By :
Gamal Albinsaid, S.Ked
Human resources in health have deficiencies in numbers, distribution and quality of the health workforce, and reportedly low productivity(WHO, 2010). The total of physicians is 2,9 per 10.000 population, it’s approach half of regional average which 5,6 per 10.000 population. But, the amount of nurses and midwives in Indonesia(20,4 per 10.000 population) is approach twice of regional average(10,9 per 10.000 population)(WHO, 2012).
In 2012, with total population 239.871.000, Indonesia have life expecatncy at birth for male 66, and female 71 same as global average. But, Adult mortality rate(probability of dying between 15 and 60 years per 1000 population) for both sexes is 190 higher than global average that is 176. With maternal mortality ratio per 100.000 live births is 220 higher than global average that is 210.
Communicable diseasesare a major cause of morbidity and mortality in Indonesia. Nearly 250 people die of tuberculosis (TB) every day, with over half a million new cases estimated to occur every year (WHO GTB 2009). Prevalence of Tuberculosis(per 100.000 population) is 289 higher than regional average(278) dan global average(178)(WHO, 2012). Malaria remains a major vector-borne disease in large parts of Indonesia. Large scale outbreaks of dengue haemorrhagic fever are reported every year. Although leprosy has been eliminated at national level, Indonesia ranks third in terms of the global burden. Case fatality rates for avian influenza in 2008 were nearly 81%. Significant efforts continue to be invested in prevention and control of avian influenza and emerging infectious diseases, with pandemic preparednessat its core. The re-introduction and spread of poliomyelitis in 2005 in several provinces, after a period of 10 years, and reported measles and diphtheria outbreaks pointed to weaknesses in the routine expanded programme of immunization. At the end of 2006, an estimated 293.200 Indonesians were living with HIV-AIDS (National AIDS Commission Publication, 2009).
An epidemiological transition towards noncommunicable diseases (NCDs)is a challenge for Indonesia. Chronic conditions such as cancer, cardiovascular diseases, metabolic disorders and tobacco dependence represent a real burden to the country in terms of cost, suffering and human lives. Non Communicable disease remain become the most cause of life lost 45%, secondly Communicable disease which 41% and followed by injuries which 13%(WHO, 2012).
Health financing in Indonesia is not enough, total expenditure on health per capita (Int $, 2010) is 112, and total expenditure on health as % of GDP (2010) is 2,6.
Indicators show that the health situation of mothers, children and adolescents in Indonesia still has much room for improvement. Wide geographical variation exists for infant and maternal mortality. Mortality rates for children (less than five years) and infants (under one year) remain at 46 and 32 deaths per 1000 live births, respectively,
All estimates confirm that the maternal mortality ratio (307/100 000 live births) in Indonesia is among the highest in the South-East Asia Region (Indonesia Demographic and Health Survey 2002-2003). The lifetime risk of a mother dying of causes related to childbirth is estimated to be 1 in 65 — compared with 1 in 1100 in Thailand (WHO 2002). In Indonesia, 58% of deliveries are estimated to take place at home; of those, 33% are in urban and 67% in rural areas.
Responding effectively to these complex disease patterns and potential threats to health is likely to remain a major set of challenges for the country during the coming years. The HIV epidemic directly affects the most productive members of the society: the young people and wage-earners. At the end of 2003, an estimated 53 000 to 180 000 Indonesians were living with HIV-AIDS (UNAIDS 2004).
In addition, Indonesia has a backlog of about two million cataract cases, leading to blindness, which needs to be addressed to reduce the social burden. Mental health has long been neglected, despite an estimated 12.3% loss of productive days due to mental and neurological disorders.
In view of the high prevalence of tobacco use in the country and given the fact that
for noncommunicable diseases (NCDs) tobacco is the second most important cause of
morbidity and mortality, development and implementation of an effective tobacco control
programme will be emphasized.
Compared with neighboring Malaysia and Thailand, Indonesia spends relatively little
on health services. The estimated total expenditure on health per capita in 2003 was
US$ 33 in Indonesia compared with US$ 149 in Malaysia and US$ 90 in Thailand
(all figures in US dollars at the then-prevailing exchange rates; Indonesia public health
expenditure review, 2004).
The human resource situation in health has major deficiencies in numbers and quality
of the health workforce. Decentralization is one of many factors exacerbating longstanding
problems with maldistribution and reportedly low productivity of health workers. At the primary health care level, Indonesia is generally regarded as having relatively adequate levels of provision, with one public health centre for every 30 000 people on average. If sub-centres are included, there is one public facility per 10 000 people.
Hunger and malnutrition remain the most devastating problems facing the majority of the Indonesian, especially for the poor. Despite general improvements in food availability, health and social services, hunger and malnutrition exist in some form in almost every district in Indonesia. At present, about half the population is iron-deficient and one-third is at risk of iodine deficiency disorders. Vitamin A deficiency disorders still affect around 10 million children. The prevalence of LBW infants in Indonesia is in a range of 7-14%, even reach 16% in some districts. The high prevalence of LBW is commonly a result of maternal malnutrition. It is at a range of 12 to 22% women aged 15-49 suffering from chronic energy deficiency (BMI <18.5), and 40% of pregnant women was anemic. In 2003, 27.5 percent of children under five in Indonesia suffered from moderate and severe underweight, or only 10 percentage points lower than in 1989, and nearly half are stunted. Malnourished children who suffer from low birth-weight and stunting in turn grow into malnourished adolescents and adults, thus perpetuating the malnutrition cycle. In contrast, unbalanced food intakes that cause excessive consumption in association with changes in lifestyle that will effect to a  range of non-communicable diseases also should be considered as emerging significant public health problem for Indonesia.
Health are heading towards becoming a major public problem, requiring sustained prevention and control of the risk factors involved. However, the major challenge ahead will be to implement the strategy and to develop multisectoral public policies in support of the strategy. While further support is required to achieve a majority in Indonesia’s legislative assembly, a considerable number of parliamentarians are already lobbying for the country to join the Framework Convention. To achieve it, awareness and willingness of public health policy will be important.
