The increase of Indonesia’s health budget allocation from 3.7 percent of Gross Domestic Product in the 1990s to 5 percent in 2017, totaling Rp104 trillion (US7.28 billion), is designed to alleviate some of the country’s healthcare delivery problems, with 75 percent of citizens still greatly depending on public health care.
But one of the biggest problems is not the provision of health care but the ability to get it to the people of a country scattered over more than 17,500 islands. There is one floating hospital but the ship, a 122-meter-long Korea-built vessel featuring an emergency room, three surgeries and six polyclinics among its facilities, is too big to land at far too many of the smaller islands.
The ship, the KRI Dr Soeharso, is administered by 75 crew members, 65 medical staff and is capable of accommodating 40 inpatients. In an emergency, the KRI Dr Soeharso can also accommodate 400 troops and 3000 passengers. The ship was invaluable for a humanitarian mission during the earthquake and tsunami that devastated Banda Aceh in 2004.
But far more floating hospitals are needed, and smaller, more maneuverable ones. Because of that, the healthy budgetary surge doesn’t directly reflect the fulfillment of primary medical care. Indonesia possesses a glaring inability to provide equal distribution, productivity, and quality of health care throughout the archipelago to a population of approximately 260 million.
Indonesia has 2,488 hospitals with 1.21 beds per 1,000 population. The ratios of physicians and dentists per 100,000 populations are 16.06 and 4.57. Compared to the WHO recommendation of 1:600 doctor-patient ratios, the condition of health care system in Indonesia is one of the lowest in Southeast Asia.
Medical Service Gaps in Indonesia
By region, according to data from Indonesia’s Ministry of Health, the largest proportion of health centers with adequate or even an excessive number of physicians are on Java and Bali (82.8 percent) and Sumatra (81.7 percent). The lack of ability to move health facilities and professionals is marked for people living in the underdeveloped borderland and island regions.
The lack of transportation and dock facilities that could accommodate large ships isolates people from quality health services who live in areas such as Maluku province, which is made up of more than 1,000 islands. Second, health centers are available but the numbers are still inadequate to serve all populations and much-needed hospitals with more advanced medical equipment and complete operation rooms are only located on the main island.
In addition to the geographical constraints, financial issues also prevent the majority of people living in such regions from affording a decent life quality in general, much less the means for adequate medical care. Indonesia’s Health Profile issued by the country’s Ministry of Health in late 2016 reports that percentage of poor in rural areas amounted to 62.76 percent. Maluku is the fourth poorest province in Indonesia with 19.36 percent of its population living below the poverty line.
Poverty is one of the leading factors for the country’s low percentage of average monthly expenditure per capita for health, amounting to only 3.29 percent of personal income. The majority of expenditure is on food (43.71 percent), with the second biggest expenditure (20.75 percent) is on housing and household amenities.
This condition forces many local residents to look for alternative medical treatment. In many cases, high transportation costs and long travel times to reach the main islands, mean locals alternately seek help from shamans or leave their injuries untreated.
Floating Hospital as a Solution
Efforts to provide better access to health care have been a hot topic for years. However, due to slow and uneven development, especially in the eastern part of Indonesia, the solution sought is how to provide medical services that can flexibly move from one island to another to reach populations living on the coast. Floating hospitals are a partial solution.
The KRI Dr. Soeharso cannot dock at the thousands of small islands. Thus although the facilities are excellent, the floating hospital is not a complete and sustainable solution.
Despite a lack of attention from the government in Jakarta, both local governments and the private sector have tried to conduct research and gather donations to build medium-sized floating hospitals tailored to the sea structure and the condition of the majority of ports on small Indonesian islands.
An important example is à DoctorShare Foundation owned by Dr. Lie Dharmawan, which has two active floating hospitals. A barge is soon expected to be transformed into their third. Airlangga University in East Java has joined the effort by spending Rp5 billion to build another ship designed to bridge the disparity of medical services for Maluku’s underprivileged residents. Such floating hospitals are indeed suitable for small ports in small islands, given their 27 meter by 7.2 meter dimensions, a fifth the size of the first floating hospital.
However, besides funding to renovate ships into hospitals with adequate facilities, which requires enormous costs, operational funds are also a constraint. For instance, East Kutai district allocates operational and maintenance funds of at least Rp1.7 billion per year for a fleet.
The addition of the aforementioned Ministry of Health allocation opens opportunities and gives space for the government to take part in the provision of health services in remote islands in Indonesia through floating hospital solutions.
The participation of local and private governments that have been actively involved in addressing the scarcity of access to health on small islands especially in Eastern Indonesia should be supported through the provision of operational grant funds to these vessels. Governments with a wide network can also attract local donors as well as from other international social institutions to help so that these efforts can be sustainable.
Muhammad Zulfikar Rakhmat is a doctoral candidate at the University of Manchester. Dikanaya Tarahita is a freelance writer from Indonesia and studied HR Management and Industrial Relations at the University of Manchester.