$Unique_ID{bob00246} $Pretitle{} $Title{Indonesia Health and Welfare} $Subtitle{} $Author{Department of Information Republic of Indonesia} $Affiliation{Embassy of Indonesia, Washington DC} $Subject{women health family planning development program indonesia services women's organizations see pictures see figures see tables } $Date{1990} $Log{See Table 25.*0024601.tab } Title: Indonesia Book: Indonesia 1990 an Official Handbook Author: Department of Information Republic of Indonesia Affiliation: Embassy of Indonesia, Washington DC Date: 1990 Health and Welfare The policy of health development is directed to the development of an integrated national health system. It strives to avail better health services to the people through Public Health Centers, hospitals as well as a more sufficient and equitable provision of drugs which the people can afford. The policy also covers efforts to improve public health through eradication of contagious diseases, improvement of nutrition, clean water supply and environmental sanitation. The policy of health development is formulated in the Panca Karya Husada or the Five Efforts in Promoting Public Health which are: strengthening and consolidating health endeavors; training and upgrading health personnel; control, providing and supervising drug supply, food and other substances which could be hazardous to health; improving nutrition and environmental health and strengthening and consolidating management and legal order relating to health. In The Fourth Five-Year Development Plan (REPELITA IV) achievements have been made in efforts concerning: 1. Health services; 2. Eradication of contagious diseases; 3. Improvement of nutrition; 4. Clean water supply; 5. Improvement of environmental health; 6. Health guidance; 7. Provision, control and supervision on food and drugs. HEALTH SERVICES More Public Health Centers (PUSKESMAS) had been set up in order to step up health services to the people, and with active participation of the community on health care programs, optimum health condition can be enjoyed by the people. In the last two years of the Fourth REPELITA, health-care facilities in three PUSKESMAS, one each in the provinces of Aceh, Jambi and East Timor, had been promoted to be able to treat in-patients and 41 Sub-PUSKESMAS had been constructed. In the meantime the POSYANDU (the Integrated Health Services Post) have been made available, also by active participation of the community in 200,000 villages throughout the country. POSYANDU provides key basic services at the community level and in 1986 the President has declared POSYANDU as the national health strategy for the 1986-1996 Decade for Children. Maternal and child health services are primarily handled by trained midwives and paramedical personnel. In 1988/89 2,500 traditional birth attendants had undergone training courses and another 5,000 in five provinces obtained upgrading courses. In order to promote equitable, effective and efficient maternal and child health services to the community, activities are carried out together with those of UPGK's (Family Nutrition Improvement Program) weighing posts and integrate the primary health services -- growth monitoring and nutritional counselling (child weighing), family planning, diarrheal disease control through ORT (oral rehydration theraphy), maternal care and immunization -- in the POSYANDU. (Integrated Health Services Post). The School Health Effort (UKS) program, which aims to improve health condition of school children, has served 8,080 schools with the assistance of 2,020 Public Health Centers (PUSKESMAS). Hospital services is a part of the health service network and it is categorized in four classes. The D class hospitals are of 25 to 100 bed capacity, the C class 100 to 400 beds with four primary medical specialists (internal disease specialist, surgeon, gynaecologist, pediatrician), B class has 400 to 1,000 beds and physicians of all branches of medicine. The A class hospitals are those with more than 1,000 beds and sub-specialist doctors. Until 1988/89 there are 1,481 hospitals consisting of 749 general hospitals with 23,680 bed capacity and 732 special hospitals with 13,820 bed capacity. To support private hospitals in their efforts on the improvement of health services, in the Fourth REPELITA drugs, medical equipment and ambulances were annually provided to 70 - 90 private hospitals, particularly those delivering more health services to the low-income group of the community. Until the fifth year of the Fourth REPELITA 27 provincial medical laboratories have been put in operation, of which 25 are representative buildings. By a presidential instruction on health facilities, for 1988/89 a budget of Rp 450 per head is allocated for medical assistance aside from an addition of 1,300 medical doctors, 14,549 paramedical personnel and 30 housing units for accommodation of medical doctors working at the Public Health Centers. These doctors are also entitled to continue studies to become specialists, when they have accomplished their term of service at the PUSKESMAS. ERADICATION OF CONTAGIOUS DISEASES PROGRAM Eradication of contagious diseases is focussed on the prevention and eradication of diarrhea, malaria, lung tuberculosis, arbovirosis, schistosomiasis as well as in keeping close surveillance on possible epidemics. In 1988/89 2.5 million of diarrhea patients were treated and 4,336 PUSKESMAS implemented the Program of the Eradication of Diarrhea (P4D) In effort to combat malaria the spraying of pesticide has been carried out, together with actions to collect blood samples and treatment of malaria patients. There were 534,500 houses sprayed and 3.35 million of blood-samples collected for laboratory tests in 1988/89. Prevention and eradication of lung tuberculosis are carried out through guidance in hygiene and application of BCG vaccination to children. During the Fourth REPELITA 15.3 million children were vaccinated, while 766,000 underwent bacteriological lab-tests and 73.5 thousand went under treatment. Other contagious diseases are prevented through mass immunizations which are particularly administered to infants, children and pregnant women. Vaccination against diphteria, whooping-cough, tetanus, and neotorum tetanus, polio, measles and lung tuberculosis had been stepped up. Those inoculate against polio and measles had increased in the Fourth REPELITA and 77.9 million were children and pregnant women. WATER SUPPLY AND ENVIRONMENT SANITATION Water is a critical part of personal hygiene and directly relate to the reduction of diarrheal diseases, skin diseases, eye diseases and ectoparasitic diseases. Since water is a community priority, it can serve as an entry point around which other basic services such as sanitation and hygiene education can be organized. The government has given priority to the improvement of water supply and sanitation services. During the Fourth REPELITA construction had been made of a piped distribution system from 154 water springs, 67 artesian wells, 14,943 reservoirs to collect rainwater, 163,531 hand-pumped shallow wells, more than 27,232 hand-pumped deep wells and 46,953 dug wells. To promote environmental sanitation, efforts are directed to check the condition of residential environments, latrine facilities and sewer systems. In line with this 68,587 private latrines with septic tanks have been made available for rural households and 53,774 sewer facilities installed in the Fourth REPELITA. In 1988/89 regular checkings have been made at 22,758 public sites; the processing, storage and selling of food and drinks; the storage, using and distribution of pesticide; 108 cases of food-poisoning have been checked out, 279 housing complexes have seen improvement in environment sanitation, 45 cases of pesticide pollution have been checked and 11,191 garbage dumping sites and industrial areas have been put under control for sanitation purposes. INFORMATION ON HEALTH A better access to information on health has been made available during 1988/89 namely through 9,967 radio broadcasts, 333 television broadcasts, 841,325 articles in print media and one documentary film. PROVISION, CONTROL AND SUPERVISION ON FOOD AND DRUGS Efforts have been made to increase the production and improve the quality of medical equipment and domestically-made drugs to meet the demand of consumers. In line with this, raw material for essential drugs are produced domestically and soluble medicine containers are also domestically produced with a capacity of three billion capsules per year. For intensive control on drugs and food, regular checking on production facilities and distribution of drugs and food had been made to more than 1,500 units, while 3,500 samples of drugs, food and other pharmaceutical supplies have been examined. Meanwhile, up to 1988/89 13,850 kinds of drugs consumed by the community had been registered. FAMILY PLANNING It is directed by the 1988 Guidelines of State Policy that the family planning program should be further promoted and expanded to all walks of life especially the young generation and also in transmigration areas. It is also mentioned that participation in family planning should be increased based on awareness and responsibility and also on a voluntary basis, taking into consideration religious values and those of the followers of Belief in the One and Only God as well as the social norms and morality. Initiated officially in 1970 under Presidential Decree No. 8 of 1970, the family planning program is a direct effort, aimed at lowering the rate of childbirth by the use of permanent contraceptives. It is realized that the success or failure of the family planning program will contribute to the success or failure of efforts to increase the prosperity of the Indonesian nation. However great the success of the achievements in other development efforts, the success will be to little avail if the population explosion fails to be curbed. It would even be impossible to raise the standard of living and the welfare of the people effectively and equally. For these reasons population explosion has become an acute problem and has to be handled seriously. In this connection the President of the Republic of Indonesia, Soeharto, has instructed a competent organization, the National Family Planning Coordinating Board (BKKBN) to accelerate its efforts. Soon the board in association with both the executive units of the government and non-government institutions works out various activities: such as recruit a number of family planning field officers, add family planning clinics, develop and introduce various approaches and methods, augment dissemination of related information, maintain and replenish the availability of effective contraceptives as well as continuously monitor and encourage eligible couples to carry out the program. The result of the aforementioned drives is tangible. The country's population growth rate declined gradually from 2.3% in the last year of the second Five-Year Development Plan (REPELITA II) in 1978/79 to 2.2% in the last year of REPELITA III in 1983/84, and it decreased further to 2.1% during the final year of REPELITA IV in 1988/89. In the last year of REPELITA V the population growth rate is expected to drop further to 1.8%, so that the average annual growth rate in the next five years will be 1.9%. At the same time crude birth rate declined from 33.5 births per thousand in 1983/84 to 28.7 in 1988/89, and fertility level dropped from 4.6 per woman of 15-49 age cohort in 1980 to 3.5 in 1988. Meanwhile infant mortality rate decreased from 90.3 in 1983 to 58.0 per thousand livebirths in 1988. The number of family planning clinics increased from one year to another. In 1983/84 it grew modestly from 7,064 clinics, of which 556 are privately run, to 9,388 including 1,065 private-run clinics in 1988/89, making an increase by 33%. The number of private-run clinics rose by 90%. Also during the same period 290 Public Health Centers and 240 hospitals were rehabilitated. To keep abreast with the increase of clinics, the number of family planning personnel also augmented to reach 37,263 in 1988/89 against 32,715 in 1987/88 and 20,953 in 1983/84. Medical doctors increased by about 83%, midwives and nurses around 87% and administrative personnel 51%. In 1988/89 new eligible couples participating in family planning totalled 5,423.8 thousand comprising 3,707.5 thousand from Java and Bali and 1,716.3 thousand from outside Java and Bali. It makes the number of new eligible couples participating in family planning total 24,679 thousand during the period of 1984/85 to 1988/89 or 0.3% below the target set for the said period. In 1988/89 the number of active family planning participants reached 18.8 million eligible couples, an increase of 30.1% compared with that of 1983/1984 which only numbered 14.4 million. Meanwhile, the total number of eligible couples in 1988 was estimated at 30.0 million. [See Table 25.: Target Achievement by New Family Planning Participants, 1985/86 - 1988/89 in thousands] The main supporting facility which ensures the success of the program is the availability of contraceptives in family planning clinics. In 1988/89 the supply of contraceptives consisted of 29.3 million cycles of family planning pills, 254.6 thousand IUDs, 277.7 thousand gross condoms, 12.7 million vials injectables, and 275.8 sets of implant. Meanwhile, active family planning participants using family planning pills declined to 50.4% in 1988/1989 from 55.4% in 1983/84, those using condoms dropped to 3.8% from 4.9%. On the contrary, active family planning by way of injections rose from 9.6% in 1983/84 to 17.2% in 1988/89. As the income of the average family planning participants has been rapidly improving with the growing economy, the concept of KB Mandiri (auto-capacity family planning) under the popular logo Lingkaran Biru (the Blue Circle) was introduced in 1986. By this concept family planning participants are encouraged to purchase contraceptives from private of commercial sectors instead of using the contraceptives provided by government clinics. The success of the family planning program has been widely acknowledged by the international community. The interest of the world in the population and family planning program of Indonesia is reflected by the willingness of other countries and international agencies to provide aid and also the ever-increasing number of guests from abroad who wish to see and even study on how the population and family planning program in Indonesia is being carried out. Moreover the Global Statement Award in Population from the Washington-based Population Institute and the 1989 UN Population Award, both for President Soeharto, is indeed inseparable from the country's successful implementation of family planning program. WOMEN IN DEVELOPMENT LEGAL BASIS The 1945 Constitution makes no distinction between women and men, securing equal rights and obligations in all fields, be it in education, law, health, political participation or employment. Moreover, Indonesia has ratified the 1952 United Nations Convention on the Political Rights of Women, under which women are guaranteed equal rights to employment, to vote and stand for election, and to hold public office. The country has also endorsed the United Nations Convention on the Elimination of All Forms of Discrimination Against Women. Meanwhile, the Guidelines of State Policy has also underlined equitable opportunities for Indonesian women to take part in national development. The Guidelines of State Policy of 1988, for instance, states that women, as citizens and human resources for development, possess the same rights, obligations and opportunities as men do in all aspects of civic life and in all development activities. While also underlining the special role of women in family life, particularly in the care and guidance of children, the Guidelines of State Policy emphasizes the necessity of developing socio-cultural climate which will stimulate wider participation of women in all fields, and of enforcing women's capabilities by enhancing their knowledge and skills. Further, subsequent regulations and legislative acts have also strengthen the guarantees set out in the 1945 Constitution and international conversions of equality between women and men regarding workers' rights, vocational education, safe working conditions and job security. Civil servant women are entitled to equal pay for work of equal value. They are also entitled to receive full pay during pregnancy leave, leave of absence following a miscarriage, and to time off from work at times to nurse their infants. THE ROLE OF WOMEN Favored by the country's history and cultural traditions, women in Indonesia have for decades and even centuries taken part freely and actively in the affairs of everyday life such as in agriculture, commerce and social affairs. In modern Indonesia, women are represented in the legislature, the President's Cabinet, the armed forces, police, civil service, etc. Many more women are now participating in the labor force, the proportion of which shows an encouraging tendency approaching a more balanced proportion. They are easily accepted and generally well-represented in professional and technical fields such as medicine and law. Moreover, there are now many more women graduating from universities. POLICY To drive the role of women in all fields of the national development, principal policies have been set out: 1. to improve the role of women as housewives in realizing healthy and prosperous families; 2. to escalate the role of women as labor force through the expansion of job opportunities in the various sectors of development; 3. to increase and develop more integratedly the role of women in various development fields through among other things improvement of vocational education; 4. to enhance women's abilities, and to develop a socio-cultural climate conducive to the participation of women in development; and 5. to improve and develop the role of women in a more integrated way in the various fields of development for the enhancement of the Indonesian people's abilities to grow and develop towards the creation of a just and prosperous society based on the Pancasila tenet. In line with these principal policies, in effort to enhance the role of women, especially that of the rural women, various endeavors have been done such as provision of guidance on marriage law, popularization of P4 (using the simulation method), eradication of illiteracy including inability to speak the Indonesian language, by the Family Welfare Movement (PKK) and the Women Promotion Program towards a Healthy and Prosperous Family (P2WKSS). These movements have encouraged and implemented programs on various farming undertakings particularly in how to make use of the yards around the houses, gardening of vegetables, health guidance, immunization and family planning. The office of the Minister of State for the Role of Women is responsible for the planning and formulation of government policies regarding the enhancement of the role of women in all fields of development. It also coordinates all activities for cooperative, balanced and integrated efforts in the overall implementation of development programs. The office coordinates operational activities of various government agencies, non-governmental institutions and organizations concerning programs for the enhancement of the role of women in development, and also submits reports, information and recommendations. WOMEN'S ORGANIZATION Since they first emerged in the second decade of this century, women's organizations have played an active role in the country's political, social and economic life. The policies and programs adopted by these organizations have been generally government's national development efforts oriented. Almost all of these organizations now promote functional literacy or non-formal education programs of one sort or another. For instance, over 90% of all kindergartens are managed by women's organizations. Some are even active in formal education, from primary to university level. Some of these major women's organizations are: KOWANI (Indonesian Women's Congress), set up in 1932, is a federation of 64 nation-wide women's organizations, ranging from professional groups to religious associations. This federation has been a member of the ASEAN Confederation of Women's Organizations (ACWO) since 1981 and the International Council of Women (ICW) since 1973. In 1986 it was elected as a voting member of ICW and in 1988 as Vice-President of ICW. DHARMA WANITA, established in 1974, is an organization of the wives of civil servants and has its units in the government agencies and institutions. Its activities support government social development programs such as functional literacy, family planning, health, nutrition, environmental preservation and cooperatives. It also runs thousands of kindergartens, schools for the handicapped, primary schools, junior and senior high schools, and vocational schools at both primary and secondary levels, and is an active supporter of charities. DHARMA PERTIWI groups the four organizations of the wives of armed forces personnel Kartika Chandra Kirana (Army), Jalasenastri (Navy), Pia Ardhya Garini (Air Force) and Bhayangkari (Police). DHARMA PERTIWI manages basic education classes, kindergartens, primary schools, junior and senior high schools, vocational and technical schools as well as schools for the handicapped. It also engages in charity activities. There is also the Indonesian National Commission to the Status of Women (KNKWI), established in 1968 in response to the UN Commission on the Status of Women to set up a national commission in the member states. Its 45 members represent women's organizations and a number of government departments considered relevant to their task of conducting surveys and research, analysing and proposing recommendations pertaining to women. As a semi-governmental autonomous body which is working towards advancement of the status and position of the Indonesian women, both in the family and society, KNKWI maintains cooperation with the Office of Minister of State for the Role of Women. The Family Welfare Movement (PKK) is a voluntary, integrated and organized movement for programs and activities directed to improve the welfare of the family in which the women are the central figure. As a movement, PKK strives for the implementation of its ten main programs which cover the major aspects of family welfare, namely: the socialization of Pancasila and its application in daily life, mutual self-help, nutritious food, clothing, housing and household management, education, knowledge and skill, primary health care, promotion of co-operatives, protection and conservation of the environment, and appropriate domestic planning. PKK motivating teams are formed at national, provincial and local levels, which facilitate and monitor activities at lower levels. The Chairperson of the National PKK Motivating Team is the wife of the Minister of Home Affairs, and this structure is generally paralleled at lower levels, with the governor's wife heading the province's motivating team, the bupati's wife the district team, and so on. At village level, the PKK forms one section of the Village Development Council (LKMD) which is responsible for enhancing community participation in the planning and implementation of local development activities. The chairperson of the village PKK Motivating Team also serves as the vice-chairperson of the Village Development Council. In recognition of its outstanding performance in motivating the people in development, PKK was awarded UNICEF's Maurice Pate Award and WHO's Sasakawa Health Prize in 1988. REGIONAL AND INTERNATIONAL FORA In the context of regional cooperation among ASEAN member states, the ASEAN Women's Program (AWP) was officially set up in 1976, and a representative from Indonesia was chairperson of ASEAN Women's Program in the period of 1981 - 1984. Under this program, the National Scientific Information and Documentation Centre of the Indonesian Institute of Sciences (LIPI) has been commissioned to act as the manager of the clearing house on women in development in ASEAN countries. In 1981, the ASEAN Confederation of Women's Organizations (ACWO) was founded for NGO's in the ASEAN region, of which KOWANI is a member. KOWANI had been the chairperson of ASEAN Confederation of Women's Organizations during 1981 - 1984. In the 1984 ECOSOC Conference, Indonesia was elected member of the Board of Trustees of the United Nations International Research and Training Institute for the Advancement of Women (UN INSTRAW) for the period of 1984-1987, and re-elected for 1987-1990 period. In the United Nations Commission on the Status of Women (UNCSW), Indonesia was a member for the period of 1983 to 1986. By virtue of Act No 7 of 1984, Indonesia ratified the Convention on the Elimination of all Forms of Discrimination Against Women, and became member of the UN Commission on the Elimination of Discrimination Against Women (UN CEDAW) for the period of 1986-1990. The Indonesian delegation attended the World Conference to Review and Appraise the Achievements of the UN Decade for women held in Nairobi, Kenya, from 15-26 July 1985. Also in July from the 8th to 17th, 1985 the Conference of NGO Forum was held in which Indonesian participants coordinated by KOWANI took part. In this forum, KOWANI presented a paper entitled "Women as a Driving Force in Development, Why and How", with the subtitle "The Case of Non-governmental Organizations in Indonesia". In 1985 KOWANI, as a member of the International Council of Women (ICW), hosted the Asia-Pacific Seminar Training Workshops with the theme "Challenge for the Family in a Rapidly Changing Society". The General Chairperson of Indonesia's Family Welfare Movement (PKK) was elected a Senior Women Advisor of the Executive Board of the United Nations Environment Program (UNEP).