Indonesia HEALTH
Immunization clinic, Jawa Barat Province
Courtesy Indonesian Department of Defense and Security
Services and Infrastructure
As access to education improved throughout the
archipelago, use
of modern forms of health care also increased. Statistics
show a
correlation between the rise of education levels and the
increased
use of hospitals, physicians, and other health resources
(see
table 11, Appendix). Indeed, in the 1970s and 1980s, health in
Indonesia
showed overall improvement. Life expectancy for men was
58.4 years
and for women 62.0 years in 1990, up 7.3 years and 7.6
years,
respectively, since 1980. By the 2000-04 period, life
expectancy
was projected by the World Bank to reach 66.5 for men and
69.7 for
women. However, the distribution of those improvements, as
well as
the resources for health maintenance and improvement, were
unequal.
Whereas infant mortality fell from an average of 105 per
1,000 live
births in the 1980 to 75.2 per 1,000 in 1990, according to
the
World Bank, and was expected to decrease to 55 per 1,000
by 1994,
these rates varied dramatically depending on location. The
poor,
rural, and uneducated classes generally suffered much
higher
mortality rates than their more educated counterparts (see
table 12, Appendix).
The number of health care personnel gradually increased
in the
1980s. By the end of the decade there were more than
23,000
physicians; 76,000 midwives; and nearly 70,000 medical
assistants,
paramedics, and other health care workers. The ratio of
health care
personnel per capita compared poorly with the other ASEAN
nations
except Brunei.
Improvements in the health of Indonesians have been
realized
largely without the benefit of enhanced hospital services.
Indonesia's ratio of hospital beds of 0.06 per 1,000
population in
the late 1980s was the lowest among ASEAN nations--which
ranged
from a high of 5 per 1,000 for Singapore to the second
lowest, 1.4
per 1,000 for Thailand. Hospital beds were unequally
distributed
throughout Indonesia, ranging from a low of 0.18 beds per
1,000 in
Lampung Province to 1.24 per 1,000 in Jakarta. In
addition, the
better equipped urban hospitals tended to have more
physicians and
higher central government spending per bed than did
hospitals in
the rural areas.
Community and preventative health programs formed
another
component of Indonesia's health system. Community health
services
were organized in a three-tier system with community
health centers
(Puskesmas) at the top. Usually staffed by a physician,
these
centers provided maternal and child health care, general
outpatient
curative and preventative health care services, pre- and
postnatal
care, immunization, and communicable disease control
programs.
Specialized clinic services were periodically available at
some of
the larger clinics.
Second-level community health centers included health
subcenters. These health centers consisted of small
clinics and
maternal and child health centers, staffed with between
one and
three nurses and visited weekly or monthly by a physician.
In the
early 1990s, the Department of Health planned to have
three to four
subcenters per health center, depending on the region. The
third
level of community health services were village-level
integrated
service posts. These posts were not permanently staffed
facilities,
but were monthly clinics on borrowed premises, in which a
visiting
team from the regional health center reinforced local
health
volunteers.
Although the community health situation was improving
slightly-
-the number of health centers increased from 3,735 in 1974
to 5,174
in 1986, and the number of health subcenters reached
12,568--the
provision of community services remained low by the
standards of
developing countries. China, for instance, had sixty-three
health
centers per 1 million population, while Indonesia had only
thirtytwo per 1 million in 1986. In particular, fiscal year
(FY--see Glossary)
1987 saw a dramatic reduction in government
spending for
communicable disease control. Thus, vaccines, drugs,
insecticides,
and antimalarial spraying programs were dramatically cut
back.
The distribution of Indonesian health care workers was
also
highly uneven. To alleviate the problem of physician
maldistribution, the government required two to five years
of
public service by all medical school graduates, public and
private.
In order to be admitted for specialist training,
physicians first
had to complete this service. Only two years of public
service were
required for those physicians working in remote areas such
as Nusa
Tenggara Timur, Sulawesi Tenggara, Kalimantan Timur,
Maluku, or
Irian Jaya provinces, whereas three to five years of
service were
required for a posting in Java, Bali, or Sumatra. Despite
such
incentives, it was difficult to attract medical school
graduates to
these remote, understaffed regions, particularly without
additional
cash incentives.
Data as of November 1992
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