The World Bank recently approved a loan of US$150 million to support Indonesia’s healthcare programs and services. The loan is set to focus on three regions in Eastern Indonesia: East Nusa Tenggara, Maluku and Papua. However, are candidates in the upcoming regional elections prioritising health in their programs?
The World Bank Executive Board approved a US$150 million loan to support primary healthcare of all Indonesians through better governance, accountability and health care services.
The World Bank Country Director for Indonesia and Timor Leste, Rodrigo A. Chaves, ensured the loan was part of the Indonesian Supporting Primary Health Care Reform (I-SPHERE) which will support the implementation of the Healthy Indonesia Program.
“Health is important for Indonesia to meet various objectives where its citizens are healthy and prosperous, and have equal opportunity to participate in growth and development of this extraordinary country,” he said.
In recent years, an increase in life expectancy demonstrates that the health sector in Indonesia has improved. In addition, the mortality rate for children under the age of 5 fell from 46 out of 1,000 births in 2002 to 32 out of 1,000 births by 2017.
Unfortunately, maternal or female mortality rates due to pregnancy and labor remains at 126 deaths per 100,000 births.
Indonesia also has the second-highest tuberculosis rate in the world. Tuberculosis accounts for over 10 percent of premature deaths in Indonesia, with only a third of those cases diagnosed prior to death.
Part of the program’s implementation is the improvement of government performance, capacity and accountability, as well as local health facilities, and the improvement of national standards by strengthening primary care accreditation.
Better local service is also expected to be achieved by improving health funding, including Universal Healthcare (JKN).
“Better performance of primary health services will improve the health of this country, which is a key component of human capital that is essential to Indonesia’s success,” Chaves said.
The program will focus on three regions in East Indonesia: East Nusa Tenggara, Maluku and Papua.
These regions face inequalities in health outcomes and access to quality primary health care. As a result, mortality of children under 5, chronic malnutrition, and stunting still occurs.
The Government of Indonesia is targeting universal healthcare for every citizen by 2019. However, improvements are still needed in its governance, access to quality health services, and funding at local and national level.
Candidates for the 2018 regional elections have publicly delivered their policy vision for the next five years. Many prioritised education, economy, poverty alleviation and social welfare. However, they have forgotten to prioritise health.
An editoral in KR Jogja contends that health should be a top priority. Data from the Central Bureau of Statistics (BPS) revealed that at least 70 percent of the 2018 electoral districts have a life expectancy below the national average of 71.06 years. At the provincial level, only four areas have a population with a longer life expectancy than the average Indonesian population in general, namely Central Java, East Kalimantan, West Java, and Bali.
Under the Health Act, provincial, district and municipal governments must allocate at least 10 percent of their expenditure on health. There are still many regions that allocate less than 10 percent of budget expenditure for health. Of the 17 provinces going through regional elections, only 4 districts have allocated health spending above 10 percent, namely Central Java, Bali, West Nusa Tenggara and South Sulawesi.
The Indonesian Ministry of Health highlights three issues: tuberculosis, stunting, vaccines and immunization.
Based on WHO Global Tuberculosis Report 2016, Indonesia ranks second with the highest TB rate in the world. TB is common in rural areas in Indonesia. The incidence trend of TB cases in Indonesia has never declined and many cases are unrecorded.
Stunting is a condition where a child has a growth disorder that causes him or her to be shorter their friends of the same age. Many toddlers in rural areas have stunting, caused by chronic malnutrition due to poor nutritional intake over a long period of time.
To address this, nutrition-specific interventions are needed in adolescents, pregnant women, infants 0-6 months, infants from 7 to 24 months, and mothers.
In addition, nutritionally-sensitive interventions are needed – such as improving the family economy, family programs, access to clean water and sanitation programs, and nutritional education programs.
Finally, recent diphtheria and measles outbreaks should push governments to evaluate immunisation programs, including the quality of vaccines as well as monitoring in various regions.