Drug Distribution Disparity in Indonesia, When Will it End? ( HMF ‘AP’ ITB, Indonesia

DRUG DISTRIBUTION DISPARITY IN INDONESIA, WHEN WILL IT END? AMBASSADOR: FAIRUZ AISYA ALZURA, JAYSON WILBERT HMF ‘AP’ ITB , INDONESIA

Until now, there are still some problems in the health sector that need attention and action to overcome them. We believe that every country has its own emphasis on health problems, including Indonesia, which still has several unanswered and unsolved problems. On this occasion, we will talk more specifically about health inequity in Indonesia. Quoted from WHO (World Health Organisation), health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. In Indonesia, there are at least 4 main obstacles that need to be addressed regarding this issue.

1. Archipelago state. Consisting of more than 17,000 islands, the distribution of food and health is often hampered because remote areas cannot be reached only by land route. This uneven geographical distribution leads to inadequate supply and resources. Despite the distribution difficulty, the biggest problem in drug distribution is the difficulty of obtaining drug logistics information. There are regencies in one province which have excessive availability of drugs, but on the other hand there are regencies that lack drugs.

2. Economic condition. As one of the LMIC (Low Middle Income Countries), around 40% of 269 million people in Indonesia live on less than US$ 3.10 per day. In addition, the health sector only gets 5% of the State Revenue and Expenditure Budget and is divided among each local government. This number shows the difficulty of providing equitable health services for the community.

3. Poor access and connectivity. The serious inequality in factors affecting access consists of transportation costs, travel time to health care facilities, availability of health insurance or guarantees, and ability to pay.

4. Low healthcare professionals to Indonesian population ratio.. The average pharmacist ratio to population per 100,000 population is only 1:35 and this disparity becomes a serious matter in almost all regions. Regarding the pandemic that is happening right now, especially in Indonesia, there has been a surge in drug demand and our country has been facing a lot of problems relating to the drug distribution equivalence. The ministry, in collaboration with the State-owned Enterprise and private pharmaceutical industries, continues to monitor the availability of drugs in the field, ranging from industry, pharmaceutical wholesalers, hospitals to pharmacies. The drugs are distributed to hospitals and pharmacies to be accessible to the public. To meet the increasing demand for drugs, the government calls on the pharmaceutical industry to increase production capacity, speed up importation and distribution of drugs. Also, these industries and the public are urged not to hoard drugs.

Other than high drug demand, our country has also been struggling with medical equipment distribution equivalence. Medical equipment is different from other kinds of tools because it is a set of tools whose quality must be ensured so that they can reach users in a good and safe condition.

The safety, quality, and benefits of imported and domestic medical equipment circulating in Indonesia has a distribution process that is in accordance with the guidelines by Regulation of the Minister of Health, that the distribution of medical equipment can only be carried out by facilities that already have a MedicalEquipment Distribution Permit (MEDP) and must be carried out in accordance with the provisions of the Good Method of Distribution of Medical Equipment. MEDP will be issued based on the company's eligibility to distribute medical devices safely and correctly. The distributor of the medical equipment is either a Limited Liability Company, cooperative, or individual company in the form of a legal entity that has a license for the procurement, storage, distribution of medical equipment in large quantities (according to the provisions of the applicable legislation).

The development of information and communication technology (ICT) has increased tremendously in all fields of life, including in administration health in Indonesia. ICT is not only to improve the service effectiveness and accessibility of health data, but also to assist in monitoring and evaluating health programs. The obstacle that often appears in pharmacies is the control process drug stock that is still done manually by looking at the drug sales book. This causes a lot of data errors and a relatively long time to check the drug stock. During the COVID-19 pandemic, the increasing demand for medicines and health supplements has reduced many people’s accessibility to the medicines they need. Due to the uneven stock of drugs in each region and the difficulty of finding the desired product, the government has created an online site to check the availability of drugs at the nearest pharmacy (farmaplus.kemkes.go.id). However, there are still many people who still do not know about the existence of this site and also drug stock data is only available for some large pharmacies such as Guardian, K-24, Watsons, etc. Not all people have easy access to these large pharmacies, because in general, large pharmacies are located in the centre of the city. Large pharmacies tend to be far away from the outskirts of town and people are having trouble accessing transportations which is also expensive for some. It is necessary to make online data information of drug stocks in small pharmacies, so that people can easily monitor the existence of the desired drug.

There are several things that the government and healthcare professionals, especially pharmacists, could do to overcome these problems. First of all, due to the uneven stock of drugs, the government could make a designated transportation system for each region. They also planned to make an online system for drugs and medical devices' stock in each region called the e-logistic system. This system will be a part of the National Health Information System. Besides that, the government also could make sure that each pharmacy and healthcare facility in each region have a stable network connection so that they could update and inform the needs for drugs and medical devices more often, thus the government could ship them on time. They also could predict the needs for the drugs and medical devices based on past needs and make orders to restock immediately.

Secondly, to address the difficulty of finding the desired products or drugs, BPOM or National Agency of Drug and Food Control in Indonesia and Indonesia’s Ministry of Health could improve the online site that has been created, which is farmaplus.kemkes.go.id. As of now, the site only gives information about the stock of eight drugs, which include antivirus, antibiotic, and vitamin that are needed for recovery from COVID-19. For improvement, they could add the stock information of many other drugs. The government could also expand their cooperation with small pharmacies so the communities will have many choices of pharmacy to buy drugs. For the pharmacists, they could update the drug stock more often, for example twice a day, so that the drug stock information that was shown in the site will be the same as the actual drug stock in the pharmacy. To make the communities aware about this site, the Ministry of Health could put up an advertisement on television and social media as well as ask news programs to inform the site to their viewers.

References

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