Susilo Chandra Highlights Urgent Need for Anesthesia Equipment Modernization Amid Indonesia's Healthcare Transformation

With the growth of the middle-income population, rising life expectancy, and the impending onset of population aging, Indonesia’s healthcare system is facing both challenges and significant opportunities. Demand for broader access to higher-quality medical services in Indonesia continues to grow steadily.

As the most populous country in Southeast Asia, Indonesia’s market potential in the healthcare and wellness sector is self-evident. The Indonesian government is striving to enhance the development of its health sector by improving infrastructure quality and seeks to introduce foreign capital and advanced medical technologies to facilitate greater progress, with a particular emphasis on medical device products. In this context, cooperation between China and Indonesia has become one of the key drivers promoting the development of Indonesia’s healthcare sector.

Recently, at the Top 100 Summit of the VBEF Future Medical Ecosystem Expo hosted by VCBeat,Mr. Susilo Chandra, a board member of the Asian and Oceanian Society for Anaesthesia in Obstetrics and Gynaecology (AOSAOG) and convener of the Indonesian Annual Anesthesia Meeting, shared insights on the current status and opportunities of the Indonesian healthcare market under the theme “Indonesian Medical Market: What Do We Need in The Future?”

Currently, China has become Indonesia's largest economic partner, and Beijing has emerged as its key strategic partner.

However, Indonesia’s healthcare market continues to face significant challenges. Dr. Susilo noted that, first, the country’s geographical landscape poses substantial difficulties for the development of medical infrastructure and service delivery. Second, there is a shortage of healthcare personnel; most health workers, including doctors and nurses, live and work in central regions such as Java and Sumatra. Their numbers are insufficient to cover the entire Indonesian population, leading to an uneven distribution of medical resources. This disparity further exacerbates inequities in access to healthcare services, making it difficult for rural areas to obtain the same level of care as urban centers. Furthermore, the current Indonesian healthcare system struggles with patient data collection, which hinders research on population health status.

To address these challenges, the Indonesian Ministry of Health partnered with healthcare organizations to launch the JKN National Health Insurance program in January 2014, committing to achieve universal health coverage by 2024. By July 2023, JKN’s enrollment had surpassed 250 million people, accounting for over 90% of Indonesia’s total population. Meanwhile, the Indonesian government has prioritized primary care services and collaborated with the World Health Organization (WHO) to improve healthcare delivery.

In 2014, the Indonesian government implemented the E-Catalogue online procurement policy, a system established to enhance the transparency and efficiency of medical product procurement. It allows public hospitals to purchase medical products, including pharmaceuticals and medical devices, through a centralized platform, thereby streamlining the procurement process, improving operational convenience, and making procurement data easier to track and analyze. The Government Procurement Office is responsible for overseeing and managing the E-Catalogue system to ensure fairness and compliance in the procurement process. The establishment of the E-Catalogue system complements the Indonesian government’s push for universal health coverage, aiming to reduce costs through centralized procurement and make healthcare services more accessible and affordable.

During the COVID-19 pandemic, Indonesia also drew on its experiences and accelerated efforts to address gaps in its health system.

The incomplete public medical security system and healthcare challenges have brought greater market demand and opportunities to Indonesia, which has huge innovation and growth potential in the Southeast Asian healthcare market.

In light of issues such as the uneven distribution of medical resources and inequitable access to healthcare services in Indonesia, Dr. Susilo categorizes the future demands of the Indonesian medical market into two major segments: basic equipment and advanced products. Basic equipment complies with all international standards and is more affordable, while advanced products feature the latest functionalities and technologies at a higher price point. By meeting the demand for these two categories of medical devices, Indonesia will be well-positioned to serve all markets, ranging from rural areas to major urban centers.

Among these urgently needed medical products, anesthesia equipment faces significant challenges. Medical devices such as anesthesia machines, monitors, infusion pumps, video laryngoscopes, and ultrasound systems will provide more precise and robust support for surgical anesthesia procedures, significantly improving Indonesia’s healthcare environment and service quality.

Regarding anesthesia equipment, the World Federation of Societies of Anaesthesiologists (WFSA) and the World Health Organization (WHO) have established international standards for anesthesia machines and perioperative facilities. Among these, infusion pumps, pulse oximeters, capnography monitors, and peripheral nerve stimulators are critically important. Currently, certain anesthesia devices are not commonly available in Indonesian hospitals. For instance, peripheral nerve stimulators can effectively prevent postoperative pulmonary complications caused by inadequate reversal of neuromuscular blockade; unfortunately, however, such devices are not widely used in Indonesia. Dr. Susilo and his colleagues have been working to address this issue and advocate for the use of reversal agents when neuromuscular blocking agents are administered.

Furthermore, as a device with a 400-year history of development, the anesthesia machine has been continuously updated and improved due to its ability to ensure patient safety and its cost-effectiveness. Currently, by integrating the safety features of any CCM device, anesthesia machines can further ensure proper pre-use checks, thereby safeguarding patient safety. Low-flow anesthesia is another key feature of anesthesia machines; it not only helps reduce costs but also benefits environmental protection by minimizing the carbon footprint of anesthetic gases.

Infusion pumps are included in the list of devices strongly recommended by the World Health Organization (WHO) and the World Federation of Societies of Anaesthesiologists. In Indonesia, standard Target Controlled Infusion (TCI) systems are common, although not all models or pharmacokinetic models may be available. The limited availability of certain infusion pump models or formulations indicates significant room for improvement and expansion in this field in the future. Susilo Chandra highlighted compatibility issues among different brands of infusion pumps, noting that some manufacturers’ product lines are compatible only with their own proprietary systems. Therefore, future device designs must address compatibility concerns, while also prioritizing battery life, portability, and multifunctionality.

In Indonesia, Dr. Susilo strongly recommends the routine use of temperature monitoring and pulse oximetry in daily anesthesia practice. Despite Indonesia’s warm climate, intraoperative hypothermia is a common issue that requires management through monitoring. Therefore, continuity of monitoring data is crucial from the operating room to the post-anesthesia care unit (PACU), as well as in the ICU. In an era where electronic medical records are widely adopted, patient monitor data should be integrated with patients’ medical records. Currently, non-invasive monitoring is not common in Indonesia; however, for high-risk patients or complex surgeries, non-invasive and dynamic monitoring may facilitate better clinical decision-making. In the future, non-invasive monitoring is expected to become standard practice.

Meanwhile, ultrasound equipment—especially handheld portable ultrasound devices—as well as ECMO systems and commonly used equipment in operating rooms or ICUs should be vigorously promoted and popularized in Indonesia’s healthcare market.

Currently, Indonesia’s healthcare security system is undergoing a major transformation, and cooperation with China can contribute to the future transformation of Indonesia’s healthcare system.

Regarding how Chinese enterprises can sustain cooperation with local partners in Indonesia, Dr. Susilo offered three recommendations:

First, Chinese enterprises can adopt comprehensive marketing strategies to cover all market segments across the lower, middle, and upper socioeconomic classes, offering both basic equipment and advanced products. Just as different types of automobiles are marketed to suit various consumer segments, medical devices should likewise meet the demands of diverse market tiers.

Secondly, pay close attention to changes in Indonesia’s trade policies and healthcare regulations. This requires coordination with local authorities, particularly regarding the requirements of the E-Catalogue. Furthermore, establishing connections with public hospitals and large hospital groups in Indonesia is crucial, as it facilitates access to a broader market.

Finally, artificial intelligence and big data represent the future trends in the healthcare market, and Indonesia is keen to participate.

Overall, the future of Indonesia’s healthcare market is promising yet challenging. Chinese companies expanding into Indonesia must align with local market demands and provide more advanced technologies.