Intro
Many of Makassar people do not get a health care as well as the number of complaints about the difficulty of health access. Other reasons as the background of the programs are the distance and costs factor make them do not have awareness to come to health care center. To legitimate the ambition as world class city, Ramdhan Pomanto, the existing Mayor of Makassar created a health program called Dottoratta or Our Doctor for poor people which was simplified the access of health service.
Objective of the practice
The program called Dottorotta in local language. It means Our Doctor. Its objective is to make sure every people on and under poverty line could access the health service through Home Care Service. health care carried out in the patient’s home by medical staff. In this way the health level of poor people in Makassar could increase as the healthy community is a precondition of world class city, as Makassar is on the process to be one. This program implements the goal number 3 of SDGs particularly in indicator of 3.8.1 and 3.8.2.
Partners
Dottorotta program has reached local people in 15 Sub District of Makassar with community health center as main implementer, under local health agency of Makassar supervision and financed by local government budget. Given the reality that the health center services include promotive, preventive, curative, and rehabilitative so when it comes to treat patients in homes, educational function runs. Patients are not only treated, but his/her family members are also trained to live a healthy life such as cleaning the house and the environment, clean and healthy living behaviors (PHBs), adequate home facilities such as the number of adequate ventilation and so on.
Up till now, there’s no similar program in Indonesia that give health service for 24 hours. The Dottoratta program is even now equipped with the modifies vehicles that made the Dottoratta team could easily visit the patient in aisles of Makassar. Makassar city government until now has been implementing this program independently, yet they always open some opportunity to initiate partnership with many parties to support this breaktrough
Implementation of the Project/Activity
The Dottoratta is including doctors, nurses, physical therapist or speech pathologist will visit the patients at home in need. In the past, before Dottoratta, the program was named Perkesmas or Community Health Care, but it has not been set in a regular basis and has not been definitive yet. With the launch of Dottoratta by the Mayor of Makassar, further strengthens the ease of access to public services in the health sector. In the sake of becoming the ideals of a world class city, people's health is an important thing that must be realized. Dottoratta was formally executed in April 2014. Every month an average of 10-20 cases handled and covers all types of diseases that can be handled by the local health center, ranging from minor ailments such as hives or severe such as psychiatric disorders, post chemotheraphy treatment, tuberculosis and many more, although there are exceptions when the type of disease can be handled independently by the patient's family. To establish this program, each health center applies a diverse schedule. For example, Dottoratta in health center of Urban Village Mangasa is regularly scheduled to be performed every Thursday and Saturday every week, in order to detect cases that had not been reported by the public. But beyond these hours, every day, Dottoratta can be done if there is a emergency call via the call center 112.
Results/Outputs/Impacts
The Dottoratta program has reached 19.303 people or 16-17% of on and under poverty line population in Makassar who called due to his/her sick condition with 10-20 case per months. And the number is in counting. On field, when the Dottoratta team could not handle the case, they will refer to the nearest hospital. Through this program, the people of Makassar who cannot access the private health service, could have 24/7 health service with equal service quality. The health service is now for everyone in Makassar. In long run, this particular program could contribute significantly in increasing the health level of people in Makassar, both physically and mentally. At the end it could made Makassar reach it ambitious of become the world class city
Enabling factors and constraints
Makassar is on its way to become a world class city. This is an ambitious goal of its existing local leader. It has been translated through various innovation program, and financed by local budget. One of them is in health sector. As there are many health problems of people that are newly known after the mass media reporting in Makassar. It is due to lack of people awareness to report the condition. The difficulty is people are more convinced in alternative medicines that target many hallways which are not afforded by health unit in Makassar. In many cases, health workers know the health condition of a people when he/she is already in a critical stage. As a result, health workers are difficult to handle the patient. The handling becomes obstructed and the patient is difficult to cure immediately. The disease is severe and harder to treat when a health worker knew. The number of poor people who cannot afford to community health centers, although health unit care is given free, is due to they do not have the ability to obtain rapid transport to health care and the remote area of the patient. Poverty and health are two things that are very related to each other. In a society, the classification of rich, middle and poor people must be distinguished. The existence of such classification has also an impact on the aspect of life, including the aspect of health. For example, the quality of life of a rich family will be much better, including in matter of health. This is clearly contrary to low-income families; they are even difficult for meals. Due to the problems as mentioned above, the approach of Dottoratta is taking the far one closer, shortening the distance, expanding the service, facilitating the patient so that the patient does not have to pay to the community health center. Taking the far one closer and shortening the distance mean that patient who lives far away can be served quickly so that the patient will still get health care for the visit of health worker to the home. The difficulty of people in obtaining the best health care is precisely due to their difficulty in reaching the service unit. This is understandable for the area of 175 km2, City of Makassar is too broad for only being served by 46 community health centers Expanding the service means the patient who lives in the suburbs still gets served by health workers. Makassar City Government wants to ensure that all people, especially poor people who are even unable to the community health centers, are reached. The basic idea is to change the way of thinking of health service, instead of waiting the ball, it is better to pick up the ball by moving most basic health cares to the homes of people who cannot afford. It is expected that with the strategy, the government’s presence in serving the basic health rights of its people is met. With the increasing number of people and case that had been handled, and the easy-to-access service through 24/7 emegency number and service, it not impossible to leverage and scale up the health service. So the City Makassar could both fulfill its role as public servant and also reach its goal as world class city.
Sustainability and replicability
From cost/ budget wise, the sustainability of the program is out of question as the health sector is mandatory task for local government. As for the environment element, the Dottoratta team always make sure to safely dispose the clinical waste and bring it back to the community health center. With this way, the team environmentally protect both patient and their surrounding from medical waste. The Dottoratta had drawn attention for replication from surrounding city especially by the time City of Makassar present the practice on Health City Seminar, held by Indonesian Municipal Organisation (APEKSI) Eastern Region in 2016. And up till now, it’s still in informal discussion.
Conclusions
Dottoratta is one of government concerns for the people, particularly the poor. It is proven by testimony a few groups of people who see this program really help cure them. Bringing the services closer to the people is the essential in Autonomy era. Support the poor to life healthier and responsible for their environment were two things directly contributing of well being in this sustainable era. Even though the program still fully funded by local budget of Makassar Government, yet the spirit to support particularly poor people health encourage the government to find some partnerships that will stand side by side with the government. Economic obstacles such as lack of income of the poor for medical expenses, transportation problems for family who take care and visit patient can be minimized through this program. One wise phrase about this Dottoratta program; who has health has hope, and who has hope has everything!
