Indonesia/right to health: “Ambitious goals can be reached only if challenges are addressed” – United Nations expert

JAKARTA / GENEVA (4 April 2017) – Indonesia is on the right track to develop an equitable and sustainable healthcare system based on universal health coverage, said today the United Nations Special Rapporteur on the right to health, Dainius Pûras, at the end of his first official visit to the country. However, he warned, “ambitious goals can be reached only if challenges are addressed.”

“Despite commendable efforts, availability, access to and quality of health services remain a challenge in a country where the population is spread throughout thousands of islands and remote areas,” he said, urging the Indonesian authorities to address such challenges “with the highest level of political commitment so that the health system guarantees all core elements of the right to health.”

“There are real opportunities and a genuine commitment to achieve the progressive realisation of the right to health in Indonesia, but public authorities need to step up efforts to address structural and systemic issues, both in law and practice, to make sure that they are not tempted by the ‘lower hanging fruit’ and none is left behind,” the expert said.

Mr. Pûras stressed that “from poor and near-poor to middle-class and wealthy users of services, public and private providers, and civil society, health professionals, and all levels of public authorities, they all need to gain and generate trust in the universal health insurance system, which is based on the principle of solidarity.”

The United Nation Special Rapporteur, who visited Indonesia from 22 March to 3 April 2017, called on the Government to increase national budget allocations for health. “However,” he said, “increased investments in healthcare only make sense if the system is efficient, transparent, accountable, and responsive to those who use it.”

The expert pointed out that important barriers persist, in law and practice, for the realization of sexual and reproductive health rights, consequently women and other key populations are exposed to different forms of violence and discrimination.

“I was discouraged to hear that planning and delivery of these services and sexuality education is being influenced by certain groups who continue to oppose policies, instruments and mechanisms for the promotion and protection of sexual and reproductive health rights,” he said.

“Cultural and religious norms need to be taken into account in all contexts,” Mr. Pûras said. “However, when their interpretation is such that it generates discrimination on different grounds and reinforces harmful practices, such as early marriage and female genital mutilation, it seriously undermines the effective realization of the right to health and it is not acceptable.”

Indonesia has a relatively low prevalence of HIV/AIDS but new infections are on the rise amongst certain key affected populations who still face stigma and discrimination, including in healthcare settings.

“I am concerned about the health status of ethnic Papuans, who are two times more likely to have HIV/AIDS than the rest of the population, and new infections are on the rise,” he noted calling for special attention and efforts from all stakeholders to build trust amongst service providers and users, and enhance access to treatment and services in a culturally-sensitive manner.

Mr. Pûras also noted that the approach to a drug policy remains excessively punitive, undermining the right to health of people who use drugs and public health efforts. “Criminalization of drug use only fuels discrimination, violence and exclusion driving people away from the health services they need and seriously undermining public health efforts,” he underscored.

“Mental health is an emerging issue but it needs additional commitments and resources to develop a system that promotes the mental health of everyone and effectively treats and prevents common mental health conditions at the community level and respects the rights of persons with psycho-social and intellectual disabilities, the expert explained.

The Special Rapporteur will present a comprehensive report on his visit to Indonesia to the United Nations Human Rights Council in June 2018.

Mr. Dainius Pûras (Lithuania) is the Special Rapporteur appointed by the UN Human Rights Council to promote and protect the right to health. He is a medical doctor with notable expertise on mental health, child health, and public health policies. Mr. Pûras is a Professor and the Head of the Centre for Child psychiatry social paediatrics at Vilnius University, and teaches at the Faculty of Medicine, Institute of International relations and political science and Faculty of Philosophy of Vilnius University, Lithuania.

The Special Rapporteurs are part of what is known as the Special Procedures of the Human Rights Council. Special Procedures, the largest body of independent experts in the UN Human Rights system, is the general name of the Council’s independent fact-finding and monitoring mechanisms that address either specific country situations or thematic issues in all parts of the world. Special Procedures’ experts work on a voluntary basis; they are not UN staff and do not receive a salary for their work. They are independent from any government or organization and serve in their individual capacity.

OHCHR Country page: Indonesia

For use of the information media; not an official record

HR17.107E