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Indonesias Progress On The 2015 - July2013 PDF
Indonesias Progress On The 2015 - July2013 PDF
CHOO YOUN-KONG/AFP
T
John Lundine he Millennium Development Goals (MDGs) were estab-
is director of programs lished in 2000 as an ambitious set of international targets for
at Save the Children development improvements during the first 15 years of the
in Indonesia. new century. Their creation marked a historical achievement and gal-
vanized political support around improving conditions for all people,
Ratna Y young and old, throughout the world. They permitted governments
Hadikusumah and other key stakeholders such as donor organizations, foundations
is the organization’s
and the private sector to “speak the same language” for the first time
advocacy adviser on the
about international development.
Post-2015 Agenda.
The majority of countries throughout the world committed to
Tata Sudrajat specific targets through 2015 to improve their results in the eight
is senior program manager MDG categories (see Table 1). Despite some cynicism, the MDGs
for family-based care. have shown that when agreement is reached and there is the political
will to implement the vision, real and dramatic change can follow.
An example is child mortality. In 2011, nearly 7 million children
died before their fifth birthday. This is still too many, but a dramatic
decline from the 12 million children who died per year two decades
IN D ON ESIA 36 0 J U LY- S E P T E M B E R 2 0 1 3 / VO L U M E 3 / N U M B E R 3 55
ago. Another example is education, with halving the percentage of the population liv-
more than 90 percent of school aged chil- ing on less than $1 per day (from 21 percent
dren enrolled in primary school and about in 1990 to 6 percent in 2008). Indonesia is
half of those girls. In other areas, the MDGs also on track to meet targets for reducing the
have not been as successful and countries prevalence of underweight children below 5
only have two and a half years left to meet years of age. As of 2010, however, the country
important goals. was behind on the percentage of its popula-
tion below the minimum level of dietary
A ‘whole of government’ approach consumption, with more than 60 percent of
the population still consuming less than the
natal mortality has not fallen as quickly, par- is still above 200, which puts Indonesia sig-
ticularly over the past decade. Immunization nificantly behind neighboring countries such
coverage has also improved significantly as Malaysia and the Philippines. In addition,
to approximately 75 percent of 1-year-old contraceptive use among married women
children immunized against measles in 2010, aged 15 to 49 and the unmet need for fam-
an increase from 45 percent in 1991. The ily planning are not on track to meet MDG
Ministry of Health is making significant ef- goals.
forts to meet the MDG targets, although Indonesia has made significant improve-
some areas remain far behind, particularly in ments in other areas of maternal health in-
eastern Indonesia where child mortality rates cluding antenatal care coverage, with more
in several provinces are more than double than 80 percent of women now receiving
the national average. at least four antenatal consultations and just
under 80 percent of births now attended by
Indonesia has surpassed its skilled health personnel, compared to only
goal of halving the percentage 45 percent in 1991.
Indonesia has had mixed results in meet-
of the population living on ing MDG6 and MDG7, and is on track to
less than $1 per day and is meet MDG8. No significant progress has
on track to meet targets been made towards reducing the spread of
HIV/AIDS, but it has significantly reduced
for reducing the prevalence the incidence of malaria, and reduced the
of underweight children. death rate from tuberculosis by more than
half since 1990. Under MDG7, Indonesia has
The results for MDG5, maternal health, not halted deforestation and emitted more
are not as successful. Indonesia is off track on carbon dioxide in 2008 compared to 2000,
reducing the maternal mortality rate from but has improved protection of fisheries and
390 maternal deaths per 100,000 live births biologically diverse land areas.
in 1991 to its goal of 102 by 2015. The rate Indonesia is not on track to meet any of
IN D ON ESIA 36 0 J U LY- S E P T E M B E R 2 0 1 3 / VO L U M E 3 / N U M B E R 3 57
its safe drinking water and sanitation targets toward a forward-looking, integrated, global
under MDG7, with less than half of the pop- and sustainable development agenda. The
ulation having sustainable access to an im- panel called for the five transformations to
proved water source and only slightly more be applied to all countries so that they: (1)
than half with access to basic sanitation. leave no one behind; (2) put sustainable de-
Finally, Indonesia has used prudent macro- velopment at the core; (3) transform econom-
economic management and steady economic ics for jobs and inclusive growth; (4) build
growth to make significant progress on peace and effective, open, and accountable
MDG8’s macroeconomic indicators. public institutions; (5) forge a new global
partnership.
The post-2015 agenda Within the report, there are four elements
and Indonesia’s leadership that demonstrated a “beyond MDG” commit-
ment to children and child rights, including:
President Susilo Bambang Yudhoyono, along • Eradicating extreme poverty and ending
with United Kingdom Prime Minister preventable child deaths by 2030
David Cameron and Liberian President Ellen • Focusing on the needs of those left be-
Johnson Sirleaf, were the three co-chairs of hind by economic growth and develop-
the 27-member High Level Panel of Eminent ment, in particular the commitments to
Persons on the post-2015 development agenda. “zero goals” (for example on poverty and
From September 2012 to May 2013, this panel child mortality) and the recommendation
was charged with providing recommendations to only consider a target reached if it is
to the UN secretary general on the global de- achieved within all key economic and so-
velopment agenda beyond 2015.Yudhoyono’s cial groups
participation reflects Indonesia’s increasing in- • Integrating key elements missing from the
ternational clout and its leadership role among MDGs, especially inequality, sustainability,
middle-income nations. accountability and conflict
The panel presented its final report in • Eliminating all forms of violence against
May, calling for five transformative shifts children
58 S TR ATE G IC R E V I EW I N DO N E SI A 360
BAY ISMOYO/AFP
Save the Children’s goals ity and working class urban productivity to
ensure that the vast majority of Indonesians
are ambitious but so were
have sufficient income to afford nutritious
the original MDGs, and the food.
progress that the world has There are huge opportunities to improve
agricultural productivity throughout the ar-
made towards achieving them
chipelago and Indonesia needs to harness the
has been extraordinary. private and public sector to raise small-hold-
er yields and incomes. This can be supported
and Disadvantaged Areas Project (P2DTK) with improved technology transfer to ap-
is one of these initiatives, as is the Special propriate crops in appropriate climates, and
Envoy to Papua, whose main role is to improvements to the overall infrastructure
maintain good dialogue with various stake- network. Continued support for the deepen-
holders. Improving conditions in Papua and ing of small-scale financial services is also
other eastern provinces will continue to be necessary to support rural communities and
Indonesia’s greatest challenge to end absolute agricultural production. Particular attention
poverty and ensure universal access to qual- will also need to be paid to promoting envi-
ity education and health care. ronmentally sustainable solutions as growing
conditions change due to global warming.
Water, sanitation and nutrition Indonesia also has to grow the formal
economy and move more urban families
understood, it is concerning that Indonesia such as the Community Led Total Sanitation
has a higher level of low birth-weight ba- project that is currently being piloted and
bies compared to international averages and scaled-up.
this likely indicates deficiencies in maternal
nutrition. It is alarming that the exclu- Poor water and sanitation
sive breastfeeding rate of infants under six
months continues to fall in Indonesia from
conditions impact children
an estimated 63 percent in 1987 to 32 per- by increasing illness and
cent in 2007, although recent data has shown diarrhea, which still kills
improvement.
Indonesia needs to enforce current regu-
approximately 50,000
lations to promote breastfeeding and work Indonesian children every year.
with the whole of society to comprehen-
sively promote it. Caretakers and families Assessing progress on health care
then need to make good choices around
complimentary feeding practices during
the 6-24 month period to address the rest
of the crucial 1,000 day window. Indonesia
I ndonesia has admirable accomplishments
reducing child mortality and aims to cover
all citizens under some type of health insur-
should look to revitalize community-based ance by the end of this decade. However,
education and outreach efforts such as the path to no preventable child or maternal
the community health and nutrition posts deaths by 2030 is still full of obstacles and
(POSYANDUS) with a specific focus on challenges.
promoting improved relevant health and nu- With the provision of health insurance
trition behaviors. It should also continue to for all Indonesians by the end of this decade
support the Scaling up Nutrition movement and as the population continues to expand
and explore how to effectively promote im- and age, utilization of health facilities will
proved nutrition among the urban poor. increase. It is therefore important to ensure
As mentioned previously, Indonesia will that all health facilities, from primary clinics
not meet its MDG goals for household water at the sub-district level (PUSKESMAS) to
and sanitation, so there is some unfinished district and provincial hospitals, are equipped
business for the next 15 years. Poor water and staffed appropriately. Local governments,
and sanitation conditions impact children which have oversight of the health system,
by increasing illness and diarrhea, which must adequately fund these facilities and
still kills approximately 50,000 Indonesian make difficult decisions about resource al-
children every year. Finding appropriate so- location. In addition, the different levels of
lutions to urban sanitation at the household the system must be able to communicate
and municipal levels will become of para- through comprehensive referral systems that
mount importance as more people crowd guide patients to appropriate levels of care.
into cities. Significant increases in funding, This will require focusing on health care
particularly from local governments, will management along with the quality of care
be needed, and the government and donors itself. Indonesia will need competent manag-
should carefully assess the success of efforts ers running increasingly complex municipal
IN D ON ESIA 36 0 J U LY- S E P T E M B E R 2 0 1 3 / VO L U M E 3 / N U M B E R 3 63
BAY ISMOYO/AFP
and district health systems and facilities, and dards. This will include improving the rigor
stronger systems of support and accountabil- of pre-service training and then promoting
ity running from the central government to in-service training, mentoring and support at
local governments. all levels.
The system should also maximize invest- In addition, Indonesia should assess the
ment in preventive health care. All women needs for specific kinds of health workers
must have access to the minimum number of such as nurses, obstetricians and gynecolo-
antenatal care visits and all children must get gists, pediatricians and others, and incentiv-
regular vaccinations and health check-ups. ize young people to choose these professions.
Much of this can be done through certified Finally, the Ministry of Health needs to en-
village midwives and PUSKESMAS staff sure that each location is adequately staffed
outreach, particularly if there is an effective with personnel who are capable of managing
referral system. More attention will need to obstetric and neo-natal emergencies.
be paid to communicable diseases in urban The nation also needs to have a special
areas and ensuring that all children receive approach for some disadvantaged and remote
vaccinations in a timely manner. areas, particularly in northern and eastern
There are difficult decisions to be made Indonesia. While in more densely populated
about resource allocation in the health sys- areas the focus is on getting more pregnant
tem. The first will be to mandate that all women and children into better functioning
health workers, from midwives to specialist facilities, the approach in remote areas will
doctors, meet minimum professional stan- still be to ensure the availability of trained
64 S TR ATE G IC R E V I EW I N DO N E SI A 360
school at young ages, often to work. the policy level, Indonesia has made progress
Over the next two decades, the education on this front by passing important laws that
ministry should focus on reducing class sizes recognize the importance of family-based
and improving the quality of instruction. protection for children from abuse, neglect,
Furthermore, as the population continues to exploitation and violence. The Child Welfare
urbanize and globalization accelerates, a high Law 4/1979 recognized that parents have the
school education will likely become a near primary responsibility for the protection and
prerequisite to attain formal sector employ- care of their children. The Child Protection
ment. Therefore, either a general high school Law 23/2002 stipulates that children have
or technical high school (SMK) education the right to be protected from abuse, neglect,
should be both available and free to all quali- exploitation and violence. The subsequent
fying students. Particular importance should law for the elimination of domestic violence
be given to improving vocational secondary prohibits violence against women and chil-
education, including linking programs close- dren in the home.
ly with employers. Despite this strong legal foundation, en-
forcement remains inconsistent. Culturally
The family environment and socially, violence against children is still
too widely accepted. Unfortunately, millions
When children grow up in a healthy fam- of children remain abused, neglected and
ily environment, they usually enjoy their trafficked. However, it is rare for a parent to
childhood and thrive developmentally. At be brought to justice to remove their pa-
66 S TR ATE G IC R E V I EW I N DO N E SI A 360
rental rights because of this abuse, although work system to implement policies that bet-
the laws stipulate that this can be done in ter protect children.
extreme cases. Indonesia needs to engage
civil society over the long term to change Children first
prevailing attitudes and also reinforce the
application of the law, particularly in remote
and rural areas.
The issue of placement of children in
I ndonesia has made impressive gains to-
wards improving the quality of life of
its people, as reflected by the progress it
institutions also continues to be of con- has made towards achieving the MDGs.
cern. There are more than 500,000 children President Yudhoyono played a lead role in
in more than 8,000 child care institutions shaping the development agenda beyond
throughout Indonesia, and the vast majority 2015. Save the Children has welcomed his
of these children still have at least one parent leadership and applauds the post-2015 rec-
who can care for them. These children are ommendations of the High Level Panel.
often in an institution for long placements However, much still needs to be done to
without a care plan or review. They grow up eradicate absolute poverty within the next
without love from their parents. two decades, and addressing inequality is
Since 2007, the Ministry of Social Affairs the cornerstone from which we must build.
has started shifting the paradigm from in- Only in this way can we achieve sustainable
stitutional care towards family-based care. growth with equity to ensure the opportu-
This is a long-term and complex process nity for health, education and freedom from
but progress has been made. The National violence for all Indonesian children. The
Standard of Care for Childcare Institutions government has consistently declared its op-
was adopted by the ministry in 2011 and timism by establishing and working to meet
dissemination and piloting have been imple- ambitious development goals. By emphasiz-
mented gradually across Indonesia. The draft ing its national capacity and putting people,
regulation on alternative care is in the pro- especially children, first, Indonesia can con-
cess of being finalized. Social welfare sectors tinue to substantially improve the lives of all
are improving but need to be strengthened of its citizens.
as Indonesia continues to improve its social