To Save Women’s Lives, A Health Budget Battle Needed

With the glittery economic indicators prior to the recent rupiah depreciation, Indonesia has set an ambitious plan to climb the ladder and join the developed countries league. 

These days, the hustle and bustle of the APEC economic forum and the euphoria surrounding the events, however, should not cloud us from the real hurdle to becoming a developed country. 

A big impediment to becoming a developed country came very recently, when the result of the Indonesian Demographic and Health Survey 2012 was released (The Jakarta Post, Oct. 3). From 228 deaths per 100,000 live births in 2007, the new 2012 maternal mortality rate (MMR) assumes an even higher rate than the 1997 rate, i.e. 359 compared to 307 per 100,000 in 1997. This soaring rate has put Indonesia on par with Laos and Timor Leste, two of the least developed countries in Southeast Asia.

Nonetheless we have seen it coming. Merely based on media coverage, we could see the increase of the MMR in many areas in Indonesia. The MMR being the indicator of the death of women related to their pregnancy and childbirth. Not to mention the familiar largest contributors to MMR nationwide such as Banten, East and West Nusa Tenggara, Papua, Southeast Sulawesi, West Java and even rich provinces like Bali and East Kalimantan for instance, also saw their MMR rates increase in 2011 and 2012.

Among the Millennium Development Goals (MDGs), to which Indonesia agreed to, the government has seen the MMR as the “toughest MDGs target”, following the fight to curb the figure in the past two decades. A number of programs to reduce the MMR and the infant mortality rate (IMR) have been launched since the late 1980s and early 1990’s. 

Adopted from the Safe Motherhood Initiative from the World Health Organization (WHO), we became familiar with the Village Midwife Program or Making Pregnancy Safer as part of Indonesia Sehat (Healthy Indonesia) 2010, and many campaigns to build awareness of ensuring safe pregnancies and childbirth. 

These included the advertisements on Suami Siaga, which depicted the role of the husband in ensuring his pregnant wife had regular examinations, among others, and the campaign of “Empat Terlalu”, which warned against risky pregnancies for women who were “too young, too old, too often” and pregnancies which were “too close” to one another. 

The universal maternity insurance (Jaminan Persalinan, or Jampersal) was launched in 2011 as a means to tackle this toughest goal, despite some operational glitches so far.

Many factors affect the MMR. The most often are irregular mother’s antenatal and post natal visits, birth attendance by poorly trained attendants with lack of facilities, as well as pregnant mothers’ low nutritional level and health condition, and the poor distribution of medical workers in remote areas.

 Road access to hospitals and health centers, water and sanitation and equipments in health facilities add infrastructure factors into the equation. Not to mention the role of women’s education, women’s empowerment and other social, economic and cultural factors. 

Whether the soaring MMR is caused by different data collection methods or failure of the family planning program, something significant is missing from public debate: the budget allocation for the health sector. Despite its daunting importance to improve the quality of life of millions of Indonesians, Indonesia’s health budget comprises only a modicum of the state budget.

If the United States government has been shut down these days because of the fight between the current government and the opposition over US President Barack Obama’s Medicare insurance, we hardly hear the battle over health budget at the House of Representatives. 

Only few legislators have demanded an increased budget for health, as well as more effective use of the low budget allocation, which was only 3 percent of the total state budget, lower than Health Law 2009 mandate, which is 5 percent.

 In particular for reducing the maternal and infant mortality rates, the state budget plan (RAPBN) for 2014 only allocates Rp 248 billion (US$215 million) or only a minuscule 0.53 percent of the budget allocation for maternal and child health, more than 20 times less than the cost to bailout an unimportant bank like Century, for instance. 

In contrast, other not-so-performing economies like Nepal have performed incredibly in terms of reducing its MMR. The Economist last month cited the remarkable decline of MMR in Nepal as one of the main reasons why the country’s poverty reduction rate fell significantly. 

Between 1996 and 2010, Nepal cut half of its MMR from 539 to 229 per 100,000 live births, which also decreased infant mortality rate by 50 percent. Data of the WHO last year showed that Nepal’s health sector received 2 percent of its total gross domestic product (GDP) while Indonesia only has 0.8 percent. A combination between emphasizing maternal health services and a more significant health budget share has proved significant in saving women’s lives. 

If we want a breakthrough, we should take a bold step. In the 2014 budget plan, the Health Ministry receives approximately 1 percent less of the budget share than the Religious Affairs Ministry and about four times less than the Defense Ministry. Our politicians in Senayan must be bold enough to fight the battle to comply with the Health Law’s mandate i.e. to increase health budget to 5 percent or at least close to it. 

Coupled with improved health policies and management, we could achieve what Nepal has achieved, or even more. And that is not too much to ask from a nation that dares to set an ambitious target to become a developed country.


*) Victoria Fanggidae: The writer is a program and research manager at Perkumpulan Prakarsa (Center for Welfare Studies), Jakarta, and a postgraduate from the University of Melbourne’s Development Studies Program.

Published: The Jakarta Post 22 Oct, 2013

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