The COVID-19 pandemic has severely affected the healthcare sector in Southeast Asia’s largest economy, Indonesia.
Meanwhile in Singapore about 1,500 healthcare workers resigned in the first half of 2021, compared to about 2,000 annually pre-pandemic, Senior Minister of State for Health Janil Puthucheary said in Parliament on Monday (Nov 1). One of the most devastating effects is a high infection and mortality rate among healthcare workers.
So far in Singapore, close to 500 foreign doctors and nurses have resigned in the first half of this year, compared with around 500 in the whole of 2020 and about 600 in 2019. “These resignations were mostly tendered for personal reasons, for migration, or moving back to their home countries,” he said in a ministerial statement in Parliament on Monday. Dr Janil noted that for healthcare workers, it has been over 20 months of continuous daily battles against the pandemic, with a large proportion of them unable to take leave since last year.
Singapore had 1,717 Covid-19 patients in hospital as of Monday. The occupancy rate for all general ward beds is 90 per cent, and 85 per cent of isolation beds are now filled. There are about 380 ICU beds in total across all hospitals, and 219 of them are reserved for Covid-19 cases. Close to two-thirds of them are now occupied. With expectations that this could increase, authorities have been reducing the number of ICU beds available for other patients. Hospitals will also further increase ICU capacity for Covid-19 patients from 219 to 280 this week, officials say.
The issue is down to staffing. Health Minister Ong Ye Kung said handling ICU beds would likely result in a “major degradation of care”. Janil Puthucheary, senior minister of state for health, on Monday told lawmakers that ICU patients require continuous care, and staff are carrying a heavy burden. “Already, our hospitals are feeling the manpower crunch, signs of fatigue can be seen among our health care workers,” he said. Many health care workers have not been able to take leave since 2020 and over nine in 10 would not be able to clear their accumulated leave for this year. Puthucheary also pointed out that 1,500 health care workers had resigned in the first half of this year, compared to about 2,000 annually pre-pandemic, which has weighed on the health care system.
The corona virus cases in Indonesia also having growth in number especially when the delta variant of the virus has discovered. Our assessment suggests that although the Indonesian Government has made considerable effort to strengthen the country’s COVID-19 response, much remains to be done to improve surge capacity. While the COVID-19 pandemic is extraordinary, shortages of healthcare workers in Indonesia have been a longstanding problem.
The country’s physician-to-population ratio is much lower than in neighboring countries such as Vietnam (0.8 physicians per 1,000 population), Thailand (0.8 physicians per 1,000 population), and Malaysia (1.5 physicians per 1,000 population) (13). Nevertheless, shortages of healthcare workers are experienced by other countries as well. At the time of writing, India faces a severe shortage of nurses to fight the Covid-19 outbreak. India’s Central Government claims it has recruited 2,206 specialist doctors, 4,685 medical officers, and 25,593 staff nurses in public hospitals across the nation under the National Health Mission since June 2020. These appointments, however, still fall short of the level the country needs (54). Workforce shortages in the UK have left the National Health Service (NHS) vulnerable to the COVID-19 outbreak. Healthcare worker shortages are a critical barrier to increasing NHS capacity and are why the Nightingale field hospitals have not been fully mobilized, despite the intense pressure on health services. The imminent risk of the NHS being overwhelmed has led to a third lockdown.
Indonesia also joined many other countries reporting disruption to essential health services over 1 year into the COVID-19 pandemic (74). Millions of people globally are still missing out on vital health care. Long-term care for chronic conditions, rehabilitation, and palliative end-of-life care is still severely disrupted, seriously affecting older people and people living with disabilities (75). The government urgently needs to safeguard essential health services.
Modifying essential health services by implementing triage to separate patients from the risk of COVID-19 transmission could also be considered a strategy to maintain essential health services. Implementation of telemedicine should be scaled up as it allows the delivery of health services under pandemic circumstances (13).
Telemedicine has been emerging as one of the most critical tools in Indonesia’s fight against COVID-19, with telemedicine firms seeing a surge of service transactions during the pandemic (13). Therefore, the government should consider collaborating with these firms to support health services provision. Digital technology could also be harnessed to support virtual monitoring and evaluation of essential health services to allow early detection of service disruptions. Several hospitals that are ready with infrastructure and systems have begun to deliver services through telemedicine.
Indonesia seems can be successful compare to Singapore because the number of healthcare provider in Indonesia is bigger than Singapore. Even tough health care worker in Indonesia also experiencing stressful and burnout situation, they still have time to take on leave during their schedule, because a lot of volunteer come to the hospital as an assistant of health care workers. The health care workers also don’t have much choice rather than stay in to their job because the economical situation in Indonesia is still not stable due to the pandemic meanwhile in Singapore, they still have option because the salary at least higher than Indonesia’s health care worker.
Singapore needs to find their way to survive ASAP. Opposition politician Jamus Lim on Monday in Singapore time questioned if there had been concerted efforts to raise the ICU capacity and bring in relevant manpower earlier on in the pandemic, when cases were lower. Puthucheary said the city state had about 300 ICU beds pre-pandemic and the average occupancy rate was about 63 per cent. If authorities had opened up more ICU beds and left them empty, it would have had an impact on resources that could be applied elsewhere, he said.
Likewise, if more specialised health care workers were brought in earlier on, they would not have gained much experience as the surge in demand for ICU care happened only recently. The thing about specialised care for ICU patients, he said, was that “you can’t stand it up and have it lying around waiting”. “What we have been doing is opening up capacity ahead of the curve [but] not so far ahead … that we are having people sit around idle while other services are undermanned or unmanned,” he said.
However in Indonesia the healthcare workers seems to stay, the government still needs to always do evaluation on the system. The Indonesian Government needs to ramp up the country’s healthcare capacity. In terms of staff, the number and distribution of healthcare workers and their well-being are still areas of concern.
Concerning logistics, there is still disproportionate distribution and a lack of dependence on imports. There has been commendable progress in terms of increasing critical bed capacity. However, the capacity to process medical waste safely is generally still lacking. Disruption to essential healthcare services also requires more attention. A wide range of strategies has been proposed to address those mounting challenges, e.g., ensuring standard protection, psychological and welfare support for healthcare professionals, accelerating development, and scaling up implementation of telemedicine; promote in-country production of medical technologies and supplies.