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Indonesia's health reform faces tough year

Jakarta Post - March 3, 2023

Nina A. Loasana, Jakarta – Ongoing efforts to reform Indonesia's healthcare system following the COVID-19 pandemic could face major hurdles this year, with the threat of a looming global recession and the 2024 presidential election getting closer, the Center for Indonesia's Strategic Development Initiatives (CISDI) has warned in a report.

The report, which was published on Feb. 23 predicted that the reform of Indonesia's healthcare system would slow down in 2023 as Indonesia enters the political year and the government focuses its funding on the elections and other major unfinished infrastructure projects, including the development of the new capital.

The CISDI highlighted that raising productivity and maintaining economic recovery take the front seat in the 2023 government working plan (RKP) as Indonesia seeks to boost economic growth while scaling back state spending amid the threat of a global recession, high inflation and geopolitical tension.

The government's priority is reflected in the state budget for health care, which was cut 20 percent compared with last year, as the pandemic recedes.

This year, the government is allocating Rp 178.7 trillion ($11.9 billion) in its healthcare budget with no specific budget allocated for the COVID-19 response.

In 2022, the government allocated Rp 255.3 trillion for health care, with Rp 82.4 trillion going to address the coronavirus pandemic. The previous year, the government allocated a staggering Rp 312.4 trillion for healthcare spending, with Rp 188 trillion spent on COVID-19 response efforts.

The CISDI said that while during the COVID-19 pandemic the government allocated a substantial amount of the state budget for health care, most of the budget went on pandemic response, especially for vaccine procurement, rather than on improving the healthcare system overall.

"Outside of the pandemic sphere, healthcare spending has largely stagnated over the past few years," the report stated.

Political dynamics

An expected shift in the national and regional political situation ahead of the 2024 general elections will also bring another challenge to healthcare-transformation efforts.

With politicians starting campaigning for the 2024 presidential race, the CISDI predicted that healthcare issues would no longer be the main focus in the public eye, especially considering the possibility that presidential hopefuls might make healthcare-related problems less of a priority in their campaigns over other practical policies.

Political dynamics at the regional level are also expected to greatly shift ahead of 2024, as more than 50 percent of the country's regencies and cities will be led by interim leaders selected by the central government as a result of delayed regional elections.

This was a consequence of the House of Representatives and the government agreement not to revise a law that stipulates holding simultaneous regional elections in 2024, leading to 271 regional leader positions left vacant prior to the elections.

The CISDI said interim regional leaders had limited political power compared with their predecessors, as they are unable to transfer civil servants to new positions or make decisions that are contradictory to the previous regent's policies. This will make innovation and changes to the current healthcare system difficult to implement.

'On track'

Health Ministry spokesperson Siti Nadia Tarmidzi however dismissed concerns over the slowing down of the ministry's efforts to reform the country's healthcare system during the political year.

"The details of our healthcare-transformation efforts have been documented in our strategic plans and a ministerial regulation. Since we have detailed plans, our efforts won't be affected by the current political situation," Nadia told The Jakarta Post on Tuesday.

Nadia also explained that the ministry had carried out thorough examinations, including into the 2023 political situation, before formulating their strategic plans and proposing healthcare budgets.

"As long as they were legalized in regulations, our healthcare reform efforts will remain on track," she said.

Health Minister Budi Gunadi Sadikin has set his sights on transforming the national healthcare system by creating programs prioritizing illness prevention, rather than treatment.

Budi has outlined six core aspects that will be improved through the transformation plan: primary healthcare services, referral services, healthcare system resilience, financing, human resources and technology.

Among these reform efforts are the "Posyandu Prima" program, which aims to revitalize the thousands of integrated health services posts (Posyandu) scattered throughout the country; the reworking of the National Health Insurance (JKN) program; and scholarship opportunities afforded to thousands of medical students.

The ministry also aims to integrate health data systems and healthcare application systems, expanding childhood immunization programs, and improving services and disease detection technologies at community health centers (Puskesmas) and hospitals across the country.

Experts have previously stated that reforming and strengthening the Indonesian healthcare system is crucial considering how ill-equipped the system was in the face of the COVID-19 pandemic.

The CISDI stressed that healthcare-system resilience had become even more important at the moment, amid global warming and an increase in zoonotic disease outbreaks across the globe.

A modeling study by researchers in the United States and South Africa published last year suggested that on a warming planet, the species-rich ecosystems and large human populations of Indonesia, India and Africa's Sahel region could turn into hot spots of zoonotic disease as humans come into increasing contact with wildlife.

In the past few years, the world has seen several outbreaks of zoonotic diseases, including COVID-19, monkeypox and most recently, bird flu.

Meanwhile, Indonesia is also still grappling with other epidemic diseases, including tuberculosis, HIV and malaria.

A 2022 World Health Organization (WHO) report shows that Indonesia was the largest contributor of new tuberculosis patients in the world after the pandemic, with the incidence of tuberculosis increasing from 301 cases per 100,000 people in 2020 to 354 per 100,000 people in 2021.

Source: https://asianews.network/indonesias-health-reform-faces-tough-year