Clin Pharm. 2015;37(5):873-882. https://doi.org/10.1007/s11096-015-0135-y
Tri Murti Andayani, Satibi Satibi. Pharmacy Practice in Indonesia. In: Fathelrahman A, Ibrahim MI, Wertheimer AI, eds. Pharmacy practice in Developing Countries: achievements and challenges. London: Academic Press; 2020. ISBN: 9780128198377
Setiadi AP, Wibowo Y, Brata C, Halim SV, Wardhani SA, Sunderland B. The role of pharmacists in community education to promote responsible self-medication in Indonesia: an application of the spiral educational model. Int J Clin Pharm. 2020. [Ahead of Print]. https://doi.org/10.1007/s11096-020-01055-8
Kimura S, Nakamura Y. A case study in Indonesia: self-medication and limited access. In: Poor quality pharmaceuticals in global public health. Singapore: Springer; 2020:119-147. ISBN: 978-981-15-2088-4
President Regulation. [The pharmacy practice Act of 2009]. Jakarta: Government of Indonesia; 2009.
Ministry of Health Indonesia. [The community pharmacy Decree of 2017]. In: Indonesia MoH. Jakarta: Ministry of Health Indonesia; 2017.
Ministry of Health Indonesia. [The standard of pharmacy services in community pharmacy]. In: Indonesia MoH. Jakarta: Ministry of Health Indonesia; 2016.
Ministry of Health Indonesia. [The standard of pharmacy services in Puskesmas]. In: Indonesia MoH. Jakarta: Ministry of Health Indonesia; 2016.
Ministry of Health Indonesia. [The standard of pharmacy services in hospital]. In: Indonesia MoH. Jakarta: Ministry of Health; 2016.
Hermansyah A, Sainsbury E, Krass I. Multiple policy approaches in improving community pharmacy practice: the case in Indonesia. BMC Health Serv Res. 2018;18(1):449. https://doi.org/10.1186/s12913-018-3258-8
Indonesia Ministry of Health. [The Standard of Tariff for Health Services in the Universal Health Coverage]. Jakarta: Ministry of Health; 2016.
Ng JYS, Ramadani RV, Hendrawan D, Duc DT, Kiet PHT. National Health Insurance Databases in Indonesia, Vietnam and the Philippines. Pharmacoecon Open. 2019;3(4):517-526. https://doi.org/10.1007/s41669-019-0127-2
Social Health Insurance Agency. [Health facilities under universal health coverage]. Jakarta: Social Health Insurance Agency; 2020.
Dewi DAPS, Satibi S, Puspandari DA. [Cost Analysis of Medicines at the Supporting Facilities and Factors associated with it in Yogyakarta during the National Health Insurance Era]. Jurnal Manajemen dan Pelayanan Farmasi. 2015;5:291-300.
Kaswindarti N, Satibi S, Puspandari DA. [Analysis of pharmacists’ perceptions on the implementation of payment system at the pharmacy level in the National Health Insurance Era in Yogyakarta]. Jurnal Manajemen dan Pelayanan Farmasi. 2015;5:275-282.
Wijaya IN, Athiyah U; Fasich , Hermansyah A. Knowledge, attitude, and practice of pharmacists towards management of hypertension in primary care centers. J Basic Clin Physiol Pharmacol. 2020. [Ahead of Print]. https://doi.org/10.1515/jbcpp-2019-0319
Susyanty AL, Yuniar Y, Herman MJ, Prihartini N. [The Suitability of Pharmaceutical Services Standard Implementation in Public Health Centre]. Media Penelitian dan Pengembangan Kesehatan. 2020;30:65-74.
Ministry of Health Indonesia. [The Minister of Health Decree on Gema Cermat]. Jakarta: Ministry of Health; 2015.
Hermansyah A, Pitaloka D, Sainsbury E, Krass I. Prioritising recommendations to advance community pharmacy practice. Res Social Adm Pharm. 2018;14(12):1147-1156. https://doi.org/10.1016/j.sapharm.2018.02.003
Setiadi AP, Wibowo YI, Setiawan E, Mulyono I, Wardhani SA, Sunderland B. Strategies to implement community training to promote responsible self-medication in Indonesia: a qualitative study of trainers. Int Health. 2020. [Ahead of Print]. https://doi.org/10.1093/inthealth/ihz115
Simbara A, Primananda AZ, Tetuko A, Savitri CN. [The educational method for improving knowledge on self-medication practice under Gema Cermat]. Indonesia Jurnal Farmasi. 2020;4:1-5.
Nining N, Yeni Y. [The education and campaign of Gema Cermat)]. Jurnal Pengabdian kepada Masyarakat. 2019;5:36-48.
Ministry of Health Indonesia. [The Ministerial Decree on Integrated Permit Administration for Electronic System in Health Care 2018]. Jakarta: Ministry of Health; 2018.
Indonesian Pharmacists Association. [The Decree of the Congress on General Program of the National Committee of Indonesian Pharmacist Association 2018-2022]. Pekanbaru: Indonesian Pharmacist Association; 2018.
Indonesian Pharmacists Association. The User Manual for SIAP Apps. Jakarta: Indonesian Pharmacist Association; 2020.
The Parliament of Indonesia - House of Representative. The Draft of the Pharmacy Law (Omnibus Law). Vol 2020. Jakarta: The Parliament of Indonesia - House of Representative; 2020.
Smith T, McNeil K, Mitchell R, Boyle B, Ries N. A study of macro-, meso- and micro-barriers and enablers affecting extended scopes of practice: the case of rural nurse practitioners in Australia. BMC Nurs. 2019;18:14. https://doi.org/10.1186/s12912-019-0337-z
Hermansyah A, Sainsbury E, Krass I. Investigating influences on current community pharmacy practice at micro, meso, and macro levels. Res Social Adm Pharm. 2017;13(4):727-737. https://doi.org/10.1016/j.sapharm.2016.06.007
Puspitasari HP, Aslani P, Krass I. Challenges in the management of chronic noncommunicable diseases by Indonesian community pharmacists. Pharm Pract (Granada). 2015;13(3):578. https://doi.org/10.18549/pharmpract.2015.03.578
Widayati A, Virginia DM, Setiawan CH, Fenty F, Donowati MW, Christasani PD, Hartayu TS, Suhadi R, Saini B, Armour C. Pharmacists' views on the development of asthma pharmaceutical care model in Indonesia: A needs analysis study. Res Social Adm Pharm. 2018;14(12):1172-1179. https://doi.org/10.1016/j.sapharm.2018.01.008
Anggriani Y, Ramadaniati HU, Sarnianto P, Pontoan J, Suryawati S. The Impact of Pharmaceutical Policies on Medicine Procurement Pricing in Indonesia Under the Implementation of Indonesia's Social Health Insurance System. Value Health Reg Issues. 2020;21:1-8. https://doi.org/10.1016/j.vhri.2019.05.005
Hadi U, van den Broek P, Kolopaking EP, Zairina N, Gardjito W, Gyssens IC; Study Group Antimicrobial Resistance in Indonesia: Prevalence and Prevention AMRIN. Cross-sectional study of availability and pharmaceutical quality of antibiotics requested with or without prescription (Over The Counter) in Surabaya, Indonesia. BMC Infect Dis. 2010;10:203. Published 2010 Jul 9. https://doi.org/10.1186/1471-2334-10-203
Puspitasari HP, Faturrohmah A, Hermansyah A. Do Indonesian community pharmacy workers respond to antibiotics requests appropriately?. Trop Med Int Health. 2011;16(7):840-846. https://doi.org/10.1111/j.1365-3156.2011.02782.x
Wulandari L, Mashuri Y, Ferdiana A, Probandari A, Wibawa T, Wiseman V. Inside the black box of antibiotic dispensing by private drug sellers in Indonesia (PINTAR study). International Society to Improve the Use of Medicine (ISIUM) Conference. Bangkok 2020.
Babar ZU, Scahill S. Barriers to effective pharmacy practice in low-and middle-income countries. Integr Pharm Res Pract. 2014;3:25-27. https://doi.org/10.2147/IPRP.S35379
Herman MJ, Handayani RS. The Preparedness of Pharmacist in Community Setting to Cope with Globalization Impact. Indonesia Pharm J. 2015;5(1):57-66.
Sugiyatmi TA, Hadi U, Chalidyanto D, Hafidz F, Miftahussurur M. Does the implementation of national health insurance affect the workload of a doctor and have an impact on service quality? A systematic literature review. J Public Health Afr. 2019;10(1s):101-105. https://doi.org/10.4081/jphia.2019.1198
Meilianti S, Bunyamin IM. How Indonesia’s pharmacists are developing their primary healthcare workforce. Int Pharm J. 2019;37:30-32.
Satibi S, Rokhman MR, Aditama H. Developing Consensus Indicators to Assess Pharmacy Service Quality at Primary Health Centres in Yogyakarta, Indonesia. Malays J Med Sci. 2019;26(4):110-121. https://doi.org/10.21315/mjms2019.26.4.13
Brata C, Fisher C, Marjadi B, Schneider CR, Clifford RM. Factors influencing the current practice of self-medication consultations in Eastern Indonesian community pharmacies: a qualitative study. BMC Health Serv Res. 2016;16:179. Published 2016 May 13. https://doi.org/10.1186/s12913-016-1425-3
Herman MJ, Susyanty AL. Analysis of pharmacy services by pharmacists in community pharmacy. Buletin Penelitian Sistem Kesehatan. 2012;15:271-281.
Hallit S, Selwan CA, Salameh P. Primary health care policy and vision for community pharmacy and pharmacists in Lebanon. Pharm Pract (Granada). 2020;18(2):2003. https://doi.org/10.18549/pharmpract.2020.2.2003
Anderson C, Sharma R. Primary health care policy and vision for community pharmacy and pharmacists in England. Pharm Pract (Granada). 2020;18(1):1870. https://doi.org/10.18549/pharmpract.2020.1.1870
Dineen-Griffin S, Benrimoj SI, Garcia-Cardenas V. Primary health care policy and vision for community pharmacy and pharmacists in Australia. Pharm Pract (Granada). 2020;18(2):1967. https://doi.org/10.18549/pharmpract.2020.2.1967
Kristina SA, Ekasari MP, Wati MR. Internet use for searching information on Health and Medicine: An Exploratory study among Indonesian customers. Res J Pharm Technol. 2019;12(12):5927-5931. https://doi.org/10.5958/0974-360X.2019.01028.X
Al-Worafi YM. Drug safety in Indonesia. In: Al-Worafi Y, ed. Drug Safety in Developing Countries: Achievements and Challenges. London: Academic Press; 2020. ISBN: 9780128198377
Parathon H, Kuntaman K, Widiastoety TH, Muliawan BT, Karuniawati A, Qibtiyah M, Djanun Z, Tawilah JF, Aditama T, Thamlikitkul V, Vong S. Progress towards antimicrobial resistance containment and control in Indonesia. BMJ. 2017;358:j3808. Published 2017 Sep 5. https://doi.org/10.1136/bmj.j3808
Ung COL. Community pharmacist in public health emergencies: Quick to action against the coronavirus 2019-nCoV outbreak. Res Social Adm Pharm. 2020;16(4):583-586. https://doi.org/10.1016/j.sapharm.2020.02.003
Mooranian A, Emmerton L, Hattingh L. The introduction of the national e-health record into Australian community pharmacy practice: pharmacists' perceptions. Int J Pharm Pract. 2013;21(6):405-412. https://doi.org/10.1111/ijpp.12034
Kusumawati W, Orbayinah S. Interprofessional education from pilot to formal curriculum. In: Forman D, Jones M, Thistlethwaite J, eds. Leadership and Collaboration. London: Palgrave Macmillan; 2015.
Lin HW, Yang LC, Mafruhah OR, Nguyen HT, Cao TT, Yam FK. Evolution of Clinical Pharmacy Practice and Pharmacy Education in Taiwan, Vietnam, and Indonesia: A Narrative Review. J Am College Clin Pharm. 2020. [Ahead of Print]. https://doi.org/10.1002/jac5.1258
Kristina SA, Gustriawanto N, Rokhman MR, Aditama H, Sari IP. Students’ first experience with Objective Structured Clinical Examination in a pharmacy school in Indonesia. J Appl Pharm Sci. 2018;8(9):102-106. https://doi.org/10.7324/JAPS.2018.8915
Ministry of Research TaHEoI. Database of Higher Education: Pharmacy. Vol 2020. Jakarta: Ministry of Research, Technology and Higher Education of Indonesia; 2020.
Remington TL, Foulk MA, Williams BC. Evaluation of evidence for interprofessional education. Am J Pharm Educ. 2006;70(3):66. https://doi.org/10.5688/aj700366
Syahrizal D, Renaldi T, Dianti SW, Jannah N, Rachmah R, Firdausa S, Vonna A. The Differences in Perceptions of Interprofessional Education Among Health Profession Students: The Indonesian Experience [published correction appears in J Multidiscip Healthc. 2020 Jun 25;13:557]. J Multidiscip Healthc. 2020;13:403-410. https://doi.org/10.2147/jmdh.s240195
Wang Lin-Nam. Workforce transformation, endorsed by Ministry of Health, is brought to Indonesia’s pharmacists by FIP. 2019 Congress of FIP; Abu Dhabi, 2019.
Indonesian Pharmacists Association. [Press release: the signing of Memorandum of Understanding between IAI and FIP on advanced pharmacist program]. Jakarta: Indonesian Pharmacist Association; 2019.
Indonesian Pharmacists Association. Advanced Pharmacy Practice Survey of Indonesia. Jakarta: Indonesian Pharmacist Association; 2019.
Rijaluddin MK, Utami W, Othman Z, Puspitasari HP, Rahem A, Sukorini AI, Hermansyah A. Exploration of barriers affecting job satisfaction among community pharmacists. J Basic Clin Physiol Pharmacol. 2020.[Ahead of Print]. https://doi.org/10.1515/jbcpp-2019-0325
Joint Partners Credentialing Task Group. Professional recognition and professional advancement: For our practitioners, for our profession and for our patients. London: Royal Pharmaceutical Society; 2013.
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