2021-11-23-亚开行-印度尼西亚长期护理的国家诊断研究（英）_96页_8mb

Country Diagnostic Study: Long-Term Care in Indonesia Summary

This report analyzes the availability, financing, regulatory frameworks, service provision, quality management, and human resource landscape for long-term care (LTC) in Indonesia, with policy recommendations to strengthen the system. Key findings and recommendations are summarized below.

1. Demographics
Indonesia's population is aging rapidly, projected to reach 23.7% elderly (aged 60+) by 2050. The elderly are predominantly rural, less educated, and increasingly likely to experience functional limitations and health issues. Overcrowding is higher in eastern Java, while the female elderly population is growing faster.

2. Need for Care
Approximately 650,000 (3.0%) elderly Indonesians are totally dependent due to difficulties with Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL), with 4.25 million having some difficulties. Care needs increase with age, particularly for those aged 70–80, and the proportion of women needing support is higher.

3. Supply of Care

• Family Care: Kinship-based care is most common, especially daughters and adult children. Both traditional and digital platforms are used for informal arrangements.
• Formal Services: Coverage is limited and largely urban. Public services include home-based care programs (Layanan Lansia) and community/day care centers, often underfunded and fragmented. Other providers include Lembaga Kesejahteraan Sosial (LKS) and registered Panti.
• Accessibility: Many require assistance beyond social supports or family networks that face viability issues. Private sector and non-governmental options exist but cater primarily to the urban middle class.

4. Regulatory and Policy Frameworks
Indonesia has several laws (notably the 1998 Law on Older Persons) and plans (National Strategy on Aging). However, integration of healthcare and social systems is poor due to weak coordination across agencies, insufficient local commission function, and lack of clear definition of LTC.

5. Quality Management
The report found minimal government oversight of quality, with many providers lacking accreditation. Existing standards (Standar Pelayanan Minimal) are not systematically monitored or applied to LTC services.

6. Human Resources

• Opportunities: Existing health workers, social workers, and volunteer cadres can form the backbone of an LTC workforce.
• Gaps: Shortages of skilled workers are pronounced outside urban centers. Caregiver training programs are being developed but lack standardization and mandatory uptake. These gaps may further widen during aging, considering the feminization of the elderly and gender pay-related issues.

7. Financing
Most care is self-funded or through out-of-pocket contributions, making high-quality care inaccessible to many poor elderly individuals, increasing preventable poverty traps. National and local social protection initiatives (e.g., ASLUT, village-based schemes) exist but are insufficiently funded and not always reaching those who need them.

8. Conclusions and Recommendations
Indonesia is at a critical juncture to strategically invest in a coordinated LTC system to prevent future social and economic challenges. Emphasis should be placed on integrated home and community care unless unable due to client conditions. Recommendations include:

• Immediate Development: Agree on a national definition of LTC, develop a coordinating body, build institutional capacity, and consult widely.
• Short-Term Actions: Improve data collection for accurate planning; ensure clear service definitions and standardization of existing programs; institutionalize quality protocols.
• Medium-Term Strategies: Expand workforce capacity through standardized programs; diversify funding streams through public-private partnerships, broadened social assistance, and inclusive legislation.
• Long-Term Focus: Projected future expenditures need holistic review and inclusion in broader fiscal and social policy processes.

Indonesia's effectiveness in addressing LTC will be determined by its capacity to integrate services, empower its aging population and their families, and strategically allocate resources.