TY - JOUR
T1 - Priorities and realities
T2 - Addressing the rich-poor gaps in health status and service access in Indonesia
AU - Utomo, Budi
AU - Sucahya, Purwa K.
AU - Utami, Fita R.
N1 - Funding Information:
This work was financially supported by the Ford Foundation through the grant number 1090-0520 to the Faculty of Public Health University of Indonesia. The authors appreciated the Indonesia Epidemiology Network for reviewing the draft manuscript. We are thankful to the staff of the Central Board of Statistics for the help tabulating relevant data from the Indonesia Demographic Health Surveys and the National Socio-Economic Surveys. We are also thankful to Ms. Suzanne Blogg for editing the grammar. We greatly acknowledge Anna Coates, Bruno Marchal and Glyn Chapman for sharing the idea of institutional analysis. The power point version of this paper was presented at the International Conference on Health and Mortality Transition in East and Southeast Asia, organized by Australian Demography and Social Research Institute, the Australian National University, Canberra, 25-27 October, 2010.
PY - 2011
Y1 - 2011
N2 - Introduction. Over the past four decades, the Indonesian health care system has greatly expanded and the health of Indonesian people has improved although the rich-poor gap in health status and service access remains an issue. The government has been trying to address these gaps and intensify efforts to improve the health of the poor following the economic crisis in 1998. Methods. This paper examines trends and levels in socio-economic inequity of health and identifies critical factors constraining efforts to improve the health of the poor. Quantitative data were taken from the Indonesian Demographic Health Surveys and the National Socio-Economic Surveys, and qualitative data were obtained from interviews with individuals and groups representing relevant stakeholders. Results: The health of the population has improved as indicated by child mortality decline and the increase in community access to health services. However, the continuing prevalence of malnourished children and the persisting socio-economic inequity of health suggest that efforts to improve the health of the poor have not yet been effective. Factors identified at institution and policy levels that have constrained improvements in health care access and outcomes for the poor include: the high cost of electing formal governance leaders; confused leadership roles in the health sector; lack of health inequity indicators; the generally weak capacity in the health care system, especially in planning and budgeting; and the leakage and limited coverage of programs for the poor. Conclusions: Despite the government's efforts to improve the health of the poor, the rich-poor gap in health status and service access continues. Factors at institutional and policy levels are critical in contributing to the lack of efficiency and effectiveness for health programs that address the poor.
AB - Introduction. Over the past four decades, the Indonesian health care system has greatly expanded and the health of Indonesian people has improved although the rich-poor gap in health status and service access remains an issue. The government has been trying to address these gaps and intensify efforts to improve the health of the poor following the economic crisis in 1998. Methods. This paper examines trends and levels in socio-economic inequity of health and identifies critical factors constraining efforts to improve the health of the poor. Quantitative data were taken from the Indonesian Demographic Health Surveys and the National Socio-Economic Surveys, and qualitative data were obtained from interviews with individuals and groups representing relevant stakeholders. Results: The health of the population has improved as indicated by child mortality decline and the increase in community access to health services. However, the continuing prevalence of malnourished children and the persisting socio-economic inequity of health suggest that efforts to improve the health of the poor have not yet been effective. Factors identified at institution and policy levels that have constrained improvements in health care access and outcomes for the poor include: the high cost of electing formal governance leaders; confused leadership roles in the health sector; lack of health inequity indicators; the generally weak capacity in the health care system, especially in planning and budgeting; and the leakage and limited coverage of programs for the poor. Conclusions: Despite the government's efforts to improve the health of the poor, the rich-poor gap in health status and service access continues. Factors at institutional and policy levels are critical in contributing to the lack of efficiency and effectiveness for health programs that address the poor.
KW - Indonesia
KW - child and infant mortality
KW - health inequity
KW - health service access
KW - institutional and policy factors
KW - prevalence of underweight children
UR - http://www.scopus.com/inward/record.url?scp=80655132136&partnerID=8YFLogxK
U2 - 10.1186/1475-9276-10-47
DO - 10.1186/1475-9276-10-47
M3 - Review article
C2 - 22067727
AN - SCOPUS:80655132136
SN - 1475-9276
VL - 10
JO - International Journal for Equity in Health
JF - International Journal for Equity in Health
M1 - 47
ER -