Stratification of Integrated Cancer Center in Indonesia to Improve the Access to Care
Authors: Kadir A. , Liastuti L.D. , Kardinah K. , Palupi O. , Widyastuti T.H. , Nindito H.R.S.W. , Saguni A. , Ariyanie C.P. 
Published: September 2018

Background and context: Indonesia as one of the low- and middle-income countries has not had a classification of cancer services yet. This classification will be very important for standardization and equalization of cancer services for all Indonesian people to access the cancer services provided. Based on Social Security Administering Agency of Health report, advanced stage of cancer have absorbed ∼17% national health budget (the third largest in financing National Health Insurance) but the outcome of the services still not good enough. Dharmais National Cancer Center (NCC) has the task of establishing cancer services system in stages throughout Indonesia by arrange the cancer services strata in Indonesia and develop its roadmap of achievement to improve the access to care. Aim: To build the stratification of integrated cancer center (ICC) in Indonesia by Health Ministerial Decree to improve access to care as a part of cancer control planning. Strategy/Tactics: 1. Build the concept of integrated cancer center stratification in Indonesia by assess the instrument of Director General of Health Services, Ministry of Health that conduct a comprehensive stratification of cancer services especially for diagnostic radiology services, nuclear medicine and radiotherapy to support the cancer services development plan in Indonesia. Currently, internal audit of radiology quality management has been developed by adopt the International Atomic Energy Agency (IAEA) standards issue with 3 instruments used to assess the radiology quality management, namely: a. Quality Assurance Audit for Diagnostic Radiology Improvement and Learning (QUAADRIL). b. Quality Management Audits in Nuclear Medicine Practices (QUANUM). c. Quality Assurance Team of Radiation Oncology (QUATRO). 2. Conducted an audience with Minister of Health to present the concept of integrated cancer center stratification in Indonesia and to initiate Ministry of Health decree as a regulation. The decree will be follow up by disseminate to all national, provincial and regional referral hospitals so they will have internal audit by IAEA to be mapping. Program/Policy process: 1. Dharmais NCC offer a model of cancer referral networking capabilities as a part of integrated national referral systems that includes preventive, promotive, curative and rehabilitative services for various levels of health care facilities with level strata as ICC strata 1, strata 2, strata 3 and NCC. 2. Encouraging the immediate issuance of Ministry of Health policy in the form of decree or regulation as the legal aspects of implementation. Outcomes: The Minister of Health agree with the proposed stratification of integrated cancer center and process the ministerial decree. What was learned: The stratification of integrated cancer center in Indonesia is very important needed to promote the NCCP especially in access to care so the cancer cases will find and treat in early stage due to closer access.