I had never before participated in a simulation event like The Sheffield World Health Organization Simulation 2018. I was really interested in giving it a go for two reasons, during my research I had investigated WHO policy and I was interested in seeing how it was formed and also because the topic was "Outbreaks and Pandemics: Addressing the Next Crisis", an area that is appealing to me, as a microbiologist.
The below is the Position Paper that had to be submitted a few weeks before the start of the simulation event.
Document
Information: Sheffield Model WHO Simulation 2018
Type
of Document: Position Paper, Country: Indonesia, WHO Region: SEARO, Delegate:
Natalie Lamb, University of Sheffield @Natnotgnats, Delegate Role: Member State
The Ministry of Health Republic of Indonesia has a
vision, of a healthy society that is self-reliant and fair. We aim to: improve
the public health status through community empowerment, protect the public
health by assuring the availability of complete healthcare for all, ensure the
availability and distribution of health resources and create good governance (Embassy of
The Republic of Indonesia, 2018) . Indicators of
overall health status in Indonesia have improved significantly over the last
two and half decades, with life expectancy rising from 63 years in 1990 to 71
years in 2012 (World Health Organization, 2017) . There is, however,
room for improvement to help address the next crisis of the future and we are
trying to make steps towards this improvement within Indonesia.
Noncommunicable diseases
and their risk factors, such as high blood pressure, high cholesterol, obesity
and smoking, are becoming increasingly important, with Indonesia ranking among
the 10 countries in the world who has the highest burden of diabetes (World Health Organization, 2017) . However, infectious
diseases remain a significant part of the disease burden, as Indonesia is among
the 10 countries in the world with the highest TB burden (World Health
Organization, 2017) . There are continuing high incidences
of tuberculosis and malaria. The effect of neglected tropical diseases may
threaten Indonesia’s economic potential, as the most poverty-stricken people
suffer from widespread helminthes infections, lymphatic filariasis,
schistosomiasis and other neglected bacterial infections including yaws and
leptospirosis (Tan, et al., 2014) . Indonesia has suffered numerous H5N1
outbreaks, with the highest number of recorded human cases of this virus in the
world (Adisasmito, et al., 2013) . Furthermore, 11% of
the country’s population suffers from mental disorders, with over 19 million of
the people of age 15 or older. There is very little amount of funding dedicated
to mental health. The total health expenditure is 2.36%, and less than 1% of
that goes towards mental health.
Natural disasters have caused many deaths and much
disruptions in recent years, the following being a few examples: 2004 An
earthquake-triggered tsunami in Aceh killed 170,000; 2006 An earthquake in
central Java killed more than 5,700 and injured 37,000; 2009 An underwater volcano
killed over 1,100 in Padang and 2010 Merapi volcano erupted, killing 353 people.
Indonesia has a stated foreign policy objective of
establishing stable fixed land and maritime boundaries with all of its neighbours,
but not all of these boundaries have been established, including: Timor-Leste (have yet to be delimited and no
maritime or Exclusive Economic Zone (EEZ) boundaries have been established),
Australia (a 1997 treaty that would settle the last of their maritime and EEZ
boundary has yet to be ratified by Indonesia's legislature and Indonesian
groups challenge Australia's claim to Ashmore Reef), Malaysia (land and
maritime negotiations ongoing), Indonesia and Singapore (defining unresolved
areas north of Indonesia's Batam Island), Palau (maritime delimitation talks
ongoing) and Vietnam (EEZ negotiations ongoing) (Central Intelligence Agency, 2018) .
Major trade partners include: China (11.6% exports, 22.7%
imports in 2016), United States (11.2% exports), Japan (11.1% exports, 9.6%
imports), Singapore (10.7% imports) (UNData, 2018) . The Embassy of The Republic of
Indonesia (2018) also noted Malaysia
and Australia as being major trade partners.
The Western world has influenced Indonesia in science,
technology and modern entertainment, political systems and issues. Djamu or
Jamu is the traditional form of Indonesian herbal medicine and may still be
preferred when treating many illnesses, especially in some remote Indonesian
regions, which still preserve uniquely indigenous culture. However, the Western
system of medicine is also popular in Indonesia (Moffatt, 2012) .
Nominal health spending has increased by 222% overall in
the last eight years, with a substantial increase in health spending at
national level, although health spending as a proportion of gross domestic
product remains below average among the low-to-middle-income countries (3.1% of
GDP in 2012) (World Health Organization, 2017) . Therefore,
increasing health expenditures are a challenge.
Traditionally, healthcare provision in Indonesia has been
fragmented, with private insurance provision or basic public coverage for the
poorest in society. NGOs would also work in specialised areas to provide
services not covered by either schemes (Britnell, 2015) . External partners’ contribution is
significant for fighting HIV/AIDS, TB and malaria in Indonesia. These three
programmes rely heavily on external resources that provided more than 60% of
total spending, and mostly for direct costs such as for TB case-finding,
HIV/AIDs prevention programmes for high risk populations, and malaria
surveillance and case detection. Development assistance for health has increased,
doubling from $256.2 million in 2005 to $521.2 million in 2012 (World Health Organization, 2017) .
In Indonesia, development assistance for health is mostly
channelled through the central ministry of health for both grants and loans, as
well as through non-profit institutions or managed directly (World Health
Organization, 2017) . In January 2014, the Indonesian
government launched Jaminan Kesehatan Nasional, a scheme to implement universal
health care. It is expected that spending on healthcare will increase by 12% a
year and reach US$46 billion a year by 2019 (Britnell, 2015) . Overall the scheme
will help Indonesia move towards coordinated policies to achieve these national
health system goals.
However, as The World Health Organization (2017) said, the Jaminan
Kesehatan Nasional cannot be expected to solve Indonesia’s health concerns
alone, due to their complexity. The country’s continuing economic growth will
allow for further investment into healthcare. However, 1.5 million Indonesian
residents travel to neighbouring countries such as Singapore and Malaysia to
seek medical treatment, with an outflow of $1.4 billion yearly, potentially due
to a lack of qualified medical personnel, despite the investment in
healthcare
(Deloitte, 2015) . The ASEAN Economic Community (Indonesia,
Cambodia, Myanmar (Burma), Thailand, Vietnam, Laos, Brunei, Malaysia,
Singapore, Philippines) could open up borders for the recruitment of health
workers from outside of Indonesia to meet the shortfall. It is also important
for external partners to continue their contribution for fighting HIV/AIDS, TB
and malaria, as well as aid in natural disasters.
Bibliography
- Adisasmito, W. et al., 2013. Human Influenza A H5N1 in Indonesia: Health Care Service-Associated Delays in Treatment Initiation. BMC Public Health, Volume 13, p. 571.
- Britnell, M., 2015. In Search of the Perfect Health System. London: Palgrave.
- Central Intelligence Agency, 2018. The World Factbook. [Online] Available at: https://www.cia.gov/library/publications/resources/the-world-factbook/geos/id.html [Accessed 20 April 2018].
- Deloitte, 2015. A Perspective of Future Healthcare Landscape in ASEAN and Singapore, s.l.: s.n.
- Embassy of The Republic of Indonesia, 2018. The Government of The Republic of Indonesia. [Online] Available at: http://www.indonesia.cz/the-government-of-the-republic-of-indonesia/ [Accessed 19 April 2018].
- Moffatt, A., 2012. Indonesian Cultural Profile, s.l.: Diversicare.
- Tan, M., R, K., L, S. & P, H., 2014. Indonesia: An Emerging Market Economy Beset by Neglected Tropical Diseases. PLoS Neglected Tropical Disease, 8(2), p. e2449.
- UNData, 2018. UN Data. [Online] Available at: http://data.un.org/en/iso/id.html [Accessed 20 April 2018].
- World Health Organization, 2017. Global Tuberculosis Report, Geneva: World Health Organization.
- World Health Organization, 2017. The Republic of Indonesia Health System Review, India: World Health Organization.
