Better politics is the only medicine for Indonesia’s health system


The picture above was taken in Lombok, in what I thought was an abandoned health centre. There was a little lab, a couple of consulting rooms, a dispensary, all mouldering with neglect. But on a door to a room in the back yard I saw a sign “The midwife is IN”. I knocked on the door, and to my amazement there she was. Could this derelict place be a living Puskesmas, a village health centre? I asked where the rest of the staff were. “Oh they’ve built a new puskesmas down the road, so it’s just me here now,” came the reply.

It’s no bad thing that people get upgraded health facilities. But just down the road? When there are so many remote areas with no facilities at all? This wreck of a building illustrates the distorted incentives in Indonesia’s health sector. It’s more profitable, both politically and financially, to build new stuff in already well-served areas than it is either to maintain existing facilities or to expand to places that qualified staff don’t want to stay in. In this piece in the new edition of Inside Indonesia, I conclude that only healthier politics can cure Indonesia’s sick health system. The whole issue is dedicated to the politics of health: there are pieces on the tobacco lobby, the neglect of mental health, abortion and much else. Check it out.