Jakarta – Public health care in Indonesia has improved, but it still needs more efficient regulations, greater private sector involvement and better financing, a World Bank report says.
The report, "Investing in Indonesia's Health: Challenges and Opportunities for Future Public Spending", was prepared by the World Bank and several government agencies at the request of the National Development Planning Agency (Bappenas).
Bappenas is tasked with formulating guidelines for the government's plan to develop a policy for nationwide health reform, which may include a social security program for the entire population.
The study and conclusions of the report will be taken into consideration in formulating the next medium-term development plan for 2010-2014, Nina Sardjunani, Bappenas deputy minister for human resources and cultural affairs said at the launch of the report Wednesday.
The report shows despite significant improvements in life expectancy and infant mortality, Indonesia is regressing in many important health areas such as maternal mortality, child malnutrition, access to clean water and sanitary and geographic disparities.
"In Bali and Yogyakarta, fewer than 25 out of 1,000 children die before the age of five. But the number increases fourfold in Gorontalo," it says.
The country faces further trouble with the emergence of diseases linked to diet and a sedentary lifestyle such as diabetes, heart disease and cancer, increasing demands on resources for existing diseases such as tuberculosis and measles.
The high birthrate of the past decade and longer life expectancy add further pressure.
"There is no fixed estimation yet, but the whole situation might eventually cost an additional 1.6 percent of GDP," Claudia Rokx, the leading health specialist at the World Bank, said.
Indonesia spent around 1 percent of its GDP (US$4 billion) on health last year, four times the 2001 expenditure. But the proportion is still much lower than that of many neighboring countries including Thailand and Vietnam.
Even when funding is available, bureaucratic procedures including those between the central and local governments stall the implementation of services. The report says local governments have limited authority in managing their medical staff and resources, hindering attempts to increase efficiency. In 2006, only 73 percent of the public health budget was spent.
In response to the report, Laksono Trisnantoro, director of the Health Service Management Center at Gadjah Mada University, said some local leaders tended to view health as the central government's responsibility.
"Many local leaders still think it is the responsibility of the central government. Some have achieved a lot in tackling high-profile diseases that win votes such as malaria, but few make an effort for the overall health system, including spending on children's nutrition or women's health," he said.