The Development of Health in the Development Reform Cabinet is carried
out through health paradigm so as to realize the "Healthy Indonesia 2010"
The main objective of health development towards Healthy Indonesia 2010
is to enhance the awareness, willingness and capability of healthy life
for individuals to realize the maximum of community's health standard through
the achievement of healthy life for the community, nation and state, marked
with the healthy citizen's behavior in their environment. Meanwhile, they
should have the capability to enjoy qualified health services justly and
equally, and they also have optimal healthy life standard in Indonesia
as a whole.
The targets of health development towards Healthy Indonesia 2010 are :
(a) healthy behavioral life;
(b) healthy environment:
(c) healthy effort;
(d) healthy development management; and (d) healthy quality.
To achieve the objectives and targets of health development towards
the realization of Healthy Indonesia 2010, there are some general policies
of healthy development such as:
(a) the Enhancement of the Public Self Reliance and Partnership;
(b) the Enhancement of Health Effort;
(c) the Enhancement the Environment Health;
(d) the Enhancement of Human Resources;
(e) the Enhancement of the Policy and management of Health Development: and
(f) the Enhancement of Research and Development.
Reform steps in the health sector consists of 12 (twelve) programs,
such as: Introducing Health Paradigm: Health Development Program oriented
to the Autonomy; Reform in the Hospital Services Sectors; Eradicating Graft
and Collusion Practice; Drug Reform Sector: Health Officers
Utility Reform: Health Services for the Poor;
Health Insurance and Community Medical Services
Insurance (JPKM): Social Safety Net in the field of health (JPS-BK) Program
Managed with JPKM Principle: Monitoring and Management of and Workers Nutrition:
Health Sector Effort in Overcoming Disasters; and Decentralization.
Since the middle of 1998, a new Health Paradigm has been introduced,
stressing in preventive and curative effort without ignoring curative and
rehabilitative services in health development. With the introduction of
this paradigm, health services will be more cost effective.
Logical consequent from this new paradigm is the need to carry out the
adjustment of health development programs and relocation of human resources
having more priority in the promotive and preventive efforts.
The health-oriented development with regional basis is always encouraged,
such as free smoking area, and healthy village, healthy island, and or
the development healthy district. Free Smoking Area has been gradually
introduced to all parts of the districts.
To develop Hospital to be a "Health Institute" as a role model for the
public at large as regard to healthy environment, safety and security of
work, as well as healthy behavior, the Ministry of Health has made a few
changes perspectively, among others, formerly a hospital functioned as
a "Curative Oriented" should be changed into "Health Care Oriented" for
all members of the families. Because its function is to take care, so hospital
does not only become "the house for patients" but it changes into a "the
existing place to take care of health".
Meanwhile, the position of Nursery and Children Hospital (RSAB) "Harapan
Kita, RS Jantung Harapan Kita, RS Kanker Dharmais" should be returned as
a technical implementator/ executor unit of the Ministry of Health and benefit
it as optimally for the interest of health development.
To implement reform in the field of medicines, the Ministry of Health
makes it compulsory for pharmacies to provide generic medicines and gradually
the Government will reduce the prices of generic medicines to make them
affordable to the people. The medicines are directly distributed to pharmacies,
hospitals and doctors from pharmaceutical factories to short cut the bureaucracy
and drug distribution.
In addition, the Government undertakes cooperation with various institutions
to develop economic raw material for pharmaceutical industry by utilizing
domestic resources and potentials especially material taken from medicinal
Under cooperation with PT Perkebunan, FT Kirnia Farma and BPPT, the
Ministry of Health encourages the establishment of medical plants plantation
by involving the people residing around the plantation; boosts partnership
between traditional medicine industry and farmers, religious boarding schools
and cooperatives around factory sites; establishment of extract factory
as well as provide information on how to establish and to utilize Family
Medicine Garden (TOGA).
Reform in the placement/utilization of new doctors and dentists is carried
out through the establishment of Reform Team on the Placement of
Doctors and Dentists, in which professional organization (IDI and PDGI)
are involved. This team is to review the placement policy of new doctors
and dentists in such a way that the placement could evenly provide medical
services but at the same time would not impede the career of those new
doctors in the future.
Destitute people should be able to enjoy better medical services as
the Government increases subsidy of medical services for those peopie and
provide them with free medical services in Public Health Centers (Puskesmas)
and government-owned hospital by using Health Card (Kartu Sehat).
In anticipation of the impact of economic crisis, the Government launched
Social Safety Net in the field of health (JPS-BK) in August 1998. This
program has been given special attention and carefully implemented. JPS-BK
program is divided into two groups of efforts, namely: a. Intervention
effort in the form of financial assistance for the operation of Puskesmas,
midwife services and provision for extra food, recovery: and b. Supporting
effort in the form of revitalization of Food and Nutrition Warning System
(SKPG), Community Medical Services Insurance and financial assistance for
provincial (Dati 1) and District Government (Dati II).
In Health Insurance, Indonesia has implemented medical services through
the Community Medical Services Insurance (JPKM) as stipulated in Law No.
23/1992. JPKM is designed to benefit all concerned parties so that the
people are protected and are guaranteed to get post medical services that
are affordable, which in turn will increase the health condition of the
For the sake of integration, the ongoing implementation of JPS-BK is
carried out based on the principal of JPKM. Meaning, the fund provided
by the Government to finance medical services for destitute people is not
directly given to Puskesmas and/or midwife in rural areas but is channeled
through organizing body (Bapel) of JPKM established in every district area
Successful implementation of JPKM will increase its role in accelerating
the decentralization as not all-medical services are managed by the central
Government or even provincial Government but are managed by each provider
of medical services involved in JPKM protlrarn. The central Government
concerns only with the legislation, provision of facility and supervision
beside provision of certain medical services for the people such as immunization,
eradication of conlagious diseases, health education, environment sanitation
and medical services for high risk elderly people as well as destitute
people through subsidy and/or direct management of various institutions.
In the framework of monitoring and handling of malnutrition, the Government
provided assistance through the implementation of SKPG in all provinces
in November through December 1998. The main objective of this activity
was among other things to increase the sense of crisis among decision-makers
in regional areas, to introduce the basic concept of SKPG (indicators,
work mechanism etc.) and to increase the involvement food and nutrition
institutions in regional areas The problem of malnutrition needs to be
handled in a professional way. For that reason the Ministry of Health has
developed a program called Tracing of Malnutrition Cases and Management
of Protein Deficiency on Children in Puskemas and hospitals. Until now
malnutrition cases in medical institutions (Puskesmas and hospitals) have
been managed professionally in accordance with WHO standard.
In JPS-BK program, efforts to maintain nutrition of the children are
undertaken by providing extra food to children aged 6 to 23 months from
destitute families. Fund allocated for this program in 1998/1999 was Rp750
per child for 3 months. In 1998/99, it has been undertaken the providing
extra food to 103.3 thousand of pregnant women who suffered from chronicle energy crisis (KEK) and 945.4
thousand children and children under 6-23 months of age. Beside, effort
to improve community/people's nutrition especially for women and
under five years old children is continually carried out through providing
high dosage A vitamin for 11.6 million under five years old children and
yodium capsule for 12.1 million people, and iron tablet (Fe) for 5.7 million
pregnant women, in the effort to overcome nutrition anemia. Effort to improve the students has been implemented
through providing extra food for 8.1 million student of PMT-AS and 52,482
student of SD/MI. Meanwhile, the improvement of the community's role is
from integrated post (posyandu) revitalization so as to support the activities
of providing extra food for pregnant women, pre-delivery women, baby and
children under one year old.
The Ministry of Health does not establish special medical services efforts
in coping with disasters. It only intensifies the utilization of the already
available facilities and infrastructure. Should there happen a disaster,
medical personnel can make use of the medical supply available at Puskemas,
pharmaceutical warehouses and hospitals. If it is felt that there are shortages
of medical supply, they can ask the nearest Kimia Farma Pharmacy to loan
them the supply while the medical assistance is provided free of charge.
In this case, an integrated coordination is established with the National
Coordinating Agency for Disaster Relief (Bakornas PB), Ministry of Social
Welfare, regional governments, medical units of the Armed Forces, police
force and National SAR (Search and Rescue) Agency.
In the framework of decentralization, hospitals that are directly managed
by the Ministry of Health will be handed over to provincial governments.
Thus, the provincial government has the authority to appoint the members
of management board of the hospital and independently manage the financial
matters. This policy is expected to reduce subsidy given bv the central
The social welfare development is part of the general welfare, and
makes up an endeavor of national movement. It is aimed at creating social
welfare by and for the whole people of Indonesia in the frame of creating
social justice, which is mentioned in the Preamble as well as in Articles
33 and 34 of the 1945 Constitution. Therefore, every citizen has equal
right to obtain social welfare and at the same time each has an obligation
to create the social welfare.
The mission of social welfare development is to implement the role in
creating a social justice by giving attention to destitute families and
the less fortune. In general, it is also to prevent, control and overcome
the social problems, including various unexpected social impacts caused
by the industrialization process, reform flow, globalization and the rapid
Furthermore, the other aim is to maintain and to strengthen social stability
and social integrity by increasing the spirit of social solidarity and
partnership among the community.
The development of social welfare is aimed at placing the basics of
social life to create a civil society. Also, it is aimed at empowering
destitute families to improve their resilience and capabilities against
the critical situation. Besides, it is to revitalize the economic life
the community as well as to prevent the spread and worsening of social
The main target of social welfare development is how the destitute families
as well as children under five (balita) can be saved and rehabilitated
from the collapse situation, which is caused by crisis and disasters.
The further target is to create and to implement the social resilience
network effectively and efficiently as well as transparently. Also it is
aimed at obtaining support and commitment from all parties. Finally, it
creates the Reform Agenda of Development for Social Welfare in general.
Based on People's Consultative Assembly Decree No X of 1998, there are
two aspects of policy and strategy of social welfare development: the sector
aspect (Kessos) and cross-sector aspect as well as the community role involvement.
The sector aspect is designed to sharpen target priorities and the activities
which are relates to social welfare service (safety rescuing, recovery,
rehabilitation as well as empowerment toward the clients/PMKS). Also it
is to improve the quality and quantity of concern and involvement of sources/PSKS,
besides to enhance professionalism and the optimal service of the social
workers by measuring the speed, accuracy, transparency, accountability
and the community participation involvement.
The cross-sector aspect and the community role involvement are designed
to increase coordination, starting from data collecting, planning, implementing
and evaluating coordinated in the centers (KOKESRA and TASKIN) and local/provincial
level which is focused on bottom-up principle and decentralization as well
The steps of reform on social welfare development consist of three
points, which are:
First, it is to reorient the vision and mission of social welfare development
from the residual charity approach to universal one, not only in the form
of full and total comprehension, recovery and empowerment, but also protection
in its role to cope with the social impact of monetary crisis.
Secondly, it is to carry out rescue program and empowerment toward the
groups of destitute families such as children, elderly people and poor
people families who are directly affected by the crisis through the social
resilience networking as well as the victims of social riots.
Thirdly, it is to grow and to enhance the spirit of social solidarity
among the communities who work together with the government level to care
about and take role in overcoming the crisis impact. Then, they make coordination
with related government agencies so that the impact of crisis can be handled
by more integratedly and directly.
Outstanding achievements have been noted in the field of protection
towards children and youths; empowerment of communities; attention to the
elderly people welfare; overcoming of disaster; making efficient use of
foreign aids; encouraging the soul and the spirit of KSN (National Social
Solidarity); improving ofPKS (Social Welfare Development) management; and
In the effort of protecting the children and youths from the critical
situation to be capable in implementing their social functions, in 1998/1999
assistance has been provided to 128,870 neglected children who live in
private or government orphanages, as well as handling 26,000 of street
children in 12 cities. These are not only implemented by local government,
but also by non-governmental organizations (LSM) and many religious organizations
Meanwhile, development effort has been implemented to improve the quality
of social service for caring children and their environment To support
these programs (Law No. of 1979 on Children's Welfare), there is currently
issued a Government Regulation on Children Protection.
In implementing community empowerment, it is directed to those with
less income, such as the socially underdeveloped tribes, the very poor
families, the victims of natural disasters as well as marginal community
groups who are affected by the monetary crisis. In 1998/1999, development
efforts have been provided to cover 5,131 families of the socially underdeveloped
tribes in 18 provinces, to 114,924 very poor families , as well as to 16,450
destitute families in 25 provinces.
In 1998/99 social assistance was extended in the form of social guidance,
vocational guidance and provision of work capital to 124,924 very poor
families over 2,891 villages. The amount of work capital is according to
their skill. Efforts for empowerment of the very poor family is carried
out by way of group approach that has succeeded to increase social relation
among members, to encourage mutual cooperation and solidarity in facing
crisis. The increase in cooperation, and access to the various social service
resource, guidance for members to benefit from the production economic
yield to meet the basic need of the family members, as well as together
solving the problem of a member, are among the activities of a "Kube" group.
This activity is an effort to prevent the rise of social problems such
as neglected children (sheet children), the elderly people, and the handicapped.
In line with Law No. 13 of 1998 on the elderly welfare, programs have
been improved in order to create the social welfare toward the elderly
people. Further agreement is still processed into a Government Regulation.
During one year of The Development Reform Cabinet, services have been given
directly to 35,296 elderly people, covering the institutional services
and family services as well as facilities in transportation. Besides, upgrading
efforts have been implemented to encourage the role of community in developing social welfare of
the elderly people.
Assistance is also given to disaster victims, including improving the
alert system toward people living in regions that are continuously threatened
by natural disasters by giving social assistance and empowerment efforts
in providing food such as rice, a variety of side dishes as well as construction
In 1998/1999 rice has been distributed in the amount of 11,490.7 tons, providing a variety of side
dishes food to 508,702 people, as well as construction materials to 12,684
families. In addition, in supporting of disaster handling, there have been,
provided 27 units of kitchen cars spread over 27 province.
The sources of aid are contributed either from the State Budget (APBN)
and foreign funding institutions such as WFP as well as private local companies.
Assistance is also given to the victims of social riots over some provinces,
such as social aid and empowerment. In the frame of social welfare development,
effort has been implemented to seek the sources of foreign aids, such as
loans and grants, in order to overcome the limitation of local budget expenditures.
These assistance are designed to develop and rehabilitate the social institutions
in the form of physical facilities as well as operational instruments.
In 1998/1999, the assistance has been given through SPL. IX and X 36
social rehabilitation institutions for the handicapped and 217 Loka Bina
Karya (LBK) for handling post rehabilitation outside institutions. In the
same year, vocational training of Pusat Rehabilitasi Bina Daksa (PRVBD)
has been officially operated. This is funded by a grant from the Japan
International Cooperation Agency (JICA). Assistance has been also received
from several international institutions or non-governmental institutions,
such as WFP, CCF, WVI, ADRA and CWS. Besides, rice assistance has been
received during three to six months to 1,319,940 people in 10 provinces
in the frame of empowerment program.
The enhancement of the soul and spirit of the National Social Solidarity
(KSN) has been implemented, involving all the communities and the business
world toward the social concern of to the communities who affected by crisis.
For examples, the participation of APKINDO, SINAR MAS GROUP, JAYANTI GROUP
and many others, has proved that the big support comes from the communities
to handle the social welfare problems. For instance, SINARMAS GROUP
provided assistance in the form of counseling and guidance, seed assistance,
production facilities and capital stock; furthermore, JAYANTI GROUP gave
financial assistance to handle social problems in three provinces, namely
Irian Jaya, Nusa Tenggara Timur and Nusa Tenggara Barat.
In the same way, many movements of KSN have been implemented, such as
cheap Food Cafe (Warung Nasi lklas), movement to replace parcels with Donation
Pack (Gerakan Mengganti Parsel dengan Paket Peduli), as well as sharing
for gathering (Berbagai Rasa Untuk Sesama). These programs reflected the
concern of high class people towards the lower class who suffer from social
The establishment of the Warung Nasi lklas program will give a benefit
such as security belt between the rich and the poor. In the same way, the
model of GAPPAI distributes community support in the form of giving parcels
to college and integrated institutions. Meanwhile, the model of Berbagi
Rasa Untuk Sesama arranges the meeting through the particular events between
In the field of arrangement and management stabilization, social welfare
development (PKS) covers data stabilization of social welfare; promoting
efficiency of human resources; and national legislation program.
In data stabilization of social welfare, cooperation has been worked
out with BPS (Central Bureau of Statistics), LIPI (Indonesian Council of
Sciences) and BPPT (The Agency for the Study and Assessment of Technology)
to stabilize data collection system. As a result, data of PMKS can be obtained,
such as children under five (balita), neglected children, elderly people,
the handicapped as well as the homeless. The process of data collecting
is connected with Survey of the National Social Economy (SUSENAS) implementation.
To improve the human resources empowerment, job transfers have been
carried out among the officials in the I, II and III echelons in the central
as well as in the local level. This is intended to promote organization
performance of social welfare development.
Apart from this, the structuring and developing of Higher Learning Institute
of Social Welfare in Bandung as education institution service in the field
of social welfare development, has been implemented.
In the range of national legislation program in 1998/1999, some products
of law have been resulted, such as Law No. 13/1998 on the elderly people
welfare, and three other products which are related with the implementation
of Law No. 48/1998 on improvement of social effort for the handicapped,
various presidential decrees, minister of social affairs' decree and related
Finally, in the frame of controlling development, verification has been
implemented to 118 objects. In that case, there are 1,194 findings, which
successfully save the state wealth at the amount of Rp.240,049,988.30.
From those findings, 368 cases have been completed with the value of Rp.37,091,654.10
and the rest is 826 findings with the value of Rp-202,958,334.20.