Indonesia is in the process of developing a public Long-Term Care (LTC) system. Policies developed under the umbrella of long-term care fall into services that would commonly be identified as social security mechanisms (i.e. old age pensions), and services that fall under the realm of health care (i.e. services and interventions to delay or reduce the number of people with long-term care needs), while other care services (i.e. day care, respite care, institutional care) are limited in availability (UNESCAP, 2014, p.12). BAPPENAS describes this split between health care and social security mechanisms as the provision of financial (social security) and non-financial (health care, long-term care, and legal protection) (Kementrian Koordinator Bidang Pembangunan Manusia dan Kebudayaan RI, 2020).

The core features of the Indonesian long-term care system are based on the Puskesmas (community health centres providing primary health care services) and Posyandu (integrated community health service posts that focus on preventive health services provided by midwives, nurse assistants, vaccinators, and health volunteers who visit communities monthly) system. Both types of services fall under the regulation of local governments (Pusat Data dan Informasi Kementerian Kesehatan RI, 2014). In 2009, the Ministry of Health and the Ministry of Home Affairs declared the Puskesmas Santuan Lansia to be the first-line providers of health and long-term care for older people. Furthermore, between 2018-2019, the Ministry of Health has issued a LTC guideline for the Puskesmas (Kementerian Kesehatan RI Direktorat Jenderal Kesehatan Masyarakat, 2018) that provide directions on the implementation of LTC in Puskesmas.

Even though the Ministry of Health and the Ministry of Home Affairs already in 2009 declared the Puskesmas Santuan Lansia to the core service provider for older people, insufficient support from provinces and cities meant that only around 42.3% of Puskesmas were able to implement the concept by 2011 (Badan Litbangkes Kementrian Kesehatan RI, 2012). Furthermore, it has been reported that there is a shortage in services provided through Puskesmas in the East of the country and in more rural regions due to concerns about workforce availability and quality (Kadar et al., 2013). Shortages could also be found in the provision of Posyandu Lansia services. The Ministry of Health stated that in 18 out of 34 provinces there were no Posyandu Lansia services available, and 11 provinces did not provide health services through the Puskesmas Ramah Lansia (Pusat Data dan Informasi Kementerian Kesehatan RI, 2017).

Ministry of Health Data (from December 2018) states that there were Puskesmas and Posyandu Lansia available in all provinces (Kementerian Kesehatan Republik Indonesia, 2019a). However, a study from 2018 suggests that there are varying levels of functioning among posyandu lansia across provinces (Pratono & Maharani, 2018). There is anecdotal evidence from the cities Malang and Surabaya about the lack of regular services, volunteers, and health workers, which suggests limited interest and commitment by the community members in the posyandu lansia. Posyandu lansia also sometimes charge additional transaction costs although services are supposed to be free. Based on data from the Program Report of the Directorate of Family Health (2017), there were 3,645 Puskesmas that provided santun lansia services (Kementerian Kesehatan Republik Indonesia, 2018).

Lack of coordination on national level, public underfunding, and high out-of-pocket expenditure are creating barriers to accessibility and availability of services for older people in Indonesia, where the government allocated only about 0.1 per cent of GDP (2006-2010) to long-term care (Rahardjo & Yerly, 2014; Scheil-Adlung, 2015, p.xi). The report further elaborates, that in Indonesia, as of 2015, 87.3% of the population aged 65 and older were excluded from accessing LTC services because of financial resource deficits (Threshold, 1.451.8 PPP$) (Scheil-Adlung, 2015, p.83).

Regulations and bills

Between 2009 and 2018 nine regulations and bills have been activated under the umbrella of long-term care to support older people with care needs.

In addition, the provision of long-term care to older people was included in the National Medium-term Development Plan 2015-2019 and is expected to also be included in the consecutive long-term development plan. Responsibility for LTC policy was given to the National Commission for Older People, which was established in 2004 (UNESCAP, 2014).

References:

Badan Litbangkes Kementrian Kesehatan RI. (2012). Ringkasan Hasil Riset Fasilitas Kesehatan (Rifaskes) 2011.

Kadar, K. S., Francis, K., & Sellick, K. (2013). Ageing in Indonesia – Health Status and Challenges for the Future. Ageing International, 38(4), 261–270. https://doi.org/10.1007/s12126-012-9159-y

Kementerian Kesehatan Republik Indonesia. (2018). Provil Kesehatan Indonesia 2017 (Vol. 1227, Issue July). https://doi.org/10.1002/qj

Kementerian Kesehatan Republik Indonesia. (2019a). Data Dasar Puskesmas.

Kementerian Kesehatan RI Direktorat Jenderal Kesehatan Masyarakat. (2018). Pedoman untuk Puskesmas dalam Perawatan Jangka Panjang bagi Lanjut Usia. Kementerian Kesehatan RI.

Kementrian Koordinator Bidang Pembangunan Manusia dan Kebudayaan RI. (2020). Tanggapan Terkait White Paper “Pemenuhan hak-hak lansia untuk hidup setara, sejahtera dan bermartabat.” Presentasi.

Pratono, A. H., & Maharani, A. (2018). Long-Term Care in Indonesia: The Role of Integrated Service Post for Elderly. Journal of Aging and Health, 30(10), 1556–1573. https://doi.org/10.1177/0898264318794732

Pusat Data dan Informasi Kementerian Kesehatan RI. (2014). Situasi dan analisis lanjut usia (pp. 1–7).

Pusat Data dan Informasi Kementerian Kesehatan RI. (2017). Analisis Lansia di Indonesia.

Rahardjo, T. B. W., & Yerly, A. N. (2014). A trend for establishing community care system in Indonesia. Forum on Conception of Harmonization of Long Term Care Certificate Between Japan and Indonesia.

Scheil-Adlung, X. (2015). Long-term care protection for older persons: A review of coverage deficits in 46 countries. In Extension of Social Security (Issue 50). http://www.ilo.org/wcmsp5/groups/public/—ed_protect/—soc_sec/documents/publication/wcms_407620.pdf

UNESCAP. (2014). Report of the Regional Expert Consultation on Long-term Care of Older Persons. https://www.unescap.org/sites/default/files/Report%20Reg-Consultation.pdf