Vast natural resources, seemingly endless human power, rapid tech advancement—with all these traits to boot, it should be natural for Indonesia to be a leading example in developing national health. But have we covered enough ground? Are we doing enough?
A new life was born. It was a beautiful experience. Surrounded by experienced nurses and doctors in a world-class hospital, the newborn is breast-fed immediately. His vitals are stellar and everything is monitored and planned well for the next 10 years, including complete vaccination, customised nutrition charts and other details. By the world’s standard, the baby could not have been healthier.
A new life was born. It was a heart-wrenching experience. It was the mother’s fourth baby. An elderly village woman is helping with the delivery—she brings medicine made from freshly gathered herbs. She chants as her hands massage the mother’s belly to help get the baby into the head-down position. Ten hours later, she cuts the umbilical cord and wraps the newborn in ragged cloth. Alive and well, there’s a chance the baby contracts neonatal tetanus.
The two births took place in the same country but you can easily tell which one happened in West Papua. This study case represents one major problem faced by a nation of 250 million people spread across 17,000 islands: health inequalities.
“While some Indonesians have easy access to health services and prevention initiatives, others are at a disadvantage,” according to Dr. Siswanto, Head of the Indonesia Agency for Health Research and Development, Indonesian Ministry of Health. “Monitoring inequalities is a fundamental part of improving the health of those who are disadvantaged, and ensuring the country fulfils its commitment of ‘no one left behind.'”
The problem is not unknown to the government, who are working hard to improve the situation. Working together with WHO, the Indonesian Ministry of Health has produced State of health inequality: Indonesia, the first WHO report to provide a comprehensive assessment of health inequalities in a Member State.
Utilising this report and with the help of many other local and global health institutions, the government has been making solid progress. Let’s have a look at some of the advancements made and other presently significant challenges.
The game-changing JKN (Jaminan Kesehatan Nasional)
Before 2004, only civil servants, police officers and military personnel were covered by a public social insurance scheme. This scheme was gradually expanded to cover the poor and include maternity care. Ultimately, the BPJS (Badan Penyelenggara Jaminan Sosial) was launched in 2014 as part of the JKN programme.
By November of the same year, some 130 million Indonesians were brought under JKN coverage, and as of June 2017 around 70 per cent were enrolled in the plan. The scheme aims to cover the whole population by the end of 2019, although some have begun to doubt the viability of this goal. And it’s not hard to see why—according to World Bank, JKN will cost 13 to 16 billion dollars (184 – 228 trillion rupiah) per year once full implementation is achieved, but the Proposed State Budget of 2019 for health only increased by 13,59 per cent from last year to 122 trillion.
Bringing the whole population of a vast archipelago under a universal coverage scheme is no easy task. Though nearly 70 per cent of the population is currently covered, approximately 40 per cent of this total is subsidised, with around 90% subscribers being from low-income groups. Furthermore, eligibility aside, less than half of the population is actually able to access hospitals or primary health care facilities because either the infrastructure is not available in their communities or neighbouring health centres are just too far away to reach. It is clear that infrastructure is another challenge altogether.
In line with infrastructure development to support a more equalised distribution of services, mobile apps and other innovative technologies are helping to fill the gap in remote areas.
In June 2017, online health platform, Alodokter revealed plans to develop and app that would allow users to compare hospitals. Its website now receives around 12 million users each month. Its app, launched in March of 2016, serves 150,000 subscribers monthly.
Another app, the Hypertension Online Treatment (HOT) service, was introduced to the market in early 2017. HOT offers online consultations and appointment reminders that help cut down waiting times in health care centres and connect patients in underserved communities to the care they need.
Mobile Obstetrics Monitoring (MOM) was introduced by Dutch technology company Philips in 2016, offering health care practitioners an innovative way to address maternal mortality rate. The app connects midwives in rural communities with gynaecologists in clinics and hospitals, allowing them to monitor patient’s vital signs and identify risk factors throughout a pregnancy. In addition to saving lives, apps like MOM can also serve as a training tool for health care providers who would otherwise have limited access to research or skills development.
In the next spread, we take a close look at some of the modern approach public and private sectors are employing to address health inequity and other major health issues.
We have travelled far in the recent decades in terms of health, but many challenges still lie ahead. Overall fitness contributes directly to the general health of a community as much as health services help prevent serious. Like their government, the people are becoming more aware of this issue. They are eating better, living healthier lifestyles and engaging in more wellness activities, among other things.
Read on to see our report of some of the most interesting wellness communities and movements, such as the Poundfit movement, gyms that offer new and unconventional ways of maintaining a fit lifestyle as well as several parks around Jakarta that promotes public health. For the sports communities, we present an in-depth view at some of the best golf courses in Jakarta.
This article is originally from paper. Read NOW!Jakarta Magazine July2019 issue “Health, Sports and Recreation”. Available at selected bookstores or SUBSCRIBE here.