Jakarta. United Nations Special Rapporteur Dainius Pūras on Monday (03/04) urged Indonesia to prioritize investments in primary health care, address mental health issues and scale up reproductive services in a preliminary report from his first visit to the country.
"Despite commendable efforts [from the government], availability, access to and quality of health services remain a challenge in a country where populations spread throughout thousands of islands," Pūras said.
Pūras, a special rapporteur on rights to health, has been in Indonesia since March 22, visiting health facilities in Jakarta, Padang, Labuan Bajo and Jayapura to assess public satisfaction on the services, especially within the framework of health-related Sustainable Development Goals (SDGs).
Pūras noted that Indonesia has made important strides to improved health care for its citizens, with a strong focus on primary care and universal access for the poorest of its population.
However, Indonesia’s ambitious plan of universal health coverage by 2019 would require the government to embrace principles of non-discrimination, accountability, participation, empowerment and formed consent, according to the UN expert.
He added that health care system in Indonesia "needs to go beyond the narrow biomedical model" to ensure "holistic, equitable and ethical care" is available for all citizens.
"The government is committed to make sure every Indonesian has access to health care," Foreign Minister Retno Marsudi said on Monday during her meeting with Pūras.
Pūras in his report criticized Indonesia’s tough anti-drug policy, describing it as "excessively punitive." He said the current approach undermines the rights to health for people who use drugs and overall public health efforts in the country.
He also encouraged Indonesia to develop a system that promotes mental health for everyone, saying that "mental health needs to be addressed as an equally important part of general health."
"While infant or child mortality rate has considerably been reduced over the past decade, Indonesia’s maternal mortality remains high and continues to pose problems in improving women’s quality of life," Pūras said.
Existing legal restrictions for young, unmarried couple to access services such as contraception and legal requirement for parental or spousal consent are some of the barriers that women face, which in turn contributes to unplanned and unwanted pregnancies and vulnerabilities to sexually-transmitted diseases.
Among the issues regarding sexual and reproductive health, Pūras shared that he was discouraged to hear sexual education has been hindered and influenced by religious groups opposing policies and initiatives because they claim it promotes sexual promiscuity or homosexual propaganda.
Health care in Papua
In his preliminary report, Pūras also highlighted that HIV/AIDS remains a concentrated problem among key affected populations, particularly ethnic Papuans, who still face stigma and discrimination, even in health care.
Maternal health in Papua also lags behind other parts of Indonesia, a regional concern that should be taken into consideration by the Indonesian government.
Prioritizing primary care
Pūras said an efficient health care system can be realized by prioritizing investments in primary care.
"Puskesmas [community health center] needs to be supported so that most health cases are effectively managed at the primary care level, and only complicated cases are referred to specialists and hospitals," Pūras said.
He added that an important precondition for universal health coverage is to have primary health care serving not only the poor, but also gaining "the trust of more affluent sectors of society."
Pūras will elaborate his findings in a comprehensive report and submit it to the UN Human Rights Council in June 2018.