Like many countries in the world, the Indonesian healthcare system was ill-equipped to deal with arguably the toughest modern health crisis when the country reported its first case in March 2020.

The government provided the newly formed National Economic and COVID-19 Recovery Committee (KPCPEN) with a war chest of Rp 695.2 trillion (US$44.5 million) that year to fund the country’s pandemic-handling effort.

The figure rose to Rp 744.4 trillion in 2021 before it went down to Rp 455.6 trillion this year.

But, the government has decided to cut the pandemic fund starting next year, in an attempt to cast the nation’s focus wider than the coronavirus.

To this end, Health Minister Budi Gunadi Sadikin penned a ministerial regulation in July that instructed regional administrations to follow a national healthcare transformation blueprint that prioritized illness prevention, rather than treatment.

When he announced the program in May, Budi outlined six core aspects that will be improved through the transformation plan: primary healthcare services, referral services, healthcare system resilience, financing, human resources and technology. 

Among these reform efforts are the “Posyandu Prima” program, which aims to revitalize the thousands of integrated health services posts (Posyandu) scattered throughout the country; the reworking of the National Health Insurance (JKN) program; and scholarship opportunities afforded to thousands of medical students.

Read also: Experts decry lax approach to mysterious hepatitis cases 

Health oversight

Amid these transformation efforts, 2022 also saw the re-emergence and discovery of diseases other than COVID-19.

Health authorities were blindsided by the death of three children in April to hepatitis of unknown origins, sending ripples of concern throughout the country over the possible emergence of a new disease afflicting only young children.

August also saw the country reporting its first mpox, formerly known as monkeypox, case in a 27-year-old man, which raised questions as to whether authorities were ready to deal with a zoonotic disease that is traditionally endemic in Africa but which had caused a sudden global outbreak.

Most recently, Indonesia reported in November its first polio case in four years, after a seven-year-old child in Aceh’s Pidie regency, who had no prior immunization, tested positive for type 2 poliovirus.

Health expert Tjandra Yoga Aditama said that the government’s lack of preventive surveillance of these diseases was due to its focus on handling the pandemic.

But, he also said that the public was also partly at fault, since many have become hesitant to visit healthcare centers, to either check their health conditions or get immunization, due to fears of being infected with COVID-19.

“If there is one thing to blame, it is that the government’s focus on COVID-19 has resulted in surveillance of other diseases falling by the wayside,” Tjandra said on Friday.

The deadly string of acute kidney injury (AKI) cases in October and November due to toxic medicines, which resulted in the death of 200 children, has also raised concerns about the Health Ministry’s and the Food and Drug Monitoring Agency’s (BPOM) weak supervision of drugs sold in the country.

Read also: Families sue government over tainted cough syrup deaths, injuries

Lingering pandemic

All the while, the country is still grappling with the COVID-19 pandemic, which has resulted in an additional 2.4 million cases and 16,000 deaths this year alone.

Indonesia’s daily caseload hit an all-time high earlier this year when authorities reported 64,718 cases during the country’s Omicron-induced third wave of cases on Feb. 16, close to 10,000 more cases than the previous record of 56,757 in July last year.

Aside from the February spike, cases have generally stabilized in the low thousands, barring another more minor spike, which caused it to reach the 8,000 figure in November due to the Omicron’s XBB subvariant.

While infections have begun to show signs of easing, the rollout of the country’s inoculation program, particularly booster doses, leaves much to be desired.

Seventy-four percent of the country’s 236 million target population have completed their primary inoculation, Health Ministry data show, but the figure has been stagnant at around the 70 percent mark since April.

In addition, only 28 percent of the total target population have so far received the first booster dose, despite it being available since the start of the year.

The way forward

With the threat of a lingering pandemic and emergence of new illnesses, health experts said a more grounded approach would be key for a successful transformation of the country’s healthcare system.

“The [current health] minister said that he wanted to prioritize preventive efforts, but so did all the ministers before him. What we need to see now is change at a grassroots level. We don’t need another world-class hospital, but we need to talk about people who are still defecating into open rivers, or people who are not getting their immunization shots,” Tjandra said.

Echoing Tjandra, epidemiologist Dicky Budiman said that the government should reassess its priorities, since a total transformation of the country’s healthcare system would take decades to realize.

“Aside from emerging diseases, our ‘homework’ of dealing with malaria, or AIDS, or stunting, has not even seen that much progress. The government cannot do everything [by 2024], so it should prioritize building the foundations,” Dicky said, adding that these foundations should include a focus on improving the country’s detection and response system as well as promoting healthier lifestyles.