The Republic of Indonesia HiT (2017)

Government investment in health has increased in Indonesia over the past two decades, but it is still inadequate. The insufficient facilities and workforce needed for public services has en-couraged the growth of private health facilities. While noncommunicable diseases (NCDs) are emerging as new priorities, problems of maternal and child health, nutrition and communicable diseases continue to persist. The progress on maternal mortality and communi-cable diseases has been slower, with maternal mortality remaining high (210 deaths per 100 000 live births in 2010), and continuing high incidences of tuberculosis (TB).

Risk factors for NCDs, such as high blood pressure, high cholesterol, over weight and smoking are increasing. Indonesia remains the only country in Asia, and one of 10 worldwide, not to have ratified the WHO Framework Convention on Tobacco Control (FCTC). Indonesia also suf-fers from significant regional disparities in terms of health status and quality, availability, and capacity of health services.

Despite this, indicators of overall health status in Indonesia have improved significantly over the last two and half decades, with life expectancy rising from 63 years in 1990 to 71 years in 2012; under-five mortality falling from 52 deaths per 1000 live births in 2000 to 31 deaths in 2012, and infant mortality falling from 41 deaths per 1000 live births in 2000, to 26 deaths in 2012.

Indonesia has also experienced an increase in health infrastructure, including primary and re-ferral health facilities, in the last two decades. Inpatient beds in both public and private hospi-tals as well as primary health centres (puskesmas) have increased. Human resources for health have also grown in the last two decades, with increases in health worker to population ratios. However, the ratios of hospital beds, puskesmas, and physician to population remain below WHO standards and lag behind other Asia-Pacific countries. Indonesia faces the challenge of increasing health expenditures, as nominal health spending has been steadily increasing in the last eight years, by 222% overall. Although there has been a substantial increase in health spending at national level, health spending as a proportion of gross domestic product (GDP) remains below average among the low-to-middle-income countries (3.1% of GDP in 2012). The Government’s share of total health expenditure also remains low, at only 39%, whereas private, primarily out-of-pocket (OOP) expenditure, is 60%.

Commencing in 2014, the government has introduced a national health insurance scheme (JKN: Jaminan Kesehatan Nasional) which progressively aims to expand coverage to cover the whole population by 2019. Moving forward, the challenge for the Government is to manage the ex-pansion of this scheme, while addressing regional disparities in service quality and accessibility, managing resources effectively, containing costs and minimizing fraud, engaging the private sector, and maintaining investment in health promotion and prevention programmes.