亚开行-印度尼西亚长期护理的国家诊断研究（英）-2021.11-96页_5mb

COUNTRY DIAGNOSTIC STUDY ON LONG-TERM CARE IN INDONESIA

Core Content

This document presents a comprehensive analysis of the long-term care (LTC) system in Indonesia, highlighting the challenges and opportunities in developing an integrated and sustainable approach to support aging populations. It outlines the current state of LTC, including demographic trends, service supply, policy frameworks, quality management, human resources, and financing, and provides recommendations for improvement.

Main Views and Key Information

Demographic Trends

• Indonesia is experiencing rapid aging due to declining fertility rates and increasing life expectancy.
• The population aged 60 and over was estimated at 21.6 million (about 8.2%) in 2015, and is projected to reach 61.7 million (19.2%) by 2050.
• The fastest-growing segment is the "older olds" (people over 80 years of age), with more women than men in this age group.
• Seventy percent of older people live in rural areas.
• The aging population is unevenly distributed across the archipelago, with significant regional disparities.

Current Care Supply

• Most LTC is provided voluntarily by family members or domestic helpers.
• Formal care services are limited and not widely accessible, especially in rural areas.
• There are some community groups and civil society organizations that provide support, linking older people with health and social services.
• Government health and social services have a mandate to support LTC but are not yet integrated or coordinated.
• Private companies mainly offer day care and equipment services in urban areas.
• The number of residential LTC facilities is around 270, with a capacity of about 18,000, but only 3,600 of these are needed.

Policy and Legal Framework

• Indonesia has several legal and policy frameworks for older people, but they are fragmented and not well-integrated.
• There is no detailed description of LTC or guidance on integrating social and health care within a system.
• A new, multisector National Strategy on Aging is being drafted by the National Development Planning Agency (BAPPENAS), which includes an integrated approach to LTC.
• The 1998 Law on Older Persons is being revised, and the mandate of the National Commission for Older Persons (NCOP) is under review.

Service Provision

• A wide range of LTC services is available in the home, community, and residential facilities.
• However, formal care services are not diverse or robust.
• The Ministry of Social Affairs (MOSA) and Ministry of Health (MOH) have policies and mechanisms for LTC at the community level.
• Services like cash transfers and posyandu lansia (healthcare posts for older people) are limited and depend on local funding priorities.

Quality Management

• No single government agency oversees quality in LTC.
• Basic service standards (SPMs) exist for social and health services at the district level, but implementation is inconsistent.
• There is no systematic monitoring or evaluation of LTC service delivery.
• Standards for caregiving and social care through home care management were introduced in 2016, but no evidence of their enforcement or oversight is available.

Human Resources

• There is a lack of clear data on the number of trained care professionals.
• The pool of trained care workers is limited and concentrated in large cities.
• There is no national standard training curriculum for caregivers.
• LTC is not clearly defined in the roles or job descriptions of social and health professionals.
• Workforce planning does not reflect the current or future demand for LTC services.

Financing

• Indonesia's economy has been stable with 5% annual growth and a GDP per capita of $3,974.
• Health expenditure is 2.80% of GDP, with 1.77% from the private sector.
• Significant wealth disparity exists, with 11.3% of the population living below the poverty line.
• The universal health insurance scheme, BJPS Kesehatan, covers 83% of its target beneficiaries but does not include LTC as a separate category.
• Costing of LTC services is difficult due to a lack of data on current and potential costs.
• Most complex and specialist care services are unaffordable for the majority of older people.

Recommendations

• Develop a national standard training curriculum for caregivers to ensure quality and consistency.
• Establish a coordinated and integrated LTC system across government sectors, involving community, village, and district authorities.
• Improve accessibility and affordability of LTC services through public investment and targeted policies.
• Create a single point of entry and case management system to streamline LTC service delivery.
• Enhance links between health, social, and community systems to ensure holistic care for older people.
• Promote public-private partnerships to expand LTC service provision, especially in rural and underserved areas.
• Implement systematic monitoring and evaluation of LTC service delivery to ensure accountability and effectiveness.
• Strengthen legal and policy frameworks to better define and support LTC, including the integration of social and health care services.

Conclusion

Indonesia is at a critical juncture in developing an LTC system that can support its aging population. The country's economic stability and low total dependency rate offer opportunities for investment in LTC. However, the lack of integration, coordination, and adequate funding poses significant challenges. The development of a comprehensive, equitable, and sustainable LTC system is essential to address the needs of older people and their families, and to mitigate future social and economic risks.