On Tuesday, 2 February 2016, the Corruption Eradication Commission (“KPK“) and the Ministry of Health, the Indonesian Doctors Association, the Indonesian Doctors Council, the Collegiate Board of Indonesian Doctors, the Disciplinary Ethics Board of Indonesian Doctors, the National Agency of Drug and Food Control, hospital representatives, the Pharmaceutical Companies Association and representatives of national and international pharmaceutical companies agreed to an 8 point agreement on gratification in the healthcare sector. From publicly available sources, the broad strokes of the agreement are as follows:
- Provision of sponsorships to doctors must be made transparently and there must be no conflict of interest in the sponsorship.
- All offers and invitations of sponsorship to doctors must be made through an institution, such as a hospital or a doctors association. The institution will lay out the mechanism for assessing the sponsorship offer. The mechanism must be transparent and accountable.
- Offers of sponsorship must not influence a doctor’s independence and must not be directly or indirectly linked with recommendations of prescription medicine.
- All relevant parties, in their own competence and capacity, must encourage the government to be responsible for providing adequate healthcare, starting with providing qualified and affordable doctors’ education.
- All relevant parties must encourage good governance in the relationship between pharmaceutical and healthcare supply companies and doctors and must also review existing regulations and revise their technical guidelines, standard operating procedures, and other joint agreements to be in line with the principles of prevention of corruption.
- All relevant parties must place regulations on provision of sponsorship as an important part of bureaucratic reform and the increase of public service in the healthcare sector.
- The government must provide an adequate budget to support the continued education and training of doctors.
- Other parties that were not invited to take part in the agreement will be invited as soon as possible to discuss the issues that have been agreed.
- The spotlight on gratification in the healthcare sector is said to stem from investigative reporting into the prevalence of gratification and bribery in the healthcare sector by pharmaceutical companies to medical professionals, primarily doctors. The investigative reporting was published in a renowned Indonesian weekly magazine in early November 2015.
The agreement seems to be the next step in the increasing public attention on gratification and bribery in the healthcare sector. But it remains to be seen whether there would be a follow-up of the agreement to become a government regulation with more details and possibly sanctions. We note that in the past, a similar agreement and even regulations have regulated the relationship between pharmaceutical companies and healthcare professionals with regards to promotion of medicine. A similar agreement was signed in 2007 between the Indonesian Doctors Association and the association of pharmaceutical companies on the ethics of promoting medicine. The Head of the National Agency of Drug and Food Control also issued regulation Number HK.00.05.3.02706 of 2002 on the Promotion of Medicine. The Ethics Code for Indonesian Doctors also regulates that doctors must be free of conflicts of interest in conducting their duties. The agreement could also be a step in KPK’s planned increase in corruption prevention programs. KPK’s deputy chairman has stated that KPK’s duties in the future will primarily be focused on corruption prevention and not enforcement. We have also observed that KPK has never investigated a corruption case involving a pharmaceutical company and a medical professional. Having said the above, pharmaceutical companies should remain cautious when dealing with medical professionals, especially those that work for a government hospital or hospitals that receive funds from the state/regional budget. Medical professionals working for these hospitals may arguably be deemed as civil servants or state administrators, making any unofficial payment to them be a violation of the Anti-Corruption Law. The Anti- Corruption Law provides sanctions for both the receiver and the giver in corrupt acts of gratification/bribery. The Anti-Corruption Law also enables sanctions to be given to a company, as seen with the Indosat IM2 case of 2013. Pharmaceutical companies must also observe Minister of Health Regulation Number 14 of 2014 on the Control of Gratification in the Ministry of Health in conducting their relationship with government officials in the Ministry of Health.