Health in Indonesia
|This article is outdated. (March 2008)|
Indonesia had a three-tiered system of community health centers in the late 1990s, currently there are 1833 hospitals with 0.66 hospital beds per 1,000 population, the lowest rate among members of the Association of Southeast Asian Nations (ASEAN). In the mid-1990s, according to the World Health Organization (WHO), there were 16 physicians per 100,000 population in Indonesia, 50 nurses per 100,000, and 26 midwives per 100,000. Among all of the 1833 hospitals in Indonesia, only 9 have been accredited by Joint Commission international (JCI). Both traditional and modern health practices are employed. Government health expenditures are about 3.7 percent of the gross domestic product (GDP). There is about a 75:25 percent ratio of public to private health-care expenditures.
HIV/AIDS has posed a major public health threat since the early 1990s. In 2003 Indonesia ranked third among ASEAN nations in Southeast Asia, after Myanmar and Thailand, with a 0.1 percent adult prevalence rate, 130,000 HIV/AIDS cases, and 2,400 deaths. In Jakarta it is estimated that 17 percent of prostitutes have contracted HIV/AIDS; in some parts of Papua, it is thought that the rate of infection among village women who are not prostitutes may be as high as 26 percent.
Three other health hazards facing Indonesia in 2004 were dengue fever, dengue haemorrhagic fever (DHF) and avian influenza. All 30 provincial-level units were affected by dengue fever and DHF, according to the WHO. The outbreak of highly pathogenic avian influenza (A/H5N1) in chickens and ducks in Indonesia was said to pose a significant threat to human health.
By 2010, there are three malaria regions in Indonesia: Nusa Tenggara Barat with 20 cases per 1,000 citizens, Nusa Tenggara Timur with 20-50, and Maluku and Papua with more than 50 cases per thousand. The medium endemicity in Sumatra, Kalimantan and Sulawesi, whereas low endemicity is in Java and Bali which almost 100 percent of malaria cases have been confirmed clear. At 1990 malaria average incidence was 4.96 per 1,000 and declined to 1.96 per 1000 at 2010. The government is targeting to rid the country of malaria by 2030 and elimination means to achieve less than 1 incidence per 1,000 people.
- 1997 Southeast Asian haze and 2006 Southeast Asian haze - In all countries affected by the smoke haze, an increase of acute health outcomes was observed. Health effects; included emergency room visits due to respiratory symptoms such as asthma, upper respiratory infection, decreased lung function as well as eye and skin irritation, were caused mainly by this particulate matter.
Indonesia has routine vaccination to children below age 5 years as World Health Organization (WHO) recommendations including vaccination of Hepatitis B which has high prevalency in Indonesia. Almost all of the vaccines provided by PT Bio Farma which one of the 29 companies with a prequalification certificate from the WHO among 200 vaccine company in the world. It also has been exported to 110 countries in the world.
PT Bio Farma as a global vaccine producer will produce pentavalent vaccine (diphtheria, pertussis, tetanus, hepatitis B and haemophilus influanzae type B or HiB). In 2012 the GAVI (Global Alliance for Vaccine and Immunization) will donate 80 percent of the needs of pentavalent vaccine and in the third year government should self-fulfilment.
June 2011: The third phase test of dengue vaccine involving 800 humans with ages of 2 and 14 years old have been held in 5 community health center around Jakarta and will be conducted also in Bandung, West Java and Denpasar, Bali with 800 and 400 participants, respectively. The first test was performed on a limited number of soldiers and the second phase was conducted on a small number of children and if within the next 5 years the vaccine is found to be safe for humans, government will apply the dengue vaccine to public.
Maternal and Child Health Care
In June 2011, the United Nations Population Fund released a report on The State of the World's Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. The 2010 maternal mortality rate per 100,000 births for Indonesia is 240. This is compared with 228.6 in 2008 and 252.9 in 1990. The under 5 mortality rate, per 1,000 births is 41 and the neonatal mortality as a percentage of under 5's mortality is 49. The aim of this report is to highlight ways in which the Millennium Development Goals (MDG) can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death. In Indonesia the number of midwives per 1,000 live births is unavailable and the lifetime risk of death for pregnant women is 1 in 190. 
According to Indonesian Demographic and Health Survey, the 2012 maternal mortality rate per 100,000 live births is 359 deaths, an significant increased from 2010 data with 220 deaths and far from the MDGs goal of 102 deaths by the end of 2015. The main cause of deaths are severe post-natal bleeding due to lack of pregnancy regular control, although National Family Planning Coordination Board and the Central Statistics Agency data showed improvement from 93 percent of women received prenatal care in 2007 increased to 96 percent in 2012.
Universal Health Coverage (BPJS)
In 2010 an estimated 56 percent of Indonesians, mainly state employees, low-income earners and those with private coverage had some form of health insurance. The rate is expected to reach 100 percent with a system of universal social health insurance coverage in place by 2014. The aim is to grant free services for all hospitalizations in basic (class-3 hospital beds).
Eleven percent of the country’s population suffers from mental disorders, with over 19 million of the people of age 15 or older. The neuropsychiatric disorders in Indonesia are estimated to contribute to 10.7% of global burden disease. There are definitely gaps in the mental health department that cannot be overlooked, with many of them are representative of the mental health gaps in Southeast Asia as a whole. The mental health policy in Indonesia was most recently revised in 2001. Since then, the nation has gone through enormous changes in all aspects as a country. Indonesia’s economy has been steadily growing in the past decade. Health wise, Indonesia has suffered numerous H5N1 outbreaks, with the highest number of recorded human cases of this virus in the world. The nation was severely affected by the tsunami tragedy in 2004. There are still many factors that have altered Indonesians’ lives, ultimately affecting the mental health status of the people greatly since 2001, calling for a more updated mental health policy.
There is very little amount of funding dedicated to mental health. The total health expenditure is 2.36%, and less than 1% of that goes towards mental health. Indonesia’s mental health legislation has the same issues mentioned above that Southeast Asia faces as a region. The legislation is far from what can be considered complete and fair, and the articles included are not well practiced and reinforced. In 1966, Indonesia was well ahead of other countries in the region by having a mental health law separated from general health laws, providing potentials for expansion of the mental health system. However, the law was repealed in 1993 and integrated into general health laws. Mental health now only occupies four articles in the current health law. The articles are too general, causing difficulties to apply and implement. Article 26 states that almost anybody can request treatment and hospitalization for persons with mental disorder, yet has no mention of the persons’ consent. By doing so, Article 26 creates an impression that mentally ill individuals are generally considered dangerous to the community because they need to be forced into treatment. This goes along with the negative stigmas associated with mental disorders mentioned above and elaborated later in this paper. Also, Article 27 states that the government will provide a presidential decree for regulations and management of mental health, yet nothing has been done.
There are also issues with accessibility and quality of mental health care. Official in-service training on training is not widely provided to the primary care professionals. WHO (2011) reports that between 2006 and 2011, the majority of primary care doctors and nurses have not received such training. There is also only one mental health hospital per five million people and one psychiatrist working in the mental health sector in ten million people. In addition to the unbalanced number of psychiatrists among population, the psychiatrists are also not well distributed in the country. Up until 2011, there is no psychiatrists in the rural area of Indonesia, while half of them are concentrated in the capital city, Jakarta, and the rest in the old capital city, Yogyakarta, and the second largest city, Surabaya. This creates a great barrier for mental health patients seeking official help.
- HIV/AIDS in Indonesia
- Water supply and sanitation in Indonesia
- Environmental issues in Indonesia
- Health systems by country
- World Health Organization ranking of health systems
- Indonesia country profile. Library of Congress Federal Research Division (December 2004). This article incorporates text from this source, which is in the public domain.
- "The State Of The World's Midwifery". United Nations Population Fund. Retrieved August 2011.
- Basten Gokkon (January 29, 2014). "Indonesia Still Haunted by High Number of Maternal and Post-Natal Deaths".
- Vitelli, Romeo (2011). “Fighting Pasung in Indonesia’s Mentally Ill”. The Huffington Post. Retrieved from http://www.huffingtonpost.ca/romeo-vitelli/indonesia-pasung_b_913585.html on 28 Mar. 2014
- Faizal, E. B. (2012). “Mentally Ill Often Taken to Traditional Practitioners”. The Jakarta Post. Retrieved from http://www.thejakartapost.com/news/2012/02/13/mentally-ill-often-taken-traditional-practitioners.html on 4 Mar. 2014
- WHO Mental Health Atlas (2011). “Department of Mental Health and Substance Abuse”. World Health Organization
- Adisasmito, W. et al (2013). “Human Influenza A H5N1 in Indonesia: Health Care Service-Associated Delays in Treatment Initiation.” BMC Public Health, 13, 571. Doi: 10.1186/1471-2458-13-571
- Pols, H. (2006). “The Development of Psychiatry in Indonesia: From Colonial to Modern Times”. International Review of Psychiatry, 18(4), 363-370
- Irmansyah, I., Prasetyo, Y.A. & Minas, H. (2009). “Human Rights of Persons with Mental Illness in Indonesia: More than Legislation is Needed.” International Journal of Mental Health Systems. 3, 14. Doi: 10.1186/1752-4458-3-14
- Dipa, Arya (2011). “Indonesia Lacks Psychiatrists”. The Jakarta Post. Retrieved from http://www.thejakartapost.com/news/2011/09/10/indonesia-lacks-psychiatrists.html on 9 Mar. 2014
- The State of the World's Midwifery - Indonesia Country Profile