Medical workers simulate isolation procedure for Covid-19 patients at Margono Soekarjo Hospital in Banyumas, Central Java, early this month. (Antara Photo/Idhad Zakaria)

Mainstreaming the Health Agenda in Indonesian Politics


FEBRUARY 18, 2020

Jakarta. The coronavirus outbreak has caused panic and hysteria among Indonesians. The last time we see this happening was during the SARS outbreak in 2003.

The government has taken the extraordinary measure of evacuating hundreds of Indonesians from Wuhan in China, the center of the outbreak, and quarantine them in Natuna Islands.

The World Health Organization (WHO), meanwhile, has declared Covid-19 – the official name for the novel coronavirus – a "public health emergency of international concern," just short of an epidemic.

People scour the latest news about the disease on their smartphones. Parents went on panic-buying for surgical masks and vitamins for their children. Previously lurking friends start posting health tips on WhatsApp groups.

All this could be seen as a positive sign of increasing public health awareness. But it is also a worrisome testament about how far public health issues are from the minds of most Indonesians. 

Indonesians only begin to care about health issues when things go bad. This stems from the peripheral position health issues occupy in the Indonesian political arena.

Health has never been at the center of the discourse for Indonesian politicians, though it is inherently a political issue.

But we rarely hear politicians speak loudly about health issues beyond promising free healthcare every election.

During the presidential and legislative elections in 2019, health issues again took a backseat to economic concerns. 

This is unfortunate since health issues are always closely intertwined with economic, developmental and ideological problems.

Nobel Laureate in Economy Amartya Sen has long argued that any effort at alleviating poverty and promoting welfare should be situated around the well-being and capabilities of human beings – ie, humans have to be healthy first before they can be prosperous. 

In many countries, competition for power is often hinged on which politicians can provide (or at least promise) the better health system.

In the United States, Republicans would promote the benefits of private health insurance while the Democrats stand firm on government-led Obamacare.

In the United Kingdom, the Conservative Party and the Labour Party argue over whether the National Health Service (NHS) should push for more or reverse privatization.

In the long run, mainstreaming the health agenda constructively transforms a country's health system since it forces politicians to do better – at least for their constituencies. 

In Indonesia, political discourses on health issues are limited to the slow pace of institutional reforms in the national health service or BPJS (Badan Penyelenggara Jaminan Sosial) and the free health service for the poor or KIS (Kartu Indonesia Sehat).

Indonesian politicians time and time again fail to understand the bigger picture of the health agenda: the multiple vexing challenges beyond fiscal and budgetary constraints, long-ignored corruption cases, excessive emphasis on curative medicine, etc. 

Sadly, there is no political process available at the moment to debate ideas to improve the health system. There is no competition to produce transformative ideas that can offer a real solution in the long run. 

Every politician agrees that the health system needs strengthening, but nobody has a clue how to do it. No political party or politician has ever made health issues the crux of their campaign.

Most efforts to mainstream the health agenda happen behind the locked doors of politicians' meeting rooms or become talking points only for the health workforce and professionals.

This might give the advantage of a "permissive consensus" – when health issues are discussed by experts and policymakers, we might expect better, and speedier, policy outcomes.

However, there also plenty of negatives.

A public transparency deficit might result from the general public being so rarely informed about health-related politics.

Since health policies are always related to the life and death of the general public, people should never be kept in the dark about what policies are being issued in their name!

We need more public scrutiny to check if efforts to strengthen the health system actually benefit the ordinary people's well-being.

More public scrutiny will also force politicians to take the health agenda more seriously and force them to come up with better ideas to strengthen the health system.

Nevertheless, Indonesians can be a little optimistic about the prospect of mainstreaming the health agenda after the success of the government's anti-stunting and environmental health campaigns.

More of Indonesia's health professionals have also joined politics, including Dr. Gamal Albin Said, Dr. Asluchul Alif, Dr. Helmi Budiman and Dr. Hasto Wardoyo. They might include the health agenda in their campaign to take it beyond the promise of free healthcare.

Mainstreaming the health agenda in Indonesian politics might seem like an immense task that would take a lifetime to achieve. But as the classic adage says, every good thing always takes time.

Abid A. Adonis is currently completing double master's degrees in international affairs at the Paris School of International Affairs, Sciences Po, and the London School of Economics and Political Science.