Equal Access to Healthcare Services throughout Indonesia: Hopes or Daydreams for the Poor in Remote Rural Areas?

 Indonesia has a huge area of archipelago. Badan Pusat Statistik Indonesia (2019) stated that Indonesia has 1.916.906,77 km2 area., 16.056 islands, and 34 Provinces. It is such a huge area for a nation to govern. Besides a huge area to govern, Indonesia also has such a big population. As we know, Indonesia is ranked fourth in the world for the total of the population of its people. The result of the population census that is done by Badan Pusat Statistik Indonesia in September 2020 is showing that Indonesia's total population is over 270,20 Million people and it keeps increasing each year. We all agree that it is such a big number of the population to govern and to protect.
With those conditions, Indonesia, especially its government, has a big task to deal with. The big task is to give equal access to all people across Indonesia to the health care services. As we know, equal access to good health care services is an absolute right for Indonesian Citizens and the Government has to fulfil it. Law Number 36/2009 about Health Article  4 regulated that everyone has a right toward health care, Article 5 Paragraph 1 and 2 regulated that everyone has an equal right to get an access to the health resources, especially health resources or facilities that are safe, in good quality, and affordable. From those regulations, we all agree that the access to health care and services are very important to the citizens of Indonesia. Our constitution also regulates it in Article 28H paragraph 1 which states that everyone has the right to live in physical and spiritual prosperity, to have a place to live, and to have a good and healthy living environment and the right to obtain health services. So, the right to obtain and have equal health services is applicable to all Indonesian throughout our archipelago no matter where and who they are.
When we talk about those rights, there will be a question that appears. Who has the responsibility for those rights fulfilment? Law Number 36/2009 about health article 14 regulated that the Government is obligated and responsible for the availability of health efforts or services that are evenly distributed and affordable by the community. Article 19 also regulated that the Government is responsible for the availability of good quality, safe, efficient, and affordable health efforts or services. We can know that the party who has the biggest responsibility to fulfil those rights is the government because the party who has the biggest authority and power is the government. One thing that we have to underline from these articles is the government is obligated to give an evenly distributed and affordable health service to its citizens. But until now, we know that our health care services are not evenly distributed yet, especially for the community in the remote and rural area. The community that lives in those areas has difficulties to gain access to good-quality primary health care and services. It is because of their condition of geographic, topographic, transportation, communication access, the high rate of poverty and any other social issues that they face in their daily life. Prof. Nila Moeloek also stated that the quality of our health human resources in those areas are far from enough and need to be improved (Kementerian Kesehatan, 2017). Those conditions directed to the inequality of access to health care for Indonesian citizens and it is in accordance with what is mandated by our constitution.
Our Nation's issues in the health care and services field are not optimal access, affordability, and quality of health services (Bappenas, 2008). What is the reason for those conditions? Bappenas (2008) also stated that the unaffordable distance and cost of health care services in rural and remote areas is one of the reasons that direct to the inequality in access to healthcare and services in this country. Although there have been a lot of government programs to handle these issues, the inequality of access to good health care services still exists in rural and remote communities. The form of inequality access to health care services is shown by the gap of the health services between the rich and the poor (Sunyoto Usman and Team, 2010). We all agree that the rich will, absolutely, get better health care and services then the poor due to their economic condition differences.
Why is the implementation of evenly distributed health service in this country so difficult to be done even though the order to do it is already stated in our constitution and law? Tri Rini Puji Lestari (2013) stated that the implementation of our law, such as Law No 36/2009 Article 14 is still difficult because of our geographic and social issues. On the other hand, our big archipelago made the distribution of healthcare service become unequal and made the rate of accessibility to the healthcare services become low, especially in the rural and remote area of Indonesia. But I believe that the geographic condition is not the only reason that causes inequality in access to healthcare services in this country. There are a lot of other reasons that can determine the access to our healthcare services. The low interest of health workers to serve in rural and remote areas and the poverty right also determine our access to healthcare service equality. Sunyoto Usman and Team (2010) stated that, in other hand, the availability of medical devices, the availability toward health information, and the healthcare services business network also become the factors of our inequality in healthcare services.
Talking about the inequality access to healthcare services in Indonesia, we will always find it related to social and geographical condition. Those two aspects will direct to the others reasons of the inequality access to healthcare services. Suharmiati and Team (2013) concluded the issues that appears and related with inequal access to our healthcare and services. The issues that exist are 1) the Low quality of primary health services in Rural and remote areas, 2) Limited and expensive transportation facilities, 3) Low quality of accessibility to health services, and 4) the availability of health services and supporting facilities in the rural and remote areas is still low. Those four factors are the big branch for our inequality problem. But above all of those factors, the low accessibility to healthcare service by the poor society is the biggest reason for our inequality for healthcare services.
What should we do to handle this problem and erase the inequality of access to healthcare service in Indonesia? Tri Rini Puji Lestari (2013) stated that in order to handle these issues, we need commitment and effort from all components of a nation, such as the government, legislative, business field, Adat society, and the citizen itself. The equalization of access to good healthcare service in the rural and remote areas has to be taken more seriously by us in order to make the equal access that we want become a wonderful hope for rural and remote areas. I strongly believe that it will help our nation to be united and stronger than ever.
Bappenas (2008) stated that, in order to fix these issues, the government has to have regulation and decisions that can help these issues. Such as improving the access and quality of health services, especially for the poor, rural, and remote areas through health centres and their networks, improving facilities, infrastructure and lower operational costs for basic health services so that the poor can afford the cost to get good healthcare services. Until now, our government has already had some programs that, hopefully, can help these issues. Sunyoto Usman and Team (2010) stated that Indonesian Government already had some programs since 2010. Such as health financing subsidies, increasing human resources in the health sector, increasing medicinal resources and medical supplies, empowering the community, and improving health management. Those programs are aiming to increase the accessibility to the healthcare services for the poor, rural, and remote society.  
Sunyoto and Team (2010) also stated that those programs have been declared as a solution for these issues for so many times. But the implementation itself still did not reach the whole healthcare services issues of our community. I strongly believe that we have to oversee those programs in order to make it right on target. Those programs will not succeed if the result still leads to gap increasement of the poor and the rich. Those programs have to be right on target as the government has planned. If it is not, the equal access to healthcare services in the poor, rural, and remote areas will be only a daydream for society.
We all know that Indonesia has such a big population as a country. But the growth of our population was not accompanied by the availability of health services. Our health workers' condition and quality are not equal, especially the one who serves in rural and remote areas. In total, we only have 17.919 units of healthcare services throughout Indonesia. It is a big number but it is not enough to afford all of our population in Indonesia. That unaffordability can hinder the development of our healthcare services that want to give evenly and fairly qualities to all citizens of Indonesia (Yuni Sari Romadhona, 2018).
Indonesian Ministry of Health (2010) planned six strategies to deal with these issues. Those are 1) Mobilizing and empowering the human resources in rural and remote area, 2) Increasing the accessibility for rural and remote society toward good healthcare services, 3) Increasing financial assistance for health facilities, 4) Increasing the availability of medicines, 5) Increasing the empowerment of Health Human Resources in the rural and remote area, and 6) Increasing the management of the healthcare services and health information system in the rural and remote area. Once again, I strongly remind us that we have to oversee these programs to make it right on target because these issues are a difficult issue to handle and it needs good collaboration between all sectors to deal with it.
As one of our Sustainable Development Goals (SDGs) is a healthy and prosperous life by ensuring the healthy life prospect and increasing the prosperity of all citizens without any exceptions. The development of health sectors, especially equal accessibility to healthcare services in rural and remote areas,  need active role and collaboration from all sectors, such as government, parliament, business field, mass media, social institutions, and scholars. We have to believe and appreciate our government effort in handling those issues. But we cannot be satisfied yet because we still have a lot of tasks to do in ensuring equal access to good healthcare services for the poor society in rural and remote areas in this country. The Equal Access to Healthcare Services throughout Indonesia has to be a bright hope for the poor society in rural and remote areas. With a good collaboration, we can achieve that equality for all citizens of Indonesia without any exceptions.
 
 
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