It's all about money

Since economic crisis on 1997, it slowed the health status of Indonesians development health system. The crisis started in Thailand with the collapse of its baht when speculators attacked the floated currency in 1997. Foreign banks began calling in their loans to Korea. The Indonesian rupiah plunged abruptly under attacks from both banks and speculators. Then came the IMF with a series of bailouts. It offered a total $40 billion program to stabilize the three currencies, but did little to rescue the plunging economies. 

  Ya, its sound so easy that the IMF easily give loan with certain huge amount of money, but it is actually comes with policies. 
Structural Adjustment Policies generally require a country to:

• slash government spending, which usually means cutbacks for health care, education, child care, and environmental protection; 
• attract foreign investment by removing tariffs and weakening labor laws and environmental protections; 
• sell off publicly owned assets such as mines, mills, forests, telephone, water and electricity companies-a process known as ~privatization" 
• focus resources on growing export crops for industrial countries, rather than supporting family farms and growing organic food for local consumption; and 
• devalue the currency to promote exports.

"Now, we are dictated by the IMF and The World Bank. A country as rich as Indonesia has been turned into a country of beggars"... quoted from this video 2:07-2:15 minit

Unfinished Agenda
The Government of Indonesia is taking special steps to protect the health of its population through the modification of its Seventh Five-Year Plan (Repelita VII), but the pace of progress in solving health problems has been slow. The health status of Indonesia still lags behind neighbouring countries. Maternal mortality in particular is very high at 334 per 100,000 live births (1997). Moreover, national figures mask considerable regional disparities in health indicators. For example, the infant mortality rate ranges from 27 per 1000 live births in Jakarta to 90 in West Nusa Tenggara(1998).

The period 2001-2005 witnessed significant changes in Indonesia. The political and socio-economic decentralization process initiated in 2000, has had a tremendous impact on the national health system. Provinces and districts now develop and budget their own health plans independently with funds they generate themselves and with funds they receive from the Ministry of Finance. This arrangement had considerably weakend the unified national health system including the once well established disease surveillance system as well as other public health programmes.

New challenges have emerged as a result of social and economic changes. From World Bank report "Improving Indonesia's Health Outcome", they come out with certain problems that deteriorate Indonesia's health system

• disease pattern has become more complex
• important regional and socioeconomic inequities 
• performance and utilization of public health services is declining and private sector now is the major source 
• health financing low 
• decentralization poses new challenges and presents new opportunities 
• HIV/AIDS transmission rates are increasing but the epidemic remains largely localized 

Point of view
Isn't it sounds contradiction between the policy of IMF loans and reports from the World bank? they stated that if you want to borrow money from the IMF you need to cut down money spending in health, decentralization and privatization. Ironically, report from world bank stated that those things that causes problem in health system.

Actually, decentralization have it owns benefit because decisions are made by those who have the most knowledge about local conditions and most important. Ok, let me define what decentralization means. It is a delegation of decision-making to the subunits of an organization. It is a matter of degree. The lower the level where decisions are made, the greater is the decentralization. Decentralization is most effective in organizations where subunits are autonomous and costs and profits can be independently measured. But, sometimes, things don't work accordingly to the plan. It can cause by the manager that have a tendency to look at their division and lose sight of overall company goals and also there can be costly duplication of services. Its all about the management matter.


Privatization means the sale of public utilities to private concerns. Supporters of privatization often cite the competitive environment that is nourished by the practice as a key to its success. But how with poor people? richer people get better services while poor people even don't have money to pay for services.


In our life's, there is yin and yang, have male and female, and of course have pros and cons. Governments not simply make a policy without thinking about their citizen. They do the research, ask from expertise, from other countries which has been implemented the same policy but it's all about the good governance and clean government

Refferences 

1. http://management4best.blogspot.com/2010/02/centralization-decentralization.html

2. http://www.iseas.edu.sg/vr72000.pdf