Reform-minded Jakarta Governor Struggles with Health Scheme

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LAST week, when news broke that a premature baby had died after Jakarta’s public hospitals – including three state-run institutions – allegedly refused treatment, there were denials all round.

“The three hospitals did not reject the patient. They also did not ask for a down payment from the patient’s family. This is based on the explanation from the medical directors of the three hospitals,” Health Ministry spokesman Murti Utami told the media.

Street vendor Eliyas Setia Nugroho, 20, the father of the infant, had a different story. Twins Dera and Dara, he said, were born prematurely via caesarean section at Zahira Hospital in South Jakarta after their mother, Ms Lisa Darawati, developed a fever.

“Dera had respiratory problems and needed surgery. The hospital staff recommended that we find a hospital with neonatal intensive care unit (NICU) facilities right away. But they did not recommend a particular hospital,” Mr Eliyas explained.

The result was a desperate search as he and his father rushed from one hospital to another across the capital. In all, they visited a total of 10 hospitals. In every case, he said, they were told either that the hospital did not have NICU facilities or that it was full.

As a Jakarta resident, the father should have been entitled to free third-class health services for his newborn child at both government and private hospitals across the city. All he needed to do was show his Jakarta Health Card – under a programme initiated by recently elected Jakarta Governor Joko Widodo – or his Jakarta ID card.

In another case reported in January, the husband of a 44-year-old housewife suffering from a painful ulcer had to pay cash after several Jakarta hospitals rejected his pleas. “Eventually, I had to pay 1.8 million rupiah (S$230) because my wife just couldn’t stand the pain,” her husband told the media. Every hospital he went to had said the same thing – all the rooms in third class were occupied.

Reports of hospitals refusing to treat patients unable to pay are so common in Indonesia that in normal circumstances they would hardly rate as news. But with the election of former Surakarta mayor Widodo as Jakarta governor in October last year, public expectations have changed.

Widely credited with revitalising Surakarta, Mr Widodo was praised as an efficient, hands-on administrator who would also work his magic on Jakarta. Thus it was that in November, when the newly elected mayor announced he was introducing a revamped health system that would reduce red tape while providing free medical care to a larger number of the city’s poor, many Jakartans took him seriously.

Mr Widodo said that residents would be issued with the Jakarta Health Card, or KJS, which would entitle holders to free medical treatment at community health centres and third-class wards in local hospitals. “Starting from light illnesses to the critical, all are covered by the KJS,” the new governor said.

However, things have not quite worked out as planned. Distribution of the cards was held up as printers failed to deliver them in sufficient quantities. Jakarta’s hospitals were also ill-prepared.

Accompanied by reporters, Governor Widodo arrived unannounced at the pharmacy of one of the city’s hospitals in January to be told by patients that they had to wait three or four hours before they could obtain the prescribed medicine. Pharmacy staff said there were not enough workers to meet the increased demand.

Baby Dera’s well-publicised death on Feb 16 added to the public relations disaster.

Why the new governor rushed into implementing something the local health system was clearly unprepared to handle is a mystery. One possibility is that he overestimated the extent to which the city’s entrenched bureaucracy was prepared to cooperate.

Normally, an incoming governor quickly replaces the heads of local agencies (responsible for such matters as roads, public parks and educational bodies) with his own supporters. But because he is an outsider, Mr Widodo has had few local loyalists to place in these positions.

Meanwhile, Mr Widodo has to answer to his political opponents, who are likely to accuse him of incompetence. Justifying his actions last week, Mr Widodo argued that a 70 per cent increase in demand for hospital services since his new health programme began was proof of success.

Having increased the city’s health budget this year, the new administration is now urging city-owned hospitals to convert 75 per cent of their second-class wings into third-class, in order to accommodate a significant increase in the number of KJS-financed patients.

As for other policies, the governor says his administration will distribute posters to all districts and sub-districts outlining his programmes so that residents can monitor implementation.

For a politician who many hope will become an important presidential candidate in next year’s elections, these are serious matters. With their expectations raised, Jakartans are unlikely to forget any more well-publicised deficiencies.

(C) Singapore Press Holdings Limited 

Key Political Risks

The inability of the government led by Prime Minister Yingluck Shinawatra to bridge the deep divisions between her populist government and its royalist opponents in the military and bureaucracy remains a major concern.

Prime Minister Yingluck has selected a competent economic team, but it is difficult for these technocrats to deliver on the new government's campaign promises without triggering inflation or hurting business. 

The government has also been unable to resolve the ongoing insurgency involving ethnic Malay Muslim rebels in the south.



  1. Attempts by the government to amend the constitution. The proposed rewrite is aimed removing legal measures initiated by the royalist generals who overthrew former Prime Minister Thaksin Shinawatra, the current prime minister's elder brother, in 2006.
  2. Ballooning government debt as officials seek to finance government programmes aimed at subsidising rice prices in order to retain the support of farmers.
  3. The relationship between Prime Minister Yingluck and senior generals. Coups have been a common means of regime change in Thai history, and any attempt by the government to purge royalist elements in the top brass could trigger yet another. Thailand

About Me

My name is Dr Bruce Gale and I am a senior writer with the Singapore Straits Times. I studied at  LaTrobe University (BA Hons) in Melbourne and later at the Centre for Southeast Asian Studies at Monash University (MA). My PhD thesis, which focussed on Malaysian political economy, was completed at the Malaysian National University (Universiti Kebangsaan Malaysia) in 1987.

From 1988 to 2003 I was Singapore Regional Manager for the Hong Kong based Political and Economic Risk Consultancy (PERC). 

I have written several books and articles on Southeast Asian affairs, including Political Risk and International Business: Case Studies in Southeast Asia (Pelanduk Publications, 2007). Books on language include Mastering Indonesian: a guide to reading Indonesian language newspapers (Pelanduk Publications, 2008)

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