The state of health in Indonesia's provinces, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Analysing trends and levels of the burden of disease at the national level can mask inequalities in health-related progress in lower administrative units such as provinces and districts. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to analyse health patterns in Indonesia at the provincial level between 1990 and 2019. Long-term analyses of disease burden provide insights on Indonesia's advance to universal health coverage and its ability to meet the United Nations Sustainable Development Goals by 2030. Methods We analysed GBD 2019 estimated cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 286 causes of death, 369 causes of non-fatal health loss, and 87 risk factors by year, age, and sex for Indonesia and its 34 provinces from 1990 to 2019. To generate estimates for Indonesia at the national level, we used 138 location-years of data to estimate Indonesia-specific demographic indicators, 317 location-years of data for Indonesia-specific causes of death, 689 location-years of data for Indonesia-specific non-fatal outcomes, 250 location-years of data for Indonesia-specific risk factors, and 1641 location-years of data for Indonesia-specific covariates. For subnational estimates, we used the following source counts: 138 location-years of data to estimate Indonesia-specific demographic indicators; 5848 location-years of data for Indonesia-specific causes of death; 1534 location-years of data for Indonesia-specific non-fatal outcomes; 650 location-years of data for Indonesia-specific risk factors; and 16 016 location-years of data for Indonesia-specific covariates. We generated our GBD 2019 estimates for Indonesia by including 1 915 207 total source metadata rows, and we used 821 total citations. Findings Life expectancy for males across Indonesia increased from 62·5 years (95% uncertainty interval 61·3–63·7) to 69·4 years (67·2–71·6) between 1990 and 2019, a positive change of 6·9 years. For females during the same period, life expectancy increased from 65·7 years (64·5–66·8) to 73·5 years (71·6–75·6), an increase of 7·8 years. There were large disparities in health outcomes among provinces. In 2019, Bali had the highest life expectancy at birth for males (74·4 years, 70·90–77·9) and North Kalimantan had the highest life expectancy at birth for females (77·7 years, 74·7–81·2), whereas Papua had the lowest life expectancy at birth for males (64·5 years, 60·9–68·2) and North Maluku had the lowest life expectancy at birth for females (64·0 years, 60·7–67·3). The difference in life expectancy for males between the highest-ranked and lowest-ranked provinces was 9·9 years and the difference in life expectacy for females between the highest-ranked and lowest-ranked provinces was 13·7 years. Age-standardised death, YLL, and YLD rates also varied widely among the provinces in 2019. High systolic blood pressure, tobacco, dietary risks, high fasting plasma glucose, and high BMI were the five leading risks contributing to health loss measured as DALYs in 2019. Interpretation Our findings highlight that Indonesia faces a double burden of communicable and non-communicable diseases that varies across provinces. From 1990 to 2019, Indonesia witnessed a decline in the infectious disease burden, although communicable diseases such as tuberculosis, diarrhoeal diseases, and lower respiratory infections have remained a main source of DALYs in Indonesia. During that same period, however, all-ages death and disability rates from non-communicable diseases and exposure to their risk factors accounted for larger shares of health loss. The differences in health outcomes between the highest-performing and lowest-performing provinces have also widened since 1990. Our findings support a comprehensive process to revisit current health policies, examine the root causes of variation in the burden of disease among provinces, and strengthen programmes and policies aimed at reducing disparities across the country. Funding The Bill & Melinda Gates Foundation and the Government of Indonesia. Translation For the Bahasa Indonesia translation of the abstract see Supplementary Materials section

Peran Rumah Singgah ‘Sanggar Anak Matahari' dan ‘Sakura' dalam Meningkatkan Pelayanan Kesehatan Anak Jalanan di Kota Bekasi 2013

Street children shelter is a shelter for street children by providing facilities for their existence, providing services and guidance with mission as preparing children for the future. The study aimed to determine roles of street children shelter in the utilization of health services. It was a qualitative study and use of secondary data. The study was conducted at two street children shelters in Bekasi City year 2013. The street children shelters were selected purposively from list of street children shelters at Bekasi City Social Office, namely Rumah Perlindungan Anak Sakura and Sanggar Anak Matahari. Qualitative data was collected by indepht interview. The qualitative data collected were processed in the form of transcrip, then text transcript and coded. The transcript was analyzed by content analysis method. It showed that Sanggar Anak Matahari had more roles in health services utilization than Rumah Perlindungan Anak because it had a sponsor in the field of health service, Zainuttaqwa Hospital. While Rumah Perlindungan Anak Sakura just referred sick street children xto the nearest health center. Both shelters had cooperation with social services for health education activities. If there is street children case can not be managed so cooperation with the Local Government is carried out. Shelters have important roles to foster street children in use of health services. It needs cooperation between shelter managers and government, private sector to increase cooperation with various stakeholders, particularly with regard to health, as health education and medical examination to support roles of shelter in the utilization of health services among street children

Networks of Waste: Informal Economic Systems and Sustainability in Bali, Indonesia

This article examines solid waste management in Badung Regency, Bali. It argues that current conventional centralised and decentralised solid waste management approaches are not proving effective and fail to cater to the needs of the majority of the population, particularly poorer communities. In contrast, it was found that informal waste networks achieved higher standards of economic efficiency, service coverage and resource recovery, contributing both to environmental protection and livelihoods. Much can be learned by planners in developing nations from these 'networks of waste', and in building upon the economic and environmental principles and behaviour around which informal waste networks function.