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Web-only Exclusives
November 30, 2000

From Our Correspondent: Hirohito and the War
A conversation with biographer Herbert Bix

From Our Correspondent: A Rough Road Ahead
Bad news for the Philippines - and some others

From Our Correspondent: Making Enemies
Indonesia needs friends. So why is it picking fights?

Asiaweek Time Asia Now Asiaweek

MARCH 31, 2000 VOL. 26 NO. 12

Freedom And Wellbeing
The failings of healthcare under Suharto
By ALAIN GUILLOUX

 
  ALSO IN ASIAWEEK

COVER: Seismic Changes
Can president-elect Chen Shui-bian meet the historic challenges posed by a changing Taiwan - and by China?
The Challenge: Now comes the hard part
Reality Check: Beijing will have to deal with the new Taiwan
Profile: Chen's split personality

Editorial: Taiwan and China have reason aplenty to make peace
Editorial: Asia needs new policies to combat prostitution

THE NATIONS
South Asia: Clinton to India and Pakistan - Start Talking
'Limited War': Don't let the term fool you
Philippines: Sister Christine vs. Estrada - yet another scandal
Extended Interview: Salamat Hashim calls for independence
Myanmar: Behind the secret "Chilston" meetings
Inside Story: Asia's "Insiders" - four people who have blown the whistle on wrongdoing
Viewpoint: A Malaysian race for Islamization?

ARTS & SCIENCES
People: Sumo's big brother calls it quits
Heritage: The struggle to save Penang's old George Town
Art: Digital works blur the line between tech and expression
Books: Why healthcare was so bad in Suharto's Indonesia
Health: Noni - The craze over a smelly green fruit
Newsmakers: Thai "List of Shame" riles the privileged

TECHNOLOGY
Games: Microsoft's X-factor
Computing: IBM's Deep Blue man is now into e-commerce
Cutting Edge: An e-book horror story

BUSINESS
Bankruptcy: The court-ordered restructuring of TPI suggests Thailand is coming to grips with deadbeat borrowers
Room to Improve: Inadequate laws in Indonesia and Korea
No Hype: Can Singapore's Pacific Internet regain investor favor?
Renong: The Malaysian conglomerate sells off key assets
Business Buzz: A deal to lift Singapore's spirits

Investing: How rising U.S. interest rates will affect Asia

How to ensure that more newborns survive and maternal deaths are reduced? Those are some of the crucial issues examined in Hollow Development: The Politics of Health in Soeharto's Indonesia (Australian National University, Canberra, 220 pages), a book on health services in the rural areas of Java. The author, Januar Achmad, is an Australian-trained medical doctor with a Ph.D. in demography and extensive field experience in Java. So he should know where some of the answers can be found.

In substance, Achmad tells us that to be effective, a rural public health system has to reach out to every village. It must be free, as most users can barely afford even minimal fees let alone the cost of transporting an emergency patient to a district hospital. There must also be some measure of participation, or at least feedback, from users to improve the quality and relevance of the services - which therefore must include a relative freedom to criticize. All the above have been tested and confirmed in two decades of primary healthcare policies throughout the developing world, inspired by the World Health Organization.

Why did Indonesia fare so poorly in this area when the country was relatively successful in family planning and poverty alleviation until 1997? Achmad lists the country's colonial heritage as one reason. But after half a century of independence, such arguments start to wear thin, even though the Dutch colonizers in Indonesia were not interested in grooming a Western-educated elite or an effective civil service as the British had achieved in India.

More convincingly, Achmad blames authoritarian rule and the low priority accorded to healthcare. The problems, he says, began from the top: Suharto, who was president from 1966 to 1998, didn't attend one single cabinet meeting on health. And as his word was law, no minister could question his priorities. Suharto was more interested in family planning. But that was no guarantee of safer births, especially when general practitioners were barred from carrying out emergency interventions. This lack of support from the top contrasts with the situation in Thailand, where the kings started promoting rural healthcare before World War II, and in the Indian state of Kerala, where child mortality is only a fraction of Indonesia's. The author traces the latter success back to the Queen of Travancore, who decided as early as 1819 that all her subjects were entitled to basic education and health services.

Poor performance is also blamed on insufficient autonomy at the local level, and on making the Home Ministry responsible for field implementation of health policies. Moreover, local authorities usually depended on funds from central government coffers, with health and hospital services as their primary source of local income. No wonder, then, that these were milked to fund activities unrelated to healthcare.

In his eagerness to make his point, however, Achmad overlooks the situation in rural China, which is far from his idyllic image of a low-cost, universal and effective health service. The communes that used to fund healthcare have long been dismantled, and no service is free nowadays. Indeed, the sorry picture across rural China is closer to Achmad's depiction of the situation in Java, where hardly anyone can afford to pay fees, where patients die at home to avoid adding to the family's debts, and where government salaries are so meager that health professionals have to supplement their income from private practice.

Of course, this is academic stuff, and the book in unlikely to appear on any best-seller lists. Nonetheless, Hollow Development is informative and exhaustively researched. Health and development professionals and other readers with an interest in the subject will appreciate its clear writing and sober diagnosis.



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