The draft of the new health law (RUU Kesehatan) attracted a lot of public debate, especially coming from policy actors whose interests are impacted by such a newly established draft. One of the major policy issues that this new bill tries to address is the lack of specialized doctors across the archipelago. The media coverage that has presented the policy narratives on the health bill is critical to garner public support and perception of the health bill, leading to swift policy change. Therefore, examining the current policy narratives on the health bill is needed to know its effectiveness in enhancing public support.
The Current Policy Narrative on the Health Bill
When we look closely into the media coverage around the “contestation”, the policy narratives surrounding the urgency of new health law have focussed much on the difficulties faced by the doctors in obtaining and extending medical licenses with the recommendation from Indonesian Medical Association (IDI). According to the statements by Indonesia’s Vice Minister of Health, Dante Laksono, medical doctors need to pay a high amount of funds worth of Rp.6.000.000,00, which he deemed as obstacles to prolonging doctors’ career pathways. The narratives resultantly cast the health workers association as the ‘villain’. The citizens impacted by the lack of doctors in their area are cast as the ‘victim’ by the current policies, however, has not been amplified much in the media coverage. The heated arguments between the Minister of Health and IDI have dominated the discussion about the health law draft, shifting the focus away from other substances contained in the materials, such as patient’s protection.
I argue, using the Narrative Policy Framework Theory (Shanahan et al., 2018), that casting the health workers association as the villain has caused the government to potentially lose public support, particularly from the health workers, while getting their support is also critical because they are the main stakeholders whose positions, roles and skills are governed through this regulation. This is evidenced by the fact that other civil society organizations have started scrutinising the draft more closely. For instance, Achilles Health Law Firm and Indonesian Dentist Association (PDGI), have joined in to criticize the substance, arguing that it has the potential to criminalize health workers for malpractices due to one of its clauses, the article 62 (1), explicitly states that “every medical and health practitioner who did heavy negligence which has caused severe harm to the patients could be facing sentences for a maximum of 3 years” Other health practitioners on Twitter have also lamented upon the potentials of health inequity in the periphery due to the policy draft that seems to be focussing on the industrialisation of healthcare industry through global medical tourism.
Shifting the narratives to focus on the victims
While the process of simplifying the doctor’s licenses has indeed impacted the working of health workers associations, there are other more profound narratives that should have been put forward to enhance public support. According to the NPF, the policy processes of expanding public support can instead focus on enhancing the victim character. These victims could include patients, the soon-to-be health workers and even the current medical practitioners themselves. By focusing on the victims, the public-based advocacy coalitions might emerge which aim towards enhancing the policy substances.
This has indeed started to play, albeit late, in the policy process of drafting the law. With the heated debate with the health workers association, the government began to subside with the public, the ‘victims’ to gain more public support. This was done through conducting public hearings, civic participation and media advocacies, contributing towards more public insights into the parts of the draft that can be improved. For instance, one of the strong Indonesian think tanks focusing on health issues, CISDI, gave their insights into the law, arguing that it has not made enough room for protection of and enhancing skills for the healthcare cadres in the primary healthcare centers (puskesmas).
What aspects can be advocated more?
The issue regarding simplifying the process of obtaining medical licenses has indeed one of the issues that needs to be tackled. However, what is missing from the current draft is the fact that medical education is expensive in Indonesia, and that there has not been enough clarity around how such new regulation could tackle this, apart from the fact the Ministry of Health will provide hospital-based education with the students not having to pay. It also promises transparency in the health education sector. However, it is not clear what this transparency entails —will each cost component of medical education be regarded as info to which the public can get access? Will the public be entitled to know how the fund will be specifically used for?
What about the students outside the scheme? The current costs, which is estimated to be around Rp. 250 million – 450 million in total, could potentially contribute towards the youth’s loss of appetite to become doctors. On the other hand, studies done by Tan et al. (2020) found that providing financial aid to medical schools have contributed towards optimal training, and also easing their financial burden which could jeopardize their school completion, but leading to the increased numbers of doctors in Singapore. WHO (2013) also recommends the good governance mechanisms of medical training and education, which include sustainable financing, accountability and strong political support, with developing curriculum that meets the population needs being one of the most important agendas.
Therefore, the policy narratives surrounding the new health law can be contextualised in the policy setting that focuses on the need for enhancing transparency and subsidy for medical education—in collaboration with Indonesia’s Ministry of Culture and Education—and thus, expanding the issues more beyond the issuing and extending medical permits. These narratives can be utilised by other policy advocates to ensure the incorporation of such an agenda into the health bill.
Editor: Moch Aldy MA