Thursday, 24 May 2018

Natalie Lamb and SheffWHO 2018: Position paper

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.


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