Health

Context

Indonesia has achieved impressive economic progress over the past 20 years, but access to quality health services, particularly for the poorest and most vulnerable people, remains a challenge. The U.S. Agency for International Development (USAID) has invested more than $1.1 billion to help Indonesia strengthen its health systems. We partner with civil society, the private sector, and the national, provincial, and local governments to eliminate preventable maternal and newborn deaths, improve nutritional intake to reduce childhood stunting, and improve Indonesia’s health care. We also work to prevent and control epidemics like tuberculosis (TB) and HIV/AIDS, and to prevent, detect, and respond to emerging infectious disease threats.

USAID’s support resulted in a number of important achievements, including: 

• USAID has improved hospital-based TB services by strengthening partnerships with six of the largest Indonesian private hospital chains. In more than 250 hospitals, our assistance supported TB screening for more than four million people, resulting in the identification and treatment of 40,000 TB patients. USAID also supported the establishment and strengthening of 12 drug-resistant tuberculosis (DR-TB) clinics that delivered life-saving treatments to 321 DR-TB patients across Indonesia.

• In 2023, more than 180,000 pregnant women received life-saving medications to prevent post-delivery bleeding – the most prevalent cause of maternal mortality in Indonesia.

• In support of Indonesia's Health Transformation efforts, USAID supported the Ministry of Health (MOH) to connect more than 23,500 healthcare facilities in 38 provinces to the Satu Sehat (One Health) platform, reducing barriers to health services for patients.

• USAID facilitated the testing of almost 110,000 people for HIV, resulting in the diagnosis of more than 4,000 cases. Additionally, with our support, more than 43,000 people continued their HIV treatment in the Jakarta and Greater Jakarta region.

• USAID helped to detect almost 34,000 potential outbreak signals, triggering verification and response by the authorities. Additionally, USAID’s support decreased the case fatality rate of leptospirosis, a potentially fatal zoonotic disease, by 20 percent in Demak District, Central Java province.

CURRENT PROGRAMS

REDUCING THE BURDEN OF INFECTIOUS DISEASES AND BOLSTERING HEALTH SECURITY

Indonesia is the world's second-highest tuberculosis burden country. In 2022, there were more than one million new cases and approximately 134,000 deaths. USAID supports the Government of Indonesia (GOI)’s goal to eliminate TB by 2030 through a suite of programs: Together Towards the Elimination and Freedom from TB (Bebas TB), Enhanced Multi Drug Resistant TB Services through a Network of Private Hospitals (Mentari TB), Health Communication Campaign for TB Preventive Treatment in Indonesia (Prevent TB), and TB Private Sector (TBPS). Through these investments, USAID is working to improve TB care in private hospitals and clinics, and enhancing public awareness about TB prevention. We introduced and tested a coaching system for health providers, which now supports 107 private hospitals in 28 districts. USAID also developed training modules that improved knowledge of managing TB cases for more than 15,000 doctors, nurses, laboratory technicians, and pharmacists. Additionally, USAID is improving the interoperability of health information systems by connecting private hospitals to national health systems.

To achieve HIV epidemic control, Indonesia has committed to diagnosing 95 percent of people living with HIV, treating 95 percent of those diagnosed, and achieving viral load suppression in 95 percent of those in treatment by 2027. USAID partners with the GOI, health practitioners, organizations, and communities to assist Indonesia in achieving these targets through programs such as Advocacy for Improved HIV/AIDS Service Delivery (Advocate4Health) and Meeting Targets and Maintaining Epidemic Control (EpiC), and through our collaboration with UNAIDS. We work to reduce new infections by integrating HIV treatments, enhance community-based HIV self-testing, and combat stigma and discrimination in Jakarta, West Java, and Banten provinces. We collaborate with key populations, organizations, and health facilities to support the implementation of these policies at the community level, focusing on the quality and availability of HIV-related care, support, and treatment.

In line with the Global Health Security (GHS) Agenda, USAID enhances Indonesia's efforts to mitigate the risks and impacts of emerging diseases and pandemics. Our GHS support focuses on strengthening the One Health laboratory network and disease surveillance; mitigating zoonotic disease threats; improving human resources; and financing. Since 2006, USAID has implemented the One Health approach to connect the human, animal, and environmental health sectors. We collaborate with partners like the Food and Agriculture Organization, the World Health Organization, the International Federation of Red Cross and Red Crescent Societies, and the Indonesia One Health University Network to prevent, detect, and respond to priority zoonotic disease threats. We also contribute to Indonesia’s digital health transformation by improving data analysis and use within the One Health framework.

PREVENTING MATERNAL AND NEWBORN DEATHS AND IMPROVING NUTRITION FOR CHILDREN

Indonesia has made remarkable progress in reducing maternal and infant mortality, lowering the mortality rate for mothers by 45 percent and for newborns by 26 percent between 2010 and 2020. The incidence of childhood stunting has also declined over the past decade. Further reducing the rates of these tragic outcomes is a priority for the GOI. Through USAID Momentum, we collaborate closely with the GOI to address critical issues related to maternal and newborn mortality. Our support extends to more than 80 hospitals and 30 primary health centers across six provinces. USAID has established referral networks between public and private health facilities and implemented quality improvement initiatives in hospitals.

USAID is actively involved in reducing childhood stunting through the Partnership to Accelerate Stunting Reduction in Indonesia (PASTI). In collaboration with the private sector, USAID pools resources and implements evidence-based best practices to support the GOI’s commitment to accelerate stunting reduction programs. USAID is leveraging $8 million of private sector financing in six provinces to improve feeding practices during the crucial first 1,000 days, which encompasses pregnant and lactating mothers and children under age two, as well as enhancing nutrition practices among vulnerable adolescents and premarital couples. We are also strengthening collaboration among healthcare facilities, community-based primary healthcare services, and other stakeholders.

STRENGTHENING HEALTH SYSTEMS

The GOI launched a complex, single-payer national health insurance system in January 2014 called Jaminan Kesehatan Nasional (JKN) with the goal of achieving universal health coverage. As of December 2023, more than 267 million Indonesians (96 percent of the population) are covered by JKN. USAID, through the Health Financing Activity, continues to strengthen JKN by building its capacity to generate and use quality data to improve performance, effectiveness, and sustainability. USAID Catalyze is mobilizing public-private partnerships to increase the number of active JKN members, which will improve the sustainability of social and financial protections.

Indonesia’s health system comprises a mixture of public and private providers and financing. There has been a drive to digitize health services, resulting in the development of many health applications by the central government, regional governments, and the private sector, fragmenting and siloing systems. To stem this fragmentation, the MOH initiated a digital health transformation and launched the Satu Sehat platform to connect data, analysis, and services to support and integrate health applications. USAID is assisting the MOH to accelerate its digital health efforts, including improving reporting and recording for maternal and newborn health, TB, HIV, and global health security, as well as strengthening human resources and health financing information systems. USAID, through Country Health Information Systems and Data Use (CHISU), supports the GOI’s digital health transformation to establish an integrated information system and strengthen data use to improve health outcomes for Indonesians.

USAID also supports the GOI’s efforts to transform primary health care through scaling up the MOH’s Integrated Primary Health Care (I-PHC) initiative in five provinces. This collaborative effort provides technical assistance to provincial and district health offices, primary health care facilities, and villages to plan, finance, implement, and monitor the I-PHC program. We provide research to improve various aspects of the I-PHC, including telemedicine, facilitative supervision, performance-based incentives for community health workers, and public-private provider networks.