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Indonesia wants the private sector to build more hospitals and reserve a quarter of the available beds for the poor, as it increases spending on free health care to tackle a rise in diseases from strokes to AIDS, the health minister said.

The plan to cover basic hospital medical services nationwide to ensure Indonesians who live in poverty get free hospital treatment, will cost 10 trillion rupiah?($1.15 billion), Endang Sedyaningsih said in an interview on Tuesday.

The extra spending comes as much of Asia seeks to improve health care facilities to prepare for an increase in chronic long-term illnesses as populations age, though many developing nations such as Indonesia are starting from scratch.    

“We are aiming that everybody doesn’t have to pay when they are hospitalized in class-3 hospital beds,” Endang said, referring to the basic level of service. “They will be covered by either the central government or the provincial government.”    

But she acknowledged that there were budget constraints and the plan will be implemented in stages.

In 2009, 76.4 million Indonesians who were considered to be poor received free medical services in class-3 hospital beds, up from 36.4 million people in 2005.    

Currently, 56 percent of Indonesia’s 238 million population have some form of health insurance. Under Indonesia’s 2011 budget, the Health Ministry has been allocated 26.2 trillion rupiah, an increase of 10 percent — but this is still just 2.3 percent of gross domestic product, versus 3.7 percent in Thailand and 15.7 percent in the United States.    

The government last year opened up its healthcare sector to foreign investment, and is encouraging private hospital builders to reserve space for its free health program.    

“I invite the private sector to build hospitals and to have at least 25 percent of class-3 beds,” Endang said. “If they can have 50 percent of the rooms in their hospitals for class-3 beds, it would be great.”  

Indonesian property firm Lippo Karawaci and the Mayapada Group are both building hospitals in Indonesia, but regional firms such as Singapore’s Raffles Medical or India’s Fortis Healthcare have yet to show interest.

President Susilo Bambang Yudhoyono has pledged to reduce the poverty level to around 8-10 percent, from above 30 percent now, though critics say strong economic growth has not benefited the poor. And, as incomes for a growing middle class rise, there is an increase in “lifestyle” diseases.

Indonesia now needs to tackle a rise in chronic, non-communicable diseases such as stroke, heart disease and cancer, even though infectious illnesses like tuberculosis, malaria, childhood diarrhoea and dengue remain huge problems, said Endang, who is currently battling lung cancer herself.    

The ministry is trying to extend health services and treat adults with hypertension, diabetes and high cholesterol. It is also studying the possibility of reducing the salt content in fast food, and looking to improve health for children under five in a nation with a relatively high mortality rate.    

Endang, who was a scientist before becoming minister in October 2009, said HIV/AIDS was a growing concern even though its prevalence across the world’s fourth-most populous country is relatively low at 0.5 percent, versus 18 percent in South Africa.    
“We have certain provinces that are facing AIDS very seriously, like Jakarta, Bali ... Papua province,” she said.    

Indonesia had 4,158 newly confirmed HIV infections in 2010, up from 3,863 in 2009. It had a cumulative 24,131 HIV/AIDS cases by end-2010.    

Endang noted that controlling the spread of HIV was difficult because the use of condoms cannot be promoted due to religious sensitivities in the world’s most populous Muslim country. The ministry is asking NGOs and religious communities to be more active in promoting safe sex.    

“We cannot put ads for condoms openly on TV. They are available, but we cannot promote their use or people will say the health ministry promotes promiscuity,” she said.


Reuters