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Ministry of Health). Some international donors also work with local governments, universities and
private sector organisations to strengthen specific aspects of the system.
Indonesia’s health data and information management systems
Indonesia has a national information system Sistem Informasi Kesehatan Nasional (SIKNAS), which is
linked with provincial health information systems and district-level health information systems,
Sistem Informasi Kesehatan Daerah (SIKDA). SIKNAS was developed per the Ministry of Health Decree
No. 511/Menkes/ SK/V/2002 and consists of six subsystems: health services; health financing; health
workforce; medicines and medical devices; community empowerment; and health management.
A negative consequence of the decentralisation was that the existing district-level health information
systems broke down or were weakened in many districts as there were no longer obligations to
regularly report to the central level. Multiple separate district-level information systems of varying
quality, using different formats, software and data collection approaches were introduced. As
highlighted by one of the stakeholders, there are currently only few health outcome indicators that
have reliable disaggregated data up to the district level as relevant data are just not collected
systematically by all districts. There are also considerable concerns about the quality of district-level
monitoring due to lack of district-level capacity. These shortcomings in district-level monitoring have
negative implications for the planning and management of local health service delivery and can lead
to the exclusion of the poor (WHO, 2017).
Another challenge is that Indonesia’s health information system has always been focussed mainly
towards the public sector and there is only limited information about the private sector engagement
in health services. Given the growing participation of the private sector the lack of information was
highlighted as a short-coming by several stakeholders. To improve data availability a number of
national health surveys supplement the incomplete district level health information systems and
collect a broader range of health information. These include: the National Health Indicator Survey
( Survei Indikator Kesehatan Nasional /SIRKESNAS); Basic Health Research (Riset Kesehatan Dasar /
RISKESDAS); and the Health Facility Survey (Riset Fasilitas Kesehatan/RIFASKES). Indonesia also
conducts regular Demographic and Health Surveys programme (Su rvei Demografi dan Kesehatan
Indonesia/SDKI) (BPS, 2012; Indonesia, 2012; World Bank, 2014; WHO, 2017).
The poorly-coordinated and fragmented health information system poses a considerable challenge for
the development of the health system and the achievement of UHC in Indonesia. There are ongoing
efforts together with WHO to strengthen the health information system by addressing key issues
related to: management capability (especially at district-level), cooperation and coordination; data
and information indicators need to be defined; improve data sources; collecting, processing and
analysing data; and provide adequate human resources and financing (WHO, 2015a).
Summary and Conclusions
Over the past decades Indonesia has shown significant progress regarding the health status of its
citizens and towards achieving Universal Health Coverage (UHC). However, several challenges remain
to be tackled and reforms of the healthcare system are necessary for further improvements in the
future. Indonesia has shown significant decreases in infant, under-five and maternal mortality rates as
well as an increase in life expectancy. On the other hand, stunting is still an issue among young children
and infectious diseases are tackled in a relatively slow pace as malaria and tuberculosis are still in high
levels. HIV/AIDS levels are also unchanged and non-communicable diseases (NCDs) are continuously
emerging, the latter recently being the cause of up to 73% of all deaths in Indonesia.
The health system in the country has been recently decentralised giving more power and more
responsibility to the provincial (PHOs) and district health offices (DHOs) to act on health issues at the
community and village level -something that has always been of high importance in Indonesia.
Although the public sector is still dominant, the health sector has opened significantly during the