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Consequently, the poor in Indonesia are systematically marginalized by being forced to present an Indonesian health card, or kartu sehat, when they require medical assistance, which, at best, entitles them to rudimentary healthcare services and deprives them of more sophisticated forms of healthcare for life-threatening illnesses.
The Indonesian health card program was introduced in August 1998 with the aim of ensuring that the poor had access to healthcare. An estimated 22 million households -- about 11 percent of Indonesians -- had received health cards by February 1999.
Nevertheless, many of the poor are still unable to acquire this health card as they lack the necessary documentation, such as an identification card. Millions of people living in slums and on the streets are unable to obtain even an identification card as they have no proof of address. It is thus a vicious cycle that provides no respite. Those who urgently require medical assistance have nowhere to go for the sole reason that they lack a health card.
In theory, health card holders are entitled to free care at public healthcare centers, but, in fact, many district governments, particularly in poor areas, are unable to fully meet the health needs of an individual. Specifically, the cost of the medicine required for more serious illnesses often exceeds the amount to which they are entitled through their health card. Therefore, in reality, the health card only entitles poor people to basic medication and treatment, depriving them a full course of treatment and recovery.
In Bandung in West Java, for example, a poor man was deprived of the expensive medication he needed for his medical condition because he possessed a health card. Thus, he was only given a general medical prescription that was inadequate for him to fully recuperate from his illness.
Additional indirect costs, such as travel expenses for poor citizens living in rural areas, deters individuals from seeking medical assistance, especially when they are only given very basic healthcare that does not necessarily guarantee they will recover from their illness. For some, it may come to a choice between seeking medical assistance and being able to buy food for a few weeks. No one should be forced to make such a decision between two fundamental human rights.
Subsequently, many people have no other option and must resort to traditional doctors, exposing them to a higher risk of infection and disease. Many are left to die from diseases that are easily curable, such as typhoid, dengue fever and malaria. An increasing number of poor Indonesian mothers die after giving birth from easily curable illnesses, such as anemia, simply because they are not entitled to the medicine that they urgently require.
Furthermore, impoverished people who seek medical assistance must suffer the humiliation of presenting their health cards, whereby they are treated separately from wealthier Indonesians. This practice clearly reveals their poor status to all and deprives them of any shred of dignity. This partiality to wealthier citizens is clear discrimination. Perhaps as a result of this humiliation an estimated 3.7 percent of health card owners, who comprise 10.4 percent of Indonesia's population, report not using the health card when seeking healthcare.
By assigning health cards to the poor of Indonesia, the government is intentionally victimizing and labeling them. Moreover, by providing meager healthcare services to them, it insinuates that, in some way, the poor do not deserve adequate healthcare. In comparison, the rich of Indonesia have full access to every medical procedure they require, maintaining the belief that, because of their wealth, their medical needs are of a higher priority and of greater importance than those living below the poverty line.
The Indonesian state has fundamentally failed to guarantee the rights of its citizens enshrined in the Constitution under Article 28H, which states that everyone has "a right to a life of well-being in body and mind" and crucially, "to receive medical care." Yet, in reality, this only applies to the wealthier sectors of society as the poor have very restricted access to medical care.
There are absolutely no grounds to justify discriminating against the most vulnerable sector of society, the poor. Healthcare is a necessity and should be equally available to all, not granted on the superficial basis of income. Despite numerous promises from Parliament members and government officials to improve access to healthcare for the poor, little has changed. The government bureaucracy has ensured that the poor receive only rudimentary healthcare and are left to fend for themselves.
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(Philip Setunga is a staff member of the Asian Human Rights Commission in Hong Kong responsible for the organization's research on Indonesia. He has a doctorate in sociology.)
