Commentary: We Need Data to Improve Health Care Access and Quality in Indonesia

The government aims to have 95 percent of Indonesians covered by the National Social Health Insurance Scheme (Jaminan Kesehatan Nasional, JKN) in 2019. (JG Photo/Yudha Baskoro)

By : Dr. Nafsiah Mboi | on 4:03 PM August 06, 2018
Category : Opinion, Commentary

Amina is a 45-year-old woman living in an impoverished seaside village on the isolated island of Alor, East Nusa Tenggara. She and her husband were working hard for the sake of their five children. Tragically, one died at birth and two others before they were five years old — one from malaria and the other from diarrhea. Their two surviving kids are grown up and in good health.

But now Amina and her husband have health problems. She has been diagnosed with diabetes and her husband, always a heavy smoker, has lung cancer. Both are feeling the effects of their respective diseases and they are concerned about their children's future.

Indonesians can be proud of the great health improvements that have been made since Amina was born. Progress has been particularly great in the past decade.

In fact, Indonesia is set to make health history: the government aims to have 95 percent of Indonesians covered by the National Social Health Insurance Scheme (Jaminan Kesehatan Nasional, JKN) in 2019. This will make it one of the largest countries in the world to make universal health coverage a reality.

To reach this challenging goal and provide health coverage for all, including people like Amina and her family, the government needs information about what diseases, injuries and risk factors impact the health of Indonesians. This will help policymakers and health workers make cost-effective decisions about how to prevent ill health and establish priorities for disease treatment.

A new study provides this critical information.  The study, "On the Road to Universal Health Care in Indonesia, 1990–2016: A Systematic Analysis for the Global Burden of Disease Study 2016," was published in The Lancet medical journal in late June. It is the largest systematic effort ever to examine Indonesian health trends and their causes.

As the lead author of the study, I managed a team of researchers from academia, public health institutions and the government, as well as partners at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, USA. The team analyzed 333 causes of death and disability in Indonesia and seven comparison countries — Brazil, India, Malaysia, Philippines, Thailand, Turkey and Vietnam.

We determined that Indonesia has made significant advances in the past 25 years, substantially reducing health losses caused by communicable diseases such as diarrhea, lower respiratory infection, malaria and tuberculosis. This has led to an impressive rise in life expectancy. Indonesians born today can expect to live eight years longer than those born in 1990.

However, the study also highlights significant challenges, including a "double burden of disease." While there has been great progress made against communicable diseases, for the moment they remain a substantial threat to health. Top killers like AIDS and tuberculosis require our ongoing attention and investment so that progress does not lose momentum or, worse, reverse.

At the same time, the impact of non-communicable diseases has risen sharply. This will be a major challenge for Jaminan Kesehatan Nasional, because non-communicable diseases are expensive and difficult to treat. Management of these ailments could strain the health care system for years to come.

Here's a closer look at that phenomenon: the health toll of noncommunicable diseases, like ischemic heart disease, cerebrovascular disease and diabetes is skyrocketing; death and disability from diabetes alone has increased 38.5 percent since 2006.

These dramatic increases are often caused by lifestyle choices, like poor diet and smoking. Tobacco consumption remains a particularly persistent and serious health risk. It is the fourth most important risk factor for premature death in Indonesia, the country has the world's highest daily smoking rate for men.

For the government to achieve universal health coverage, strategic investments must target this double burden of disease. Specifically, more resources are needed to further promote healthy lifestyle choices, like increasing physical activity, improving diets and reducing smoking, as well as detecting and treating diseases early. These combined efforts will help slow the rise of noncommunicable diseases.

Indonesia has a unique chance to provide universal access to quality health care across its crowded cities and quiet island communities. This study provides useful information to facilitate that process and develop more informed health policies and investments.

But this is just a first step. There are 260 million Indonesians scattered unevenly across more than 17,000 islands, and they have a diversity of health needs and risks. As universal health coverage moves forward, additional research will be needed to examine, among other things, how health is influenced by gender, socioeconomic status and geography.

Indonesians have the opportunity to live longer, healthier lives. Let's get the data to facilitate access to quality health care for all – including Amina and her family.

Dr. Nafsiah Mboi, former minister of health, is the lead author of this study. Contact her at For more information on the study, visit:

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