10-7-2023 (JAKARTA) Indonesia’s efforts to improve healthcare in a nation where life expectancy lags behind upper-middle-income peers face opposition from local nurses and doctors. The proposed legislation, which parliament is scheduled to discuss soon, aims to make it easier for foreign doctors to work in the country and exempt Indonesians aspiring to become physicians from paying tuition fees during hospital residency.
The measure may also shift the burden of funding hospitals to the private sector by removing a required government spending from the budget. It also seeks to clarify the criteria by which a woman may seek an abortion. Healthcare workers have staged protests, saying that the changes could jeopardize their work, and that parliament discussions lacked transparency.
Indonesia seeks to improve health services for its 270 million people, as the lack of doctors in remote areas and months-long wait for treatments keep its life expectancy at 71.3 years in 2019. That compares with the 76.3 years average for upper-middle-income countries.
According to World Bank data, Indonesia has six doctors for every 10,000 people, compared with neighboring Singapore with 25 and Thailand with nine. This has prompted many Indonesians to spend $11.5 billion a year on medical treatments overseas.
The bill will remove the requirement for the state to spend at least 5% in the national budget and a minimum of 10% in the regional budget for health spending. It will allow the government to tap the private sector to build public hospitals. The measure will also provide a mechanism for communities to provide funding to improve hospital services.
The proposed legislation would simplify the process for doctors applying for a license to practice and allow foreign doctors to practice onshore for up to four years if requested by local facilities, as long as they pass a competency evaluation and agree to learn the local language. However, the Indonesia Doctors Association (IDI) said the changes do not address the more pressing gap for services between urban and rural areas. According to IDI Chairman Adib Khumaidi, the country has enough specialists, but the problem is in the distribution that is still centered in big cities.
The bill clarifies how abortion can be performed, allowing for abortions due to a medical emergency. However, it is still illegal in Indonesia, except when it is done for a married woman with her husband’s consent or for victims of sexual assault. The proposed law also imposes punishment for non-compliance, subjecting the woman to up to four years of imprisonment, and healthcare workers performing the procedure to up to 12 years of jail, depending on whether it was done with the patient’s consent or not. The physician could face up to 15 years of incarceration if the abortion leads to the patient’s death.
