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AREA OF WORK
SUSTAINABLE DEVELOPMENT
Country Issues and Challenges :
Foreign aid to the health sector increased following the economic crisis, and comprised
an estimated 17.9% of total health expenditure in 1998/99. As described in greater detail
in the WHO Country Cooperation Strategy 2001, major donor support has previously focused on
disease control efforts, under which several major donors have developed partnerships. While
coordination efforts were optimal during the economic crisis, the large number and complexity
of donor projects has complicated regular coordination between government and donor resources.
Currently, a number of major donors, including the World Bank, ADB, and AusAid are providing
strong support to efficiency and equity in health systems development. Optimal communication
and exchange among MoH and major donors is needed to prevent duplication of effort and sharing
of lessons learned.
In 1999, Partnerships for Health provided a forum to bring together major bilateral donors
from USA and Canada, UNICEF, WHO, Asian Development Bank and World Bank. Recently, WHO was
nominated co-chair of the Health Working Group under the Consultative Group on Indonesia (CGI),
with its major objective of improving communication and exchange among the major donors and GoI
and gaining political and financial support to health.
An additional area is advocacy for establishing health in the development agenda. Local
financing decisions on sector priorities may be more relevant to population health needs. Yet,
the continued funding of the existing public health delivery system relies on political will at
district level. This realization primarily depends on individuals within the local government
itself, their understanding and willingness to support health as a priority among sectors, the
negotiating strength of provincial and district health authorities, and the population's vocalized
priorities. The greatest health gains, however, are to be made among the poor, who carry a
disproportion burden of illness, and ill health is costly. Given recent evidence that good health
contributes to economic productivity, directing health subsidies to the poor is an important priority
in national development. Within the current economic situation, health resources are particularly
constrained and can severely affect health, household savings, and investments in nutrition or education.
Advocacy is urgently needed in support of health service delivery in general, and the continued support
to public health activities and services for the poor in particular.
Expected Contribution :
- Active support to collaborative mechanisms for coordination and exchange among GoI colleagues,
major donors, other key stakeholders to promote positive developments in population health and welfare.
HEALTH AND ENVIRONMENT 1
Country Issues and Challenges :
The National profile of the chemical infrastructure prepared in 1998 is under the process
of updating. Substantial development has taken place in last few years, while the National Agency
for Drugs and Food Control Itself has gone under Major Reorganization. The ongoing chemical
afety activities required to be reassessed in view of the developmental changes that have taken place.
Expected Contribution :
- Strengthening national chemical safety and poison control programs.
- Support activities pertaining to clinical analytical toxicology.
HEALTH AND ENVIRONMENT 2
Country Issues and Challenges :
The on going Globalization process, Asean Free Trade Agreement (AFTA) and rapid
development of technology, communication and transportation are a major challenge fro
the Indonesian Occupational Health and Safety Program. The Center for Occupational Health,
recently established under the MOU possesses potential opportunity for addressing OCHS issues
by systematic awareness creation and by involving the NGOs working in this sector.
Protection of vulnerable groups against emating environmental harmful conditions is still
considered a low priority in the country. However, the impact of environmental risk factors on
human health is growing both in magnitude as well is in variability. It becomes therefore imperative
to adequately advise concerned agencies and the public with authoritative information for measures
to mitigate adverse health effects caused by environmental factors.
Expected Contribution :
- Collaborative intersectoral awareness building for the informal sector worker groups in the OCHS program.
- Reduction of environmental exposure to workers supported by HRD in Occupational Health.
- Environmental risk factors systematically assessed, analyzed and documented with focus on vulnerable groups.
HEALTH AND ENVIRONMENT 3
Country Issues and Challenges :
There exists a need to improve understanding of the contribution of unsafe water,
sanitation and hygiene to the overall burden of disease but there is no doubt that these
risk factors are important causes of mortality and morbidity especially among children and
more so among children who are poor. Although water supply coverage in Indonesia stands
at approximately 87%, the safety of water for human consumption is often suspect: a recent
HO/SEARO study concluded that no SEAR country has an adequate national programme of drinking
water quality and surveillance. Similarly, although sanitation coverage in Indonesia is estimated
at 66%, hygiene practices necessary to optimize the health impact of sanitation infrastructure
are poor especially in rural zones and urban slums. Moreover, sector professionals increasingly
acknowledge that the true water supply and sanitation coverage is significantly lower than the
above-mentioned estimates. Greater levels of investment in water supply and sanitation infrastructure,
and greater sector efficiency, are needed in order for Indonesia to achieve the Millennium Development
Goals (MDG) for water supply and sanitation and the closely related MDG for child mortality.
Simultaneously, Indonesia needs to improve and expand hygiene promotion programmes and also promote
low-cost interim measures such as household-level water treatment among others. A separate but
related challenge exists to strengthen the country's capacity to prevent and mitigate water-related
health emergencies associated with natural disasters.
Expected Contribution :
- Capacity of health authorities and partners to reduce burden of disease due to unsafe water,
sanitation and poor hygiene will be strengthened.
FOOD SAFETY
Country Issues and Challenges :
Prevalence of foodborne and waterborne diseases and their outbreaks in Indonesia reported
to be high, while most of the outbreaks are not investigated adequately. Risk assessment and
risk communication on food safety is crucial in this aspect. Collaborative efforts by establishment
of networking mechanism with the research/training institutes possess potential for reducing
outbreak frequencies.
National Agency for Drugs and Food Control has been reorganized by enhancing its technical and
functional capacities. Strengthening its risk assessment capacity in a systematic manner is crucial
for enhancing the Food Safety program of the agency.
Expected Contribution :
- Collaborative network with research institutions on assessment of Microbiological risks.
- Risk communication and Food-Safety Education on food borne disease outbreaks.
- Strengthening national capacity for risk assessment and outbreak response.
EMERGENCY PREPAREDNESS AND RESPONSE
Country Issues and Challenges :
EMERGENCY PREPAREDNESS AND RESPONSE
Expected Contribution :
- Improved capacity and ability of MoH at central, provincial and district levels to
manage Health Emergencies and Disaster Situations in Indonesia through effective prevention,
preparedness and response.
- Establishing effective partnerships for Health Emergencies and Disaster Management in Indonesia
through promoting coordination and collaboration mechanisms with international and national
agencies, international and local NGO's at the central, provincial, district and community levels.
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