Jakarta, Indonesia – A polio outbreak that spread rapidly through Indonesia after a decade-long absence, crippling hundreds of children, has exposed weaknesses in the sprawling archipelago’s long-neglected health care system.
Hampered by chronic funding shortages, clinics in the poorest parts of the country have been forced to scale back, reducing the time and money they spend on community outreach, health education and immunization programs.
As a result, 239 children under 5 have been infected by polio since March, prompting a series of vaccination campaigns that were completed Tuesday.
Measles cases have increased tenfold since 2000, while the country saw its worst-ever dengue fever outbreak last year. There also are fears that bird flu, which already has killed six people nationwide, could mutate into a form that spreads easily among humans.
“The context for these events is a primary health care system that has suffered from a decrease in resources and is struggling to manage the expectations placed on it,” UNICEF’s David Hipgrave said. “What we’re seeing are major inconsistencies between the rich and poor provinces.”
It was not always this way.
During the 32-year dictatorship of Suharto, the health system, like much of government, was centralized, and services reached down to the village level. Polio was eradicated in 1995, and key indicators like child malnutrition and poverty rates fell.
But most of the programs linked to Suharto were abandoned after his ouster in 1998.
Radical decentralization, introduced in 2001 in response to demands for increased autonomy, has added to the country’s health care woes. Almost overnight, the government handed control of public services to regional and local authorities. But their roles were unclear, experts say, funding was inadequate and priorities were left to the whims of inexperienced governments, mayors and village heads.
