VZCZCXYZ0000
PP RUEHWEB

DE RUEHJA #0260/01 0440857
ZNR UUUUU ZZH
P 130857Z FEB 09
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC PRIORITY 1483
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC

UNCLAS JAKARTA 000260 
 
SIPDIS 
SENSITIVE 
 
AIDAC USAID FOR MELLIS/ASIA/AA, SSOLAT/ASIA/EAA, 
GCOOK/ME/TS, SRADLOFF/GH/PHR, JBORRAZZO/GHIDN/MCH 
SENSITIVE BUT UNCLASSIFIED 
 
E.O. 12958: N/A 
TAGS: SENV CASC EAID ID
SUBJECT: FAMILY PLANNING/REPRODUCTIVE HEALTH (FP/RH) 
SERVICES LAGGING IN INDONESIA: TIME TO ACT 
 
1.(SBU) Summary. Several national surveys and a recent 
report by senior experts provide compelling evidence that 
IndonesiaQs reproductive health program is lagging and has 
lost its status as an exemplar of global excellence. This 
cable outlines these problems and proposes several actions 
by USAID to address them. Most importantly, now is the time 
for a targeted re-engagement on this problem. End Summary. 
 
Background: Disappointing Results 
--------------------------------- 
¶2. Preliminary Demographic Health Survey (DHS) results 
provide evidence of the poor performance of the recently 
decentralized health system in Indonesia and slowed 
progress toward achieving Millennium Development Goals 
(MDG), particularly with regard to maternal and child 
health indicators. This was reported in reftel: #00089 
Jakarta May 08. 
 
¶3. A World Bank coordinated meta-analysis, the 2008 Health 
Public Expenditure Review (HPER), revealed that public 
expenditure in the health sector by the Government of 
Indonesia (GoI) has been very low. Since 2001, public 
expenditure on health constitutes only 1% of GDP, among the 
lowest in the Asia region. The financial commitment has not 
improved and is exacerbated by poor leadership in the 
Ministry of Health. New leadership might emerge after the 
2009 elections. Results from the HPER were delineated in 
reftel: AID 08/07/08. 
 
¶4. In November 2008, an independent study conducted by 
Professors Mosley (Johns Hopkins University) and Hull 
(Australia National University) of the Indonesia National 
Family Planning Program (BKKBN) called for revitalizing 
FP/RH services. The authors expressed concern with the 
situation, noted the global demographic consequences of the 
backsliding and recommended an urgent re-engagement in this 
sector by international partners. The report calls for: a) 
a measured approach to capacity re-building for the BKKN; 
b) an effort to expand the narrowing method mix of 
voluntary family planning options in order to reduce 
maternal mortality and unwanted abortions; and c) increased 
access to quality post abortion care. 
 
USAIDQs Past Role 
----------------- 
¶5. USAID supported FP/RH programs for over two decades. 
This resulted in increased contraceptive prevalence and 
reduced fertility rates. Unfortunately, early successes 
have since been eroded, first in the wake of the Asian 
economic crisis in the late 1990s, and secondly over the 
past 5 years as the GoI attempted to deploy a new 
decentralization plan under IndonesiaQs first 
democratically elected government in the worldQs fourth 
most populous nation. In 1997, the Indonesia program had 
been a model for the world. 
 
Missing Women 
------------- 
¶6. The Mosley/Hull report found one omission in the DHS 
(unmarried women were not included in the respondent pool), 
representing a group with unmet needs that if unaddressed 
could lead to an increase in unwanted abortions. A report 
by the Indonesia Planned Parenthood Association (PKBI) 
estimates that there are 2 million illegal abortions 
annually, which include many unmarried women. Secondary 
analyses will provide further insights regarding geographic 
and demographic disparities which are assumed to be 
significant. According to the authors, total fertility 
rates were unaffected by this finding and not unusual for a 
DHS. 
 
What To Do 
----------- 
¶7. The Mosley/Hull report calls for a revitalization of the 
FP/RH sector in light of the stagnating DHS indicators. The 
report recommends: a) increasing capacity building for the 
BKKBN, with a particular focus on capacity building at the 
local (provincial/district) levels; b) technical assistance 
to address post-abortion care; and c) widening 
contraception method-mix options, which have also 
substantially narrowed over the past decade with the 
predominant method of choice now being the use of short- 
term injectable contraceptives. 
 
Planned USAID Response 
-------------- 
 
- Analysis 
 
¶8. While FP/RH support from the DA account was concluded in 
2007, USAID plans to utilize discrete carry-over funds to 
support secondary analysis of the 2007 DHS (final results 
to be published in February 2009) in order to further 
inform current and future policy makers, particularly at 
the decentralized levels, in order that future policies 
(and legislation) in support of FP/RH are evidence-based 
and fully deployed throughout the archipelago. 
 
- Advocacy 
 
¶9. USAID will continue its innovative efforts to advance 
local legislation in support of health priorities such as 
MCH and FP/RH. It also plans to work more closely with the 
National Midwives Association to ensure that more equitable 
and wider method-mix options are recognized and accessible. 
However, this effort has been severely limited in light of 
a 30% decrease in MCH funding during 2008 (in lieu of 
support for water & sanitation). 
 
- Care 
 
¶10. Since one of the objectives in the new USAID strategy 
is to reduce maternal mortality (in line with MDG 5: 
Improving Maternal Health), USAID is urgently seeking 
targeted support for FP/RH from the DA account that could 
be made available from the 2009 plus up for the FP/RP 
earmark. This vital support for an under-served sector 
would be utilized toward achieving the intermediate result 
of reducing deaths during pregnancy, and the overarching 
global goal of reducing unwanted abortions. The BKKBN and 
MOH would clearly welcome any related technical support 
that could be forthcoming. Currently, the only major donor 
support for family planning in Indonesia is via UNFPA, 
largely through the sporadic provision of contraceptives. 
 
- Private Sector 
 
¶11. Given that the majority of health and FP/RH services 
are provided through the private sector (a little 
understood and largely unregulated industry in Indonesia), 
USAID is supporting (in coordination with the World Bank 
and other donors) the first assessment of the private 
health sector as part of a larger National Health Sector 
Review that could be a valued resource for senior policy 
makers in the next GoI administration as it seeks to 
strengthen strategic synergies between public and private 
sectors. 
 
HUME