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[Indonesia] Resistance to seeing a doctor? Awareness and Measures towards Health in Indonesia

Indonesia is the world's fourth-most-populous country, with over 279 million people (*1). The Indonesian economy has been growing at an amazing pace in the past decades. It is already the 16th-largest economy in the world. Many typical consequences of a fast-developing economy are happening in Indonesia: a drop in fertility and increased life expectancy and per capita income. However, health outcomes remain noticeably poor and unevenly distributed, in large part due to an underdeveloped healthcare industry. This has led to multiple problems. (*1)

One of the latent problems is the low awareness and knowledge regarding health. Health is precious and it is a human right. For most Indonesians, the awareness for maintaining health, preventing diseases or awareness to consult in the medical institution about their health condition can be considered as low. A snippet that might reflect the low awareness is the percentage of people who are going to the hospital in these past 5 years. From Indonesia total population, in the past 5 years, the percentage of people who are going to the doctors (in the hospital) are below 30 % (*2).  It indicates that Doctor is not a favourite person to meet, in sick condition and even in healthy condition. There is a reluctance to meet the doctor.

Source: Statistics Indonesia, Government bureau (*2)

The common behaviour amongst Indonesian is if the person still can do their activity while being sick, usually they just take the natural remedy(jamu) or OTC medicine.  If it is getting worse and it makes the person “cannot stand on their feet anymore”, it is the time to meet the doctor. They can stand the suffering just because they don’t want to see the doctor. Why is that so?

There are push and pull factors that become the main reasons. Pull factor is the intrinsic motivation that is coming from the external environment in this case, the medical institution. Push factor is coming from inside, the internal consideration of the patient. 

Pull factor for Indonesians are: 

1. The “bad” perception toward doctors

especially in hospital institutions. Going to the doctor, especially in the hospital, is frightening for most Indonesians. When in a sick condition, doctors become a backup plan. The first thing to do is consuming natural remedy (jamu) or OTC that they usually consumed or what’s been recommended by their significant others   for example parents, sisters, or close friends. Lots of trust issues for doctor in Indonesia based on the word of mouth amongst Indonesians. 

So, why are going to the doctor becoming frightening? 

The judgemental advice or diagnosis from the doctors in Indonesia.

There is a common perception that Doctors in Indonesia are prone to give a very bad or serious diagnosis toward the patient’s sickness. A simple symptom can lead to a grandeur diagnosis. This is frightening because it means the patient need to take more medicine (which must be more expensive) or the diagnosis might be worse than the real condition. With the same symptom, when they compared with the medical check-up outside of Indonesia, the diagnosis is not that serious. If it is serious, the solution offered might be more varied compared to what’s been offered in Indonesia. 

Misleading diagnosis

untold story but it is heard everywhere. It is known from the online media (news, social media) and word of mouth from their significant others. Diagnosis from doctor often prone to misleading diagnosis which led to taking unnecessary medicine or in the worst case, the wrong medical action which led to disability or death. Some examples of the misleading diagnosis: 

Misleading medical action when delivering a baby with Caesar operation. The Caesar operation goes wrong, bleeding happened, and the doctor decided to pick up the mom’s uterus. After Caesar was done, mom found it difficult to pee. The family decided to check in the different hospital from where the Caesar operation is done and it turned out the urinary tract is affected (it is strangulated) because of the Caesar operation (*4). This kind story is everywhere, spread almost all over Indonesia. This does not mean that all medical institutions have the similar problem but there might be a chance for this kind of problem to arise, especially in the small town. 

Different hospitals might have different points of view regarding the diseases. One of the examples is coming from the writer’s personal experience.  One of the significant other of the writers was being hospitalized in hospital A because of dengue. In the middle of the treatment, came out another diagnosis, beside dengue the patient also had TB (Tuberculosis). The patient went to hospital B for a second opinion. The patient went to a pulmonary specialist, underwent several procedures and it turned out it is not TB. This was shocking news, and it might be happening to many people in Indonesia. This creates distrust toward the health institutions, especially hospitals. 

Sources: (*4)

Insufficient number and quality of physicians

The misleading diagnosis and the differences perception between hospital raises the perception that the doctor quality in Indonesia is perceived as relatively low.
It might be because of the severe talent shortage: It needs 15 times its current number of doctors to meet OECD (The Organization for Economic Cooperation and Development) standards. The gap between supply and demand is estimated to be equivalent to an annual $68 billion of unaddressed healthcare needs. (*1)  

2. The hassle of the procedure for those who are using the national health insurance scheme called BPJS.

Need to be patient in using BPJS, as there are many steps and procedures in the hospital e.g. if the patient needs to meet several different doctors, with BPJS, the patient can only meet one doctor for a day. The waiting time for the doctor can be considered as longer than patients who are using personal payment / not with BPJS. There’s no such thing as a free lunch. 

3. The fear or anxiety toward the local health system.

Patients lack trust in the local system and infrastructure, as written in the journal of the future of the Indonesian healthcare ecosystem. Because of the misleading diagnosis, most Indonesians perceive there is also a shortage in medical talent in Indonesia and limited infrastructure, especially outside the big cities in Indonesia.  More than 600,000 people a year travel to neighbouring countries for medical treatment. The direct cost of such medical tourism has grown at an annual rate of over 10 percent since 2006 and is now nearly $1.9 billion a year. When indirect spending is included, the annual cost is nearly $4 billion. (*1)

Meanwhile, the push factor for Indonesians is the ignorance toward their health condition. Not going to the doctor means a peace of mind. Doctor’s diagnosis often leads to a situation in which people need to change their habit drastically or the fear that it might not reflect the real condition of their sickness (the diagnosis is more severe than the real condition). Ignorance is bliss. 

Nevertheless, the awareness to maintain health to prevent diseases slightly increased after the long era of Covid. There are some ways of maintaining health for Indonesians: 

Indonesian methods of health maintenance

1. Natural remedy/jamu. 

First and foremost, when about to sick or already sick is to consume natural remedies or jamu. For curing, a natural remedy/ jamu is usually consumed when the diseases start to kick in and the body feels not good (aching or sore). To maintain their health, they usually consume jamu as a preventive action in maintaining their long-term immunity.
Indonesians tend to choose natural remedies because of the high availability, less chemical and it has less side effects, and the price is quite affordable. Natural remedy or jamu consists of herbs or natural ingredients e.g ginger, honey, turmeric, curcuma, lime, cinnamon. It is usually consumed as a beverage, either it is home-made, or it is sold in the store as a ready to drink. For home-made, it is a combination of hot water, squeezed lime or lemon, a spoon of honey and the herbs itself (ginger, turmeric, etc).  with hot water or combined with lime or lemon. 

2. Exercising.

Indonesians are not into exercise.   
Walking is the simplest exercise that can be done daily. Apparently, this is not the habit for most people in Indonesia. It is because the pedestrians are not proper pedestrians for walking (uneven pavement, many streets hawker and even there are motorcycle crosses during the traffic jam), the humid weather and commuting with motorcycles day by day. 

There are slight changes in this behaviour, predominantly in this past 3 years and after covid era.  The interest toward exercise has increased. Many people, across ages, are starting to do exercise daily. The most common is walking and running. The other exercises that many people grow fond of are badminton, tennis, and golf. These are predominantly liked by the middle to upper SEC class. 

3. supplements

Consume vitamins or supplements. It is not for maintaining health but more for preventive action from diseases. The common perception of the ingredients   that are perceived as coming from nature, are natural and a basic need of the body. The ingredients that are commonly consumed are Vitamin C , B, A,D, as it is perceived to become a necessity to maintain the immune system and health of bone strength. 
Indonesians are into multi vitamin compared with the vitamin with single ingredient. It is seen as a one-stop solution and the more the merrier. 

The common perception of the ingredients that are perceived as coming from nature are natural and a basic need of the body. The ingredients that are commonly consumed are Vitamin C , B, A,D, as it is perceived to become a necessity to maintain the immune system and health of bone strength.

Indonesians are into multivitamins compared with vitamins with single ingredients. It is seen as a one-stop solution and the more the merrier.

4. the OTC medication

Take on the OTC medication that is recommended by their significant others.  It is trusted because of the testimony of others and easy to find, available in the mini market around them. 

There is a saying in Indonesia.  “Mencegah lebih baik dari Mengobati”, “Prevention is better than curing”.

It is a common knowledge for Indonesians, but apparently in reality, it often happens in reverse. Prevention might not be as popular as curing. The curing process itself has varied ways and the doctor is not at the top of mind when they are sick. It reflects the drive to just live in the grey area about the sickness until it has a tangible and harmful effect daily, then it is the time to meet the doctor. A long way to go but not impossible to have a greater awareness toward maintaining health rather than curing. 

     Sources:
            1.    the-future-of-the-indonesian-healthcare-ecosystem.pdf
            2.    https://www.bps.go.id/id/statistics-table/1/MTYyMCMx/persentase-penduduk-yang-berobat-jalan-sebulan-terakhir-menurut-provinsi--dan-tempat-cara-berobat--2009-2022.html
            3.    https://databoks.katadata.co.id/datapublish/2023/07/13/penduduk-indonesia-tembus-278-juta-jiwa-hingga-pertengahan-2023
            4.    https://www.detik.com/sumut/hukum-dan-kriminal/d-6134267/ibu-hamil-ngaku-korban-malpraktik-di-sibolga-sempat-tak-bisa-pipis/1
            5.    https://www.instagram.com/suweorajamu28/?hl=en
            6.    https://www.instagram.com/kejar.kejarun/?locale=en_gb
            7.    https://www.instagram.com/damaiindahgolfofficial/reels/
            8.    https://www.instagram.com/tennissehati/
            9.    https://www.instagram.com/blackmoresid/?hl=en
          10.    https://www.instagram.com/panadolid/?hl=en
          11.    https://www.instagram.com/bodrex/?hl=en

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  Author profile

  Grace Sininta

  A qualitative researcher who lives in Jakarta. She has been working for 15 years in market research, involved in various industries with various research methods(especially qualitative).  She enjoys observing people and wondering why people think and feel in a diverse way.

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  Intage Inc.

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• Jul 19, 2024
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