Australian Consortium for In-Country Indonesian Studies (ACICIS) Public Health Study Tour 2017

Transcription

1 Australian Consortium for In-Country Indonesian Studies (ACICIS) Public Health Study Tour 2017 Emily O Connell SWM620 Case Study Presentation 23 October 2017

2 Outline About the ACICIS Public Health Study Tour Country Profile Indonesia Health System Organisation & Financing Summary of Field Trips Key Learnings

3 About the ACICIS Public Health Study Tour

4 Country Profile - Indonesia Geography Largest archipelago in the world ( 17,500 islands) Five main islands: Sumatra, Java, Kalimantan (2/3 of Borneo), Sulawesi & Papua Capital city Jakarta: 7% total land mass, 60% total country population Tropical climate, high humidity, rainy season Oct-April

5 Sociodemography Population 260 million 4 th largest in world 50% urban & 50% rural Median age = 27 years Official language is Bahasa Indonesia 724 recognised languages and dialects! 80% from 15 largest ethnic groups (Sudanese, Batak, Malay), remainder from 619 very small ethnic groups Freedom of religion in Constitution but only 6 official religions 87% Muslim (largest in the world), 10% Christian, 2% Hindu, 1% Buddhist, 0.05% Confucian & remainder as other/unreported

6 Economic status Low-middle-income country Gross NationaI Income (GNI) per capita $3400 USD in th largest economy in East Asia 28 million below the poverty line & 68 million near-poor /vulnerable Urbanisation = urban poor to exceed rural poor by 2020 Young population = need for job creation High % employed in informal sector no financial risk protection & social health insurance

7 Political System & Structure President & Vice-President elected every 5 years 3 rd largest democracy in the world presidential with parliamentary characteristics Constitution, 3 branches of government 5 layers of government: central, provinces, districts, subdistricts and villages Decentralised system (since 1999 law on local autonomy) Central power = finance, foreign affairs, defense, security, religion, state administration & justice Funding to districts for health, education, public works, environment, communication, transport, agriculture, manufacturing & other economic sectors Allows localised approach but criticisms = low technical abilities of subnational governments & fragmented implementation of national laws by local governments

8 Health System Structure & Organisation Central government sets national strategic directions; provides financial & HR to provincial & district governments; manages specialist hospitals; and implements national standards & regulations Provincial governments own local hospitals; manage local services; & coordinate monitoring/surveillance District governments manage hospitals and health services in primary health centres (Puskesmas) ** Not a hierarchical system, limited accountability = inefficiencies, geographic/se inequalities & overall low service quality

9 Field Trip Puskesmas

10 Field Trip - Posyandu

11 Field Trip Private Hospital

12 Field Trip Kali Code Riverside Community

13 Field Trip Eliminate Dengue Project

14 Key Learnings Decentralisation challenges and opportunities Key public health issues & the influence of sociocultural, geographic and economic factors Role of actors both within & outside government Challenges for achieving universal health coverage Importance of nation-wide monitoring and surveillance Double-burden of diseases = need to shift focus from treatment to prevention Impact Western bias on perception of key health issues Equitable distribution of public goods critical for health

15 References 1. World Health Organization Regional Office for South-East Asia. WHO country cooperation strategy : Indonesia. New Delhi: World Health Organization, World Health Organization Regional Office for South-East Asia. The Republic of Indonesia health system review. New Delhi: World Health Organization, Regional Office for South-East Asia, United Nations Department of Economic and Social Affairs. World population prospects: the 2017 revision, key findings and advance tables. New York: United Nations, World Health Organization. Indonesia urban health profile Available from: 5. World Bank. World development indicators. Washington DC: International Bank for Reconstruction and Development/World Bank, Central Bureau of Statistics. Population by region and religion. Jakarta: Indonesian Central Bureau of Statistics of the Republic of Indonesia, World Bank. Gross national income Available from: 8. Aji P. Summary of Indonesia's poverty analysis. Manila: Asian Development Bank, Rokx C, Schieber G, Harimurti P, Tandon A, Somanathan A. Health financing in Indonesia: a reform roadmap. Washington DC: The World Bank, Nasution A. Government decentralization program in Indonesia. Tokyo: Asian Development Bank Institute, 2016.