http://orcid.org/0000-0002-1319-0961
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ABSTRACT
Background: Achieving the Sustainable Development Goal of ‘ensuring healthy lives and promoting well-being for all at all ages’ necessitates regular monitoring of inequality in the availability of health-related infrastructure and access to services, and in health risks and outcomes.
Objectives: To quantify subnational regional inequality in Indonesia using a composite index of public health infrastructure, services, behavioural risk factors and health outcomes: the Public Health Development Index (PHDI).
Methods: PHDI is a composite index of 30 public health indicators from across the life course and along the continuum of care. An overall index and seven topic-specific sub-indices were calculated using data from the 2013 Indonesian Basic Health Survey (RISKESDAS) and the 2011 – Village Potential Survey (PODES). These indices were analysed at the national, province and district levels. Within-province inequality was calculated using the Weighted Index of Disparity (IDISW).
Results: National average PHDI overall index was 54.0 (out of a possible 100); scores differed between provinces, ranging from 43.9 in Papua to 65.0 in Bali. Provinces in western regions of Indonesia tended to have higher overall PHDI scores compared to eastern regions. Large variations in province averages were observed for the non-communicable diseases sub-index, environmental health sub-index and infectious diseases sub-index. Provinces with a similar number of districts and with similar overall scores on the PHDI index showed different levels of relative within-province inequality. Greater within-province relative inequalities were seen in the environmental health and health services provisions sub-indices as compared to other indices.
Conclusions: Achieving the goal of ensuring healthy lives and promoting well-being for all at all ages in Indonesia necessitates having a more focused understanding of district-level inequalities across a wide range of public health infrastructure, service, risk factor and health outcomes indicators, which can enable geographical comparison while also revealing areas for intervention to address health inequalities.
Responsible Editor Peter Byass, Umeå University, Sweden.
Special Issue Monitoring Health Inequality in Indonesia
Responsible Editor Peter Byass, Umeå University, Sweden.
Special Issue Monitoring Health Inequality in Indonesia
Acknowledgments
We acknowledge the inputs of Anne Schlotheuber in the analysis and preparation of figures for this manuscript. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of their institutions.
Author contributions
S analyzed the data, led interpretation and revisions. NK assisted in data analysis and writing. DN and T drafted the introduction and discussion sections and edited the full manuscript. AH conceptualized the study and provided input to the analysis and interpretation of results. All authors approved the final version of the manuscript.
Disclosure statement
No potential conflict of interest was reported by the authors.
Ethics and consent
The PHDI was derived from secondary, de-identified, non-private data from multiple datasets. As such, it does not represent human subject research.
Paper context
Achieving the SDG of ‘ensuring healthy lives and promoting well-being for all at all ages’ necessitates regular monitoring of inequality of health-related infrastructure, access to health services, health risks and outcomes. This paper presents the Indonesian Public Health and Development Index and its sub-indices at the national, provincial and district levels, reports within province inequalities in the index and its sub-indices, and reveals topical and geographic areas for intervention to address health inequalities.
