The COVID-19 pandemic provides lessons on the importance of developing a comprehensive health system on a national scale. A health system based on the principles of knowledge management will properly guide the nation in facing the crisis and the aftermath.
The importance of developing a national health system was discussed in a series of discussions on the COVID-19 pandemic research study with the theme "Development of a National Health System". This discussion which is part of KSI4RDI#3 was held online on Tuesday (28/7). The speakers in this discussion were Director of Public Health and Nutrition of the Ministry of National Development Planning Bappenas, Pungkas Bahjuri Ali, Director of the National Disaster Management Agency (BNPB) Udrekh, Researchers at the Center for Health Management Policy (PKMK) Universitas Gadjah Mada Laksono Trinantoro, Andreasta Meliala and Bella Donna. The moderator for this discussion was the Secretary of the Human Resources Development and Empowerment Agency (BPPSDM) of the Ministry of Health Trisa Wahyuni Putri.
Laksono Trinantoro from PKMK UGM said, as a nation, so far there have been lost memories, especially when talking about knowledge in dealing with disease outbreaks. Notes from past experiences are lost, so when faced with cases such as the COVID-19 pandemic there is no experience that can be used as a reference. Seeing this, knowledge management, especially related to the health system, becomes important. "Knowledge management is needed in the context of health," he said.
According to him, the national health system (SKN) which is based on knowledge management will be able to provide a reference regarding the steps that need to be taken both in normal situations and when there is a disaster. The existence of a comprehensive SKN is increasingly needed in an unpredictable pandemic situation. In this system, it is envisioned that there are information anchors that can record and store the dynamics of changes from normal to pandemic situations. It also provides information on a list of people and institutions with the required expertise, health workers, sources of financing, and so on. "The source of funds for knowledge management is also important, because so far there have been a lot of funds for research but the funds for storing and developing knowledge are still minimal," he added.
Udrekh from BNPB explained that a pandemic had occurred in the 1900s with quite a lot of casualties. However, the records regarding the pandemic were minimal so that when the COVID-19 pandemic appeared the anticipation was a bit too late. "If only from the beginning of the incident in China there were all-out restrictions, this outbreak would probably not spread worldwide," he said.
He said, since the task force was formed, various models have been tried and the impact is adequate. Large-scale social distancing policies (PSBB) and social distancing, for example, can significantly reduce the mobility of residents. However, this policy is difficult to be implemented continuously because there are pressures on the economic needs of the community. Therefore, community-based pandemic management efforts will be intensified in the future. "How to communicate health protocols in language that is easy for the public to understand, we can learn from the 1918 pandemic. At that time the colonial government used wayang media. This learning pattern must be archived," he explained.
Pungkas Bahjuri Ali said that Bappenas is currently preparing the 2020-2024 National Medium-Term Development Plan (RPJMN) which includes health system reform as lessons learned from the COVID-19 pandemic. The targets for health system reform are disease control and compliance on the supply side. "It will have a lot to do with strengthening health centers, starting from the number, personnel, infrastructure, service standards, and so on, including community empowerment," he said.
Andreasta Meliala and Bella Donna from PKMK UGM explained that the mechanism for managing human resources (HR) for health during a disaster has been neglected. With a limited number of health human resources, when there is a pandemic case happens, confusion occurs. Therefore, the activation model for human resources in the health sector during a disaster must be an important part of the national health system. Not only medical human resources, non-medical human resources such as administration, finance and information technology teams play an important role, especially in times of disaster. In addition, community empowerment is also the key because it is the people who know the most about vulnerable groups in their respective areas. Thus, the community can play a role as health cadres who can break the chain of disease transmission so that the burden on medical personnel and limited health facilities can be reduced. "Health cadres can be empowered, there can be regular training for various types of disasters," said Bella Donna.
Several things can be concluded based on the explanation from the panelists, the first is regarding the development of its main knowledge management system in supporting SKN reform efforts in the fight against COVID-19. The use of a knowledge management system can synergize knowledge and information as an initial effort to support strengthening community literacy. The ideal knowledge management ecosystem for the national health system requires several key actors in it i.e policy makers, knowledge providers (universities or research institutions) who are able to produce/supply and disseminate knowledge based on the agreed taxonomies, there are also knowledge users (Ministries / Agencies, government hospitals and private sector) and also the funders (government, donors, partnerships).The second is to apply risk management in every disaster management program at Puskesmas. The direct activation of risk management will empower the community to actively participate in disaster management, both natural and non-natural disasters through the activities of health volunteers and health cadres.
KSI4RDI (KSI for Research, Development and Innovation) is an interactive discussion initiated by the Knowledge Sector Initiative (KSI) in partnership between the governments of Indonesia and Australia with funding from the Australian Department of Foreign Affairs and Trade (DFAT). KSI4RDI discussion activities are held twice a month with the aim to facilitating interaction and collaboration between knowledge producers and policy makers to support the knowledge-to-policy (K2P) process. The KSI4RDI#3 discussion series brought together stakeholders and knowledge producers consisting of the Ministry of National Development Planning/Bappenas, BNPB, the Ministry of Health, a Research Team from Gadjah Mada University and the Indonesian Policy Analyst Association to discuss the importance of supporting the reform of the National Health System which uses the principles of knowledge management as an effort to tackle COVID-19 in Indonesia.