Two Years of Pandemic:

Momentum to Improve Control of COVID-19 to Prevent Gaps in Access and Services

Joint Statement

CISDI, Report COVID-19, and Transparency International Indonesia

Jakarta, March 2 2022 – Indonesia has entered the third year of the COVID-19 pandemic since the first case was announced on March 2 2020. To date, at least 5,589,176 confirmed cases have been found, followed by 148,660 deaths (01/03). The number of recorded cases and deaths is likely still much lower than reality due to limited testing, tracing and recording systems at the central and regional levels. Pandemic preparedness still needs to be maintained, considering that there is still the potential for the emergence of new worrying variants.

Meanwhile, administration of the second vaccine dose has only reached 69.39% and boosters just reached 4.90%. Moreover, in the vulnerable group cluster, only 54.04% of the elderly and 57.51% of vulnerable and general community groups have received the full dose of vaccine. On the other hand, vulnerable groups are not classified separately from the general public so the doses given do not necessarily cover those who need it most. Throughout 2020-2021, CISDI, LaporCOVID-19, and Transparency International Indonesia noted nine important things in handling the outbreak that the government needs to pay attention to.

First, the CISDI survey with WHO (2021) shows disruption of essential health services during the pandemic. This survey stated that several health services failed to be met, ranging from urgent medical care needs (18%), home-based long-term care (15%), planned elective surgery (14%), treatment of chronic diseases (14%), and mental health (14%). More than 25% of respondents reported that people had difficulty accessing necessary health services before the pandemic.

Second, throughout 2020-2021 there is still the problem of the absence of data as a basis for making evidence-based policies. There are discrepancies between central and regional government data and not all data presentation is carried out real time. In addition, differences in capacity were found between regional governments in collecting and presenting data on handling outbreaks. As a result, not all regions are able to present this data to the public.

Third, lack of commitment to prioritizing vulnerable groups in the national vaccination program. The CISDI-PUSKAPA policy input report (2021) notes several problems, starting from the absence of an operational definition of vulnerable groups which has an impact on the absence of special vaccine allocations for vulnerable populations, the lack of outreach programs for vulnerable groups, to unclear targets for vulnerable groups. This situation has the potential to widen and maintain inequality in access to vaccinations and health services for vulnerable groups in Indonesia.

Fourth, health services have not been responsive and adaptive to face the surge in cases. In 2022, LaporCovid-19 received a spike in citizen reports during the outbreak of the Omicron case. As of February 23 2022, LaporCovid-19 had received at least 538 reports, this figure has increased compared to the reports received in January-February 2021 of 415 reports related to health protocols, vaccines, health and other non-health complaints. When the Omicron surge occurred, 203 reports were found regarding the difficulty of residents getting access to 3T treatment, both related to access to self-isolation from the Indonesian Ministry of Health and the unresponsiveness of community health centers in monitoring self-isolating residents due to excessive burdens. The unresponsiveness of the health center can be evidence of the unresponsiveness and adaptability of health services in dealing with the surge in cases.

Fifth, there are high reports of unpreparedness in handling outbreaks in schools. LaporCovid-19 received 156 reports regarding schools that were no longer safe because many students and teachers were positively infected. However, the government's response to this matter is very minimal and tends to ignore reports from residents and allow cases of COVID-19 infection to occur in school environments. LaporCovid-19 sees this as a form of neglect of public health due to administrative and governance obstacles in making decisions related to PTM that are not based on facts in the field, considering the danger of Omicron transmission. Neglect also downplays the impact of COVID-19 infection on children.

Sixth, various problems with the management of handling the outbreak are still found. Many residents have complained about the central government's slowness in providing treatment for COVID-19 patients. Several examples of cases show that there are still laboratories that do not input patient data properly, or when they do, the government is not ready to deliver medicines to a large number of patients. Citizens' rights to access medicines are not being fulfilled due to logistical constraints, such as the limited number of private logistics partners who distribute these medicines.

Seventh, various complaints are still often found regarding access to vaccines and 3T. In 2021, complaints about vaccine access (403 reports) and 3T (233 reports) respectively became the second and third highest number of reports that LaporCovid-19 received after health protocol violations. Residents complain about difficulties in accessing tests due to high costs, but at the same time the testing capacity of community health centers is increasingly limited. Meanwhile, the government is often inconsistent in carrying out tracking efforts, as can be seen from the rise and fall of national test numbers during the third wave period. The high cost of PCR makes many people choose not to get tested. Financial constraints are a logical consequence of implementing an independent tracking and testing strategy that places full responsibility on the community. Regarding vaccine access, residents complained about information asymmetry, namely that they did not receive complete information about accessing and registering for the vaccination program.

Eighth, there are still problems with public information disclosure in the procurement of goods. This issue is still in the spotlight, especially in the procurement of goods and services. Over the last two years, the process of procuring goods and services to deal with the pandemic has not shown any improvement. Emergency situations are a reason to speed up the procurement process. Even though it is permitted, the process of recording emergency procurement is not widely known to the public. The emergency procurement process should be published via available public pages. The very large budget allocation for vaccine procurement and vaccination logistics tends to have a high risk of corruption. Therefore, the coalition assesses that the government has not seriously mitigated the risk of corruption in vaccine procurement and vaccination support logistics.

Ninth, There is no solid and integrated data regarding the need for supporting infrastructure for vaccination programs at the central and regional levels. In the context of vaccination, quite a lot of local governments do not have good storage infrastructure for certain types of vaccines so that damage can occur. This situation certainly raises the vulnerability of duplication of budgets for handling the pandemic between the central government and regional governments.

Therefore, with various learning notes, we conclude that the situation in handling the pandemic tends towards survival of the fittest scenario or when people who have access and resources are able to coexist with COVID-19, but leave behind those who do not have adequate resources.

In this scenario, improvements in public health conditions move slowly, regularly, and start from areas with low vulnerability. However, this scenario still leaves the possibility of gaps in inequality between regions. If this problem is not addressed immediately, the treatment of COVID-19 will suffer the same fate as other endemic diseases (DHF, malaria, tuberculosis) when deaths persist and antimicrobial drug resistance continues to increase.

Based on the notes above, we ask the government to look at various problems in handling the outbreak over the past two years as momentum for improvement by recognizing the breadth and diversity of problems in handling the outbreak in various aspects, starting from data availability, governance, cross-sector collaboration, to public participation.

Based on these notes we provide six recommendations as follows:

1. The government needs to integrate COVID-19 services in the JKN beneficiary scheme by including vaccination, outpatient and testing services so that recording of COVID-19 cases occurs in one channel of the BPJS Health system and eliminates cost barriers in ensuring optimal protection for the community.
2. The government needs to increase data collection capacity for handling outbreaks at the regional level, including the addition of daily cases, daily deaths, BOR capacity, and vaccination coverage.
3. The government must provide special affirmation to vulnerable groups by providing operational definitions, supply allocations, and special clusters for data collection on vulnerable groups dashboards Indonesian Ministry of Health COVID-19 vaccination.
4. The government must ensure meaningful public participation in monitoring and making decisions on handling the outbreak as a form checks and balances between the public and the government.
5. The government needs to improve the mechanism feedback, monitoring, evaluation and supervision in a more participatory outbreak handling process.
6. The government is obliged to prioritize the principles of transparency and accountability in handling the pandemic, especially in the aspect of procurement of goods and services by opening procurement contract documents and publishing provider companies that participate in the procurement of health material equipment, vaccination support logistics, and companies involved in vaccine distribution.

-FINISHED-

———————————–Contact person: Amru (0877-8273-4584)———————————

About CISDI

The Center for Indonesia's Strategic Development Initiatives (CISDI) is a non-profit organization that encourages evidence-based health policies to create an empowered, healthy and prosperous Indonesian society by implementing a healthy paradigm. CISDI carries out research and program management as well as policy advocacy to create transparent, adequate and equitable governance, financing, human resources and health services. Information: https://cisdi.org/id/

About ReportCOVID-19

LaporCovid19 is a forum (platforms) fellow citizens to share information regarding the number of incidents related to COVID-19 around us. Approach bottom-up through citizen reporting or crowdsourcing so that every citizen can participate in conveying information about cases related to COVID-19. For more information, visit the website: www.laporcovid19.org, IG: @laporcovid19, Twitter: @LaporCovid, FB: LaporCovid-19 Citizens Coalition.

About Transparency International Indonesia

Transparency International Indonesia (TII) is one of them chapters Transparency International, a global network of anti-corruption NGOs that promotes transparency and accountability to state institutions, political parties, business and civil society. Together more than 90 chapters Others, TII strives to build a world that is free from the practices and impacts of corruption throughout the world. Information: https://ti.or.id/

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