Health system and EPI Program
Indonesia launched its national immunization program in 1977. The program progressed steadily. The country has been polio-free since 2006. Maternal and neonatal tetanus has been eliminated from 87% of the country. Measles is targeted for elimination by 2018, rubella by 2020. The Ministry of Health has set a target of 100% full immunization coverage by 2014, a target all but 1% of jurisdictions have achieved. WHO and UNICEF estimate that 81% of children were fully immunized in 2012. Yet due to its population of 243m, the remaining 19% make Indonesia home to the third highest number of unimmunized children.
According to the country’s 2011-2014 cMYP, immunizations in Indonesia are delivered through a network of 8,750 community-based health centers and 1,378 hospitals. There are 475 health district immunization managers and 33 provincial EPI managers. At central level, the Immunization Program is a sub-directorate of the Directorate of Immunization and Quarantine in the Division of Communicable Disease Control and Environmental Health, Ministry of Health. The Government of Indonesia strongly supports the immunization program. Immunization is currently one of the government's top priorities as is evidenced by the Vision, Mission and Strategy (Strategic Plan) of the MoH and EPI National Action Plan 2010 – 2014.
Decentralization and political reform have affected the availability of funding for immunization. The central level is responsible for supplementary immunization activities, procurement of vaccines and syringes, technical assistance, development of guidelines, monitoring and evaluation, quality control and training. District governments are responsible for supporting operational costs for running their immunization programs. Provinces and districts form and execute their own health budgets. Financial management capacity of the local governments varies. The result is that there is less than full absorptive capacity in the health sector.
Over the period 2006-2011, Indonesia’s Gross National Income (GNI) per capita grew from 1,370 US$ to 2,940 US$, making it a GAVI graduating country. In practice, immunization is almost entirely funded through annual federal transfers to the provinces and districts. According to the WHO/UNICEF-Joint Reporting Form Database, Indonesian Government routine immunization expenditures fluctuated over this period. In 2006, reported government expenditures were 34 million US$- around 8 US$ per infant. The next year, contributions increased, to 119 million US$ (28 US$ per infant). In 2008, government expenditures decreased to 33 million US$, almost equal to what was spent in 2006. From 2008-2010, government expenditures continued to fluctuate, ranging from 8 US$ per infant in 2008 to 2 US$ per infant in 2010. In 2011, the Indonesian Government’s contributions again increased, from 8.5 million in 2010 to 67 million- about 15 US$ per infant.
Indonesia is a presidential representative democratic republic, where the President is both head of state and head of government, and of a multi-party system. The 1945 constitution provided for a limited separation of executive, legislative and judicial power. Executive power is exercised by the government. Legislative power is vested in both the government and two People's Representative Councils. The People’s Consultative Assembly has 695 members. Members include all 550 members of the People's Representative Council (the House of Representatives) plus 130 regional representatives.
The judiciary is independent of the executive and the legislature
Immunization is a priority for the Government as is evidenced by the laws, regulations and policies that have been developed to regulate it:
- Law No. 36/2009 on Health.
- Law No. 23 year 2002 on Child Protection, children have right to obtain health services including Immunization.
- KEPMENKES No. 1611/SK/IX/2005 about Guidelines of Immunization Implementation.
- PERMENKES RI NO.741/MENKES/PER/VII/2008 _ Minimum Service Standard of Health in District/Municipality.
- KEPMENKES RI NO. 828/MENKES/SK/IX/2008 _ Technical Guidelines for the Health Sector Minimum Service Standards in District/Municipal.
- Vision, Mission and Strategy (Strategic Plan) of MoH and EPI National Action Plan 2010 – 2014.
- Constitutional and structural reforms (devolution) provide additional legislation governing health care financing and provision:
- Law No. 12 year 2008 about revision of Law No. 32/2004 on Governance at local level.
- Law No. 33/2004 about Fiscal Balance between Central and Local Government.
- PP RI NO.38 year 2007 about sharing of the Governmental Affairs between the Central, Provincial and District/Municipality Government.
- Inpres no.1 year 2010 about Acceleration of National Development Priorities 2010.
- Inpres no.3 year 2010 about Development Program with Justice.
Showcasing Indonesia's Progress in 2013
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- July 2013: Senior Program Officer Khongorzul Dari and SIF Director, Mike McQuestion, conducted a joint mission with WHO and GAVI to Indonesia.
- August 2013: Indonesian delegates attended and actively participated in Sabin’s Second Colloquium on Sustainable Immunization Financing in Dakar, Senegal.