Moving toward universal health coverage of Indonesia: where is the position?

The intention to provide the people’s rights to health has driven any attempts to achieve universal health coverage. The right to health is not right to be healthy, but the State must secure citizen’s rights to access health care services and any underlying determinants of health. The Indonesian health care reform accelerated since 1998 is intended to provide universal health coverage. It is one of attempts to fulfills the right to the highest attainable standard of health as mandated by international and national legal instruments. This thesis attempts to explore whether the health care reform toward universal health coverage in Indonesia improves the fulfillment of the right to the highest attainable standard of health. This thesis assesses the impacts from policy and legal perspective through literature review to describe the history of the reform, the legal and policy instruments developed during the health care reform, the interaction among policy actors, and human right assessment on three dimensions of coverage, availability, accessibility, acceptability and quality. During the movement toward universal health coverage, some improvements have achieved, supported by community pressure, including improvement of the three dimensions of coverage, availability, accessibility, and acceptability. Decentralization, in some extent, has a pivotal role in the reform to improve universal access, but it also creates unequal access countrywide. However, the movement to achieve universal health coverage and fulfill the rights to the highest standard of health is still challenging. Some shortages are evident, such as remained high proportion of uncovered people, lacking health care professionals and their unequal distribution, physical and financial constraints to access health care, and poor quality of health care services. Some recommendations are provided to improve the movement toward universal health coverage including how to improve coverage, increase availability, facilitate accessibility, and improve the quality of health services.