03.01.04. Private long-term care sector | Indonesia
03.01.04. Private long-term care sector | Indonesia
14 Apr 2022
The Indonesian long-term care policy emphasises the care of older people on kekerabatan, which refers to care through a kinship system in multi-generational households and bases its support structure on this assumption (Setioko & Pandelaki, 2015, p.57; Rahardjo & Yerly, 2014). This may explain the limited number of LTC services, such as day care, respite care, institutional care services. The Indonesian family focused approach is not without problems, as migration patterns outlined previously show that larger family structures become fragmented when younger generations move for employment opportunities and the traditional family unit providing LTC may not always be a feasible and appropriate assumption.
According to the Ministry of Health’s Director of Mental Health Development, out of the 9,599 puskemas in the country, there are about 528 puskesmas across 231 cities equipped with “santun lansia”/geriatric-friendly facilities (not dementia-specific) that include ground-floor rooms, toilets suitable for older people, and prioritisations of older patients in registration and medicine dispensing (Herman, 2015).
The second important long-term care role was given to the Posyandus, however, in contrast to the Puskesmas no specific role was outlined in the National Strategic Plan for older people (No.25/2016) (Pratono & Maharani, 2018). This community service, which is run by midwives and volunteers, initially focused on family planning and maternal health (Posyandu Balita). In recent years, the community service received an optional second task: the provision of health ‘promoting and preventive’ services to senior citizens (Posyandu Lansia). These include regular basic health services as well as other community activities, such as taking a medical history, physical examination, assessing people’s ability to complete activities of daily living independently, basic laboratory tests as well as the provision of information on nutrition and some services may provide home visits, health promotion activities, legal and social aid, day care, and social activities as well as religious and mental spiritual services (Metkono et al., 2017; Pusat Data dan Informasi Kementerian Kesehatan RI, 2014; Rahardjo & Yerly, 2014; UPTD Puskesmas Kandangan, 2015).
According to regulation No. 7/2007 issued by the National Ministry of Home Affairs, each Posyandu should cover between 30 and 50 households and be run by five to 10 volunteers.
Some Posyandu Lansia may also provide home care services in the community, however, the level of service provision was reported to vary considerably between areas. According to Rahardjo and Yerly (2014), there are 70,000 Posyandu Lansia services available in Indonesia. Another source suggests that there are 52,450 Posyandu Lansia operating in the province of East Java, while ten provinces are reported (Aceh, West Sumatra, Bengkulu, Gorontalo, Riau Islands, Lampung, South Kalimantan, Southeast Sulawesi, West Sulawesi, West Nusa Tenggara, and Papua) to not have any (Pusat Data dan Informasi Kementerian Kesehatan RI, 2014)
Placing the responsibility of the Posyandu Lansia services on midwives led to challenges of expertise versus the high expectations of the local community, where midwives without appropriate training were expected to ‘provide guidance on preventive measures such as early detection of diseases, hypercholesterolemia and hypertension, as well as health and psychological counselling’ (Pratono & Maharani, 2018, p.1569). Shortage of medical workforce in some areas may exaggerate this as well as create overlap in workload between medical professions.
Pratono & Maharani (2018), following their study of role of posyandus in LTC in the East Java Province identified several limitations. It appears that in rural areas the monthly posyandus provide only social events as LTC (e.g., dance, prayer, and recreation) services in addition to basic health care provision. While health care services are free, participants are expected to pay for uniforms or to provide a contribution fee for their participation in activities, which limits accessibility. In addition, the reliance of volunteers means that posyandus may be run by religious groups, which may lead to exclusion of population groups (Handayani & Wahyuni, 2012; Pratono & Maharani, 2018, p.1566). Furthermore, the authors raised issues regarding accessibility of services due to distance and transportation costs as well as quality of services. They highlighted a report by the Ministry of Health (2015) that showed that ‘only 10% of Posyandu met the minimum standard and only 1% of Posyandu were able to independently manage their financial resources’ (Pratono & Maharani, 2018, p.1571). Reliance on volunteers meant that many Posyandu were unable to provide regular activities due to lack of volunteers and capability (Pratono & Maharani, 2018). ‘The long-term care requires health cadres or caregivers who support the health workers, however, health cadres or caregivers need to conceive a decent knowledge regarding long-term care on the elderly’ (Aquino Amigo & Nekada, 2019). Rahardjo et al,. presented in an LTC expert dialogue forum in Kitakyushu, Japan (2019), hosted by Economic Research Institute for ASEAN and East Asia the results of their unpublished data from West Jakarta, in which they found the lack of training for volunteers and low understanding of LTC among the volunteers (60%), despite previous training.
In addition to the health focused Puskesmas and Posyandu, the Ministry of Social Affairs provides nursing homes (Panti Wredha). These nursing homes services are provided to people without access to family or community support and in need of long-term care. Volunteers are likely to identify eligible people (Kadar et al., 2013). There are only very few publicly funded shelters and nursing homes managed by the Ministry of Social Affairs available to older people in Indonesia, as these services are not yet fully developed. Local governments, on the other hand, have been found to have established nursing homes across several provinces. However, there were some regions, including Bangka Belitung, East Nusa Tenggara, Central Sulawesi, and West Sulawesi that do not yet have institutional care facilities.
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