Former health minister
A new study on child deaths, published in the journal Nature on Oct. 16, has profound implications for our country. Indonesia has seen remarkable health improvements over the past three decades, especially in the areas of prevention and treatment of childhood diseases.
But it is imperative that we now work to close remaining gaps in health inequity to help ensure that all babies born today can live well past 2024 and grow into healthy and productive adults.
Some of those gaps are geographic and are readily apparent in the study, which examines the mortality rate of children under 5 in Indonesia and nearly 100 other countries. But before considering the gaps we face today, let’s step back to look at the progress Indonesia has made in recent years.
In 1990, the national mortality rate for children under 5 was 86 per 1,000 live births. By 2017 that rate dropped significantly to 26 per 1,000 live births. The neonatal death rate (deaths of infants under 28 days) likewise fell from 32.7 per 1,000 live births in 1990 to 13.7 per 1,000 live births in 2017.
How did we make such impressive improvements?
First, over the nearly 30 years covered in the study, socioeconomic development in Indonesia showed steady improvement.
Second, our country took to heart its commitment to the global community’s efforts to achieve the United Nations Millennium Development Goals (MDGs) and we devoted significant resources to the country’s health system infrastructure, including expansion of our primary healthcare system, increased immunization coverage and improved specialist and intensive health care for children, especially for children aged under 5.
At the same time, we encouraged multisectoral partnerships in program planning and service delivery. Increasingly, the nation’s health system has not worked alone, but has partnered with and benefitted from progress in other fields like education, household water and sanitation, housing and income generation.
This holistic approach was essential to the success our nation achieved.
Increased coverage of services was facilitated by the launch of health insurance for the poor (AsKesKin) in 2005, which was later strengthened and broadened based on experience; the addition of childbirth insurance (Jampersal) in 2010 specifically to reduce infant and maternal mortality by providing free and improved antenatal and postnatal care; and the launch on Jan. 1, 2014, of national health insurance (JKN) toward achieving universal health care.
The trajectory of improved health and well-being, especially among the poor, has been impressive. It has been the product of determination, dedication and perseverance at all levels of government, civil society and the community.
Now, we must dedicate ourselves to addressing those remaining gaps that still allow too many avoidable child deaths.
In collaboration with the Institute of Health Metrics and Evaluation (IHME) at the University of Washington, United States, we have conducted studies of our burden of disease (BoD) at both national and subnational levels. Using the BoD methodologies, we now have comparable data for all 34 provinces for the period 1990 to 2017. This can be analyzed in many ways to help make well targeted corrective action more effective and cost-efficient.
For example, in relation to under-5 mortality, in Sumatra, the highest under-5 mortality rate was 50.1 per 1,000 live births in Lingga, Riau Islands, 3.4 times higher than the lowest rate of 14.7 per 1,000 live births in Pekanbaru, Riau. In Java the highest rate was 38.3 per 1,000 live births in Sumenep, Madura, while the lowest rate was 11.6 per 1,000 live births in Surakarta, Central Java. In Kalimantan, the highest rate was 42.7 per 1,000 live births in Hulu Sungai Tengah, South Kalimantan, while the lowest rate was 18.7 per 1,000 live births in Palangkaraya, Central Kalimantan. In Sulawesi, the lowest rate of under-5 mortality was 18.2 per 1,000 live births in South Sulawesi, while the highest rate was three times higher, at 57.7 per 1,000 live births on Buton Island, Southeast Sulawesi. In Papua and West Papua, the gap was even wider, with the lowest under-5 mortality rate recorded at 19.0 per 1,000 live births in Sorong, West Papua, while the highest rate was 4.7 times higher at 89.1 per 1,000 live births in Asmat, Papua.
This data shows clearly that new administrative regions, islands and more isolated areas need priority attention.
The availability of regency and city level data like this is significant for policy and program decision makers as well as community leaders concerned with health. It can inform decisions related to priorities for funding, action, research, health system development and longer term policy development taking into consideration available resources, existing regulations as well as the political, social and economic environment.
We now have good additional data to show us our unfinished business in the field of health. I salute the fact that Indonesia has made good use of this data to provide a strategic and holistic approach to health planning and development in our 2020-2024 National Medium-Term Development Plan (RPJMN).
The challenge for us all, particularly at the local government level, is action. Data can be helpful for promoting and facilitating action. Looking at data in comparable settings we can see not only gaps and inequities, but also identify successes. We can learn from each other about what works in Indonesia. In fact, in 2017, 94 regencies and cities had already met the target for Sustainable Development Goal (SDG) 3.2 on under-5 mortality.
Another challenge is for us to ensure long-term, lifelong behavioral change and adopt healthy lifestyles with sports, healthy diets and no smoking. The roles of formal and non-formal education, public policy, community leadership and cross-sectoral activity will all be vital in promoting and sustaining such changes.
Our sights must be higher than “just” reducing child mortality. Our goal must be for every child to look forward to a long, fulfilling life.
Disclaimer: The opinions expressed in this article are those of the author and do not reflect the official stance of The Jakarta Post.