WHO in Indonesia

The general decentralization process implemented in 2001 has had many impacts on the health system, even though it was not designed specifically with the health sector in mind. In particular, health financing, health information system, human resources for health and service provision have been affected. Under decentralization, responsibility for health care provision is largely in the hands of regional governments.

Human Resources

The human resource situation in health has major deficiencies in numbers and quality of the health workforce.

Decentralization is one of many factors exacerbating long-standing problems with mal distribution and reportedly low productivity and quality  of health workers.  This in turn impacts on the quality, efficiency and equity of health care provision. Limited number of health workers  affected health service in Indonesia. In 2006,  ratio  of general practitioners  was 19.9  per 100,000 population  while  ratio of  midwife per 100,000 population was 35.4.

Most  general practitioners and midwifes are working in urban area, and limited number  in remote area. In 2001, the Ministry of Health reorganized its human resource functions by establishing A new Institute for Empowerment and Development of Health Manpower  to link and coordinate the previously separate centres in the development of an overall integrated strategic plan for health workforce development & a corresponding integrated information system.

Decentralization resulted in a partial breakdown of health information systems and led to an unclear division of reporting responsibilities.

Health Information System

As a result, no comprehensive data exist that cover the entire nation. The disruption of the information flow makes it difficult to develop strategies and monitor health programmes in provinces and districts. Exceptions do exist in some vertical programmes (tuberculosis, malaria or HIV-AIDS) where the Central Government retains the responsibility as the principal recipient of GFATM grants to the country.

Health Financing

Indonesia spends relatively little on health services. Estimated total expenditure on health (per capita, in 2003) was $ 33 in Indonesia .

Within that, public sector spending on health (per capita, in 2003) was estimated at $ 11 in Indonesia. The overall health financing situation in Indonesia is complex and incompletely documented. In 2003, around 34% of total health expenditure is undertaken by public sector agencies, while 66% is private. By far the largest single source of private expenditure is direct out-of-pocket payments by households, accounting for nearly half of the total expenditure.

Privately provided services are largely financed by out-of-pocket payments, with some insurance and employer-financed expenditure benefiting a minority of formal sector employees. Publicly provided services are financed by a mix of public budgets and user fees, in turn financed by a combination of households, employers and insurers. Until the advent of the new social insurance scheme for the poor, insurance coverage of the population was low, at well under 10%.

	At primary health care level, Indonesia is generally regarded as having relatively adequate levels of provision,  one public health centre for every 30 000 people on average.	Health Services
If sub-centres are included, there is one public facility per 10 000 people.  However, these averages conceal large variations in geographic accessibility, with people in remote interior or small island locations having particularly poor access. In addition to public facilities, private practices are operated by doctors, nurses and midwives, in many cases by the same personnel as are employed in public facilities. At the hospital level, Indonesia has low levels of bed provision at 62,5 beds per 100,000 population. Paradoxically, the utilization is also low, with bed occupancy rates in the vicinity of 56.2 % in both public and private facilities.
The private sector is increasingly important in the provision of health care in Indonesia, especially in big cities, with wide variations in quality of care. Furthermore, since there is no regulation of pricing or quality of service in place, users are vulnerable to excessive treatment and expenses. The role of nongovernmental organizations (NGOs) in Indonesia has been growing during the last two decades but the exact number of NGOs providing health care services remains unknown. While medicines to treat the vast majority of tuberculosis, malaria and HIV-AIDS cases exist, drugs are not reaching everyone due to limited affordability and availability as well as other factors. Despite the presence of a strong Drug Regulatory Authority, responsible for the registration of medicines as well as quality control and inspection, counterfeit drugs remain a big problem. The fight against counterfeit drugs is resource intensive and requires substantial cooperation of other sectors. At the same time, the use of traditional medicines (such as ‘jamu’) is popular and widespread in Indonesia. Yet procedures for quality control of traditional medicines are limited in scope, and difficult to implement, also because large numbers of small-scale manufacturers exist.

A Survival Guide To Health Care In Indonesia

Whether you come from an American like system of high quality private health care or the Canadian and European public health model you will find the Health care system in Indonesia very different from what you are used to. Having worked for a number of years in Indonesia providing health insurance for expats I have some unique local knowledge based on firsthand experience as well as problems I have seen my clients deal with. I hope that you will find this guide informative and that your stay is a happy and healthy one. But if you fall ill or are injured this guide should help you avoid a lot of misery and may even save your life.

Make Sure You Have Adequate Health Insurance.

If you find yourself needing treatment for a serious illness or injury you will need adequate health insurance. Be sure that your policy allows for Emergency Medical Evacuation.  You do not want to bet you or your family’s life on the vagaries of local health care providers. When you purchase your cover make sure it is from a reputable Financial Adviser or Insurance Broker who has specific local knowledge about which insurance companies will be more likely to evacuate you to somewhere you can receive adequate medical treatment. If you purchase Medical Insurance in your home country your adviser is unlikely to know this.

If It's an Emergency Don't Wait For An Ambulance.

Anyone who has driven for sometime in Indonesia will notice that local people do not make way for ambulances even if they are using their lights and sirens. In Indonesia ambulances are primarily for transporting dead people, so unless you are already dead, you would be better off making your way on your own to the nearest hospital rather than waiting for an ambulance. The so called "Golden Hour" that emergency medical people talk about would be better spent in a clinic or hospital rather than in an ambulance stuck in a traffic jam.

Just Because The Doctor Has A Diploma Does Not Mean He Is Competent.

Like many other facets of Indonesian life, the education system is rife with corrupt practices. Many people have been granted advanced degrees based more on the kind of bribes they where willing to pay and not their exam results. While there are a number of very competent local doctors there are also a number very dangerous quacks practicing medicine. You need to be sure that the Doctor who is treating you or your family knows what he is doing. The only way to ensure this is by always seeking treatment at a reputable institution that makes sure its staff are competent. At the bottom of this Guide you will find a list of the Health Care providers I would recommend.

Treatment Quality Depends on The Cost.

Health Care quality does not just vary from Hospital to Hospital, but also varies by the class of treatment sought. It ranges from category 3 in which the staff will change IV's and administer basic medicine, but not change sheets or assist patients to the toilet all the way to VVIP where your surroundings and service will be more akin to a five star hotel than what you would expect in a Hospital. So it is important to make sure that your Insurance will provide the level of cover you would expect.

Be Careful About Complaining About Poor Treatment.

In a recent highly publicized case a patient is being tried for Defamation because she complained that the Hospital Staff where incompetent and her illness was misdiagnosed. It is far better to make sure you only deal with competent Medical Providers rather than deal with the health and legal ramifications of dealing with some of the less reputable institutions.

Summary

It is important that you have adequate Medical Insurance, the only people who have the unique local knowledge about which Health Insurance plan among the hundreds available will meet your needs and expectation are local Financial Advisers and Insurance Brokers. Make sure that your policy will cover Emergency Medical Evacuation, if it doesn't it may cost you or a family member their life.

Medical Insurance In Indonesia

Companies operating in Indonesia, whether they are local or multinational, realize the importance of a comprehensive medical plan to cover sickness and accidents of the staff that they hire. This is a moral and often a legal obligation.

Find out before you come

The company that you are with, or are going to work for, should provide medical insurance for expatriate staff and their family members, as well as their permanent Indonesian staff. Ask for details from your employer to ensure that your policy will adequate cover your family members for sickness or accident emergency, whether in Indonesia or when you are returning home on leave or when you are visiting other countries in the course of your work or on vacation.

If you are joining a new company, you must remember that they may never love you more than when you first join. Do not rely on promises that medical insurance coverage will be sorted out when you arrive in Indonesia. It may in fact be taken care of to your satisfaction, but it could be the case that what the company considers ideal coverage may not meet your expectations. Be sure, before you come, that you understand what medical coverage your company will provide for regular medical concerns, and major medical situations such as surgery or deliveries, as well as medical evacuation to another country or from a remote site to a big city in Indonesia.

Medical Evacuations from Indonesia

Medical evacuations are a big factor in medical coverage as the quality of medical service will be quite poor in outlying areas in Indonesia. Emergency medical evacuation (medivac) to a large city or even to a neighboring country is considered essential in most medical emergencies. Learn more about medical evacuations from Indonesia.

Group Practice Medical Clinics

Some multinational firms enroll their employees in one of the Group Practice Medical Clinics which provide for all the minor medical outpatient needs for an annual membership fee or a pay-by-visit basis. Often these member-based plans include medical evacuation as well. These local clinic schemes with medivac coverage that cater to expatriates provide good service and overall you will get good advice from their doctors.

Note: There have been cases when a member of one of these local group practice schemes was evacuated to Singapore for an operation. While the evacuation was covered by the scheme, the patient found that there was no medical insurance coverage once they get overseas and they had to pay for their own medical expenses. For these instances, it is necessary to buy health insurance for hospitalization to add to the local clinic plan and this can prove to be very expensive.

Some of these local schemes have an alliance with the local office of an international insurance company so that hospitalization or serious outpatient treatment will be paid for. But covering the whole span from mild outpatient service to a major operation is not as cost effective as if the complete plan is engineered from square one to include everything you need.

Options in Medical insurance coverage

International Medical Insurance plans from the U.K. for instance, include emergency medical evacuation and there is the possibility to add outpatient services to cover everything but minor outpatient items. The reason for excluding minor outpatient claims is to keep the costs down as the paperwork involved in claims could well exceed the claim itself. The outpatient claims therefore have a deductible.

The deductible is related to the illness - not the claim - so the patient may have several doctor and specialist visits plus the prescribed medicine for one particular bout of sickness and there would only be one deductible. A point worth noting is that a person could be undergoing outpatient treatment with a very serious illness, which would not be covered under a local clinic scheme.

There are many foreign joint venture insurance companies with offices in Jakarta selling medical, hospitalization and other general insurance products for group and individual medical insurance policies, so you do have a large choice of companies and products. You could also purchase a medical insurance or travel plan from a company based in your home country which provides some medical cover while you are traveling overseas, however, you must be very sure about the restrictions on such plans as it may not cover you completely while residing overseas.

Finding the best plan for your particular requirements can be very time consuming with the many options. Any local or group venture health insurance company representative will tell you how good the product is from his company. That's what he's paid to do, and it could in fact be the best plan available for you. The representative is not paid to explain that another company does the same thing (or better) at a cheaper cost, and he's not paid to promote his competitors' products.

Consider Costs

Good, comprehensive medical insurance is not cheap, nor is emergency medical evacuation, so most people will take cost into account when making their decision on medical insurance coverage. It is important to find out all your options from an unbiased source, which could be an agency or broker, who can assist you to make the choice based upon your individual or company requirements

Indonesia Insurance Information

ndonesia is a vast archipelago that contains the fourth most populous country in the world and the largest range of biodiversity on the planet. Rife with natural resources, investment opportunity, and fascinating culture, Indonesia's 17,508 islands have been attracting expatriates since its economy began to boom in the early 1980s. Located in Southeast Asia and bordering Malaysia, Papua New Guinea and East Timor, Indonesia is advantageously situated for travel and trade. With both a fascinating contemporary culture and a history that extends back 500,000 years to the time of “Java Man,” Indonesia is one of the most exciting places to visit today.

Some of the oldest Homo erectus fossils were unearthed in Indonesia and named the “Java Man”. The more recent peoples of Indonesia originated from an Austronesian race that likely migrated to the islands of Indonesia from Taiwan Around two millennia ago, Indonesia began to partake in the circuitous trade routes of Southeast Asia. First doing business with China and then with Indian and Middle Eastern merchants, Indonesia embraced outside cultural influences and therefore developed a fascinating culture that enlisted new ideas from all over the world.

Indonesia experienced a “golden age” between the 10th and the 13th centuries. Under a Buddhist and then Hindu leader, Indonesian culture and economy thrived. With Islamist roots that date back to the 13 th century, Indonesia is now the largest Muslim-majority country in the world. While the government emphasizes Indonesian national unity, the multitude of diverse native ethnic groups still maintain their traditions and languages.

European influence in Indonesia dates back to the 17th century, when Portuguese captain Francisco Serrao arrived in the “Spice Islands” seeking cloves and pepper. After the departure of the Portuguese, the Dutch were able to establish a very strong influence in the area, first as a territory of the Dutch East India Company and then as a Dutch colony. Dutch powers remained in Indonesia until World War II, at which point Japan occupied the islands from 1942-1945. After the Japanese surrendered, Sukarno, who had been the primary leader of the Indonesian nationalist movement, installed himself as president and declared independence from the Dutch. The Dutch did not officially cede rule until the end of 1949, after which Indonesia entered into the United Nations as an independent country.

Indonesia's history as an independent entity has been somewhat unstable. Sukarno suffered opposition from a number of political parties, barely surviving a failed coup in 1965. Finally, his main opponent, Suharto, pushed out the president in 1968 and asserted his rule. Since the establishment of Suharto's presidency and his “New Order” national rehabilitation plan, Indonesia has seen an almost uninterrupted period of growth and development.

A main component of Suharto's “New Order” plan has been to encourage international investment in Indonesian industry. Even though it is a Muslim-majority country, Indonesian cities are open and welcoming to Westerners. However, while many parts of Indonesia are accessible, keep in mind that there are still many ways in which Indonesia needs to develop.

In 2006, 17% of Indonesia's population was below the poverty line, and almost 50% lived on less than US$2 per day. The country's public services must vastly develop in order to live up to foreigners' expectations of care. If you are planning to relocate to Indonesia, it is important that you get international insurance coverage so you will be covered in the case of emergency. To receive care from an international medical facility can get expensive, but this is the safest option because some Indonesian hospitals are unable to provide up-to-par medical treatment. Having the security of global insurance will help you adjust to your life in Indonesia, giving you the freedom to explore everything there is to discover.

Moving to Southeast Asia may be daunting, and, for some international families, finding reliable healthcare facilities is the first concern. An international medical insurance plan from Pacific Prime will allow you to have Western-style healthcare that you can afford. The hospitals available for expatriates in Indonesia will provide you with just the type of treatment that you need.

We can give expatriates in Indonesia health insurance plans that will provide total cover in Southeast Asia and the entire globe. Most of our plans have a range of benefits that can be tailored to fit your international requirements. With options such as dental, maternity, out-patient services, and emergency evacuation, you know that you will receive high-quality care all over the world.

Healthcare Costs and U.S. Competitiveness

Introduction

The United States spends an estimated $2 trillion annually on healthcare expenses, more than any other industrialized country. According to data from the Organization for Economic Cooperation and Development (OECD), the United States spends two-and-a-half times more than the OECD average, and yet ranks with Turkey and Mexico as the only OECD countries without universal health coverage. Some analysts say an increasing number of U.S. businesses are less competitive globally because of ballooning healthcare costs. U.S. economic woes have heightened the burden of healthcare costs both on individuals and businesses. The U.S. healthcare reform law signed by President Barack Obama on March 23, 2010, includes measures aimed at making healthcare less expensive and more accessible, including upgrades to government-run Medicare and Medicaid. Still, reforming healthcare has proved politically divisive, especially over the option to expand social medicine, as well as new mandates on employers and individuals. Whether these reforms will reduce the healthcare-cost burden on U.S. industry remains under debate.

Competitive Disadvantage

The United States spent more than 17 percent of its GDP in 2009 on healthcare, higher than any other developed nation. The nonpartisan Congressional Budget Office (CBO) estimates that number will rise to 25 percent by 2025 without changes to federal law (PDF). Employer-funded coverage is the structural mainstay of the U.S. health insurance system. According to the U.S. Bureau of Labor Statistics, about 71 percent of private employees in the United States had access to employer-sponsored health plans in 2006. A November 2008 Kaiser Foundation report says access to employer-sponsored health insurance has been on the decline (PDF) among low-income workers, and health premiums for workers have risen 114 percent in the last decade (PDF). A March 2010 report by Thomson Reuters, a business intelligence service, found that employers' healthcare costs rose 7.3 percent in 2009 (PDF) compared with 4.8 percent in overall U.S. health spending that year. Small businesses are less likely than large employers to be able to provide health insurance as a benefit. At 12 percent, healthcare is the most expensive benefit paid by U.S. employers, according to the U.S. Chamber of Commerce.
Some economists say these ballooning dollar figures place a heavy burden on companies doing business in the United States and can put them at a substantial competitive disadvantage in the international marketplace. For large multinational corporations, footing healthcare costs presents an enormous expense. General Motors, for instance, covers more than 1.1 million employees and former employees, and the company says it spends roughly $5 billion on healthcare expenses annually. GM says healthcare costs add between $1,500 and $2,000 to the sticker price of every automobile it makes. Health benefits for unionized auto workers became a central issue derailing the 2008 congressional push to provide a financial bailout to GM and its ailing Detroit rival, Chrysler.

Some economists say these ballooning dollar figures place a heavy burden on companies doing business in the United States and can put them at a substantial competitive disadvantage in the international marketplace.

Still, other experts debate the degree to which healthcare affects U.S. industries. "Health benefits are largely substitutes for other forms of labor compensation," says American Enterprise Institute Fellow Thomas Miller in a CFR.org roundup. "Hence U.S. firms have performed well [in the past], despite rising levels of healthcare costs, because high levels of productivity and a favorable investment climate were (and remain) much more important factors in determining competitiveness."
Healthcare is one of several factors--entrenched union contracts are another--that make doing business in the United States expensive, and it's difficult to parse the effects of each factor. Moreover, economists disagree on the number of U.S. jobs that have been lost to offshoring--the transfer of business operations across national boundaries to friendlier operating environments. A RAND June 2009 study published in the Health Services Research Journal found that industries with the highest level of employer-sponsored healthcare (such as manufacturing, telecommunications, education, and finance) showed the slowest amounts of growth between 1987 and 2005 compared to industries with the smallest level of employer-provided insurance in the United States and compared to their industry competitors in Canada, where insurance is provided by the state. U.S. News and World Report Money blogger Rick Newman uses some of the RAND data to project the decrease in industry growth and potential job losses for fifteen sectors should healthcare costs rise to 20 percent of U.S. GDP.
Some analysts say the healthcare situation affects the ability of startup companies to find the best workers, impeding U.S. innovation. "In the cradle of American innovation, workers are making career choices based on co-payments, preexisting conditions, and other minutiae of health insurance," writes David Leonhardt in the New York Times." They are not necessarily making decisions based on what would be best for their careers and, in turn, for the American economy."

Health Reform's Impact on Business and the Economy

The healthcare reform legislation passed by Congress largely focuses on decreasing the number of uninsured--projections estimate reducing these numbers by about 60 percent, but it is less clear how much these reforms would affect the U.S. economy. Overall, the new law would produce close to $1 trillion in new government spending. Although the CBO found that the final law would reduce the federal deficit (PDF) by as much $138 billion by 2019, the Centers for Medicare and Medicaid Services, a U.S. government agency, also found that the legislation would do little to stem the rise in healthcare expenditures--expected to increase to more than 20 percent of GDP in the next decade.
The Senate Finance Committee's Democratic majority says its reforms will add an additional thirty million people with less than a 1 percent rise in overall expenditures (PDF). Democratic lawmakers say the law is paid for by new taxes and lower Medicare payments, but critics cast doubt on whether those lower payments--roughly half of the spending offsets (WSJ)--would ever come about. According to former CBO head Douglas Holtz-Eakin, if "unrealistic accounting" for Medicare, along with a number of other "gimmicks and budgetary games," is removed, the new law would actually cost $562 billion in new government spending by 2019 (NYT).
The law mandates that employers either provide insurance for their employees or pay a penalty that would go toward government subsidies so employees could buy their own insurance. In a December report (PDF), the Lewin Group, a private consulting firm, found that employers currently providing insurance will see a reduction of $223 per employee in healthcare spending under the Senate's version of the bill, which became the basis for the new reform law--"primarily because the employer penalty is low enough that employers can afford to discontinue their plans." Non-insuring companies will pay $316 per worker in new health spending, according the Lewin report.

The 'Triple Tax'

Many company officials say a wasteful public-private system is pushing costs much higher than they should be. Jeffrey Rideout, a medical doctor and former head of the Internet Business Solutions Group at Cisco Systems' Healthcare Practice, says the amount businesses pay for employee insurance is just one element of their total healthcare costs. Rideout says businesses incur a "triple tax." First, they pay for insurance programs through health benefits. Second, businesses indirectly subsidize Medicare and Medicaid, the federally supported programs for primarily poor and elderly Americans.

[T]he Centers for Medicare and Medicaid Services, a U.S. government agency, found that the legislation would do little to stem the rise in healthcare expenditures-–expected to increase to more than 20 percent of GDP in the next decade.

Businesses pay higher insurance premiums to make up for the fact that Medicare and Medicaid reimbursements often do not match the total costs hospitals incur treating these patients, a "hidden tax" confronted in a healthcare proposal (PDF) laid out by California Governor Arnold Schwarzenegger. Third, Rideout says, businesses also subsidize the strain on the system wrought by the cost of treating America's uninsured, again through higher insurance premiums.
It is unclear to what extent these concerns would be alleviated under the reform plan. The new reform law expands access to Medicaid and the children's health program SCHIP. It also creates a new health exchange program that would allow small businesses and workers without employer-provided health insurance to purchase subsidized private insurance. In total, the plan is expected to cover more than thirty million people, but roughly another twenty million are expected to remain uninsured (one-third of whom are expected to be undocumented workers). One of the numerous ways the lawmakers hope to control costs is through reforms to Medicare, particularly by lowering payments to private insurers participating in Medicare Advantage and some health service providers. Whether such measures will simply transfer higher costs to private plans (Crain's), as some critics suggest, remains up for debate. A 2010 annual survey released in March by the National Business Group on Health, a coalition of big employers, found that more than two-thirds of large employers surveyed expected their health costs to increase (WashPost) as an impact of reform, and more than a quarter were considering reducing benefits to employees to control costs internally.

Improving Value

Healthcare experts agree the people with the most control over what drugs get prescribed and what procedures get done have little incentive to lower these costs (indeed, to the extent that they get paid by the procedure, their incentives are often quite the opposite). Likewise, patients often feel little need to control the costs of their own medical care if it is covered by insurance. The system bears the brunt of the excess, and employers make up the difference in the rates they pay.
While there is competition in the U.S. healthcare system, it operates at the wrong level, argue Harvard Business School Professor Michael E. Porter and Elizabeth Olmstead Teisberg, a professor at the University of Virginia's Darden School of Business, the authors of the book Redefining Health Care: Creating Value-Based Competition on Results. "Competition is both too broad and too narrow," Porter and Teisberg write. "Competition is too broad because much of the competition now takes place at the level of health plans, networks, hospital groups, physician groups, and clinics. It should occur in addressing particular medical conditions. Competition is too narrow because it now takes place at the level of discrete interventions or services. It should take place for addressing medical conditions over the full cycle of care, including monitoring and prevention, diagnosis, treatment, and the ongoing management of the condition."
The law tries to improve competition through the creation of a "health insurance exchange" (PDF) for small businesses and individual buyers. But new competition in the marketplace may be limited. The CBO found that premiums for individual plans on these insurances exchanges would increase by 10 percent to 13 percent by 2016.
Investment analyst Julia Coranado (PDF) argues, "Most people covered by employer-sponsored plans will not see many changes or benefits from increased competition, so there is little expected impact from the [Senate bill] on healthcare inflation, although lower Medicare reimbursements will apply some downward pressure."
Some experts say companies should do more than focus their attentions strictly on direct costs of providing healthcare and look at the benefits of reducing poor health. Some health analysts argue there are "spin-off" benefits to supporting healthy employees such as productivity, intellectual capacity, and reduced absenteeism. Meanwhile, reviews have been mixed on whether the costly U.S. health system leads to health outcomes as good as developed countries with lower health costs. The law contains some measures that would monitor the quality of health outcomes of the insured.

Tapping Technology

Technology, too, can play an important role in minimizing overall health costs by improving efficiency and reducing mistakes. Rideout points out that the U.S. healthcare industry lags in information technology (IT) spending behind not only its competitors internationally, but also other industries domestically. Rideout says the average company outside the health industry spends seven times as much as U.S. healthcare companies on information technology, and companies in some wealthier industries like banking spend up to twenty times as much. U.S. competitors abroad have also consistently outspent the U.S. government on healthcare IT investment.

One of the most commonly cited goals that could be spurred by increased investment is the shift to electronic medical records. Though critics worry about privacy, digitizing patient records achieves a number of ends at once: It cuts paper costs and also reduces the likelihood of errors in prescriptions and in the transfer of data between hospitals--flaws that can cause medical errors and prompt the need for expensive ongoing care. The new law aims to improve coordination among health providers electronically, including requiring all medical

DEVELOPMENT OF THE HEALTH SYSTEM In Indonesia

 Health policies and strategies

The creation of “Healthy Indonesia 2010” forces the Ministry of Health and Social Welfare to forge collaborative relationships with others. As health is a shared responsibility, the Ministry of Health and Social Welfare must involve all strata of the community, all related government departments and agencies, and the private sector.  In the effort to achieve “Healthy Indonesia 2010,”the Ministry of Health and Social Welfare must also be proactive and forward-thinking.

The ‘Healthy Indonesia 2010’ goals are:

      To initiate and lead a health orientation of the national development

      To maintain and enhance individual, family, and public health along with improving the environment

      To maintain and enhance quality, accessible, and affordable health services

      To promote public self-reliance in achieving government health

While the Ministry of Health and Social Welfare was redefining the new Vision and Mission, two new fundamental Acts were enacted, namely Act No. 22/1999 on Local Governance and Act No. 25/1999 on Financial Balance Between Central Government and Local Governments.  The two Acts are a reference for the implementation of decentralization policy in Indonesia, which give provinces and districts a large autonomy to manage their own home affairs except defence, monetary and fiscal, foreign affairs, justice, and religion.

Based on the new Vision and Mission of National Health Development and in line with the decentralization policy, it is agreed that there are four paramount issues to serve as the pillars in formulating a Strategy for National Health Development. These are:

      Initiating health-oriented national development

      Professionalism

      Community Managed Healthcare Programme (JPKM)

      Decentralization

The identification of these four elements as pillars of the Strategy for National Health Development does not mean that other programmes should not be supported.  All programmes and plans of potential assistance to the Ministry of Health and Social Welfare in achieving the new Vision and Mission should be continued, even though these four pillars have the highest priority.

Related Links

Program and Policies

Community Health

Millennium Development Goals (MDGs)

The progress made towards achievement of health related MDGs is given at Annex-2.

Organization of the health system

Structure of the Health System

There are 33 provinces and each province is sub-divided into districts and each district into sub-districts. As decentralization had been already implemented, the 349 regencies and 91 municipalities are now the key of administrative units.

Each sub-district in Indonesia has at least one health centre headed by a doctor, usually supported by two or three sub-centres, the majority of which are headed by nurses. Health centres mainly provide eight programs. Most of the health centres are equipped with four-wheel drive vehicles or motorboats to serve as mobile health centres and provide services to underserved populations in urban and remote rural areas.

At the village level, the integrated Family Health Post provides preventive and promotive services. These health posts are established and managed by the community with the assistance of health canter staff. To improve maternal and child health, midwives are being deployed to the villages.

The Decentralization Policy has been implemented in Indonesia, with the implementation of Act No. 22/1999 regarding Regional Governance and Act No. 25/1999 regarding the financial equality between Central and Regional government. With the implementation of the aforementioned Acts, the government system in Indonesia has been changed from Centralized to Decentralized type of government, which provide regional autonomy.  In the Act No. 22/1999, there have been three levels of regional autonomy, i.e., Province, District, and City regional autonomy.

Paragraph 4, sub-paragraph 2 stated that there is no hierarchical links between these three regional autonomy regimes. However, in the explanation of paragraph 4, it is stated that Governor (as Head of Province Regional Autonomy and Head of Administrative area) will have to perform links in guidance, monitoring and supervision to the District and City areas.  This is in relation to the delegation of responsibility to Province which has been stated as having limited autonomy; but it has been also given broader de-concentration as representative of Central government.  The rule of Guidance and Supervision has been clearly stated in the Government Act No. 20/2001 regarding Guidance and Supervision of Governance implementation applied to local government.

Organizational Structure of Health System

In line with Province government responsibility, Broader Decentralization has been given to District and City levels.  Regional government has also been given the authority of “support = perbantuan” or “medebewind”.  This has an implication that regional development has to be performed by District/City, while the development at Province level is limited only to those, which have not been covered by District/City, and Inter-district/Inter-city.  Meanwhile, the Central government has to perform the role of policy formulation, standards and providing guidance to Province and District/City government levels.

Government Act on Health No. 23/1992 has stated that Health Systems should be implemented by the community with government as facilitator.  Private sectors will perform an active role, so that government will act in the provision of guidance and supervision.

Health Information System

A.         NATIONAL HEALTH INFORMATION SYSTEMS (NHIS)

National health information systems reforms has been indicated by the development of a new NHIS policy and strategy included in the Ministry of Health decree No. 468/MENKES-KESOS/SK/V/2001, dated 25 May 2001, which has been amended by decree No. 511/MENKES/SK/V/2002, dated 24 May 2002.

Although the NHIS Policy and Strategy has been developed in support of Decentralization on health to achieve Healthy Indonesia by the year 2010, current condition shows that constraints and classical problems have been chronically identified.

Below are the elaboration of vision and mission of NHIS, strength and opportunity, and constraints or challenges (SWOT analysis) of the current NHIS.]

Related Links

Information for Policy – WHO/INO

A.1       Vision and Mission of NHIS

The vision of NHIS is to support the achievement of Healthy Indonesia by the year 2010. Healthy Indonesia achievement will be accelerated with the provision of accurate, updated and timely presentation of information. Reliable and valid information in other word is a prerequisite for the achievement of Healthy Indonesia 2010. Motto of NHIS VISION is RELIABLE HEALTH INFORMATION 2010.

To support the above vision, the following MISSION of NHIS has been formulated:

      The development of data management, which includes data collection, storage and retrieval, and analysis

      The development of Data Bank, Health Profiles, and presentations of information for different purposes

      The development of networking/sharing information among different data and information users

      The development of methods for the use of data and information for action purposes

A.2       Strength and opportunity

The strength and opportunity that will contribute to the development of NHIS are:

Firstly, the strength to support the development of a comprehensive NHIS includes the provision of adequate health infrastructures have been provided by government from national down to sub-district level, different HIS for different purposes have been developed, the initiatives of HIS developed by the unit for local purposes, and the rapid development of Information Technology.

Secondly, there are opportunities which consider will accelerate the development of HIS, which includes Regional Autonomy Implementation which will consider HIS as an important support for the health provider in convincing other health related sectors of its usefulness for decision makers.  Structural streamlining organization and empowering professional/functional health personnel, will allow the maximum utilization of HIS personnel. Independency policy of regional health unit with the obligation to provide the quality health services to the community will have to use evidence-based information for decision making purposes.

Considering the aforementioned strengths and opportunities, the development strategy of NHIS consists of the following:

      The integration of existing HIS

      The streamlining of current procedure and mechanism of reporting and recording systems

      The empowerment of regional capacity relating to HIS

      The development of HIS human resources, taken into consideration the rapid advance of Information Technology and maintenance of equipment

      The provision of adequate information for decision makers and community

For example, at the peripheral level of health management i.e. Health Centre level, apart from illustrating current health problem or situation, information should perform its usefulness as action oriented, which also involve situation analysis for the implementation of programme activity or prompt action to recover the health problems within the area of responsibility.

 At the District/Municipality health level, apart from health services delivery monitoring, HIS will also include resources mobilization or relocation, as well as local health system planning and health management improvement

In line with the development of HIS, the improvement of data management should also include integrating data collection, reporting, and use of the information for improving health services effectiveness and efficiency through better management at District/Municipality under decentralized settings.

A.3       Constraints and challenge  

Some constraints identified regarding the development of NHIS includes fragmented HIS i.e. different HIS for different programme purposes, lack of regional capacity, minimum use of information for management purposes, minimum use of information by community, minimum usage of Information Technology.  These constraints have been more burden to the fact that financial support for the implementation and maintenance of HIS facility and equipment are considered as the least priority in the budgetary line items and provision of an adequate and dedicated HIS personnel is in fact not an evidence in most units either at the point of services or health management level.

B.         DISTRICT/CITY HEALTH INFORMATION SYSTEMS

The objective of HIS is to co-ordinate and provide planning and management support to the service delivery levels (Design and Implementation of HIS, WHO 2000)

The most important issue in which the Central Health Systems level can be situated are whether the system in the country is “Centralized” or “Decentralized”; government or private sector-managed systems’ horizontally and vertically managed health services systems.  For example: budgeting and decisions on financial allocation will be made at the national level in a centralized system, while it will be delegated to the district/city level in decentralized systems.  In a country with a predominantly private sector managed health systems, most of listed health functions are perform by private institutions, while the government only has a regulatory role, setting policies, and making legislation.  In a health systems managed mainly through vertically organized health programmes, the manager has taken over responsibilities in resource management and supervision of the line managers.

Health Information Systems, in which District Health Report is one of its important elements, have to be developed in line with decentralization policy on health.

(Technical Guidelines, District/City Health Report under Decentralised Health Systems Implementation, Jakarta, June 2004)

Emergency preparedness

Indonesia is located in an area of the world that experiences regular natural disasters, such as earthquakes, tsunamis, floods, severe droughts and volcanic eruptions.  Since the Indonesian archipelago forms a part of the Pacific Ring of Fire, it is prone to earthquakes and volcanic eruptions. The government has since last year been putting 10 of its 129 active volcanoes on “alert” status. In recent years, political, economic, religious and social crises have led to complex emergency situations in several provinces, notably Maluku, North Maluku, NTT (West Timor), Aceh, Sulawesi, Papua and Kalimantan.  These civil disturbances have contributed to an increasing number of emergencies in Indonesia in recent years. Both, natural and man-made disasters have resulted in increased mortality and morbidity, as well as a growing population of displaced people.

ASEAN Foundation and Royal Philips conduct forum on healthcare affordability in Rural Indonesia

The ASEAN Foundation and Royal Philips Electronics have held a roundtable discussion on “Healthcare Affordability: Delivering high-quality, affordable healthcare to rural communities” on 26 July 2011 in Surabaya, East Java, Indonesia. The event attended by academics, government officials and professionals from the healthcare industry in East Java, is part of a programme by Philips and the ASEAN Foundation to understand the healthcare needs of rural Indonesia.

Dr. Untung Suseno, Advisor to the Minister of Health of Indonesia on Finance and Community Empowerment, Dr. Makarim Wibisono, Executive Director of the ASEAN Foundation, Mr. Wayne Spittle, Senior Vice-President and Commercial Leader for Philips Healthcare Asia Pacific, Mr. Teguh Purwanto, General Manager for Healthcare, PT Philips Indonesia and Dr. Pranawa, Chairman of the Indonesia Medical Doctors Association, East Java graced the forum.

“Philips is deeply committed to delivering affordable solutions to support the sustainability of primary and secondary healthcare needs in Indonesia.  Our partnership with the ASEAN Foundation is designed to bring expert collaborators together to engage on the role that innovation and medical technology can facilitate access to healthcare in a cost-effective way,” said Mr Wayne Spittle, Senior Vice-President and Commercial Leader Philips Healthcare Asia Pacific.

Participants at the forum discussed the current situation of healthcare in non-urban Indonesia, focusing on identifying the meaning of affordability and value to healthcare providers in the front-line.

Dr. Pranawa SpPD, K-GH, Chairman of Indonesia Medical Doctors Association, East Java, stated, “Poverty and unprecedented progress in health technologies are identified to have strained our health systems. In entering the new 21st century, our healthcare system should be able to provide a range of services that cover the full continuum of care, keep pace with technological progress and provide health care services to the entire population.” 

The Surabaya event is one of a series of roundtable discussions under a joint collaboration between the ASEAN Foundation and Philips. The goal of the events is to build a platform for the private sector to assist in the delivering of affordable healthcare in the region.

“Amidst the intrinsic diversity between countries in this region, there is a growing effort to learn that people is the center of healthcare development. Collaborative efforts between private, government and public sectors to implement new technology and strong advocacy of the patient-physician will lead the battle to obtain affordable and better access to healthcare for Indonesian people.” said Dr. Makarim Wibisono, Executive Director of ASEAN Foundation.

Succeeding roundtable will be held in Vietnam and the Philippines. The forum in Surabaya is also supported by the Indonesia Medical Doctors Association (Ikatan Dokter Indonesia – IDI).