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Extending free healthcare for the poor of Indonesia

Indonesia has come a long way since independence in the 1960s. Over the last half-century, economic growth has reduced the number of people living in poverty from around 6 in 10 to just 2 in every 10 people and life expectancy has risen from 45 to 70 years.

However, despite tackling a range of health issues – from maternal mortality to malnutrition – Indonesia still faces huge challenges, particularly with an ageing population and rising rates of degenerative disease.

Healthcare is seen as key to Indonesia’s development and the nation is committed to universal provision. To this end, the government has recently announced increases in its spending on healthcare. More than half of Indonesia’s population have some form of health insurance. For the rest, the cost of basic hospital treatment is covered either by the central or provincial government. To ensure poor Indonesians receive free basic healthcare, the government is increasing its spending in 2011 by 10 per cent, with an extra 1.15 billion dollars. This will allow poor patients to access treatments for illnesses such as strokes and heart disease.

Speaking to Reuters, the Indonesian health minister Endang Sedyaningsih, said the goal of the government was to ensure no-one had to pay for a basic level of care in Indonesia’s hospitals. In 2009, over 76 million poor Indonesians received free medical treatment in class-3 hospital beds. To provide more places, the minister is also keen to encourage private investors, where hospitals are built with at least a quarter of beds reserved for state-funded patients.

Mrs Sedyaningsih, who has lung cancer herself, spoke of the country’s battle to meet the growing number of stroke, heart disease and cancer patients. However, she also admitted the nation still faces problems in tackling illnesses such as tuberculosis, malaria, childhood diarrhoea and dengue fever. With a relatively high mortality rate among under-fives (in 2008, 41 children under the age of 5 died for every 1,000 live births), the government is looking to improve health services for young children.

This task is harder given the number of Indonesia’s remote regions. While in the cities, there is one doctor for every 2,700 residents, rural locations have an average of one doctor for every 16,000 inhabitants. As a result, rural communities are particularly vulnerable to outbreaks of disease and healthcare expense remains an issue. Even with free treatment available in hospitals, costs of travel can be prohibitive. Despite the government’s proposed increase in healthcare spending, the health budget still represents just 2.3 per cent of gross domestic product (compared to 3.7 per cent in Thailand and over 15 per cent in the USA). Some experts warn that this level of spending will not address all the healthcare needs of Indonesia’s growing population, nor ensure adequate universal access for the poorest.

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