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Overview
Overall, health conditions in Indonesia have improved over the past few decades. Standards for sanitation, medical care and access to hospital treatment have all increased. As a result, life expectancy rose by approximately ten years between 1980 and the mid-1990s. By 1996, an Indonesian child could expect to live for nearly 65 years on average.
Click on the following link for more information:
The World Bank Group, Social Policy and Governance
Improvements in the health care system between the 1970s and mid-1990s can be attributed to economic growth and a commitment on the part of the government to improve health. Between 1969 and 1994, the Ministry of Health expanded access to health care by establishing government health centers (Puskemas), and the number of medical personnel increased. These centers, staffed by a physician, focus on disease prevention, the health of mothers and children, and general nursing services.
In response to an explosive birth rate in the 1950s and 1960s, Indonesia introduced what is widely hailed as one of the most successful family-planning programs in the developing world. In 1989, President Suharto was awarded a special citation by the United Nations in recognition of this success.
Infant mortality rates also dropped significantly. In 1967, the rate was 124 per 1,000 live births, and by 1997 the rate had dropped to 41.44 per 1,000 births.
For the source of these figures please click on:
Indonesia Health Profile
The government is currently in the process of decentralizing the health care system, bringing planning, management and financing of health care under the provincial governments. More health care is also being taken on by the private sector as demands for medical services increase.
Challenges
Despite such improvements, however, the standards of health services in Indonesia remain low compared to other developing countries. There is a shortage of medical and paramedical personnel, particularly in rural areas, which are isolated and inaccessible.
Infectious diseases have been reduced, but not eliminated. The main causes of death in Java and Bali are circulatory diseases, while respiratory diseases are the main causes of death in other regions of Indonesia. Tuberculosis (TB) and Dengue Hemorrhagic Fever remain public health threats.
Children often suffer from respiratory infections, skin and eye diseases, intestinal parasites, malaria, tuberculosis, gastroenteritis and acute diarrhea. More than 50% of all Indonesian deaths are children under five years old. (See Project Concern International: "Indonesia - A Successful History of Making a Difference")
HIV/AIDS is also a growing concern. Prevalence remains low but cases have been reported throughout Indonesia, and especially in among high-risk populations in large cities in Java and West Papua, and in regions including Riau and Bali.
Some improvements in health have also been disproportionate. While general infant mortality rates have dropped, much of the decrease was not seen in poor, rural areas. The Indonesian population grew at a rate of 1.5% a year in 1998and maternal and neonatal mortality rates are among the highest in the region. (See USAID: "Improving the Health of Women and Children")
The 1997 economic crisis also exacerbated health problems in Indonesia. One of the first factors to be affected was the price of drugs (including vaccines and contraceptives), most of which are imported. A survey conducted by the World Bank indicated that drug prices increased by 200% to 300% between November 1997 and March 1998.
The food supply is also severely threatened by the economic situation. Droughts on the eastern islands in particular created severe food shortages and a need for large food imports, which became more expensive as a result of the falling of the Rupiah.
In response to the crisis, budget allocations for essential drugs and basic health services were protected, and health services for the poor were accorded priority. International organizations have contributed to medical supplies, drugs and vaccines. The government also re-established the country's Food and Nutrition Surveillance System to provide early warning of nutrition needs, especially in areas where food production has fallen.
Insurance
Health insurance in Indonesia has developed slowly. Only an estimated 15% of the population of Indonesia has health insurance, the majority of which are government employees and employees of larger corporations. The benefits package for Indonesian health insurance is also limited. A co-payment system is widely implemented in health insurance policies.
In reaction to economic crisis, the Indonesian government has begun to provide a health services Social Safety Net for the poor, using Asian Development Bank (ADB) funds. Additionally, in 2001, for the first time, the fund from fuel oil subsidies was used to finance health services for the poor. However, this fund was small relative to the needs of Indonesia's poor.
Separatist violence and the increasing number of IDPs have also caused health crises. Local medical facilities for refugees in camps in Maluku in particular are under great strain and are running out of essential supplies like drugs and blood bags.
Traditional healers (Dukun) have continued to play an important role in health care in Indonesia, especially because of the high price of Western-style drugs. For instance, while over 60 percent of births nationally are assisted by health care personnel, in rural areas, a high percentage of births are assisted by Dukun Bayi, traditional midwives. In order to improve mother and child health care in rural areas, midwives are assigned to villages.
For more information on health in Indonesia, see:
Indonesia Ministry of Health Website, Indonesian Health Profile
Indonesia Family Life Survey Introduction: "Health, Education, and the Economic Crisis in Indonesia" by Elizabeth Frankenberg, Kathleen Beegle, Duncan, Thomas, Wayan Suriastini
"Health, Family Planning and Well-being in Indonesia during an Economic Crisis: Early Results from the Indonesian Family Life Survey"
by Elizabeth Frankenberg, Kathleen Beegle, Bondan Sikoki, Duncan Thomas
Cornell University: "Social Risk Management Options for Medical Care in Indonesia"
by Menno Pradhan and Nicholas Prescott
AUSaid: "The Impact of the Asian Financial Crisis on the Health Sector in Indonesia"
World Bank: "What Do Doctors Want? Developing Incentives for Doctors to Serve in Indonesia's Rural and Remote Areas"
by Kenneth M. Chomitz, Gunawan Setiadi, Azrul Azwar, Nusye Ismail, and Widiyarti (March 1998)
Updated April 2002
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