Infrastructure the real question over Indonesia's health problems

We are what we eat: the old saying may always ring true. The catch is that not every one of us is privileged with options.The World Health Organisation has picked food safety as the theme of World Health Day, which falls today. It reminds countries that poorly produced food causes hundreds of communicable and non-communicable diseases, urging them to watch over the supply chains of the food that makes it to their plates.

But in a growing, populous country like Indonesia, where access to welfare remains unequal, even to reach a regular food supply flow is still a challenge with the meager infrastructure and a lack of protection from the government.

With vast waters surrounding the archipelagic nation, the task of keeping the islands connected has been unresolved since the country's independence. The lack of basic infrastructure such as roads and access to clean water has hampered the provision of food and health facilities in Indonesia, particularly on islands outside of Java, where almost half the population lives.

In Jambi, 11 members of the Orang Rimba tribe, known as Anak Rimba, reportedly died of hunger because plantations have replaced the forests that had sustained their livelihood for generations. The rapid expansion of the palm oil industry in the country has taken a toll on the lives of forest people and wildlife in the area. The Health Ministry has revealed that among the most malnourished regions in the country are East Nusa Tenggara and Maluku, island provinces surrounded with fish-rich waters that should be a sufficient source of protein.

Many factors have contributed to these two complicated cases. But if the government can start by providing a regular supply of food to regions outside of Java, especially to small islands, it can reduce the amount of hunger and malnutrition among the people there.

A review of the country's achievements for the Millennium Development Goals (MDG) has shown that Indonesia will likely miss the targets of reducing maternal mortality rates during delivery (MMR), the prevalence of HIV and of increasing access to clean water and basic sanitation.

In the country's small islands, many mothers are often found too late for assistance during delivery so that health officials often find themselves incapable of doing anything to help. A bottleneck in the supply of food also hinders the mothers from receiving a balanced diet during pregnancy and that also leads to weak conditions during delivery.

Under Jampersal, for the past four years the government has provided free pre-delivery treatment, childbirth care and contraceptives to mothers. But the programme is less effective given the poor access to health facilities.

The government under President Joko "Jokowi" Widodo has elevated infrastructure as a priority, but even after the first quarter of this year, it has yet to kickstart any promised infrastructure projects, let alone focus on opening access to remote regions.

In the health sector, the government is currently concentrating on covering all citizens with National Health Insurance (JKN). It is even considering an increase of the premiums paid to the JKN provider, the Healthcare and Social Security Agency (BPJS Kesehatan), although a government regulation stipulates that such an increase should only be made in 2016.

The review of the premiums was initiated after BPJS Kesehatan reported a deficit between the claims it had paid and the premiums it had received. In 2014, the deficit stood at Rp 1.54 trillion (S$160.5 million), with Rp 42.6 trillion paid out in claims and Rp 41.06 trillion received in premiums.

Before it decides to allocate more taxpayer money to cover for the insurance, it would be better to address the cause of the overclaims and determine whether it is right to raise premiums.

Until now, BPJS Kesehatan hasn't released a comprehensive report on their performance last year. Given the poor infrastructure in the regions, the taxpayer money that paid for the insurance might also have built roads, access to sanitation and other facilities in the country's far-flung areas.

Health development should not give priority only to curative efforts, but also to programs that are about staying healthy. The lack of effort to support the regions that suffer from poor basic infrastructure will raise the costs of curing diseases in the future.

The WHO recorded that Indonesia's healthcare spending stood at 2.7 per cent of its gross domestic product, far lower than the world average of 10 per cent. From that amount, the government only covers 34.6 per cent, with the remainder being paid by citizens and the private sector.

The only way to improve health service for all is by contributing more. And it should start with the government, because without basic infrastructure to support the health system, it is very hard to expect significant improvement in the country's health status.

So when talking about the food chain, the problem for Indonesia is mostly not about scrutinizing the food to ensure it is safe to eat. The chain is not even there yet.