Health Care and Medical Education in Indonesia by Tri Nur Kristina

(Interview with Tri Nur Kristina)

Tri Nur Kristina took part in the PhD programme of the School of Health Professions Education and earned her PhD degree from Maastricht University in 2005 for her thesis entitled: Generic objectives for community-based education in undergraduate medical programmes: the perspective from developing countries. In 1984 she received her medical degree from the Diponegoro University. She completed a Master of Science in Clinical Epidemiology at Gadjah Mada University in 1997. Most of her activities are focused on medical education. She works as a lecturer in Microbiology and is also involved in the medical education unit of the Faculty of Medicine of Diponegoro University. She is also an internal audit member for educational activities.

Her interest in medical education results from her PhD study at Maastricht University and also from attending two Network: TUFH conferences in Brazil and Australia. In the future she hopes to become more involved in academic affairs and she aspires to contribute to achieving the International Standard with the curriculum of Diponegoro University.

How is health care structured in Indonesia?

A key role in health care services in Indonesia is played by the Community Health Centre called 'puskesmas' (Pusat Kesehatan Masyarakat). Every district of about 10,000 to 20,000 inhabitants has such a centre with staff consisting of nurses, midwives and other auxiliary personnel. A doctor heads the puskesmas, mostly 'young newly graduated' doctors. Although a puskesmas serves the majority of the population, working in this government institution is not considered the most prestigious job for a doctor. Most doctors will enter postgraduate medical training and afterwards work as a specialist.
The six basic services a puskesmas provides are: health promotion, mother & child health/ family planning, communicable disease control, nutrition, environmental sanitation and curative care. Additional developmental services may be added according to local areas' needs. To support the activities of the puskesmas, the community health effort is organised in the form of the Integrated Service Post called 'posyandu' (Pos Pelayanan Terpadu) run by a 'kader' (a woman who lives in the village and provides health service to the mothers and children in that area in terms of monthly health education, monthly checkups of children under the age of five and immunisations). Each posyandu receives assistance and supervision from the local puskesmas staff. When the puskesmas is not sufficiently equipped to offer adequate care, a patient can be referred to the hospital.

Does the structure of health care influence the organisation of medical education in Indonesia?

A new document outlining Standard Competencies of Indonesian Doctors (Indonesian Medical Council, 2006) stated that all medical schools should adopt a competency-based curriculum to train primary care-oriented physicians who are able to practise family medicine.

What is your opinion of health professional education in Indonesia?

The introduction of the Standard Competencies of Indonesion Doctors raised questions in many medical schools about how they were to be implemented. Questions such as: How to develop a school-specific competency-based curriculum; How to introduce such a curriculum; and How to assess the specified competencies. These concerns stem from the observation that the medical schools have to make substantial changes in their approaches to teaching and learning in spite of their limited resources and shortage of facilities. Moreover, the required changes will also affect the school's organisation (planning, management, etc). I hope there will be some examples of good practices on how to implement a competency-based curriculum.

Tri Nur Kristina- PhD graduate SHE 2005