The Jakarta Post, Tuesday, June 23, 2009
Time To Overhaul RI's Public Health System Salut Muhidin and Jerico Franciscus Pardosi, Brisbane In their campaigns, our three presidential candidates have largely concentrated on economic issues, including macro and micro economics, but we need to remember that the nation is also facing other no less urgent issues such as the health of the population. It is disappointing that so far the three candidates have only focused a little on their health platforms. Many cases have emerged recently relating to issues of public health. For example, the report on food and drinking water poisoning at some schools resulting from hygiene and sanitation issues. Based on the Yogyakarta-based Gadjah Mada University (UGM) research in 2009, catering services were involved in 65 percent of reported cases of food poisoning, followed by small scale food industries (19 percent) and household foods (16 percent). Moreover, malnutrition is still a major issue in Indonesia, even in its capital city, in the Jakarta metropolitan area. Between January and March 2008, there were 34 reported cases of malnutrition, most of which affected children. Common diseases such as dengue fever, tuberculosis, malaria, food poisoning and malnutrition still exist in varying degrees in different provinces. At a national level, according to a ministry of health report in 2007, there were 4.1 million cases related to nutrition and malnutrition issues. Recently, the ministry has begun a malaria elimination program, aiming to eradicate the disease by 2030. It has been more than 50 years since the first malaria elimination program began. However, about 1-2 million people contract malaria each year, resulting in some 100,000 deaths. Eastern Indonesia has made slow progress in reducing the prevalence of malaria and tuberculosis compared to the Java and Bali region. Alongside communicable diseases, Indonesia is also facing non-communicable diseases (NCD) such as cardiovascular disease (CVD), diabetes and hypertension. The 2007 Basic Health Research (Riskesdas) conducted by the National Institute of Health Research and Development (BALITBANGKES) indicated that 31.7 percent of Indonesians suffer hypertension (the most common NCD) and 7.2 percent suffer CVD. If we look further, from an international perspective, Indonesian health levels are still below health levels of other South-East Asian countries. This can be seen from basic health indicators, such as Infant Mortality Rates (IMR) and Maternal Mortality Ratio (MMR). In 2007, Indonesia's IMR was 34 per 1,000 live births, and its MMR was 228 per 100,000 live births (Demographic and Health Survey 2007). Meanwhile, Indonesia's Human Development Index (HDI) ranking was 107th, below Thailand in 78th , Malaysia in 63rd, Vietnam in 105th and the Philippines in 90th. Even though the trends for both indicators are improving, the figures have not changed significantly. In terms of communicable diseases, Indonesia is in the third rank for tuberculosis after India and China. This disease should have been eradicated. A more significant issue is Indonesia's health budget. Health expenditure in Indonesia was equivalent to 2.8 percent of its GDP in 2003 which was considerably less than that of Thailand (3.5 percent) or Malaysia (4.2 percent). And more recently there have been no major changes in these figures. At present, Indonesia's health budget is equivalent to only 3.1 percent of its GDP, which is not enough to cover all needs within the health system. On the other hand, health insurance from both government and private sectors has reached 44.5 percent coverage, which indicates 55.5 percent of the population is still without health insurance. There are several things that should be considered by the government and other sectors regarding public health. First, the low health spending in proportion to the national GDP should be increased because of rapid population growth, poverty alleviation and a future aging population. Second, we need to learn from past population health problems. In 1953, E. Ross Jenney made a report on "Public Health in Indonesia". The problems the population faced at that time were malaria, tuberculosis, malnutrition and high infant mortality and maternal mortality rates. What happened after fifty-five years? These problems still exist and become a major health issues affecting the population, especially in the eastern Indonesia. Third, we need to shift the focus of the health platform from curative programs toward promotion and prevention. It is true, the total number of health facilities has increased over the past 50 years, but if the government of Indonesia allocates too much money for curative programs instead of promotion and prevention, this will cause more problems. With less money invested in promotion and prevention programs, many people rely on health care services without a good understanding of the benefits of prevention. The 2009 Health Ministry budget was about Rp 18 trillion. Of this total, 48.5 percent was allocated for curative and medicine operational costs, 15.8 percent was for public health, but only 7.7 percent was for communicable and non-communicable disease programs. Interestingly, the health program for poor people has been allocated Rp 4.6 trillion, whereas health promotion has received only 1 percent of the total budget. Therefore our presidential candidates need to make a much clearer agenda in their health programs. There are still opportunities for them to promote health plans in the upcoming televised debates and other campaign activities. Salut Muhidinis is PhD, School of Geography, Planning, and Environmental Management, The University of Queensland. Jerico Franciscus Pardosi is taking a Master Degree on Population Health, at the University of Queensland. ---------- No virus found in this outgoing message. Checked by AVG - www.avg.com Version: 8.5.374 / Virus Database: 270.12.89/2197 - Release Date: 06/23/09 05:54:00 [Non-text portions of this message have been removed]
