Indonesia - Govt woos specialists to work in regions

Bracing for a stream of foreign medical professionals entering the country after the implementation of the ASEAN Economic Community (AEC), the government is devising a set of incentives to encourage local specialists to work in the regions.

The Health Ministry hopes the incentives will lure surgeons, pediatricians, internists, obstetricians and anesthetists to areas in short supply of specialists for at least a year.

The plan also aims to keep local specialists competitive compared to the foreign doctors that will soon be allowed to move freely between countries in Southeast Asia.

The ministry’s Director General of Community Services, Bambang Wibowo, when opening the Indonesian Medical Council (KKI) national coordination meeting in Surabaya, East Java, said foreign doctors would make efforts to take over regions in Indonesia that have a shortage of doctors.

“The number of specialists is very limited in those regions, especially in the eastern part of Indonesia as well as in border regions and on islands. This requires awareness of the doctors that they are needed there,” said Bambang Wibowo in Surabaya on Tuesday.

Indonesia, according to Bambang, has become a lucrative market for players in the health service. Doctors are still in short supply at many of the country’s 9,754 community health centers (Puskesmas) and 2,573 hospitals. Moreover, the population of Indonesia is estimated to reach 270 million people in 2020, which would include a significant number of middle-income earners able to afford private health care.

The policy to assign specialists to areas that lack doctors for at least a year is backed up by an existing program to assign teams of newly-graduated physicians, dentists, midwives and health analysts to remote areas in a bid to cover the shortage of doctors in Indonesia.

Based on KKI data, Indonesia currently has 175,410 registered doctors, 31,414 of whom are specialists.

KKI chairman Bambang Supriyatno said synergy between all stakeholders was needed to address the issue.

“This month, we will discuss domestic regulations in response to the potential and threat of the influx of foreign doctors to Indonesia,” said Bambang.

At the same occasion, University of Defense professor Rear Admiral (ret.) Setyo Harnowo said Indonesia faced no obvious military threats from outside in the next 10 years, but it faced non-military ones instead.

“Indonesia is facing the threat of a proxy war, or a weakening of the nation using non-military means, such as economic and health threats, and the health threats must be faced by those in the health sector,” said Setyo.

Separately, House of Representatives Commission IX chairman Dede Yusuf Macan Effendi, who also spoke at the forum, said he was encouraging the Health Ministry and KKI to maintain an equal distribution of doctors across Indonesia.

The Democratic Party politician related his experience in meeting with the regent of Membramo in Papua, who he said was willing to provide Rp 50 million as “settling-down” cash, aside from regular income and other facilities, to specialists willing to serve in the regency.

“Seeing that the administration is willing to give Rp 50 million, imagine the desire of the regency to have specialists there,” said Dede.

Dede urged KKI to encourage the presence of medical schools in regions with a shortage of doctors, because doctors generally gathered in campuses with medical schools.

Wahyoe Boediwardhana

thejakartapost

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Japan - Why is Japan not having sex?

In a culture saturated with sexual content, the Japanese are increasingly choosing abstinence. Can the rapidly ageing society encourage millennials to start having sex again?

A recent survey conducted among unmarried Japanese found that 42% per cent of men and 44.2% of women aged between 18 and 35 have never had sex. The poll, conducted every five years by The National Institute of Population and Social Security (NIPSSR), also revealed that among those aged 18-35, nearly 70% of males and 60% of females were single. Most of them expressed a expressed a vague wish to get married ‘some time in the future’ but 1 in 3 are not looking for a partner.

The numbers are alarming, especially in relation to the 2010 results of the same survey when only 36.2% of men and 38.7% of women said they were virgins.

Head of NIPSSR, Futoshi Ishii, explains this shift in terms of a disparity between young people’s expectations and actual lives. “They want to tie the knot eventually. But they tend to put it off as they have gaps between their ideals and the reality.”

A hyper-aged society

Low fertility rates, combined with the longest life expectancy on the planet, have resulted in the world’s highest number of elderly citizens. At present, 1 in 4 Japanese is over 65 and the population continues to decline at an unprecedented rate. It is believed that in less than a century, some 40% of the citizens will be 65 or older.

In a terrifying prediction for Japan’s dystopian future, researchers from the Tohoku University estimate that there will be but one child left by the year 3776.

As the shrinking workforce threatens the county’s growth, the impacts of society’s ageing can be seen in every step. Every year hundreds of schools close down to become care centres for the elderly, and abandoned houses are a common and depressing sight. 

At present, 41% of Japanese seniors live with their children, but it’s a far cry from 80% in the sixties. As family ties erode, the hyper-modern society becomes increasingly individualistic. In a phenomenon known as ‘parasite singles’, millennials often choose to stay in their family homes – not to care for the elderly parents, but out of convenience.

No sex in the city

Dedicated to work, or consumed by entertainment, young adults have little or no interest in sex. The so-called “herbivore men” remain abstinent out of choice or timidity. Their lack of sexual drive, as well as no interest in marriage, are believed to be linked to the economic downturn, as well as a crisis of male identity.

In Japan, masculinity still hinges on a man’s economic status and his ability to provide for a family. On top of the sluggish economy, increasingly independent women make it even harder for men to fit in the role of “carnivores”. Feeling inadequate, Japanese males turn to falling in love with fictional characters, fall prey to depression, or simply put their love lives on hold.

According to Professor Keisuke Nakashima from Kobe City University of Foreign Studies,  Japan’s extreme working culture is also a major factor.

The gender gap trap

One positive finding of the recent NIPSSR survey is that for the first time in Japan’s history, more than 50% of women return to work after having their first child. However, the drop off is still much more pronounced than in other developed countries.

In the past, marrying within the same company was a standard practice and many women entered the workforce with the sole purpose of finding a spouse and then resigning.

Now, ambitious Japanese women see marriage as a real threat to their careers. “The bosses assume you will get pregnant,” explains 32-year old Eri Tomita. Filing a resignation is often expected, but as for many it’s “not an option”, and they refrain from relationships altogether. This is known as matahara, a neologism derived from the English words “mother-harassment”.

Even if women were encouraged to combine work with child rearing, their chances at succeeding would remain slim, as the average Japanese husband contributes only an hour of his time to household duties.

Young Japanese singles may live individualistic lifestyles and value career over marriage, but societal norms are still rigid. Many fear entering an informal relationship and, without marriage, there can be no children. While in the US over 40% of babies are born out of wedlock, in Japan it’s only 2%.

The real solution 

When it comes to the ageing of society, as well as the nation’s low sex drive, Japan is definitely at the forefront internationally, but these traits are not exclusive to Japan. The hype over the recent survey is part of a government strategy for raising awareness of the issue, which, in fact, is a disease of affluence affecting many countries. For example, a recent survey in Britain revealed almost comparable levels of sexual abstinence.

However, in a country where an electronic body suit can replace human intercourse, and a bride can throw a wedding without groom, there’s more than one reason behind the nation’s falling libido.

Prime Minister Shinzo Abe is implementing policies targeting the elderly, as well as providing government incentives to young parents. However, without a profound change in the working culture which discriminates against women, he will fail to raise the fertility rates from 1.4 to 1.8 by 2025.

A change in corporate tradition has to be implemented from top down, but it is no priority for older, male executives who can’t see the long term benefits of diversifying their workforce. Women will have to wait for regulatory action from the government, and PM Abe is unlikely to oppose the powerful business lobby anytime soon.

Zofia A. Reych

aseantoday

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Philippines - Philippines to benefit from population of young people

MANILA, Philippines - The Philippines stands to benefit from its large population of young people, but to realize the demographic dividends, teenage girls must have access to quality education and youth-friendly health services as they prepare for working age, the United Nations Population Fund (UNFPA) said yesterday.

According to UNFPA country representative Klaus Beck, adolescent girls aged 10-19 currently make up 10 percent of the Philippines’ 100 million population.

“They hold enormous opportunity to transform the future of the Philippines but this can only happen if they have the right information and skills and are healthy and empowered to make informed decisions in life,” he said.

He issued the statement as World Population Day was celebrated yesterday.

Beck underscored the need to take action, citing a study spearheaded by the National Economic and Development Authority and supported by UNFPA, called the “Demographic Sweet Spot and Dividend in the Philippines: The Window of Opportunity is Closing Fast.”

The study showed the “high probability that the Philippines will miss the rare opportunity of additional economic growth.”

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This is due to the relatively high fertility rate, or the average number of children by women, especially the poorest, and the relatively high unemployment rate, particularly among the youth sector.

Philippine celebration

World Population Day was commemorated at the Rizal Memorial Coliseum in Manila with the participation of some 2,000 teenage girls.

The event was spearheaded by the Commission on Population.

Health Undersecretary Gerardo Bayugo said there is a need to combine the efforts of the government and non-governmental organizations to address the rising teenage pregnancy in the country.

“We need to inspire our teenage girls… They need special care. Not only because they are the future. They will give life and nurture the future of our country,” Bayugo said.

This year’s event was highlighted by the launching of the “BABAEnihan” campaign which seeks national attention to issues that affect the future of young women.

It is a call for stakeholders to work together to expand opportunities for girls through investments in their education, health, and wellbeing. 

Beck said this year’s theme about investing in adolescent girls is particularly relevant and urgent because teenage girls are among the marginalized sectors of society in terms of accessing social services that respond to their real needs.

He added that based on a new study of the UNFPA, adolescent fertility has gone down in all countries in the Asia-Pacific region, except for the Philippines.  

Among the Filipino girls aged 15-19, about one in 10 has given birth.

Instruments for transformation

Vice President Leni Robredo also joined the call for more investments in the education and health of teenage girls, saying that women “are the hope for our nation’s transformation.”

“Embrace the soft power of your femininity. There is strength in being a girl. You are the hope for our nation’s transformation,” Robredo said in a speech, read by her eldest daughter Aika at the World Population Day celebration in Manila.

Robredo skipped the World Population Day celebration to attend her first Cabinet meeting in Malacañang.

Meanwhile, the Department of Education (DepEd) also enjoined schools and community leaders to make sure that female students are given an education that will empower them.

“Let us grow young females whose rights, needs, well-being, and potentials are not compromised or violated. Let us take strides to allow our young women to lead and have a voice that’s heard,” the agency said in a statement.

DepEd noted that despite the world’s achievements in gender equality, teenage girls remain vulnerable and compromised by social and economic disparities.

In many parts of the world, girls are deemed, even forced, by their community and their families to be ready for marriage and childbirth, DepEd said.

Sheila Crisostomo

philstar

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Thailand - Thailand can be centre for elderly care

WITH A RISING elderly population, Thailand will promote it|self as a centre for elderly-care service, as it already has the healthcare and medical infrastructure |to serve this group of people, according to a Commerce Ministry plan.

Commerce Minister Apiradi Tantraporn said the ministry's Business Development Depart-ment planned to promote the growth of medical and healthcare businesses to serve the senior population, which is not only getting bigger in Thailand, but also in many other countries.

"This group of people needs more healthcare and medical service, while they have high spending power. Thailand has hospitality facilities to serve this group of the world population and could be a hub of medical and healthcare service in the world market," she said.

These kinds of services are not as expensive here as in many other countries, while they have high quality and offer good hospitality. Thus many foreigners choose to use these services in Thailand each year.

The ministry has forecast that the number of senior people in Thailand will reach 13 million, almost one-fifth of the total population, by 2020. Their number is expected to reach 17.5 million by 2030.

Each year, more than 4 million foreigners who travel to Thailand use medical or healthcare services here.

Businesses developed

Under the idea of making Thailand a hub of medical and healthcare service, the ministry drew up a plan five years ago to provide such operations with knowledge on business operation, service, and cost reduction. Since then, 442 businesses have been developed as professional medical or healthcare businesses.

Among those, 55 companies have passed an international test and been accepted under an international standard.

The ministry has also promoted more funding and joint ventures by international investors in this type of business.

Senior-care businesses can be categorised into three types: day care, long stay, and nursing service at home.

Thailand now has about 400 healthcare service businesses. |Of these, 49.2 per cent are in Bangkok.

Petchanet Pratruangkrai

nationmultimedia

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Singapore - OCBC Report: Public hospitals may not cope with patients surge in 2030

Public hospitals will not hit targets in terms of facilities and manpower when hospital admissions are projected to skyrocket to 791,000 patients per annum from the year 2030. An OCBC report which made this prediction said that in the past 5 years, public hospitals have only added an average of 188 beds per year.

The report further added that “public hospitals need an additional c.6,000 beds by 2030, which is approximately 440 beds per year,” and that, current private hospitals have the capacity to add 500 beds with existing licensed beds capacity, which is approximately half of the c.1,000 beds required by 2030.

“Based on the Healthcare 2020 Masterplan, the addition of 1,900 beds coming mainly from the newly completed Ng Teng Fong Hospital (~700 beds yet to be included in the current operational number of beds) and Sengkang General Hospital (1,000 beds to be completed by 2018) represents only a quarter of the total number of beds required by 2030,” OCBC said.

OCBC noted that the government has four acute hospitals in the pipeline subject to review in 2020.

“While it may be easier to add ‘brick and mortar’ i.e. medical facilities, it is more challenging to build manpower in the near-to-medium term especially specialised doctors. The number of new physicians needed by 2030 is around 6000 physicians, or 371 physicians per year,” the report said.

“From historical trends, Singapore has been able to add an average of 677 physicians per year, double the number required per year. The increase is typically drawn from around 300 doctors who are Singapore residents, and 300 to 350 non-resident doctors, of which, c.200 are graduates from Singapore’s medical institutions,” the report added.

In a White Paper released in 2013, the Government said that it intends to increase the population of Singapore to 6.9 million by the year 2030.

theindependent

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Indonesia - Number of elderly people to hit 80m

While Indonesia is currently enjoying a demographic bonus in the shape of a high proportion of young people among its population, the number of seniors is predicted to quadruple to 80 million by 2050.

Analysts have warned that the government must start preparing a robust healthcare system to accommodate this aging population.

Indonesian law stipulates a senior as someone who is more than 60 years old. In 2014, there were 20.24 million seniors, constituting 8.03 percent of the total population, but by 2020, that number will climb to 28.8 million, 11.34 percent of the population.

“If the percentage is over 10 percent, then we’ve already entered the category of an aging country,” Indonesian Gerontology Medical Association (PERGEMI) chairwoman Siti Setiadi said during a discussion at the Health Ministry to mark National Day of the Elderly which falls on Sunday.

The day is celebrated every May 29 to commemorate the first session in 1945 of the Preparatory Body for Indonesian Independence (BPUPKI), with 66-year-old Radjiman Wedyodiningrat as its chairman.

During the discussion, the Health Ministry pointed out that the number of seniors would climb to 41 million by 2035 and 80 million by 2050, leading to concerns about whether the country’s healthcare system will be equipped to handle the soaring number of elderly patients suffering from chronic illnesses.

In 2014 alone, the Healthcare and Social Security Agency (BPJS Kesehatan), which manages the National Health Insurance (JKN) program, had to pay Rp 42.6 trillion (US$3.1 billion) in hospital bills for elderly patients. The premiums that those patients paid to the BPJS Kesehatan were insufficient to cover the bills, forcing the agency to cover the 4 percent deficit.

Hospital bills for the elderly are usually higher as they often suffer from multiple chronic illnesses.

Health Ministry research in 2013 showed 45.9 percent of people aged 55 to 64 and 57.6 percent of those aged 65 to 74 suffered from hypertension.“The most common disease for the elderly in Indonesia is hypertension, or abnormally high-blood pressure. And this can lead to other diseases like heart disease, cardiac arrest, stroke and so on. These diseases almost bankrupted the BPJS,” Siti said.

Moreover, seniors also often suffer from deteriorating cognitive functions, which can lead to dementia, she said.

“[Patients with] these diseases are very difficult to care for. They need caregivers and eat up lots of energy and money. It’s not that the disease is deadly, it’s the demand for long-term care,” said Siti.

The salary of a caregiver for an elderly patient usually starts from Rp 2 million per month and can rise to more than Rp 3 million.

The problem with seniors is that they are often rendered dependent on other people due to poor health, which results in more costly health care. Families usually try to cut the cost of health care by taking care of sick seniors by themselves in their homes.

Furthermore, as in many countries in Asia, the use of government-established elderly care is rare in Indonesia, as there is a tradition of family-oriented care-giving with the younger generation looking after senior family members.

“Indonesian people always care for their families. So if there are seniors, they usually live with their families. But in other countries, these elderly people are usually sent to nursing houses,” Health Ministry secretary-general Untung Suseno said.

However, life expectancy in Indonesia also keeps climbing as health care in the country improves, leading to cases where people in their nineties will be looked after by their children, themselves already in their seventies.

“In the past, seniors were relatively younger and so they could still be taken care of by their children. But one day, there will come a time when our elderly are getting older while we also grow old. There’s no way we can take care of our parents who are in their nineties when we are already in our seventies,” Siti said.

If that is the case, then people will have to hire caregivers or send their parents to nursing homes, further adding to costs. Therefore, the government plans to educate families on how to take care of the elderly.

“Medical workers from community health centers [Puskesmas] will go from house to house, not to take care of the elderly, but to train family members. After the third visit, family members will have the capacity to take care of the elderly in their homes,” the ministry’s family health director, Eni Gustian, told The Jakarta Post.

Hans Nicholas Jong

thejakartapost

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