SummaryBackgroundAs Indonesia moves to provide health coverage for all citizens, understanding patterns of morbidity and mortality is important to allocate resources and address inequality. The Global Burden of Disease 2016 study (GBD 2016) estimates sources of early death and disability, which can inform policies to improve health care.MethodsWe used GBD 2016 results for cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 333 causes in Indonesia and in seven comparator countries. Estimates were produced by location, year, age, and sex using methods outlined in GBD 2016. Using the Socio-demographic Index, we generated expected values for each metric and compared these against observed results.FindingsIn Indonesia between 1990 and 2016, life expectancy increased by 8·0 years (95% uncertainty interval [UI] 7·3–8·8) to 71·7 years (71·0–72·3): the increase was 7·4 years (6·4–8·6) for males and 8·7 years (7·8–9·5) for females. Total DALYs due to communicable, maternal, neonatal, and nutritional causes decreased by 58·6% (95% UI 55·6–61·6), from 43·8 million (95% UI 41·4–46·5) to 18·1 million (16·8–19·6), whereas total DALYs from non-communicable diseases rose. DALYs due to injuries decreased, both in crude rates and in age-standardised rates. The three leading causes of DALYs in 2016 were ischaemic heart disease, cerebrovascular disease, and diabetes. Dietary risks were a leading contributor to the DALY burden, accounting for 13·6% (11·8–15·4) of DALYs in 2016.InterpretationOver the past 27 years, health across many indicators has improved in Indonesia. Improvements are partly offset by rising deaths and a growing burden of non-communicable diseases. To maintain and increase health gains, further work is needed to identify successful interventions and improve health equity.FundingThe Bill & Melinda Gates Foundation.
Indonesia has been building a National Social Security System since 2004. Formal action to build the health component in the system (National Social Health Insurance Scheme, or JKN) started in 2005. In line with the JKN roadmap, full achievement of Universal Health Care is not expected until 2019. Preparations before the launch of JKN on 1 January 2014 involved multi-level and multi-sector efforts related to issues of equity of access, coverage, finance, quality of care (infrastructure, pharmaceuticals and medical devices, medical education), management information, and fees and tariffs. This commentary by Indonesia's Minister of Health examines the preparations and first eight months of JKN, and briefly discusses these various issues as well as the policy and practices in place at the time of launch. The article includes information on the early implementation of JKN and four lessons learned from the Indonesian experience of developing and launching national social health insurance: the importance of strong political commitment; the role of comprehensive analysis of the national health system; the use of multiparty participation in developing and implementing the plans; and the importance of systematic, continuous monitoring and evaluation from technical and administrative perspectives as well as patient satisfaction, to assure progress toward Universal Health Care.
Early successes in controlling HIV epidemics in Asia may not be sustainable in the future. There is an urgent need to make prevention scale-up as robust as treatment scale-up and to focus programmes on high impact prevention, which directly contributes to reduction of new HIV infection. A necessary objective is to convince policy makers that the emergency posed by HIV continues.
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