How to reap Indonesia's demographic dividend

MORTALITY RATES: Improving quality of life of the newborn is crucial, says Razali Ritonga

THE performance of a nation in the health sector is usually reflected in indicators, such as mortality rates and life expectancy.

The lower the mortality rate and the higher the life expectancy, the better the health programme in that country.

Unfortunately, the health programme in Indonesia shows a low performance, as indicated by a high mortality rate and neonatal mortality rate.

For every 1,000 live births, 19 die within a month. In industrialised countries, neonatal mortality stands at four per 1,000 live births according to the World Health Organisation in 2008.

Therefore, the government should seek every opportunity to bring down the neonatal mortality rate. This is crucial since Indonesia faces a demographic dividend that started in 2010 and will last until 2050. The demographic dividend is expected to peak in 2025.

This will create a window of opportunity for Indonesia to reach a higher potential economic growth and welfare status, since the proportion of the population at a productive age exceeds that of a non-productive age.

A shrinking, young population could allow the government to save its budget and invest in economic activities and human wellbeing.

However, hopes of reaching those goals may not be realised if the government fails to improve the quality of the population who will enter the labour market in 2020-2050. One segment of that population is those aged below 1.

The importance of bringing down the neonatal mortality rate is also shown by the higher contribution of this to infant mortality (under 1) and child mortality (under 5). The contribution of neonatal mortality to infant mortality is about 60 per cent, and to child mortality it is about 40 per cent (WHO, The State of the World's Children, 2008).

Generally, the causes of neonatal deaths are pneumonia, infections and diarrhoea. The "Neonatal survival series 2005" in the medical journal, The Lancet, reported that at least three out of four million neonatal deaths in the world could be anticipated if 90 per cent of pregnant women had access to health services.

Although Indonesia on average reached that percentage, health services for pregnant women remained below standard. The results of a demographic and health survey in 2007 reported that only 73 per cent of pregnant women received anti-tetanus injections, only about 77 per cent of pregnant women consumed iron pills and only 46 per cent of pregnant women gave birth at health facilities.

There are reasons for the failure to provide pregnant women with access to health services. The World Bank (2006) outlined four reasons that brought about the low coverage of pregnant women with access to health services in developing countries.

The first is low education and knowledge. The majority of pregnant women in developing countries lack knowledge on how to manage their pregnancies.

Second is women's exclusion from decision-making. In fact, pregnant women might know that they have to visit health services, but their husbands sometimes do not give them permission.

Third is a lack of health facilities. This aspect becomes a major problem in some regions in Indonesia, especially remote areas where health facilities are rare.

Fourth are non-technical aspects, such as pregnant women who are not ready to undergo medical treatment provided by male doctors or medical workers.

The government needs to take these four factors into consideration in delivering health services. Although the government, for example, gives pregnant women free access to health services, it is not a guarantee that they are ready to come and visit health centres.

Based on those reasons, it comes as no surprise that the health budget is enjoyed by higher-income groups rather than those in lower-income brackets. Surveys conducted by the World Bank in 2004 in 21 countries discovered that 20 per cent of high-income groups received 25 per cent of the total health budget, compared with 15 per cent that went to 20 per cent of low-income groups.

It is, therefore, high time for the government to increase its health budget and distribute it fairly in order to reduce the mortality rate, especially in the neonatal group. The government cannot rely on women to treat their children themselves.

It needs to do more to increase the quality of life of the population, especially newborn babies. Years from now, they will not only become productive workers but will also be taking over leadership positions in the country.

Failure to improve their quality of life will mean that Indonesia will waste the population dividend and perhaps lead the nation to the brink of disaster.

(sumber : nst.com.my)