Indonesia

GREETINGS……
After looking at all my previous post, a thought struck my mind. I have been talking about disaster management in Indonesia, mHealth and also rational drug usage policy of Indonesia, but I haven’t really talked about the actual health problems outline in diverse country.
Indonesia is the fourth most populated country in the world, with 300 ethnic groups speaking 350 languages spread over the country's 6,000 inhabited islands. For 30 years from 1967, Indonesia made remarkable progress. A period of economic growth raised per capita income from US$50 in 1968 to US$ 1,124 in 1996, despite an increase in population from 147 million in 1980 to 179 million in 1990, with a forecast of 210 million in the year 2000. Between 1980-1990 the annual population growth rate was 1.9%, with a Crude Birth Rate of 22.5 per 1000 and a Crude Death Rate of 7.4 per 1000 in 1998. The population pyramid grew towards an older population, with a life expectancy at birth of 64 years for males and 67 years for females (1996). As a consequence of better socio-economic development and improved preventive and curative services, the infant mortality rate declined from 142 per 1000 in 1968 to 50 per 1000 in 1998. The proportion of the population living in poverty dropped from 60% in 1970 to an estimated 11 -13% in 1996. Most of the poor lived in rural areas, in some of the remote islands or upland areas. By 1997 the literacy rate for those aged 10 years or more was 89%. These achievements received a severe set back in mid-1997 when the Indonesian economy collapsed. The value of the currency plummeted, prices increased, and unemployment rose dramatically. In addition, parts of the country suffered from long droughts and extensive forest fires. This sudden crisis resulted in political turmoil and, in 1998, a change of government. The ensuing political instability has had a direct impact on economic recovery. The proportion of population living in poverty increased from the estimated 11-13 % (1996) to 24.2%(1998).

Although the health status of Indonesians has not been affected drastically in the short term, the economic crisis has certainly slowed development of the health system. The Government of Indonesia is taking special steps to protect the health of its population through the modification of its Seventh Five-Year Plan (Repelita VII), but the pace of progress in solving health problems has been slow. The health status of Indonesia still lags behind neighboring countries. Maternal mortality in particular is very high at 334 per 100,000 live births (1997). Moreover, national figures mask considerable regional disparities in health indicators. For example, the infant mortality rate ranges from 27 per 1000 live births in Jakarta to 90 in West Nusa Tenggara(1998). In Indonesia, Communicable diseases are a major cause of morbidity and mortality in Indonesia. Technical strategies for communicable disease control have already been accepted, adapted to country-specific needs and adopted. However, implementation of these accepted strategies needs to be improved, particularly given the shift to a decentralized health system. Major problems include:

1. Tuberculosis which is the second highest cause of death and the primary killer among infectious diseases. An estimated 175,000 people die every year from tuberculosis. The DOTS strategy has been expanded to 225 districts (74.8%) out of a total at of 311 districts, covering 88 out of the 210 million people. Case finding is presently only 10% of the expected incident cases.
2.  Leprosy is on the verge of being eliminated. Current efforts focus on final campaigns.
3.  Dengue fever/dengue haemorrhagic fever usually occurs in epidemic proportions during the peak season, starting in November and peaking in May. In 1998, 30,000 cases were reported from cities and also from some rural areas.
4.  Malaria is still a public health problem. Approximately 1.5 million cases are detected annually. In 1997, the parasite incidence ranged from 0.12 per 1000 population in Java and Bali to around 40 per 1000 population, under 10 years of age, in the outer islands. In 1998, there were malaria outbreaks in the highlands of Irian Jaya and resurgence in Central Java.

Apart from that, Indonesians are increasingly exposed to health risks from environmental hazards. Cases of severe urban air pollution and massive air contamination of ground and surface water resources by industries and households are common. Many potentially harmful chemicals are readily available to the public and are regularly used at places of work in agriculture, industry and commerce. Food contamination of both microbiological and chemical origin is a major issue. The haze from the forest fires in Indonesia has had significant disruptive social and economic effects on people living in affected areas. However, there is little serious commitment to tackle these problems because of complexity of the issues, and a lack of clear responsibilities both in the public and private sectors. In addition Indonesia is currently facing a large number of complex emergencies arising from multiple natural disasters and many areas of civil unrest. Vast displacements of populations - amounting to about 1 million by the end of 2000 -have taken place in West Timor, Malukus, and Aceh provinces.

This is the diagram showing Indonesia and its location in the pacific Ring of Fire. It poses a risk of Indonesia being struck by natural disaster such as earthquake and volcano eruption.

As for this diagram, it shows the list of major volcano in Indonesia and also its respected location:

Fortunately, above all of the aforementioned health problems and disaster risk, Indonesia still maintains its image as one of the most friendly and beautiful country in South East Asia, which also have some other unique and exotic nation such as MALAYSIA, Philippines and Thailand.