Health and Sanitation in Indonesia
Indonesia had a three-tiered system of community health centers in the late 1990s, with 0.66 hospital beds per 1,000 population, the lowest rate among members of the Association of Southeast Asian Nations (ASEAN). In the mid-1990s, according to the World Health Organization (WHO), there were 16 physicians per 100,000 population in Indonesia, 50 nurses per 100,000, and 26 midwives per 100,000. Both traditional and modern health practices are employed. Government health expenditures are about 3.7 percent of the gross domestic product (GDP). There is about a 75:25 percent ratio of public to private health-care expenditures.
Unsafe drinking water is a major cause of diarrhea, which is a major killer of young children in Indonesia.
In 2005 there were 303 reported cases of polio in Indonesia.
HIV/AIDS has posed a major public health threat since the early 1990s. In 2003 Indonesia ranked third among ASEAN nations in Southeast Asia, after Myanmar and Thailand, with a 0.1 percent adult prevalence rate, 130,000 HIV/AIDS cases, and 2,400 deaths. In Jakarta it is estimated that 17 percent of prostitutes have contracted HIV/AIDS; in some parts of Papua, it is thought that the rate of infection among village women who are not prostitutes may be as high as 26 percent.
Three other health hazards facing Indonesia in 2004 were dengue fever, dengue haemorrhagic fever (DHF) and avian influenza. All 30 provincial-level units were affected by dengue fever and DHF, according to the WHO. The outbreak of highly pathogenic avian influenza (A/H5N1) in chickens and ducks in Indonesia was said to pose a significant threat to human health.
By 2010, there are three malaria regions in Indonesia: Nusa Tenggara Barat with 20 cases per 1,000 citizens, Nusa Tenggara Timur with 20-50, and Maluku and Papua with more than 50 cases per thousand. The medium endemicity in Sumatra, Kalimantan and Sulawesi, whereas low endemicity is in Java and Bali which almost 100 percent of malaria cases have been confirmed clear. At 1990 malaria average incidence was 4.96 per 1,000 and declined to 1.96 per 1000 at 2010. The government is targeting to rid the country of malaria by 2030 and elimination means to achieve less than 1 incidence per 1,000 people.
1997 Southeast Asian haze and 2006 Southeast Asian haze – In all countries affected by the smoke haze, an increase of acute health outcomes was observed. Health effects; included emergency room visits due to respiratory symptoms such as asthma, upper respiratory infection, decreased lung function as well as eye and skin irritation, were caused mainly by this particulate matter.
Indonesia has routine vaccination to children below age 5 years as World Health Organization (WHO) recommendations including vaccination of Hepatitis B which has high prevalency in Indonesia. Almost all of the vaccines provided by PT Bio Farma which one of the 29 companies with a prequalification certificate from the WHO among 200 vaccine company in the world. It also has been exported to 110 countries in the world.Indonesian vaccines are prefer among countries with high Moslem population due to they are halal vaccines.
PT Bio Farma as a global vaccine producer will produce pentavalent vaccine (diphteria, pertussis, tetanus, hepatitis B and haemophilus influanzae type B or HiB). In 2012 the GAVI (Global Alliance for Vaccine and Immunization) will donate 80 percent of the needs of pentavalent vaccine and in the third year government should self fulfilment.
June 2011: The third phase test of dengue vaccine involving 800 humans with ages of 2 and 14 years old have been held in 5 community health center around Jakarta and will be conducted also in Bandung, West Java and Denpasar, Bali with 800 and 400 participants, respectively. The first test was performed on a limited number of soldiers and the second phase was conducted on a small number of children and if within the next 5 years the vaccine is found to be safe for humans, government will apply the dengue vaccine to public.
Maternal and Child Health Care
In June 2011, the United Nations Population Fund released a report on The State of the World’s Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. The 2010 maternal mortality rate per 100,000 births for Indonesia is 240. This is compared with 228.6 in 2008 and 252.9 in 1990. The under 5 mortality rate, per 1,000 births is 41 and the neonatal mortality as a percentage of under 5’s mortality is 49. The aim of this report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death. In Indonesia the number of midwives per 1,000 live births is unavailable and 1 in 190 shows us the lifetime risk of death for pregnant women.
100 percent insured
On 2010, an estimated 56 percent of Indonesian mainly state employees, low-income earners and those with private coverage have some from health insurance. It will boost to 100 percent with a system of universal social health insurance coverage in place by 2014. The aim is that everybody doesn’t have to pay when they are hospitalized in basic/class-3 hospital beds
Water supply and sanitation in Indonesia is characterized by poor levels of access and service quality. Over 100 million people in Indonesia lack access to safe water and more than 70 percent of the country’s 220 million population relies on water obtained from potentially contaminated sources. With only 2% access to sewerage in urban areas is one of the lowest in the world among middle-income countries. Pollution is widespread on Bali and Java. Women in Jakarta report spending US$ 11 per month on boiling water, implying a significant burden for the poor.
The Government of Indonesia has stated its commitment to achieving the Millennium Development Goals (MDGs). In order to do so, an estimated 78 million more people will require improved water supply and 73 million improved sanitation services between 2000 and 2015, not to mention necessary improvements in service quality for those already shown as having access. Current levels of investment of only US$2 per capita and year are insufficient to attain the MDGs. Furthermore, policy responsibilities are fragmented between different Ministries and local utilities that operate and maintain urban water systems remain weak.
Since decentralization was introduced in Indonesia in 2001 local governments (districts) have gained responsibility for water supply and sanitation. However, this has so far not translated into an improvement of access or service quality, mainly because devolution of responsibilities has not been followed by adequate fund channelling mechanisms to carry out this responsibility. The provision of clean drinking water has unfortunately not yet been taken up as a serious development priority in Indonesia, particularly at the provincial government level.
Water and sanitation issues remain as a serious issue in Indonesia for the government to deal with, especially in the rural areas. In slums and farming provinces, almost half of Indonesians have no access to potable water. This is a major concern because lack of clean water reduces the level of hygiene in the communities and it also raises the probability of people contracting skin diseases or other waterborne illnesses. Besides poor access to safe water, a failure to aggressively promote behavioural change, particularly among low-income families and slum dwellers has further worsened Indonesia’s water and sanitation situation.
Water resources and use
Most rivers in Indonesia, such as the Serayu River in Central Java shown here, are relatively short, seasonal and carry a high sediment load
Indonesia has over 5,590 rivers, most of them short and steep. Because of high rainfall intensities most rivers carry large quantities of sediment. Average rainfall is above 2,000 mm on most islands, except for the Lesser Sunda Islands where it is 1,500 mm. 80% of rain falls during the rainy season (October to April). While water resources are quite abundant in Sumatra, Kalimantan, Sulawesi, Maluku and Irian, water shortages occur during the dry season in parts of Java, Bali and the Lesser Sunda Islands. In particular in Java, the dry season flows are inadequate to meet the demand, leading to irrigation shortages. Irrigation accounts for 93% of water use. The total storage capacity amounts to only 5% to 6% of the river flows. Construction of reservoirs is constrained by lack of good reservoir sites, high density of population at possible reservoir sites and expected short reservoir lifetimes due to siltation. Groundwater potential in Indonesia is very limited. However, much of the eastern islands depend on groundwater because of surface water scarcity. Groundwater overxploitation occurs in heavily populated coastal areas of Java, including in Jakarta and Semarang. In Jakarta it has caused seawater intrusion up to 10 km from the coast and land subsidence at a rate of 2–34 cm/year in east Jakarta. In Semarang land subsidence occurs at a rate of 9 cm/year.
Water utilities abstract water from rivers and lakes (60%), springs (25%) and groundwater (15%). For example, the main water source for Jakarta is the Jatiluhur Dam on the Citarum River 70 km southeast of the city. For those who are self-supplied or receive water from community-based organizations, shallow groundwater and springs are by far the main sources of water on most islands. On Sumatra and Irian, however, rainwater harvesting is also an important water source.
Pollution. Domestic sewage, industrial effluents, agricultural runoff, and mismanaged solid waste are polluting surface and groundwater, especially in Java. Indonesia ranks among the worst countries in Asia in sewerage and sanitation coverage. Few Indonesian cities possess even minimal sanitation systems. The absence of an established sanitation network forces many households to rely upon private septic tanks or to dispose of their waste directly into rivers and canals. The commonality of the latter practice, together with the prevalence of polluted shallow wells used for drinking water supply in urban areas, has led to repeated epidemics of gastrointestinal infections.
Domestic Waste. According to Water Environment Partnership in Asia (WEPA), only 42.8 percent from 51,372,661 houses in Indonesia have domestic waste treatment. More than half of households dispose their domestic waste directly to the river body. Data from the World Bank shows that in 2008, only 52% of Indonesian population has an adequate access to excreta disposal facilities. Such facilities are important as they can help to minimize human, animal, and insect contact with excreta, thereby increasing the hygiene level and enhancing the living conditions for the slum-dwellers. Without proper construction and maintenance of these facilities, domestic wastes are disposed ineffectively and increases the rate of water resources degradation.
Industrial Waste. Industrial activities wastes such as small-scale industries, agriculture, textile, pulp and paper, petrochemical, mining and oil and gas also contribute to the degradation of water quality in Indonesia. Water quality in locations near to the mining areas is potentially contaminated by heavy metal such as mercury (Hg). According to WEPA, some level of mercury (Hg) concentration has been detected at 9 out of 16 sampling points and the highest level of dissolved mercury in one of the area reach 2.78 ug/l.
Therefore, the result of water quality monitoring in 30 rivers in Indonesia indicates that most of river water quality do not meet water criteria class 1, i.e. water that can be used for standard water, drinking water, and or other usage that requires the same water quality with such usage, due to pollution by domestic and industrial wastes (drinking water raw based on Government. Tv. Y h. Regulation Number 82, 2001 , Water Quality Management and Wastewater Controlling)