Indonesia has made major improvements in health outcomes
Health outcomes have improved significantly since 1980 when life expectancy was only 52 years compared to almost 70 today, and some 100 infants out of every 1000 died before their first birthday, compared to less than 30 today. The total fertility rate has declined from 4.7 children per woman to slightly above 2. Despite these impressive improvements, Indonesia’s achievements have been less impressive than some of its neighbours, and for certain health outcomes, such as maternal mortality, the country does not perform as well as other comparable income and health spending level countries.
(an example of the Puskesmas)
Indonesia’s health delivery capacity has expanded significantly
Indonesia’s health delivery system expanded significantly over the past 40 years. Virtually all Indonesian’s have access to basic care through a network of 8000 Puskesmas and 22,200 Puskesmas Pembantu, and some 5,800 mobile health clinics. On the other hand, while Indonesia has far fewer hospital beds per capita compared to other comparable income countries, these beds are poorly utilized with occupancy rates on the order of 60 percent. In terms of human resources for health, while nurse mid-wives are readily available throughout the country, Indonesia’s health workforce overall is small relative to other similar income countries and concerns over quality and efficiency persist. Its physician workforce is very small relative to comparators, and there are severe shortages of specialists, which are particularly problematic given the proposed expansions in health insurance coverage and the oncoming non-communicable disease burden. There are serious equity, quality, and efficiency problems underlying Indonesia’s current health delivery system which, unless corrected, will result in major access, cost, and sustainability problems as the country moves to universal health insurance coverage.
(some puskesmas provide in-patient ward facility)
Indonesia’s health spending is relatively low and the country gets reasonable ‘value for money’ in terms of some health outcomes as well as relatively good financial protection
Indonesia spends only slightly more than 2 percent of its GDP on health, about half the level of other comparable income countries. Half of all health spending is public. About one-third of health spending comes directly from of out of pocket payments by households. Health is a relatively small share of the government’s budget, some 5 percent, although the share has been increasing since the implementation of the Askeskin program in 2004. Despite low spending health outcomes and financial protection are relatively good, although these latter results may be due to Indonesia’s relatively high education levels and extended family social structure. On the other hand, some health outcomes such as maternal mortality, which is dependent on a well functioning health system, are worse than other comparators and analyses of technical efficiency suggest that there are some potentially serious problems.