382 B. Nugraha et al.
Indonesia will face an increased number of PWD within the next 15 – 25 years. Based on the 2010 survey, approximately 7 % of the population are over 65 years old. It is estimated that the proportion of Indonesia’ s population over 60 years old will increase to 12.8 % and approximately 22.3 % in 2025 and 2050, respectively( 30). Thus, the rate of ageing of the population in Indonesia is quite high. Various debates related to ageing and disability are ongoing. Some argue that there will be a decrease in the prevalence of disability as life expectancy increases( compression morbidity); others that there will be an increase in the prevalence of disability as life expectancy increases( expansion comorbidity)( 31). Disability in the ageing population tends to decrease in high income countries( 31). Indonesia is categorized as a lower middle income country. There is no published report, either positive or negative, on the trend of disability and ageing in Indonesia. However, considering the ageing population in Indonesia, together with the risk of disability in these populations, this subject requires serious consideration. In addition, reducing risk factors for disabling health conditions( e. g. stroke, cancer) is of importance to prevent disability( e. g. through non-smoking campaigns or programmes).
Indonesia has a very large population, of approximately 260 million( 6); however, there is an enormous lack of capacity regarding health provision and the number of health professionals, including in the field of rehabilitation. For example, in high income countries, the ratios of PRM, PT and OT per 1 million population are 20, 850 and 4, respectively( 32). As shown in Table V, these ratios are much lower for rehabilitation professionals in Indonesia. Other barriers are geographical, e. g. regarding urban and rural areas. Indonesia consists of more than 13,000 islands( 4), many of which are isolated islands with poor infrastructure and difficulty accessing health services.
Although the Government of Indonesia has established a regulation that rehabilitation medicine should be an integral part of hospital types A, B and C, the low number and poor distribution of rehabilitation professionals are huge challenges, as most of them work in large cities and there are little data available.
Rehabilitation for PWD in Indonesia is the responsibility of, in particular, the Ministry of Health and the Ministry of Social Welfare; therefore it is strongly recommended that actions and programmes for PWD are coordinated between ministries.
Based on the results of this study, the authors have proposed a number of recommendations to strengthen rehabilitation services in Indonesia. These recommendations are generic, since they were discussed only among the authors according to the results of situation analysis. Furthermore, this generic list of recommendations cannot be classed as priorities according to the most relevant needs of the country, since no stakeholder dialogue was performed.
Conclusion
Based on these situation analyses, it is clear that Indonesia still faces challenges with regard to PWD. In the health services, it is indispensable to strengthen rehabilitation services, including in the areas of the rehabilitation health workforce and its distribution, coordination among ministries, education, and information about disability and rehabilitation service provision.
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