The House of Representatives had finally enacted the new Health Draft Bill (Health Bill) on July 11, 2023. Agung Sapta Adi, Chairman of the Presidium of United Indonesia Doctors invited various professors from various campuses to try to oppose the passing of the Health Bill.

The ratification of the Health Bill was also attended by government representatives, including Minister of Health Budi Gunadi Sadikin, Minister of Administrative Reform and Bureaucratic Reform Abdullah Azwar, and Deputy Minister of Law and Human Rights Eddy Hiariej.

The majority of factions in the House of Representatives, including PDIP, Golkar, Gerindra, PKB, PPP, and PAN, approved the ratification of the Health Bill.

Meanwhile, the Democrat and PKS factions expressed their rejection against the enactment of the Health Bill.

Petition to stop the enactment of the Health Bill

One of the effort made to challenge the enactment of the Health Bill was the creation of a petition signed by 200 professors with several important points. For example: the drafting of the bill was considered rushed and not transparent, the bill also did not contain abolish the provision on mandatory spending on the health budget, and also that the bill is believed to threaten national health security.

"The many pros and cons in making this Health Bill can give rise to acceptance weaknesses," said Laila Nuranna, professor of Obstetrics and Gynecology at the Faculty of Medicine, University of Indonesia.

The Inter-Professional Professors Forum asked President Joko 'Jokowi' Widodo to postpone the enactment of the Health Bill into a law.

According to the plan, the House of Representatives (DPR) will pass the Health Bill into a law containing 456 articles. Once passed, this law will revoke eleven laws such as the Law on Drugs Ordinance, the Law on Outbreaks of Infectious Diseases, the Law on Medical Practice, the Law on Health, the Law on Hospitals, the Law on Medical Education, the Law on Mental Health, the Law on Health Workers, the Law on Nursing, the Law on Health Quarantine, and the Midwifery Act.

Previously, the policy formulation process involved the wider community to evaluate policies and regulations related to the national health system through the problem inventory list (DIM). However, a number of parties were still disappointed with the DIM submitted by the Ministry of Health to the House of Representatives because it was deemed not transparent, not accountable, and did not accommodate the input of all parties.

Disappointment and protests arose from health professional organizations. Thousands of health workers held a peaceful demonstration to demand that the deliberation of the Health Bill be stopped.

The Health Bill not only regulates health professional organizations, but the health system as a whole, which will become the legal basis for various health policies.

Various organizations express concerns about

Previously, various health organizations have voiced their concerns, urging the government through the Ministry of Health to improve the discussion process by prioritizing transparency, taking into account public input and related stakeholders, such as health organizations, associations of higher education institutions for health, and other health associations.

The action was represented by five health organizations, namely the Indonesian Doctors Association (IDI), the Indonesian Dentists Association (PDGI), the Indonesian National Nurses Association (PPNI), the Indonesian Pharmacist Association (IAI), and the Indonesian Midwives Association (IBI) demanding that it be continued by ensuring transparency and broad community involvement.

As for criticism from the Association of Indonesian Public Health Experts (IAKMI) and the Association of Indonesian Public Health Higher Education Institutions (AIPTKMI). Both stated that the discussion process seemed rushed, lacked coordination, and was not transparent, as well as the lack of clarity over the follow-up of various inputs through the public hearing.

"We strongly protest the unclear follow-up of the various inputs that have been submitted during the public hearing on the Health Bill," said Dedi Supratman, Chairman of IAKMI.

Meanwhile, Hermawan Saputra, General Chairperson of PP IAKMI, said that evaluating policies related to the national health system is a natural thing, and should be done. A number of regulations that have been in force for too long, are even irrelevant to current developments.

This regulation is like the Law on Outbreaks of Infectious Diseases which has not been updated since 1984. The Health Law has been in effect since 2009 and the Law on the National Social Security System since 2004.

"Many regulations with dynamics, especially after the pandemic, we really have to align. This is indeed needed, but on the one hand, don't be in a hurry," said Hermawan.

Meanwhile IAKMI, AIPTKMI proposed that public health regulations could be prioritized in the rules drawn up in the Health Bill. The implementation of primary health must also focus on promotive and preventive efforts, and the existence of the Council of Indonesian Health Workers can also be maintained.

Previously, it was proposed that the Indonesian Medical Council, the Indonesian Health Workforce Council, and the collegium definition be removed.

Tjandra Yoga Aditama, Professor at the Indonesian Faculty of Medicine, said that medical councils are recognized in a number of countries, including Southeast Asian countries. However, not in Indonesia.

"A number of ASEAN member countries show that medical councils have a very important role in medical and health services, and have very clear rules. Of course, the hope is that our Health Bill can produce precise and clear rules regarding councils in Indonesia," he said.

In addition, rules related to control of addictive substances are maintained and strengthened, including regulations on advertising, promotion and sponsorship of tobacco products.

Nina Samidi, Program Manager for the National Tobacco Control Commission, said that as many as 144 countries in the world have banned advertising and other forms of marketing of tobacco products. However, Indonesia is the country and the only country in Southeast Asia that does not ban cigarette advertisements.

"The article on addictive substances is very important because it will become an anchor in various regulations related to the products included in it. This article must exist. However, there are allegedly attempts to eliminate this clause in the health omnibus," she said.

Government response

Separately, Syahril, said that the health bill was an initiative by the DPR intended to improve existing laws. Including articles regarding legal protection for health workers.

He considered that the rejection of the deliberation of the Health Bill from health professional organizations could hinder the need for clearer and stronger legal protection for health workers, such as doctors, nurses, midwives, pharmacists and other health workers.

"If the concern is about legal protection, why not from the start [a long time ago]" he said.

Mohammad Syahril, a spokesperson for the Ministry of Health explained that the triggers for the rejection of the Health Bill included genomics or the study of genes. Even though the bill follows the example of neighboring countries such as Malaysia and Thailand. He also stated that he would open a discussion room for the professor whenever asked.